OnTrack Incorrect Questions Flashcards
1
Q
What does the latin abbreviation ‘a.u’ mean?
A
Both ears
2
Q
A patient on warfarin who takes phytomenadione will have what change in their INR?
A
Decrease = vitamin K
3
Q
Which of the following is most likely to be attributed to rosuvastatin? Myositis Anxiety Weight gain Bruising that may be heavy Black stools
A
Myositis = Myositis means inflammation of the muscles that you use to move your body. An injury, infection, or autoimmune disease can cause it. Two specific kinds are polymyositis and dermatomyositis. Polymyositis causes muscle weakness, usually in the muscles closest to the trunk of your body.
4
Q
Which drug has a risk of overdosing an infant if used in breast-feeding women due to a maternal variation in capacity to metabolise? Codeine Ibuprofen Morphine Paracetamol Tramadol
A
Genetic polymorphism of enzymes involved in the metabolism of codeine to morphine can lead to increased levels of morphine in the mother.
5
Q
Ibuprofen is a commonly used NSAID medication to help relieve pain and inflammation, which can be used over-the-counter.
what is the maximum adult OTC daily dose?
A
1.3g, 200-400mg every 4 hours if needed, must not exceed 1.2g in 24 hours.
6
Q
A patient with bipolar disorder, treated with lithium, requires analgesia. Which is the LEAST appropriate analgesic for this patient?
Codeine ibuprofen Morphine Paracetamol Tramadol
A
Lithium + NSAIDs leads to reduced excretion of lithium and subsequent toxicity. The CNS side effects of the use of opioid analgesis are not desirable but the risk of toxicity is lower.
The pharmacokinetic interaction is more important than the pharmacodynamic interactions.
7
Q
Which of the following does not cause discolouration of the urine? Co-beneldopa Co-careldopa Co-danthramer Co-danthrusate Co-fluampicil
A
Co-fluampicil is the only one which does not cause discolouration.
8
Q
Which of the following must be present on a midwife supply order to order pethidine, an opioid based analgesis?
Occupation of the midwife
Name and address of the midwife
Total quantity of the drug to be obtained
Signature of an appropriate medical officer
Details of patient for which the controlled drug is being obtained.
A
Occupation of the midwife
Name and address of the midwife - NO
Total quantity of the drug to be obtained
Signature of an appropriate medical officer
Details of patient for which the controlled drug is being obtained.
9
Q
First line treatment of DKA
A
Intavenous insulin infusion.
10
Q
What does the latin abbreviation ‘p.c’ mean?
A
After food
11
Q
Which of the following antibiotics can cause cholestatic jaundice to occur, up to two months after treatment with this antibiotic has stopped?
Benzylpenicillin sodium Flucloxacillin Linezolid Nalidixic acid Phenoxymethylpenicillin
A
Flucloxacillin may cause cholestatic jaundice at any time during treatment and up to two months post treatment.
12
Q
What is a laxative ONLY licensed for use in patients who are in palliative care or terminally ill?
A
Co-danthramer
13
Q
How many times can private prescriptions for combined hormonal contraceptives that state “repeat” be dispensed within 6 months?
A
6 times in 6 months
14
Q
What is the most suitable drug for a newly diagnosed 37 year old man suffering with absence seizures?
A
Sodium valproate
15
Q
A male patient presents with newly diagnosed generalised tonic-clonic seizures and a doctor requests information on the first line treatment of this condition. Which drug would you recommend?
A
Sodium valproate
16
Q
A 9 year old child has been initiated on a medication for epilepsy which upon review has been noted to be causing undesirable effects including behavioural disturbances and hyperkinesia. What is the most likely drug?
A
Phenobarbital
17
Q
An epileptic patient develops acute myopia with secondary angle closure glaucoma within a month of starting a new medicine for their epilepsy. Which medication is most likely to be the causative factor?
A
Topirimate
18
Q
Malabsorption of what vitamin, as a result of pernicious anaemia, can cause megaloblastic anaemia?
A
Vitamin B12
19
Q
1 mg of this vitamin could be given as a single intramuscular injection at birth to prevent serious bleeding, including intracranial bleeding.
A
Vitamin K
20
Q
Thiamine is what vitamin?
A
Vitamin B1
21
Q
Which of the following drugs can colour the urine dark red?
Tacrolimus topical Co-careldopa Ketoprofen Cefalexin Detrusitol Sandocal Amitriptyline Triamterene
A
Co-careldopa
22
Q
What is triamterene?
A
Triamterene is a potassium-sparing diuretic used in combination with thiazide diuretics for the treatment of hypertension and edema.
23
Q
Triameterene can colour the urine what colour?
A
Blue fluorescent
24
Q
Which laxative can cause the urine to become coloured red?
Senna or co-danthramer?
A
Co-danthramer = red Senna = yellow or red-brown
25
Nalidixic acid is only indicated for what?
UTI at a dose of 900mg every 6 hours for 7 days then reduced to 600mg every 6 hours for prolonged therapy in chronic infections.
26
What drug would be given via intravenous infusion to treat meningococcal disease?
Benzylpenicillin sodium at a dose of 2.4grams every 4 hours via slow intravenous injection or by iv infusion.
27
Severe optic neuropathy may occur with the use of this antibiotic and as such visual function should be monitored regularly if treatment is required for longer than 28 days.
Linezolid
28
This is an antimicrobial drug with a high activity against anerobic bacteria and protozoa; it has a relatively long duration of activity.
Tinidazole, longer duration of action than metronidazole.
29
This antibiotic is cautioned when used by inhalation in those suffering with haemoptysis.
Aztreonam, risk of further haemorrhage.
Aztreonam is a monocyclic beta-lactam. Not active against Gram-positive.
30
What is the incubation period for chickenpox?
1-3 weeks
31
What is the incubation period for slapped cheek disease?
1-20 days
32
What is the incubation period for whooping cough?
1-3 weeks
33
What is the incubation period for mumps?
14-25 days
34
What SNRI is indicated for stress urinary incontinence?
Duloxetine
35
Can isotretinoin be dispensed from a repeat prescription?
NO
36
Which medication is used at a continuing dose of 1 mg daily in the management of Parkinson's disease?
```
Trihexyphenidyl
Procyclidine Hydrochloride
Orphenadrine Hydrochloride
Tolcapone
Amantadine Hydrochloride
Rasagiline
Selegiline hydrochloride
Entacapone
```
Rasagiline is used at a dose of 1mg daily in the management of Parkinson's disease. It is either used alone or as an add on therapy with either co-beneldopa or co-careldopa.
37
Which of the following may colour the urine reddish-brown?
Tolcapone
Rasagiline
Entacapone
Entacapone
38
Early treatment with what can delay the need for levodopa therapy?
Selegiline
39
Which of the following medications may exacerbate oedema and as such is cautioned for use in congestive heart failure?
```
Tolcapone
Selegiline
Amantadine
Entacapone
Rasagiline
```
Amantadine
40
What Parkinson's drug can cause hair loss as a side effect?
Selegiline
41
A patient is being treated for deep vein thrombosis and is only aware of the dose of the medication they are taking. They inform you they were told to take '10 mg twice daily for 7 days, then a maintenance dose of 5 mg twice daily'. Which medication is this likely to be?
Apixaban
42
What is Persantin?
Dipyridamole
43
Bezoar formation in a 59 year old male with slow gastric emptying is most likely due to
Sucralfate
44
Akathisa is most likely due to:
```
Ranitidine
Docusate
Felodipine
Prochlorperazine
Carbocisteine
```
Akathisia (restlessness) is an extrapyramidal side-effect which is commonly associated with high initial doses of piperazine phenothiazines like prochlorperazine.
45
What is fosavance?
Alendronic acid and colecalciferol
46
What is Teysuno?
Teysuno is indicated in adults for the treatment of advanced gastric cancer when given in combination with cisplatin.
It is tegafur, gimeracil and oteracil.
47
What is in Triapin?
Ramipril and felodipine
48
What is in Targinact?
Oxycodone and naloxone
49
What impact does candersartan have on lithium levels?
Candersartan can lead to lithium toxicity, manufacturer advises that we monitor concentration and adjust dose.
50
Which of the following non-prescription topical preparations is to be used with caution in patients taking phenytoin?
```
HC45® hydrocortisone 1% cream
Clotrimazole 2% cream
Daktarin® oral gel
Zovirax® 5% cream
Canesten® soft gel pessary
```
Daktarin = miconazole enhances the anticonvulsant effect of phenytoin (plasma concentration enhanced) although with topical use, the risk is lower.
51
What type of laxative is glycerol?
Osmotic laxative
52
What type of laxative is liquid paraffin?
Faecal lubricant
53
What type of laxative is docusate sodium?
Faecal softener
54
What type of laxative is bisacodyl?
Stimulant laxative
55
Is lower abdominal pain a side effect of the EHC?
No, lower abdominal pain may be indicative of an ectopic pregnancy.
56
```
Which of the following is not a side effect of amitriptyline?
Dry eyes
Constipation
Dry mouth
Epigastic pain
Drowsiness
```
Dry eyes is not listed as a side effect of amitriptyline, epigastric pain is a form of abdominal pain which is the most common side effect.
57
Which of the following will facilitate the absorption of calcium?
```
Ascorbic acid
Colecalciferol
Hydroxocobalamin
Pyridoxine
Phytomenadione
```
Colecalciferol will facilitate the absorption of calcium.
58
Which of the following is not a long term side effect of corticosteroid usage?
```
Weight gain
Glaucoma
Osteoporosis
Nystagmus
Diabetes
```
Nystagmus.
59
Which of the following does not stimulate the pancreas to release insulin?
```
Gliclazide
Exenatide
Canaglifozin
Vildagliptin
Repaglinide
```
Canaglifozin is a SGLT2 inhibitor which reversibly inhibits SGLT2 in the kidney to reduce glucose reabsorption and increase urinary glucose excretion - UTI risk
60
Ms AL suffers from depression and has been taking phenelzine 15mg three times daily for the last 6 months. As she is not responding to treatment her doctor has decided to change her to fluoxetine capsules,
How long after stopping the phenelzine can she start taking the fluoxetine?
Two weeks after stopping the MAOi.
61
Mrs S is a 26 year old female who comes into your pharmacy to ask for your advice. Her doctor has asked her to book an appointment to receive MMR vaccination. She tells you that she is planning to become pregnant and is worried about having this vaccination.
Does she need this vaccine?
When can she have it?
What impact may it have on trying for a child?
Rubella should be given to individuals who do not have immunity to the condition, including woman of child-bearing age. Avoid pregnancy for at least 1 month after vaccination.
62
Mr G is a 45 year old mechanic who has angina. His GP contacts you to discuss the options of beta-blockers to prescribe to Mr G. He is looking for a once daily dosing regimen.
Which of the following beta-blockers is less suitable for a once daily regime?
```
Atenolol
Bisoprolol fumarate
Celiprolol hydrochloride
Nadolol
Propranolol
```
Some beta blockers, such as atenolol, bisoprolol fumarate, celiprolol hydrochloride, and nadolol, have an intrinsically longer duration of action and need to be given only once daily.
Propranolol is given multple times daily.
63
What is the most sensitive indicator of renal impairment?
eGFR
64
Clotrimazole 2% OTC is licensed only for what?
External treatment of thrush
65
Glyceryl trinitrate 400 microgram sublingual spray prn, Verapamil 120 mg t.d.s, Baclofen 20 mg t.d.s, Loperamide m.d.u, withdrawal of which of these medicines can cause life-threatening side-effects such as hallucinations and fever?
Serious life-threatening side-effects such as hallucinations and fever result from sudden withdrawal of baclofen therapy. Patients must be warned not to suddenly stop taking this medication
66
What is the risk of giving balcofen alondside captopril and atenolol?
Baclofen increased the hypotenseive effects of ACE inhibitors and beta blockers.
67
What does MDRD stand for?
Modification of diet in renal disease, used to calculate the eGFR of a patient.
68
What impact dose smoking have on clozapine?
Dose adjustment of clozapine treatment might be necessary if smoking is started or stopped during treatment
69
Which antibiotic is the primary reason for pyridoxine supplementation?
Peripheral neuropathy can occur as a result of isoniazid especially in those at highest risk (see BNF) and in these patients pyridoxine should be prescribed when treatment with isoniazid is started.
70
Mrs F tells you she's getting married next month. She worries that the "bumps" on her hands are something contagious. On closer inspection, you see rough, raised papules with a cauliflower-like appearance and black dots on their surface.
What is the cause of this condition?
HPV
| Human Papilloma Virus
71
Which ONE of the following drugs is NOT suitable for both supraventricular and ventricular arrhythmias?
```
Verapamil
Sotalol
Amiodarone
Flecainide
Propafenone
```
Verapamil is usually effective for supraventricular tachycardias only.
72
People who have had their spleen removed should get what vaccine?
Pneumococcal vaccine. They are at an increased risk of pneumonococcal infection.
73
Impetigo is usually caused by what bacteria?
Either Staphylococcus aureus or Streptococcus pyogenes
74
What are the usual risks of antipsychotics in the elderly?
Hyperglycaemia,
Diabetes,
VTE
75
Which of the following antisecretory and mucosal protectant drugs may cause severe diarrhoea which may require withdrawal of this drug?
```
Cimetidine
Misoprostol
Paracetamol
Ranitidine
Tripotassium dictratobismuthate
```
Misoprostol
76
Which of the following is suitable for OTC travel sickness?
```
Domperidone
Hyoscine butylbromide
Hyoscine hydrobromide
Metoclopramide
Nabilone
```
Domperidone, metoclopramide and nabilone are prescription only medicines. Hyoscine butylbromide (Buscopan) is not indicated for travel sickness, hyoscine hydrobromide (Joy-Rides or Kwells) can be sold to the public and is indicated for travel sickness.
77
Which insulin can be used as an alternative to the classic soluble insulin in the cases of diabetic emergencies?
```
Hypurin bovine neutral
Insulin aspart
Insulin glargine
Insulin degludec
Biphasic insulin aspart
```
Insulin aspart is fast acting and can replace soluble insulin in this setting.
Insulin glargine is a long acting basal insulin analogue.
Insulin degludec is an ultralong-acting basal insulin analogue
78
Zolendronic acid can be used in woman of child bearing age. True or False.
False.
| Zolendronic acid is contraindicated in woman of child bearin age.
79
```
Which of the following does not affect the monoamine oxidase enzyme family?
Selegiline
Linezolid
Moclobemide
Phenelzine
Clonidine
```
Cloinidine is the only option which does not affect the monoamine oxidase enzyme family.
80
Mr GU is a 67 year old man weighing 57 kg, admitted to hospital for the treatment of status epilepticus. His past medical history is myocardial infarction, depression and epilepsy. His hepatic and renal function are normal.
Which medicine is most likely to have caused his admissed to hospital?
```
Aspirin
Bisoprolol
Ramipril
Isosorbide monoitrate MR
Sertraline
```
Sertraline is an SSRI and can lower seizure threshold.
81
What effect does alcohol have on the antidiabetic effect of sulphonylureas?
Enhanced, increased risk of hypoglycaemia.
82
What laxative can cause interference of fat solube vitamins?
Liquid parafin
83
Which of the following requires a dose reduction with concomitant use of verapamil?
```
Warfarin
Rivaroxaban
Dabigatran
Apixaban
Pheninidione
```
Verapamil may increase the plasma concentration of dabigatran therefore increasing its effects. For this reason, the manufacturer advises that the dose is reduced in patients taking verapamil.
See also Stockley's Drug Interactions.
Note Stockleys does state Diriazem and possibly verapamil may cause a minor decrease in warfarin metabolism but the anticoagulant effect of warfarin is unlikely to be affected.
84
Miss RG asks your advice on taking her combined oral contraceptive as she is 5 hours late in taking her next tablet. She is at the middle of her cycle.
Which of the following would be the correct advice?
Take two tablets now and no further action is required.
Take the tablet straight away and no further action is required.
Take the tablet straight away and use other contraception for 7 days.
Take the tablet straight away and use other contraception for 14 days.
Stop the present cycle of the pill and start a new cycle in 7 days time.
Take the tablet straight away and no further action is required.
'Missed pill' is one that is 24 hours late.
85
Ergocalciferol use leading to nausea and vomitting is due to what?
The vitamin D may have led to an increase in serum calcium causing the symptoms.
86
Which one of the following medicines can podiatrists prescribe for oral administration?
```
Diazepam
Morphine sulphate concentrated oral solution
Morphine sulphate tablets
Oxycodone normal relase
Oxycodone prolonged release
```
Podiatrists can prescribe diazepam, dihydrocodeine, lorazepam and temazepam only for oral administration.
87
Mr Markus has uncontrolled hypertension on the following medications:
* Trimethoprim 200mg BD initiated whilst in hospital
* Amlodipine 10mg OD
* Ramipril 10mg OD
* Atorvastatin 20mg ON
According to NICE Hypertension in adults: diagnosis and management guidance what would be the most appropriate additional anti-hypertensive to recommend?
```
Atenolol 25mg OD
Candersartan 8mg OD
Bendroflumethiazide 2.5mg OD
Indapamide modified release 1.5mg OD
Doxasozin 1mg OD
```
According to NICE Hypertension in adults: diagnosis and management guidance NICE guidelines [CG127] (https://www.nice.org.uk/guidance/CG127)
Bendroflumethiazide or hydrochlorothiazide are no longer the recommended thiazide-like diuretics for hypertension.
If a diuretic is started or changed, give:
• Chlortalidone 12.5 to 25mg once daily,
• indapamide 1.5mg modified-release once daily or 2.5mg once daily.
88
A patient presents with poor renal function, upon calculating her renal function it is determined that her eGFR is currently 27mL/minute. Which of the following drugs would be ineffective for use in this patient?
```
Ursodeoxycholic acid
Amiodarone
Bendroflumethiazide
Pseudoephedrine
Piperacillin with Tazobactam
Levomemprazine
Sodium Hyaluronate 0.1% eye drops
Colestryramine
```
Thiazides and related diuretics are ineffective if eGFR is less than 30ml/minute and should be avoided.
89
You receive a phone call from a GP regarding the suitability of medicines in a patient suffering with complete biliary obstruction. Which one of the listed drugs is contraindicated in a patient suffering with complete biliary obstruction?
```
Ursodeoxycholic acid
Amiodarone
Bendroflumethiazide
Pseudoephedrine
Piperacillin with Tazobactam
Levomemprazine
Sodium Hyaluronate 0.1% eye drops
Colestryramine
```
Colestyramine is contraindicated in complete biliary obstruction as it is NOT likely to be effective.
Not absorbed from the digestive tract.
Cholesterol is probably the sole precursor of bile acids. During normal digestion, bile acids are secreted into the intestines.
Colestyramine works to remove bile acids thus stimulating more use of cholesterol to produce bile acids - lowering levels of circulating cholesterol .
90
On a ward round you discover a patient has been admitted with acute inflammation of the gall bladder. Which medication is contraindicated in this patient?
```
Ursodeoxycholic acid
Amiodarone
Bendroflumethiazide
Pseudoephedrine
Piperacillin with Tazobactam
Levomemprazine
Sodium Hyaluronate 0.1% eye drops
Colestryramine
```
Ursodeoxychoic acid is contraindicated in patients with acute inflammation of the gall bladder.
Used for dissolution of gallstones and primary billary cirrhosis.
Reduces cholesterol absorption and is used to dissolve (cholesterol) gallsones in patients who do not want surgery.
91
What is the length of time a private prescription for morphine sulfate 10mg/5ml oral solution is valid for?
6 months
92
What counselling should accompany first prescribing of lamotrigine?
Immediately report any signs or symptoms of anaemia, bruising or infection to your doctor.
These are signs of bone marrow suppression which lamotrigine can cause.
93
What is the most appropriate counselling to a patient newly prescribed co-careldopa for Parkinsons's disease?
You may experience sudden onset of sleep. Please exercise caution when performing skilled tasks.
94
What is the risk with taking spironolactone and potassium chloride?
Spironolactone is a potassium-sparing diuretic, together with potassium supplements increases the risks of developing hyperkalaemia which may cause cardiac arhythmias
95
What is the risk with taking Warfarin and oral piroxicam?
Piroxicam is an NSAID, the anticoagulant response of warfarin is increased when used in combination with warfarin.
96
Narist is the latin term for
Nasal drops
97
when should oral cyanocobalamin be taken? (hint: i.c.)
between meals
98
Vitamin D requires hydroxylation by the _______ to its active form. Therefore _________ should be prescribed in patients with ______ renal function who are deficient.
kidneys, alfacalcidol, renal
99
What helps the absorption of calcium in the gut?
Vitamin D, the main action of vitamin D is to make sure enough of the calcium in our diet is absorbed.
100
Can ergotamine be safely used in a 45 year old female with a BP of 187/112mmHg?
Ergotamine is contraindicated in inadequately controlled hypertension.
Used for treatment of acute migraine attacks but its biological activity as a vasocontrisctor means it is contraindicated in patients with high BP
101
Why could nitrazepam not be used in a patient with Myasthenia Gravis?
Use of benzodiazepine drugs can futher reduce the effectivness of neuromuscular transmission in a patient with MG and cause increased clinical weakness.
102
What laxative can colour the urine red?
Co-danthramer
103
Blood pressure above what value is a reason to stop the combined oral contraceptive pill?
160mmHg systolic
OR
95mmHg diastolic
104
Which of the following medications i known to precipitate migraine?
```
GI motility stimulants
Oral contraceptives
Benzodiazepines
Beta-blockers
NSAIDs
```
Oral contraceptives
105
Why is there a risk of bronchospasm with NSAIDs?
Increasing leukotriene production due to cyclooxygenase-1 isoenzyme inhibition.
106
Which of the following antisecretory and mucosal protectant drugs inhibits the metabolism of warfarin?
```
Cimetidine
Misoprostol
Lansoprazole
Ranitidine
Tripotassium dicitrabobismuthate
```
Cimetidine
107
Which of the following terms is defined as shortness of breath on lying down?
```
Apnoea
Dysphagia
Dysplasia
Dyspraxia
Orthopnea
```
Apnoea: cessation of breathing during sleep
Dysphagia: difficulty in swallowing.
Dysplasia: abnormal cell growth.
Dyspraxia: developmental disorder
Orthopnea is defined as shortness of breath (dyspnoea) when lying down flat.
108
A patient calls you at your pharmacy at 8 pm. They use Toujeo and usually administer their medicine at 6pm. The patient got stuck in traffic on his way home from work and his insulin was at home. He has only just arrived home. He asks what to do about taking his dose of Toujeo.
When needed, patients can administer Toujeo up to 3 hours before or after their usual time of administration.
109
Mrs X, is a 55 year old patient. She has recently been suffering from acute migraine attacks which have not responded to paracetamol. She has a history of ischaemic heart disease.
What would not be a suitable recommendation for her to treat migraine?
Serotonin 5HT1 agonists are contraindicated in patients with ischaemic heart disease.
110
Mrs D is a 75 year old patient who was diagnosed with osteoarthritis two months ago.
Which of the following medications would be suitable for long-term pain-relief?
```
Ketoprofen
Ibuprofen
Meloxicam
Naproxen
Paracetamol
```
Paracetamol should be used first for pain relief in osteoarthritis and soft-tissue disorders. Given that this is a chronic condition, the use of NSAID's (the other options) long term can result in an increased risk of gastro-intestinal bleeding and ulcers. NSAID's could be used for the short-term relief of pain in osteoarthritis.
111
What sch is midazolam?
Sch 3
112
What is the recommended compression-ventilation ratio for CPR on an 18 year old patient?
30:2
| 30 chest compression followed by two rescue breaths for as long as possible or until help arrives
113
What type of laxative is first-line treatment for constipation in breastfeeding women? Which of the following would be appropriate to use:
Ispaghula husk
Lactulose
Loperamide
Senna
A bulk forming laxative is the first-line treatment for constipation in breastfeeding women. It is suitable for sale over the counter:
ispaghula.
Lactulose: osmotic laxative
114
Diabetes, osteoporosis and muscle wasting are side effects associated with which type of steroid?
Glucocorticoid side-effects include diabetes, osteoporosis and muscle wasting.
Mineralcorticoid side effects:
Calcium loss, hypertension, potassium loss and water retention.
115
Mrs R is a patient who has AIDS. She has been diagnosed with mild pneumocystis pneumonia. She is unable to tolerate trimethoprim.
Which single medication is the most likely treatment option for her pneumonia?
```
Atovaquone
Co-trimoxazole
Hydrocortisone
Pentamidine isetionate
Prednisolone
```
Atovaquone is licensed for the treatment of mild to moderate pneumocystis infection in patients who cannot tolerate co-trimoxazole (co-trimoxazole is made up of sulfamethoxazole and trimethoprim - Note that Mrs R can not tolerate trimethoprim). The other options are suitable for severe pneumocystis infection.
116
What are the first line drugs of choice in depression in breastfeeding patients?
Setraline: Low levels of exposure via milk expected. Often recommended as the antidepressant of choice in breastfeeding.
Paroxetine: Short half-life limits potential for accumulation but increases risk of withdrawal effects. Avoid if there is a risk of subsequent pregnancy.
Imipramine, nortriptyline:
Short half-lives and lower risk of sedation or antimuscarinic adverse effects compared with other tricyclic antidepressants.
117
This combination causes ventricular arrhythmias:
```
Digoxin and quinine.
Digoxin and cefalexin.
Ketoprofen and cefalexin.
Ketoprofen and paracetamol.
Sildenafil and isosorbide mononitrate.
Atenolol and ibuprofen.
Clonidine and propranolol.
Pimozide and ketoconazole.
Metronidazole and ketoconazole.
```
This combination is very dangerous as pimozide is a CYP3A4 enzyme substrate and ketoconazole is a potent inhibitor of CYP3A4 leading to a marked increase in pimozide serum levels. This causes ventricular arrhythmias.
118
As a precautionary measure for male patients, it is now recommended that either the patient or their female partner use reliable contraception during treatment with mycophenolate medicines and for at least how many days after stopping?
As a precautionary measure for male patients, it is now recommended that either the patient or their female partner use reliable contraception during treatment with mycophenolate medicines and for at least 90 days after stopping
119
What are the mineralcorticoid side effects?
Glucocorticoid side-effects include diabetes, osteoporosis and muscle wasting.
Mineralcorticoid side effects:
Calcium loss, hypertension, potassium loss and water retention
120
Fidoxamicin is indicated for use in what?
C.diff infection but cautioned for use in severe or life threatening C.diff infection.
121
WHat is the drug of choice in the treatment and prophylaxis of Pnuemocystis jiroveci pneumonia?
Co-trimoxale
122
Sodium fusidate is cautioned for use in what conditions due to the risk of reduced elimination leading to toxic effects?
Billary disease or billary obstruction
123
Which antibiotic requires the use of 'ideal weight for height' to prevent excessive dosage in obese patients?
```
Ceftazidime
Ertapenem
Tetracycline
Amikacin
Clarithromycin
Sodium Fusidate
Co-trimoxazole
Fidaxomicin
```
Amikacin use in obese patients requires the use of 'ideal weight for height' to calculate the dose.
Serum amikacin must be closely monitored too.
124
The appropriate date for a private script is always what?
The date on which it was signed.
125
Simvastatin has an interaction with:
Amiodarone
OR
St John's Wort
There is an icnreased risk of myopath when simvastatin is given wth amiodarone.
126
Carbamazepine administered with erythyromycin leads to what?
increased risk of carbamazepine toxicity as the plasma concetration of carbamazepine is increased by erythromycin.
Can cause dizziness, blurred vision, nause and vomiting and ataxia.
127
A requisition for a Schedule 3 CD from a registered doctor is:
```
Retained for one year
Retained for two years
Retained for five years
Retained for ten years
Returned to the patient
Returned to the prescriber
Submitted to the local accountable officer.
Submitted to the relevant NHS agency
```
Requisitions from doctors for Schedule 3 CDs should be sent to the relevant NHS agency.
128
An invoice for a Schedule 3 CD is
```
Retained for one year
Retained for two years
Retained for five years
Retained for ten years
Returned to the patient
Returned to the prescriber
Submitted to the local accountable officer.
Submitted to the relevant NHS agency
```
Retain for two years.
129
An invoice for Schedule 5 CD should be:
```
Retained for one year
Retained for two years
Retained for five years
Retained for ten years
Returned to the patient
Returned to the prescriber
Submitted to the local accountable officer.
Submitted to the relevant NHS agency
```
5 years
130
Can you dispense a hand written and signed prescription from a French Doctor presented by a britsh patient for a french branded medicine?
EEA and Swiss prescribers can write prescriptions that can be dispensed in the UK so long as it is a product available in the UK and meets prescription writing requirements.
So no.
131
How many times can an NHS prescription for bendroflumethiazide with "repeat x 2" stated in the body of the prescription be repeated?
0.
Standard NHS prescriptions are not repeatable. In England the repeat dispensing service exists, but specific forms are used for this service and stating "repeat x 2" in the body of a standard prescription would not be suitable for dispensing.
132
Out of amitriptyline and destrusitol (tolterodine), which would have the following warning labels:
This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol.
Amitriptyline.
This is warning label 2 in the BNF. Detrusitol (tolterodine) can also cause drowsiness but this has warning label 3 in the BNF which does not mention alcohol.
133
Mr A is a 45 year male with hypertension. He has developed mouth sores, a sore throat and flu-like symptoms.
Which of the following could cause this?
```
Azilsartan medoxomil
Bendroflumethiazide
Captopril
Eprosartan
Furosemide
Indapamide
Spironolactone
Telmisartan
```
The symptoms described are those of agranulocytosis, this is an uncommon side effect of bendroflumethiazide.
134
A 50 year old Caucasian lady who has been taking ramipril and amlodipine for the past 4 weeks at maximum dosing. The patient has a blood pressure reading of 170/105 mmHg that was taken in the surgery.
Which medication should be added?
```
Atenolol
Bendroflumethiazide
Candersartan
Indapamide
Lacidipine
No drug treatment
Perindopril
Spironolactone
```
Indapamide
Step 3: ACE inhibitor or angiotensin II receptor blocker + CCB + thiazide-like diuretic.
135
Mrs R, a 73 year old retired teacher, has reported extreme lethargy and dizziness 7 days after starting a second antihypertensive. She has already been taking atenolol for 10 years. Her heart rate was reported to be 45 bpm and her blood pressure as 75/40 mmHg.
What drug could be causing this?
```
Amlodipine
Atenolol
Bendroflumethiazide
Bumetanide
Doxazosin
Lisinopril
Methyldopa
Verapamil
```
Both verapamil and atenolol can increase the risk of bradycardia. This is a severe interaction.
136
What are the time limits on private repeat prescriptions?
There is no legal limit on the dispensing of private repeat prescriptions if the dispensing took place within 6 months of the appropriate date.
It should be based on clinical judgement.
137
Which of the following conditions are cautioned with the following over the counter products?
Sudafed decongestant tablets.
```
Diabetes and hypertension
Hayfever
Asthma
Hypertension and asthma
Epilepsy
Migraine
Ulcer
Ulcer and asthma
```
Diabetes and hypertension, this is cautioned in hypertension and diabetes.
138
Which of the following conditions are cautioned with the following over the counter products?
Non-drowsy Sinutab
```
Diabetes and hypertension
Hayfever
Asthma
Hypertension and asthma
Epilepsy
Migraine
Ulcer
Ulcer and asthma
```
Sinutab® contains paracetamol and pseudoephedrine, the latter is cautioned in hypertension and diabetes.
139
How long after stopping methotrexate should someone use contraception for?
Does this differ between male and female?
3 months for both.
140
Miss W is a 19 year-old patient who has developed several painful red lumps and patches (that measure 1-5cm) on her lower legs.
Which of the below is an appropriate treatment?
```
Betamethasone
Clobetasone butyrate
Griseofulvin
Hydrocortisone
Ketoconazole shampoo
Miconazole
Rest and ibuprofen
Tetracycline
```
These lumps are characteristic of erythema nodosum.
Treatment is usually rest and painkillers such as NSAIDs.
141
Mrs D comes into your pharmacy with her 5 year old son. She tells you that her son was diagnosed with ringworm one month ago and shows you a large swelling on a section of his scalp.
Which of the below is an appropriate treatment?
```
Betamethasone
Clobetasone butyrate
Griseofulvin
Hydrocortisone
Ketoconazole shampoo
Miconazole
Rest and ibuprofen
Tetracycline
```
The swelling on his scalp is a kerion, which could develop in severe ringworm infections, in this case tinea capitis.
If left untreated it could result in hair loss and permanent scarring
142
Mr A is a 42 year old man who comes into your pharmacy. He shows you hyperpigmented patches on his trunk and back. They are not red or itchy.
Which is the most appropriate treatment?
```
Betamethasone
Clobetasone butyrate
Griseofulvin
Hydrocortisone
Ketoconazole shampoo
Miconazole
Rest and ibuprofen
Tetracycline
```
Pityriasis versicolor, sometimes called tinea versicolor, is a common condition that causes small patches of skin to become scaly and discoloured (hypo/hyperpigmented). They usually occur on the trunk and back and upper arms. Pityriasis versicolor is caused by a type of yeast called Malassezia and is treated by ketoconazole shampoo.
143
Which of the following can be used to help resolve alcohol cravings?
```
Acamprosate
Buprenorphine
Disulfiram
Fluoxetine
Haloperidol
Paracetamol
Parenteral thiamine
Pimozide
```
Acamprosate is indicated as therapy to maintain abstinence in alcohol-dependent patients.
It should be combined with counselling.
Disulfiram may be used, however, it acts by causing an acute sensitivity when Mr K drinks instead of resolving the alcohol cravings.
144
What is the incubation period for chickenpox?
1-3 weeks
145
What is the incubation period for slapped cheek disease?
1-20 days
146
Which laxative can be used at a dose of up to 500mg daily in divided doses in adult patients suffering with chronic constipation?
Docusate sodium can be used up to 500mg daily in divided doses for adults suffering with chronic constipation.
147
Involuntary movements of the face would be what?
Tardive dyskinesia
148
Constantly active, unable to stop moving and feeling restless all the time would be what?
Akathisia
149
This medication must be used with caution in patients who have a sensitivity to sulfonamides.
```
Aspirin
Clotrimazole
Guaifenesin
Loratidine
Paracetamol
Pholcodine
Sumatriptan
Xylometazoline
```
Sumatriptan
150
Veterinary prescriptions for Schedule 2 CDs have what retention requirements?
Retained in pharmacy for five years
151
A requisition for a Schedule 2 CD from a vet has what retention requirements?
Retain five years
152
Which of these is suitable for use in pruritus?
```
Carbamazepine
Cinnarizine
Hydroxyzine hydrochloride
Ketotifen
Loratadine
```
Hydroxyzine hydrochloride is indicated for use in pruritus.
153
The metabolism of which one of the following medicines is NOT increased by cigarette smoking?
```
Theophylline
Clozapine
Pirfenidone
Ropinirole
Varenicline
```
The metabolism of varenicline is NOT increased by cigarette smoking.
Varenicline is a high-affinity partial agonist for the a4B2 nicotinic acetylcholine receptor subtype that leads to the release of dopamine in the nucleus accumbens when activated, and therefore, has the capacity to reduce the feelings of craving and withdrawal caused by smoking cessation.
154
Insulin strengths greater than how many units per ml are considered high strength insulin?
200units/ml
155
Idebenone may cause what discolouration to the urine?
red-brown, chromaturia, harmless effect
156
Dermatophyte infections such as tinea corporis may be exacerbated by prolonged use of topical steroids such as hydrocortisone as these exhibit immunosuppressive properties.
What oral antifungal is indicated in the treatment of tinea corporis?
Terbinafine and itraconazole
157
In an emergency, a dentist can be supplied with methadone on the undertaking the requisition will be supplied within how long?
24 hours
158
Which of the following is the most suitable treatment for a UTI in a woman who is in the first trimester of pregnancy?
Why are the other alternatives NOT appropriate?
```
Ciprofloxacin 250mg twice daily.
Doxycycline 200mg once daily.
Nitrofurantoin 50mg four times a day.
Ofloxacin 200mg daily.
Trimethoprim 200mg twice daily.
```
Trimethoprim should not be given because it is a folate antagonist and teratogenic in the first trimester.
Ciprofloxacin and ofloxacin are quinolone antibiotics and should thus be avoided in pregnancy.
Doxycycline is a tetracycline that should not be given to pregnant women due to effects on skeletal development being documented in the first trimester.
Nitrofurantoin should be avoided in pregnant mothers at term and in those who are breastfeeding but would be appropriate for someone in the first trimester.
159
Which of the following is NOT a recommended check point for avoiding dispensing errors?
```
Right dose
Right medicine
Right patient
Right quantity
Right route
```
Double checking when prescribing or administering any medicine is important to avoid any medication errors. You can double check it is the: right medicine, right patient, right dose, right route, right time.
160
What colour can rifampicin turn urine?
Red
161
What colour can ferrous salts turn the urine?
Black/dark red/brown
162
What colour can amitriptyline colour the urine?
Blue/green
163
What colour can nitrofurantoin colour the urine?
Brown/red
164
Cimetidine can colour the urine
Dark blue
165
Mrs H comes to collect her prescription for candesartan regularly from your pharmacy. She has recently been prescribed lithium for the treatment of depression. She comes into your pharmacy disorientated and complains of diarrhoea and vomiting.
What do you suspect may be the most likely cause of Mrs H's presentation?
Gastro-intestinal disturbances are a side effect of candesartan.
Candesartan could cause hypernatraemia which is causing lithium toxicity.
Lithium toxicity secondary to Mrs H taking extra doses of lithium.
Taking candesartan could lead to lithium toxicity.
Candesartan potentially increases the concentration of lithium. Manufacturer advises monitor concentration and adjust dose.
severity: Severe
evidence: Anecdotal
166
Which ONE of the following is NOT a reason to STOP the combined oral contraceptive pill?
```
Sudden breathlessness
Severe stomach pains
Hypertension - 150/90 mmHg
Jaundice
Unexplained swelling of the calf of one leg
```
Only blood pressure above systolic 160mmHg or diastolic 95mm Hg is a reason to stop the combined oral contraceptive pill.
167
Xylometazoline should not be used in children under what years of age?
<6
168
She is breastfeeding her four week old baby and the baby has oral thrush. She has been prescribed miconzaole cream for herself but she is unsure what to do with it. What is the best advice to give to the lady?
Advise her that this is not the correct treatment for her.
Advise her to apply it to her nipples after feeding the baby.
Advise her to apply it to her nipples before feeding the baby
Advise her to stop breastfeeding while undergoing treatment.
Refer her to her health visitor.
y
| The cream should be applied after feeding the baby.
169
What should happen to private prescriptions for Sch 3 CDs after they have been dispensed?
Private prescriptions for Sch 3 CDs should be sent to the relevant NHS agency.
170
What should happen to a requisition for a Sch 3 CD from a registered Dr after it has been processed?
It should be sent to the relevant NHS agency
171
What counselling should accompany the prescription of lamotrigine?
Immediately report any signs or symptoms of anaemia, bruising or infection to your doctor.
172
What illness is characterised by white spots surrounded by a red ring on the inner cheek and gums?
Measles (morbilli)
173
Pregnant women have to be extra cautious to ensure that they will not come into contact with this disease as there is an increased risk of congenital abnormalities.
German measles (rubella)
174
A 23 year old female suffers from rapid onset headaches around her right eye every night for the past week. She describes it as excruciating and tells you that she suffers from photophobia in that eye.
```
Cluster headache
Epilepsy
Meningitis
Migraine
Rebound headache
Sinus headache
Tension headache
Vertigo
```
Her signs are typical of a cluster headache: brief headaches around an eye with possible associated symptoms of unilateral photophobia, redness, lid swelling and nasal stuffiness.
These are recurrent and could last for a couple of weeks.
175
A 45 year old male comes into the pharmacy. You note that he has hallitosis. He describes a dull, throbbing headache which is made worse when he bends down.
```
Cluster headache
Epilepsy
Meningitis
Migraine
Rebound headache
Sinus headache
Tension headache
Vertigo
```
His signs are typical of a sinus headache: a dull, throbbing headache in the upper half of the face which is MADE WORSE ON BENDING DOWN. It can also be associated with hallitosis and pain, swelling and tenderness around the eyes, cheeks and forehead.
176
A 28 year old male suffers from several episodes of a type of headache throughout the year. He describes it as a throbbing unilateral headache which lasts 3 hours and is associated with photophobia, phonophobia and vomiting.
```
Cluster headache
Epilepsy
Meningitis
Migraine
Rebound headache
Sinus headache
Tension headache
Vertigo
```
His symptoms are typical of a migraine. The patient could also experience an aura prior to the start of the headache, although this does not occur in some patients.
177
What is the incubation period of chicken pox?
1-3 weeks (the same as whooping cough).
Chicken pox is most infectious one to two days before the rash appears, but it continues to be infectious until all the blisters have crusted over.
178
What is the incubation period of slapped cheek disease?
1- 20 days.
| Infectious for a few days before the rash appears but children are no longer contagious when the rash appears.
179
What is the incubation period of whooping cough?
1-3 weeks (the same as chicken pox).
Infectious from first signs of illness until about three weeks after coughing starts, if an antibiotic is given, the infectious period will continue for up to five days after starting treatment.
180
What is the incubation period of Mumps?
14-25 days.
| Infectious from a few days before starting to feel unwell until a few days afterwards.
181
What is the incubaton period of Measles?
7 - 12 days.
| Infectious from around 4 days before the rash appears until 4 days after it is gone.
182
What is the infectious and incubation period for chicken pox?
1-3 weeks (the same as whooping cough).
Chicken pox is most infectious one to two days before the rash appears, but it continues to be infectious until all the blisters have crusted over.
183
What is the infectious and incubation period for slapped cheek disease?
1-3 weeks (the same as chicken pox).
Infectious from first signs of illness until about three weeks after coughing starts, if an antibiotic is given, the infectious period will continue for up to five days after starting treatment.
184
What is the infectious period and incubation period for measles?
7 - 12 days.
| Infectious from around 4 days before the rash appears until 4 days after it is gone.
185
What is the incubation period and infectious period for German measles (Rubella)?
Incubation period: 15 to 20 days
| Infectious period: From one week before symptoms develop until up to four days after the rash appeared.
186
Which of the following is the most appropriate treatment for narcolepsy?
Dexamfetamine sulfate.
Methylphenidate
Dexamfetamine sulfate is indicated for narcolepsy and initially used at 10mg daily in divided doses.
Methylphenidate is indicated for use in narcolepsy but it is an off-licence use.
187
Following dispensing, private prescriptions for Sch 2 CDs should
Be sent to the relevant NHS agency to track prescribing trends.
188
Mr A is a 45 year male with hypertension. He has developed mouth sores, a sore throat and flu-like symptoms. Which is the most likely culprit?
```
Azilsartan medoxomil
Bendroflumethiazide
Captopril
Eprosartan
Furosemide
Indapamide
Spironolactone
Telmisartan
```
BendroFLUmethiazide.
The symptoms described are those of agranulocytosis.
Agranulcytosis is an uncommon side effect of bendroflumethiazide.
