Greenlight25 I got wrong/hard Flashcards
(20 cards)
A 27-year-old breastfeeding mother has been managing her tonic-clonic seizures with antiepileptic medication for several years. Her neurologist recently adjusted her prescription, and she’s now concerned about the potential impact on her 3-month-old infant. She’s read online that some antiepileptic drugs are metabolized differently in infants.
Which of the following accumulates due to slower metabolism in infants?
Question 58 Answer
A.
Carbamazepine
B.
Ethosuximide
C.
Lamotrigine
D.
Primidone
E.
Zonisamide
Lamotrigine
Infants should also be monitored for adverse effects associated with the antiepileptic drug particularly with newer antiepileptics, if the antiepileptic is readily transferred into breast-milk causing high infant serum-drug concentrations (e.g. ethosuximide, lamotrigine, primidone, and zonisamide), or if slower metabolism in the infant causes drugs to accumulate (e.g. phenobarbital and lamotrigine).
A 33-year-old woman at 13 weeks gestation, presents to her GP with symptoms of dysuria, urinary frequency, and lower abdominal discomfort. A urine dipstick test confirms a urinary tract infection (UTI). She has NKDA.
What is the correct first line option for her?
Question 57 Answer
A.
Amoxicillin 500mg capsules TDS for 7 days
B.
Nitrofurantoin 50mg tablets QDS for 7 days
C.
Nitrofurantoin MR 100mg tablets BD for 3 days
D.
Trimethoprim 100mg tablets TDS for 3 days
E.
Trimethoprim 200mg tablets TDS for 7 days
Patient is pregnant. First line is nitrofurantoin and 7 day course.
A 78-year-old gentleman from Leeds, has recently been diagnosed with mild to moderate Alzheimer’s disease by his consultant. He has been prescribed rivastigmine patches to help manage his cognitive symptoms. During his initial consultation, the consultant explains the importance of regular monitoring while taking rivastigmine.
Which of the following is a monitoring requirement for rivastigmine?
Question 55 Answer
A.
Blood pressure
B.
Full blood count
C.
Liver function tests
D.
Urea and electrolytes
E.
Weight
Decreased weight is a common side effect.
A 68-year-old woman is browsing the shelves of your pharmacy. She notices a vaginal moisturising cream containing estriol. She’s been experiencing vaginal dryness and discomfort for some time, and recalls a friend mentioning estriol. The packaging suggests it can relieve symptoms of vaginal atrophy.There is a different initial and maintenance dose.
What is the maintenance dose for estriol over the counter?
Question 53 Answer
A.
One application daily
B.
One application on alternate days
C.
One application twice daily
D.
One application weekly
E.
One application twice weekly
The initial dose is once at night for two weeks followed by this maintenance dose.
Mr. B, a 59-year-old man, has been prescribed warfarin for the past year and is now presenting with a prescription for an antibiotic to treat a suspected infection. He does not have any allergies.
Which of the following antibiotics is the most appropriate with his warfarin?
Question 49 Answer
A.
Amoxicillin
B.
Cefalexin
C.
Ciprofloxacin
D.
Clarithromycin
E.
Doxycycline
Cefalexin is a first-generation cephalosporin antibiotic that is generally considered safe to prescribe with warfarin. It does not significantly affect warfarin metabolism or its anticoagulant effect. This makes it the safest choice in the context of Mr. B’s current medication regimen.
Amoxicillin potentially alters the anticoagulant effect of Warfarin. Manufacturer advises monitor INR and adjust dose.
Ciprofloxacin and Doxycycline increases the anticoagulant effect of Warfarin. Manufacturer advises monitor INR.
Clarithromycin increases the anticoagulant effect of Warfarin. Manufacturer advises monitor INR and adjust dose.
Before undergoing major surgery, a patient’s drug therapy must be reviewed. Long-term medications may be stopped prior to surgery, although certain medications may be continued if the risk of losing disease control is greater than the risk posed by continuing the medication during surgery.
Which of the following medicines is most suitable to continue on the day of surgery?
Question 43 Answer
A.
Aspirin for stable angina
B.
Co-careldopa for Parkinson’s disease
C.
Ethinylestradiol / levonorgestrel for contraception
D.
Lithium for bipolar disorder
E.
Ramipril for hypertension
Aspirin for stable angina – this presents an increased risk for surgery, and would usually only be continued if there is a high thrombotic risk (e.g. recent ACS, recent stents, or recent stroke).
Co-careldopa for Parkinson’s disease - antiparkinsonian drugs should normally not be stopped before surgery, as per the BNF treatment summary.
Ethinylestradiol / levonorgestrel for contraception – combined hormonal contraceptives should be discontinued at least 4 weeks prior to major surgery. If this is not possible, thromboprophylaxis should be considered due to increased VTE risks due to CHC.
Lithium for bipolar disorder - Lithium should be stopped 24 hours before major surgery
Ramipril for hypertension – ACE inhibitors can be associated with severe hypotension after induction of anaesthesia and should be stopped 24 hours before surgery.
A mother has brought their child to the pharmacy for advice. The child has been struggling with constipation in the last few days. You confirm they are 3 years old. An over-the-counter laxative is sold.
Which of the following preparations is most suitable for this child?
Question 35 Answer
A.
Bisacodyl 5mg gastro-resistant tablets
B.
Glycerol suppositories
C.
Macrogol sachets
D.
Senna 7.5mg/5mL syrup
E.
Sodium picosulfate 5mg/5mL liquid
Offer the following oral laxative regimen, and review all children undergoing disimpaction within 1 week:
Prescribe a macrogol (Movicol® Paediatric Plain or Movicol® depending on the child’s age) first-line, using an escalating dose regimen. Ensure that an effective dose is used, and adjust the dose according to symptoms and response. It is unflavoured, but fruit squash may be added if preferred to improve adherence.
If this fails to lead to disimpaction after 2 weeks, add a stimulant laxative (such as senna).
Note: the use of Movicol® Paediatric Plain to treat faecal impaction in children younger than 5 years of age is off-label. In addition, laxative doses above the licensed maximum dose may be needed. Informed consent should be verbally obtained and documented in these circumstances.
If the macrogol is not tolerated, substitute a stimulant laxative (such as senna) either on its own or, if stools are hard, in combination with lactulose or another stool softener laxative, such as docusate.
The daughter of a patient with terminal cancer has come to the pharmacy to collect a prescription for morphine on his behalf. She explains her father cannot come to the pharmacy himself due to his condition. You confirm the daughter’s identity and hand out the prescription, then make an entry in the controlled drugs register.
Which of the following details is NOT legally required when making the entry in the controlled drugs register?
Question 6 Answer
A.
Date of supply
B.
Name and address of the patient
C.
Name and address of the person collecting the prescription
D.
Quantity supplied
E.
Whether proof of identity was requested of the patient or patient’s representative
Name and address of the person collecting the prescription is only legally required if this is a healthcare professional. In this instance, the patient’s daughter is collecting the prescription therefore there is no requirement to record their name and address. The only requirement is to record whether the patient or a patient representative collected the prescription. The other answers are all legal requirements for CD register entries for schedule 2 controlled drugs such as morphine.
A patient has been admitted to your cardiology ward with endocarditis, and has been prescribed intravenous amoxicillin and gentamicin for the treatment of this. You decide to undertake a teaching session with the nurses to explain the antibiotic gentamicin.
Which of the following is NOT a key point for gentamicin?
Question 67 Answer
A.
Gentamicin should be dosed using actual body weight
B.
Gentamicin should not be given in patients with myasthenia gravis
C.
Peak and trough levels should be taken if a patient is taking >1 dose
D.
There is risk of nephrotoxicity when using gentamicin
E.
There is risk of ototoxicity when using gentamicin
ACTUAL BODY weight
Remember surgery case with Rachael. Myasthenia graves is CI but we do not use actual body weight for dose
A 51-year-old patient attends your pharmacy and requests some ibuprofen. It has been recommended by a friend for pain, and the patient would like to buy some. He has had some pain in his chest (especially on inspiration) for a couple of days. He thinks he may have pulled a muscle at the gym.
The patient has NKDA and takes Edoxaban 60 mg OD for a provoked DVT after a long-haul flight 1 month ago.
What is the most appropriate advice for this patient?
Question 70 Answer
A.
Recommend a different analgesic due to the interaction with edoxaban
B.
Recommend a different analgesic due to the patient’s age
C.
Refer the patient to Accident and Emergency as he may be unwell
D.
Refer the patient to their GP for chest pain
E.
Supply the ibuprofen with safety netting advice for the pain
A+E
Recognising that this is a symptom of a pulmonary embolism and may be more likely after a recent provoked DVT and flight.
(DUNNO HOW YOU PUT GP LAST TIME YOU MUPPET)
A patient who has been prescribed the recommended insulin doses remains acutely confused and is receiving intravenous antibiotics for an infection. On your daily review, you observe a capillary blood glucose level of 15 mmol/L. You request a ketone level, and the result is 4.5 mmol/L.
What is the most appropriate immediate course of action for this patient?
Question 72 Answer
A.
The patient shows signs of diabetic ketoacidosis and requires an urgent medical review
B.
The patient’s insulin doses are too high and should be reduced
C.
The patient’s insulin doses are too low and should be increased
D.
The patient is stable, and treatment should continue as is
E.
The patient requires a review of their antibiotic treatment
cORRECT IN THE MOCK but diab revision
The patient is presenting with key signs of diabetic ketoacidosis (DKA): confusion (a sign of altered mental status), high blood glucose (15 mmol/L), and elevated ketones (4.5 mmol/L). DKA is a serious complication of diabetes that requires urgent medical attention, typically involving correction of fluid and electrolyte imbalances, insulin administration, and close monitoring. Immediate medical review is necessary to manage this condition effectively.
While the patient is receiving antibiotics for an infection, the clinical signs point more to a metabolic issue (DKA) rather than an issue with the antibiotic treatment. The primary concern here is the possibility of DKA, and addressing that is more urgent than reviewing antibiotics
A 65-year-old male patient with a long history of chronic kidney disease (CKD) has now reached end-stage renal failure and is about to begin his first dialysis session. He has been experiencing symptoms such as fatigue, bone pain, and pruritus. Routine blood tests are taken to assess his pre-dialysis status.
As a result of his test results, you are considering prescribing a medication to address a specific abnormality.
Which of the following is most likely to be decreased in this patient, prompting the need for medication intervention?
Question 74 Answer
A.
Parathyroid hormone
B.
Serum calcium
C.
Serum creatinine
D.
Serum phosphate
E.
Serum urate
Patients with end-stage renal disease (ESRD) or chronic kidney disease (CKD) often experience abnormalities in their mineral and bone metabolism due to impaired kidney function. In particular, disturbances in calcium and phosphate balance are common.
In CKD, the kidneys’ ability to convert vitamin D into its active form (calcitriol) is impaired, leading to reduced calcium absorption from the gut. Additionally, phosphate retention can bind to calcium, further lowering serum calcium levels. Calcium supplements or calcium-based phosphate binders are commonly prescribed to address this deficiency.
A 68-year-old male patient has been diagnosed with non-valvular atrial fibrillation (AF). He has no history of stroke or transient ischemic attacks (TIA), and he does not have significant renal or hepatic impairment. His CHA2DS2-VASc score is 3, and his HAS-BLED score is 2, indicating a moderate risk of stroke and a moderate risk of bleeding. The patient expresses a preference for a once-daily medication.
Which of the following medications is most appropriate for stroke prevention in this patient?
Question 90 Answer
A.
Aspirin
B.
Apixaban
C.
Dabigatran
D.
Edoxaban
E.
Warfarin
READ THE QUESTION YOU DOUGHNUT - ONCE DAILY EDOXABAN
A 58-year-old man with heterozygous familial hypercholesterolaemia (FH) has been taking Atorvastatin 80 mg and Ezetimibe 10 mg for the past 6 months. His LDL remains above 3.5 mmol/L, despite good adherence to treatment. What is the most appropriate next step?
Question 101 Answer
A.
Atorvastatin 20 mg once daily
B.
Atorvastatin 80 mg once daily
C.
Bempedoic acid 180 mg once daily
D.
Discontinue treatment
E.
Ezetimibe 10 mg once daily
F.
Inclisiran SC injection
G.
PCSK9 inhibitor (e.g., Alirocumab)
H.
Repeat lipid profile in 3 months
The National Institute for Health and Care Excellence (NICE) technology appraisal guidance recommends inclisiran as an option for treating primary hypercholesterolaemia (heterozygous familial and non-familial) or mixed dyslipidaemia as an adjunct to diet in adults only if [NICE, 2021b]:
There is a history of acute coronary syndrome (such as myocardial infarction or unstable angina needing hospitalization), coronary or other arterial revascularization procedures, coronary heart disease, ischaemic stroke, or peripheral arterial disease, and LDL cholesterol concentrations are persistently 2.6 mmol/L or more, despite maximum tolerated lipid-lowering treatment (that is, maximum tolerated statins with or without other lipid-lowering treatments or other lipid-lowering treatments when statins are not tolerated or are contraindicated).
Inclisiran is recommended only in research for treating primary hypercholesterolaemia (heterozygous familial and non-familial) or mixed dyslipidaemia in adults who have no history of cardiovascular events. This research is in the form of a clinical trial currently in development.
It is a small interfering RNA therapy that inhibits PCSK9 synthesis, leading to increased LDL receptor activity and greater LDL clearance.
Inclisiran is given by subcutaneous injection. The recommended dosage is initially 284 mg for 1 dose, then 284 mg after 3 months for 1 dose, then 284 mg every 6 months.
For each of the statements below, select the single most appropriate age the product is licensed from the list. Each option may be used once, more than once, or not at all.
A 35-year-old male seeks advice for managing nasal congestion associated with a cold. Which age group is pseudoephedrine licensed for over-the-counter sale?
Question 106 Answer
A.
2 years and above
B.
4 years and above
C.
6 years and above
D.
8 years and above
E.
10 years and above
F.
12 years and above
G.
16 years and above
H.
18 years and above
6
A 25-year-old male seeks advice for athlete’s foot and wants an over-the-counter topical antifungal cream. Which age group is terbinafine cream licensed for over-the-counter sale?
Question 109 Answer
A.
2 years and above
B.
4 years and above
C.
6 years and above
D.
8 years and above
E.
10 years and above
F.
12 years and above
G.
16 years and above
H.
18 years and above
16
Terbinafine tablets, cream and gel can be prescribed for adults and children aged 1 year old and over. The cream, gel and spray that you can buy in a pharmacy or shop are suitable for people aged 16 years old and over. The solution is only suitable for adults aged 18 years old and over.
A patient presents with symptoms consistent with a ST-elevation myocardial infarction (STEMI) and is within 10 hours of symptom onset. The local hospital does not have PCI capability, and the patient cannot be transferred to a PCI centre. What is the most appropriate management for reperfusion therapy?
Question 110 Answer
A.
Angiography
B.
Aspirin with clopidogrel
C.
Aspirin with prasugrel
D.
Aspirin with ticagrelor
E.
Clopidogrel
F.
Fibrinolysis
G.
Primary Percutaneous Coronary Intervention (PCI)
H.
Ticagrelor
According to NICE guidelines, fibrinolysis should be offered to patients with STEMI who present within 12 hours of symptom onset and are unable to access PCI within 120 minutes. Fibrinolysis is the preferred treatment when PCI cannot be performed in a timely manner. If the patient presents later than 12 hours, fibrinolysis is generally not recommended unless there is ongoing ischemia.
A 62-year-old patient with STEMI arrives at the emergency department, and the healthcare team is preparing for an imminent PCI. The patient is on edoxaban therapy due to a history of atrial fibrillation. Which of the following should be administered immediately to the patient as part of the early management?
Question 111 Answer
A.
Angiography
B.
Aspirin with clopidogrel
C.
Aspirin with prasugrel
D.
Aspirin with ticagrelor
E.
Clopidogrel
F.
Fibrinolysis
G.
Primary Percutaneous Coronary Intervention (PCI)
H.
Ticagrelor
NICE guidelines recommend that for patients with STEMI who are already on an oral anticoagulant (such as edoxaban), the management involves dual antiplatelet therapy (DAPT) using aspirin and clopidogrel.
Aspirin with prasugrel would be offered if not already taking an anticoagulant. For people aged 75 and over, think about whether risk of bleeding with prasugrel outweighs its effectiveness ; if so offer ticagrelor or clopidogrel as alternatives.
A 49-year-old male patient presents to the emergency department with symptoms consistent with STEMI. After assessment, it is determined that the patient is not eligible for reperfusion therapy. The patient has low bleeding risk. The healthcare team is focusing on medical management to reduce the risk of complications. What is the most appropriate medical management for this patient?
Question 112 Answer
A.
Angiography
B.
Aspirin with clopidogrel
C.
Aspirin with prasugrel
D.
Aspirin with ticagrelor
E.
Clopidogrel
F.
Fibrinolysis
G.
Primary Percutaneous Coronary Intervention (PCI)
H.
Ticagrelor
In patients with STEMI who are not eligible for reperfusion therapy (i.e., they cannot undergo primary PCI or receive fibrinolysis), the goal is to provide effective medical management to prevent thrombus formation and minimize complications. The NICE guidelines recommend dual antiplatelet therapy (DAPT) with aspirin and ticagrelor for these patients. Consider clopidogrel with aspirin, or aspirin alone, for high bleeding risk.
A 50-year-old male patient with type 2 diabetes mellitus has been started on a semaglutide weekly injections to help with weight loss. What is a likely adverse effect of this medication?
Question 119 Answer
A.
Binge eating
B.
Burping
C.
Hyperglycaemia
D.
Mouth ulcers
E.
Oily stools
F.
Pain in both knees
G.
Reduced dental mobility
H.
Sweating
Semaglutide is a GLP-1 receptor agonist used for type 2 diabetes and weight loss. It works by increasing insulin secretion, suppressing glucagon release, and slowing gastric emptying, which leads to reduced appetite and weight loss. However, like other GLP-1 receptor agonists, semaglutide can cause gastrointestinal side effects.
The likely adverse effect in this case is B) Burping, which is a common side effect of GLP-1 receptor agonists. Other gastrointestinal side effects that may occur include nausea, vomiting, diarrhea, and abdominal discomfort. These effects are often dose-related and may improve with continued use or dose adjustments.
