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1. 問題 1 · UK Pharmacy and Healthcare Calculations

   A dentist plans local infiltration anaesthesia using lidocaine hydrochloride 2% w/v injection. One full 5 mL ampoule is drawn up. How many milligrams of lidocaine hydrochloride are in the syringe? Give your answer to the nearest whole milligram.

   1. A10 mg
   2. B40 mg
   3. C100 mg
   4. D200 mg
   5. E1000 mg
   正解と解説を表示

   正解: C 100 mg

   解説

   1) 2% w/v means 2 g in 100 mL. 2) 2 g = 2000 mg, so the concentration is 2000 mg / 100 mL = 20 mg/mL. 3) 20 mg/mL x 5 mL = 100 mg. Final answer: 100 mg. The answer 10 mg comes from reading 2% as 2 mg/mL, and 1000 mg comes from misplacing the decimal point when converting grams to milligrams.

   参考文献

   • emc SmPC search: lidocaine hydrochloride injection

2. 問題 2 · UK Cardiovascular and Endocrine

   A 50-year-old man has a clinic blood pressure of 154/96 mmHg, and a repeat reading in the same consultation is similar. He then has ambulatory blood pressure monitoring (ABPM), which shows a daytime average of 141/88 mmHg. He has no symptoms suggesting accelerated hypertension. Using NICE NG136 thresholds, which is the most appropriate interpretation?

   1. AMasked hypertension
   2. BStage 2 hypertension
   3. CStage 1 hypertension
   4. DWhite-coat effect with normal blood pressure
   5. ESevere hypertension needing same-day referral
   正解と解説を表示

   正解: C Stage 1 hypertension

   解説

   NICE NG136 defines stage 1 hypertension as a clinic BP of 140/90 mmHg or above with an ABPM daytime average of 135/85 mmHg or above. Stage 2 requires a clinic BP of 160/100 mmHg or above with an ABPM daytime average of 150/95 mmHg or above. This man's ABPM average of 141/88 mmHg meets stage 1 but not stage 2. A white-coat effect would require an ABPM average below 135/85 mmHg.

   参考文献

   • NICE NG136: Hypertension in adults: diagnosis and management

3. 問題 3 · UK Central Nervous System and Musculoskeletal

   A 68-year-old woman takes aspirin 75 mg daily for secondary prevention after a transient ischaemic attack. She has moderate depression, and her GP plans to start sertraline 50 mg daily. She has no history of peptic ulcer and normal renal function. What is the most appropriate additional measure to reduce her risk of gastrointestinal bleeding?

   1. AStart sertraline at 25 mg on alternate days
   2. BCo-prescribe misoprostol 200 micrograms twice daily
   3. CStop aspirin for the duration of sertraline treatment
   4. DCo-prescribe a proton pump inhibitor such as omeprazole
   5. ESwitch aspirin to clopidogrel before starting sertraline
   正解と解説を表示

   正解: D Co-prescribe a proton pump inhibitor such as omeprazole

   解説

   SSRIs impair platelet serotonin uptake and increase the risk of GI bleeding, especially with aspirin or NSAIDs. NICE CKS (depression) and the BNF advise considering a gastroprotective proton pump inhibitor when an SSRI is given with aspirin in older people. Stopping aspirin would remove necessary secondary prevention after a TIA. Clopidogrel is also an antiplatelet and does not remove the interaction.

   参考文献

   • NICE NG222: Depression in adults
   • SPS: Antidepressants and bleeding risk

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