PSI Patient Counselling & Drug Interactions 4

Question 1

Which key counselling message is most important for a patient newly diagnosed with type 2 diabetes starting metformin?

Accepted Answer

GI side effects (nausea, diarrhoea) are common at the start — take with food and they usually resolve; do not stop without speaking to your pharmacist/GP

Answer

GI intolerance is the most common reason for early metformin discontinuation. Taking with or after food and titrating the dose slowly significantly reduces GI side effects. Metformin does not cause hypoglycaemia alone.

Question 2

When should a patient using a reliever inhaler (salbutamol) be advised to seek urgent medical review?

Accepted Answer

If using reliever more than 3 times per week — indicates poor asthma control requiring step-up therapy

Answer

Reliever use >3 times/week signals inadequately controlled asthma. This requires review of preventer therapy (ICS) and adherence. Dependence on reliever without preventer increases severe attack risk.

Question 3

Which interaction between alcohol and benzodiazepines is clinically important?

Accepted Answer

Additive CNS depression — combination causes excessive sedation and respiratory depression risk

Answer

Both alcohol and benzodiazepines are CNS depressants. Combined, they produce additive sedation, impaired coordination, and potentially fatal respiratory depression. Patients must avoid alcohol during benzodiazepine treatment.

Question 4

A patient on a statin reports new onset muscle pain. The pharmacist should advise:

Accepted Answer

Stop the statin, seek GP review — report any dark urine urgently as this may indicate rhabdomyolysis

Answer

Statin-induced myopathy ranges from mild myalgia to severe rhabdomyolysis. Dark urine (myoglobinuria) is a red flag for rhabdomyolysis — a medical emergency causing acute kidney injury. The statin must be stopped.

Question 5

Probenecid, used for gout, inhibits renal tubular secretion. Which antibiotic interaction is clinically significant?

Accepted Answer

Probenecid blocks penicillin/amoxicillin secretion, raising antibiotic levels (formerly used therapeutically)

Answer

Probenecid competitively inhibits OAT transporters in the renal tubule, blocking active secretion of penicillins and raising their plasma levels. This was historically exploited to prolong penicillin action (e.g., during wartime antibiotic shortages).

PSI Pharmacy Practice Test

PSI Pharmacy Practice Test

PSI Patient Counselling & Drug Interactions 4