Mistake Log 2 Flashcards
(294 cards)
1
Q
Which aminoglycosides are active against pseudomonas?
A
TAG - tobramycin, amikacin, gentamicin
2
Q
Which aminoglycoside is mainly reserved for tuberculosis?
A
Streptomycin
3
Q
How is tobramycin given for pseudomonas colonised cystic fibrosis?
A
28 days of nebulised tobramycin followed by 28 days free
4
Q
Should iron tablets be used alongside c diff infection?
A
No - may promote c diff growth and cause GI irritation
5
Q
Age requirement of OTC bonjela original
A
16+ - can use bonjela junior in younger patients
6
Q
How does lymecycline differ from the other tetracyclines in licensing?
A
Can’t be used below 8 - rather than 12
7
Q
Which tetracycline has a broader spectrum?
A
Minocycline - no longer recommended due to vertigo and dizziness + increased lupus reaction and discolouration
8
Q
Which tetracyclines can be taken with milk but still not the others (indigestion remedies, iron, zinc)
A
Doxycycline, lymecycline, minocycline
9
Q
Indometacin vs ivermectin
A
Indometacin - NSAID
Ivermectin - antithelminitic used also in papular rosacea
10
Q
Which documentation would be held the longest in the pharmacy?
A
A patient safety incident report - especially if ended fatally
11
Q
Phenelzine and pseudoephedrine interaction
A
Increased risk of hypertensive crisis
12
Q
Which LAMA is not licensed for once daily use?
A
Aclidinium
13
Q
Which antibiotics are most associated with c diff infection?
A
4Cs - clindamycin, cefalexin, ciprofloxacin, co-amoxiclav
14
Q
What side effect is nicorandil associated with?
A
Ulceration of skin, mucosa and eyes - may want to review if patient experiencing heartburn
15
Q
What visual symptoms can patients experience in digoxin overdose?
A
Halos around lights, seeing spots, changes in colour
16
Q
How do you catch giardiasis?
A
Parasitic infection from contaminated water - be conscious of risk in people who have been to third world counties
17
Q
What does pink frothy sputum indicate?
A
Pulmonary oedema - can be caused by the use of ACEi and diuretics (especially together)
May have other fluid build up symptoms - swollen ankles
18
Q
What does rust coloured sputum indicate?
A
Bleeding in lungs - can be seen in smokers
19
Q
Which anaesthetic can be given in caesarean section?
A
Isoflurane
20
Q
Which opioid has mixed agonist and antagonist activity at the opioid receptor?
A
Meptazinol - better in chronic respiratory disease
21
Q
Which opioid can be used in low renal function?
A
Fentanyl/alfentanil
22
Q
What does Boostrix IPV protect against?
A
Diphtheria, tetanus, pertussis, polio
23
Q
OTC age requirement for simple linctus
A
12+
24
Q
OTC age requirement for Levonelle
A
16+
25
How should sildenafil be taken?
Before food as can delay effect
26
What is pholcodine?
An opioid cough suppressant (antitussive)
27
Licensed age for seretide use
4+ - will be off label if younger
28
When disposing of medication, should tablets/capsules be deblistered?
No
29
When disposing of medication, should the medication be returned to the original pharmacy?
Not a requirement - can go anywhere
30
How many times can OTC oral lidocaine be used in a day?
6 times
31
Medication patches should be removed before which scan?
MRI - patches can have metal backing that heats up and burns skin
Caution with nicotine and fentanyl patches
32
Interaction between penicillins and methotrexate
Can increase methotrexate toxicity
33
What condition other than lipodystophy may insulin cause if not rotated to different injection sites?
Cutaneous amyloidosis
34
Ondansetron in pregnancy
Increased risk of oral cleft if given in first 12 weeks
35
How to calculate units in alcohol
(ABV x volume (mL)) / 1000
36
Use of OTC flurbiprofen
Relief of short term sore throat
Spray - 18+
Lozenge - 12+
37
Maximum number of times OTC hydrocortisone 1% can be given per day
Twice
38
Can adrenaline auto injectors be used after expiry?
Shouldn’t ideally but can be if no other option
39
Can tramadol be used first line in postherpetic pain?
No - can be considered if acute rescue therapy is required but needs specialist for long term
40
When is gradual withdrawal needed for steroids?
40mg+ daily for more than 1 week
More than 3 weeks treatment
Repeat doses in the evening
Recently received repeated courses
Taken a short course within 1 year of stopping long term steroids
41
Initial dose of irbesartan
150mg - much higher than expected
42
Aciclovir regimen for shingles
800mg five times a day for 7 days
43
Which drug can orlistat reduce absorption of
Levothyroxine - avoid use together
44
Which medical emergency is more likely when taking GLP-1 and insulin together?
DKA - especially after discontinuation or rapid reduction of insulin
45
How much should you reduce your salt intake to reduce CV risk?
Less than 6g (1 teaspoon) a day
46
How much moderate activity exercise a week reduces CV risk?
At least 150 minutes - e.g. cycling or brisk walking
47
Alcohol targets for reducing CV risk
No more than 14 units a week - both men and women
If you drink this much, then aim to spread drinking over 3+ days
48
How should a dose of GTN be taken?
Sat down
49
Which thiazide-like diuretic remains effective below eGFR 30?
Metolazone - however increased risk of excessive diuresis
50
How should a stye be treated?
Apply a warm compress to the eye for 5-10 mins 2-4 times a day
51
Odd patient advice for minocycline
Can be taken sitting or standing with full glass of water
52
Which antidepressant can cause weight gain?
Mirtazapine
53
Contraindications of EHC
Active cancer, undiagnosed vaginal bleeding
Ulipristal only - severe asthma controlled by steroids
54
At what age does Gillick competence need to be considered
<16 years old - implied competence 16+
55
Which drug class does methotrexate have severe interactions with?
PPIs - decreases methotrexate clearance
56
Which antipsychotics are licensed for use in non-cognitive symptoms of dementia?
Risperidone and haloperidol
57
If metformin is insufficient at controlling gestational diabetes, what insulin can be added?
Rapid acting insulin
58
Does grapefruit juice interact with warfarin?
Not listed on BNF
59
Which contraceptives count as long-acting reversible contraception
Progestogen-only implant, copper IUD, levonorgestrel IUD
Preferred when on teratogenic drugs
60
What contraceptive is preferred with enzyme inducing meds e.g. carbamazepine, rifampicin
Long-acting reversible contraceptive
Induction of enzymes can affect contraceptive efficacy
61
Effect of contraceptives on lamotrigine
CHC reduces exposure in active hormone phase - decreased seizure control
Increased exposure in hormone-free week
POP increases exposure
62
Contraceptive choices with griseofulvin
Do not use POP or progestogen-only implant
Avoid CHC as the risks may outweigh the benefits
Long-acting reversible contraceptive instead
63
How should contraception be managed if patient on drugs that induce severe nausea and vomiting
Long acting reversible contraceptive - avoid reduction in absorption from vomiting/diarrhoea
64
How many osteonecrosis of the ear present in those on bisphosphonates?
Should report any ear pain or discharge from ear
Should also report any ear infections
65
When should bisphosphonates be taken?
At least 30 mins before breakfast
66
Which antidepressants can not be used alongside triptans?
SSRIs, SNRIs and mirtazapine - all increase risk of serotonin syndrome
67
Which TCA has the best safety profile and often preferred?
Lofepramine
68
What anticoagulant should be given to a patient with a mechanical heart valve?
Warfarin
Do NOT use LMWH or DOAC - CI based on clinical trials
69
What extra indication does wegovy (semaglutide) have other than weight loss?
Cardiovascular risk reduction - in conjunction with dietary and exercise measures
Must have established CVD and a BMI of 27+
70
At which weight/BMI is EHC affected?
Weight >70kg, BMI >26
Use ulipristal or double dose of levonorgestrel (unlicensed)
71
What symptoms may indicate hypoparathyroidism?
Muscle spasms
Abdominal pains
Tingling/burning/numbness of fingers, toes or face
Dry skin/hair
Brittle nails
72
At what age should rotavirus vaccine not be given and why?
Over 15 weeks of age - risk of intussusception (bowel blockage)
73
What oestrogens are commonly used in contraceptive pills?
Ethinylestradiol (most common)
Mestranol
Estetrol
Estradiol
74
What contraception is considered first line?
Monophasic combined contraceptive containing 30mcg or less of ethinylestradiol in combination with levenorgestrel or norethisterone (to reduce CV risk)
75
What contraceptive should be avoided in patients who weigh more than 90kg?
Topical preparations
76
Examples of monophasic 28-day contraceptives
Drovelis, Zoely, Eloine, Femodene ED, Microgynon 30 ED
77
Examples of multiphasic 21-day contraceptives
Logynon, TriRegol, Synphase
78
Examples of multiphasic 28-day contraceptives
Qlaira, Logynon ED
79
Examples of tailored combined contraceptive regimens (unlicensed)
Can only be used with monophasic combined!
Shortened HFI - 21 days followed by 4 days free
Extended use (tricycling) - 9 weeks followed by 4 or 7 days free
Flexible extended use - 21 days or more followed by 4 days free when breakthrough bleeding occurs
Continuous use - no days free
80
Disadvantages of traditional regimen for combined contraceptives
Heavy or painful withdrawal bleeds, headaches, mood changes
81
Common progestogen hormones in progestogen-only contraceptives
Levonorgestrel, norethisterone, desogestrel, drospirenone
82
Which contraceptive may be more suitable for patients with heavy menstrual bleeds or dysmenorrhea?
Parenteral long-acting progestogens - often lead to amenorrhoea or reduced bleeding
83
Advice about use of depot medroxyprogesterone acetate (Depo-Provera)
Concerns of bone density loss:
Can use under 18 if all other options unsuitable
Aged 50 and over should switch method
Avoid in patients at risk of osteoporosis
Review continued use after 2 years
84
How often is Depo-Provera given?
Every 13 weeks
85
How long does it take for fertility to return after stopping Depo-Provera?
Up to 1 year
86
Can progestogen-only contraceptives be used in surgery?
Yes they can continue
87
How should combined contraceptives be used alongside EHC?
Levonorgestrel - use combined alongside and use barrier method for 7 days (9 days for Qlaira)
Ulipristal - start combined 5 days after and use barrier method for 7 days (9 days for Qlaira)
88
When are oral EHC options ineffective?
If ovulation has already occurred - copper IUD is only option
89
Which contraceptive options are suitable for women with diabetes?
Without cardiovascular disease - all contraceptives
With cardiovascular disease, nephropathy, retinopathy or neuropathy - combined not recommended but all others are fine
90
Which contraceptive options are suitable for women with migraines?
Without aura - all are fine but should consider switching combined if migraine develops
With aura or history of aura - do NOT use combined, others fine
91
Which contraceptive options are suitable for women with cardiovascular risk factors?
Risks include: smoking, diabetes, obesity, etc
All except combined and progestogen depot
92
Which contraceptive options are suitable for women who are obese?
BMI <35 - all can be used
BMI >35 - combined not recommended
93
Which contraceptive options are suitable for women with hypertension?
All but combined are fine
Do NOT use combined if BP consistently above 160/100
Combined not recommended if systolic is more than 140-159 or diastolic is more than 90-99
94
Which contraceptive options are suitable for women with VTE?
All fine but combined
Do NOT use combined if history or active DVT, immobilisation after surgery
Not recommended in family history of DVT
95
Which contraceptive options are suitable for women who smoke?
All fine but combined
Do NOT use combined if 35 years or older who smoked 15 cigarettes or more a day
Combined not recommended in anyone over 35 who smokes or stopped smoking in last year
96
How soon should a notifiable disease be reported after identification?
If urgent - within 24 hours
All other cases - within 3 days
97
Antifungals for aspergillosis
First line - voriconazole
Amphotericin B if unsuitable
Caspofungin or itraconazole - if refractory to both first line agents
98
Which bacteria are carbapenems not active against?
MRSA
99
Which carbapenems are active against pseudomonas?
Meropenem and imipenem
100
First line for bacterial vaginosis and dose
Metronidazole 400-500mg BD for 5-7 days
OR
Metronidazole 2g for 1 dose
101
Alternative treatments for bacterial vaginosis
Topical metronidazole for 5 days
OR
Topical clindamycin for 7 days
102
Treatments and doses for genital chlamydia
Doxycycline 100mg BD for 7 days
If unsuitable, azithromycin:
1g OD for 1 days, then 500mg OD for 2 days
OR
2g for 1 dose
103
What special administration advice should be given for azithromycin?
Do not take with indigestion remedies - 2 hours before or after
104
Treatments and doses for syphilis - less than 2 years since infection OR asymptomatic contacts
Benzathine benzylpenicillin IM - 2.4 million units once in gluteus maximus
Alternative - doxycycline 100mg BD for 14 days
105
Treatments and doses for syphilis - more than 2 years since infection
Benzathine benzylpenicillin IM - 2.4 million units once weekly in gluteus maximus for 3 weeks
Alternative - doxycycline 100mg BD for 28 days
106
Treatment and doses of pelvic inflammatory disease
Doxycycline 100mg BD for 14 days
Metronidazole 400mg BD for 14 days
Single dose of 1g IM ceftiraxone
OR
Metronidazole 400mg BD for 14 days
Ofloxacin 400mg BD for 14 days
107
Treatment and doses for gonorrhoea
First line if sensitivity unknown: ceftriaxone IM 1g for 1 dose
If sensitive to ciprofloxacin: 500mg for 1 dose
Treatment longer if disseminated infection
108
Advice about sex if being treated for STI
Avoid any type of sex during treatment for STI - usually 7 days after first treatment dose
Avoid for 2 weeks in syphilis
109
Can NSAIDs be used in liver cirrhosis?
Not recommended - increases risk of bleeding and fluid retention
110
Which vaginal thrush treatment should be used for patients on warfarin?
Clotrimazole 500mg pessaries before bed - no interaction
Avoid oral fluconazole
111
Which advisory statement should be included on the label for all beta blockers?
Label 8: Do not stop taking this medication unless your doctor tells you to stop
Can cause rebound tachycardia if stopped suddenly
112
Indication of nimodipine
Treatment/prevention of ischaemic neurological defects flowing subarachnoid haemorrhage
113
Which body system is more sensitive in the elderly and which drugs may need dose reduction?
CNS
Might need to reduce opioids, benzodiazepines, antipsychotics, antiparkinsonian meds
114
How much of a change in renal function would prompt discontinuation of an ACE inhibitor when initiating?
More than a 25% drop in eGFR from baseline OR more than a 30% increase in creatinine from baseline
Plus no other identifiable cause
115
What should be done to be able to provide patient information on request of a police officer?
Obtain a request in writing and determine whether there is a legitimate reason
116
Can NSAIDs and methotrexate be given together?
Increased methotrexate tox - can still be used but it should be warned of signs
117
What temperature and durations in childhood fevers should be referred?
>38 - less than 3 months old
>39 - 3-6 months old
>24 hours - 3-6 months old
>72 hours - >6 months
Children with fever for more than 5 days
118
What brands are tyramine rich?
Bovril, OXO, Marmite - meat/yeast extracts
119
Which drugs can help to reduce anorexia in palliative care?
Dexamethasone, prednisolone or a progestogen (such as megestrol acetate)
Metoclopramide or domperidone if issue is due to early satiety because of delayed gastric emptying
120
Which drugs for addiction require a license from the Home Secretary to prescribe?
Diamorphine
Dipipanone
Cocaine
Buprenorphine and methadone don’t require a license
121
First line for vaginal candidiasis
Fluconazole 150mg single dose
If unsuitable - clotrimazole 500mg pessary single dose
If vulval symptoms - add clotrimazole cream 2-3 times a day (normally 2%)
122
Age requirement for terbinafine cream
16+
123
Can clotrimazole 2% cream be used in children
No, should only be used between 16-60
124
Treatments for meningitis
Benzylpenicillin sodium
If penicillin allergic, use cefotaxime
If allergic to both, use chloramphenicol
125
What should be used of clopidogrel is not tolerated as secondary prevention for stroke?
Aspirin 75mg and dipyridamole MR 200mg BD
If either agent is not tolerated, use the other as monotherapy
126
How should spacer devices be cleaned?
Once a month with wild detergent and allowed to air dry
Don’t wipe dry as would affect electrostatic properties of the spacer
127
Which macrolide can be given with statins?
Azithromycin - does not interact
128
Risk factors for VTE
Family history is a first-degree relative under 45 years old
BMI >30
Long term immobilisation
History of superficial thrombophlebitis
Age over 35
Smoking
Use combined contraceptive with caution if 1 risk factor, avoid if 2 or more
129
Which patients cannot receive OTC Maloff Protect and should be referred?
Under 18
More than 12 week travel
History of depression
Pregnant/breastfeeding
Weighing less than 40kg
130
How should once daily long acting insulins be modified during surgery?
Give at 80% of the usual dose
131
SGLT2s and surgery
Should be interrupted in patients who are hospitalised for major surgical procedures or acute serious medical illness
Restart when ketones are normal and condition stable
132
TIA/stroke and driving rules
Single TIA - do not drive for 1 month but don’t need to notify DVLA
Multiple TIAs - do not drive for 3 months and most notify DVLA
Stroke - do not drive for 1 month. If neurological deficit after 1 month, must inform DVLA and can’t drive
133
Secondary prevention of TIA/stroke if patient also has AF/flutter
Use anticoagulation as secondary prevention- start within 14 days depending on severity
Until established - use 300mg aspirin daily
134
When should a stroke patient be started on an antiplatelet after thrombolysis?
24 hours after unless contraindicated
135
How long should aspirin be used alongside antiplatelets in DAPT for TIA/stroke?
Clopidogrel - 21 days
Ticagrelor - 30 days
136
Which diuretics can increase cardiac toxicity alongside digoxin?
Thiazide-like diuretics - hypokalaemia risk
137
When should thiazides be taken?
In the morning
138
What virus commonly causes warts?
Human papillomavirus (HPV)
139
How does long term use of topical steroids affect hair?
Can cause hypertrichosis
140
Which parasitic worm can cause children to wake at night and wet the bed?
Threadworm
141
What is required for a direction to be legally appropriate on a CD prescription
Must contain the number of doses to be taken/used
142
What is the legal obligation for reporting female genital mutilation?
Must be reported orally or in writing to the police if:
They observe physical signs that FGM may have taken place in under 18s
A child or young person reports that they have had FGM
143
Which CDs require an important/export license and invoice retention?
CD3s
144
Why should pregnant women avoid eating liver products?
High levels of retinol (vitamin A) - teratogenic
145
What is penicillamine?
A DMARD as well as a copper chelator
Can be used in rheumatoid arthritis and Wilson’s disease
146
What dose of bendroflumethiazide is used for hypertension?
2.5mg OM - rarely necessary for higher dose
5-10mg OM used for oedema
147
Should national procedures be used for spillages and disposal of cytotoxics?
No - BNF states local policy should be used
148
What is an FP10PCD and what is it used for?
Private prescription for controlled drugs - only used for CD 2 and 3
Normal medication need to be prescribed on a normal private prescription
149
Which schedule CDs can EEA or Swiss prescribers prescribe?
Schedule 4 and 5
This applies to emergency supplies as well
150
What interaction does citalopram and sildenafil have?
Potentiates QT prolongation of citalopram
151
What urological condition is duloxetine licensed for?
Stress urinary incontinence
152
What is pizotifen used for?
It’s a sedating antihistamine
Used for prevention of headaches and migraines
153
What is sucralfate and what odd side effect can it cause?
Complex of aluminium hydroxide and sulfated sucrose that forms a barrier to protect GI ulcers
Can cause bezoar formation - solid mass of indigestible material that can cause blockage
154
What side effect can occur at high doses of all antipsychotics?
Photosensitisation - increased sun protection precautions
155
What side effect can chlorpromazine cause and what handling precaution should be followed?
Contact sensitisation - do not crush tablets and take care while handling
156
Which antipsychotic can aggravate symptoms of aggression even at low doses?
Sulpiride
157
In which patient group is angle closure glaucoma more likely?
Patients with hyperopia (long-sightedness)
158
Which DOAC should be taken with food?
Rivaroxaban
159
What skin condition mainly affects the lower extremities?
Discoid eczema
160
Signs of cluster headache
Brief headaches around the eye with possible associated symptoms like unilateral photophobia, redness and nasal stuffiness
Recurrent and could last a couple of weeks
161
Signs of sinus headache
Dull throbbing headache in the upper half of the face - made worse on bending down
Associated with halitosis and pain, swelling and tenderness around the eyes, cheeks and forehead
162
What serious side effects can linezolid cause?
Optic neuropathy - report changes in acuity, changes in colour vision, blurred vision or any visual field defects
If taking longer than 28 days, visual function should be regularly monitored
Can also cause haematopoesis - measure FBC weekly
Closer monitoring in those taking more than 10-14 days treatment, pre-existing myelosuppression, severe renal impairment
163
Signs and treatment of erythema nodosum
Painful red lumps and patches (1-5cm wide) on lower legs
Give ibuprofen and tell to rest - self limiting
164
Tinea captis treatment and problems if untreated
Scalp infection requires systemic treatment - can use griseofulvin
If left unchecked, tinea captis can form a kerion (fungal abscess) that can result in hair loss and permanent scarring
165
What is tinea versicolor and how to treat
Infection by a yeast called malassezia that causes small patches of skin to become scaly and hypo/hyperpigmented - normally on trunk/bank and upper arms
Treat with ketoconazole shampoo - apply once daily for up to 7 days, leave preparation in for 10 minutes before rinse
166
Which laxative can be used up to 500mg in divided doses for chronic constipation?
Docusate
167
When should isotretinoin be ideally dispensed?
On the same day as pregnancy test and when prescription issued
168
How long should a Sativex invoice be retained in pharmacy?
6 years
169
How much high intensity exercise is recommended a week to reduce cardiovascular risk?
75 minutes
170
Which OTC diarrhoea medication interacts with aspirin?
Pepto Bismol - increased risk of salicylate toxicity (tinnitus, easy bruising) as well as GI effects
171
Perimenopause definition and symptoms
12 months after last menstrual period
Symptoms include irregular menstrual cycles, hot flushes, night sweats, mood swings, sleep disturbances, and vaginal dryness
172
Increased intake of which macronutrient can reduce levodopa absorption?
Protein - compete for absorption in GI tract
173
Which beta blockers are licensed for heart failure?
Bisoprolol, carvedilol, nebivolol
174
Can private prescription be repeated?
Yes - but just have a have a direction stating to repeat
If no number given - can be repeated once (unless contraceptive which can be repeated 5 times)
175
Maximum supply of pseudoephedrine and ephedrine OTC
720mg pseudoephedrine
180mg ephedrine
Can’t supply both together either
176
Can a healthcare professional prescribe and dispense for the same person?
Yes but should only be down in exceptional circumstances
Should use a mental break to separate activities and maximise patient safety
177
What dose of zopiclone should be used in the elderly, hepatically impaired, and renally impaired
Initially 3.75mg
These patient groups are more sensitive and more prone to side effects of sedation and falls
178
Can tamoxifen be taken at night to reduce hot flushes?
No, it will not affect it
179
Tamoxifen and paroxetine interaction
Paroxetine reduces effectiveness of tamoxifen by reducing its conversion into its active form
180
How should tamoxifen be taken for breast cancer?
Daily to reduce the risk of recurrence - ongoing review for risk vs benefit
181
How should metformin be initiated with CrCl 30-45?
500mg OD with gradual dose escalation to minimise risk of adverse effects
Monitor renal function closely throughout
182
How should mebeverine be taken?
20 minutes before meals
183
POM register requirements for supply to other healthcare professionals or organisations
Date the POM was supplied
Name, quantity and, where it is not apparent, formulation and strength
Name and address, trade, business or profession of the person supplied
Purpose for supply
184
Which weak opioid can be used in breastfeeding?
Dihydrocodeine - use short term and with infant monitoring
Avoid codeine
185
What is the first and second line for back pain?
First line - NSAIDs
Second line - weak opioid with/without paracetamol
Paracetamol alone is ineffective
186
How many days of treatment for a breastfeeding mother with an opioid would require close medical supervision?
3 days +
187
How can administration of ciclosporin solution be aided?
Mix with apple juice, orange juice or soft drinks immediately before taking
Do not mix with grapefruit juice - increases concentration
188
Supply of gonadotropin-releasing hormone analogues to block puberty
Banned - unable to dispense private prescriptions dated on or after 3rd June 2024 for anyone younger than 18
Individuals already receiving prescriptions can continue
189
How long should lidocaine patches be used for?
12 hours per day - remove before bed as can increase risk of systemic toxicity
190
Which drugs should sildenafil be avoided alongside?
QT prolonging meds - both contribute
CYP3A4 inhibitors/inducers - macrolides
191
How should a patient be advised to use a sublingual GTN spray?
Spray directly under tongue and close mouth immediately after use
192
Contraindication to initiating a copper IUD
Unexplained vaginal bleeding
193
Use of EHC if on enzyme inducer and copper IUD contraindicated
Levonorgestrel 3mg - double licensed dose
Don’t double Ulipristal
194
What medications can pharmacies accept for destruction?
Any unused or unwanted medication
Store in secure waste containers away from medication fit for use and use sharps containers for sharps
Dispose as per local guidelines
195
What genetic deficiency is nitrofurantoin contraindicated in?
G6PD deficiency
196
Can human medication be given as emergency supplies to animals?
Cannot be supplied if licensed only for humans - must be prescribed under cascade
Refer to vet
197
Vitamin D and digoxin interaction
Excessive vitamin D dosing can induce hypercalcaemia - increased risk of digoxin toxicity
Close monitoring and potential vitamin D dose reduction
198
Treatment options for mild to moderate fungal infection in chronic otitis externa
Clotrimazole 1% solution
Clioquinol with flumetasone
Acetic acid (unlicensed)
199
Which chlamydia treatment is available OTC?
Azithromycin under PGD - 4 x 250mg tablets (1g) as single dose
200
When is bowel cancer screening offered?
54-74 years old - moving to 50-74 soon
Every 2 years using FIT
201
When is cervical cancer screening offered?
25-64 years old
Under 25 invited for a test up to 6 months before they turn 25
25-49 - every 3 years
50-64 - every 5 years
202
When is breast cancer screening offered?
50-70 years old
Every 3 years
203
How often are tetanus boosters recommended?
Every 10 years
204
When can aspirin be used in children?
Kawasaki disease
205
When can alcohol be taken after metronidazole treatment?
48 hours after
206
Do bisphosphonates cause hypocalcaemia?
No - contraindicated in hypocalcaemia
Denosumab can cause though
207
Who should not be given chloramphenicol treatment for conjunctivitis?
Patients with glaucoma, photophobia, pain in the eye or pregnant patients (grey baby syndrome)
Refer to GP
208
What conditions can increase the risk of lactic acidosis?
Conditions that alter renal function - dehydration, severe infection, shock
Diseases that may cause tissue hypoxia - cardiac or respiratory failure, myocardial infarction
Also hepatic insufficiency, alcohol intoxication
209
Which tetracycline has the lowest photosensitivity risk?
Minocycline - rare side effect
210
Which drug class increases the risk of tendinitis when using quinolones?
Corticosteroids
211
How should pivmecillinam be taken?
With or just after food
212
What test can be used to diagnose Cushing’s syndrome?
Overnight dexamethasone suppression test - if cortisol stays high after dex dose then Cushing’s
213
Which test can be used to suggest an inflammatory bowel disease may be present in a patient?
Faecal calprotectin (faecal white cell marker) - if raised then could suggest UC or Crohn’s
Not raised in IBS
214
What test can be used to rule out coeliac disease?
Immunoglobulin (Ig)A tissue transglutaminase antibody test
215
What test can be used to assess for lactose intolerance?
Hydrogen breath test - detects small intestinal bacterial overgrowth
216
What is the other name for folic acid?
Vitamin B9
217
Symptoms of scurvy
Weakness, feeling tired, sore arms and legs
If left untreated can cause decreased RBCs and inflamed//bleeding gums
218
Factors that increase the risk of developing scurvy
No fresh fruits or veg for >3 months
Poor dietary intake - possibly due to chemo or eating disorders
Smoking - decreased vitamin C absorption
219
Why should Methyldopa be stopped 2 days post birth in gestational hypertension?
May increase the risk of depression
220
Treatment of DVT/PE regimen for rivaroxaban
15mg BD for 21 days, then 20mg OD thereafter
221
What is hand, foot and mouth disease and treatment
Highly contagious viral infection - causes ulcers in the mouth and raised lesions on the sides and back of the hands/feet
As viral - no antibiotics
Just antipyretics
222
Which vitamin is often reduced in patients on metformin?
Vitamin B12
223
Pancreatin administration directions
Inactivated by gastric acid - give with food
Don’t use hot food as will denature pancreatin
Take whole with milk or apple juice
224
Tranexamic acid max dose per day
4g
225
What rare side effect would require discontinuation of tranexamic acid?
Change in colour vision, visual impairment
226
When would a patient need EHC?
If 2 or more tablets are missed from the first 7 days of a pack and unprotected sex has occurred since the last pack
227
What strategy should be used for the first 48-72 hours after a sprain/strain?
PRICE - protection, rest, ice, compression, elevation
P - protect from further injury by using a support or high-top, lace-up shoes
R - avoid activity for 48-72 hours
I - apply ice wrapped in a damp towel for 15-20 minutes every 2-4 hours during the day - don’t use overnight
C - with a simple elastic bandage or elasticated tubular bandage - snug but not tight and remove before bed
E - keep injured area supported in a pillow until swelling controlled
228
Which antibiotics greatly increase ticagrelor exposure when given together?
Clarithromycin, azithromycin
229
Which high risk antiepileptics reduce the anticoagulant effects of DOACs?
Carbamazepine and phenytoin
Use warfarin instead
230
Which detail is not a legal requirement on prescriptions from EEA and Swiss prescribers?
Patient’s address
231
Potential signs of ectopic pregnancy
Abdominal pain - one sided in the lower abdomen, pain on the tip of the shoulder, abnormal vaginal bleeding
232
ORBIT score
O - older than 74
R - reduced haemoglobin (anaemia) - 2 points
B - bleeding history (2 points)
I - inadequate renal function (eGFR 60)
T - treatment with antiplatelet
0-2 low risk, 3 medium risk, 4-7 high risk
233
How many insulin requirements differ in renal failure?
Reduced requirements due to reduced insulin metabolism
234
1-3-6-9-12 rule for paediatric ibuprofen
50mg below 1 year
100mg up to 3 years
150mg up to 6 years
200mg up to 9 years
300mg up to 12 years
Above 12 is 300-400mg TDS/QDS (adult dose)
235
Paediatric paracetamol doses based on age
3-5 months - 60mg QDS
6-23 months - 120mg QDS
2-3 years - 180mg QDS
4-5 years - 240mg QDS
6-7 years - 240-250mg QDS
8-9 years - 360-375mg QDS
10-11 years - 460-500mg QDS
12-15 years - 480-750mg QDS
16+ years - 500-1000mg QDS (adult dose)
236
When would ovulation likely occur during the menstrual cycle?
Around day 14 - EHC ineffective afterwards and needs copper IUD
237
Contraindications of acarbose
Disorders of digestion or absorption, inflammatory bowel disease, hernia (may worsen condition)
238
How to treat bloodshot eyes
Self-limiting and will resolve in 1-2 weeks
Naphazoline hydrochloride eye drops available GSL for 12+ years
239
Which laxative can’t be given with mesalazine?
Lactulose - lowers stool pH and prevents release of mesalazine
Can worsen symptoms or trigger a flare
240
Why’s should iron tablets be swallowed whole and not chewed?
Risk of mouth ulceration and tooth discolouration
241
How should phenytoin be used alongside enteral feeding?
Interrupt feed for 2 hours before and after dose
242
How long should effective contraception be continued after discontinuation of mycophenolate mofetil?
6 weeks for women
90 days for men
243
When should levothyroxine be taken?
30-60 minutes before breakfast, caffeine-containing liquids, or other medications
244
How should a GTN patch be used?
Apply to the side of the chest for 12-14 hours and then remove
Can also be applied to the upper arm, abdomen or shoulder
245
Non-pharmacological interventions for UTI
Maintain adequate hydration and aim to drink 1.5L of water a day
Do not recommend cranberry or citrate salt OTC products (e.g. potassium citrate)
246
What treatment should be used for life-threatening c diff infection?
Oral vancomycin + IV metronidazole
247
Can trimethoprim be used in pregnancy?
Manufacturer advises avoid throughout. However, only properly contraindicated in first trimester
248
Can Nitrofurantoin be used in pregnancy?
Yes except for at term (around 37 weeks) - risk of neonatal haemolysis
249
Important linezolid interactions
Risk of seretonin syndrome - e.g. SSRIs, SNRIs
Risk of hypertensive crisis - tyramine rich foods, pseudoephedrine OTC
250
Which drug class is linezolid related to?
MAOIs - shares similar side effects
251
What laboratory test can Nitrofurantoin affect?
Can cause false positive urinary glucose
252
MHRA warnings for Nitrofurantoin
Pulmonary and hepatic toxicity
Closely monitor for new or worsening pulmonary symptoms- discontinue
Monitor for signs of liver tox especially in long term use
253
What neurological side effect can Nitrofurantoin cause?
Peripheral neuropathy (tingling sensation) - cautioned in those susceptible and vitamin B deficiency
254
What serious side effect does co-trimoxazole have that trimethoprim doesn’t?
Risk of SJS/TENS
255
How should Nitrofurantoin be taken?
With or just after food
256
In which condition are all aminoglycosides contraindicated?
Myasthenia gravis - may impair neuromuscular transmission
257
Can neomycin be used IV?
No - it is toxic IV
258
Monitoring requirements for clindamycin
Monitor liver and renal function if treatment exceeds 10 days
259
Examples of beta-lactamase sensitive penicillins
Benzylpenicillin sodium
Benzathine benzylpenicillin
Phenoxymethylpenicillin
260
Examples of penicillinase resistant penicillins
Flucloxacillin
Temocillin
261
Examples of broad-spectrum penicillins
Amoxicillin
Co-amoxiclav
Ampicillin
Co-fluampicil - ampicillin + flucloxacillin
262
Examples of antipseudomonal penicillins
Piperacillin
Ticarcillin
263
Second line agents for UTI in women and pregnant women
Women - Nitrofurantoin (if not used first line), fosfomycin, pivmecillinam, amoxicillin
Pregnant women - amoxicillin (if culture susceptible) or cefalexin
264
Prophylactic options for recurrent UTI in non-pregnant women
If behavioural and hygiene methods are not enough, follow in this order:
1. In perimenopausal, menopausal and post menopausal - vaginal estriol or estradiol and review in 12 months
2. Single dose antibacterial prophylaxis when exposed to trigger
3. Methenamine hippurate - review within 6 months then annual
4. Daily antibacterial prophylaxis
265
Oral first line for pyelonephritis in men and non-pregnant women
Cefalexin
If sensitivity known - co-amoxiclav or trimethoprim
If others unsuitable - ciprofloxacin
266
Intravenous first line for pyelonephritis in men and non-pregnant women
Amikacin, ceftriaxone, cefuroxime or gentamicin
If sensitivity known - co-amoxiclav
If others unsuitable - ciprofloxacin
267
Oral and intravenous first lines for pyelonephritis in pregnant women
Oral - cefalexin
IV - cefuroxime
268
CURB-65
C - confusion
U - urea >7 mmol/L
R - respiratory rate >30 per minute
B - BP systolic <90 or diastolic <60
65 - over 65 years old
0-1 - low risk
2 - moderate risk
3-5 - high risk
269
Treatment of low risk CAP
Amoxicillin
If penicillin allergic - clarithromycin, doxycycline, or erythromycin (in pregnancy)
270
Treatment of moderate risk CAP
Amoxicillin (with clarithromycin or erythromycin if atypical suspected)
If penicillin allergic - clarithromycin or doxycycline
271
Treatment of high risk CAP
Co-amoxiclav with clarithromycin or erythromycin (pregnancy)
If penicillin allergic - levofloxacin
272
How to differentiate between community and hospital pneumonia
Community-acquired - occurs within 48 hours of hospital admission
Hospital-acquired - occurs after 48 hours of hospital admission
273
Treatment of non-severe or low resistance risk HAP
Co-amoxiclav
If penicillin allergic - doxycycline, cefalexin (caution as cross-sensitive), or co-trimoxazole (unlicensed)
If all others unsuitable, levofloxacin
274
Treatment of severe or high resistance risk HAP
Tazocin, ceftazidime/ceftazidime with avabactam, ceftriaxone, cefuroxime, meropenem, or levofloxacin
275
How long before travel should malarial chemoprophylaxis be done?
Atorvaquone with proguanil or doxycycline - 1-2 days
Chloroquine - 1 week
Mefloquine - 2-3 weeks
276
How long after travel should malarial chemoprophylaxis be continued?
4 weeks
Except for atorvaquone with proguanil - 1 week
277
For how long after return from a high malaria risk country should any illness be reported?
1 year - especially in the first 3 months
Malaria is a notifiable disease
278
How long can antimalarials be used for long-term prophylaxis?
Atorvaquone with proguanil - 1 year
Doxycycline - 2 years
Mefloquine - 3 years (only licensed up to 1 year)
279
What antibiotics are the treatment of choice for infections from all chlamydial species?
Tetracyclines
280
Which corticosteroids are long-acting?
Dexamethasone and betamethasone
281
Which antibiotics are active against legionella?
Macrolides
282
How does doxycycline affect appetite?
Decreases appetite
283
Which insulin preparation is naturally cloudy in appearance?
Insulatard
284
What is the indication for dapoxetine?
Premature ejaculation - using side effect of SSRI
285
Indications of misoprostol in Cytotec brand
Treatment of gastric, duodenal or NSAID-induced ulcers - 400mcg BD for at least 4 weeks
Prophylaxis of NSAID-induced ulcers - 200mcg 2-4 times a day
286
What label is required for a CD supplied by a dentist?
‘For dental treatment only’
287
Which non CD1 or 2 drug requires entry in the controlled drug register?
Sativex (schedule 4 part I)
288
Which schedule CDs would require a CD requisition form?
CD 2 and 3
289
Which areas are exempt from needing to use CD requisition forms?
Hospices and prisons
290
Antiemetics of choice for nausea associated with gastritis, gastric stasis, and functional bowel obstruction
Metoclopramide or domperidone - both pro kinetic
291
Antiemetic of choice for nausea associated with a chemical cause (such as hypercalcaemia, morphine use, and renal failure)
Haloperidol
292
Antiemetic of choice for nausea associated with raised intracranial pressure and/or vestibular dysfunction
Cyclizine (with Dexamethasone if due to raised pressure
293
Age requirement for domperidone
12+
294
What is the maximum legal quantity of paracetamol 500mg tablets that can be sold per transaction?
‘Up to 100 tablets’ -> 99 tabs
