Greenlight xtra Flashcards
(13 cards)
Which of the following symptoms is not relieved by
taking Gina® (estradiol 10 mcg) tablets?
A. Night sweats
B. Painful Intercourse
C. Vaginal dryness
D. Vaginal itching
E. Vaginal soreness
Gina does not treat vasomotor-related symptoms of
the menopause, therefore night sweats is not
something that can be relieved with this
medication. All the other options are symptoms of
vaginal atrophy, which is the correct licensed
indication of Gina.
A 48-year-old woman asks for some advice regarding her cough, which she has
had for the last 4-months. She is bringing up phlegm and has a wheeze
alongside the cough. She tells you she smokes 15-20 cigarettes a day and
reports unexplained weight loss.
She takes the following medication:
* metformin 500 mg three times a day
* ramipril 10 mg once a day
* aspirin 75 mg once daily
Which of the following is the most appropriate action to take?
A. Contact the prescriber to discuss an alternative to ramipril
B. Refer to her GP urgently
C. Sell her a bottle of glycerol linctus OTC and advise her to return in 5 days if
the cough has not cleared up
D. Signpost her to an NHS stop smoking service
E. Suggest she manages the cough at home with hot water, lemon and honey
Refer
his patient qualifies as a heavy smoker, and she is over 40 years old. With
the continuous cough and unexplained weight loss, this is a red flag and
referral to the doctor would be necessary, so she could receive an urgent
chest X-ray to screen for lung cancer.
Which of the following patients would least require an urgent referral
to a doctor?
A. A 35-year-old man with abdominal pain, rectal bleeding and
constipation
B. A 58-year-old man with a mouth ulcer lasting three weeks that has
not responded to OTC treatment
C. A 49-year-old non-smoker with recurrent chest infections and a
persistent cough
D. A 31-year-old woman with endometriosis complaining of heavy
menstrual bleeds and pelvic pain
E. A 22-year-old woman with a new asymmetrical mole after
returning from a beach
eavy menstrual bleeds and pelvic pain are known symptoms associated with endometriosis. As this
patient has been diagnosed, the worst that this could be is an exacerbation of her symptoms and though
it may require a review of her current therapy, it is still less urgent than the other options.
* A requires urgent referral as these three symptoms (unexplained abdominal pain and change in bowel
habit with rectal bleeding) in adults under the age of 50 are all symptoms suggestive of colorectal
cancer.
* B requires referral as ulceration in the oral cavity (unexplained and lasting for more than 3 weeks) is a
possible sign of oral cancer.
* C requires referral as the patient is over 40 with recurrent chest infections and a cough, which are
possible signs of lung cancer.
* E requires referral as a new asymmetrical mole is a possible sign of skin cancer, especially given that she
has a history of UV exposure.
A patient is attending the chemotherapy day unit for their
first cycle of treatment for breast cancer. The pharmacist
is asked to counsel the patient on what to expect from
the treatment, including any side effects that may
occur.
Which of the following is the least likely side effect of
chemotherapy?
A. Alopecia
B. Increase in blood glucose
C. Nausea and vomiting
D. Oral mucositis
E. Thromboembolism
- Change in blood glucose for patients comes from
use of adjuvant dexamethasone, not from chemo.
All other options are side effects of chemo
Mr H presents at the pharmacy with severe abdominal pain. He
explains that it began in the centre of his stomach but then
spread to the lower right hand side of his abdomen. He explains
that the pain went away for a little while but has now returned.
Mr H appears flushed, finds it hard to stand up straight and is
feeling nauseous.
Which of the following is the most appropriate response for this
patient?
A. Call an ambulance
B. Make a sale of paracetamol 500 mg tablets
C. Make a sale of Windeze (simeticone 125 mg)
D. Refer the patient to his GP
E. Suggest that he takes ginger tea to ease the nausea
TThis patient is presenting with symptoms of
appendicitis and a burst appendix. This situation
requires emergency hospital admission
You are working as a hospital pharmacist and you suspect
that one of your patients is having signs of digoxin
toxicity.
Which of the following medications is most likely to
contribute to digoxin toxicity?
A. Bisoprolol
B. Furosemide
C. Ramipril
D. Sodium valproate
E. Spironolactone
FFurosemide can cause hypokalaemia which is the
most significant electrolyte disturbances as it can
increase the risk of digoxin toxicity.
Hypomagnesaemia and Hypercalcaemia can also
increase the risk of digoxin toxicity.
* Ramipril and spironolactone cause hyperkalaemia
and hyponatremia.
* Sodium valproate commonly causes
hyponatraemia
* Bisoprolol is not known to cause electrolyte
disturbances.
A patient reports feeling hopeless, having no energy, sleeping too
much, and admits thoughts about self-harming. The patient’s family
member has concerns about their recent behaviour. The patient does
not demonstrate any psychotic symptoms. Following an assessment,
they are diagnosed with severe depression and drug treatment is
started while awaiting input from the crisis resolution and home
treatment (CRHT) team.
Which of the following pharmacological options would be most
suitable for this patient?
A. Atomoxetine
B. Venlafaxine
C. Pericyazine
D. Pregabalin
E. Quetiapine
An SSRI or SNRI drug such as venlafaxine is a suitable choice according to
NICE recommendations for treatment of more severe depression. Note that
SSRIs (fluoxetine, sertraline, citalopram, etc) are usually chosen rather than
an SNRI such as venlafaxine as first-line treatment, but NICE guidance does
support the use of SNRIs such as venlafaxine.
As part of a medication review, you are checking the suitability
of aspirin for a patient without a prior history of cardiovascular
disease i.e. for primary prevention.
According to current guidance, in which group of patients
should aspirin be routinely prescribed for the primary
prevention of cardiovascular disease?
A. Aspirin should not be routinely prescribed for primary
prevention of cardiovascular disease
B. Patients with a diagnosis of hypertension
C. Patients with a family history of cardiovascular disease before
age 60 in a first-degree relative
D. Patients with atrial fibrillation
E. Patients with type II diabetes mellitus
NNICE guidance suggests antiplatelet treatment for primary
prevention can be considered in patients with a high risk of
stroke or myocardial infarction, however aspirin is not
licensed for the primary prevention of CVD and there is
limited evidence of benefit even in people with multiple risk
factors, while there is a risk of harm.
* Antiplatelets are NOT used in primary prevention of CVD,
including in those with hypertension or diabetes, because the
benefits are negligible (1666 people have to be treated with
aspirin for 1 year to prevent 1 CV event (NNT 1666/year), and,
for every 3333 people you treat for a year, one will have a
significant bleed (Lancet 2009:373:1849 & 1821).
* Exam framework: CV system, endocrine system
* The correct answer is: Aspirin should not be routinely
prescribed for primary prevention of cardiovascular disease
An elderly woman has come to your pharmacy complaining of
constipation and requesting an over-the-counter laxative. You
ask her if she takes any other medicines, and it transpires she
takes a number of medicine associated with constipation.
Which of the following medicines is least likely to be
contributing to the patient’s constipation?
A. Amlodipine
B. Codeine
C. Darifenacin
D. Metformin
E. Ranitidine
All except metformin are known to cause constipation alone or cumulatively.
A 64-year-old woman has recently been diagnosed with atrial
fibrillation. She has a history of hypertension and
hypercholesterolaemia. Her regular medications include
bisoprolol 5 mg once a day, amlodipine 10 mg once a day, and
atorvastatin 40 mg once a day. All her blood results are within
normal range.
Which of the following medications would be most appropriate
for the prevention of stroke in this patient?
A. Apixaban 5 mg twice a day
B. Aspirin 75 mg once a day
C. Clopidogrel 75 mg once a day
D. Dipyridamole m/r 200 mg twice a day
E. Warfarin (conditional dose according to INR)
Anticoagulation reduces the risk of stroke
associated with AF by 60-70%
* Note that antiplatelet is not effective for Stroke
Prevention in Atrial Fibrillation (SPAF) so options
B-D incorrect.
* The first line treatment for SPAF according to NICE
(NG196) is DOAC rather than warfarin so option E
incorrect.
For the treatment of endocarditis, the patient was commenced on flucloxacillin IV 2g four times a day,
rifampicin 600mg PO twice a day and gentamicin 500mg IV stat.
Which of the following drugs must be changed upon the introduction of antibiotic therapy?
A.Aspirin
B.Atorvastatin
C.Ramipril
D.Rivaroxaban
E.Verapamil (Half Securon SR)
This is a recognised interaction. Rifampicin is a
CYP450 inducer so it is predicted to decrease
the exposure to Rivaroxaban. Manufacturer
advises avoid. Patient should be switched to
warfarin during the duration of antibiotics and
for 4-6 weeks after.
Which of the following drugs is it most important to withhold temporarily in view of his current blood
pressure and heart rate (low in both) ?
A. Aspirin
B. Atorvastatin
C. Ramipril
D. Rivaroxaban
E. Verapamil (Half Securon SR
The patient’s blood pressure is 94/56 mmHg and his
heart rate is 56bpm, so he is both hypotensive and
bradycardic. Verapamil is a rate-limiting CCB so
affects both BP and pulse. Stopping ramipril is also
appropriate (as will help with hypotension) however
the question asks for the most important drug to be
stopped.
Irritable bowel syndrome (IBS) is a chronic, relapsing, and
often debilitating disorder, with several different clinical
features.
Which of the following is the least appropriate medicine
to use in a patient with IBS?
A. Amitriptyline
B. Fybogel
C. Lactulose
D. Loperamide
E. Mebeverine
The BNF advises avoiding lactulose for this reason and using
alternative laxatives such as Fybogel.
* A is incorrect because a low dose of a TCA such as amitriptyline
can be used off-label to treat abdominal pain/spasm second-line, if
mebeverine or peppermint oil does not work. Therefore E is also
incorrect, as this can be used in IBS.
* D is incorrect because loperamide, as an antimotility drug, is used
first line to treat persistent diarrhoea in patients with IBS.
