Pathology EMQ template.

Name: Chiara Taylor

Candidate number:

Theme: Therapeutic Drug Monitoring

OPTION LIST

A	Azathioprine	I
B	Cyclosporin	J
C	Digoxin	K
D	Gentamycin	L
E	Lithium	M
F	Phenytoin	N
G	Temazepam	O
H	Theophylline	P

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

1. 0.3% of the population have undetectable activity of the enzyme thiopurine methyltransferase (TPMT); in these people, treatment with which drug can result in bone marrow and liver toxicity?

2. Important adverse effects include ototoxicity and nephrotoxicity with which drug?

3. A drug with a wide (high) therapeutic index.

4. Plasma levels of this drug should be measured at least 6 hours after the first dose to get an accurate reflection of tissue levels.

5. Grapefruit juice increases the bioavailability of this drug.

ANSWERS

1. A

2. D

3. G

4. C

5. B

Notes:

· Benzodiazepines (e.g. temazepam) replaced barbiturates as hypnotics because of their comparatively wide therapeutic index.

· Digoxin takes a long time to be properly disptributed throughout the tissues, so plasma samples that are taken within 6 hours will be high and yet tissue levels may be below the therapeutic range.