JOBE (of note) Flashcards
(46 cards)
An 85-year-old care home patient has been admitted to hospital with increasing confusion and dizziness following a fall. The patient has advanced dementia and had become increasingly agitated in the care home so the GP decided to prescribe a medication to manage this agitation. Which medication is most likely to be associated with the patient’s fall?
Amlodipine
Mirtazapine
Metformin
Lorazepam
Codiene
Lorazepam is a benzodiazepine, which is commonly used for acute agitation, anxiety, or insomnia, especially in older adults. However, in elderly patients, particularly those with advanced dementia, benzodiazepines can cause:
Sedation
Dizziness
Impaired coordination
Confusion
Increased risk of falls
These effects are amplified in older patients due to slower drug metabolism and increased sensitivity to CNS depressants.
C
With regards to veterinary prescribing ‘under the cascade’, which of the following is the preferred treatment choice for an animal where a licensed veterinary product for the species does not exist?
- A veterinary medicine imported from outside Europe via the Special Import Scheme
-A veterinary medicine authorised in the UK for a different indication in the same species
-A veterinary medicine prescribed by the vet responsible for treating the animal and prepared especially on this occasion by a vet, a pharmacist or a person holding an appropriate manufacturer’s authorisation
-A veterinary medicine authorised in the UK for a different indication in the same species
A 32-year-old male has brought his 1-year-old daughter into the pharmacy who appears to be teething. She has become increasingly agitated over the past few days and has been dribbling excessively and chewing on objects around the house. He is looking for a product that will relieve the symptoms. Which product would be most appropriate to sell?
Ashton and Parson’s teething sachets
Paracetamol 120mg/5mL oral suspension
Bonjela baby soothing teething gel Anbesol liquid
Sell no product, the condition is self-limiting
A 55-year-old male patient has been admitted to hospital following an NSTEMI. He has undergone coronary revascularisation and is to be discharged from hospital today. He has a high risk of bleeding as a result of a previous duodenal ulcer. Which of the following blood thinning medications would be most appropriate for him to take alongside aspirin for 12 months?
Clopidogrel
Apixaban
Prasugrel
Warfarin
Ticagrelor
✅ Clopidogrel
Rationale:
Dual antiplatelet therapy (DAPT) — typically aspirin + a P2Y12 inhibitor — is recommended for 12 months after NSTEMI with PCI (percutaneous coronary intervention).
Clopidogrel is the P2Y12 inhibitor of choice in patients at high bleeding risk, because it is:
Less potent than ticagrelor or prasugrel
Associated with a lower bleeding risk
Supported by ESC and NICE guidelines in high bleeding risk patients
You have been asked by your superintendent pharmacist to implement procedures to minimise the risk of look-alike sound-alike (LASA) errors from occurring in your pharmacy following a recent incident surrounding allopurinol and amlodipine. Which of the following would not be appropriate to reduce the risk of these errors?
-Request all staff perform mandatory training on LASA errors and how to minimise their risk
-Separate allopurinol and amlodipine stock in the pharmacy
-Identify and discuss trends of LASA errors from monthly near miss reporting logs.
-Create a list of medications that are often implicated in LASA errors and pin these to dispensary workstations
-Inform all staff in a meeting that a LASA error recently occurred and that all staff need to work harder to minimise the risk
Inform all staff in a meeting that a LASA error recently occurred and that all staff need to work harder to minimise the risk
A 32-year-old male with type 1 diabetes has presented to your pharmacy asking for advice relating to his diabetes. He is currently being treated for a chest infection and understands he needs to enforce temporary changes to his diabetes management.
Which of the following would be inappropriate to recommend?
A. Ensure regular meal consumption
B. Increase fluid intake
C. Increase frequency of ketone monitoring
D. Increase frequency of blood glucose monitoring
E. Increase insulin dosage
E. Increase insulin dosage – this is inappropriate to recommend without clinical supervision. While insulin adjustments may be needed, they should only be made under medical guidance (e.g., by a diabetes team or GP), especially when infection or risk of DKA is involved.
You are running a public health campaign on the COVID-19 vaccination programme. As part of this campaign, you provide information about the at-risk groups who are priorities for vaccination.
Which of the following patient groups would be classified as high risk for vaccination?
A. A 42-year-old woman with multiple sclerosis taking alemtuzumab
B. A 48-year-old woman with schizophrenia taking quetiapine
C. A 32-year-old man with depression taking sertraline
D. A 44-year-old woman with rheumatoid arthritis currently managed by OTC painkillers
E. A 55-year-old man with hypothyroidism taking levothyroxine
Alemtuzumab is a disease-modifying therapy (DMT) that significantly suppresses the immune system, putting the patient at increased risk of severe COVID-19.
Such patients are classified as clinically extremely vulnerable (CEV) and are prioritised for vaccination.
A patient has newly been prescribed domperidone for nausea and vomiting. You decide to contact the prescriber over concerns surrounding the prescribing of domperidone alongside which of his regular medications?
A. Escitalopram
B. Metformin
C. Bisoprolol
D. Montelukast
E. Morphine
Domperidone and escitalopram both prolong the QT interval, increasing the risk of life-threatening arrhythmias like torsades de pointes.
The combination should be avoided or used with extreme caution, especially in high-risk patients (e.g. elderly, electrolyte disturbances, heart disease)
Regarding consent to treatment, which one of the following is true?
A. Consent must be given verbally or in writing
B. If a person does not have the capacity to decide, the healthcare professionals treating them can give treatment if they believe it is in the patient’s best interests
C. A person with parental responsibility is always required to give consent for treatment for a child under 16 years old
D. If an adult patient lacks capacity in relation to one consultation, they must be assumed to lack capacity for all future consultations
E. Consent can be presumed if written consent for the same treatment was given on an occasion in the last 30 days
✅ Correct answer: B. If a person does not have the capacity to decide, the healthcare professionals treating them can give treatment if they believe it is in the patient’s best interests
A 43-year-old woman has asked for your advice relating to cold and flu symptoms. She started to feel run down four days ago and has now developed nasal congestion. What would be the most appropriate treatment option?
She currently takes the following medications:
Allopurinol 100mg OD
Mirtazapine 15mg OD
Simvastatin 40mg OD
Which of the following would be most appropriate for her nasal congestion?
A. Beclomethasone nasal spray
B. Ibuprofen
C. Paracetamol
D. Pseudoephedrine
E. Olbas oil
Pseudoephedrine is an effective systemic decongestant that works quickly by vasoconstricting nasal blood vessels, reducing swelling and congestion.
While caution is advised when using pseudoephedrine with medications like mirtazapine due to a theoretical risk of hypertensive interaction, this is not a contraindication — it can be used short-term and with monitoring.
There are no significant interactions with allopurinol or simvastatin.
Beclomethasone is more suited for allergic rhinitis or long-term use, not acute cold symptoms.
Paracetamol and ibuprofen help systemic symptoms but don’t address congestion.
Olbas oil may help with subjective relief but lacks strong evidence of effectiveness compared to pseudoephedrine.
A 6 year old patient has recently been diagnosed with scarlet fever. What would be the most appropriate first-line treatment?
Doxycycline
Phenoxymethylpenicillin
No treatment - the condition is self-limiting Paracetamol
Clarithromycin
Phenoxymethylpenicllin
A 65-year-old woman is admitted to hospital following a severe neck of femur fracture. Her past medical history includes atrial fibrillation and hypertension. She is prescribed the following regular medications:
Amlodipine 10 mg OD
Atorvastatin 80 mg OM
Edoxaban 60 mg OD
Sotalol 80 mg BD
Her eGFR is 97 mL/min/1.73m² and BP is 132/87 mmHg.
She has her leg immobilised while awaiting surgery.
She is initially prescribed:
Enoxaparin SC 20 mg two hours before surgery and then once daily
Morphine sulphate IV 5 mg PRN and adjust according to response
Paracetamol 1g QDS PRN
You decide to contact the prescriber because:
A. Enoxaparin is contraindicated for this patient
B. Morphine is not suitable for this patient due to their renal function
C. The morphine dose prescribed is too high for an opioid-naive patient
D. Enoxaparin should not be administered before surgery
E. The patient should be prescribed a bisphosphonate and calcium supplementation
✅ Correct answer: A. Enoxaparin is contraindicated for this patient
Explanation:
Enoxaparin is contraindicated here due to:
Recent use of edoxaban (a DOAC)
Risk of major bleeding if both anticoagulants are active around the time of surgery
Bridging anticoagulation (like LMWH) is not recommended for most patients on DOACs like edoxaban, especially with good renal function and low thrombotic risk.
You are working on the gastroenterology ward and have been asked to review the medications of a 70-year-old male patient who has been admitted to hospital with a gastric bleed. On endoscopy, this was identified to be a peptic ulcer.
Which of the following medications is most likely to have contributed to this?
A. Diclofenac
B. Codeine phosphate
C. Alendronic acid
D. Allopurinol
E. Erythromycin
Rationale:
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are strongly associated with the development of peptic ulcers and gastrointestinal bleeding due to:
Inhibition of COX-1, which reduces protective prostaglandins in the gastric mucosa.
Increased gastric acid secretion and mucosal vulnerability
A 56-year-old patient asks for advice on a headache lasting two days, described as a dull ache that worsens when bending over. His temperature is 37.3°C. He takes:
Amlodipine (for hypertension)
Clenil Modulite (beclometasone inhaler for asthma)
Options:
A. Sell ibuprofen
B. Sell paracetamol
C. Provide self-care advice only
D. Sell beclomethasone nasal spray
E. Refer to GP
The dull nature of the headache, normal temperature, and no red flags (e.g. neurological symptoms, fever, sudden onset, trauma, vomiting, visual changes, or immunosuppression) suggest this is likely a mild sinus-related or tension-type headache.
As the temperature is not raised, this is unlikely to be a bacterial sinus infection, which would warrant GP referral.
Paracetamol is the safest first-line option for symptom relief, especially considering the patient’s comorbidities (hypertension and asthma).
A patient has been admitted to hospital following presentation with increased thirst, increased urination, and a fruity smell on their breath. Which of the following would be the most appropriate management?
A. Insulin glargine
B. Soluble insulin
C. Insulin aspart
D. Insulatard
E. Insulin detemir
Explanation: These symptoms suggest diabetic ketoacidosis (DKA). The first-line treatment in hospital for DKA is IV soluble insulin to correct hyperglycaemia and stop ketone production. Long-acting or intermediate insulins are not appropriate for emergency use
A 76-year-old male presents with recent onset confusion and a chest infection that has been ongoing for 3 days, for which he was prescribed doxycycline. His daughter is concerned that the medication has not taken effect. You notice his skin appears mottled on his legs. Basic observations are as follows:
Temperature: 38.8°C
Oxygen saturations: 92%
Heart rate: 110 bpm
Respiratory rate: 26 bpm
Blood pressure: 99/63 mmHg
Options:
A. Continue with doxycycline
B. Switch antibiotic to amoxicillin
C. Bring in sputum sample for culture testing
D. Refer to A&E
E. Refer to G
REFER TO A +E
The patient’s symptoms (fever, confusion, mottled skin, elevated heart rate, low blood pressure, and respiratory rate) are indicative of sepsis, potentially due to the chest infection. The mottled skin and low blood pressure (hypotension) are concerning signs of possible septic shock, which requires urgent medical attention.
Given the severity of these symptoms, the patient should be referred to A&E for urgent assessment and management. This will allow for appropriate intervention, including intravenous antibiotics, fluid resuscitation, and possibly further investigations (e.g., blood cultures, imaging).
A 56-year-old female presents with symptoms of urinary frequency and dysuria which started yesterday. A urine culture showed no evidence of bacterial origin. She has asked to purchase a product to relieve her symptoms. Her current medications are as follows:
Sertraline 50mg once daily
Amlodipine 10mg once daily
Lisinopril 10mg once daily
Warfarin as per yellow book
Options:
A. Potassium citrate mixture
B. Refuse sale and refer to GP
C. Self-care advice
D. Cystopurin sachets (potassium citrate)
E. CanesOasis (sodium citrate with cranberry extract)
Given that the urine culture shows no bacterial growth, the patient’s symptoms suggest non-bacterial cystitis or irritative urinary symptoms, which are often self-limiting and may not require antibiotics or other prescription medications. For such cases, the most appropriate management involves self-care advice.
An 82-year-old male with heart failure has presented to your pharmacy to have a private discussion. He has recently been started on a new medication for heart failure and has noticed his breasts have started to swell and enlarge. Which of his regular medications is most likely to have contributed to this?
A) Bisoprolol
B) Ramipril
C) Spironolactone
D) Furosemide
E) Digoxin
The most likely cause of breast swelling and enlargement in this patient is spironolactone, which is known to have anti-androgenic effects leading to gynecomastia. It would be important to discuss this with the prescribing healthcare provider to assess the need for adjusting the medication.
A 59-year-old patient presents at A&E with shortness of breath. The consultant diagnoses him as having a DVT and decides to start rivaroxaban. Which of the following is the most suitable dose for this indication?
15mg twice daily for 21 days followed by 20mg daily thereafter
10mg daily
20mg twice daily
20mg once daily
10mg daily for 7 days then 20mg daily thereafter
15mg twice daily for 21 days followed by 20mg daily thereafter
A 58-year-old white Caucasian male has been to see you for a routine blood pressure check. His clinic blood pressure reading is 155/92mmHg and ambulatory reading is 142/89mmHg. He has no other medical conditions and takes no medications. He was initiated on calcium channel blockers but could not tolerate these. Which is the most appropriate treatment?
Doxazosin
Indapamide
Furosemide
Captopril
Irbesartan
Indapamide
You are running a public health campaign as your CCG has the highest trends of current smokers in the country. In your campaign, you advertise the use of various therapies to support smoking cessation. Which of the following is not true regarding the available treatment options?
A) NRT gums should be chewed until the taste becomes strong before resting the gum in between gum and cheek
B) Varenicline should be discontinued in the presence of depressive disorders
C) NRT mouth sprays are a widely used adjuvant therapy due to their rapid onset of action
D) Patients should be advised to take caution when driving due to risks of dizziness when taking bupropion
E) Smokers who have an urge for a cigarette as soon as they wake up would be suitable for a 16-hour NRT patch
E is not true. Smokers who have a strong urge to smoke as soon as they wake up are generally better suited for a 24-hour NRT patch rather than a 16-hour patch. The 24-hour patch provides a steady release of nicotine throughout the day and night, which helps reduce cravings upon waking up. The 16-hour patch is typically worn during the daytime and may not cover cravings that occur first thing in the morning
As part of this regime, the patient is given dexamethasone on days 1-4 alongside vincristine and doxorubicin. What is the purpose of dexamethasone?
A) To reduce the risk of extravasation associated with the VAD protocol
B) To reduce the risk of hyperuricaemia associated with the VAD protocol
C) To decrease the risk of hypersensitivity reactions associated with the VAD protocol
D) To reduce the risk of neutropenic sepsis associated with the VAD protocol
E) To provide anti-emetic action caused by the VAD protocol
E) To provide anti-emetic action caused by the VAD protocol
Explanation:
Dexamethasone is often used as part of chemotherapy regimens, including in the VAD protocol (Vincristine, Doxorubicin, and Dexamethasone), to help manage the side effects of chemotherapy, particularly nausea and vomiting. It has potent anti-emetic (anti-nausea and vomiting) properties, which are beneficial in controlling chemotherapy-induced nausea and vomiting (CINV).
An 18-year-old patient has collapsed in your pharmacy after accidentally consuming food containing traces of peanuts. Their breathing rapidly deteriorates, and their lips begin to swell. You administer a 3mL emergency dose of adrenaline 1 in 1000 auto-injector. How many mcg of adrenaline have been administered to the patient?
A) 150mcg
B) 300mcg
C) 500mcg
D) 0.5mcg
E) 0.3mcg
300mcg
In which of the following patients would it be suitable to supply Hana (Desogestrel) to from your pharmacy?
A) A 17-year-old female who has used contraceptives in the past on prescription and is requesting six months’ treatment
B) A 25-year-old female who is currently taking carbamazepine for epilepsy
C) A 19-year-old female with type 1 diabetes mellitus
D) A 28-year-old female who was admitted to hospital with a provoked deep vein thrombosis when she was 22 years old
E) A 33-year-old female who has intermittent vaginal bleeding
????????????
D) A 28-year-old female who was admitted to hospital with a provoked deep vein thrombosis when she was 22 years old
The patient who had a provoked DVT at 22 would typically be considered suitable for the supply of Desogestrel, as long as no other contraindications are present.
This aligns with guidelines that suggest a lower thrombosis risk after a provoked event, particularly when there are no ongoing risk factors. The key consideration is to ensure there is no ongoing elevated risk of clotting, and in this case, a past provoked DVT does not typically present a contraindication to using Desogestrel.
