Published: 4 December 2025

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Quiz answers

Published: 4 December 2025
Prescriber Update 46(4): 72
December 2025

1. The use of Contrave (naltrexone + bupropion) is contraindicated in which of the following patients?
   1. A patient with controlled hypertension and a BMI of 32
   2. A patient receiving opioid substitution therapy
   3. A patient with a history of smoking and mild depression
   4. A patient with well-managed type 2 diabetes and no psychiatric history

   b. Contrave is contraindicated in patients currently dependent on opioids, including those on opioid substitution therapy, due to the risk of serious life-threatening reactions. (June 2025)

2. True or false: Fluoroquinolone-induced tendon rupture can occur months after stopping treatment.

True. Tendon rupture may occur months after stopping fluoroquinolone therapy, and reactions can affect patients of any age, even without pre-existing risk factors. (September 2025)

3. How long after starting immunotherapy does immune effector cell-associated neurotoxicity syndrome (ICANS) usually occur?

4–5 days. Immune effector cell-associated neurotoxicity syndrome (ICANS) occurs a median of 4–5 days following the use of any immunotherapy that activates or engages T-cells and/or other immune effector cells. (March 2025)

4. A patient on long-term systemic retinoid therapy starts to experience musculoskeletal problems, including back pain, morning stiffness and reduced range of motion. What condition may have developed?

Diffuse idiopathic skeletal hyperostosis (DISH). Cases of DISH have been reported following use of systemic retinoids, usually after prolonged use and/or at high doses. (September 2025)

5. What advice should be given to patients starting on GLP-1 receptor agonists to reduce the risk of acute renal injury?

Advise them to stay well hydrated by drinking plenty of fluids (eg, water) and inform them of the potential risks associated with dehydration. Also advise them to seek medical attention if gastrointestinal symptoms are severe or persistent.  (June 2025)

6. Which of the following statements about colchicine is false?
1. Reduce the colchicine dose by half if the patient’s creatinine clearance is ≤10 mL/min
2. Itraconazole, clarithromycin, verapamil and amiodarone can interact with colchicine
3. Colchicine may increase the risk of bleeding in patients taking anticoagulants
4. The first signs of colchicine toxicity may be a feeling of burning and rawness in the mouth and throat and difficulty in swallowing

a. Colchicine is contraindicated if the patient’s creatinine clearance is ≤10 mL/min. (March 2025)

7. What is the mechanism for paracetamol-induced high anion gap metabolic acidosis (HAGMA)?
1. 5-oxoproline depletion due to low glutathione levels
2. 5-oxoproline accumulation due to high glutathione levels
3. Pyroglutamate accumulation due to low glutathione levels
4. Pyroglutamate depletion due to high glutathione levels

c. Paracetamol can cause HAGMA due to pyroglutamic acidosis. It is associated with glutathione depletion, which causes 5-oxoproline/pyroglutamic acid to accumulate. (December 2025)

8. Is cholestatic jaundice typically associated with short or long term use of nitrofurantoin?

Short-term use. Cholestatic jaundice is typically associated with short-term nitrofurantoin use, while c hronic active hepatitis, which can progress to hepatic necrosis, is generally linked to long-term use. (June 2025)

9. A 45-year-old woman presents with intermittent abdominal pain, nausea and vomiting. Imaging shows bowel wall thickening and mild ascites. Of the medicines listed below that she is taking, which is the most likely to have caused this?
1. Paracetamol
2. Levonorgestrel
3. Perindopril
4. Gabapentin

c. This patient may be experiencing intestinal angioedema due to perindopril (an ACE inhibitor). (December 2025)

10. A couple is considering starting a family but one of them is taking methotrexate. How long after stopping methotrexate should they continue to use contraception for?
1. At least 3 months after stopping for males and at least 3 months for females
2. At least 6 months after stopping for males and at least 6 months for females
3. At least 6 months after stopping for males and at least 3 months for females
4. At least 3 months after stopping for males and at least 6 months for females

d. If either partner is receiving methotrexate, pregnancy should be avoided and effective contraception used during treatment and after discontinuation for at least 3 months after treatment for males and at least 6 months for females. (March 2025)