Published: 5 December 2024

Publications

Prescriber Update 45(4): 95–96
December 2024

Quiz answers

1. Pseudoephedrine must not be used in patients:
   1. with uncontrolled hypertension or severe coronary artery disease
   2. taking monoamine oxidase inhibitors (MAOIs) or who have taken MAOIs within the previous 14 days
   3. with known hypersensitivity or idiosyncratic reaction to pseudoephedrine and any other ingredients in the medicine
   4. all of the above
   4. All of the above. Pseudoephedrine must not be used in patients with uncontrolled hypertension or severe coronary artery disease, taking monoamine oxidase inhibitors (MAOIs) or who have taken MAOIs within the previous 14 days, or with known hypersensitivity or idiosyncratic reaction to pseudoephedrine and any other ingredients in the medicine. (June 2024)
2. Drug-induced tendinopathy is most commonly associated with which four classes of medicines?
   
   Fluoroquinolones, long-term glucocorticoids, statins and aromatase inhibitors. (September 2024)
3. Which of the following statements is false?
   1. Sodium-glucose co-transporter-2 (SGLT-2) inhibitors predispose patients to ketoacidosis by multiple mechanisms that favour ketogenesis and lipolysis.
   2. Some risk factors for ketoacidosis include acute infection, surgery, pancreatic disorders, high carbohydrate diet, heavy alcohol use, severe dehydration.
   3. Monitor ketones and temporarily discontinue SGLT-2 inhibitors in clinical situations known to predispose patients to ketoacidosis.
   4. Patients with ketoacidosis secondary to SGLT-2 inhibitors may have normal blood glucose levels.
   2. Acute infection, surgery, pancreatic disorders, heavy alcohol use and severe dehydration are true risk factors for ketoacidosis, but a high carbohydrate diet is false. A low carbohydrate diet is a risk factor for ketoacidosis. (December 2024)
4. Approximately what percentage of long-term glucocorticoid users develop secondary osteoporosis?
   1. 30 to 50 percent
   2. 20 to 40 percent
   3. 10 to 20 percent
   4. 5 to 10 percent
   1. Approximately 30 to 50 percent of long-term glucocorticoid users develop secondary osteoporosis. (June 2024)
5. Antihistamines and leukotriene receptor antagonists are associated with psychiatric side effects. List three other medicine classes (excluding psychotropics) that can cause psychiatric side effects.

ACE inhibitors, antivirals, antibiotics, anticholinergics, beta-blockers, calcium channel blockers, cardiac glucosides, combined oral contraceptives, corticosteroids, proton pump inhibitors, other (isotretinoin, tacrolimus) are also associated with psychiatric side effects. (March 2024)

6. Topiramate inhibits which enzyme in the kidneys, thereby lowering serum bicarbonate levels?
   
   Topiramate inhibits carbonic anhydrase in the kidneys, affecting bicarbonate reabsorption. (September 2024)
7. Plasma levels of certain antiepileptic medicines (AEM) may decrease during pregnancy. Which of the following are possible pharmacokinetic mechanisms for the decreases?
   1. altered protein binding, decreased hepatic metabolism, increased renal clearance, increased gastrointestinal absorption
   2. increased gastrointestinal absorption, altered protein binding, enhanced hepatic metabolism, decreased renal clearance
   3. enhanced hepatic metabolism, increased renal clearance, reduced gastrointestinal absorption, altered protein binding
   4. reduced renal clearance, reduced gastrointestinal absorption, altered protein binding, reduced hepatic metabolism
   3. Possible pharmacokinetic mechanisms for decreases in plasma AEM levels in pregnancy are enhanced hepatic metabolism, increased renal clearance, reduced gastrointestinal absorption, altered protein binding. (March 2024)
8. True or false: Bioequivalence studies are designed to investigate switchability.
   
   False. Bioequivalence studies are not designed to investigate patients’ suitability to change from one brand to another during their treatment (‘switchability’). (June 2024)
9. A principal histological feature of __________ is the accumulation of phospholipids and the inducing medicine/metabolite in affected cells.
   
   Drug-induced phospholipidosis. (March 2024)
10. The risk of hypophosphataemia with parenteral iron infusions is highest with [iron polymaltose / ferric carboxymaltose].
    
    Ferric carboxymaltose. (December 2024)

Bonus question

In which year was the 100^th Medicines Adverse Reactions Committee (MARC) meeting held?

1. 1981
2. 1999
3. 2010
4. 2024

2. The 100^th MARC meeting was held on 25 November 1999. (December 2024)