MCQ Flashcards
(142 cards)
1
Q
What is the initial treatment for oral thrush precipitated by corticosteroids?
A
nystatin (100 000 units/mL) 1 mL QDS topically before using fluconazole systemically
2
Q
Counselling for Symbicort (budesonide)
A
Inhale quickly and deeply- deposit drug further down rather than into the mouth
Oral thrush can be prevented by rinsing the mouth after using steroid containing inhalers
3
Q
Which drugs cannot be crushed for use in a NG tube?
A
Modified release tablets
4
Q
Which blood result should be monitored with clozapine?
A
Clozapine can lead to agranulocytosis, neutropenia
and depleted white blood cells. It is imperative that Mr F’s white cell count is in range during therapy
5
Q
What is the interaction between alcohol and clozapine?
A
Increased sedation. Both have sedative effects.
Should avoid alcohol whilst taking anti-depressants.
Can increase risk of falls.
6
Q
What to do if missed 48 hours of taking clozapine?
A
Mental health specialist must be contacted to discuss re-initiation.
7
Q
What is first line for C.diff?
A
Oral metronidazole should be used first line in the first episode of C. difficile infection
8
Q
Which of Mr V’s concurrent medications may have precipitated the C. difficile infection?
A
Cefuroxime 250 mg BD
PPIs can lead to C. diff with chronic use
9
Q
Counselling points for doxycycline?
A
Avoid drinking milk and eating dairy close to doxycycline dose
Do not take indigestion remedies close to doxycycline dose
Do not use sunbeds while taking doxycycline
Take doxycycline with a full glass of water
Avoid lying down for 30 minutes; sit upright
10
Q
Counselling for bumetanide?
A
Take the doses at 8 am and 2 pm.
Loop diuretics can be used twice daily, but to avoid disturbing sleep the second dose should be given no later than 4 pm
11
Q
Which drug may have caused a sore thorat?
A
Mirtazapine- antidepressants can cause agranulocytosis which can cause sore throats
12
Q
Which tablet cannot be crushed?
A
Finasteride- take whole with water
13
Q
What do advise for dry, scaly skin?
A
Simple emollient such as Diprobase
14
Q
Patient has INR of 8 and has bleeding gums, what do you suggest?
A
Take dose of Vit. K, stop warfarin
15
Q
Benzodiazepine and driving?
A
No offence as long as driving not impaired, taken as prescribed and in limit.
Can cause sedation
16
Q
Laxative for opioid induced constipation?
A
lactulose 10 mL BD and senna 7.5–15 mg ON PRN
Lactulose (regularly) and senna
(regularly/PRN) are commonly used in patients experiencing opioid- and
immobility-induced (e.g. hospitalisation) constipation
17
Q
Which medicine cause deficiencies in A, D, E, and K?
A
Orlistat
18
Q
Risk of beta-blocker in diabtes?
A
Hypoglycaemia
19
Q
First choice antihypertensive in african-caribbean with T2DM?
A
Calcium channel blocker + ACEi/ARB
ramipril 2.5 mg OD and amlodipine 5 mg OD
20
Q
Which drug may cause dazzling by bright lights?
A
amiodarone 200 mg OD
21
Q
Which medicine causes stool to be discoloured to a dark colour?
A
ferrous sulfate 200 mg TDS
If caused by a bleed the stools would be described as tarry in consistency (malaena)
22
Q
Which drug not recommended for ileal resection in a 14 year old?
A
Metoclopramide
Monograph for metoclopramide states that it is contraindicated in individuals who have had gastrointestinal surgery within the past 3–4 days. Metoclopramide is also not advised for people under 18 years of age, due to risk of dystonias. This is due to the pharmacology of metoclopramide
23
Q
Advice for baby with flaky scalp not itching?
A
Cradle cap can be treated with olive or coconut oil, or a simple emollient.
24
Q
Advice for baby with flaky scalp not itching?
A
Cradle cap can be treated with olive or
coconut oil, or a simple emollient.
25
Counselling for alderonic acid?
Tablets should be swallowed whole. Doses should be taken with plenty of water while sitting or standing, on an empty stomach at least 30 minutes before breakfast (or another medicine); patient should stand or sit upright for at least 30 minutes after administration
26
Interactions with NSAIDs?
aspirin, dabigatran, lithium and methotrexate
27
Process with medication error?
You can lawfully make a supply of the correct medicine as this was authorised on the original prescription, even in the case of a CD.
In the case of a dispensing error, an apology should not be confused with an admission of liability. Ask to inspect the incorrect medicine but make
it clear that you do not wish to retain the medication and that inspecting the medicine can give valuable clues about what went wrong
28
What are the colours of warfarin?
1 mg brown, 3 mg blue and 5 mg pink
29
How to deal with a small burn?
Always cool the burn first and then dress it. Blisters should never be popped and creams, ointments and fats should not be applied. The burn is not big or serious enough to warrant an ambulance
30
Which is a significant interaction?
Trimethoprim and methotrexate
31
Which ONE of the following corticosteroids is used to treat inflammation and eczema in otitis externa?
Otomize contains dexamethasone with glacial acetic acid and neomycin sulfate
32
Which ONE of the following ear drop preparations stains skin and clothing?
Clioquinol stains skin and clothing
33
Which ear preparation unsuitable for nut allergy?
Cerumol contains arachis (peanut) oil
34
When can exenatide be stopped?
Only if HbA1c is reduced by at least 1% point and a weight loss of at least 3% is achieved within 6 months of starting treatment
35
clobetasone butyrate is unavailable, recommend an alternative steroid cream with a similar potency
alcometasone dipropionate 0.05% (Modrasone)
36
Drug for UTI without antimuscarinic effect?
Mirabegron is a beta-3-adrenoceptor agonist (i.e. not an antimuscarinic drug). It is recommended by NICE as an option only for patients in whom antimuscarinic drugs are ineffective, contraindicated or not tolerated
37
Which drug is contraindicated with miconazole?
Simvastatin- use nystatin for fungal infections- can increase statin dose and cause muscle damage
Warfarin- enhanced anticoagulation effect
38
OTC for eczema flare up?
1% hydrocortisone and 0.05% clobetasone butyrate
HC45 1% cream and Eumovate eczema/dermatitis cream are 1% hydrocortisone and 0.05% clobetasone butryrate, respectively. Hydrocortisone
1% cream is also available generically
39
Hydrocortisone for haemorrhoids?
Haemorrhoidal preparations containing hydrocortisone are available as P medicines
They should be used only in patients over 18 years of age
They should not be used during pregnancy or breastfeeding
They should not be used for more than 7 days
They should not be recommended to new sufferers who have not consulted their doctor
40
what does each ingredient do in different haemorrhoid preparations
Bismuth oxide is an astringent.
Cinchocaine is a local anaesthetic.
Mucopolysaccharide polysulfate is a fibrinolytic agent.
Shark liver oil is a skin protectant.
Yeast cell extract is a wound-healing agent
41
Antacids
Bismuth salicylate can cause blackening of the faeces
Calcium carbonate can cause constipation
Magnesium hydroxide can cause diarrhoea
Potassium bicarbonate can cause hyperkalemia
Sodium bicarbonate is absorbed systemically
42
permethrin 5% (Lyclear)
Used to treat scabies and lice.
| It should be left on for 8–12 hours. If hands are washed during that time, then the cream should be applied again
43
How to take other medication with colestipol?
1 hour before or 4 hours after
44
What is the interaction between aspirin and methotrexate?
Decreased renal excretion of methotrexate
45
Referral for IBS?
Abdominal pain, bloating, constipation and diarrhoea are common in IBS. Vomiting is not
46
Benefits of smoking cessation?
Energy levels begin to increase. Circulation improves, making physical activity easier at 2–12 weeks. Coughing, shortness of breath and wheeziness improve at 3–9 months. Risk of lung cancer is half that of a smoker at 10 years. Risk of myocardial infarction falls to the same as someone who has never smoked at 15 years.
47
Unsuitable in pregnancy for hypertension?
Propranolol
Methyldopa is considered safe for use in
pregnancy. Modified-release preparations of nifedipine [unlicensed] are
also used, but it may inhibit labour; manufacturer advises avoid before
week 20; risk to foetus should be balanced against risk of uncontrolled
maternal hypertension; use only if other treatment options are not
indicated or have failed. Beta-blockers may cause intra-uterine growth
restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater
in severe hypertension. Labetalol is widely used for treating hypertension
in pregnancy. The use of labetalol in maternal hypertension is not known
to be harmful, except possibly in the first trimester
48
OTC Sale when RP not present
Esomeprazole is GSL whereas the
rest are P medicines. GSL medicines can only be sold when the pharmacist
is signed in, however they may be physically absent for a limited period
while remaining responsible, thus permitting sales of GSL medicines. See
relevant SPCs. These are the best places to look for OTC licensing queries
49
OTC sale
Naproxen is available OTC as Feminax Ultra and licensed for
ages 15–50. Amorolfine is licensed from 18 years, hydrocortisone 1%
cream is licensed from 10 years, orlistat is licensed from 18 years and
ulipristal acetate is suitable for women of childbearing age
50
Which require referral?
Daktarin Sugar Free Oral Gel is licensed from
3 months. Piriton syrup is licensed from 12 months. Germoloids HC spray is licensed from 16 years. Beconase Hayfever Relief nasal spray is
licensed from 18 years. Regaine for Men Extra Strength is licensed only up until 65 years
51
What is Nexium Control?
Nexium Control is esomeprazole. The OTC
dose is 20 mg once daily. It is licensed for the short-term treatment of
reflux symptoms in adults
52
Miss Taylor brings in her 9-month-old child who has tiny vesicles that
are filled with fluid. They are surrounded by red areas on the trunk and
are all over. The rash developed 3 days ago and appears to be getting
worse. The child was restless for a few days before the rash appeared.
The child is on no other medication and is healthy.
Which ONE is the most appropriate course of action?
The symptoms describe chickenpox. There are no reasons to refer in
this scenario. The rash appears to be getting worse in the eyes of the
parent but this is just the progression of symptoms of chickenpox. An
appropriate OTC product should be recommended to help with the
symptoms, e.g. calamine lotion and/or chlorphenamine solution. You
could refer to the GP but that would not be the most appropriate option
as it can be dealt with in the pharmacy.
53
Antiemetic for motion sickness?
Antiemetics should be given to prevent motion sickness rather
than after nausea or vomiting develop. The most effective drug for the
prevention of motion sickness is hyoscine hydrobromide
54
Referral for otitis externa?
Profuse mucopurulent discharge
Symptoms lasting for 4 or more days without improvement
Pain on palpitation of the mastoid area
Fever lasting 24 hours
55
Diagnose: red patches on his knees and elbows. lesions appear salmon pink with silvery white scales.
When the scales on the surface of the plaque are gently removed and the lesion is rubbed, it reveals pinpoint bleeding from the superficial dilated capillaries
Symptoms are consistent with plaque psoriasis, which is the most common form. Only plaque and scalp psoriasis can be treated in a community pharmacy
56
Advice for diarrhoea?
A Avoid food intake for at least 6 hours
B Take small frequent sips of water then slowly increase fluid intake
C Use glucose solutions such as soda to settle the stomach and decrease the number of stools
D It is a self-limiting condition and therefore no treatment is necessary
E If symptoms are severe or persistent, doxycycline may be prescribed for a 7-day course
Highly osmotic solutions of glucose, such as soda, may result in more water being absorbed into the
intestinal tract and exacerbating
diarrhoea. In many cases, diarrhoea will resolve within 48 hours without treatment; however, in severe cases of infectious diarrhoea it may be
treated with antibiotics
57
Which ONE of the following is least likely to increase myocardial oxygen demand?
Due to the beta-adrenergic-blocking effects of metoprolol (e.g. decreased heart rate, decreased blood pressure, decreased inotropic effect), there is a net decrease in myocardial oxygen demand. The opposite effect is seen in isoprenaline, which is a beta agonist. Cold temperatures increase the myocardial oxygen demand by increasing sympathetic stimulation, systolic blood pressure and cardiac diastolic pressure, and volume
58
Onset of constipation medicines?
Bisacodyl acts within 10–12 hours,
docusate sodium acts within 24–48 hours and lactulose may take up to 48 hours. Ispaghula husk ‘full effect may take days to develop’.
Note: senna acts within 8–12 hours
59
Osteonecrosis of the jaw
Bisphosphonates or antiresorptive monoclonal antibodies (eg, denosumab and romosozumab), inhibit osteoclasts. At doses for cancer treatment rather than osteoporosis. Dental check up before commencing treatment.
Antiangiogenic drugs such as anti-endothelial vascular growth factor monoclonal antibodies or tyrosine kinase inhibitors.
Patients with cancer receiving bevacizumab or sunitinib may also be at risk of osteonecrosis of the jaw.
60
Sumatriptan contraindications?
Sumatriptan should not be administered to patients with severe hepatic impairment. Liver disease does not indicate severe impairment. Sumatriptan is contraindicated in patients who have ischaemic heart disease or have had a myocardial infarction,
coronary vasospasm (Prinzmetal’s angina), peripheral vascular disease, or symptoms or signs consistent with ischaemic heart disease. It should
also not be administered to patients with a history of cerebrovascular accident (CVA) or transient ischaemic attack (TIA), or to patients with
moderate and severe hypertension and mild uncontrolled hypertension.
Sumatriptan causes vasoconstriction; this effect when present in coronary vessels may cause chest tightness as a normal side-effect. However, in patients with ischaemic heart disease, angina or a risk of coronary artery disease, this could precipitate attacks of angina or potentially cause myocardial infarction, and thus should not be used in these patients
61
Which medicine causes staining of the teeth?
Intrinsic staining of teeth is most commonly caused by tetracyclines. Effects on teeth may be seen if given at any time from about the fourth month in utero until the age of 12 years. All tetracyclines may
cause permanent unsightly staining in children, varying from yellow to grey. Chlorhexidine may stain teeth brown but can easily be removed by polishing. Iron salts in liquid form can stain the enamel black. Superficial staining has been reported rarely with co-amoxiclav suspension. Excessive ingestion of fluoride leads to dental fluorosis with mottling (white
patches) of the enamel and areas of hypoplasia or pitting
62
Drugs causing oral ulceration
The oral mucosa is particularly vulnerable to
ulceration in patients treated with cytotoxic drugs, e.g. methotrexate. Other drugs that are capable of causing oral ulceration include ACE inhibitors, gold, nicorandil, NSAIDs, pancreatin, pencillamine, proguanil and protease inhibitors. Aspirin tablets allowed to dissolve in the sulcus for the treatment of toothache can lead to a white patch followed by ulceration. Propranolol is a beta blocker that has not been shown to cause aphthous ulcers.
63
Drugs causing SJS?
Erythema multiforme or Stevens-Johnson syndrome may follow the use of a wide range of drugs including antibacterials, antiretrovirals, sulfonamide derivatives, and anticonvulsants; the oral mucosa may be extensively ulcerated, with characteristic target lesions on the skin. Oral lesions of toxic epidermal necrolysis have been reported with a similar range of drugs.
64
Other oral side effects?
Lichenoid eruptions are associated with ACE inhibitors, NSAIDs, methyldopa, chloroquine,oral antidiabetics, thiazide diuretics,and gold.
Candidiasis can complicate treatment with antibacterials and immunosuppressants and is an occasional side-effect of corticosteroid inhalers.
65
Drug with side effects of: weight
| loss, tachycardia and waking throughout the night due to stress.
Levothyroxine has a narrow therapeutic index. Small dosing errors can induce hyperthyroid side effects like tremor, tachycardia, weight loss, insomnia and anxiety
66
Which vitamin contraindicated with warfarin
Vit K
Oral anticoagulants act by inhibiting the liver biosynthesis of prothrombin, which is the precursor of the enzyme thrombin that catalyses the
conversion of soluble fibrinogen to the insoluble polymer fibrin, resulting
in clot formation. One of the principal factors in the biosynthesis of
prothrombin is vitamin K, with which warfarin competes to inhibit this
process. Vitamin K thus acts as an antagonist to the oral anticoagulants
through reversible competition
67
Methotrexate counselling
Regular blood tests MUST be performed every 1–2 weeks due to risk of neutropenia.
Severe interaction with trimethoprim- increased risk of agranulocytosis
Take once per week
Take folic acid on an alternative day
Increased risk of infection
68
Intrathecal chemotherapy?
Vinblastine, vincristine, vindesine, vinflunine and
vinorelbine injections are for intravenous administration only. Inadvertent intrathecal administration can cause severe neurotoxicity, which is usually fatal
69
Cough treatment for 2 year old?
Demulcent cough preparations contain soothing substances, such as syrup or glycerol, and some patients believe that such preparations relieve a dry irritating cough. Preparations such as simple linctus have the advantage of being harmless and inexpensive; paediatric simple linctus is particularly useful in children. Compound preparations are on sale to the public for the treatment of coughs and colds but should not be used in children under 6 years; the rationale for some is dubious. Care
should be taken to give the correct dose and not to use more than one preparation at a time
70
HPV
HPV can be passed even when an infected person has no signs or symptoms
HPV can cause cervical and vulvovaginal cancers
HPV can cause genital warts
HPV is so common that nearly all sexually active men and women get it at some point in their lives
The strain HPV that can cause genital warts are not the same as the types of HPV that can cause cancers
71
treatment of insect bites and stings in 6 year old
Hydrocortisone can be used only in adults and children over 10 years of age. Chlorphenamine (>1 year), crotamiton (>3 years), lidocaine (>4 years), ammonia 3.5% w/w (>2 years).
72
Which ONE of the following symptoms is NOT a sign of chlamydia infection?
A vulvovaginal sores- herpes not chlamydia
B pain in the lower abdomen
C vaginal bleeding during sexual intercourse
D dysuria
E penile discharge
73
In which of the following cases may tamsulosin (Flomax) be supplied OTC?
E Patients with enlarged prostate gland
Tamsulosin is used for benign prostatic hyperplasia (BPH) in which the
prostate gland is enlarged and responsible for urinary symptoms. Uncontrolled or undiagnosed diabetes can cause damage to the autonomic
nervous system which, among other things, controls bladder function.
This damage can lead to urinary frequency (which is also a symptom
of BPH), but other symptoms that may be present with uncontrolled
or undiagnosed diabetes include excessive thirst and tiredness. Tamsulosin should not be given to men who experience postural hypotension
because, as with other alpha-1 blockers, a reduction in blood pressure
can occur in some people during treatment with tamsulosin
74
Which ONE of the following statements regarding treatment with tranexamic acid is NOT true?
Tranexamic acid is indicated for the reduction of heavy menstrual bleeding over several cycles in women with regular 21- to 35-day cycles with no more than 3 days’ individual variability in cycle duration for
women of 18 years and above. Patient criteria for OTC sale differ from use with prescription. Note that tranexamic acid when prescribed may be used with caution in patients with irregular menstrual bleeding according to the BNF. However, patients with more than 3 days of menstrual cycle
variability are not eligible for OTC sale of tranexamic acid
75
sunscreen agents and active ingredients
| to prevent a drug-induced photosensitivity reaction
padimate O and avobenzone
padimate O and oxybenzone
titanium dioxide
zinc oxide
76
Sitagliptin
It is an inhibitor of dipeptidyl peptidase enzyme (DPP-4) which enhances the incretin hormone. It can cause hypoglycaemia with sulfonylureas It is not appropriate for use in type 1 diabetes. It can be taken with or without food It should be continued only if HbA1c concentration is reduced by at least 0.5 percentage points within 6 months of starting treatment
77
Which of the following would you recommend within the first 48 hours following a sports injury?
compression
elevation
ice
rest
78
Scabies
The itching that is worse at night (when your skin is warmer) is characteristic of scabies. It is not chickenpox as the face and head are not affected. This is again characteristic of scabies. Men usually have one or more very itchy, lumpy, 3 to 10 mm spots on the skin of the genitals.
79
Which antiepileptic not suitable for allergy to TCAs?
Carbamazepine is structurally similar to TCAs therefore should not be given to patients with a TCA hypersensitivity
80
Tamoxifen
Tamoxifen may increase
the risk of endometrial cancer.
It increases the efficacy of warfarin and therefore increases susceptibility to high INR readings.
Timing of tamoxifen will not reduce the hot flush which is a common side-effect.
Tamoxifen increases the risk of VTE and a swollen leg could suggest a DVT, which requires urgent medical attention in a hospital
81
Benzoyl peroxide and acne advice
Do not squeeze acne lesions
Exposure to sunlight may cause painful damage
Apply gel once or twice daily to the whole face, not just to the active lesions
Use water-based non-comedogenic cosmetics
Benzoyl peroxide has a potent bleaching effect
82
Rhinitis in pregnancy
The patient has allergic rhinitis, which is differentiated from the common cold by the nasal itching. Pseudoephedrine and Breathe Right Nasal Strips are indicated for nasal congestion, which she does not have. Both chlorphenamine and intranasal sodium cromoglicate are recommended for relief of sneezing and rhinorrhoea in pregnancy. However, with sodium cromoglicate it will take 1–2 weeks for symptoms to improve whilst chlorphenamine will provide relief within hours. Therefore, chlorphenamine
is the best choice for this patient. Most manufacturers of antihistamines
advise avoiding their use during pregnancy; however, there is no evidence of teratogenicity except for hydroxyzine for which toxicity has been reported with high doses in animal studies. The use of sedating antihistamines in the latter part of the third trimester may cause adverse effects
in neonates, such as irritability, paradoxical excitability and tremor.
83
Olanzapine and glucose monitoring
Patients taking olanzapine should have fasting blood glucose tested
at baseline, after one months treatment, then every 4–6 months
(= 18 weeks). Diabetics require more frequent monitoring
84
high-pitch tone, clenching fists, drawing up legs.
| crying excessively frequently
Simeticone- colic
85
Yellow brown urine
Nitrofurantoin- ‘urine may be coloured yellow or brown’
86
Clindamycin diarrhoea
Patients should discontinue immediately and contact doctor if diarrhoea develops because clindamycin has been associated
with antibiotic-associated colitis (see BNF, section 1.5), which may be fatal. It is most common in middle-aged and elderly women, especially following an operation. Although antibiotic-associated colitis can occur
with most antibacterials, it occurs more frequently with clindamycin
87
Contraindication in acute stroke
Prophylactic enoxaparin is contraindicated following an acute stroke
88
Advice regarding Janumet
As Janumet contains metformin hydrochloride, the treatment should be discontinued 48 hours before elective surgery with general, spinal or epidural anaesthesia. Treatment should not usually be resumed
earlier than 48 hours afterwards and only after renal function has been re-evaluated and found to be normal
88
Advice regarding Janumet
As Janumet contains metformin hydrochloride, the treatment should be discontinued 48 hours before elective surgery with general, spinal or epidural anaesthesia. Treatment should not usually be resumed
earlier than 48 hours afterwards and only after renal function has been re-evaluated and found to be normal
89
Why should Janumet be discontinued before the administration of iodinated contrast agents via the intravascular route?
The intravascular administration of iodinated contrast agents in radiological studies can lead to
renal failure, which has been associated with lactic acidosis in patients receiving metformin. Therefore, treatment should be discontinued prior to, or at the time of, the test and not reinstituted until 48 hours afterwards, and only after renal function has been re-evaluated and found to be normal
90
Metformin contraindication
alcoholism
breastfeeding
dehydration
hepatic impairment
Not contraindicated in mild renal impairment,
only in moderate and severe renal impairment (creatinine clearance
<60 mL/minute)
91
Tolbutamide
St John’s wort increases the effects of tolbutamide,
which may lead to increased hypoglycaemic events, whereas extracts of ginkgo biloba may decrease absorption of tolbutamide and thereby
decrease its efficacy and hypoglycaemic effect
91
Tolbutamide
St John’s wort increases the effects of tolbutamide,
which may lead to increased hypoglycaemic events, whereas extracts of ginkgo biloba may decrease absorption of tolbutamide and thereby
decrease its efficacy and hypoglycaemic effect
92
Which of the following is appropriate advice to include in your consultation with Mr W regarding tolbutamide?
A: A possible side-effect is blurry vision – if this occurs, do not
drive or operate machinery
B Tolbutamide should not be used as a substitute for diet and exercise
C Consumption of alcohol may lead to hypoglycaemia
D See GP if persistent fever or sore throat develops
E If you have difficulty swallowing you may crush the tablets
Alcohol may increase hypoglycaemic effects
and may also cause a disulfiram-like reaction. See also section 4.8,
Undesirable effects. Paraesthesiae and headaches have been reported.
Patients may become intolerant to alcohol and should limit intake
93
Diagnose: crusty yellow rash around his mouth and chin, which has spread to his trunk. The rash is causing discomfort and pruritus.
Impetigo
Treatment: macrolide antibiotic- clarithromycin
94
Which ONE of the following statements is true regarding the condition Master W has presented with?
It can be caused by a staphylococcal infection
It can be caused by a streptococcal infection
Topical treatment should be used for up to 10 days
Systemic treatment should be for at least 7 days
95
RP duties
If you leave the store you must remain contactable with the pharmacy staff or arrange for another pharmacist to be available
96
Cystic fibrosis
```
Abidec multivitamin drops – 1.2 mL OM
Azithromycin 250 mg M/W/F each week
Creon 10 000 unit capsules – up to 32 per day
Dornase alfa 2.5 mg nebules – 2.5 mg OD
Salbutamol 100 mcg inhaler – 2 puffs BD
Fluticasone 50 mcg inhaler – 2 puffs BD
Vitamin A + D tablets – 1 OM
Vitamin E 100 mg/mL suspension – 50 units OM
```
97
Amphotericin
Liposomal amphotericin is compatible only in glucose 5%
| A cumulative dose in the range 1–3 g may be needed for treatment
98
During the infusion, Mrs Y complains of mild muscle and back pain.
Which ONE of the following is the most appropriate method of action?
Continue infusion at slower rate
99
Interaction between statin and clarithromycin?
The most pressing interaction is that of an increased plasma concentration
of atorvastatin when used concomitantly with clarithromycin, leading
to potential myopathy The mechanism is potentially three fold, via
(i) a CYP450 isoenzyme pathway, via (ii) P-glycoprotein (MDR1) efflux
transporter, and (iii) via OATP1B1 inhibition.
99
Interaction between statin and clarithromycin?
The most pressing interaction is that of an increased plasma concentration
of atorvastatin when used concomitantly with clarithromycin, leading
to potential myopathy The mechanism is potentially three fold, via
(i) a CYP450 isoenzyme pathway, via (ii) P-glycoprotein (MDR1) efflux
transporter, and (iii) via OATP1B1 inhibition.
100
Tests before starting alreronic acid?
Bone and mineral electrolytes need to be
| checked (e.g. calcium, vitamin D and phosphate
101
Physical check before alderonic acid?
Dental examination needed due to risk of
| osteonecrosis of the jaw
102
Alderonic acid counselling
You'll usually take it as a tablet or liquid, once a week.
Take alendronic acid first thing in the morning, before you have anything to eat or drink and before you take any other medicines.
Stay sitting or standing for 30 minutes so the medicine does not irritate your food pipe (oesophagus).
It's important to look after your teeth and have regular dental check-ups while taking alendronic acid because it can sometimes damage the jaw bone, but this is rare.
103
Codeine counselling
To start at a low dose and increase as per GP advice only if your pain is uncontrolled
To take the medication when required for pain relief and use for the shortest time
To continue taking the medication as needed and increase fluid intake if constipation occurs
To continue taking the medication as needed even if it causes drowsiness as this is common
Stop taking the medication if experiencing breathing difficulties
104
DVT
A positive D-dimer result indicates that the body contains a high level of cross-linked fibrin by-products
A positive D-dimer result suggests that Mr W may have developed deep vein thrombosis
A positive D-dimer result will necessitate the use of a low-molecular-weight heparin product
Depending on the clinical and drug history, unexplained calf pain may be indicative of deep vein thrombosis
An impairment of liver function with respect to prothrombin may be indicative of a problem in the coagulation cascade
105
What are the following tests used for?
Thyroid-Hormone Stimulating (TSH) Test- A high TSH suggests your thyroid is underactive (hypothyroid) and not doing its job of producing enough thyroid hormone. A low TSH suggests your thyroid is overactive (hyperthyroid) and producing excess thyroid hormone
Overnight Dexamethasone Suppression Test- sed to find out if there is an excess amount of cortisol in your body. Diagnose Cushings syndrome.
Alanine aminotransferase (ALT) test- diagnose liver damage
C-Reactive Protein Test- inflammatory marker- infection
D-Dimer Test- checks for blood clots
106
Warfarin and antibiotic
INR 3.5
Mr TS is at risk of bleeding as his INR is higher than normal
Mr TS’s blood is not clotting as quickly as it should be
Mr TS’s antibiotic medication has led to a highINR compared with target
Mr TS’s warfarin dose does need adjusting to rectify the change in INR
Mr TS’s INR has increased due to a increase in the effect of warfarin
107
Warfarin advice
Mr TS should be advised to not adapt to a Mediterranean diet while on holiday- no drastic changes in diet
Mr TS should be advised to continue his medication as prescribed
Mr TS should carry his yellow warfarin card and book on him at all times
Mr TS should not purchase any medication without seeking appropriate advice
Mr TS should be advised to report any bruising or bleeding to a medical professional
107
Warfarin advice
Mr TS should be advised to not adapt to a Mediterranean diet while on holiday- no drastic changes in diet
Mr TS should be advised to continue his medication as prescribed
Mr TS should carry his yellow warfarin card and book on him at all times
Mr TS should not purchase any medication without seeking appropriate advice
Mr TS should be advised to report any bruising or bleeding to a medical professional
108
Combination causing hypokaelaemia?
prednisolone, salbutamol and furosemide
109
VTE risk assessment must be undertaken in a hospital setting following admission
24 hours after
110
Responding to symptoms
A Supply Dioralyte with appropriate advice- child with diarrhoea, no temp. The child is responsive and no other warning signs are described. Whilst the number of stools is not too worrying, his dry lips would make oral rehydration the most plausible option.
B Supply lactulose with appropriate advice
C Supply loperamide with appropriate advice
D Supply mebeverine with appropriate advice
E Supply omeprazole with appropriate advice
F Supply Gaviscon Advance suspension with appropriate advice- heartburn after spicy food. The spicy food may have triggered the dyspepsia and heartburn, and therefore an alginate product would be an appropriate first choice. Consider referring the patient if the alginate product does not work. Pregnancy acid-reflux-Gastro-oesophageal reflux is
common in the later stages of pregnancy as the fetus gets larger. These symptoms can respond well to alginate products, which can be taken throughout the day and also at night
G Supply senna with appropriate advice- constipation for 10 days. Mrs K should try senna as this is much faster acting than lactulose. If her
constipation does not resolve within 4 days, or she develops stomach pains, she should see her GP
H No treatment needed currently, give appropriate advice- constipation for 2 days. Constipation is fairly common and warrants treatment only in patients
who feel the effects of constipation, or have been constipated for longer (7–14 days).
I Refer the patient to their GP- patient complaining of dyspepsia. Unexplained weight loss.
J Refer the patient to A&E
111
Counselling
A Disperse this medicine in a glass of water and take at least 1 hour before bed
B Do not use sunbeds and protect the skin from sunlight, even on a cloudy day, when taking this medicine- doxycycline
C Take this medicine as you go to bed and remain lying down for as long as possible
D Take this medicine at least 30 minutes before food- Lansoprazole should be taken 30–60 minutes before food
E Take this medicine at least 30 minutes before breakfast with a full glass of water, remaining upright for 30 minutes after- Alderonic acid
F Take this medicine at least 1 hour before food or other medicines, or 2 hours after- flucloxacillin
G Take this medicine with food or just after a meal
H This medicine can be sucked or chewed before being swallowed
112
Glaucoma
A acetazolamide- oral adjunct treatment
B apraclonidine
C brimonidine
D brinzolamide
E dorzolamide
F latanoprost- eye irritation (e.g. excessive watering)
severe enough to make them consider stopping treatment. Can cause eyelashes to
become darker, thicker and longer.
G pilocarpine- Blurred vision due to pilocarpine may
affect performance of skilled tasks (e.g. driving), particularly at night or in reduced lighting
H timolol- Beta blockers should be avoided in
uncontrolled heart failure
113
Inhalers
A aclidinium- a long-acting muscarinic
antagonist (LAMA) and is available as Eklira Genuair
B ciclesonide- glucocorticoid, Alvesco
C glycopyrronium- a LAMA and is available as Seebri Breezhaler
D indacaterol- a long-acting beta agonist (LABA) and is available as Onbrez Breezhaler
E olodaterol- a LABA and is available as Striverdi Respimat
F salbutamol- a SABA, Ventonil
G terbutaline- Bricanyl Turbohaler, SABA
H umeclidinium- a LAMA and is available as Incruse Ellipta
114
Contraceptives
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A Cerazette (desogestrel)- a 12-hour window
before contraceptive cover may be lost. Other drugs in the same class have a 3-hour window
B Depo-Provera (medroxyprogesterone acetate)- long acting reversible contraceptive. repeated every 12 weeks
C ellaOne (ulipristal acetate)- licensed for up to 120 hours after
D Levonelle (levonorgestrel)
E Microgynon (ethinylestradiol with levonorgestrel)
F Noriday (norethisterone)
G Qlaira (estradiol valerate with dienogest)- an everyday phasic preparation
H Zoely (estradiol with nomegestrol acetate)- an everyday monophasic preparation
```
115
Laxatives
A bisacodyl
B dantron- indicated only for constipation in terminally ill patients of all ages. This is because of its potential carcinogenicity and evidence of genotoxicity
C ispaghula husk- constipation in pregnancy
D lactulose- produces an osmotic diarrhoea of low faecal pH and discourages the proliferation of ammonia-producing organisms. It is therefore useful in the treatment of hepatic encephalopathy
E linaclotide- a guanylate cyclase-Creceptor agonist that is licensed for the treatment of moderate-to-severe IBS associated with constipation
F liquid paraffin- can cause anal seepage
and consequent anal irritation after prolonged use
G macrogols
H senna
116
Antidiabetic medication
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A Byetta (exenatide)
B Galvus (vildagliptin)- licensed in over-18s as
triple therapy with metformin and sulfonylureas
C Invokana (canagliflozin)- reversibly inhibits sodium– glucose co-transporter 2 in the renal proximal convoluted tubule, to reduce glucose reabsorption and increase urinary glucose excretion. As such, UTIs may occur.
D Lantus (insulin glargine)
E Lyxumia (lixisenatide)
F Starlix (nateglinide)- a maximum dose of 180 mg TDS
G tolbutamide- a short-acting sulfonylurea. Long-acting sulfonylureas should be avoided in the elderly
H Tresiba (insulin degludec)- available as
100 units/mL and 200 units/mL. Ensure correct strength is prescribed and dispensed
```
117
Antidepressants
A agomelatine- melatonin receptor agonist and a
serotonin-receptor antagonist
Patients should be given a booklet with more information on the risk of hepatic side effects, told how to recognise signs of liver disorder, and advised to seek immediate medical attention
if symptoms such as dark urine, light coloured stools, jaundice, bruising, fatigue, abdominal pain, or pruritus develop
B citalopram
C duloxetine- a serotonin and noradrenaline re-uptake inhibitor
D lofepramine
E mirtazapine- presynaptic alpha-adrenoreceptor
antagonist which increases central noradrenergic and serotonergic neurotransmission
Patients should be advised to report any fever, sore throat, stomatitis or other signs of infection during treatment. Blood count should be performed and the drug stopped immediately if blood dyscrasia suspected.
F phenelzine- irreversible monoamine-oxidase A and
B inhibitor
G reboxetine- noradrenaline re-uptake inhibitor
H trazodone
118
Time
A 0 days
B 1 day
C 3 days- emergency supply/ If you know a patient has missed three days’ prescribed treatment (or the number of days defined by any local agreement
with the prescriber), there is a risk that he or she will have lost tolerance to the drug and the usual dose may cause overdose. In the best interests of the patient, consider contacting the prescriber to discuss appropriate next steps
D 5 days
E 7 days- Under the PPP, prescriptions are valid for seven
days and ideally should be dispensed on the date the prescription is
written. Prescriptions which are presented after seven days should be considered expired and the patient should be referred to the prescriber
for a new prescription. Pregnancy status may need to be reconfirmed by a further negative pregnancy test
F 14 days
G 28 days- vet CDs
H 30 days- max days for emergency supply at request of patient
119
OTC doses
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A 20 mg
B 43.75 mg- flurbiprofen
C 150 mg- ranitidine
D 500 mg
E 750 mg- naproxen
F 1200 mg- ibuprofen
G 4000 mg
H 4200 mg- Pepto Bismol
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120
Ophthalmology
A antazoline sulfate 0.5%, xylometazoline hydrochloride 0.05% eye drops
B chloramphenicol 0.5% eye drops- Mucopurulent discharge is a classic symptom of bacterial conjunctivitis. Treat with chloramphenicol eye drops for a maximum of 5 days.
C carmellose sodium 0.5% eye drops
D hypromellose 0.1% eye drops
E ganciclovir 0.15% gel- Herpes simplex infections producing dendritic corneal ulcers can be
treated with aciclovir or ganciclovir
F sodium cromoglicate eye drops- Sodium cromoglicate is a prophylactic agent for the treatment of allergies and is safe for use in pregnant women
G timolol 0.25% eye drops- Topical application of a beta blocker to the eye reduces intra-ocular pressure effectively in primary open-angle glaucoma, probably by reducing the rate of production of aqueous humour. Systemic absorption can follow topical application to the eyes; therefore, eye drops containing a beta-blocker are contraindicated in patients with bradycardia, heart block or uncontrolled heart failure.
H tropicamide 0.5% eye drops- Short-acting, relatively weak mydriatics, such as tropicamide 0.5% (action lasts for 4–6 hours), facilitate the examination of the fundus of the eye
121
Infectious childhood conditions
A chickenpox
B rubella
C glandular fever- Classic symptoms of glandular fever include swollen glands, fever, malaise and headache, as well as a maculopapular rash which appears on the trunk
D impetigo- characteristic symptoms include vesicles that exude, forming yellow crusts around facial area, particularly nose and mouth. It is most common among school-aged children. In the community, acute impetigo on small areas of the skin may be treated by short-term topical application of fusidic acid. Impetigo is often caused by either Staphylococcus aureus or Streptococcus pyogenes through broken skin. Impetigo infection may occur through a breach in the skin and stops being infectious after 48 hours of treatment starting or after the sores have stopped blistering or crusting
E measles- Koplik’s spots and a rash first appear on ear and face and then progress to trunk and limbs
F meningitis- symptoms include fever, lethargy, stiff neck, vomiting, photophobia and a rash with purplish blotches
G mollscum contagiosum
H mumps
122
Gastrointestinal
A bisacodyl- Bisacodyl tablets act in 10–12 hours
B colestyramine- an anion-exchange resin that is not absorbed from the gastrointestinal tract. It relieves diarrhoea and pruritus by forming an insoluble complex with bile acids in the intestine
C docusate sodium
D lactulose- may be used to treat constipation in children
E liquid paraffin
F macrogols- Bowel cleansing preparations, e.g. MoviPrep and KleanPrep, are prescribed for bowel evacuation before colonoscopy or surgery
G omeprazole- Omeprazole is used in conjunction with amoxicillin 500 mg three times daily and metronidazole 400 mg three times daily as triple therapy for Helicobacter pylori eradication
H prucalopride- a selective serotonin
5HT4-receptor agonist with prokinetic properties
123
Monitoring high-risk and commonly prescribed medicines
A amiodarone- used in the treatment of arrhythmias, particularly when other drugs are ineffective or contraindicated, must undergo chest x-ray LFT and thyroid function tests. Follow up every 6 months. The patient requires a loading dose of 200 mg
TDS for 7 days, then 200 mg BD for 7 days, followed by a maintenance dose of 200 mg once daily.
B aspirin- Aspirin (chewed or dispersed in water) is given for its antiplatelet effect, a dose of 300 mg is suitable. If aspirin is given before arrival at hospital, a note saying that it has been given should be sent with the patient
C digoxin- When switching from intravenous to oral route, dose may need to be increased by 20–33% to maintain the same plasma-digoxin concentration. Digoxin doses in the BNF may differ from those in the product literature. For plasma concentration monitoring, blood should be taken at least 6 hours after a dose
D lithium
E methotrexate- moderate rheumatoid arthritis and
is monitored every 2–3 months for blood dyscrasias and liver cirrhosis
F phenytoin
G theophylline- . Adverse effects can occur within the range 10–20 mg/L and both the frequency and severity increase at concentrations above 20 mg/L
H warfarin
124
Adverse effects
A hyperuricaemia- Cancer patients receiving chemotherapy may be prescribed allopurinol
as a prophylaxis for hyperuricaemia
B hypocalcaemia
C hyperkalaemia- Ciclosporin enhances the risk of
hyperkalaemia, especially in patients with renal dysfunction
D hypokalaemia- In hepatic failure, hypokalaemia
caused by diuretics can precipitate encephalopathy
E hypermagnesaemia
F hypomagnesaemia- There is an increased risk of hypomagnesaemia in alcoholic cirrhosis
G hypernatraemia
H hyponatraemia- Lithium toxicity
is made worse by sodium depletion; also, concurrent use of diuretics (particularly thiazides) is hazardous and should be avoided
125
Pathogens causing disease
A Aspergillus niger- Otomycosis (also known as Singapore ear) is a superficial mycotic infection of the outer ear canal caused by Aspergillus niger. It is more common in tropical countries and after prolonged treatment with antibiotics
B Chlamydia psittaci- may affect domestic bird owners and is an occupational disease of zoo and pet shop workers, poultry farmers and vets.
Characteristic symptoms include splenomegaly, and should prompt consideration of this diagnosis if found in conjunction with pneumonia
C Escherichia coli
D Legionella pneumophila- Legionnaires’ disease is a severe, potentially fatal, acute pneumonia
acquired by droplet inhalation of water contaminated by the bacterium Legionella pneumophila. British Thoracic Society (BTS) guidelines recommend investigations for legionella infection for all patients with severe community-acquired pneumonia, for other patients with specific
risk factors and for all patients with community-acquired pneumonia during outbreaks. Most people become infected when they inhale microscopic water droplets containing legionella bacteria. This might be the spray from a shower, tap or whirlpool, or water dispersed through the ventilation system in a large building. Outbreaks have been linked to a
range of sources, including hot tubs and whirlpools on cruise ships, cooling towers in air-conditioning systems, swimming pools, physical therapy
equipment, and water systems in hotels, hospitals and nursing homes
E Staphylococcus aureus
F Streptococcus pneumoniae
G Trichomonas vaginalis- profuse, frothy, greenish-yellow and malodorous discharge accompanied by vulvar itching and dysuria
H Pseudomonas aeruginosa- Pseudomonas aeruginosa can cause hospital-acquired pneumonia. Piperacillin with tazobactam has activity against a wider range of Gram-negative organisms than ticarcillin with clavulanic acid, and it is more active against Pseudomonas aeruginosa
126
Parasiticidal preparations
A dimeticone- effective against head lice (Pediculus humanus capitis), and acts on the surface of the organism by coating the head lice and interfering with water balance. This prevents the excretion of water by head lice and leads to rupture. It is less active against eggs and treatment should be repeated after 7 days
B fipronil
C ivermectin- severe case of Norwegian scabies in which hyperkeratotic, warty crusts have developed. This medicine has been prescribed at a dose of 200 mcg/kg.
D malathion- an organophosphorus
insecticide that is used as an alternative for the treatment of head lice.
Resistance may be an issue with this medicine
E mebendazole- perianal itching which is worse at night. This medicine is taken as a single
dose.
F praziquantel and pyrantel embonate- used to deworm cats and are sold in pharmacies. It
is effective against Toxocara cati, Toxascaris leonina, Dipylidium caninum and Taenia taeniaeformis
G selenium sulfide- Pityriasis (tinea) versicolor can be treated with selenium sulfide shampoo (unlicensed indication). It can be used as a lotion (diluting with a small amount of water can reduce irritation) and left on the affected area for 10 minutes before rinsing off; it should be applied once daily for 7 days, and the course repeated if necessary
H zinc pyrithione
127
Topical preparations
A amorolfine- Apply to infected nails once or twice
weekly after filing and cleansing; allow to dry (approximately 3 minutes); treat fingernails for 6 months, toenails for 9–12 months (review at intervals of 3 months); avoid nail varnish or artificial nails during treatment
B salicylic acid and lactic acid
C glutaraldehyde
D formaldehyde
E terbinafine
F silver nitrate- Silver nitrate may cause chemical burns on surrounding skin; it stains skin and fabric. Instructions in proprietary packs generally incorporate advice to remove dead skin before use by gentle filing and to cover with an adhesive dressing after application. Bazuka is known to irritate surrounding skin and damage fabric. It is the term burn and the staining properties of silver that fully define this answer
G miconazole
H mupirocin- In hospital or in care establishments,
mupirocin nasal ointment should be reserved for the eradication (in both patients and staff) of nasal carriage of meticillin-resistant Staphylococcus aureus (MRSA). The ointment should be applied three times daily for 5 days and a sample taken 2 days after treatment to confirm eradication
128
Cardiovascular
A aspirin
B amiodarone- There is a known interaction between simvastatin and amiodarone (which is used for treating atrial fibrillation). The simvastatin dose will need to be reduced to 20 mg OD to minimise this risk. Note that amlodipine is a distractor in this question as it is not used in atrial fibrillation
C amlodipine
D bumetanide- more potent than furosemide
E chlorothiazide- can worsen glucose control in T2DM
F digoxin- glycoside
G eplerenone
H furosemide
129
Prescription charges and record retention
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A 0- Patients with active treatment for cancer or cancer-related side-effects are exempt from prescription charges. Pregnant women are exempt from prescription charges. Inpatients are exempt also
B 1
C 2- CD register
D 3
E 4
F 5- responsible pharmacist record
G 6
H 7
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130
Cautionary and advisory labels
A Warning: This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol
B Warning: Do not drink alcohol- metronidazole
C Warning. Do not stop taking this medicine unless your doctor tells you to stop- antibiotics
D Warning: Read the additional information given to you with this medicine
E This medicine may colour your urine. This is harmless- nitrofurantoin
F Take 30–60 minutes before food- flucloxacillin
500 mg capsules, which he must take for 2 weeks in order to completely treat cellulitis.
G Do not take indigestion remedies 2 hours before or after you take this medicine
H Take with a full glass of water
131
Neurology
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A carbamazepine
B diazepam
C levetiracetam- Keppra
D lorazepam
E midazolam- via buccal route in children
F phenobarbital- a special alcohol-free and sugar-free preparation because the licensed product contains 38% alcohol. She also has to sign the back of a prescription form when she collects it from her community pharmacy.
G phenytoin
H sodium valproate
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132
Cardiovascular
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A aspirin- chew in central chest pain radiating to left side of body (MI)
B atorvastatin- primary prevention
C bisoprolol- beta blocker
D glyceryl trinitrate- angina
E oxygen
F prasugrel- prescribed prior to percutaneous coronary intervention
G ramipril- ace inhibitor
H simvastatin- statin
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133
Adverse drug reactions
A Stop taking the drug and report to your GP or local hospital immediately
B Stop taking the drug and make a routine appointment with your GP
C Continue taking the drug and speak with your GP to change to an alternative
D Continue taking the drug as normal since this reaction is harmless
E Continue taking this drug as normal and report the reaction to your GP- normal side effect but can be reduced through dose reduction
F Report this to the MHRA even though this product/device is not intensively monitored- reaction to vaccine
G Report this reaction to the MHRA as this product/device is intensively monitored- fall with dapagliflozin induced hypotension
H Report this error to the MHRA via a yellow card report
134
Central nervous system
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A 10 mg TDS- metoclopramide hyperemesis
B 20 mg TDS
C 50 mg TDS- cyclizine PRN post surgery N+V
D 100 mg TDS
E 120 mg TDS- orlistat
F 200 mg TDS
G 300 mg TDS- gabapentin for neuropathic pain
H 400 mg TDS
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135
Over-the-counter scenarios
A Advise initially to increase fluid intake- child with diarrhoea for 2 days
B Advise the purchase of paracetamol- Sertraline carries an increased risk of bleeding when given alongside NSAIDs; in this instance, paracetamol as first choice is a reasonable suggestion
C Advise the purchase of some throat lozenges
D Advise the purchase of some loperamide
E Advise the purchase of an eye ointment
F Advise that no treatment is necessary
G Advise waiting for 2 days and then seeing the GP
H Advise seeking urgent medical attention- bruising and sore throat with carbimazole
136
Nutrition and blood
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A hypocalcaemia- Hypoparathyroidism
B hypercalcaemia- Pamidronate
C hypokalaemia- diuretics (furosemide)
D hyperkalaemia- ACEi
E hypomagnesaemia- PPI
F hyponatraemia- SSRI
G hypophosphataemia- antacids
H hyperphosphataemia- hypoparathyroidism
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137
Respiratory
A inhaled beclomethasone
B inhaled salbutamol
C IV aminophylline
D IV hydrocortisone- severe acute asthma
E nebulised ipratropium
F oral montelukast- uncontrolled asthma in child
G oral prednisolone- poor control, on theophylline and inhaled therapy
H oral theophylline
138
Diabetes
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A diazoxide- intractable hypoglycaemia
B gliclazide- patient has poor renal function
C glucagon- hypo unconscious
D glucose 50% infusion
E insulin infusion
F Lantus Solostar pen
G Lucozade energy drink (55 mL)
H metformin- first line
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