Keel of note Flashcards
(11 cards)
A 24-year-old male comes into the pharmacy with a FP10MDA for three times weekly pick-up of unsupervised methadone. He has recently started a new job and is struggling to attend appointments with the prescriber to obtain his prescriptions.
What is the maximum period of treatment allowed on this prescription type?
7 days
14 days
28 days
30 days
56 days
FP10MDA forms for instalments are limited to a maximum period of treatment of 14 days (PSNC, 2022).
A 61-year-old female has been recommended for treatment to prevent postmenopausal osteoporosis. She eats a healthy balanced diet and has no menopausal symptoms.
Which one of the following would be the most appropriate drug to recommend?
calcitonin
risedronate
teriparatide
tibolone
zoledronic acid
BNF - Oral bisphosphonates, alendronic acid and risedronate sodium are considered as first-line choices for most patients with postmenopausal osteoporosis due to their broad spectrum of anti-fracture efficacy. Alendronic acid and risedronate sodium have been shown to reduce occurrence of vertebral, non-vertebral and hip fractures. Intravenous bisphosphonates (ibandronic acid or zoledronic acid), denosumab, or raloxifene hydrochloride are alternative options in women who are intolerant of oral bisphosphonates or in whom they are contra-indicated.
Hormone replacement therapy (HRT) is an additional option. The use of HRT for osteoporosis is generally restricted to younger postmenopausal women with menopausal symptoms who are at high risk of fractures. This is due to the risk of adverse effects such as cardiovascular disease and cancer in older postmenopausal women and women on long-term HRT therapy.
Teriparatide is reserved for postmenopausal women with severe osteoporosis at very high risk for vertebral fractures. Its duration of treatment is limited to 24 months.
A 68-year-old man is taking the following medicines: · Atorvastatin 20mg once daily ·
Metformin 500mg twice daily · Naproxen 500mg twice daily · Paracetamol 1g four times a day · Valsartan 80mg once daily
He has been admitted to the Emergency Department having vomited fresh blood.
Which of his existing medicines should be stopped?
atorvastatin
metformin
naproxen
paracetamol
Valsartan
NICE states that NSAIDS including COX-2 inhibitors should be stopped during the acute phase in patients presenting with GI bleeding
A patient presents to the Emergency Department with a serum potassium level of 6.4 mmol/l (3.6 – 5.2 mmol/l) and no ECG changes. They take the following medication:
Amlodipine 5mg daily Aspirin 75 mg daily Atorvastatin 40mg daily Indapamide 2.5mg daily Spironolactone 50mg daily
Which of their current drugs would you suggest is reviewed in light of their blood results?
amlodipine
aspirin
atorvastatin
indapamide
spironolactone
Spironolactone can cause hyperkalemia and should be reviewed in this patient
A 26 year old male is suffering with postherpetic neuralgia. He has no other symptoms and he does not describe any warning signs or symptoms. He has tried paracetamol without success. He is not taking any other medication and has no allergies.
Which one of the following medications would be the most suitable first line option for
this patient?
co-codamol
ibuprofen
morphine
pregabalin
tramadol
Neuropathic pain - pregabalin
A 21-year-old woman has recently had a diagnosis of epilepsy. She experiences tonic-clonic seizures. Her neurologist would like to start her on medication to prevent further seizures.
She does NOT have any further medical conditions. She is also NOT taking any medication and has no allergies.
Which one of the following medications would be the most suitable to prevent the
patient experiencing further tonic-clonic seizures?
clobazam
lamotrigine
levetiracetam
sodium valproate
topiramate
As the lady is premenopausal lamotrigine would be first line in this patient
Sodium valproate is the first-line treatment for newly diagnosed generalised tonic-clonic seizures (except in female patients who are premenopausal) Lamotrigine is the alternative choice if sodium valproate is not suitable, but may exacerbate myoclonic seizures. In those with established epilepsy with generalised tonic-clonic seizures only, lamotrigine or sodium valproate may be prescribed as the first-line treatment. Carbamazepine and oxcarbazepine may also be considered in newly diagnosed and established tonic-clonic seizures, but may exacerbate myoclonic and absence seizures. Clobazam, lamotrigine, levetiracetam, sodium valproate or topiramate may be used as adjunctive treatment if monotherapy is ineffective or not tolerated (BNF)
A 62-year-old man is taking warfarin for atrial fibrillation. His target INR is
2.5 (range 2-3). His maintenance dose is 3mg daily. Today, he has attended the anticoagulant clinic and has an INR of 7. He has no signs of bleeding.
Which one of the following is the most appropriate course of action?
reduce dose of warfarin to 1mg daily and recheck INR in 1 week
reduce dose of warfarin to 2mg daily and recheck INR in 1 week
stop warfarin. Give oral phytomenadione, repeat if INR still high after 24 hours. Restart warfarin when INR < 5
stop warfarin. Give phytomenadione by slow intravenous injection. Restart warfarin when INR < 5
withhold 1 or 2 doses of warfarin and reduce subsequent maintenance dose
Withold 1-2 doses of warfarin and reduce subsequent maintenance dose
You receive a phone call from your local GP. He has a 75-year-old female patient with lower-back pain. The patient has a known history of depression and currently takes citalopram 20mg od. He is wondering what would be the most appropriate analgesic for her.
What is the most appropriate treatment to recommend for this patient?
co-codamol 8/500mg 1-2 QDS
co-codamol 30/500mg 1-2 QDS
ibuprofen 400mg TDS
paracetamol 500mg 1-2 QDS
naproxen 250mg TDS
co-codamol 8/500mg
Ref BNF. A weak opioid, either alone or with paracetamol, can be used to manage acute low back pain only if an NSAID is contra-indicated, not tolerated or ineffective (see Opioid analgesics under Analgesics). Paracetamol alone is ineffective for managing low back pain. NSAID is CI as increased risk of hyponatraemia and risk of bleeding with citalopram.
You are the RP and have been made aware of a patient safety incident where carbimazole was supplied to a patient instead of carbamazepine. There has been no harm caused to the patient and they are now in possession of the correct medication.
Which one of the following is the most appropriate action to now take?
complete an audit on dispensing errors
contact your indemnity insurance supplier
physically separate the carbimazole and carbamazepine on the shelf
report the incident through DATIX
share the details of the incident at your next safety huddle
Report the incident through datrix
A 42-year-old female is a new patient who presents at your pharmacy with an initial prescription for glycopyrrolate 0.05% w/v in water 250ml, the directions on the prescription are ‘for use with an iontophoresis machine to treat hyperhidrosis’. You discover that this will need to be ordered from your Specials supplier. You look in the BNF and find a licensed glycopyrrolate bromide powder for solution for iontophoresis.
Which of the following is the most appropriate action to take?
ask the patient to return to the prescriber to get the prescription changed to a licensed product
contact the prescriber to determine whether the licensed product could be used instea
explain to the patient that the product is unlicensed, and the potential risks involved
inform the patient that you do not deal with Specials and ask her to take her prescription elsewhere
order the product from your Specials supplier ensuring you keep full records of the supply
B
