Buttercups Mock Revision

Question 1

What is the paracetamol dosing in a child 10-11 years old?

Answer 1

480-500mg every 4-6 hours, maximum 4 doses in a day (2g)

Question 2

What is the paracetamol dosing in a child 6 months - 1 year old?

Answer 2

120mg every 4-6 hours; maximum 4 doses per day (480mg)

Question 3

What is the paracetamol dosing in a child 2-3 years?

Answer 3

180mg every 4-6 hours; maximum 4 doses per day.

Question 4

What is the ibuprofen dosing in a child 3 - 5 months old?

Answer 4

50mg tds,

Question 5

what is the ibuprofen dosing in a child 6-11 months?

Answer 5

50mg tds-qds, maximum 30mg/kg per day.

Question 6

What is the ibuprofen dosing in a child 1 - 3 years old?

Answer 6

100mg 3 times a day/

Question 7

What is the ibuprofen dosing in a child 4-6 years old?

Answer 7

150mg tds

Question 8

What is the ibuprofen dosing in a child 7-9 years?

Answer 8

200mg tds;

Question 9

What is the ibuprofen dosing in a child 10-11 years old?

Answer 9

300mg tds

Question 10

What is the ibuprofen dosing 12+?

Answer 10

300-400 tds-qds, increased to 600mg qds if needed (POM), OTC max = 1.2mg, POM max = 2.4mg.

Question 11

Do pharmacies need to hold a CD disposal/denaturing license?

Answer 11

No

Question 12

What does ‘Use by..’ refer to?

Answer 12

USe by 12.2018 means this item can be used until the end of 11.2018, hence use by the beginning of 12.2018

Question 13

What does ‘Expiry Date..’ refer to?

Answer 13

Expiry date 12.2018 means the item can be used until the end of this month.

Question 14

Expires January 2019 means

Answer 14

Discard 31/01/2019

Question 15

Which of the following is NOT a contraindication using Maloff Protect OTC?

Recieving treatment for depression.
17-year old female.
Planning to concieve.
50 year old taking metformin.
Are using etoposide for cancer, metoclopramide for nausea.
Recently been switched from warfarin to rivaroxaban.

Answer 15

It is fine to use Maloff Protect if taking metformin for T2 diabetes.

Question 16

Which of the following is NOT a contraindication to purchasing Viagra Connect OTC?

A patient who carries GTN spray for chest pain.
A recreational user of the party drug ‘poppers’ (amyl nitrite).
A patient recieving treatment for chonic thromboembolic pulmonary hypertension following surgery.
A 50 year-old man who occasionally takes cimetidine.
A 48 year-old man prescribed diffundox XL for BPH.
A 55 year-old man with Glaucoma.
A 25 year-old man with Sickle cell anaemia.

Answer 16

Sildenafil potentiates the hypotensive effects of nitrates, and its co-administration with nitric oxide donors, amyl nitrate (poppers), or nitrates in any form (GTN, isosorbide, nicorandil etc).

Riociguat is used for chonic thromboembolic pulmonary hypertension following surgery. It is a soluble guanylate cyclase stimulator and the co-administration of phosphodiesterase type 5 inhibitors such as sildenafil with guanylate cyclase stimulators, may lead to symptomatic hypotension.

Clearance of sildenafil has been reduced when used with CYP3A4 inhibitors such as ritonavir, ketoconazole, itraconazole, erthyromycin and cimetidine.

Postural hypotension can result from PDEv inhibitors and alpha blockers: alfuzosin, doxasozin or tamsulosin.

Patients who have conditions which may predispose them to priapism (such as sickle cell anaemia, multiple myeloma or leukaemia) should consult a doctor.

Nothing in SPC or questionnaire about Glaucoma.

Question 17

Which of the following is NOT a contraindication to usage of Viagra Connect?

A man with Peyronie’s disease.
A man with retinitis pigmentosa.
A man with glucose-galactose malabsorption.
A man with multiple myeloma.
A man taking warfarin.
A man currently taking omeprazole 20mg once daily.

Answer 17

Peyronies disease = penis problem caused by scar tissue (bent penis) silfenafil CI in any physical penis deformities.

Vision problems: CI.

Galactose intolerance, Lapp lactase deficiency or glucose-galactose: the film coating of the tablet contains lactose.

Patients who have conditions which may predispose them to priapism (such as sickle cell anaemia, multiple myeloma or leukaemia), should consult a doctor before using agents for the treatment of erectile dysfunction, including sildenafil.

Warfain is fine.

The omeprazole could be to treat a gastric ulcer:
bleeding issues like haemophillia or active stomach ulcers are a contraindication.

Question 18

Which of these IS a contraindication to usage of Viagra Connect?

Usage of Aspirin 
Usage of Warfarin
Usage of Tolbutamide 
Usage of Diltiazem
Usage of Amlodipine
Usage of Ramipril

Answer 18

CI: CYP3A4 inhibitors such as saquinavir (HIV infection), Cimetidine (heartburn), Diltiazem (high blood pressure), eryhromycin or rifampacin, itra/ketoconazole.

Question 19

What is the target range for fasting blood glucose?

Answer 19

4-7mmol/L

Question 20

Which of the following can only be administered by someone with suitable training under the HMR 2012?

Adrenaline 1:1000 up to 1mg for intramuscular use in anaphylaxis. 
Atropine sulphate injection.
Chlorphenamine injection.
Glucagon injection
Glucose injection
Hydrocortisone injection
Naloxone injection. 
Pralidoxime chloride injection
Salbutamol injection

Answer 20

Schedule 19 of the HMR 2012 sets out what medicinal products can be parenterally administered in an emergency:
Adrenaline 1:1000 up to 1mg for intramuscular use in anaphylaxis
Atropine sulphate and obidoxime chloride injection
Atropine sulphate and pralidoxime chloride injection
Atropine sulphate injection
Atropine sulphate, pralidoxime mesilate and avizafone injection
Chlorphenamine injection
Dicobalt edetate injection
Glucagon injection
Glucose injection
Hydrocortisone injection
Naloxone hydrochloride
Pralidoxime chloride injection
Pralidoxime mesilate injection
Promethazine hydrochloride injection
Snake venom antiserum
Sodium nitrite injection
Sodium thiosulphate injection
Sterile pralidoxime

Salbutamol is not included.

Question 21

What are the best sources of dietary iron?

Answer 21

Liver (not in preg)
Meat
Beans
Nuts
Dried fruit - dried apricots
Wholegrains such as brown rice
Fortified breakfast cereals
Soybean flour
Dark-green leafy vegetables - such as watercress and curly kale.

Question 22

How much iron do men over 18 need each day?

Answer 22

8.7mg a day for men over 18

Question 23

How much iron do women aged 19-50 years need a day?

Answer 23

14.8mg a day

Question 24

How much iron do women over 50 need?

Answer 24

8.7mg a day, same as men over 18.

Question 25

What are good sources of Vitamin A?

Answer 25

``` Cheese Eggs Oily fish Fortified low-fat spreads Milk and yoghurt Liver and liver products such as liver pate, avoid in preg. ``` Also beta-carotene is turned into vit A in body so: yellow, red and green (leafy vegetables), such as spinach, carrots, sweet potatoes and red peppers. Yellow fruit, such as mango, papaya and apricots.

Question 26

How much vitamin A is recommended daily for adults aged 19-64 years old?

Answer 26

0. 7mg for men | 0. 6mg for women

Question 27

What are the B vitamins? (the important ones on NHS.uk)

Answer 27

``` Thiamin (vitamin B1) Riboflavin (vitamin B2) Niacin (B3) Pantothenic acid Vitamin B6 Biotin B7 Folic acid Vitamin B12 ```

Question 28

What is the role of Thiamin (B1)?

Answer 28

Break down and release energy from food. | Keep the nervous system healthy.

Question 29

What are good sources of Thiamin (B1)?

Answer 29

``` Peas Fresh and dried fruit Eggs Wholegrain breads Some fortified breakfast cereals Liver ```

Question 30

How much thamin (B1) do adults (19-64 years) need?

Answer 30

1mg a day for men | 0.8mg for women.

Question 31

What is the role of riboflavin (vitamin B2)?

Answer 31

Keeps skin, eyes and the nervous system healthy. | Helps the body release energy from food.

Question 32

What are some good sources of riboflavin?

Answer 32

Milk, eggs, fortified breakast cereals. Rice.

Question 33

What antibiotics are associated with ototoxicity?

Answer 33

Aminoglycosides (gentamacin and tobramycin) - once-daily dosing may protect against this. Macrolide antibiotics, including erythromycin, are associated with reversible ototoxic effects.

Question 34

What diuretics are associated with ototoxicity?

Answer 34

Loop and thiazides. | Loop furosemide is particularly associated with ototoxicty when doses exceed 240mg per hour.

Question 35

What OTC blood thinner can cause high-pitch tinnitus and hearing loss in both ears which is typically reversible upon stopping the drug?

Answer 35

Aspirin, (also quinine and other salicylates).

Question 36

Chemotherapeutic agents containing what element are associated with ototoxicity?

Answer 36

Platinum-containing agents: cisplatin, carboplatin. Less frequently with oxaliplatin.

Question 37

What other chemotherapy agents, apart from platinum containing ones, can cause ototoxicity?

Answer 37

Vinca alkaloids such as vincristine are associated with reversible ototoxicty.

Question 38

Is methadone safe to use during pregnancy?

Answer 38

YES!

Question 39

Is buprenorphine a licensed alternative to methadone in pregnancy?

Answer 39

NO

Question 40

Which of the following is no appropriate counselling for methotrexate? Moderate your caffeine intake. May cause drowsiness. Do not take medicines containing aspirin or ibuprofen (unless told to do so by GP). Avoid getting pregnant or fathering a child whilst on this medicine and for three months after treatment has finished. Folic acid should never be taken more than once weekly. Inform GP if any of the following develop: sore throat, mouth ulcers, unusual bruising, severe abdominal pain, being sick, dark urine, high temp, skin rash.

Answer 40

The British Society for Rheumatology guidelines for disease modifying anti-rheumatic drug therapy recommends a typical folic acid dose of 5mg once weekly, preferably the day after the methotrexate. They state that folic acid can be given any day as long as it is not on the same day as methotrexate. Folic acid reduces toxic effects and improves continuation of therapy and compliance. However, some GPs do prescribe folic acid to be taken everyday of the week apart from the day methotrexate is taken. The BNF only lists the once weekly dosing regimen for the prophylaxis of methotrexate side-effects.

Question 41

Is supervised consumption a legal requirement if the script says supervised consumption?

Answer 41

Nope, someone else can pick up on behalf if stipulated in writing by the patient.

Question 42

Is it a legal requirement for someone to sign the back of a CD script?

Answer 42

No, they can legally refuse.

Question 43

NICE NG80 recommends that if a SABA and Low dose ICS is ineffective what should be added to treatment?

Answer 43

LTRA trial.

Question 44

BTS recommends that if a SABA and low dose ICS is ineffective what should be added to treatment?

Answer 44

LABA.

Question 45

What are the first line treatment options for severe asthma in the community? (inhaled) [3]

Answer 45

Either: Salbutamol 100mcg OR salbutamol nebulised solution (1mg/mL, 2mg/mL) OR Terbutaline sulfate nebuliser solution (2.5mg/mL). Plus a steroid and high-flow oxygen if possible, monitor response 15-30 minutes after nebulisation; if any signs of acute asthma persist, arrange hospital admission. While awaiting ambulance, repeat nebulised beta2-agonist (as above) and give with ipratropium bromide nebuliser solution.

Question 46

What are the first line treatment options for severe asthma attack in the community? (Not the inhaled ones)

Answer 46

Alongside one of the three inhlaed options (salmbutamol inhaler, salbutamol nebulised, terbutaline nebulised): Either Prednisolone tablets (or soluble tabs) 5mg OR Hydrocortisone [preferably as sodium succinate].

Question 47

What is the dosing of dexamethasone oral solution (2mg/5ml) for severe croup presenting in the pharmacy?

Answer 47

Child 1 month - 2 years 150 micrograms/kg as a single dose.

Question 48

In the management of severe asthma attacks presenting in the community, what should be done once the decision to arrange hospital admission is made?

Answer 48

Repeat nebulised beta2 agonist as earlier in pathway and add ipratropium bromide nebuliser solution (250micrograms/mL)

Question 49

What is the only licensed medication to treat trigeminal neuralgia?

Answer 49

carbamazepine | Amitriptylin is unlicensed

Question 50

A class 4 recall from the MHRA is also known as what?

Answer 50

A caution in use notification.

Question 51

A Class 1 recall presents

Answer 51

A life threatening or serious risk to health.

Question 52

A class 2 recall is because the product may..

Answer 52

cause mistreatment or harm to the patient, but it is not life-threatening or serious.

Question 53

A class 3 recall is unlikely

Answer 53

To cause harm to the patient, and the recall is carried out for other reasons, such as non-compliance with the marketing authorisation or specification.

Question 54

A class 1 recall must be actioned

Answer 54

immediately including out of hours.

Question 55

A class 2 recall must be actioned

Answer 55

Within 48 hours

Question 56

A class 3 recall must be actioned

Answer 56

Within 5 days

Question 57

A class 4 recall (caution in use) must be actioned

Answer 57

within 5 days

Question 58

Why can domperidone not be used in heart failure patients?

Answer 58

domperidone is a dopamine antagonist with antiemetic properties. QT prolongation = risk of cardiac arrythmias and death. Should be used at lowest effective dose for shortest time possible. ``` Contraindicated now in: HF Other QT prolongation meds. Potent CYP3A4 inhibitors. Severe hepatic impairment. ```

Question 59

Why is hyoscine hydrobromide cautioned in cardiac conditions?

Answer 59

It is an antimuscarininc medicine and for all antimuscarinics (systemic) the BNF states caution use in: Acute myocardial infarction (in adults); arrhythmias (may be worsened); autonomic neuropathy; cardiac insufficiency (due to association with tachycardia); cardiac surgery (due to association with tachycardia); children (increased risk of side-effects) (in children); conditions characterised by tachycardia; congestive heart failure (may be worsened); coronary artery disease (may be worsened); diarrhoea; elderly (especially if frail) (in adults); gastro-oesophageal reflux disease; hiatus hernia with reflux oesophagitis; hypertension; hyperthyroidism (due to association with tachycardia); individuals susceptible to angle-closure glaucoma; prostatic hyperplasia (in adults); pyrexia; ulcerative colitis

Question 60

Gradual withdrawal of systemic corticosteroids should considered in those whose disease is unlikely to relapse and have recieved more than __ prednisolone (or equivalent) daily for more than _ week.

Answer 60

Gradual withdrawal of systemic corticosteroids should be considered in those whose disease is unlikely to relapse and have: received more than 40 mg prednisolone (or equivalent) daily for more than 1 week; been given repeat doses in the evening; received more than 3 weeks’ treatment; recently received repeated courses (particularly if taken for longer than 3 weeks); taken a short course within 1 year of stopping long-term therapy; other possible causes of adrenal suppression.

Question 61

Gradual withdrawal of systemic corticosteroids should considered in those whose disease is unlikely to relapse and have been given repeat doses in the ______.

Answer 61

Gradual withdrawal of systemic corticosteroids should be considered in those whose disease is unlikely to relapse and have: received more than 40 mg prednisolone (or equivalent) daily for more than 1 week; been given repeat doses in the evening; received more than 3 weeks’ treatment; recently received repeated courses (particularly if taken for longer than 3 weeks); taken a short course within 1 year of stopping long-term therapy; other possible causes of adrenal suppression.

Question 62

Gradual withdrawal of systemic corticosteroids should considered in those whose disease is unlikely to relapse and have received more than _ weeks' treatment.

Answer 62

received more than 40 mg prednisolone (or equivalent) daily for more than 1 week; been given repeat doses in the evening; received more than 3 weeks’ treatment; recently received repeated courses (particularly if taken for longer than 3 weeks); taken a short course within 1 year of stopping long-term therapy; other possible causes of adrenal suppression

Question 63

Gradual withdrawal of systemic corticosteroids should considered in those whose disease is unlikely to relapse and have taken a short course within __ year(_) of stopping long-term therapy.

Answer 63

taken a short course within 1 year of stopping long-term therapy; other possible causes of adrenal suppression

Question 64

Would an acidic mouthwash be recommended for mucositis?

Answer 64

No, so no listerine.

Question 65

What is the treatment pathway for those of Afro-caribbean heritage with hypertension?

Answer 65

1st line: CCB 2nd line: CCB + ARB (in preference to an ACE inhibitor). 3rd line: Thiazide-like diuretic, such as chlortalidone (12.5mg-25mg once daily) or indapamide (1.5mg modified-release once daily or 2.5mg once daily). 4th line: Consider further diuretic therapy with low-dose spironolactone (25 mg once daily) if blood potassium level is 4.5mmol/L or lower.

Question 66

What is the first line treatment of hypertension in anyone of afro/caribbean origin in whom CCBs are not tolerated?

Answer 66

Thiazide-like diuretic, such as chlortalidone (12.5mg-25mg once daily) or indapamide (1.5mg modified-release once daily or 2.5mg once daily). `

Question 67

For step 4 treatment of resistant hypertension, why should higher-dose thiazide-like diuretic treatment be the treatment of choice (over low-dose spironolactone) if the blood potassium level is higher than 4.5mmol/l?

Answer 67

Spironolactone is a potassium-sparing diuretic and in cases where the blood potassium level is higher than 4.5mmol/l its use should be avoided due to the risk of hyperkalaemia.

Question 68

What is milia?

Answer 68

Milia are small, bump-like cysts found under the skin. They are usually 1 to 2 milimeters in size. They form when skin flakes or keratin, a protein, become trapped under the skin. Milia most often appear on the face, commonly around the eyelids and cheeks.

Question 69

ellaOne is a better EHC in people of what weight?

Answer 69

70kg and above.

Question 70

When would two levonelle tablets be taken as EHC?

Answer 70

When enzyme inducing medication is being taken or has been taken in the last 4 weeks.

Question 71

If a patient needs EHC, having taken which of these drugs within the last 4 weeks (or currently) would NOT require them to take two levonelle 1500microgram tablets? ``` Carbamazepine for trigeminal neuralgia. St John's Wort for mild depression (OTC) A sulphonylurea for diabetes. Griseofulvin for tinea pedis. Rifampacin (alongside isoniazid for prevention of TB in susceptible close contacts). Ritonavir (as part of HAART). ```

Answer 71

Sulphonyureas for diabetes. 4.5 Interaction with other medicinal products and other forms of interaction The metabolism of levonorgestrel is enhanced by concomitant use of liver enzyme inducers, mainly CYP3A4 enzyme inducers. Concomitant administration of efavirenz has been found to reduce plasma levels of levonorgestrel (AUC) by around 50%. Drugs suspected of having similar capacity to reduce plasma levels of levonorgestrel include barbiturates (including primidone), phenytoin, carbamazepine, herbal medicines containing Hypericum perforatum (St. John's Wort), rifampicin, ritonavir, rifabutin, griseofulvin. For women who have used enzyme-inducing drugs in the past 4 weeks and need emergency contraception, the use of non-hormonal emergency contraception (i.e. a Cu-IUD) should be considered. Taking a double dose of levonorgestrel (i.e. 3000 mcg within 72 hours after the unprotected intercourse) is an option for women who are unable or unwilling to use a Cu-IUD, although this specific combination (a double dose of levonorgestrel during concomitant use of an enzyme inducer) has not been studied. No mention of interactions between sulphonylureas and levonelle.

Question 72

What does SICKFACES.COM stand for?

Answer 72

Enzyme inhibitors: ``` Sodium valproate Isoniazid Cimetidine Ketoconazole FLuconazole Alcohol chronic Chloramphenicol Erythyromycin Sulfonamides Ciprofloxacin Omeprazole Metronidazole ```

Question 73

What does SCRAP GP stand for?

Answer 73

Enzyme inducers: ``` Sulphonylureas Carbamezapine Rifampin Alcohol Phenytoin Griseofulvin Phenobarbital ```

Question 74

What can we use to treat oral thrush in someone taking warfarin?

Answer 74

Not daktarin oral gel (miconazole) as it interacts with warfarin. Systemic miconazole can potentiate the anticoagulant effect of warfarin, because it is a strong inhibitor of the P450 isoenzyme CYP2C9, one of the main enzymes involved in warfarin metabolism. Nystatin can also be used for candidal infections. It is not known to affect cytochrome P450, so it would not be expected to affect warfarin metabolism. (POM only)

Question 75

What is the risk with the using chloramphenicol orally?

Answer 75

Aplastic anaemia, affecting 1 in 24,000-40,000 patients who take it orally.

Question 76

What are the antibiotics of choice in pregnancy?

Answer 76

Penicillins and cephalosporins.

Question 77

What antibiotics should be avoided entirely in pregnancy? (4)

Answer 77

Quinolones Tetracyclines Aminoglycosides unless severe of life threatening infection. High dose metronidazole.

Question 78

What antibiotics should only be used at certain times during pregnancy?

Answer 78

Trimethoprim should not be used in the first trimester as it is a folate antagonist. Nitrofurantoin should not be used near term due to risk of neonatal haemolysis.

Question 79

Why should streptomycin not be used in pregnancy?

Answer 79

It can cause foetal auditory nerve damage.

Question 80

Can erythromycin be used in pregnancy?

Answer 80

Not known to be harmful but penicillins and cephalosporins should be used instead.

Question 81

What dosing is usually seen with Apixaban?

Answer 81

Twice daily

Question 82

What is the target fasting serum triglyceride level?

Answer 82

<1.7mmol/L

Question 83

A triglyceride level of what is a reasonable level at which to prompt referral or seeking of specialist advice?

Answer 83

> or = 10mmol/L

Question 84

A triglyceride level of what indicates the need for urgent referral (or urgent specialist advice)?

Answer 84

>20 mmol/L

Question 85

What are some of the secondary causes for high triglyceride levels?

Answer 85

High alcohol Uncontrolled diabetes Isotretinoin.

Question 86

Do triglycerides contribute to athersclerosis?

Answer 86

Nope

Question 87

What can cause blue wee?

Answer 87

Triamterene - used for oedema etc.

Question 88

What electrolyte imbalances can SSRI's cause?

Answer 88

Hyponatraemia. | Syndrome of inappropriate ADH secretion.

Question 89

A rough feeling rash which blanches, with white spots on the tongue indicates what?

Answer 89

Scarlet fever.

Question 90

What does a presentation of scarlet fever in the pharmacy need to end in?

Answer 90

Referral for antibiotics from the GP

Question 91

Ocular prostaglandin use can cause

Answer 91

Thickening of eye lashes. | Darkening of pigments of iris and the skin around the eye.

Question 92

Azole drugs cause what organ damage?

Answer 92

Hepatits not renal

Question 93

What are the symptoms of DKA?

Answer 93

``` Abdominal pain Pear odour Metallic taste in mouth Exessive thirst Slow pulse ```

Question 94

What is balantis?

Answer 94

Balanitis is a skin irritation on the head of the penis that can affect men and boys. Symptoms include: a sore, itchy and smelly penis redness and swelling build-up of thick fluid pain when peeing

Question 95

Canaglifozin is what type of drug?

Answer 95

SGLT-2 inhibitor associated with increased risk of lower limb amputation.