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GPhC Qs Flashcards

1
Q

How long do you retain signed orders for?

A

2 years from date of supply

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2
Q

EMERGENCY SUPPLY

PATIENT REQUEST?

A

immediate need
previously prescribed
appropriate dose
5 days- phenobarbital/schedule 4/5

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3
Q

EMERGENCY SUPPLY
EEA ES
NOT ALLOWED?

A

SCHEDULE 1/2/3

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4
Q

EMERGENCY SUPPLY PATIENT

ENTRY?

A

DATE
NAME/QUANTITY/FORM/SRENGTH
NAME+ADDY OF PATIENT
NATURE

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5
Q

EMERGENCY SUPPLY

PATIENT LABELLING?

A 
DATE
NAME/QUANTITY/FORM/STRENGTH
ANME OF PATIENT
NAME+ADDY OF PHARMACY
'EMERGENCY SUPPLY'

VET
‘KEEP OUT OF REACH OF CHILDREN’ ‘must’ lol

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6
Q

EMERGENCY SUPPLY PRESCRIBER

REQUIREMENTS

A

PROVIDE SCRIPT IN 72HOURS

NO CDS 1/2/3 (except pheno)

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7
Q

EMERGENCY SUPPLY PRESCRIBER REQUEST

ENTRY?

A 
DATE
NAME/QUANTITY/FORM/STRENGTH
NAME+ADDY OF PRACTITIONER
NAME+ADDY OF PATIENT
DATE PRESCRIPTION
AMEND ENTRY, INCLUDE DATE PRESCRIPTION RECEIVED
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8
Q

WHAT CDs REQUIRE DENATURING?

A

RETURNED/EXPIRED/OBSOLTE

SCHEDULE 2/3/4 (part 1)

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9
Q

SCH 2/3/4 RETURNED

AUTHORISED WITNESS NEEDED?

A

NO,

just witness to see is preferred, myna

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10
Q

EXPIERD CD

AUTHORISED WITNESS REQUIRED?

A

YES, ONLY IF SCHEDULE 2!

3? Good practice, etc…

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11
Q

patient returned cd entry?

A

NO, KEEP it separate, but record destruction yes

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12
Q

EXPIRED STOCK ENTRY?

A

RECORD FOR SCHEDULE 2 CDs

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13
Q

CDs, bank holiday coming up, prescription wording wag1?

A

Instalments due on days when the pharmacy is closed should be dispensed on the day immediately
prior to closure

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14
Q

Methadone+contraceptive pill?

A

Should be calm

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15
Q

Fluclo, breastfeeding?

A

Ery preferred

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16
Q

Warfarin+miconazole?

A

Inhibitor, INR increases, bleed

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17
Q

Theophylline, patient stopped smoking?

A

Reduce dose

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18
Q

Ibuprofen dose 3 year?

A

100mg TDS

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19
Q

Paracetamol dose 7 year old?

A

240-250mg QDS

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20
Q

Vaginal thrush treatment?

A

Fluconazole/itraconazole/clotrimazole/minconazole

Etc

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21
Q

Bacterial vaginosis treatment?

A

Metronidazole

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22
Q

Fungal nail infection?

A

2 nails max, tips/sides only
1-2 times a week amorofline, 18+
yellow/distored, crumblish

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23
Q

Fever+chicken pox?

A

Give paracetamol, not ibuprofen

infection risk L

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24
Q

dabigatran labelling?

A

read additional info!

swallow whole, do not chew or crush!

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25
topiramate labelling?
sleepy, don't drive/use tools/machines do not stop taking this med!!!! (anti-epileptic) +kidney stones? cool
26
alendronic acid dosing?
10mg OD or 70MG WEEKLY 70MG OD is an L risk, osteonecrosis, fractures, auditory canal
27
metformin+next intensification bladder L, takes trimethoprim UTI, needs to lose weight?
Pioglitazone L bladder Flozin L urine Sulphonylurea L weight gain GLP-1? HMMM
28
Child Clenil+SABA+next up?
LTRA
29
Under 16, UPSI 2 days, best contraceptive, doesn't wnna see anyone?
Ulipristal, any child bearing age (but IUD probs best)
30
Trimethoprim+Methotrexate?
bone marrow suppression L, anti-folate, blood counts teratogenic btw, avoid in pregnancy, UTI no!
31
How often do you clean spacers?
Once a month mild detergent air dry, no rinse DO NOT USE A CLOTH INSIDE! Wipe detergent off mouthpiece obvs
32
How often do you replace spacers?
6-12 months
33
END OF LIFE Diamorphine, preferred, route?
Syringe driver
34
Meds contraindicated syringe route?
Chlorpromazine Prochlorperazine Diazepam Cyclizine Levomepromazine skin reactions L
35
Animal bite?
Co-amoxiclav OR Doxy+metro (allergy)
36
Animal scratch?
Flucloxacillin
37
Cyclophosphamide/alkylating agents | BIG BOY RISK?
Neutropenia contraception during+3 months after Cisplatin- during+6 months after
38
Sespsis in children symptoms?
dry nappies Crying clinging mute :|
39
profound bradycardia?
bisoprolol? really?
40
stage 1 hypertension, <55, >10% cvd risk?
ACE/arb gogo
41
Vincristine route?
IV, neurotoxicity risk otherwise
42
VET prescription years?
5 years
43
Ring worm, yute arm, treatment?
Clotrimazole
44
What drugs cause hypercalcaemia?
Hydrochlorthiazide Thiazide-like Lithium Excess vitamin A/d/calcium
45
palpitations+feeling faint, sign of?
HYPOKALAEMIA SALBUTAMOL+CORTICOSTEROIDS ABCDE
46
SSRI, hypo?
hyponatraemia
47
signs of hyponataraemia?
nausea headache irritability seizures
48
HIGH TSH, LOW T3/T4, WHAT IS THAT? TREATMENT?
hypothyroidism levothyroxine
49
C diff. treatment order? Relapse in 12 weeks of resolution? Relapse after 12 weeks? Life threatening?
Oral vanc Oral fidaxo Relapse in 12 weeks of resolution? fidaxomicin Relapse after 12 weeks? vancomycin/fidaxomicin Life threatening? vanc+ IV metro
50
PYELONEPHRITIS, AVOID?
RENALLY CLEARED DRUGS PROBS
51
COPD exacerbation, penicillin allergy? purulent sputum
Doxy 200mg first day, 100mg OD +4 days | + prednisolone 30mg 5 days
52
Animal scratch?
Fluclo apparently
53
Apixaban DVT/PE general treatment?
10mg BD 7 days, 5mg BD maintain
54
Apixaban VTE prophylaxis after knee surgery?
2.5mg BD 10-14 days
55
APIXABAN | VTE prophylaxis after hip surgery?
2.5mg BD 32-38 days
56
APIXABAN 2.5MG BD DOSING CRITERIA?
>/= 133 creatinine >/= 80 years = 60kg
57
Boostrix, pertussis, protects you from?
WHOOOOOOOOOOOOOPING COUGH
58
CHLAMYDIA TREATMENT?
``` AZITHROMYCIN 1G STAT OR DOXYCYCLINE 7 DAYS OR ERYTHROMYCIN 14 DAYS ```
59
antibiotic myna penicillin allergy, thrush?
fluclo, might as well give it :| be a MAN! (or woman)
60
SICK DAY RULES? SADMAN
``` SGLT ACE DIURETICS METFORMIN ARBS NSAIDS ```
61
SICK DAY RULES diabetes SICK?
SUGAR- increase bgm, (some anti-diab drugs dose increase) INSULIN- NEVER STOP! (bar SADMAN) (possible dose increase) CARBS- adequate hydration+carbs KETONES- type 1, check every 2-4hrs, EXTRA rapid acting insulin dose! wow
62
gap between 2 different eye drops?
5mins
63
CARER, ONCE DAILY INSULIN?
Determir (OD/BD) Degludec Glargine isophane?
64
insulin the mixes?
Biphasic, multiple, with meals, duh!
65
swollen ankles?
CCBs!
66
CLOZAPINE MONITORING?
leukocytes, blood counts weekly first 18 weeks, then fortnighly till year, then monthly look out for intestinal obstruction/constipation!
67
MUSCLE ACHE STATINS?
creatine kinase?
68
STATINS HEPATIC L?
ALT levels
69
STROKE PREVENTION CHA2-DS2-VAS SCORE? WHEN DO YOU TREAT?
``` C congestive HF Hypertension Age 75+ (2) Diabetic Stroke/TIA (2) Vascular disease- dvt, aneurysm, etc Age 65-74 Sex- female ``` When is thromboprophylaxis NOT needed? Men= 0 Women= 1 TREAT? >/= 2, men 1? consider...
70
MHRA only report the serious, adverse effects?
is codeine constipation established? yes DKA, FLOZIN, REPORT TO MHRA
71
DKA, SLGT, REPORT?
YEAH PROBS :z
72
Lithium+antidepressants risk?
Serotonin syndrome C A N ikykyk
73
breakthrough pain?
1/10th to 1/6th
74
MORPHINE dose increase?
1/3 to 1/2
75
QUNINE INDICATION
NOCTURNAL LEG CRAMPS 200-300 mg ON MALARIA Not the best, side-effects, tinnitus, QT prolongation Can take 4 weeks to work, review every 3 months
76
amiodarone+digoxin interaction?
bradycardia risk
77
what is duty of candour?
being honest when things go wrong
78
How long do you retain private scripts?
2 years, date of supply!
79
BISOPROLOL CAUTIONARY LABEL?
Do not stop taking this medicine unless your doctor tells you to stop
80
RIVAROXABAN CAUTIONARY LABEL?
Take with or just after food, or a meal Warning: Read the additional information given with this medicine
81
digoxin yellow vision, toxicity, mangement?
withdraw. specalist, a&E? digoxin specific antibody K+ sparing diuretic also helps, as hypokalaemia potentiates toxicity :(
82
Hypoglycaemia treatment?
15-20g sucrose/glose 3-4 heaped spoons sugar (in water?) 150-200ml juice NOT diet coke lol
83
HYPOGLYCAEMIA- SYMPTOMS?
``` SWEATING LETHARGIC DIZZINESS HUNGER TREMOR TINGLING LIPS PALPITATIONS EXTREME MOODS PALE ```
84
MASTITIS TREATMENT?
Flucloxacillin 10-14 days Erythromycin 10-14 days
85
EVIDENCE HIERARCHY ORDER?
``` SYSTEMATIC REVIEW/META-ANALYSIS RCT COHORT CASE-CONTROL CASE SERIES/REPORTS ```
86
Methotrexate, what drug to avoid?
Trimethoprim, bone marrow L
87
METHOTREXATE+NSAIDs?
reduces mtx clearance, but just monitor more, calm
88
methotrexate contraception monitoring?
during+ 6 months
89
What is the 6-in-1 vaccine? DTPHPHs
``` DIPTHERIA TETANUS PERTUSSIS HEPATITIS B POLIO HAEMOPHILIUS INFLUENZA B ```
90
emergency supply insulin, brand not in stock, action?
other pharmacies? any brand? :O Some are by brand, eg. glargine, careful
91
insulin prescribing?
UNITS PLEASE TY
92
PRIVATE CDs?
Use standardised form (vet excluded) Send to NHS Prescribe POMs separately (so you can retain 2 years) needs 'prescriber ID number' not reg hmm
93
pom REGISTER?
2 YEARS FROM LAST ENTRY
94
private prescriptions?
repeatable, not NHS | repeat, repeat once, dispense total twice
95
private prescription, oral contraceptive?
can repeat 5 times, dispense total 6 tiems
96
private script, dispense within?
6 months, rest repeats doesn't matter
97
private script schedule 4, dispense within?de
28 days, rest repeats no limit
98
desogesterl depression?
side-effect
99
desogestrel+phenytoin?
L
100
SCHIZO | HALOPERIDOL+RISPERIDONE TRIED, L, WHAT'S NEXT?
CLOZAPINE!
101
WARFARIN+CLARITHROMYCIN INTERACTION?
Increases INR, adjust dose, monitor MACROLIDE BRUH
102
ibuprofen 3 year old?
100mg TDS
103
PARACETAMOL DOSE 10 YEAR OLD?
480-500MG QDS
104
WHAT IS THIS?
VERRUCA Pressure areas, sole of feet, painful, black spos
105
WHAT IS THIS?
Warts smooth, raised, hands refer if wart on face/genitalia
106
WARTS/VERRUCA TREATMENT?
SALICYLIC ACID GLUTARALDEHYDE LACTIC ACID CRYOTHERAPY FILE W/ EMERY BOARD WATERPROOF PLASTER+SOCKS TO STOP SPREAD
107
symptoms of candidiasis?
white patches easily wiped off bleeding, red area loss of taste cracks
108
oral thrush treatment?
miconazole after food, hold in mouth, swirl, continue 7 days after lesions healed breastfeeding/nipples calm but wash remove? same with permethrin
109
phenelzine+pseudoephedrine interaction?
hypertensive crisis avoid+for 14 days after stopping MAOI, phenelzine
110
Longtec OD, shortec PRN, CDs
111
flucloxacillin counselling?
Take this medicine when your stomach is empty. This means an hour before food or 2 hours after food space doses evenly, complete course
112
enoxaparin+rivaroxaban?
risk of bleed :(
113
enoxaparin thrombocytopenia MHRA?
114
risedronate dosing treatment osteoporosis female? male?
female? 5MG OD 35MG ONCE A WEEK male? 35MG ONCE A WEEK prevent females 5mg od btw
115
patient, candidiasis, steroid, advice?
spacer
116
stage 1 hypertension, cvd risk>10%, diabetic?
ACE/ARB?
117
ACTIVITIES NOT REALLY NEEDING RP PRESENCE? STILL NEED TO SIGN IN!
``` ASSEMBLY ACCURACY CHECKING DISPENSING GSL MEDS? WASTE STOCK PROCESS? ORDERING RECEIVING (excluding CDs) ```
118
NAPPY RASH TREATMENT?
BARRIER PREPS CLOTRMIAZOLE/MICONAZOLE (+7 days after rash has gone) HYDROCORTISONE 1% CREAM POM FLUCLO/ERY IF BACTERIAL INFECTION
119
ALLERGIC DERMATITIS TREATMENT?
EMOLLIENTS STEROIDS CALAM ITCHINESS RELIEF
120
URTICARIA TREATMENT?
cetirizine (non-sedating) oral L? IV/IM chlorphenamine
121
Morphine MR instead of IR issue?
delayed pain relief
122
Patient w/ low HB+folate treatment?????
Hydroxycobalamin injections (probs)
123
birth prevent bleeding?
vitamin k antagonist!
124
TB INITIAL?
``` RIPE rifampicin isoniazide (+pyridoxine b6) pyrazinamide ethambutol ``` 2 months
125
TB CONTINUOUS?
RIFAMPICIN ISONIAZID 4 months
126
SSRI+sodium valproate interaction, electrolyte?
hyponatraemia
127
spironolactone electrolyte?
hyperkalaemia, SPARES POTASSIUM!
128
AKI, drugs to stop?
renally cleared drugs, ace/arb/nsaids, metformin, lactic acidosis!!!!
129
VET label requirements?
``` expiry (when human, under cascade) name+addy of owner name+addy of pharmacy name of VET id+species of animal for animal treatment only ```
130
VET PRESCRIPTION LEGAL REQUIREMENTS?
NAME/ADDY/TELEPHONE NUMBER/QUALI/SIG OF PRESCRIBER (schedule 2/3, need RCVS registration number as well) NAME+ADDRESS OF OWNER ID/SPECIES/ADDY OF ANIMAL DATE- 6 MONTHS VALIDITY | SCH 2/3/4- 28 DAYS NAME/QUANTITIY/DOSE/ADMINISTRATION- 'as directed' is poor ANY WARNINGS/WITHDRAWAL PERIODS?
131
SIGNED ORDER REQUIREMENTS?
``` NAME OF SCHOOL PRODUCT DETAILS (+ spacer) STRENGTH (if relevant) PURPOSE OF PRODUCT TOTAL QUANTITY SIGNATURE OF PRINCIPAL/HEAD TEACHER headed paper not a legal requirement ```
132
patient, thorn, cellulitis? staph? treatment?
add in IV vancomycin teicoplanin linezolid
133
eye drop+eye ointment gap?
5 minutes, same same
134
CURB65 SCORE INDICATORS?
CONFUSIONt UREA NITROGEN>7mmol/L RAISED RESP. RATE>/= 30breaths/min low bp systolic <90, dyastolic /=65 years 1 point each
135
diabetes uti medication?
flozins, proximal tubule, excretes glucose in urine
136
meds falls?
risepirdone....
137
amiodarone warning label?
Protect your skin from sunlight—even on a bright but cloudy day. Do not use sunbeds
138
GLARGINE HAS TO BE BY BRAND!!!
139
Ciclosporin patient has H pylori?
PPI+AMOXI+ METRO, not clari, interaction
140
stool softener?
docusate
141
EMERGENCY SUPPLY, RX, PRESCRIBER?
72 HOURS
142
COELIAC DISEASE, AVOID?
GLUTEN WHEAT BARLEY RYE
143
REASON FOR CHEMOTHERAPY BREAK?
LET BLOOD CELL LEVELS RECOVER, WE GO AGAIN
144
PATIENT 60+ | AMLODIPINE+RAMIPRIL, what's next step?
INDAPAMIDE!
145
Child fever, cold-like symptoms, white spots?
Measles
146
alufozin+sildenafil?
big hypotension risk! stabilse on alfuzosin first, THEN add sildenafil lowest dose
147
Orange book?
aseptic stuff manufacture and distribution of human medicines good manufacturing practice
148
Green book?
broader distribution of human medicines DSITRIBUTE! good dstributing practice!
149
Memantine maximum daily dose, dementia?
20mg OD
150
GOUT Patient on diuretic+antihypertensive, treatment?
COLCHICINE Avoid NSAID cos hyperkalaemia/renal impairment L
151
resuscitation adult ompression:breath ratio?
30:2
152
babies resuscitate?
5 rescue breaths before starting chest compression :(
153
Fluoxetine+St John's wart interaction?
serotonin syndrome
154
Methylphenidate PR advice?
Do not crush/chew equasym/medikinet- can sprinkle on apple sauce/yoghurt, then swallow 6+, CD2 BTW
155
PATIENT UTI | METHOTREXATE, PEN ALLERGY?
Nitro calm
156
Private prescription, HRT, menopause symptoms, record in POM register?
Prescriptions for oral contraceptives are exempt from record keeping :/
157
EMERGENCY SUPPLY FUN FACTS TREATMENT LENGTHS! CDs 4/5? POM?
If the emergency supply is for a CD (i.e. phenobarbital or Schedule 4 or 5 CD), the maximum quantity that can be supplied is for five days’ treatment. For any other POM, no more than 30 days can be supplied except in the following circumstances: • If the POM is insulin, an ointment, a cream, or an inhaler for asthma (i.e. the packs cannot be broken), the smallest pack available in the pharmacy should be supplied • If the POM is an oral contraceptive, a full treatment cycle should be supplied
158
validity schedule 4 part 1/2? 5?
4 part 1/2? 28 days | 5? 6 months
159
Atorvastain muscle pain, monitor?
creatine kinase >x5 upper limit L :(
160
ATORVASTATIN LFT MONITORING?
BEFORE AT 3 MONTHS AT 12 MONTHS
161
Patient using OTC co-codamol, 3 days, still in pain, next step?
co-codamol POM? but 3 days tramadol? step up? even up morphine? :o
162
Co-codamol 8/500 max OTC pack size?
32 units, but 3 days use only max
163
co-codamol label?
Do not take more than 2 at any one time. Do not take more than 8 in 24 hours Contains paracetamol. Do not take anything else containing paracetamol while taking this medicine. Talk to a doctor at once if you take too much of this medicine, even if you feel well
164
OTC pain arthritis, tried co-codamol, what's next?
Capsaicin, topical? Idk
165
CITALOPRAM/ESCITALOPRAM/DOMPERIDONE/ERYTHROMYCIN/FLUCONAZOLE/QUININE BIG BOY RISK?
QT prolongation SPECIFIC EXAMPLES BTW
166
ETANERCEPT PRESCRIBING?
BRAND PLEASE TY biological drugs!!
167
brand prescribing?
``` CP3 qvar/clenil inhalers potency ciclosporin tacrolimus etanercept glargine ``` NOT fentanyl? hmm
168
WHAT IS THIS?
``` STYE excessively watery swelling eyelish lid/follicle small yellow-pus ```
169
STYE advice?
1month+ self-limiting warm compress 2-4x a day 5-10mins till stye drains avoid makeup, contact lenses
170
DABIGATRAN REVERSAL AGENT?
IDARUCIZUMAB
171
peak expiratory flow?
blow out hard+fast
172
cellulitis minor allergy?
jus give the fluclo
173
numb, cramp?
treat hypocalcaemia
174
Potentially life-threatening hypertensive crisis can develop in those taking MAOIs who eat tyramine-rich food (such as mature cheese, salami, pickled herring, Bovril®, Oxo®, Marmite® or any similar meat or yeast extract or fermented soya bean extract, and some beers, lagers or wines) or foods containing dopa (such as broad bean pods). Avoid tyramine-rich or dopa-rich food or drinks with, or for 2 to 3 weeks after stopping, the MAOI.
175
hba1c 46?
diet advice
176
VET LABEL REQUIREMENTS
Name of the prescribing veterinary surgeon • Name and address of the animal owner • Name and address of the pharmacy • Identification and species of the animal • Date of supply • Expiry date of the product • The name or description of the product or its active ingredients and content quantity • Dosage and administration instructions • If appropriate, special storage instructions • Any necessary warnings for the user (e.g. relating to administration, disposal, target species, etc) • Any applicable withdrawal period (i.e. the time between when an animal receives a medicine and when it can safely be used for food) • The words: ‘For animal treatment only’ • The words: ‘Keep out of reach of children
177
SATIVEX VALIDITY?
28 DAYS
178
SERETIDE?
fluticasone w/ salmeterol
179
kid, | Seretide+ICS, next step up?
increase ICS dose or change to SABA
180
lady on seretide, next step?
increase ICS dose or add LTRA
181
COPD, had, green sputum, prescribe?
AMOXI,DOXY,CLARI
182
DRUGS THAT CAUSE HYPONATRAEMIA?
``` CERTAIN DRUGS DITCH SALT Carbamazepine Diuretics Desmopressin/Vasporessin SSRIs ```
183
DRUGS THAT CAUSE HYPERNATRAEMIA?
``` SALTY CEO Sodium Bicarbonate/Chloride Corticosteroids Effervescent Formulations Oestrogens/Androgens ```
184
what patch is 7 days?
BUPRENORPHINE BUTRANS Manufacturer advises apply patch to dry, non-irritated, non-hairy skin on upper torso, removing after 7 days and siting replacement patch on a different area (avoid same area for at least 3 weeks).
185
STYE FIRST LINE?
HOT COMPRESS
186
chickenpox
no ibu
187
WHAT'S THIS?
IMPETIGO ``` HYDROGEN peroxide fusidic acid mupirocin fluclo clari/ery ```
188
WHAT IS THIS?
molluscum contagiosum
189
s&S molluscum?
all over the body | small/raised/smooth/pink/papules, sometimes black dots
190
how do u manage molluscum?
self-limiting ``` don't share towels don't scratch can go school wear waterproof bandages lesions r contagious :( ``` paracetamol calm!
191
ENZYME INDUCING ANTI EPILEPTICS?
CP3T ``` Carbamazepine. Eslicarbazepine acetate. Oxcarbazepine. Perampanel (at a dose of 12 mg daily or more). Phenobarbital. Phenytoin. Primidone. Rufinamide. Topiramate (at a dose of 200 mg daily or more). ```
192
valproate, non-enzyme inducer, cu iud still?
193
chest pain?
nitroglycerin/GTN
194
SUBCONJUNC, NO PAIN ,ETC?
CALM, REASSURE
195
POSSIBLE SIGNS OF STROKE?
CALL 999
196
Patient | slurred speech, can't raise arm
Call 999 can't give aspirin 300 cos it might be haemorrhagic, bp+statins ;)
197
HYPOGLYCAEMIA- SYMPTOMS?
``` SWEATING LETHARGIC DIZZINESS HUNGER TREMOR TINGLING LIPS PALPITATIONS EXTREME MOODS PALE ```
198
travel sickness, 4 year old?
kwells hyoscine hydrobromide joy ride 3+
199
'CASCADE' IS FOR?
THE VET PRESCRIPTION, NOT THE LABEL
200
'FOR ANIMAL TREATMENT ONLY'
THAT'S FOR THE LABEL BRUH
201
VET PRX MEETS CASCADE YEAH BUT ALWAYS | GO FOR SPECIES LICENSE FIRST
202
CASCADE ORDER?
203
EXPIRY 10/21?
31/10/21!
204
mr ISNTEAD OF IR?
DELAYED PAIN RELEIEF
205
ES NOT ALLOWED?
SCHEDULE 3, TRAMADOL, L
206
TAMSULOSIN OTC?
45 and 75 years Symptoms of BPH present for a minimum of three months A two week supply of tamsulosin can be supplied initially If there has been an improvement in urinary symptoms within the initial two weeks, a further supply of four weeks can be made After six weeks, a further supply can be made only where the patient confirms that the doctor has carried out a clinical assessment and agreed further supplies are appropriate.
207
MTX+FOLIC ACID SEPARATE DAYS?
Give folic acid to reduce side-effects. Folic acid decreases mucosal and gastrointestinal side-effects of methotrexate and may prevent hepatotoxicity; there is no evidence of a reduction in haematological side-effects. Withdraw treatment if ulcerative stomatitis develops—may be first sign of gastro-intestinal toxicity. Treatment with folinic acid (as calcium folinate) may be required in acute toxicity.
208
UPPER UTI?
Oral first line (upper UTI symptoms): | Cefalexin, ciprofloxacin, co-amoxiclav (if culture susceptible), or trimethoprim (if
209
trimethoprim uti dose?
Manufacturer advises dose reduction to half normal dose after 3 days if eGFR 15–30 mL/minute/1.73 m2.
210
TRI UTI DOSE?
Adult | 200 mg twice daily for 3 days (7 days in males).
211
short-term prednisolone side-effect?
increased appetite, mood changes and difficulty sleeping
212
metallic taste abx/dabetic?
metronidazole | metformin
213
methadone and driving?
as long as it's not impaired
214
zolpidem elderly?
risk of falls
215
zolpidem schedule?
4
216
elderly PK?
decreased renal function?
217
LITHIUM+ ANTIPSYHCO SSRI MAOI
ANTIPSYCHOTICS- QT prolongation SSRI/MAOI- serotonin syndrome L MAYBE just clozapine?
218
chemotherapy break?
recover from myelosuppression?
219
trimethoprim duration uti?
females 3, men 7
220
TEETHING MANAGEMENT ORDER?
``` GUM RUBBING RING CUDDLING WIPE AWAY SALIVA PARACETAMOL/IBUPROFEN (3MONTHS+ and/or really?) LIDOCAINE, 5MONTHS+ ```
221
15 year old UPSI? dlow
ULI
222
13 year old lithium, period pain?
Can't do NSAIDS, age, interaction! Give dihydrocodeine w/ parcetamol paramol
223
pharmacy record?
5 years
224
cd register from date of entry?
2 years
225
You need minimum 75 people in each arm. You have 3 arms at a ratio of 1:2:2
226
STATIN MONITORING?
Before starting treatment with statins, at least one full lipid profile (non-fasting) should be measured, including total cholesterol, HDL-cholesterol, non-HDL-cholesterol (calculated as total cholesterol minus HDL-cholesterol), and triglyceride concentrations, thyroid-stimulating hormone, and renal function should also be assessed. Liver function There is little information available on a rational approach to liver-function monitoring; however, NICE suggests that liver enzymes should be measured before treatment, and repeated within 3 months and at 12 months of starting treatment, unless indicated at other times by signs or symptoms suggestive of hepatotoxicity (NICE clinical guideline 181 (July 2014). Lipid Modification—Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease). Those with serum transaminases that are raised, but less than 3 times the upper limit of the reference range, should not be routinely excluded from statin therapy. Those with serum transaminases of more than 3 times the upper limit of the reference range should discontinue statin therapy. Creatine kinase Before initiation of statin treatment, creatine kinase concentration should be measured in patients who have had persistent, generalised, unexplained muscle pain (whether associated or not with previous lipid-regulating drugs); if the concentration is more than 5 times the upper limit of normal, a repeat measurement should be taken after 7 days. If the repeat concentration remains above 5 times the upper limit, statin treatment should not be started; if concentrations are still raised but less than 5 times the upper limit, the statin should be started at a lower dose. Diabetes Patients at high risk of diabetes mellitus should have fasting blood-glucose concentration or HbA1C checked before starting statin treatment, and then repeated after 3 months.
227
H PYLORI MACROLIDES OR AMOXI L?
A proton pump inhibitor, plus bismuth subsalicylate [unlicensed], plus metronidazole, and tetracycline [unlicensed].
228
HYPERTENSION 57 YEAR OLD+BLACK CAN'T TAKE CCB?
ARB!!! SARTANNNNN
229
lansoprazole GR label directions?
Do not take indigestion remedies 2 hours before or after you take this medicine Take 30 to 60 minutes before food Swallow this medicine whole. Do not chew or crush
230
OMEPRAZOLE long-term side-effect?in
may reduce absorption of vitamin B12 with long-term treatment C diff risk btw
231
key aspect of audit?
investigating and comparing to gold standard
232
ciclosporin, cyp induce/inhibit interaction?
doxy calm?
233
rivaroxaban dosing?
15mg BD 21 days, then 20mg OD 2.5mg BD too low 15-49mL/min? 15mg OD
234
RIVAROXABAN DOSE ADJUSTMENTS?
When used for Treatment of deep-vein thrombosis or pulmonary embolism: Following the first 21 days of treatment for deep-vein thrombosis or pulmonary embolism, the usual dose of 20 mg once daily can be given, but consider reducing to 15 mg once daily if creatinine clearance 15–49 mL/minute and the risk of bleeding outweighs the risk of recurrent deep-vein thrombosis or pulmonary embolism. When used for Prophylaxis of recurrent deep-vein thrombosis or pulmonary embolism: When the recommended dose is 20 mg once daily, consider reducing to 15 mg once daily if creatinine clearance 15–49 mL/minute and the risk of bleeding outweighs the risk of recurrent deep-vein thrombosis or pulmonary embolism. When used for Prophylaxis of stroke and systemic embolism in patients with non-valvular atrial fibrillation: Reduce dose to 15 mg once daily if creatinine clearance 15–49 mL/minute.
235
mebendazole advice?
wear underwear, don't scratch, silly
236
DRUG BREAST PAIN/CHANGES
spironolactone
237
Levofloxacin seizures?
lowers threshold
238
statin, 3 months, 12 months?
LFTs
239
tamsulosin+sildenafil?
hypotension risk Tamsulosin causes significant hypotensive effects when given with Sildenafil – patient should be stabilised on first drug then second drug at lowest recommended dose
240
tamsulosin+amlodipine?
hypotension again
241
Adults should eat no more than 6g of salt a day (2.4g sodium) – that's around 1 teaspoon. Children aged: 1 to 3 years should eat no more than 2g salt a day (0.8g sodium) 4 to 6 years should eat no more than 3g salt a day (1.2g sodium)
242
Ulcer 5 weeks?
Refer, cancerous
243
Meropenem+valproate?
Concentration decreased | Valp
244
EEA CDs?
Not buprenorphine
245
methadone, citalopram, QT avoid
246
fluclo, breastfeeding, calm mastitis
247
miconazole, warfarin, inhibitor, conc berzerk
248
recurrent UTIs, trimethoprim, now diabetes, first drug????
249
under 16, UPSI, dlow?
ulipristal 30mg (levo 1.5mg) 5mg is fibroids!!
250
trimethoprim, methotrexate?
anti folate, renal L, nephrotoxicity risk
251
Route in palliative care? End of life adding hyoscine + diamorphine hydrobromide always give it
SYRINGE DRIVER
252
NEUTROPENIC SEPSIS TREATMENT?
beta lactam (fluclo etc) monotherapy with piperacillin with tazobactam X aminoglycoside or glycopeptides
253
Lady was shopping and fell and has profound bradycardia
Bisoprolol, B for bradycardia!
254
stage 1 hypertension, CVD>10%, FIRST LINE?
TREAT WITH GUIDELINE
255
Pharmacist signed in, not present, what can HCA do?
Dispense+Accuracy check
256
ARM, ringworm, OTC?
miconazole, clotrimazole, etc
257
hypercalcaemia, POM vitamin supplement treatment? but if malignancy?
dehydration iv sodium chloride pamidronate sodium but if malignancy? calcitonin, pamid best still
258
high tsh, low t3 t4, is? treatment?
HYPOTHYROIDISM GIVE LEVOTHYROXINE
259
Prescribed medication 50mcg/kg and the drug was 250mg per 5ml. (4) doses of tinzaparin. Patient had surgery and are on amlodipine and have a respiratory rate of 18 and BP was 100/58 and it was 70 beats per minute. What drug modification do you recommend?
Hypotensive, stop the CCB? Hmmm
260
Mania, first-line antipsychotic, no regular testing?
LORAZEPAM? ROQ? Etc
261
pertussis, whooping cough calm
262
citalopram+valproica cid?
hyponatraemia!
263
LITHIUM+ANTIDEPRESSANTS?
SERTRALINE- SEROTONIN SYNDROME CITALOPRAM- QT PROLONGATION
264
MED, MOST LIKELY TO CAUSE FALLS? | INDAPAMIDE/METFORMIN/FERROUS/VALSARTAN/CHOLECALCIFEROL?
Valsartan hyperkalaemia, persistent postural hypotension- falls
265
Where a product states ‘Use by’ or ‘Use before’, this means that the product should be used before the end of the previous month. For example, ‘Use by 06/2022’ means that the product should not be used after 31 May 2022.
266
STATIN+MACROLIDE?
exposure statin, myopathy
267
cough for someone who wants to snooze?
pholcodiene linctus, 12+ generally children 6-12 5 days only ok diphenhydrdamine?
268
sildenafil+tamsulosin?
hypotension
269
INSULIN ONCE DAILY?
isophane or DDG? Hmmm
270
malaria, pregnancy?
Chloroquine and Proguanil can both be used at normal doses in pregnancy as benefit of malaria prophylaxis outweighs any risk BUT recommend FOLIC ACID 5mg to be taken with proguanil
271
short-term contraception, wants to get pregnant later?
pill- 2 weeks calm desogrestel- 2months (smoking)
272
long-acting, doesn't want kids anymore
SURGERY ETONORGESTREL- 5 YEARS IUD PRO DEVICE, MIRENA 5 YEARS^
273
ALWAYS DOUBLE CHECK INPUTTED ANSWER! FUMING :D
274
q19 september 2019 alternative
275
What is it? What you doing?
Chickenpox, paracetamol, calm
276
1st line- NSAID 2nd line- Codeine with/without paracetamol 3rd line- spasm, short course benzo, diazepam
277
QT PROLONGATION DRUGS Long hearts make vets cut animals - lithium /Haloperidol /Macrolides /Venlafaxine /Citalopram /Amiadorone
278
BACK PAIN?
NSAID, lowest dose | codeine with/without paracetamol
279
280
Drug, dry cough, help sleeping?
281
vancomycin, c diff, oral,?
licensed
282
Olanzapine issue, diabetes?
weight gain | hyperglycaemia
283
osteoporosis+prednisolone L
284
BABY NO URINATION refer?
285
baby, paracetamol post-immunisation dose?
up to 6months 60mg right after vaccination 60mg 4-6hrs after first dose 60mg 4-6hrs after second dose
286
vaccine that sets offever?
menb
287
MALARIA MEDS WHILST ON CONTRACEPTION?
NO INTERACTION!
288
med to stop diarrhoea, sick?
SADMAN!
289
burnt hand,HIL
``` run water don't use ice cover burns with cling film, X wet dressings, topical creams elevate, avoid oedema pain relief ``` REFER KIDS UNDER 5!
290
BURNS REFERRAL?
CHILDREN UNDER 10
291
SECRETIONS IN PALLIATIVE CARE?
hyoscine hydrobromide/butylbromide | glycopyrroinum bromide
292
LAXATIVE+CONSTIPATION? Hmmm
293
Subconjunctival haemorrhage?
self-limiting, dw, calm
294
slapped cheek maangement?
paracetamol nsaid etc
295
formoterol, next stepup?
Add LTRA, if not already MART?
296
spacer technique?
``` Breathe in through your mouth, slowly and steadily over 4 to 5 seconds or, breathe in and out through your mouth, slowly and steadily ```
297
UTI, women, penicillin allergy, sensitive to trim and ntiro?
298
EHC, uli, childbearing age
299
TEMAZEPAM?
Temazepam is schedule 3 but subject to safe custody and special Rx requirements – same with Butec
300
fentanyl patch return?
Remove the backing and fold the patch over on itself. Place into a waste disposal bin or a CD denaturing kit. denature, witness good practice, boss doesn't care
301
VET CD?
ANIMAL UNDER MY CARE
302
P<0.05
303
megaloblastic anaemia?
vitamin b12 Megaloblastic anaemia – one cause is pernicious anaemia which is down to vitamin b12 deficiency. Can give oral hydroxocobalamin or if it is due malabsorption IM hydroxocobalamin If folate deficiency – Folic Acid OD for 4 months. Never give alone if undiagnosed = neuropathy of spinal cord
304
folic acid dosing?
5mg, 400mcg certain, sickle?
305
VET label needed?
animal treatment only | out of reach of children
306
ACEI+ccs?
HYPERKALAEMIA :/
307
afro carib?a
ARB>>> candesartan
308
levothyroxine hair loss?
can contribute :/
309
methotrexate adr?
mucositis | myelosuppression
310
patient adr, wrong med, wat do u do?
NRLS report? yellow card? manager? idk
311
insulin before/after meal?
before usually
312
metallic taste?
metformin | metronidazole
313
b2 agonist+prednisolone?
hypokalaemia
314
REVALIDATION SUBMIT?
4 CPDs 1 peer discussion 1 reflective
315
sore throat, can't have amoxicillin?
order phenoxy clary/ery
316
FLOZINS, dry cough?
dry mouth yes, but cough? UPPER respiratory tract infection, really?
317
plans to stop smoking?
preparation
318
stopped smoking, came, what can i take?
action?
319
alcohol units Q
answer 15 units ABV x ml of alcohol/ 1000
320
gaviscon feeds, not in the same line?
321
CD cupboard?
morhpine 13mg/ml mad strength
322
ampoules? cocain?
For liquid containing ampoules, open the ampoule and empty the contents into a CD denaturing kit, or dispose of in the same manner as liquid dose formulations above. Dispose of the ampoule as sharps pharmaceutical waste cocain?e big boys
323
bets evidence?
systematic then meta then etc
324
osteoporosis vitamin needed?
vitamin d- calciferol etc
325
folic acid methotrexate dose?
5mg weekly g
326
'animal use only'?
not needed on prescription
327
"animal under my care"?
not needed on label lol
328
private POM years?
2
329
es REQUEST prescriber?
72 hrs
330
insulin hypoglycaemia risk?
long acting glibenc prosb
331
stimulates insulin secretion?
sulphonylureas | meglitis?
332
once weekly insulin?
GLP-1s, dulaglulatides, etc
333
RI, maintenance, 4 months
334
valproate in pregnancy?
lowest effective dose etc
335
anticoagulant in blister pack?
apixaban/rivaroxaban/edoxaban NOT dabigatran
336
annual flu vac?
immunocompurosemise
337
migraine, contraceptive?
COC calm
338
nasal congestion, CVD, avoid ephed?
give inhalation
339
what is clinical governance?
Clinical Audit, Risk Management, Education + CPD, Evidence based care and effectiveness, patient + carer experience and involvement, staffing arrangement clinical governancea system through which NHS organisations are accountable for continuously improving the quality of their services
340
tramadol advice?
Warning: This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol Dissolve or mix with water before taking
341
shingles treatment?
aciclo, refer, etc
342
treatment of diabetes, pt has renal and heart failure, egfr is 25, can’t take SGLT-2, their BMI is overweight?
linagltiptin FTW
343
cyclophosphamide?
neutropenia
344
oxycodone?
less s-e, better in renal
345
rivaroxaban stroke?
20mg od with food
346
aripiprazole s-e?
``` hyperglycaemia hyperprolactinaemia weight gain qt ED Fatigue ```
347
CD LEGAL REQUIREMENTS?
Patient name and address Drug name Dose (‘as directed’ on its own is not permitted) Formulation Strength (where appropriate) Total quantity/dosage units of the preparation in both words and figures (for liquids, total volume in ml) Prescriber signature and address Date of issue For instalment prescriptions, specify the instalment amount AND instalment interval The words “for dental treatment only” written on it if issued by a dentist
348
dystonia, procyclidine?
It is used to treat symptomatic Parkinsonism and extrapyramidal dysfunction caused by antipsychotic agents. The mechanism of action is unknown. It is thought that Procyclidine acts by blocking central cholinergic receptors, and thus balancing cholinergic and dopaminergic activity in the basal ganglia.
349
56 year old omeprazole, heart burn?
refer, 55+! but constipation 50+ refer
350
parenteral guidance, paediactric drug administration?
medusa? green book?
351
azathioprine?
inhibits purine synthesis
352
girl on COC and had missed one pill what to do ? Missed pill = >24 hours for COC Take one pill ASAP and next dose normal time even if it means taking 2 together. No extra precautions Whereas – if it was POP, missed pill = >3 hours (Desogestrel >12 hours). Take ASAP and use condom for 2 days
353
someone was on levo and baclofen and was suffering hypothyroid symtoms - is it DDI or is it just baclofen causing them Baclofen: drowsy, dizzy, weak, tired, nausea, constipatedVet surgery details, N & A, Qualification – RCVS no. for CD2 or CD3 Animal: Name + Species (inc. address if different from owner) Medication: Name, strength, form, dosage Admin instructions, NOT “as directed” Warnings e.g. withdrawal period If repeat, state no. If human/unlicensed = “FOR ADMINISTRATION UNDER THE VETINARY CASCADE” If CD2/CD3 = “THIS ITEM HAS BEEN PRESCRIBED FOR AN ANIMAL OR HERD UNDER CARE OF VET” Vet signature Date: 6-month expiry and 28 day expiry for CD2,3,4
354
VET RX?
Vet surgery details, N & A, Qualification – RCVS no. for CD2 or CD3 Animal: Name + Species (inc. address if different from owner) Medication: Name, strength, form, dosage Admin instructions, NOT “as directed” Warnings e.g. withdrawal period If repeat, state no. If human/unlicensed = “FOR ADMINISTRATION UNDER THE VETINARY CASCADE” If CD2/CD3 = “THIS ITEM HAS BEEN PRESCRIBED FOR AN ANIMAL OR HERD UNDER CARE OF VET” Vet signature Date: 6-month expiry and 28 day expiry for CD2,3,4
355
vet label
``` Name of prescribing veterinary surgeon Name + Address of owner Medication: Name, Strength, Dosage and administration Any special storage instructions “FOR ANIMAL TREATMENT ONLY” Name and Species of animal Pharmacy Name and Address Expiry and Date of Supply KOROC ```
356
buprenorphine?
cd3 no reg but safe custdoy
357
dose for allopruionol and colchicije and ibuprofen in GOUT
allo 100mg mild 300-600mg moderate severe
358
GOUT DOSING?
Gout: Acute 1st Line: NSAIDs e.g. Diclofenac, Naproxen Ibuprofen: initially 300-400mg TDS-QDS Diclofenac: 75-150mg OD in 2-3 divided doses Alt: Colchicine: max 500mcg BD-QDS max 6mg per course and do not repeat course in 3 days Gout: Prevention 1st Line: Allopurinol: Initially 100mg OD 2nd Line: Feboxust Alt: Sulfinpyrazone (initiation may precipitate an acute attack)
359
CHLORAMPHENICOL DOSING?
Drops: Every 2 hours for the first 48 hours then every 4 hours during waking hours for 5 days Ointment: Apply 3-4 times OD for 5 days Refer if not improving >48 hours C/I: FH of blood dyscrasias, history of myelosuppression
360
VERRUCA?
SALICY
361
MICONAZOLE AGE?
4MONTHs+
362
patients with COPD give oxygen at 88-92 % in acute asthma or COPD because of the risk of sending them into hypercapnic drive (normal patients it's usually 98% o2 I think something quite high) Exacerbations of COPD: Target = 88-92% Acute asthma: Target = 94-98% (if not at risk of hypercapnic respiratory failure)Digoxin Monitor: K+, Mg2+, Ca2+. Toxicity increased by hypokalaemia, hypomagnesaemia and hypercalcaemia, RF, plasma digoxin. Cardiac arrhythmias, weakness, lethargy, dizzy, headache, confusion, nausea, anorexia, diarrhoea, blurred or yellow vision Overdose: more likely 1.5-3 mcg/litre
363
DIGOXIN?
Digoxin Monitor: K+, Mg2+, Ca2+. Toxicity increased by hypokalaemia, hypomagnesaemia and hypercalcaemia, RF, plasma digoxin. Cardiac arrhythmias, weakness, lethargy, dizzy, headache, confusion, nausea, anorexia, diarrhoea, blurred or yellow vision Overdose: more likely 1.5-3 mcg/litre
364
PD, LEVODOPA
“On” state = may feel energetic and able to move more easily “Off” state = very stiff slow Occurs as an end of dose, “weaning” off – worsening of motor function Means shorter length of benefit M/R preps may help of Levodopa or take at specific times of the day to avoid off periods Advanced PD: can use Apomorphine for refractory motor fluctuations “OFF” episodes
365
BACK PAIN?
Offer NSAID if no C/I (otherwise codeine with or without paracetamol)
366
. Patient on b2 agonist, corticosteroids, and is currently on a 9 month relegeous fast. What electyolyte disturbaces do you see. She breaks her fast daily to injest her meds. what electrolyte disturbance are they at risk of ?
367
WHOOPING COUGH MANAGEMENT?
Prescribe clarithromycin for infants less than 1 month of age. Prescribe azithromycin or clarithromycin for children aged 1 month or older, and non-pregnant adults. Prescribe erythromycin for pregnant women. From 36 weeks' gestation, this is recommended to reduce the risk of transmission to the newborn baby. Prior to this, it is likely to be of clinical benefit for the woman only if administered within the first 21 days of the illness, or may be advised if she is likely to come into close contact with a person from a vulnerable group. Prescribe co-trimoxazole if macrolides are contraindicated or not tolerated (off-label indication). However, co-trimoxazole is contraindicated during pregnancy, and is not licensed for use in infants younger than six weeks of age. For full information on dosing regimens, contraindications, and adverse effects of antibiotics, see the section on Prescribing information.
368
SATIVEX?
just records, not safe custody
369
Child 4 years old with cough which was chesty now its dry it's been 10 days?
370
pholcodine linctus age?
16+
371
med increase neutrophils?
filgrastim
372
``` sativex nabilone epidyolex dronabinol ? ```
schedule 4 cd pom schedule 5 cd schedule 2 d
373
GI surgery past 5 days?
metoclopramide contraindicated
374
mentronidazole inhibits, careful, clary ery
375
CO-BENELDOPA WHEN?
EMPTY STOMACH 1 HOUR BEFORE/2 HOURS AFTER COLOURS URINE, HARMLESS
376
n&v in migraines?
bucclizien, buccastem
377
NAUSEA IN RADIOTHERAPY?
DEXAMETHASONE
378
SUBARROCHNOID HAEMORRHAGE TREATMENT?
NIMODIPINE
379
drug to avoid in gout?
bendroflumethiazide
380
caffeine+bp?
L
381
verapamil side-ef?
constipation
382
NSAIDS lowest CVD risk?
naproxen+ibu 1.2
383
pink sputum?
HF
384
osteomyelitis treatment?
fluclo (6 weeks) w/ fusidic acid/rifampicin (2 weeks)
385
septicaemia?
tazobacta+piperacillin
386
isotretinoin+vitamin A, cod liver?
avoid in pregnant!
387
SET INTERACTION?
SILDENAFIL ERYTHROMYCIN TADALAFIL
388
DISULFIRAM, DRINK ALCOHOL?>
FULL BODY RASH!
389
IBANDRONIC ACID OSTEOPOROSIS?
150mg monthly
390
HBA1C TARGETS?
48 IF NO hypoyglycaemia drugs | 53 IF HYPOYGLYCAEMIA DRUGS
391
RECURRENT VAGINAL THRUSH DOSE?
moetronidazole | 150MG every third day for 3 doses+150mg ONCE weekly for 6 months
392
ulipristal BF?
1 WEEK GAP
393
BMI>30?
OBESE
394
ORAL VACCINE?
ROTAVIRUS
395
EXCRETE 1 UNIT OF ALCOHOL?
1HOUR
396
OT?
PATIENT DISABILITY LIFE
397
SPEECH AND LANGUAGE?
SWALLOWING DIFFICULTIES
398
ISOTRETINOIN BLOOD DONATION?
AVOID DURING+1 MONTH AFTER
399
BEST BOOK FOR VACCINE INFO?
GREEN BOOK, KO
400
VAC IN PREGN?
INFLUENXA? OK
401
oral thrush yeah but nystatin is POM REFER
402
Patient, ace, diabetic, HF?
indapamide!
403
over 65, hypertension, ccb, next?
increase dose
404
methotrexate common?
fever hm
405
chadvas 2 female?
start treatmetn
406
impulse drug?
levodopa, non-erogt prami the worst
407
mefanamic acid+naproxen?
both same class!
408
low hb/folate?
``` Give hydroxocobalamin (vitamin B12) at intervals of up to 3 months Frequent IM injections to replenish stores- then maintenance ```
409
HYDROXOCOBALAMIN DOSING?
Initially 1 mg 3 times a week for 2 weeks, then 1 mg every 2–3 months
410
statin lfts monitor?
before 3m 12m
411
COPD fev1<50 | laba+ics, enxt?
lama
412
zopiclone shcedule?
4, no words fiugres
413
CIPROFLOXACIN?
Do not take milk, indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine Space the doses evenly throughout the day. Keep taking this medicine until the course is finished, unless you are told to stop Swallow this medicine whole. Do not chew or crush
414
clari+statin?
jus withold 7 days? contact?
415
hives, urticaria?
chlorphenamine gwarn
416
diabetic patient low egfr HF ?
glipti
417
letrozole+hrt?
avoid
418
denosumab risk?
hypocalcaemia
419
Pow ferritin?
Give ferrous sulphate
420
FOSTAIR LOWER DOSE THAN BECLO?
POTENCY!
421
METHOTREXATE, BREATHING, TOXIC
422
gentamicin bacteria?
MRSA
423
CICLOSPORIN- SIDE-EFFECTS? bit longer start
``` HYPER- glycaemia/uricemia/kalaemia/lipidaemia/tension HYPO- magnesaemia Renal/Liver Impairment Skin Reactions Gingival Hyperplasia Hair changes (hirsutism) Eye inflammation/vision Ls (topical) ```
424
CICLOSPORIN- INTERACTIONS Increases exposure? GPOM Decreases exposure? PG Can mix with?
GRAPEFRUIT+POMELO juice-> increased ciclosporin exposure PURPLE GRAPE JUICE-> decreased ciclosporin exposure BUT... Can mix with orange/apple juice to improve taste
425
TACROLIMUS- SIDE-EFFECTS?
``` HYPER-glycaemia+uricaemia/kalaemia HYPO/HYPERtension RENAL/LIVER IMPAIRMENT SKIN REACTIONS VISUAL DISTURBANCES BLOOD DYSCRASIA CVD (QT prolongation/cardiomyopathy in children) Nervous system disorder/peripheral neuropathy ```
426
TACROLIMUS- INTERACTIONS? GP^2 Patient has hypersensitivity to macrolide?
GRAPEFRUIT/POMEGRANATE/POMELO juice- INCREASES tacrolimus levels Patient has hypersensitivity to macrolide? DO NOT USE
427
drug pre-screen TB?
Etanercept
428
palliative care | bowel colic/secretions?
hyoscine glyc BITYL??
429
4 YEAR OLD NAUSEA?
HYOSCINE JOY RIDE 3+ KWELLS KIDS 4+
430
hives?
iv chlorphenamine!
431
methotrexate likely?
fever
432
Know hypertension guidelines inside out. Pt was on ACE and diabetic, I chose thiazide as had heart failure too
433
Patient over 65 hyper tension on amlodipine 10mg, either add next step, I chose increase to max 20mg dose first??????????????????????????/
434
Where the CD prescription is written by a dentist, the words ‘for dental treatment only’ must be presen
435
RL for vet on label- what is not a LR I put ‘under cascade’ as this is LR under prescription only
436
zopiclone, sch 4, no need words n figures
437
Do not take letrozole with HRT as it may interfere with letrozole effectiveness?
438
HYPOCALCAEMIA- depressed, forgetful muscle cramp confusion
439
isotretinoin suicidal?
gp asap!
440
myelosuppression monitoring?
full blood count
441
Diabetic pt, what is first step. I chose gliptin, as had an eGFR of lower than 30 and had heart failure
442
Breastfeeding | Paroxetine – present but not known to be harmful
443
Advice if immunosuppressed and taking influenza vaccine – IM inactivated version
INJECTION NOT NASAL!!!
444
Carbamazepine – increased risk of major congenital malformations
445
Labetolol doses – same as for HT 100mg BD initially
446
clozapine monitiring?
weekly, 18 weeks, 1 year, monthly
447
osmotic?
lactulose+macrogol
448
carbamazepine vitamin
d
449
neutropenia side-effect
Diarrhea. Vomiting. Burning or pain with urination. Unusual vaginal discharge or irritation
450
neutropenia side-effects
``` Chills, with or without a fever. Body aches. Extreme fatigue. Sore throat. Mouth sores. Runny nose. New or worsening cough ```
451
gums?
gingival
452
colchicine+azithromycin?
Azithromycin is predicted to increase the exposure to Colchicine. Manufacturer advises avoid P-glycoprotein inhibitors or adjust Colchicine dose.
453
Three pictures of prescriptions saying what's wrong: one was epinephrine and phenalizine interaction serious 3. Another was a duplication of same medicine of mst it was wrong dose coz longtec given less frequently than shortec
454
LITHIUM, PERIOD, PAIN/
dihydro+parace
455
renal L?
calcium
456
MEASLES
457
CONTACT DERMATITIS
458
SHINGLES
459
MOLLUSCUM
460
NAPPY RASH?
CLOTRIMAZOLE 1%
461
headlice,med, doesn't smell?
dimeticione 1% lotion?
462
dabigatran MOA?
direct thrombin (factor IIa) inhibitor
463
rivaroxaban stroke?
20mg od
464
butrans?
7 days
465
lithium+depression?
fluox and olanzapine, olanzapine, quetiapine or lamotrigine
466
methotr+trim?
anti folate, myelo
467
lady falls give?
vitamin d
468
neutropenia leads to?
sepsis
469
quetiapine, antibiotic chocie?
doxycycline!
470
rate control af?
beta blocker
471
low ferrtin+hb?
give ferrous sulp
472
fluclo
jaundice
473
mesalazin report or na blodo dyscrasia?
474
zolpidem sch 4 ES?
5 DAYS
475
grey circle inhaler?
handihaler?
476
kid, asthma, add?
ltra probs
477
h pylori amox allergy?
pcm
478
finasteridepc
moodbs
479
fludricort storage?
check spc
480
euresis kid ,water swallow?
hypernatraemia
481
``` Very common greater than 1 in 10 Common 1 in 100 to 1 in 10 Uncommon [formerly 'less commonly' in BNF publications] 1 in 1000 to 1 in 100 Rare 1 in 10 000 to 1 in 1000 Very rare less than 1 in 10 000 ```
``` Very common greater than 1 in 10 Common 1 in 100 to 1 in 10 Uncommon [formerly 'less commonly' in BNF publications] 1 in 1000 to 1 in 100 Rare 1 in 10 000 to 1 in 1000 Very rare less than 1 in 10 000 ```
482
naproxen age?
15-50
483
tranexamic acid age?
18-45
484
clari+statin?
omit statin 7 days?
485
statin, muscle pain, test?
creatinien kinase
486
CHADVASC ORBIT HASBLED
487
HPV VAC?
CERVICAL PREVENT
488
COC+AMOX
CALM
489
Seizure medicine for an 8 week year old oromucosal tabs put under tongue or yogurt - buccual midazolam
490
co-codamol max?
240mg/day, 4-6hrs
491
isotretinoin 7 days
492
ssri valp?
hyponatraemia
493
amiodarone, weight, tired?
thyroid
494
yellow eyes, nausea?
fluclo
495
neutropenia symptoms?
sore throat
496
RINGWORM
497
RASH
498
WHITE SPOTS MOUTH
499
GREY EGG INHALER?
TRELEGY ELIPTA
500
heart failure, drug to stop?
amlodipine
501
BASAL-BOLUS REGIME!
502
apix dvt?
10mg bd 7 days, 5mg bd
503
MHRA REPORTING?
We are particularly interested in receiving Yellow Card reports of suspected ADRs: in children in patients that are over 65 to biological medicines and vaccines associated with delayed drug effects and interactions to complementary remedies such as homeopathic and herbal products
504
505
Permethrin once weekly for 2 doses – apply to whole body including face and wash off after 8-12 hours
506
Morphine patient and one some IV randomcaine – why do you contact the prescriber about the morphine? This is for spine surgery? HELP
507
signed order?
he reason for requesting inhalers was missing
508
Paracetamol kid dose for a 2 month baby
30–60 mg every 8 hours as required, maximum daily dose to be given in divided doses; maximum 60 mg/kg per day.
509
HAP+PEN ALLERGY?Usually give co-amoxiclav for 5 days but pen allergic so doxycycline + metronidazole
Non severe: usually Co-amoxiclav but pen allergic so alt: doxycycline Severe HAP: IV Pip/Taz, cephalosporins, meropenem or levofloxacin
510
BITE+PEN ALELRGY?
Usually give co-amoxiclav for 5 days but pen allergic so doxycycline + metronidazole
511
EPILEPSY AFTER CARE?
Recovery position
512
HIGH TSH, LOW T3T4?
hypothyroidism
513
Woman's arms and legs hurt she's on simvastin what blood test does she need - serum creatinine
514
saba uncuntrolled ,40?
beclo, celnil
515
factor no dvt?
exercise
516
seizure, 8 week?
buccal midazolam
517
drugs, driving, methadone, driving?
it impairs
518
naproxen days max?
3 days, pack of 9
519
lansop?
Take 30 to 60 minutes before food Do not take indigestion remedies 2 hours before or after you take this medicine
520
metro+statin?
calm
521
only chc, oestrogen stopped pre- srugery, not proges
522
emergency supply cd?
refer | out of hours
523
pom register?
POM Register (private rx): Supply date, Rx date Medicine details (name, qty, form, strength) Rx’er details and Pt details
524
confidential?
20 days normally and has to be a written request
525
VET SCRIPT?
et surgery details, qualification (RCVS if CD 2/3) Animal name and species Owner Med details Admin instructions Repeatable rx – write no. If human med/unlicensed: for admin under vet cascade If CD2/3: Item has been rx’d under care of vet etc Vet signature Date: 6 month expiry (inc. repeats) and 28 day expiry for CD2/3/4 Good practice: 28 days’ supply
526
SCHD 2, SAFE STORAGE, THEN DISPOSE?
Sch 2 e.g. diamorphine, methadone, oxycodone, ketamine
527
PHENYTOIN INTERACTION?
``` Sodium Valproate Isoniazid/Itraconazole Cimetidine Ketoconazole Fluconazole, Fluoxetine, Amiodarone, Diltiazem, Verapamil Alcohol Chloramphenicol Erythromycin/Clarithromycin Sulphonamide (sulfadiazine/co-trimoxazole) Ciprofloxacin Omeprazole Metronidazole/Miconazole ```
528
ASPIRIN+NAPRO?
BLEED
529
HEADACHE REFER?
LIGHTS+VOMIT
530
whooping cough) Pertussis, Infranix or Boosterix
531
OPIOID INDUCED?
STIMULANT+OSMOTIC
532
ALREADY TRIED BULK LAXATIVE?
Chronic constipation: bulk-forming, then osmotic and can try stimulant after (or after – prucalopride)
533
ASTHMA
Adult: (SABA as required) Low-dose ICS Trial Regular preventer: Low-dose ICS regular Initial add-on: LABA 🡪 MART therapy Additional: Medium-dose ICS OR LTRA Child (SABA as required) Very low-dose ICS trial e.g. Clenil modulate 50mcg TT BD Regular preventer: Very low-dose ICS or 5 add LABA or LTRA and if <5 LTRA Additional: Increase to low dose, >5 add LABA or LTRA and if no response to LABA, discontinue
534
patient was 4 had nocturnal asthma what inhaler should be prescribed most likely add LTRA
535
patient was on salbutamol but badly controlled what is the next treatment If adult, put on low dose ICS
536
patient was on salbutamol but badly controlled what is the next treatment If adult, put on low dose ICS
537
BECLO
800BD AMXXX
538
Clinical Audit, Risk Management, Education + CPD, Evidence based care and effectiveness, patient + carer experience and involvement, staffing arrangement
539
OWNER-STANDARDS
540
lithium monitor?
weekly till stable 3 months 6 months 3months, 65+, elderly peak etc
541
citalopram?
taste disturbed
542
omeprazole L LONG-TERM?
VITAMIN B12 DOWN
543
hydrocortisone?
apply sparingly TWICE A DAY maximum for 7 days
544
post-herpetic neuralgia
paracetamol mild | amitripyline serious
545
breastfeeding?
Levonorgestrel – wait 8 hours and for Ulipristal wait one week
546
Person is smoking and would like quit sometime in the future but not now, at what stage is this in the change cycle
contemp
547
tests
Rhabdomyolysis CK Agranulocytosis WBC liver dysfunction LFTS
548
IMBALANCES SYMPTOMS K+ , Na+ , Ca2+, Mg2+
549
HYPOKALAEMIA vs HYPERKALAEMIA?
HYPOKALAEMIA- muscle cramps, arrhythmias HYPERKALAEMIA- numbness, nausea, SOB, chest pain both palpitations- heart rate
550
HYPONATRAEMIA vs HYPERNATRAEMIA?
HYPONATRAEMIA- nausea, headache, irritability, seizures | HYPERNATRAEMIA- thirst, fatigue, confusion
551
HYPOCALCAEMIA vs HYPERCALCAEMIA?
HYPOCALCAEMIA- depressed, forgetful HYPERCALCAEMIA- nausea, lethargy, arrhythmias both muscle cramp/confusion
552
mouth ulcer order?
``` hydrocortisone lidocaine benzydamine chlorhexidine doxycycline ? ```
553
subconjuntival?
myna
554
subarrochnoid?
serious
555
phenytoin+doxy?
less doxy
556
paclitaxel class?
taxane
557
myelosupp?
7-10daysafter
558
559
SPC Qs?
There's always a contradiction!
560
DIABETIC KETOACIDOSIS?
soluble insulin such as Actrapid (insulin soluble human) given intravenously
561
HYPO?
For adults with hypoglycaemia, give 15–20 g glucose, repeated after 15 minutes if necessary. 15–20 g is available from 60–80 mL oral glucose liquid, 4–5 glucose tablets, or 1.5–2 tubes of glucose 40% oral gel. If oral glucose formulations are not available, the dose may be given using another fast-acting carbohydrate; 15–20 g is available from approximately 3–4 teaspoonfuls of sugar dissolved in an appropriate volume of water, or 150–200 mL of pure fruit juice.
562
READ THE Q, LEAST APPROPRIATE?!!! CHILD, RINGING BELLS
DOXYCYCLINE!
563
ALL HAVE QT RISK BAR CCB!!!
564
DOXY+WARFARIN?
INR ROCKET
565
Chlorthalidone is a diuretic
SICK DAY
566
Ranolazine is a treatment for angina. Dehydration is an uncommon side effect, however there are no sick day rules for it. It isn’t widely recognised as a medicine to be withheld during dehydrating illness.
DON'T STOP!
567
what drugs cause gord?
alpha-blockers, anticholinergics, benzodiazepines, beta-blockers, bisphosphonates, calcium-channel blockers, corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), nitrates, theophyllines, and tricyclic antidepressants should be reviewed NOT INDAPAMIDE!!!!
567
what drugs cause gord?
Drugs that may cause or exacerbate the symptoms of GORD, such as alpha-blockers, anticholinergics, benzodiazepines, beta-blockers, bisphosphonates, calcium-channel blockers, corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), nitrates, theophyllines, and tricyclic antidepressants should be reviewed
568
Mirtazapine is a presynaptic alpha2-adrenoreceptor antagonist. It is given at bedtime due to its sedating effect. Citalopram, fluoxetine, paroxetine and sertraline are all SSRI drugs. They are not usually associated with sedating effects.
569
Mrs R is taking the DMARD sulfasalazine, which acts as an immunosuppressant. Yellow fever is a live vaccine and should therefore be avoided in all patients taking DMARDS due to the increased risk of possibly life-threatening generalised infections. Specialist advice must always be sought in such situations. - Hepatitis A, DTP, meningitis ACWY and rabies are all inactivated vaccines and are therefore safe for Mrs R
570
PPI LONG-TERM?
B12!
571
FUNGAL SKIN?
apply twice daily continuing for 10 days after lesions have healed
572
A 72-year-old patient who is required to start an intermediate acting insulin regimen which can be administered by her carers.i
INSULATARD INTERMEDIATE!!
573
A 45-year-old patient with type 2 diabetes who wants to change from his current basal-bolus insulin regimen to a biphasic insulin regimen to reduce his number of daily injections.
NovoMix 30 (insulin aspart) twice daily MIX!!!
574
ISOPHANE IS?
INTERMEDIATE ACTING!!
575
Mrs L presents in the pharmacy with yellow skin. You explain this is likely the result of high bilirubin levels in her blood due to one of her medicines.
Patients should be told how to recognise signs of liver disorder and advised to seek prompt medical attention if symptoms such as anorexia, nausea, vomiting, fatigue, abdominal pain, jaundice, dark urine, or pruritus develop. The correct answer is: propylthiouracil
576
LIVER DISORDER, YELLOW SKIN, DIFERENT TO PANCREATITIS, ABDDOMINAL PAIN!
577
PD/ASTHMA exacerbations + ABX Amoxicillin 500mg TDS for 5 days 200mg stat doxy and then 100mg OD for 7 days 200mg BD clarithromycin for 7 days Prednisolone: 40mg OD for asthma for 5 days 30 OD for COPD for 7-14 days If prophylaxis then Azithromycin Three times per week
578
VERAPAMIL CCB IN AF, NOT DILTIAZEM!
VERAPAMIL CCB IN AF, NOT DILTIAZEM!
579
warfarin
Isolated calf-vein DVT = 6 wks Provoked VTE = 3 months Unprovoked DVT or PE = at least 3 months (long-term possibly)
580
analgesia | pains/strains?
Paracetamol or topical NSAID + codeine adjuvant 48hrs post injury PO NSAID PRICE – what to do HARM – what to avoid Seek medical advice 5-7 days or worsening Sx
581
analgesia | Effervescent preparations = high salt content. Avoid espec if HT
582
Routes: INTRATHECALLY = methotrexate, cytarabine and hydrocortisone VINKA alkaloids = INTRAVENOUSLY or orally If IV for adults to be in 50ml mini-bag If IV for paeds can be in 10 or 20ml syringe
583
toujeo high strength 300 units
584
Oral agents plus basal insulin Type 2 only ``` Basal bolus Rapid acting with meals (bolus) Long acting once daily (basal) or Long-acting: or Twice daily mixture Mix of short and intermediate acting ```
585
number needed to treat (NNT) the number of patients that we would need to treat with ‘drug’ to prevent event. 1 / ARR => 1/ 0.02 = 50 i.e. 50 people have to be treated before 1 outcome is achieved. Higher number = less efficacious
586
Systematic Review collection of studies asking same Q & basing conclusions on the cumulated results Meta-analysis is the statistical process of combining the results Only as good as source Retrospective RCT Participants (individuals or groups) randomly allocated to receive either the new intervention or a control treatment (usually the standard treatment or a placebo). Prospective Qualitative study Examines the experiences and beliefs of people from their own perspective e.g. interviews Cohort study Follow-up or longitudinal study, is a type of observational study At the end of the period of observation the incidence of disease or frequency of health outcome in the exposed group is compared to that in the unexposed group. prospective as it looks forward from potential cause to consequence. Case-Control study Observational group of studies Got disease = case. Not = controls retrospective because it looks backwards in time to the earlier exposures of individuals.
587
DEPRESCRIBING
588
589
when to NOT use depot?
quick result needed skin allergy
590
591
592
593
594
595
596
597
598
599
600
VERAPAMIL CCB IN AF, NOT DILTIAZEM!

GPhC BNF (48 decks)

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