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Question 52 of 171 A 63-year-old female is brought to the Emergency Department due to a decreased level of consciousness.

An urgent CT head is performed as she takes warfarin for atrial fibrillation and shows an intracranial haemorrhage. What is the most appropriate management?ia A.A Protamine sulphateia B.A IV vitamin K aloneia C.A IV vitamin K + prothrombin complex concentrateia D.A Fresh frozen plasma aloneia E.A IV vitamin K + fresh frozen plasmaia As fresh frozen plasma takes time to defrost prothrombin complex concentrate (PCC) should be used in such an urgent situation. The use of PCC is currently limited by availability Warfarin overdose sqweqwesf erwrewfsdfs adasd dsqweqwesf erwrewfsdfs adasd dhe The following is based on the BNF 50 guidelines, which in turn take into account the British Committee for Standards in Haematology (BCSH) guidelines. A 2005 update of the BCSH guidelines emphasised the preference of prothrombin complex concentrate over FFP in major bleeding
Major bleeding Stop warfarin Vitamin K 5mg IV Prothrombin complex concentrate - if not available then FFP* INR > 8.0 No bleeding or minor bleeding Stop warfarin, restart when INR < 5.0 If risk factors for bleeding then give vitamin K 0.5mg IV or 5mg po Dose can be repeated after 24 hours if INR still high INR 6.0 - 8.0 No bleeding or minor bleeding Stop warfarin, restart when INR < 5.0

*as FFP can take time to defrost prothrombin complex concentrate should always be used in cases of intracranial haemorrhage
Question stats A 8.5% B 9.9% C 36.6% D 9.9% E 35.2% 36.6% of users answered this question correctly Session score = 0%

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Question 99 of 171 Which one of the following drugs is contra-indicated whilst breast feeding?ia A.A Aminophyllineia

B.A Carbamazepineia C.A Sodium valproateia D.A Methyldopaia E.A Amiodaroneia Breast feeding: contraindications sqweqwesf erwrewfsdfs adasd dhe The major breastfeeding contraindications tested in exams relate to drugs (see below). Other contraindications of note include: galactosaemia viral infections - this is controversial with respect to HIV in the developing world. This is because there is such an increased infant mortality and morbidity associated with bottle feeding that some doctors think the benefits outweigh the risk of HIV transmission Drug contraindications - always check the BNF The following drugs can be given to mothers who are breast feeding: antibiotics: penicillins, cephalosporins endocrine: glucocorticoids (avoid high doses), levothyroxine* epilepsy: sodium valproate, carbamazepine asthma: salbutamol, theophyllines psychiatric drugs: tricyclic antidepressants, antipsychotics** hypertension: beta-blockers, hydralazine, methyldopa anticoagulants: warfarin, heparin digoxin The following drugs should be avoided: antibiotics: sulphonamides, aminoglycosides, tetracycline, chloramphenicol , metronidazole psychiatric drugs: lithium, benzodiazepines
Question stats A 7.3% B 9.1% C 14.5% D 7.3% E 61.8% 61.8% of users answered this question correctly Session score = 0%

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eMRCP.com file:///C|/Users/User/Desktop/emrcp/MRCP1-part1/Pharma/198.htm[4/6/2011 9:41:00 AM]

aspirin carbimazoleQuestion 110 of 171 Low molecular weight heparin has the greatest inhibitory effect on which one of the following proteins involved in the coagulation cascade?ia A.A Factor IXaia B.A Factor XIaia C.A Factor Xaia D.A Thrombinia E.A Factor XIIaia sulphonylureas cytotoxic drugs amiodarone

*may affect neonatal hypothyroidism screening **clozapine should be avoided

Question 110 of 171 Low molecular weight heparin has the greatest inhibitory effect on which one of the following proteins involved in the coagulation cascade?ia A.A Factor IXaia B.A Factor XIaia C.A Factor Xaia D.A Thrombinia E.A Factor XIIaia Heparin sqweqwesf erwrewfsdfs adasd dhe Heparin can be given as either unfractionated, intravenous heparin, or low molecular weight heparin (LMWH), given subcutaneously. Heparins generally act by activating antithrombin III. Unfractionated heparin forms a complex which inhibits thrombin, factors Xa, IXa, XIa and XIIa. LMWH however only increases the action of antithrombin III on factor Xa Heparin overdose may be reversed by protamine sulphate
Question stats A 8.5% B 1.2% C 62.2% D 23.2% E 4.9% 62.2% of users answered this question correctly September 2007 exam Session score = 0% External links British Committee for Standards in Haematology 2005 heparin guidelines

Question 10 of 52 Thrombocytopenia is associated with each of the following drugs except:ia A.A Abciximabia B.A Quinineia C.A Warfarinia D.A Penicillinia E.A Sodium valproateia Drug-induced thrombocytopenia sqweqwesf erwrewfsdfs adasd dhe Drug-induced thrombocytopenia (probable immune mediated) quinine abciximab NSAIDS diuretics: frusemide antibiotics: penicillins, sulphonamides, rifampicin anticonvulsants: carbmazepine, valproate heparin
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A 7.8% B 5.9% C 52.9% D 19.6% E 13.7% 52.9% of users answered this question correctly Session score = 0%

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DVT: risk factors sqweqwesf erwrewfsdfs adasd dhe Haematological thrombophilia: e.g. activated protein C resistance, protein C and S deficiency polycythaemia paroxysmal nocturnal haemoglobinuria hyperviscosity syndrome Autoimmune antiphospholipid syndrome Behcet's Drugs antipsychotics have recently been shown to be a risk factor OCP: 3rd generation more than 2nd generation Other conditions homocystinuria
Question stats A 5.6% B 5.6% C 11.3% D 71.8% E 5.6% 71.8% of users answered this question correctly Session score = 0%

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All contents of this site are 2005-2007 eEach of the following drugs are known to inhibit cytochrome P450, except:ia A.A Ketoconazoleia B.A Ciprofloxacinia C.A Erythromycinia D.A Clopidogrelia E.A Amiodaroneia P450 enzyme system sqweqwesf erwrewfsdfs adasd dhe

Induction usually requires prolonged exposure to the inducing drug, as opposed to P450 inhibitors, where effects are often seen rapidly Inducers of the P450 system include antiepileptics: phenytoin, carbmazepine barbiturates: phenobarbitone rifampicin St John's Wort chronic alcohol intake griseofulvin smoking (affects CYP1A2, reason why smokers require more aminophylline) Inhibitors of the P450 system include antibiotics: ciprofloxacin, erythromycin isoniazid cimetidine, omeprazole amiodarone allopurinol imidazoles: ketoconazole, fluconazole SSRIs: fluoxetine, sertraline ritonavir sodium valproate acute alcohol intake quinupristin
Question stats A 7.7% B 7.7% C 9.6% D 57.7% E 17.3% 57.7% of users answered this question correctly Session score = 0%

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eMRCP.com file:///C|/Users/User/Desktop/emrcp/MRCP1-part1/Pharma/271.htm[4/6/2011 9:41:36 AM]

Question 17A 55-year-old diabetic man presents to clinic concerned about erectile dysfunction. What is the mechanism of action of sildenafil?ia A.A Phosphodiesterase type V inhibitoria B.A Nitric oxide synthetase inhibitoria C.A Nitric oxide donoria D.A Non-selective phosphodiesterase inhibitoria E.A Phosphodiesterase type IV inhibitoria Sildenafil is a phosphodiesterase type V inhibitor Sildenafil sqweqwesf erwrewfsdfs adasd dhe Sildenafil is a phosphodiesterase type V inhibitor used in the treatment of impotence Contraindications patients taking nitrates and related drugs such as nicorandil hypotension recent stroke or myocardial infarction

non-arteritic anterior ischaemic optic neuropathy Adverse effects visual disturbances e.g. blue discolouration nasal congestion flushing raised intra-ocular pressure
Question stats A 48.4% B 4.7% C 3.1% D 15.6% E 28.1% 48.4% of users answered this question correctly May 2005 exam Session score = 0%

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AllQuestion 28 of 52 Which one of the following drugs is contra-indicated whilst breast feeding?ia A.A Heparinia B.A Lithiumia C.A Penicillinia D.A Warfarinia E.A Carbamazepineia Breast feeding: contraindications sqweqwesf erwrewfsdfs adasd dhe The major breastfeeding contraindications tested in exams relate to drugs (see below). Other contraindications of note include: galactosaemia viral infections - this is controversial with respect to HIV in the developing world. This is because there is such an increased infant mortality and morbidity associated with bottle feeding that some doctors think the benefits outweigh the risk of HIV transmission Drug contraindications - always check the BNF The following drugs can be given to mothers who are breast feeding: antibiotics: penicillins, cephalosporins endocrine: glucocorticoids (avoid high doses), levothyroxine* epilepsy: sodium valproate, carbamazepine asthma: salbutamol, theophyllines psychiatric drugs: tricyclic antidepressants, antipsychotics** hypertension: beta-blockers, hydralazine, methyldopa anticoagulants: warfarin, heparin digoxin The following drugs should be avoided: antibiotics: sulphonamides, aminoglycosides, tetracycline, chloramphenicol , metronidazole psychiatric drugs: lithium, benzodiazepines
Question stats A 5.6% B 66.7%

C 3.3% D 15.6% E 8.9% 66.7% of users answered this question correctly Session score = 0%

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eMRCP.com file:///C|/Users/User/Desktop/emrcp/MRCP1-part1/Pharma/294.htm[4/6/2011 9:41:47 AM]

aspirin carbimazole sulphonylureas cytotoxic drugs amiodarone *may affect neonatal hypothyroidism screening **clozapine should be avoided

What is the mechanism of action of heparin?ia A.A Activates antithrombin IIIia B.A Vitamin K antagonistia C.A Activates tissue plasminogen activatoria D.A Inhibits antithrombin IIIia E.A Inhibits protein Cia Heparin sqweqwesf erwrewfsdfs adasd dhe Heparin can be given as either unfractionated, intravenous heparin, or low molecular weight heparin (LMWH), given subcutaneously. Heparins generally act by activating antithrombin III. Unfractionated heparin forms a complex which inhibits thrombin, factors Xa, IXa, XIa and XIIa. LMWH however only increases the action of antithrombin III on factor Xa Heparin overdose may be reversed by protamine sulphate Question 2 of 151 A 54-year-old male with no past medical history is found to be in atrial fibrillation during a consultation regarding a sprained ankle. If the patient remains in chronic atrial fibrillation what is the most suitable treatment to offer the patient?ia A.A Aspirinia B.A Warfarin, target INR 2-3ia C.A No anticoagulationia D.A Warfarin, target INR 3-4ia E.A Warfarin, target INR 2-3 for six months then aspirinia Young AF, no TIA or risk factors, just give aspirin Atrial fibrillation: anticoagulation sqweqwesf erwrewfsdfs adasd dhe The Royal College of Physicians and NICE published guidelines on the management of atrial fibrillation (AF) in 2006 The guidelines suggest a stroke risk stratification approach when determining how to anticoagulate a patient, as detailed below:

Low risk- annual risk of stroke = 1% age < 65 years with no moderate or high risk factors use aspirin Moderate risk - annual risk of stroke = 4% age 65-75 years with no high risk factors, or: age < 75 years with diabetes, hypertension or vascular disease (ischaemic heart disease or peripheral artery disease) use aspirin or warfarin depending on individual circumstances High risk - annual risk of stroke = 8-12%
Question stats A 48.3% B 38.3% C 4.7% D 2.5% E 6.2% 48.3% of users answered this question correctly Session score = 0% External links NICE/RCP 2006 Atrial fibrillation guidelines Postgraduate Medical Journal Review of atrial fibrillation Postgraduate Medical Journal Emergency management of atrial fibrillation

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eMRCP.com file:///G|/emrcp/MRCP1-part1/cardiology/004.htm[05-Apr-11 3:31:54 PM]

age > 75 years with diabetes, hypertension or vascular disease (ischaemic heart disease or peripheral artery disease) previous TIA, ischaemic stroke or thromboembolic event valve disease, heart failure or impaired left ventricular function use warfarin AllA 62-year-old female with no past medical history is admitted to hospital with a left-sided hemiparesis. Examination reveals that she is in atrial fibrillation. CT scan of her brain shows a cerebral infarction. What is the most appropriate anticoagulation strategy for this patient?ia A.A Life-long warfarin, started immediatelyia B.A Life-long warfarin started after 2 weeksia C.A Life-long aspirin, started immediatelyia D.A Life-long aspirin started after 2 weeksia E.A 6 months of warfarin, started immediatelyia Atrial fibrillation post-stroke sqweqwesf erwrewfsdfs adasd dhe The Royal College of Physicians and NICE are due to publish joint guidelines on the management of atrial fibrillation (AF) in 2006. A consultation copy of the guidelines is currently available Recommendations include: following a stroke or transient-ischaemic attack (TIA) warfarin should be given as the anticoagulant of choice. Aspirin/dipyridamole should only be given if needed for the treatment of other comorbidities

in acute stroke patients, in the absence of haemorrhage, anticoagulation therapy should be commenced after 2 weeks. If imaging shows a very large cerebral infarction then the initiation of anticoagulation should be delayed
Question stats A 25.3% B 54% C 10.3% D 2.3% E 8% 54% of users answered this question correctly Session score = 0%

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