SMLE Pharmacology

Question 1

A patient with heart failure is prescribed digoxin. Which electrolyte abnormality increases the risk of digoxin toxicity?

Accepted Answer

Hypokalaemia

Answer

Hypokalaemia increases the risk of digoxin toxicity because digoxin and potassium compete for binding at the Na+/K+ ATPase pump. Low potassium levels increase digoxin binding, enhancing its toxic effects including cardiac arrhythmias.

Question 2

Which antibiotic class is associated with tendon rupture, particularly the Achilles tendon, especially in elderly patients?

Accepted Answer

Fluoroquinolones

Answer

Fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin) are associated with tendinopathy and tendon rupture, particularly the Achilles tendon. Risk is increased in patients over 60, those on corticosteroids, and organ transplant recipients.

Question 3

A patient on warfarin therapy has an INR of 8.5 with no active bleeding. What is the most appropriate management?

Accepted Answer

Hold warfarin and administer oral vitamin K

Answer

For supratherapeutic INR (>4.5-10) without active bleeding, the recommendation is to hold warfarin and administer low-dose oral vitamin K (1-2.5 mg). FFP and PCC are reserved for active bleeding or INR >10 with high bleeding risk.

Question 4

Which drug is the antidote for opioid overdose?

Accepted Answer

Naloxone

Answer

Naloxone is a competitive opioid receptor antagonist used to reverse opioid overdose. It rapidly reverses respiratory depression, sedation, and miosis. Due to its shorter half-life compared to many opioids, repeated doses or an infusion may be needed.

Question 5

A pregnant woman requires treatment for a urinary tract infection. Which antibiotic is considered safest in the first trimester?

Accepted Answer

Amoxicillin

Answer

Amoxicillin (category B) is one of the safest antibiotics during pregnancy, including the first trimester. Fluoroquinolones are contraindicated (cartilage damage), tetracyclines (teeth discolouration, bone effects), and trimethoprim is avoided in the first trimester (folate antagonist, neural tube defect risk).

SMLE Practice Test

SMLE Practice Test

SMLE Pharmacology