Questions from Licensed exam Practice

Antifungal that causes gynecomastia

• Ketoconazole (oral).

• Mechanism: It inhibits androgen synthesis and displaces testosterone from sex hormone-binding globulin.

Drugs that cause a metallic taste in the mouth

• Metronidazole, Clarithromycin, Metformin, Zopiclone, and Capto- or Lisinopril.

 Drugs that cause gingival hyperplasia (Gum overgrowth)

The Big Three: Phenytoin (antiepileptic), Cyclosporine (immunosuppressant), and Calcium Channel Blockers (most famously Nifedipine).

 Drugs that induce a Lupus-like syndrome (DILE)

• Most Common Answers: Hydralazine, Procainamide, and Isoniazid.

• (Memory trick: "CHIMP" - Chlorpromazine, Hydralazine, Isoniazid, Methyldopa, Procainamide).

What is true about Nifedipine?

• Key Exam Facts: It is a Dihydropyridine Calcium Channel Blocker. It causes peripheral vasodilation. Major side effects include reflex tachycardia, peripheral edema (ankle swelling), and gingival hyperplasia. Immediate-release nifedipine should not be used for acute hypertension management due to stroke/MI risk.

Anti-diabetic drugs that cause weight gain

• Sulfonylureas (e.g., Glipizide, Gliclazide), Thiazolidinediones/TZDs (e.g., Pioglitazone), and Insulin.

 Common cause of hyperthyroidism

• Graves' Disease (an autoimmune disorder) is the most common cause.

 Metformin and Contrast Imaging protocol

• Metformin must be held prior to or at the time of the procedure, and withheld for 48 hours after the procedure. It should only be restarted once renal function (eGFR/CrCl) has been re-evaluated and confirmed to be normal. This prevents lactic acidosis if contrast-induced nephropathy occurs.

 Acute Mountain Sickness (AMS) treatment

• Prophylaxis/Treatment: Acetazolamide (a carbonic anhydrase inhibitor).

Alternative/Adjunct: Dexamethasone.

 Diazepam antidote

•  Flumazenil (a competitive benzodiazepine receptor antagonist).

Clopidogrel and Omeprazole interaction

• Omeprazole is a CYP2C19 inhibitor. Because clopidogrel is a prodrug that requires CYP2C19 to be activated, omeprazole decreases the efficacy of clopidogrel, increasing the patient's risk of cardiovascular events (clotting).

 Warfarin and what antibiotic causes bleeding?

• Sulfamethoxazole/Trimethoprim (Bactrim), Metronidazole, or Fluoroquinolones (like Ciprofloxacin). They inhibit warfarin's metabolism (via CYP2C9), spiking the INR.

Apixaban MOA (Mechanism of Action)

• Direct, selective Factor Xa inhibitor (Oral anticoagulant).

Terazosin MOA

•  Selective Alpha-1 (alpha1) adrenergic receptor blocker (used for BPH and hypertension).

Natural remedy for vomiting

• Ginger (Zingiber officinale) or Pyridoxine (Vitamin B6).

 Can Lisinopril and Tetracycline be taken together?

• Yes, but with caution/separation. Tetracyclines can chelate with heavy metals, though Lisinopril itself isn't a primary perpetrator. However, ACE inhibitors can sometimes alter renal clearance or increase the risk of adverse GI effects when paired with broad antibiotics. Check for a separation of dosing if a specific antacid co-administration was implied.

Drugs that induce or exacerbate Myasthenia Gravis

•  Fluoroquinolones (e.g., Ciprofloxacin), Aminoglycosides (e.g., Gentamicin), and Beta-blockers.

What antibiotic causes C. difficile?

• While almost any antibiotic can, Clindamycin, Fluoroquinolones, and Cephalosporins are the highest risk.

Grey Baby Syndrome

• Caused by Chloramphenicol toxicity in neonates due to their immature liver lacks the glucuronidation enzymes to metabolize the drug.

GFR target for a diabetic patient

•  Ideally > 60 mL/min/1.73m². Diabetic kidney disease (nephropathy) is screened when eGFR drops below 60 or if albuminuria is present.

Thiazide-like diuretics examples

•  Chlorthalidone, Indapamide, and Metolazone.

 Kinetics Math: A drug has a half-life... starting at 80mg, how much was left after 3 half lives?

• Calculation to get 10:

  • Start : 80mg

  • 1 Half-life: 40mg

  • 2 Half-lives: 20mg

  • 3 Half-lives: 10mg

• Answer: The question likely asked how much drug is left after 3 half-lives.

Nifedipine: Effects on Pregnancy

• Clinical Use: Nifedipine (a dihydropyridine calcium channel blocker) is widely used in pregnancy as a first-line agent for chronic hypertension and gestational hypertension/preeclampsia. It is also used off-label as a tocolytic to delay premature labor.

• Safety Profile: Generally considered safe and effective in pregnancy (often preferred over other antihypertensives, alongside methyldopa and labetalol).

• Adverse Effects / Risks: * Can cause maternal peripheral edema, flushing, headaches, and reflex tachycardia.

  • Crucial Risk: Severe maternal hypotension can occur, which may lead to uteroplacental hypoperfusion (decreased blood flow to the fetus) and fetal distress.

 What year was the heart initiative founded in Grenada?

• : 2025 (as noted in your text).

 Who is in charge of The Heart Initiative / The Founder?

• Note: This refers to a highly localized or specific institutional initiative within Grenada. Review your specific lecture slides or local program directory for the exact name of the leading physician or coordinator.

 What is the first-line treatment for a patient with hypoglycemia?

• Conscious Patient (Can swallow safely): The "Rule of 15". Give 15 grams of fast-acting carbohydrates (e.g., 4 ounces of fruit juice or regular soda, 3–4 glucose tablets, or hard candies). Recheck blood glucose in 15 minutes; repeat if still < 70 mg/dL.

• Unconscious/Severe Hypoglycemia (Cannot swallow safely): * In a community setting: Subcutaneous or intramuscular Glucagon injection (or intranasal glucagon).

  • In a hospital setting: Intravenous Dextrose (typically 10% to 50% water solution, e.g., 25–50 mL of D50W).

 What institution is in charge of the education and training of Future Pharmacists?

• TAMCC (T.A. Marryshow Community College), as noted in your text.

 What is the role of the pharmacy council?

The Pharmacy Council is a regulatory body responsible for protecting public health by:

• Setting and maintaining standards for pharmacy education and practical training.

• Registering and licensing qualified pharmacists and pharmacy technicians.

• Enforcing code of ethics and professional conduct.

• Inspecting and licensing pharmacy premises (premises registration).

 Who is in charge of registering new pharmacists?

• Pharmacy Council.

 Decrease of Folic Acid, Side Effects, and Drug Interactions of Phenytoin

• Folic Acid Depletion: Phenytoin decreases the absorption and accelerates the metabolism of dietary folate. Chronic use can lead to folate deficiency and potentially megaloblastic anemia.

• Side Effects of Phenytoin:

  • Acute/Dose-related: Nystagmus, ataxia, diplopia, slurred speech, and sedation.

  • Chronic: Gingival hyperplasia (overgrowth of gums), hirsutism, vitamin D deficiency (leading to osteomalacia), peripheral neuropathy, and coarsening of facial features.

  • Idiosyncratic/Severe: Stevens-Johnson Syndrome (SJS) / Toxic Epidermal Necrolysis (TEN).

• Drugs that Inhibit Absorption/Metabolism of Phenytoin (Increase Phenytoin levels): * Amiodarone, cimetidine, fluconazole, isoniazid, and chloramphenicol inhibit CYP2C9/CYP2C19, increasing phenytoin toxicities.

  • Note on absorption: Antacids containing calcium carbonate or magnesium/aluminum hydroxide can physically bind phenytoin in the gut, decreasing its absorption if taken simultaneously. Space them by at least 2 hours.

Asthma is an inflammatory condition.

• True Statement. It is a chronic inflammatory disorder of the airways characterized by bronchial hyperresponsiveness, mucosal edema, and mucus production, leading to reversible airway obstruction.

 Risedronate (Actonel): Inhibits effects on osteoclasts.

• Mechanism of Action: Correct. Risedronate is a pyridinyl bisphosphonate that binds to bone hydroxyapatite and inhibits osteoclast-mediated bone resorption, thereby preserving bone mass and reducing the risk of fractures in osteoporosis.

Treatment of Impetigo:

• Mupirocin (Bactroban) 2% Ointment/Cream: * Dosage: Apply a small amount to the affected area 3 times daily for 5 to 10 days. The area may be covered with a sterile gauze dressing if needed.

• Fusidic Acid 2% Cream/Ointment:

Dosage: Apply to the affected area 3 to 4 times daily (or 1–2 times daily if covered with a dressing) typically for 7 to 14 days.

Side Effects of Statins & Avoidances (Interactions)

• Side Effects: Myalgia (muscle pain/weakness), myopathy, rare rhabdomyolysis (severe muscle breakdown), mild elevation in serum transaminases (liver enzymes), and a slight increase in blood glucose levels.

• Drug-Drug Interactions (CYP3A4 Inhibitors to Avoid):

  • Strong inhibitors: Macrolide antibiotics (clarithromycin, erythromycin), azole antifungals (ketoconazole, itraconazole), protease inhibitors, and amiodarone. These significantly increase statin concentrations, increasing the risk of myopathy.

• Drug-Food Interactions:

  • Grapefruit Juice: Contains furanocoumarins which inhibit CYP3A4 in the gut wall, leading to drastically increased bioavailability and toxicity of certain statins (specifically simvastatin, atorvastatin, and lovastatin). Patients should avoid large quantities of grapefruit juice.

Classes, Side Effects, and Uses of Diabetic Drugs

Drug Class	Key Examples	Primary Clinical Uses	Common Side Effects
Biguanides	Metformin	First-line for Type 2 Diabetes; prediabetes; PCOS.	GI upset (diarrhea, nausea), metallic taste, lactic acidosis (rare but severe), Vitamin B12 deficiency.
Sulfonylureas	Glipizide, Gliclazide, Glimepiride	Type 2 Diabetes (when metformin isn't enough or tolerated).	Weight gain, Hypoglycemia.
SGLT-2 Inhibitors	Empagliflozin, Dapagliflozin, Canagliflozin	Type 2 Diabetes, Heart Failure (HF), Chronic Kidney Disease (CKD).	Genital yeast infections (mycotic), UTIs, polyuria, hypotension, rare euglycemic ketoacidosis.
GLP-1 Receptor Agonists	Semaglutide, Liraglutide	Type 2 Diabetes, significant weight management, CV risk reduction.	Nausea, vomiting, diarrhea, delayed gastric emptying, rare risk of pancreatitis.
DPP-4 Inhibitors	Sitagliptin, Linagliptin	Type 2 Diabetes (weight neutral, low hypo risk).	Nasopharyngitis, headaches, rare severe joint pain.
Thiazolidinediones (TZDs)	Pioglitazone	Type 2 Diabetes.	Weight gain, fluid retention/edema (contraindicated in severe Heart Failure), atypical fractures.

Sulfonylureas can cause weight gain.

• Mechanism: Sulfonylureas stimulate pancreatic beta cells to secrete more insulin. Higher circulating insulin levels promote glucose uptake into tissues and lipogenesis, which structurally drives weight gain.

 SGLT-2 Inhibitors: Yeast Infections & Heart Failure First-Line

• Yeast Infections Cause: SGLT-2 inhibitors lower blood glucose by blocking renal glucose reabsorption in the proximal convoluted tubules, resulting in a large amount of glucose excreted in the urine (glucosuria). This glucose-rich environment in the urinary tract creates an ideal breeding ground for Candida species, leading to genitourinary yeast infections.

• Heart Failure Status: True. SGLT-2 inhibitors (specifically Empagliflozin and Dapagliflozin) are established as foundational first-line therapies for Heart Failure with Reduced Ejection Fraction (HFrEF) and Heart Failure with Preserved Ejection Fraction (HFpEF), independent of whether the patient has diabetes.