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A12 E Staphylococcus aureus, Haemophilus influenzae, Streptococcus pyogenes hydrocodone irregular heartbeat and Pseudomonas aeruginosa are all microorganisms that can cause otitis media. Enterobius vermicularis is a threadworm leading to an infection characterised by itchy anus and the presence of white worms.

A13 B Combined oral contraceptives may cause migraine and are contraindicated in such patients. Progesterone-only contraceptives are more suitable in this case. A14 C Ciclosporin, a calcineurin inhibitor, is a potent immunosuppressant useful in the prevention of rejection in organ transplants and grafting procedures. Vincristine is a vinca alkaloid cytotoxic agent; fluorouracil and methotrexate are both antimetabolite cytotoxic agents; and bleomycin is a cytotoxic antibiotic. A15 A Legionnaire's disease is an acute respiratory disease caused by the Gram- negative, aerobic, non-sporing bacillus Legionella pneumophila. The disease is transmitted through the inhalation buy cheap phentermine without prescription of infected water droplets. A16 B Ginvigal hyperplasia is a side-effect commonly associated with phenytoin. A17 B The application of a mild topical corticosteroid, such as hydrocortisone, is effective in patients presenting with multiple mosquito bites. Paracetamol, which is an antipyretic agent is not indicated in mosquito ethex 041 is oxycodone hydrochloride bites. Fusidic acid cream is an anti-infective agent and is indicated if the mosquito bites have been scratched and there is risk of infection. Benzocaine (anaesthetic) and mepyramine (antihistamine) may relieve itchiness but are less effective in multiple mosquito bites than hydrocortisone. A18 A The difference between ampicillin and amoxicillin is the hydroxyl group that makes amoxicillin more soluble than ampicillin. Amoxicillin is in fact administered three times daily rather than four times daily.

A19 A Clarithromycin is a macrolide antibacterial agent that should be used with caution in patients with renal impairment.

The dose should be reduced if creatinine clearance is less than 30 mL/minute buy cheap phentermine without prescription and the modified-release oral preparation should be avoided in this scenario. A20 C Co-amoxiclav consists of the combination of amoxicillin (penicillin antibacterial agent) and clavulanic acid (beta-lactamase inhibitor) which is associated with a risk of crystalluria in patients with renal impairment who are receiving high doses, particularly during parenteral therapy.

Gentamicin is an aminoglycoside, which is a group of antibacterial agents that is associated with nephrotoxicity and ototoxicity. Their systemic administration to patients with renal impairment should be undertaken carefully but the advantages of this group of antibacterials (particularly their activity against many Gram-negative microorganisms) should outweigh this risk. When gentamicin and other aminoglycosides are used systemically, the serum concentration is monitored to prevent nephrotoxicity and ototoxicity. In patients with renal impairment, drug serum concentration monitoring should be started earlier ritalin adhd and more frequent measurements are recommended. A22 D Fusidic acid is a narrow-spectrum, buy cheap phentermine without prescription antibacterial agent that relies on hepatic elimination. No cautionary action is recommended for patients with renal impairment. A23 E Gentamicin, as with other aminoglycosides, is tylenol acetaminophen 'fastest' hydrocodone codeine excreted through the kidney, and in renal impairment there is the risk of accumulation.

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