Past Paper questions- Clinical BNF Flashcards
(225 cards)
1
Q
You are working in a busy pharmacy in central london when a worried looking mother brings in her 5 year old son Jack. He has a temperature of 39 degrees and has not been eating well for the past two days. He has developed red spots on the inside and outside of his mouth. He also has raised spots on his fingers and soles of his feet. Jack has a sore throat but no other cold-like symptoms. Which one of the following would you recommend as the best course of action?
- Recommend calamine lotion and paracetamol. Ensure ibuprofen is avoided
- Ring 999 for the ambulance service as Jack requires prompt admission into hospital
- Advice Jack’s mother to make an appointment with the GP as Jack requires antibiotics
- Recommend miconazole sugar free oral gel for the spots inside the mouth and an antiseptic cream for the feet
- Advise Jack’s mother to ensure Jack is adequately hydrated and recommend analgesics such as paracetamol and iibuprofen
A
5 is the correct answer
Rational:
The patient is presenting with signs of hand, foot and mouth disease. It gets better on its own in 7 to 10 days
The first signs of hand, foot and mouth disease can be: a sore throat; a high temperature; not wanting to eat
After a few days mouth ulcers and a rash will appear
To help the symptoms:
drink fluids to prevent dehydration – avoid acidic drinks, such as fruit juice
eat soft foods like yoghurt – avoid hot and spicy foods
take paracetamol or ibuprofen to help ease a sore mouth or throat
2
Q
Jermaine has been diagnosed with bipolar disorder and placed on lithium carbonate to help stabilise his condition. The prescribing consultant has asked you for some advice on initiating therapy.
Based on your knowledge of this medication, which of the following would be inappropriate advice regarding lithium?
- Prescribing should be by brand
- Signs of lithium toxicity include tremor and visual disturbances
- Thyroid function should be assessed before initiating treatment
- Ideal serum concentration is 1.5mmol/litre
- Concurrent use of thiazide diuretics should be avoided
A
The correct answer is D
Rational:
-Lithium should always be prescribed by brand, changing brand requires the same precautions as initiation of treatment
- Lithium toxicity signs include apathy; restlessness; tremor; GI disturbance; hypernatremia
- Before initiating and during treatment the monitoring should include renal and cardiac function; initiation serum concentration 12 hrs after first dose–> then weekly –> then every 3month when stable; thyroid function before and every 6month
- Ideal serum concentration should be 0.4-1mmol/L
- Toxic range is 1.5mmol/L +
-↓ LITHIUM EXCRETION – ↑ TOXCICITY- NSAIDs; ACE inhibitors; LOOP diuretics; K sparing and aldosterone antagonists; thiazide and relate
3
Q
Miss Tina Lopez, a 67-year-old female, comes to collect her prescription medicines from a pharmacy you are locuming in. She takes the following medications:
- Ramipril 5mg tablets
- Amlodipine 10mg tablets
- Sulfasalzaine 500mg tablets
- Hyoscine butylbromide (Buscopan®) 10mg tablets
- Tibolone 2.5mg tablets
You go through the prepared medicines with Miss Lopez prior to testing her blood pressure and realise that baclofen 10mg tablets have been dispensed instead of Buscopan® 10mg tablets. This error is corrected. You then proceeded to test Miss Lopez’s blood pressure three times, of which the average was found to be 165/98.
Which of the following is the most appropriate action to take?
- Advise Miss Lopez on the importance of diet and exercise
- Advise Miss Lopez to book an appointment with her doctor to review her medication
- Record the dispensing error in the near miss log
- Report your concern of the dispenser’s competency to the superintendent pharmacist
- Stop treatment of tibolone
A
The correct answer is 5
Rational:
Tibolone (Brand name Livial) is POM medicine similar to combined HRT.
Miss Tina has high BP, the recommended BP for her age 140/90.
4
Q
Mr Parker has been very busy in his new role, and has forgotten to order his repeat medication. He has now run out of his regular medication and has contacted his surgery in Brighton. The Brighton surgery has faxed you a prescription for Mr Parker for the following items:
- Amlodipine 10mg tablets x 56
- Simvastatin 10mg tablets x 56
- Aspirin 75mg tablets x 56
- Allopurinol 100mg tablets x 28 (new medication)
Which of the following statements regarding the faxed prescription is correct?
- The original prescription needs to be sent to the pharmacy within five days of being faxed
- You can only supply up to 30 days’ worth of treatment
- The faxed copy of the prescription is not a legally valid prescription
- Faxed prescriptions need to be retained in the pharmacy for 2 years
- Schedule 3 Control Drugs which aren’t under safe custody regulations are allowed to be dispensed against a faxed prescription
A
The correct answer is 3
5
Q
Which of the following is not a notifiable disease in the UK?
- Food poisoning
- Zika virus
- Malaria
- Smallpox
- Coronavirus (COVID-19)
A
The correct answer is 2
Rational: The following are all notifiable diseases in the UK: Anthrax Botulism Brucellosis Cholera COVID-19 Diarrhoea (infectious bloody) Diphtheria Encephalitis (acute) Food poisoning Haemolytic uraemic syndrome (HUS) Haemorrhagic fever (viral) Hepatitis (acute infectious) Legionnaires’ disease Leprosy Malaria Measles Meningitis (acute) Meningococcal septicaemia Mumps Paratyphoid fever Plague Poliomyelitis (acute) Rabies Rubella Severe acute respiratory syndrome (SARS) Scarlet fever Smallpox Streptococcal disease (Group A, invasive) Tetanus Tuberculosis Typhoid fever Typhus Whooping cough Yellow fever
6
Q
Before proceeding, the surgeon and anaesthetist want to check the severity of the patients renal function. Her estimated glomerular filtration rate (eGFR) is 20ml/min/1.73 m2.
What level of renal function does the patient have?
- Mild reduction relative to normal range for a young adult
- Mild-moderate reduction
- Moderate-severe reduction
- Severe reduction
- Kidney failure
A
The correct answer is 4
Rational:
A normal eGFR is 60 or more. If your eGFR is less than 60 for three months or more, your kidneys may not be working well.
Stage 1= eGFR in normal range (greater than 90) with other signs of kidney damage, like protein in urine or physical damage to the kidneys
Stage 2= eGFR in normal range (60-89) with other signs of kidney damage, like protein in urine or physical damage to the kidneys
Stage 3= eGFR 30-59, moderate kidney damage
Stage 4= eGFR 15-29, severe kidney damage
Stage 5= eGFR less than 15, the kidneys are close to failure or have already failed
7
Q
You have discovered that Mrs Williams takes a few medications that are interacting with each other and query a few of them with Mrs Williams. Which is the most significant of the interactions described below?
- Alcohol and sertraline
- Clarithromycin and naproxen
- Naproxen and prednisolone
- Naproxen and sertraline
- Sertraline and clarithromycin
A
The correct answer is 3
Rational:
- Using prednisolone together with naproxen may increase the risk of side effects in the gastrointestinal tract such as inflammation, bleeding, ulceration, and rarely, perforation
- Taking naproxen with sertraline MAY increase the risk of bleeding
8
Q
Mr Winks then tells you the medication he is currently taking. You suggest to Mr Winks that it may be one of his medicines causing his dry eyes and mouth.
Which of the following medications is most likely to be causing his dry mouth?
- Amlodipine
- Olmesartan medoxomil
- Oxybutynin
- Piroxicam
- Salbutamol
A
The correct answer is 3
Rational:
Amlodipine is a CCB
Olmesartan is an ARB
Piroxicam is a NSAID - highest risk of GI bleeding
Salbutamol is a SABA- associated with muscle cramps
Oxybutynin is an anti-muscarinic
Antimuscarinic SE include:
Constipation; dizziness; drowsiness; dry mouth; dyspepsia; flushing; headache; nausea; palpitations; skin reactions; tachycardia; urinary disorders; vision disorders; vomiting
9
Q
Mr Andy Collins, a 34-year-old man, suffers from type 1 diabetes. He has recently invested in a machine to measure his blood glucose levels at home before eating lunch.
Which of the following is a recommended target for his blood-glucose concentration?
- 3 ‒ 7 mmol/litre
- 4 ‒ 7 mmol/litre
- 5 ‒ 7 mmol/litre
- 5 ‒ 9 mmol/litre
- At least 5 mmol/litre
A
The correct answer is 2
Rational:
Blood glucose targets:
- HbA1c for T1D 6.5-7.5% (48-59) or less ; if diabetic patient is at high risk of arterial disease <6.5%
- A fasting blood glycose of 5-7 on waking
- A blood glucose of 4-7 before meals
- A blood glucose of 5-9 90 minutes after meals
- A blood-glucose of at least 5 when driving
10
Q
A junior doctor wants to administer diazepam to one of his patients who is suffering from convulsive status epilepticus. However, there are not any intravenous injections available on the ward so she asks you for an alternative.
Based on your knowledge of drug absorption and the current available formulations, which one of the following would you recommend to the junior doctor?
- Diazepam buccal tablet
- Diazepam patches
- Diazepam intramuscular injection
- Diazepam oral solution
- Diazepam enema
A
The correct answer is 5
Rational:
Diazepam does not come as buccal tablets and not recommended as IV it can result in phlebitis
11
Q
Surjit, a 26-year-old man, has been taking olanzapine 10mg once daily for 6 months. He explains to you that the doctor has now changed his medication as he has gained 5kg and possibly has diabetes, since starting the tablets.
He has not made any changes to his diet and lifestyle.
Which of the following antipsychotic medication is the most suitable option for the doctor to have switched Surjit onto? Group of answer choices
- Chlorpromazine
- Clozapine
- Risperidone
- Amisulpride
- Quetiapine
A
The correct answer is 4
12
Q
Sarah, a 16-year-old high school student, has complained of drowsiness and confusion to her teacher; it is affecting her ability to concentrate during lessons. Sarah has been taking fluoxetine 20mg daily for the last 3 months; she was previously taking 10mg daily.
Which of the following is the most likely cause of these symptoms?
- Hypothermia
- Hypocalcaemia
- Hyponatraemia
- Hypokalaemia
- Hypothermia
A
The correct answer is 3
Rational:
All antidepressants can result in hyponatraemia- drowsiness, confusion, convulsion esp. SSRIs and usually occurs in elderly
13
Q
Mr Bing asks to speak to you in private. You show him into the consultation room and he tells you that he wants to buy some Viagra® as he has heard that you can now buy it over the counter. You explain that Viagra Connect® (sildenafil) 50mg tablets can be sold, but that you need to check that the drug is suitable for Mr Bing before you can sell it to him.
Which of the of the following would NOT prevent you from selling Viagra Connect® 50mg tablets to Mr Bing today?
- He is 17-years-old
- He is currently taking ibuprofen 400mg tablets three times a day
- He has no difficulty achieving or maintaining an erection
- He has Peyronie’s disease
- He has low blood pressure (85/49 mmHg)
A
The correct answer is 2
Rational:
https://hcp.viagraconnect.co.uk/sites/default/files/2020-12/Viagra%20Connect%20Checklist_0_0.pdf
14
Q
You receive a prescription for Nathan, a 12-year-old boy, for nystatin 100,000 units to be taken four times daily to treat oral thrush. You have 30mL bottles containing 100,000 units/ml.
How long should Nathan take the nystatin for?
- 5 days and continued for 24 hours after the lesions have resolved
- 7 days and continued for 24 hours after the lesions have resolved
- 7 days and continued for 48 hours after the lesions have resolved
- 10 days and continued for 24 hours after the lesions have resolved
- 10 days and continued for 48 hours after the lesions have resolved
A
The correct answer is 3
15
Q
Jennifer is 37 years of age and has four children. She does not want to have any more children and would like to take the combined oral contraceptive pill, which she used to take when she was younger. However, she is not sure if her GP will prescribe it to her, as she is a smoker (40 cigarettes a day). She does not have any medical conditions and does not take any medication. Her BMI is 23.5.
What can you advise Jennifer about the suitability of the combined oral contraceptive pill for her?
- She will be able to take the combined oral contraceptive as she only has one risk factor for venous thromboembolism and/or for arterial disease
- She will be able to take the combined oral contraceptive as she only has two risk factors for venous thromboembolism and/or arterial disease
- She will not be able to take the combined oral contraceptive as she has one risk factor for venous thromboembolism and/or arterial disease
- She will be able to take the combined oral contraceptive, as she has no risk factors for venous thromboembolism and/or arterial disease
- She will not be able to take the combined oral contraceptive as she has two risk factors for venous thromboembolism and/or arterial disease
A
The correct answer is 5
Rational: Increased risk of VTE; risk factors that increase it: - Type of progestogen: desogestrel, gestodene, drosperinone - Obesity BMI >30 - Smoking - Primary relative under 45 with VTE - Superficial thrombophlebitis - Long-term immobilisation - Age >35 years
Increased risk of ATE with:
- diabetes mellitus
- Hypertension
- Migraine without aura
AVOID IF 2 OR MORE RISK FACTORS PRESENT
16
Q
A 10-month-old baby has been admitted to A&E presenting with unexplained petechial rash and fever. The baby appears to be quite ill and irritated.
Which of the following blood parameters indicate the condition to be bacterial meningitis?
- C-reactive protein
- Creatinine kinase
- D-dimer
- Total serum calcium
- Red blood count
A
The correct answer is 1
17
Q
Natalie is visiting your pharmacy in Devon, the week before Christmas, to seek advice about her son Ben who has coeliac disease. She is worried as he is not eating very well and is quite small for a 7-year-old. He complains of constant soreness and she has read that calcium and vitamin D absorption can be impaired in people with coeliac disease. She asks which vitamin supplement you would recommend.
Which of the following options would be the best advice to give to Natalie?
- Recommend vitamin D 25mcg tablets as Ben’s vitamin D levels are most likely to be low
- Recommend vitamin D 25mcg tablets as this the advice given by Public Health England for all individuals in the UK during the winter months. As well as this, advice that Ben should take a multivitamin containing calcium, as he is not receiving the correct nutrition from his diet
- Recommend vitamin D 10 mcg tablets as this is the recommended dose for his age
- Recommend vitamin D 10 mcg tablets as this the advice given by Public Health England for all individuals in the UK during the winter months. However, also advise Natalie to take Ben to his GP to review his vitamin levels via a blood test, as his coeliac disease may mean that he needs additional supplementation
- Recommend vitamin D 10 mcg tablets as this the advice given by Public Health England for all individuals in the UK. However, also advise Natalie to take Ben to his GP to review his vitamin levels via a blood test, OTC vitamins should be used with caution in people with coeliac disease
A
The correct answer is 4
18
Q
One of your pharmacy technicians has been writing CPD entries on the subject of methotrexate and would like to check that they have understood the patient counselling points required when dispensing methotrexate. Which of the following is the least accurate advice for a patient taking methotrexate tablets?
- The patient should be carefully advised of the dose and frequency and the reason for taking methotrexate
- The patient should not self-medicate using aspirin or ibuprofen
- The patient should report immediately any symptoms of blood disorders, liver toxicity or respiratory effects, and should be advised what these symptoms might be
- The patient can take their dose with or without food
- The patient should use effective contraception during and for at least three months after treatment
A
The correct answer is 5
Rational:
The patient whether male or female should use effective contraception during and for at least 6.5 months (26 weeks) after stopping treatment before trying for a baby
19
Q
This medication should not be used by Michelle who is 63-years-old and takes sotalol 40mg tablets twice a day as it is contraindicated.
- Trifluoperazine
- Domperidone
- Hyoscine hydrobromide
- Betahistine
- Nabilone
- Cinnarizine
- Aprepitant
- Promethazine
A
The correct answer is 2
20
Q
This medication can be prescribed short-term as a treatment for Victoria who is 7 weeks pregnant and has been severely vomiting. She has already tried using ginger tea and ginger biscuits but these have not helped.
- Trifluoperazine
- Domperidone
- Hyoscine hydrobromide
- Betahistine
- Nabilone
- Cinnarizine
- Aprepitant
- Promethazine
A
The correct answer is 8
21
Q
Sandra, who is 38-years-old, should be advised not to drive as this medication causes drowsiness.
- Amlodipine
- Bendroflumethiazide
- Bisoprolol
- Doxazosin
- Lisinopril
- Methyldopa
- Nifedipine
- Verapamil
A
The correct answer is 6
22
Q
Steven, a regular patient, who has just recovered from a hip fracture, has come to your pharmacy to return some medicines that he no longer needs to use. This medication requires entry into the Controlled Drugs patient returns register but does not require an authorised witness to be present when it is destroyed.
- Temazepam
- Oxycodone
- Zopiclone
- Codeine phosphate
- Zolpidem
- Tramadol
- Nitrazepam
- Trazodone
A
The correct answer is 2
23
Q
This medication was prescribed to John to sedate him during a dental procedure.
- Temazepam
- Oxycodone
- Zopiclone
- Codeine phosphate
- Zolpidem
- Tramadol
- Nitrazepam
- Trazodone
A
The correct answer is 1
24
Q
This medicine was given IV to an 18-day-old neonate with immature hepatic metabolism and has developed abdominal distension, pallid cyanosis and circulatory collapse whilst on this medication.
- Chloramphenicol
- Cefuroxime
- Clarithromycin
- Ethambutol
- Gentamicin
- Facid
- Sodium stibogluconate
- Terbinafine
A
The correct answer is 1
25
Magda, a 4-year-old girl, has been initiated on montelukast to prevent symptoms of asthma. She suffered from this side effect which is known to occur frequently.
1. Blurred vision
2. Candidiasis
3. Drowsiness
4. GI bleeding
5. Hyperkinesia
6. Paradoxical bronchospasm
7. Severe hypokalaemia
8. Palpitations
The correct answer is 5
26
Mrs Fife is a 72-year-old woman who is now in the advanced stage of Parkinson’s disease. She has started experiencing unpredictable ‘off’ periods with her cocareldopa treatment. Mrs Fife’s specialist is going to try adding in a potent dopamine receptor agonist, which will need to be initiated in the specialist’s clinic.
1. Apomorphine
2. Co-beneldopa
3. Entacapone
4. Orphenadrine
5. Rasagiline
6. Selegiline
7. Tolcapone
8. Amantadine
The correct answer is 1
27
Mrs Perez has type 2 diabetes and has come into your pharmacy for some advice on stopping smoking. She often experiences vaginal thrush as her blood sugar levels are sometimes uncontrolled. She has come in to buy clotrimazole cream as she is experiencing a burning feeling when she urinates. She mentions that she has also seen blood in her urine for the last few days and thinks this medication may have caused it.
1. Acarbose
2. Gliclazide
3. Pioglitazone
4. Saxagliptin
5. Tolbutamide
6. Metformin
7. Canagliflozin
8. Exenatide
The correct answer is 3
Rational:
Bladder cancer is common with pioglitazone. Symptoms to watch for :
Blood in the urine (hematuria). This is the most common early symptom of bladder cancer and typically the first sign of bladder cancer that is seen
UTI-like symptoms
Unexplained pain
Decreased appetite
Postmenopausal uterine bleeding
28
Oncology:
A 70-year-old male has commenced treatment for stage 3 colon cancer
and suffers from severe nausea and vomiting. He has been prescribed
a 5HT3 receptor antagonist to inhibit the chemoreceptor trigger zone
(CZT) vomiting centre.
A 5-fluorouracil
B Anastrozole
C Bleomycin
D Cisplatin
E Dexamethasone
F Ondansetron
G Tamoxifen
H Trastuzumab
The correct answer is F
29
Oncology:
Is prescribed as an adjunct to manage symptoms of nausea and vomiting.
A 5-fluorouracil
B Anastrozole
C Bleomycin
D Cisplatin
E Dexamethasone
F Ondansetron
G Tamoxifen
H Trastuzumab
The correct answer is E- Dexamethasone
30
Oncology:
May cause palmar-plantar erythrodysesthaesia
A 5-fluorouracil
B Anastrozole
C Bleomycin
D Cisplatin
E Dexamethasone
F Ondansetron
G Tamoxifen
H Trastuzumab
The correct answer is A
31
Oncology:
A 50-year-old female has HER2 positive metastatic breast cancer.
A 5-fluorouracil
B Anastrozole
C Bleomycin
D Cisplatin
E Dexamethasone
F Ondansetron
G Tamoxifen
H Trastuzumab
The correct answer is H
32
Oncology:
May be prescribed for the primary prevention of breast cancer in
women at moderate or high risk.
A 5-fluorouracil
B Anastrozole
C Bleomycin
D Cisplatin
E Dexamethasone
F Ondansetron
G Tamoxifen
H Trastuzumab
The correct answer is G
33
Oncology:
A two- to three-fold increase in the risk for VTE has been demonstrated in healthy women
A 5-fluorouracil
B Anastrozole
C Bleomycin
D Cisplatin
E Dexamethasone
F Ondansetron
G Tamoxifen
H Trastuzumab
The correct answer is G
34
Oncology:
Careful monitoring by audiometry should be performed prior to initiation
of therapy and prior to subsequent doses.
A 5-fluorouracil
B Anastrozole
C Bleomycin
D Cisplatin
E Dexamethasone
F Ondansetron
G Tamoxifen
H Trastuzumab
The correct answer is D
35
Oncology:
Treatment should be stopped at the first sign of oral ulceration, or
if there is evidence of gastrointestinal side effects such as stomatitis, diarrhoea, bleeding from the gastrointestinal tract of haemorrhage at
any site, oesophago pharyngitis or intractable vomiting.
A 5-fluorouracil
B Anastrozole
C Bleomycin
D Cisplatin
E Dexamethasone
F Ondansetron
G Tamoxifen
H Trastuzumab
The correct answer is A
36
Oncology:
Should not be used in premenopausal women with breast cancer
A 5-fluorouracil
B Anastrozole
C Bleomycin
D Cisplatin
E Dexamethasone
F Ondansetron
G Tamoxifen
H Trastuzumab
The correct answer is G
37
Vaccines:
Is not offered to children via the NHS due to concerns that it could
increase the risk of shingles in adults
A Human papillomavirus vaccine
B Influenza vaccine
C MMR vaccine
D Pertussis vaccine
E Pneumococcal vaccine
F Rotavirus vaccine
G Varicella vaccine
H Yellow fever vaccine
The correct answer is G
38
Vaccines:
Protect against genital warts
A Human papillomavirus vaccine
B Influenza vaccine
C MMR vaccine
D Pertussis vaccine
E Pneumococcal vaccine
F Rotavirus vaccine
G Varicella vaccine
H Yellow fever vaccine
The correct answer is A
39
Vaccines:
Recommended for patients who have had their spleen removed
A Human papillomavirus vaccine
B Influenza vaccine
C MMR vaccine
D Pertussis vaccine
E Pneumococcal vaccine
F Rotavirus vaccine
G Varicella vaccine
H Yellow fever vaccine
The correct answer is E
40
Vaccines:
Offered to pregnant women to protect them and their babies against whooping cough.
A Human papillomavirus vaccine
B Influenza vaccine
C MMR vaccine
D Pertussis vaccine
E Pneumococcal vaccine
F Rotavirus vaccine
G Varicella vaccine
H Yellow fever vaccine
The correct answer is D
41
Vaccines:
The first oral dose is given to infants at 8 weeks
A Human papillomavirus vaccine
B Influenza vaccine
C MMR vaccine
D Pertussis vaccine
E Pneumococcal vaccine
F Rotavirus vaccine
G Varicella vaccine
H Yellow fever vaccine
The correct answer is F
42
Which ONE the following is most likely to cause dry mouth?
1. Salbutamol
2. Salmeterol
3. Ipratropium
4. Terbutaline
5. Theophylline
Ipratropium - antimuscarinic drug results in dry mouth
43
In your pharmacy there is a dispensing error leading to a patient safety incident.
What is the most appropriate technique to identify the cause of the dispensing error?
1. Clinical audit
2. Root cause analysis
3. SMART criteria
4. SWOT analysis
5. Systematic review
2. Root cause analysis
44
You are a hospital pharmacist working in ICU. Mr K, who is a pharmacy summer student, comes to ask you about the acronym MDRD which he saw in a patient's medical record.
Regarding this acronym, which one of the following is correct?
1. MDRD stands for malnutrition disease related to diabetes
2. MDRD stands for malnutrition double the risk of developing disease
3. MDRD stands for malnutrition of diet in renal disease
4. MDRD is used for patients in the ICU who have special dietary requirements
5. MDRD is used to measure eGFR of a patient
5. MDRD is used to measure eGFR of a patient
45
Mr W comes into your pharmacy. He tells you that he suffers from severe pain and is currently taking paracetamol.
Which of the following painkillers can Mr W take in addition to his paracetamol?
1. Co-codamol
2. Codis
3. Co-dydramol
4. Panadol Actifast
5. Tramacet - tramadol and paracetamol combination
2. Codis - aspirin and codeine combination
46
You are learning about the use of cytotoxic medicines.
According to NPSA guidance, which of the following does a patient NOT need written information on when taking oral cytotoxic medicines?
1. Intended drug regimen
2. Monitoring arrangements
3. Side effects they have experienced
4. Their specialists contact details
5. Treatment plan
3. Side effects they have experienced
Rational:
"Patients should be fully informed and receive verbal and up-to-date written information about their oral anticancer therapy from the initiating hospital. This information should include contact details for specialist advice, which can be shared with non-specialist practitioners. Written information including details of the intended oral anti-cancer regimen and treatment plan including arrangements for monitoring, taken from the original protocol, should be given to the patient. When shared with pharmacists and dispensing staff, this would enable the above dispensing requirements to be satisfied."
47
Warts are a common skin condition seen in children.
Which symptom best describe warts?
1. Raised crusty lesions
2. Raised hyperkeratotic papules
3. Raised papules with central dimples
4. Raised smooth papules
5. Raised waxy lesions
2. Raised hyperkeratotic papules
48
A middle aged man presents to the pharmacy complaining of epigastric pain.
Which condition is most closely associated with pain seen in this region?
1. Appendicitis
2. Diverticulitis
3. Gastric ulcer
4. IBS
5. Renal colic
3. Gastric ulcer
Rational:
"Appendicitis has central or right lower quadrant pain; diverticulitis and irritable bowel syndrome are associated with left lower quadrant pain; renal colic pain is usually in the loin area."
49
Mr XX visits your pharmacy to ask about getting some sleep aids as he has been struggling to get a good night of sleep.
Which of the following conditions is most likely to be disturbing his sleep pattern?
1. Frozen shoulder
2. Housemaid's knee
3. Lateral epicondylitis (tennis elbow)
4. Medial epicondylitis (golfer's elbow)
5. Rotator cuff syndrome
1. Frozen shoulder
Rational:
"Pain is observed in all conditions. Epicondylitis are not associated with night pain, and neither is housemaid's knee. Rotator cuff and frozen shoulder can wake the patient, but it is frozen shoulder that is the more likely of the two to cause this problem."
50
Mrs WB is a 77-year-old woman, who is admitted to hospital for the treatment of hallucinations. Her past medical history is multiple sclerosis. Her doctor decides to prescribe haloperidol.
The next day the ward pharmacist carries out a medicines reconciliation with Mrs WB. Which ONE of the following medicines could be contributing to the reason for Mrs WB's admission to hospital?
1. Paracetamol 1 g QDS started 5 years ago
2. Dantrolene 100 mg four times daily started three months ago
3. Baclofen 10 mg TDS started 3 weeks ago
4. Bendroflumethiazide 2.5 mg OM started 20 years ago
5. Metformin 500 mg TDS started 5 years ago
3. Baclofen 10 mg TDS started 3 weeks ago- causes hallucinations
51
The responsible pharmacist has left the pharmacy to deliver a medication to the nearby nursing home.
Given that the responsible pharmacist is allowed to be away from the Pharmacy for up to 2 hours, and that they are the only pharmacist working at the pharmacy, which one of the following activities could you do in their absence?
1. Hand over medications to a patient, which had been dispensed and checked earlier in the day
2. Provide insulin, as an emergency supply, to a diabetic patient
3. Supply Beconase® 0.05% Hayfever Nasal Spray 100 dose pack to a patient with hayfever
4. Supply chloramphenicol eye drops to a patient with conjunctivitis
5. Supply 2 packs of 32 tablets of paracetamol to a patient with osteoarthritis
3. Supply Beconase® 0.05% Hayfever Nasal Spray 100 dose pack to a patient with hayfever
52
Which ONE of the following is NOT a reason to STOP the combined oral contraceptive pill?
1. Sudden breathlessness
2. Severe stomach pain
3. Hypertension 150/90
4. Jaundice
5. Unexplained swelling of the calf of one leg
3. Hypertension 150/90- only blood pressure of
| 160/95 is a reason to stop the COC
53
In which one of the following patients should combined oral contraceptives be avoided due to arterial disease risk factors?
1. A patient who smokes 30 cigarettes a day
2. A patient with blood pressure of 150/90
3. A 45 year old patient
4. A patient with BMI of 33
5. A patient with severe migraines with aura
5. A patient with severe migraines with aura-are at an increased risk of stroke
54
A junior doctor wishes to prescribe morphine sulfate on a discharge prescription following a hip replacement for a 45-year-old patient.
What is the maximum number of days that should be prescribed in this instance?
1. 7 days
2. 10 days
3. 14 days
4. 28 days
5. 30 days
5. 30 days
55
Primary dysmenorrhoea is a common presenting symptom seen by community pharmacists and has a well described set of symptoms.
Which of the following statements is FALSE with regard to primary dysmenorrhoea?
1. Back pain if often experienced
2. Is always caused by an underlying condition
3. Pain is described as dull and continuous
4. Pain tends to decrease once the period has begun
5. Pain typically starts just before the period starts
2. Is always caused by an underlying condition
Rational:
"Period pain usually begins around the onset of menstruation; pain is seen prior to the period starting and lessens once it has started; not all, but a substantial number of women, experience back pain. It is painful cramping and usually throbbing."
56
You are dispensing a prescription for sodium valproate for Mrs DS who is 26 years old.
When dispensing the prescription, you ask if she has signed a risk acknowledgement form, but she says that she hasn't. What should you do?
[https://www.gov.uk/drug-safety-update/valproate-medicines-are-you-in-acting-in-compliance-with-the-pregnancy-prevention-measures](https://www.gov.uk/drug-safety-update/valproate-medicines-are-you-in-acting-in-compliance-with-the-pregnancy-prevention-measures)
1. Dispense, the prescription, but advise the patient to see her GP as soon as possible
2. Dispense the prescription without taking any further steps
3. Do no dispense the prescription and advise the
patient to see her GP as soon as possible
4. Do not dispense the prescription and alert the GP that you have not dispensed it
5. Do not dispense the prescription as this form should be signed before the prescription can be dispensed
1. Dispense, the prescription, but advise the patient to see her GP as soon as possible
Rational:
"When dispensing sodium valproate pharmacists should check whether women are enrolled in the Pregnancy Prevention Programme and have signed a Risk Acknowledgement Form - if not, dispense the prescription and advise the patient to speak to her GP as soon as possible (including by contacting the GP directly if necessary) for a specialist referral."
57
You are gaining a patient's consent to disclose their information to another pharmacy.
Which one of the following things regarding patient information are NOT relevant for the patient to understand?
1. What information will be disclosed
2. Why information will be disclosed
3. Who the information will be disclosed to
4. Consequences of non-disclosure
5. How to contact you if they change their mind
5. How to contact you if they change their mind
58
A doctor approaches you on the ward to discuss side effects of antibiotics and in particular antibiotics that may affect the functioning of the liver.
Which of the following antibiotics may cause cholestatic jaundice to occur, up to two months after treatment with this antibiotic has stopped?
1. Benzylpenicillin Sodium
2. Flucloxacillin
3. Linezolid
4. Nalidixic acid
5. Phenoxymethylpenicillin
2. Flucloxacillin
Rational:
"MHRA warning stipulates that flucloxacillin may cause cholestatic jaundice at any time during treatment and up to two months post treatment. Patients should be adequately counselled and report any concerns to a healthcare professional."
59
Ms AL suffers from depression and has been taking phenelzine 15 mg 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.
The SPC is provided here: [http://www.medicines.org.uk/emc/medicine/25737](http://www.medicines.org.uk/emc/medicine/25737)
How soon after stopping the phenelzine can Mrs AL start taking the fluoxetine?
1. immediately
2. 1 week
3. 2 weeks
4. 3 weeks
5. 4 weeks
3. 2 weeks
60
A patient experiencing an epileptic seizure is brought into Accident and Emergency for treatment.
What is the most appropriate treatment for patients to be prescribed for treatment of status epilepticus should they experience this in their day-to-day life?
1. Clobazam tablets
2. Clonazepam tablets
3. Diazepam IV
4. Diazepam rectally
5. Midazolam buccally
5. Midazolam buccally
Rational:
"Diazepam IV would be unusual for epilepsy with rectal diazepam being preferred as it is a safer and rapidly acting option. However, in day-to-day life this may be difficult to administer. Midazolam buccal would be the drug of choice in practice as it is also well absorbed. It is placed between the gum and the teeth along the side of the tongue and may be split so that a dose is given into each cheek to avoid accidental swallowing."
61
It is mid-March and a patient presents to you in the pharmacy displaying cold-like symptoms. On questioning she says she remembers having a really bad cold last year at the same time.
On questioning the patient, you suspect she might have an allergy rather than a cold. What is the likely cause of her allergy?
1. Dust mites
2. Grass pollen
3. Mould
4. Pet allergy
5. Tree pollen
5. Tree pollen
62
Mrs T comes into the hospital with a potassium level of 7 mmol/L (range 3.5-5.3) and is diagnosed with hyperkalaemia.
Which drug requires monitoring for hyperkalaemia?
1. Citalopram
2. Enoxaparin
3. Ferrous sulphate
4. Naproxen
5. Salbutamol
2. Enoxaparin
Rational:
"Enoxaparin can raise potassium levels due to it inhibiting aldosterone secretion. This is particularly in patients with diabetes mellitus, chronic renal failure, pre-existing metabolic acidosis, taking medicinal products known to increase potassium. Plasma potassium should be monitored regularly especially in patients at risk.
**References:**
BNF: individual drug monographs
[https://www.medicines.org.uk/emc/product/4499]"
63
There are several drugs which may interact with the oral contraceptive Yasmin.
Which of the following drugs reduces the effectiveness of Yasmin?
1. Naloxone
2. Paracetamol
3. Ranolazine
4. Rifabutin
5. Selegiline
4. Rifabutin
64
A person is travelling to an area where there is poor sanitation and poor food hygiene and requires advice.
Which vaccine is indicated for this patient?
1. Hep B vaccine
2. Meningococcal A, C, W135 and Y vaccine
3. Pneumococcal vaccine
4. Rabies vaccine
5. Typhoid vaccine
5. Typhoid vaccine
65
Your dispenser is measuring out the daily methadone liquid prescriptions. As she returns the bottle to the cupboard she drops it and it smashes on the floor.
What is the most appropriate way to clear up the spillage?
1. Clear up with tissue and denature
2. Clear up with tissue and store in a bag in the CD cupboard
3. Clear up with tissue and throw in the bin
4. Mop up the floor and pour waste water down the drain
5. Mop up the floor and pour waste water into denaturing kit
2. Clear up with tissue and store in a bag in the CD cupboard
Rational:
"Destruction of stock of a CD should be witnessed by an authorised person. This includes spillages. Therefore, the spillage should be cleaned up and kept in the CD cupboard until destruction can be witnessed."
66
An elderly woman presents in the pharmacy on a Friday morning complaining of a bothersome headache.
Which one of the following symptom clusters require you to make an urgent referral to the doctor?
1. Bilateral generalised headache
2. Bilateral headache with symptoms that worsen as the day progresses
3. Unilateral frontal headache which worsens on bending down
4. Unilateral headache with associated nausea
5. Unilateral headache with malaise
5. Unilateral headache with malaise
Rational:
"Unilateral headache with associated nausea suggests migraine; bilateral generalised headache and bilateral headache with symptoms that worse as the day progresses suggests tension-type headache; unilateral frontal headache which worsens on bending down suggests sinusitis; unilateral headache with malaise could be temporal arteritis."
67
You are counselling a patient on the use of her newly prescribed conventional DMARD.
How long is it until she is most likely to see an effect from her treatment?
1. 2-3 days
2. 1-2 weeks
3. 2-3 weeks
4. 1-2 months
5. 2-3 months
5. 2-3 months
Rational:
Conventional DMARDs have a slow onset of action and can take 2-3 months to take effect.
68
Mrs W is a 75-year-old lady with a leg ulcer who is on your ward. She has acute pain over the weekend in her knee and the doctor thinks it might be gout.
You check her renal function on Monday and it has considerably deteriorated. Her doctor asks you to have a look at her medication history and determine which one, if any, of her medicines is most likely to be related to a decline in renal function.
- Ibuprofen 400 mg QDS
- Flucloxacillin 500 mg QDS
- Penicillin VK 500 mg QDS
- Paracetamol 1 g QDS
What would be the most appropriate response?
1. Not likely to be related to any of the medicines
2. Related to a drug interaction between the medicines
3. Likely to be caused by ibuprofen
4. Likely to be caused by Penicillin VK
5. Likely to be caused by the paracetamol
3. Likely to be caused by ibuprofen
69
Mr G is a 78-year-old retired school teacher. He has arthritis and is experiencing severe discomfort in his movements.
Which one of the following allied healthcare professionals is the most suitable to assess and support Mr G with his discomfort and could provide the patient with the support aids to assist him?
1. Dietitian
2. Occupational therapist
3. Orthoptist
4. Orthotist
5. Support Worker
4. Orthotist
Explanation of the occupations:
Occupational therapist - "help people who have difficulties carrying out day-to-day activities because of a disability, illness, trauma, ageing, and a range of long-term conditions"
Orthoptist - "help improve the quality of people’s lives by treating eye disorders and spotting serious neurological conditions"
Orthotist -"provide support aids to correct problems or deformities in people's nerves, muscles or bones. Examples include splints, braces and special footwear (orthotics)."
70
When looking at a patient's urea and electrolytes levels, you notice that the potassium level is 2.7 mmol/L.
Which of the patient's regular medications could cause this low potassium level?
1. Aspirin
2. Atorvastatin
3. Salbutamol Nebulisers - may cause hypokalaemia
4. Lactulose
5. Soluble paracetamol
3. Salbutamol Nebulisers - may cause hypokalaemia
71
Miss J is a 23-year-old female who has just been admitted into hospital following a car accident. She is recovering from a hip fracture. Her consultant prescribes her zoledronic acid.
Which one of the following action is the most suitable for you to take?
1. Dispense zoledronic acid, no further action is required
2. Advise Miss J's consultant to add calcium 500 mg daily and vitamin D 400 units daily
3. Zolendronic acid may not be suitable in woman of child bearing age. Contact Miss J's consultant to discuss this further.
4. Advise Miss J to eat before her dosage is given
5. Dispense an alternative bisphosphonate
3. Zolendronic acid may not be suitable in woman of child bearing age. Contact Miss J's consultant to discuss this further.
72
Evidence-based practice promotes better clinical outcomes for patients. To ensure that medicines and practice are evidence-based, a process of reviewing and appraising the literature is needed.
Which of the following types of literature would be deemed to provide 'the best available evidence'?
1. Case-controlled studies
2. Cohort studies
3. Expert opinion
4. Randomised controlled trials
5. Systematic reviews
5. Systematic reviews
73
You are the on duty pharmacist in a community pharmacy. Miss JA, who is 17 years old, presents in your pharmacy enquiring about a rash she has developed. You note from her patient medication record that you recently dispensed amoxicillin capsules for her. She tells you that this was for tonsillitis. Her patient medication record suggests she has received amoxicillin before but she states that she has never had a rash like this before now.
What is the most suitable course of action?
1. Refer to her dentist
2. Refer to the GP for further investigation and/or treatment
3. Refer to her GP urgently
4. Sell her a throat lozenge
5. Send her to the A&E department
2. Refer to the GP for further investigation and/or treatment
Rational:
"Miss JA's symptoms suggest she may have glandular fever and the GP should investigate this further. Patients with glandular fever may experience a rash when given amoxicillin."
74
Which of the following terms is defined as shortness of breath on lying down?
1. Apnoea
2. Dysphagia
3. Dysplasia
4. Dyspraxia
5. Orthopnea
5. Orthopnea
Rational:
"Orthopnea is defined as shortness of breath (dyspnoea) when lying down flat. Apnoea is cessation of breathing during sleep. Dysphagia is difficulty in swallowing. Dysplasia is abnormal cell growth. Dyspraxia is a developmental disorder."
75
A 5-year-old child has been diagnosed with a bacterial chest infection.
Which is the LEAST appropriate antimicrobial agent to use in a 5-year-old child?
1. Azithromycin
2. Ciprofloxacin
3. Co-amoxiclav
4. Co-trimoxazole
5. Doxycycline
5. Doxycycline
76
You are the Responsible Pharmacist and you are helping your pre-registration pharmacist to revise about Controlled Drugs.
Which of the following Controlled Drugs is most likely to require a licence for import/export as well as the need to retain the invoice for 2 years?
1. Diazepam tablets 2 mg
2. Morphine sulfate Oral Solution 10 mg/5 mL
3. Morphine sulfate Oral Solution 100 mg/5 mL
4. Morphine sulfate tablets 10 mg
5. Temazepam 10 mg tablets
5. Temazepam 10 mg tablets
77
An adult presents to the pharmacy with a rash on their lower left leg.
Which condition is classically associated with the lower extremities?
1. Discoid eczema
2. Ringworm
3. Seborrheic dermatitis
4. Shingles
5. Urticaria
1. Discoid eczema
78
A patient newly started on tuberculosis treatment comes into your pharmacy with a bowel complaint.
What is the most likely cause of flatulence?
1. Ethambutol
2. Isoniazid
3. Pyrazinamide
4. Rifampicin
5. Streptomycin
1. Ethambutol
79
You receive a prescription for phenytoin injection 250 mg/5 mL, 100 mg three times daily for one of your patients. The trainee dispensing technician comments that she has never seen phenytoin prescribed in injection form before and asks you why this is.
What is the best explanation to give her?
1. Injectable phenytoin decreases adherence
2. Injectable phenytoin increases the risk of adverse effect
3. Injectable phenytoin is more error-prone with a risk of death
4. Injectable phenytoin provides a slower response
5. Injectable phenytoin reduces efficacy
3. Injectable phenytoin is more error-prone with a risk of death
80
Ritonavir is a protease Inhibitor prescribed for use in HIV.
Which of the following drugs will NOT interact with ritonavir?
1. Omeprazole
2. Repaglinide
3. Tacrolimus
4. Tadalfill
5. Zopiclone
1. Omeprazole
81
A terminally ill patient is very constipated and a doctor asks you to recommend a suitable laxative.
Which one of the following is licensed only for use in terminally ill patients?
1. Bisacodyl
2. Co-danthramer
3. Docusate sodium
4. Lactulose
5. Senna
2. Co-danthramer
82
Counselling for medicines often involves advising patients to look out for key side effects.
Which of the following side effects of clozapine should be reported due to the risk of fatality?
1. Blurred vision
2. Constipation
3. Headache
4. Nausea
5. Tiredness
2. Constipation
83
Which of the following medicines must be cautioned in diabetes due to affects on blood glucose?
1. Beconase
2. Dulcolax
3. Nurofen 200mg tablets
4. Sterimar
5. Sudafed decongestant tablets
5. Sudafed decongestant tablets - pseudoephedrine increase blood glucose levels
84
A 12-year-old girl is taken to see her GP by her mother to discuss prevention of cervical cancer.
Which vaccine is indicated for this patient?
1. BCG vaccine
2. Hepatitis A vaccine
3. Human papilloma virus vaccine
4. Intradermal seasonal influenza vaccine
5. Poliomyelitis vaccine for oral use
3. Human papilloma virus vaccine
85
A patient is initiated on a medication for which they will need to take extra precautions to protect their skin from sunlight whilst taking it.
Which of the following drugs when given at higher doses does this advice apply to?
1. Indapamide
2. Lithium carbonate
3. Pizotifen
4. Promazine
5. Ramipril
4. Promazine
86
Which one of the following medicines does NOT affect the monoamine oxidase enzyme family?
1. Selegiline
2. Linezolid
3. Moclobemide
4. Phenelzine
5. Clonidine
5. Clonidine
Rational:
"Clonidine is the only one that does NOT affect the monoamine oxidase enzyme family. Linezolid is a reversible, non-selective inhibitor of monoamine oxidase; however, at the doses used for antibacterial therapy, it does not exert an anti-depressive effect.
**References:**
[http://www.medicines.org.uk/emc/medicine/21711#PHARMACOLOGICAL_PROPS]"
87
A 61-year-old man has been prescribed finasteride 5 mg tablets for the treatment of benign prostatic hyperplasia.
For which of the following adverse effects should you advise him to immediately stop his finasteride tablets and refer him back to the prescriber?
1. Depression
2. ED
3. Low libido
4. Pruritis
5. Rash
1. Depression
88
You are training your pre-registration pharmacist on immunisations.
Which of the following disease, that could be prevented by vaccination, is the most contagious?
1. Influenza
2. Measles
3. Mumps
4. Pertussis
5. Small pox
2. Measles
Rational:
"A person with measles is likely to infect an average of 12-18 people, the rate is 1.4-4 for influenza, 4-7 for mumps, 12-17 for pertussis and 5-7 for smallpox."
89
You attend a CPD seminar on side-effects of mineralocorticoid and glucocorticoids.
Which one of the following effects is associated more with glucocorticoid use?
1. Calcium loss
2. Diabetes
3. Hypertension
4. Potassium loss
5. Water retentio
2. Diabetes
90
Which of the following over the counter medication is most likely to have an MHRA warning associated with its abuse, due to increased risk of cardiovascular events?
1. Senna
2. Loperamide
3. Paracetamol
4. Glycerine
5. Dioralyte
2. Loperamide
Rational:
"QT prolongation, Torsade de pointes, cardiac arrest"
91
During pregnancy patients with thyroid disorders must be monitored carefully as demands on the thyroid gland change. Which of the following treatments is most appropriate for a pregnant women with hyperthyroidism in her second trimester?
1. Propylthioyracil
2. Levothyroxine
3. Blocking-replacement regimen
4. Carbimazole
5. Liothyronine
4. Carbimazole
Rational:
"1st trimester give propylthioyracil, 2nd give carbimazole. Blocking-replacement regimen and radiotherapy are CI in pregnancy"
92
You are the responsible pharmacist and a 45 year old woman would like to speak to you about her new medication, nicorandil. She is taking 5mg BD as prophylaxis medication for her recently diagnosed stable angina.
Which of the following counselling points would be the least appropriate?
1. The patient should consult with a pharmacist before taking any OTC remedies
2. The tablets are not recommended when breastfeeding
3. Treatment should be stopped if ulcers develop
4. This medication may cause nausea and vomiting
5. The tablet may be crushed and mixed with soft food if a patient is unable to swallow tablets whole
5. The tablet may be crushed and mixed with soft food if a patient is unable to swallow tablets whole
93
A patient aged 34 presents in the GP with a recent cat bite on the hand. The GP decides to prescribe antibiotics as prophylaxis for a bacterial infection as the wound is significant. The patient has a documented penicillin allergy which has caused anaphylaxis.
Which is the most appropriate antibiotic regimen for a seven day course?
1. Co-amoxiclav
2. Metronidazole and doxycycline
3. Metronidazole
4. Clarithromycin
5. Flucloxacillin
2. Metronidazole and doxycycline
94
You are a band 6 rotational pharmacist currently on your surgical rotation. A junior doctor would like to know which of the following intravenous anaesthetic is most appropriate in children, to provide a quick patient recovery and minimal hangover effect?
1. Propofol
2. Etomidate
3. Ketamine
4. Nitrous oxide
5. Thiopental sodium
1. Propofol
95
A four-year old has chronic asthma and his current
medication is: Salbutamol MDI used when required with a
spacer and Beclometasone 100mcg (Qvar) MDI inhaler with a
spacer. However, his asthma has been uncontrolled recently
and the asthma nurse would like to step up his therapy.
Which of the following is most appropriate next step?
1. Budesonide
2. Salmeterol
3. Montelukast
4. Terbutaline
5. Tiotropium
3. Montelukast
Rational:
<5 LATRA
>5 LABA
96
A patient wants to speak to you about her sore mouth which
she has been experiencing for a few weeks now. Following
further questioning you rule out a few conditions and begin
to ask about her medication. Which of the following is most
likely to cause a sore mouth?
Which of the following is most likely to cause a sore mouth?
1. Ibuprofen
2. Rivaroxaban
3. Bisoprolol
4. Revlar Ellipta
5. Salbutamol
4. Revlar Ellipta
97
A ten-year old child has developed wide-spread impetigo.
Following a skin scraping test for cultures and sensitivities
the doctor found that it was not caused by a methicillin
resistant staphylococcus aureus bacterial strain.
Which of the following is the most appropriate treatment
choice?
1. Topical fuscidic acid
2. Topical mupirocin
3. Oral flucloxacillin
4. Oral clarithromycin
5. Oral doxycycline
3. Oral flucloxacillin
98
Which of the following antibiotics are the safest in pregnant
women?
1. Metronidazole
2. Doxycycline
3. Gentamycin
4. Clindamycin
5. Chloramphenicol
4. Clindamycin
99
Vinka Alkaloids are derived from the Madagascar periwinkle
plant and are used as chemotherapeutic agents. Which of
the following administration routes is most appropriate for
vinca alkaloids such as vincristine and vinblastine?
1. IM
2. Intrathecal
3. IV
4. SC
5. Oral
3. IV
100
Chemotherapeutic agents are associated with both general
toxicities such as nausea and also specific toxicities related
to various organs within the body.
Which of the following is most likely to cause pulmonary
related side-effects?
1. Bleomycin
2. Cisplatin
3. Doxorubicin
4. Gefitinib
5. Vinblastine
1. Bleomycin
101
Miss J, aged 16-years, comes into the pharmacy asking to speak to the pharmacist privately. Miss J explains that she is experiencing very heavy periods and often bleeds through her bedding at night. She also needs to change her sanitary protection every two hours throughout the day which is preventing her from doing her normal everyday activities. She read online that there are medicines she can buy to help with this. She is currently not taking any other medicines and has no allergies.
What would be the most appropriate response to Miss J?
1. No action required, condition is self-limiting
2. Refer to GP
3. Supply ibuprofen tablets
4. Supply paracetamol tablets
5. Supply tranexamic acid tablets
2. Refer to GP
Rationale: patient has symptoms of menorrhagia, this can be treated OTC with tranexamic acid however as patient is 16 years old, we cannot supply (women aged 18-45 years), therefore must refer patient to GP to get prescription. Paracetamol, ibuprofen would not be sufficient for treatment.
102
Mr. P attends your pharmacy based travel clinic with his 9-year old son. He asks for advice about malaria tablets for their upcoming trip to Ghana. Mr. P is currently taking citalopram 10 mg and amlodipine 10 mg. His son does not take any regular medication. Neither Mr P nor his son have any known allergies.
You check the appropriate website and confirm that there is a high risk of malaria in Ghana and the recommended anti-malarials are atovaquone with proguanil hydrochloride or doxycycline or mefloquine.
Considering Mr P would prefer for both him and his son to take the same anti-malarial tablets, which of the following would be the most appropriate?
1. Atovaquone alone
2. Atovaquone combined with proguanil
3. Doxycycline
4. Mefloquine
5. Proguanil alone
Answer: 2 - Atovaquone/Proguanil
Rational:
Doxycycline not suitable for children <12 years.
Mefloquine not suitable for Mr P due to history of depression.
Atovaquone/proguanil suitable for both
103
Master M, an 8-year-old child, has been diagnosed with scarlet fever. He is known to be allergic to penicillin.
Which of the following would be the most appropriate option for Master M to treat his condition?
1. Azithromycin 300 mg once daily for 5 days
2. Doxycycline 200 mg daily for 7 days
3. No treatment, the condition is self-limiting.
4. Phenoxymethylpenicillin 250 mg qds for 10 days
5. Treatment with paracetamol alone
Answer 1, Azithromycin
Rational:
2 and 4 are not possible, due to child’s age and history of penicillin allergy - 3 and 5 are incorrect. Paracetamol can be given alongside the antibiotics.
Scarlet fever should be treated promptly with antibiotics to prevent complications, regardless of the severity of illness. Azithromycin is recommended for people with penicillin allergy.
1st line is phenoxymethylpenicillin qds for 10 days, however, this is unsuitable due to history of allergy.
Doxycycline is unsuitable as it is not a recommended antibiotic for this condition, plus it should not be prescribed for children <12 years.
104
Miss V, a 10-year-old child, has been experiencing fever, runny nose, and a red rash for the past 72 hours. Her mother took her to see the GP who recommended paracetamol and plenty of fluids and said the child does not need to stay off school. The GP found no other symptoms, including no signs of photophobia, stiff neck or vomiting.
Which of the following conditions is the most likely diagnosis for Miss V’s condition?
1. Chickenpox
2. Impetigo
3. Meningitis
4. Scarlet fever
5. Slapped cheek syndrome
Answer is 5- slapped cheek syndrome
Rational:
Once diagnosed with slapped cheek syndrome, you do not need to keep your child off school because once the rash appears, they are no longer infectious. It is usually a mild, self-limiting illness.
For children and adults (who are not pregnant) with suspected parvovirus B19 infection, management includes advice on:
Symptom relief, such as fluids, analgesia, and rest.
The need for exclusion from school, nursery, or work (if appropriate). Note: this is not usually necessary as the person is no longer infectious one day after any rash or symptoms develop.
Scarlet fever, impetigo and meningitis would all require antibiotic treatment. If your child has chickenpox, they need to be kept off school until all the spots have crusted over.
105
A GP practice based pharmacist is carrying out a medication review for Mrs L, aged 67 years. The pharmacist is considering the appropriateness of a statin for Mrs L, given her myocardial infarction 2 years ago. According to her current and past medication lists, Mrs L has never been prescribed a statin. You cannot see from her notes any clinical reason why a statin would not be appropriate and so decide to initiate one.
Which statin would be considered first line for Mrs L?
1. Atorvastatin 20mg OD
2. Atorvastatin 80mg OD
3. Rosuvastatin 20mg OD
4. Simvastatin 20mg OD
5. Simvastatin 80mg OD
2. Atorvastatin 80mg OD
Rational:
NICE recommends prescribing atorvastatin 80mg once a day first line for secondary prevention of CVD.
https://cks.nice.org.uk/topics/lipid-modification-cvd-prevention/management/lipid-therapy-secondary-preventionof-cvd/
High intensity statin treatment is the most clinically effective option for the prevention of CVD. However, statins at any intensity reduce CVD risk compared with no treatment.
106
Mr N has brought in a new prescription for Priadel© 200 mg MR tabs (lithium carbonate) for the management of bipolar disorder. Mr N has been told by the prescriber that he will require frequent monitoring whilst he is taking this medicine.
Which of the following tests is least likely to be conducted whilst Mr N is taking Priadel©?
1. Body Mass Index
2. Liver function test
3. Renal function test
4. Serum electrolytes
5. Thyroid function test
2. Liver function test
Rational:
Answer: BNF recommends monitoring body weight/BMI, serum electrolyte, eGFR, thyroid function every 6 months.
See: https://bnf.nice.org.uk/drug/lithium-carbonate.html#monitoringRequirements
107
Miss V has recently found out she is 6 weeks pregnant. She would like to purchase multivitamins as she has read that this is important to ensure a healthy pregnancy. Miss V has a previous medical history of asthma and sickle cell disease.
Which of the following would be the most appropriate advice for Miss V?
1. Miss V should avoid taking medications in pregnancy and instead eat a balanced, healthy diet with ginger if required for nausea.
2. Miss V should purchase a multivitamin supplement over the counter which contains iron and folic acid.
3. Miss V should see her GP for a prescription for folic acid 5 mg.
4. Miss V should talk to her GP as she will need a blood test first to establish if she requires multivitamins.
5. Miss V should take folic acid 400 microgram each day to prevent neonatal defects.
3. Miss V should see her GP for a prescription for folic acid 5 mg.
Rational:
Folic acid 5 mg daily should be prescribed during pregnancy to reduce the risk of neural tube defect and to compensate for the increased demand for folate during pregnancy.
This strength is not available for purchase OTC and therefore a Rx is required.
108
Which of the following risk factors does a HAS-BLED score NOT take into account as part of the calculation?
1. Age
2. Alcohol use
3. Congestive heart failure
4. Hypertension
5. Liver disease
3. Congestive heart failure
Rational:
Congestive heart failure, which is part of the CHADVASc stroke risk score.
```
HASBLED
Hypertension
Renal disease
Liver disease
Stroke history
Prior major bleeding
INR
Age >65
Medication usage predisposing to bleeding
Alcohol use
```
109
An 82-year-old patient has been newly diagnosed with type 2 diabetes mellitus. Their past medical history includes atrial fibrillation, previous bladder cancer and hypertension. Recent blood results show an eGFR of 25 mL/min.
Which of the following would be the most appropriate initial drug therapy for this patient?
1. Dapagliflozin
2. Glibenclamide
3. Metformin
4. Pioglitazone
5. Sitagliptin
5. Sitagliptin
Rational:
Dapagliflozin unsuitable because it isn’t recommended in eGFR<60
Glibenclamide unsuitable because there is a higher risk of hypoglycaemia in patients who are elderly or have renal impairment, due to its longer action.
Metformin is unsuitable due to this patient’s poor renal function. Higher risk of lactic acidosis in AKI.
Pioglitazone is unsuitable due to history of bladder cancer being a contraindication.
Sitagliptin may be used for this patient, at a reduced dose for renal impairment.
110
Neuroleptic malignant syndrome is a potentially life-threatening adverse effect related to the use of some antipsychotic and antiemetic drugs. It may affect up to 3% of patients taking antipsychotic agents and is characterized by distinctive clinical signs and symptoms.
Which of the following symptoms is NOT part of the typical tetrad of symptoms associated with neuroleptic malignant syndrome?
1. Altered mental state
2. Hyperthermia
3. Muscle rigidity
4. Red or purple rash
5. Tachycardia
4. Red or purple rash
Rational:
The typical tetrad of symptoms of NMS are mental state change, muscular rigidity, hyperthermia and autonomic instability. See https://www.uptodate.com/contents/neuroleptic-malignant-syndrome for information.
A red or purple rash is a sign of Stevens-Johnson Syndrome, associated with some antiepileptics among other medicines . See https://www.nhs.uk/conditions/stevens-johnson-syndrome/ for information.
111
A patient is admitted to hospital after developing slurred speech, a one-sided facial droop and confusion. They are diagnosed with an acute ischaemic stroke, and intracerebral haemorrhage is excluded by brain imaging. The patient has dysphagia and they are in atrial fibrillation.
What therapy should be initiated for this patient within 24 hours of presentation?
1. Apixaban 5 mg plus atorvastatin 80mg orally
2. Aspirin 300 mg orally
3. Aspirin 300 mg plus atorvastatin 80mg orally
4. Aspirin 300 mg rectally or by enteral tube
5. Clopidogrel 300 mg rectally or by enteral tub
4. Aspirin 300 mg rectally or by enteral tube
Rational:
Aspirin 300 mg orally if they do not have dysphagia or aspirin 300 mg rectally or by enteral tube if they do have dysphagia.
Ensure that people with disabling ischaemic stroke who are in atrial fibrillation are treated with aspirin 300 mg for the first 2 weeks before anticoagulation treatment is considered.
Immediate initiation of statin treatment is not recommended in people with acute stroke
Clopidogrel 75 mg is used for patients with aspirin hypersensitivity, or those intolerant of aspirin despite the addition of a proton pump inhibitor. A 300 mg loading dose is given for patients with STEMI or NSTEMI.
112
A 60-year-old patient of black African family origin attends an annual health review at their GP surgery. They have type 2 diabetes treated with metformin, and osteoarthritis treated with co-codamol. At their health review, they have high blood pressure. This is confirmed with follow-up readings and it is decided they should start a new medicine to control their blood pressure.
Which class of antihypertensive drugs is the first-line choice for this patient according to NICE guidance?
1. Angiotensin II receptor antagonist
2. Beta blocker
3. Calcium channel blocker
4. Thiazide diuretic
5. Neprilysin inhibitor
1. Angiotensin II receptor antagonist
Rational:
ACEi or ARB is first choice step 1 treatment for people with type 2 diabetes regardless of age or family origin.
If this patient didn’t have diabetes, choose a CCB. If they were black but under 55, choose a CCB.
NICE do not recommend initiating thiazide diuretics for hypertension, but patients already on them and wellcontrolled can continue Thiazide-like diuretics aren’t first line. Add a thiazide-like diuretic if step 1 treatment fails.
Beta blockers are only added if treatment resistant (i.e. ACEi/ARB + CCB + diuretic fails)
The neprilysin inhibitor sacubitril is only licensed for treatment of symptomatic chronic heart failure (in the sacubitril/valsartan combination Entresto)
Step 1 treatment
1.4.30 Offer an ACE inhibitor or an ARB[3] to adults starting step 1 antihypertensive treatment who:
have type 2 diabetes and are of any age or family origin (see also recommendation 1.4.29 for adults of black African or African–Caribbean family origin) or
are aged under 55 but not of black African or African–Caribbean family origin. [2019]
1. 4.31 If an ACE inhibitor is not tolerated, for example because of cough, offer an ARB[3] to treat hypertension. [2019]
1. 4.32 Do not combine an ACE inhibitor with an ARB to treat hypertension. [2019]
1. 4.33 Offer a calcium-channel blocker (CCB) to adults starting step 1 antihypertensive treatment who:
are aged 55 or over and do not have type 2 diabetes or
are of black African or African–Caribbean family origin and do not have type 2 diabetes (of any age). [2019]
1. 4.34 If a CCB is not tolerated, for example because of oedema, offer a thiazide-like diuretic to treat hypertension. [2019]
1. 4.35 If there is evidence of heart failure, offer a thiazide-like diuretic and follow NICE's guideline on chronic heart failure. [2019]
1. 4.36 If starting or changing diuretic treatment for hypertension, offer a thiazide-like diuretic, such as indapamide in preference to a conventional thiazide diuretic such as bendroflumethiazide or hydrochlorothiazide. [2019]
1. 4.37 For adults with hypertension already having treatment with bendroflumethiazide or hydrochlorothiazide, who have stable, well-controlled blood pressure, continue with their current treatment. [2019]
NICE guidelines updated in August 2019 (see: https://www.nice.org.uk/guidance/ng136/chapter/Recommendations#choosing-antihypertensive-drug-treatmentfor-people-with-or-without-type-2-diabetes
113
As part of information governance, pharmacy professionals must comply with the relevant data protection legislation.
Which of the following statements regarding data protection is CORRECT?
1. Data protection legislation applies to anonymised data as well as patient identifiable information
2. Hand written records are exempt from data protection requirements
3. Patient consent is required each time their data is accessed
4. Patients can consent by default to their data being collected, stored and processed
5. The Data Protection Officer must ensure non-compliance with data protection legislation is reported to the Information Commissioner’s officer within 72 hours
5. The Data Protection Officer must ensure non-compliance with data protection legislation is reported to the Information Commissioner’s officer within 72 hours
Rational:
he key legislation is the Data Protection Act 2018 and the General Data Protection Regulation (GDPR).
– anonymised data does not fall within this.
– hand written records are still protected under data protection legislation.
– consent would be required if it was being accessed for a different purpose to what was consented to originally
e.g. you can use a patient’s phone number/email address to inform them their prescription is ready to collect if this is what they consented to, but you can’t email them with information about a new service unless they specifically consented to this first. We wouldn’t ask for consent to access a phone number every month before calling a patient with information regarding their Rx
– Consent cannot be given by default or assumed, it must be gained.
Be aware of Data Protection Act 2018, and General Data Protection Regulation (GDPR), 2018. See MEP guide.
114
You have been approached by a junior doctor who is reviewing a patient presenting with Clostridium difficile infection. The patient has recently finished a course of antibiotics but is unable to recall the name of them.
Which of the following is least likely to cause Clostridium difficile infection?
1. Aminoglycosides
2. Cephalosporins
3. Clindamycin
4. Co-amoxiclav
5. Quinolones
1. Aminoglycosides
115
Every time a pharmacy professional renews their registration with the GPhC, they must submit records to show how they have carried out and recorded revalidation activities.
Which of the following statements regarding revalidation is CORRECT?
1. Each year, and by the time a pharmacy professional renews their registration, the GPhC will expect them to carry out, record and submit nine CPD entries, at least two of which must be planned learning activities.
2. Each year, and by the time a pharmacy professional renews their registration, the GPhC will expect them to carry out, record and submit two peer discussions and two reflective accounts.
3. Planned learning is a learning and development activity that encourages you to engage with others in your reflection on learning and practice.
4. The purpose of the reflective account is to encourage pharmacy professionals to think about how they meet the GPhC standards for pharmacy professionals in the work which they do.
5. Unplanned learning is when you decide to develop your knowledge and/or skills in advance of carrying out the learning activity.
4. The purpose of the reflective account is to encourage pharmacy professionals to think about how they meet the GPhC standards for pharmacy professionals in the work which they do.
Rational:
Option 1 is incorrect as the GPhC will expect them to submit four CPD entries, at least two of which must be planned learning activities.
Option 2 – only one peer discussion and one reflective account required
Options 3 describes peer discussion
Option 5 describes planned learning
116
Mrs Peters comes into your pharmacy. She is a regular customer of yours and wants to speak to you about a recent hospital appointment. She has visited the gastroenterology department and after a simple test has been found to have H. pylori infection.
Which ONE of the following options best describes the diagnostic test/s that would have been used to identify Mrs Peters’ infection?
Select one:
a. Stool antigen test
b. Urea breath test
c. Blood antibody test
d. Stomach biopsy
e. All of the above
e. All of the above
117
You work in a GP practice where they have asked you to review their formulary and indicate what would be an adequate strategy to manage patients with mild musculoskeletal disorders, for which it may be appropriate to prescribe a topical formulation.
Which ONE of the following would NOT be used for this purpose?
Select one:
a. Nicotinates
b. Hyaluronidase
c. Choline
d. Menthol
e. Capsaicin
c. Choline
118
Mrs Fazil hands you a prescription for carbimazole tablets which she has just been prescribed, she is concerned about taking them and asks you about side effects.
Which ONE of the following would NOT be a reason to stop taking carbimazole straight away?
Select one:
a. Mouth ulcers
b. Fever
c. Nausea
d. Feeling unusually tired
e. Unusual bruising
c. Nausea
Rational:
Side effects of carbimazole include Bone marrow suppression i.e. infection, fever, malasie, mouth ulcers, sore throat.
Rash give an antihistamine or switch to propylthiouracil
119
While doing your ward round a junior house officer ask for your help.
She wants to know which ONE of the listed drugs, when administered in the injectable form, has a serious risk of adverse effects (tachycardia, hypotension and anaphylaxis) in patients with underlying cardiac disease?
Select one:
a. Omeprazole
b. Hyoscine butylbromide
c. Cimetidine
d. Co-magaldrox
e. Indometacin
b. Hyoscine butylbromide
120
Mr Mannet brings in a veterinary prescription for pethidine 50mg tablets 1 OD x 60 for Millie the dog. You decide to ring the vet to discuss the quantity supplied.
What is the maximum number of days that should be prescribed on a vet CD prescription?
Select one:
a. 7 days
b. 14 days
c. 28 days
d. 1 month
e. 6 month
c. 28 days
121
Mrs Nathanal visits her GP because of a painful ankle. The GP prescribes diclofenac 50mg TDS, as initial treatment with paracetamol alone has been unsuccessful.
Which ONE of the following is least likely considered to be a risk involved in using diclofenac?
Select one:
a. Increased risk of myocardial infarction
b. Increased risk of renal failure
c. Increased risk of stroke
d. Increased risk of liver failure
e. Increased risk of GI bleeding
d. Increased risk of liver failure
122
Ms Laine is a patient in your heart failure clinic, you wish to assess her as she is reported to have a high digoxin level.
Which ONE of the following signs or symptoms is NOT characteristic of digoxin toxicity?
Select one:
a. Nausea
b. Fatigue
c. Distorted colour vision
d. Confusion
e. Tachycardia
e. Tachycardia
Digoxin toxicity causes bradycardia (slow heart rate)
123
You are working on a ward round with the pharmacy technician who asks you about phenobarbital and how it works.
Which ONE of the following statements would be the most appropriate response?
Select one:
a. Barbiturates are opioid analgesics
b. The respiratory depressant effects of barbiturates are enhanced by low doses of amphetamine
c. Barbiturates increase the frequency of opening of chloride ion channels on the GABAB receptor complex They work on GABAA receptors
d. Barbiturates are analeptic drugs
e. Barbiturates induce the CYP450 enzymes
e. Barbiturates induce the CYP450 enzymes
124
You are asked by a counter assistant to advise on a suitable preparation to treat nappy rash on a 6-month-old baby. On questioning, you find out that the baby has had diarrhoea for two days and that has led to redness and slight ulceration in a small part of the nappy area. The baby’s diarrhoea has now recurred but the irritation is still present. The mother tells you that it has not got any worse in the last day or so.
Which ONE of the following recommendations would be MOST suitable?
Select one:
a. Use clotrimazole 1% twice a day on the affected area
b. Use clotrimazole 2% four times a day on the affected area
c. Use E45 cream after each nappy change
d. Use antihistamine cream twice a day
e. Referral to GP for prescription drugs
a. Use clotrimazole 1% twice a day on the affected area
Can be sold OTC 2% cream and pessaries are 16+
http://psnc.org.uk/herefordshireandworcestershire/wp-content/uploads/sites/114/2017/09/OTC-Restricted-Supply-by-Community-Pharmacies-final.pdf
125
Mrs Smith is a 75-year-old woman, who weights 67kg and has altered renal function is suffering from osteoarthritis of the hips and knees and paracetamol is not touching the pain. You want to recommend she starts using a NSAID, but need to check suitability.
Which ONE of the following is NOT a relative or absolute contraindication to NSAID use?
Select one:
a. Asthma
b. Concomitant aspirin use
c. Concomitant steroid use
d. Congestive heart failure
e. Previous gastric ulcers
c. Concomitant steroid use
Drugs that should not be taken with steroids are:
- Anticoagulants
- Drugs for blood pressure
- Antiepileptics
- Antidiabetic drugs
- Antifungal drugs
- Bronchodilators such as salbutamol
- Diuretics
Conditions in which steroids should be avoided:
- TB
- Herpes
- Fungal infection
- Hypothyroidism
- Diabetes
126
You are conducting a new medicines service for a patient who has been prescribed Ramipril 10mg tablets. You are explaining the importance of patient monitoring on this drug.
Which ONE of the following tests from the options below will you be explaining to the patient?
Select one:
a. Renal function and electrolytes
b. Renal, thyroid and cardiac function
c. Renal and liver function tests and full blood count
d. Full blood count
e. Liver function test
a. Renal function and electrolytes
127
You are presented with a veterinary prescription in a community pharmacy. Upon inspecting the prescription, you decide that you are unable to dispense the veterinary medicine as you notice that some of the prescription requirements are not present.
Which ONE of the following is NOT a prescription requirement for a POM-V medicine?
Select one:
a. Name and address of the owner
b. Identification and species of the animal
c. Prescriptions are valid for six months and 28 days for schedule 2, 3, and 4 controlled drugs
d. A statement highlighting that the medicine is prescribed under the veterinary cascade
e. Standardised forms are required for Schedule 2 or 3 Controlled Drugs
e. Standardised forms are required for Schedule 2 or 3 Controlled Drugs
128
Mrs Shah visits Moorfields eye hospital for a consultation regarding her glaucoma. She has been given a new prescription for some eye drops and the optometrist tells her that it acts by opening the inefficient drainage channels in the trabecular meshwork.
Which ONE of the following glaucoma treatments has she been prescribed?
Select one:
a. Pilocarpine
b. Timolol
c. Brinzolamide
d. Bimatoprost
e. Acetazolamide
a. Pilocarpine
129
Since reformulation in 2013 to allow for long-term storage at room temperature.
Which ONE of the following products has had an increased reporting of eye irritation across the European Union?
Select one:
a. DuoTrav
b. Xalatan
c. Alphagan
d. Ganfort
e. Cosopt
b. Xalatan
130
One of your patients Tom, comes into your pharmacy and gives you a prescription for promethazine, which he is collecting for his mother-in-law Betty who has come to visit. You have no patient medication records for Betty and when you ask Tom whether she takes any medication he is not sure. He believes that Betty had a diagnosis of some condition last year.
Patients suffering from which ONE of the following conditions should care be taken when taking promethazine for motion sickness?
Select one:
a. Glaucoma
b. Hypertension
c. Peptic ulceration
d. Diabetes mellitus
e. Parkinson’s disease
a. Glaucoma
131
Can be used in a child between the ages of 2 - 5 years at a dose of 2.5mg BD
```
Acrivastine.
Adrenaline 150mcg.
Adrenaline 300mcg.
Adrenaline 500mcg.
Cetirizine.
Chlorphenamine.
Loratadine.
Promethazine.
```
Adrenaline 300mcg
132
Which of these is the drug of choice in treatment of absences seizures?
```
Sodium Valproate
Orlistat
Phenytoin
Phentermine
Carbamazepine
Lorcaserin
Lamotrigine
Pirenzepine
```
Sodium Valproate
133
If the adverse effects of the drug used with phenytoin become too toxic, which alternative would you recommend?
```
Sodium Valproate
Orlistat
Phenytoin
Phentermine
Carbamazepine
Lorcaserin
Lamotrigine
Pirenzepine
```
Carbamazepine
134
Which of these is useful in treating partial seizures, tonic-clonic and absence seizures?
```
Sodium Valproate
Orlistat
Phenytoin
Phentermine
Carbamazepine
Lorcaserin
Lamotrigine
Pirenzepine
```
Lamotrigine
135
Recommended by NICE as the most cost effective first line treatment for GAD, this medication is not licensed for this indication in the UK.
```
Sertraline
Serotonin Noradrenaline Reuptake Inhibitors (SNRIs)
Benzodiazepines
Pregabalin
Quetiapine
Buspirone
Beta blockers
Hydroxyzine
```
Sertraline
136
This class of medication can be used to treat GAD effectively, but may not be suitable for some patients as side effects include increases in blood pressure
```
Sertraline
Serotonin Noradrenaline Reuptake Inhibitors (SNRIs)
Benzodiazepines
Pregabalin
Quetiapine
Buspirone
Beta blockers
Hydroxyzine
```
Serotonin Noradrenaline Reuptake Inhibitors (SNRIs)
137
This medication acts quickly and is generally well tolerated but should be avoided in patients with a previous history of substance misuse.
```
Sertraline
Serotonin Noradrenaline Reuptake Inhibitors (SNRIs)
Benzodiazepines
Pregabalin
Quetiapine
Buspirone
Beta blockers
Hydroxyzine
```
Pregabalin
138
This class of medication has a long standing history of therapeutic effect in patients with anxiety disorders, but can be difficult for patients to stop taking.
```
Sertraline
Serotonin Noradrenaline Reuptake Inhibitors (SNRIs)
Benzodiazepines
Pregabalin
Quetiapine
Buspirone
Beta blockers
Hydroxyzine
```
Benzodiazepines
139
Master Sterling (6 years old) was prescribed a Ventolin inhaler nine months ago due to exercise induced asthma. He has since found that he has been using his inhaler on average 6 times a week and has been suffering from difficulty breathing in the cold weather. You have checked his inhaler technique and found it to be satisfactory. His peak flow has been down by 30% over the last 2 weeks and you decide to step up his asthma treatment
```
Bricanyl nebuliser solution 5mg TDS.
Clenil MDI 200mcg BD.
Flutiform MDI 125mcg QDS.
Montelukast 10mg ON.
Seretide DPI 100mcg OD.
Spiriva Respimat 5mcg OD.
Theophylline MR 250mg every 12 hours.
Ventolin MDI 200mcg PRN up to QDS.
```
Clenil MDI 200mcg BD.
140
Mrs Singh is attending her yearly asthma review and has been complaining of shortness of breath with normal daily activities. Her peak flow has been consistently down by approximately 40% for the last month compared to her readings last year. Her current regime is Flutiform 125/5, two puffs twice a day with a spacer which she reports provides some control but it is not adequate. She also takes amlodipine 5mg OD.
```
Bricanyl nebuliser solution 5mg TDS.
Clenil MDI 200mcg BD.
Flutiform MDI 125mcg QDS.
Montelukast 10mg ON.
Seretide DPI 100mcg OD.
Spiriva Respimat 5mcg OD.
Theophylline MR 250mg every 12 hours.
Ventolin MDI 200mcg PRN up to QDS.
```
Montelukast 10mg ON.
141
which ONE of the below listed diseases is a contraindication to their therapy?
Mr Wade prescribed 75mg of imipramine at night time.
```
Acute porphyria.
Asthma.
Diabetes Mellitus.
History of TB.
Hyperkalaemia.
Hyperthyroidism.
Hypophosphatemia.
Ulcerative colitis.
```
Acute porphyria.
142
which ONE of the below listed diseases is a contraindication to their therapy?
Mrs Potts prescribed 150mg of fluconazole, on a long term treatment course.
```
Acute porphyria.
Asthma.
Diabetes Mellitus.
History of TB.
Hyperkalaemia.
Hyperthyroidism.
Hypophosphatemia.
Ulcerative colitis.
```
Acute porphyria.
143
Mr Peeps is experiencing severe acidosis as a result of high serum levels of this drug. He will be treated with sodium bicarbonate and potentially an IV infusion of lipid emulsions.
```
Aspirin.
Alteplase.
Dipyridamole MR.
Warfarin.
Amiodarone.
Phytomenadione.
Apixaban.
Fondaparinux sodium.
```
Amiodarone
144
Mrs Peterson is an 85-year-old female with impaired renal function. She has come into the pharmacy today as she is feeling tired and has had an upset stomach. During your consultation with her you identify that she has been experiencing some numbness and tingling as well. When you look at her PMR you suspect that one of her drugs is causing this. You are aware that there is an increased risk of hyperkalaemia in those with impaired renal function with this drug. Which drug from the above list is most likely to be causing these symptoms?
```
Losartan
Enalapril
Nebivolol
Aspirin
Simvastatin
Warfarin
Paracetamol
Spironolactone
```
Enalapril
145
This drug has been prescribed to Mrs Potter who is 75 years old. She started on 1.25mg OD for 1-2 weeks and then was titrated up to 10mg OD after a further 4 weeks. She has mild to moderate heart failure. Which of the above listed drugs was prescribed for Mrs Potter?
```
Losartan
Enalapril
Nebivolol
Aspirin
Simvastatin
Warfarin
Paracetamol
Spironolactone
```
Nebivolol
146
A patient is suffering with swelling and pain in his big right
toe. The GP diagnosed the patient with a flare up of his gout.
He is also suffering with hypertension and
hypercholesterolaemia for which he is treated with
allopurinol, atorvastatin, furosemide, amlodipine and
paracetamol.
Which drug is most likely contributing to his flare up?
1. Allopurinol
2. Atorvastatin
3. Furosemide
4. Amlodipine
5. Paracetamol
3. Furosemide
147
Which of the following drug combinations is known to introduce a risk of rhabdomyolysis?
1. Ibuprofen with paracetamol
2. Digoxin with amiodarone
3. Beclomethasone with salbutamol
4. Fluvastatin with bezafibrate
5. Phenytoin with sodium valproate
4. Fluvastatin with bezafibrate
148
You are dispensing a prescription for a patient for an emollient which contains 40% paraffin.
The patient tells you he's seen on the television that such emollients can catch fire and asks you for a paraffin-free alternative from the shelves in your shop. What advice would you give him?
1. There is also a risk of fire with emollients that don't contain paraffin
2. There is only a risk of fire if you are a smoker
3. There is no risk of fire with paraffin-containing products
4. The product contains less than 50% paraffin so there is no fire risk
5. The risk is only if the patient is using bandages over their emollient
1. There is also a risk of fire with emollients that don't contain paraffin
Rational:
"There is a fire risk with all paraffin-containing emollients, regardless of paraffin concentration, and it also cannot be excluded with paraffin-free emollients. A similar risk may apply for other products which are applied to the skin over large body areas, or in large volumes for repeated use for more than a few days.
**References:**
[https://www.gov.uk/drug-safety-update/emollients-new-information-about-risk-of-severe-and-fatal-burns-with-paraffin-containing-and-paraffin-free-emollients](https://www.gov.uk/drug-safety-update/emollients-new-information-about-risk-of-severe-and-fatal-burns-with-paraffin-containing-and-paraffin-free-emollients)"
149
A patient presents with poor renal function, upon calculating her renal function it is determined that her eGFR is currently 27 mL/minute. Which of the following drugs would be ineffective for use in the patient?
1. Amiodarone
2. Bendroflumethiazide
3. Pseudoephedrine
4. Cholestyramine
5. Piperacillin with tazobactam
2. Bendroflumethiazide
150
You are reviewing a patient with sinoatrial block, which drug is contraindicated for use in the patient
1. Amiodarone
2. Bendroflumethiazide
3. Pseudoephedrine
4. Cholestyramine
5. Piperacillin with tazobactam
1. Amiodarone
151
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?
1. Amiodarone
2. Bendroflumethiazide
3. Pseudoephedrine
4. Cholestyramine
5. Piperacillin with tazobactam
4. Cholestyramine
152
Which illness is characterised by white spots surrounded by a red ring on the inner cheek and gums?
1. Atopic eczema
2. Chicken pox (varicella)
3. German measles (rubella)
4. Impetigo
5. Measles (morbilli)
6. Mumps (epidemic parotitis)
7. Slap cheek syndrome (parvovirus)
8. Whooping cough (pertussis)
5. Measles (morbilli)
153
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.
1. Atopic eczema
2. Chicken pox (varicella)
3. German measles (rubella)
4. Impetigo
5. Measles (morbilli)
6. Mumps (epidemic parotitis)
7. Slap cheek syndrome (parvovirus)
8. Whooping cough (pertussis)
3. German measles (rubella)
154
This combination causes nausea and vomiting
1. Digoxin and quinine
2. Digoxin and cefalexin
3. Ketoprofen and paracetamol
4. Sildenafil and isosorbide mononitrate
5. Atenolol and ibuprofen
6. Clonidine and propranolol
7. Pimozide and ketoconazole
8. Metronidazole and cimetidine
1. Digoxin and quinine
155
This combination causes ventricular arrhythmias
1. Digoxin and quinine
2. Digoxin and cefalexin
3. Ketoprofen and paracetamol
4. Sildenafil and isosorbide mononitrate
5. Atenolol and ibuprofen
6. Clonidine and propranolol
7. Pimozide and ketoconazole
8. Metronidazole and cimetidine
7. Pimozide and ketoconazole
156
This combination may cause a marked hypotensive effect which may be fatal
1. Digoxin and quinine
2. Digoxin and cefalexin
3. Ketoprofen and paracetamol
4. Sildenafil and isosorbide mononitrate
5. Atenolol and ibuprofen
6. Clonidine and propranolol
7. Pimozide and ketoconazole
8. Metronidazole and cimetidine
4. Sildenafil and isosorbide mononitrate
157
Which of the following anti-secretory and mucosal protectant drugs is a potent uterine stimulant?
1. Cimetidine
2. Misoprostol
3. Lansoprazole
4. Ranitidine
5. Tripotassium dicitratobismuthate
2. Misoprostol
Uterine stimulants causes a woman uterus to contract
158
Which ONE of the following is most likely to cause ketoacidosis?
1. IV salbutamol
2. Salmeterol
3. Ipratropium
4. Tiotropium
5. Inhaled salbutamol
1. IV salbutamol
Rational:
In common with other beta-adrenoceptor agonists, salbutamol can induce reversible metabolic changes such as increased blood glucose levels. Diabetic patients may be unable to compensate for the increase in blood glucose and the development of ketoacidosis has been reported. Concurrent administration of glucocorticoids can exaggerate this effect.
159
Mr TS, aged 29, presents to the pharmacy with a red eye. He has not
previously experienced these symptoms and woke up this morning with
a red left eye. He would like your advice. On examining the eye, you
note redness on the area of the left eye. The right eye is unaffected. Mr
TS reports nil pain and nil discharge. He does not have a temperature
and states he feels fit and well otherwise.
What is the likely diagnosis?
1. Bacterial conjunctivitis
2. Haemorrhagic conjunctivitis
3. Keratitis
4. Subconjunctival haemorrhage
5. Viral conjunctivitis
4. Subconjunctival haemorrhage
160
Which of the following medications should be prescribed and dispensed
by brand due to differences in bioavailability between various
formulations?
1. Amlodipine
2. Aripiprazole
3. Fluoxetine
4. Hyoscine butyl bromide
5. Tacrolimus
5. Tacrolimus
161
You are a community-based pharmacist and receive a call from the
local GP within the health centre you work at. The query is related to a
known patient – Mrs GF, aged 72, who has known chronic pain. She
is unable to tolerate a higher dose of her fentanyl patch (she is currently
prescribed a 37.5 microgram patch applied every 72 hours). The GP is
considering the addition of a buprenorphine patch to help with pain
management.
What advice do you give to the GP?
1. Avoid the addition of buprenorphine patch as it will cause addiction
2. Avoid the addition of buprenorphine patch as it will increase the risk of opiate withdrawal
3. Can add buprenorphine but recommend an alternative route such as sublingual tablets
4. Can add buprenorphine patch at any strength due to
patient’s history of chronic pain
5. Can add buprenorphine patch at the lowest strength possible and titrate up
2. Avoid the addition of buprenorphine patch as it will increase the risk of opiate withdrawal
162
Mr AJ, aged 58, has been recently diagnosed with osteoporosis. You are
reviewing his recent bone density scan at the general practice surgery
you work for. The recommendation is to start bisphosphonate therapy.
1. Alendronic acid 70 mg daily
2. Alendronic acid 70 mg once weekly
3. Risedronate 5 mg once daily
4. Risedronate 35 mg once daily
5. Risedronate 35 mg once weekly
5. Risedronate 35 mg once weekly
Rational:
Alendronic acid is not licenced in men
163
Which of the following medications would require liver function monitoring
at regular 3-monthly intervals if treatment is required for longer
than 6 months?
1. Duloxetine
2. Griseofulvin
3. Levofloxacin
4. Minocycline
5. Simvastatin
4. Minocycline
164
Miss SN, aged 32, presents to the community pharmacy with her 3-
year-old son. She is concerned about a cough he developed overnight.
Upon discussing the cough, you are able to note that it started 6 hours
ago, there is a sudden temperature, the cough sounds like a barking
cough and a hoarse voice (her son started with a runny nose 24 hours
ago). There is no phlegm described by mum.
Which of the following is the most appropriate advice to give to the
child’s mum?
1. Offer paracetamol liquid
2. Offer paracetamol liquid and simple linctus paediatrics
3. Offer simple linctus paediatrics
4. Signpost to A & E
5. Signpost to GP
4. Signpost to A & E
165
Mr BK, aged 35, presents to the community pharmacy complaining
about an earache in his right ear. He informs you it feels blocked but
also is quite itchy. You confirm his past medical history which is nil
medication and nil allergies. He also informs you he swims regularly to
keep active.
Which of the following is the most appropriate course of action?
1. Offer acetic acid ear spray
2. Offer hydrogen peroxide ear drops
3. Offer olive oil ear drops
4. Refer to A & E
5. Refer to GP
5. Refer to GP
"signs of swimmer ears"
166
You are a prescribing pharmacist working in a general practice environment.
You are reviewing a patient (Mr BP, aged 39) at your clinic
today and diagnose him with an acute exacerbation of gout. The patient
did have their uric acids levels recently tested which were raised. You
decide to initiate them on allopurinol therapy.
Which of the following statements is correct regarding allopurinol?
1. Can only be initiated by a specialist
2. Dose adjusted according to potassium levels
3. Dose adjusted according to sodium levels
4. Dose usually initiated at 450 mg OD
5. Increased risk of acute gout arthritis attack in early stages
5. Increased risk of acute gout arthritis attack in early stages
167
Mr SC, aged 39, has been initiated on clozapine therapy for the management of his treatment-resistant schizophrenia. As part of his treatment plan, he has been advised that he will need regular blood tests every week for the first 18 weeks, then at least every 2 weeks, and if clozapine is decided to continue long term then regular bloods at least every 4 weeks.
1. Cardiomyopathy
2. Hyperprolactinaemia
3. Myocarditis
4. Neutropenia
5. Pancreatitis
4. Neutropenia
168
Mrs MS, aged 72, presents to your minor ailment clinic complaining of urinary symptoms. You are a prescribing pharmacist and undertake the relevant investigations including temperature (38◦C), urine dipstick (positive for nitrates and leucocytes) and understanding the patient’s
general symptoms (dysuria, increased frequency). After reviewing the patient, you decide she does have an uncomplicated UTI. Her medication is as follows: aspirin 75 mg OD, bisoprolol 2.5 mg OD, lisinopril 10 mg OD, atorvastatin 80 mg OD, methotrexate 10 mg once weekly,
folic acid 5 mg once weekly, paracetamol 1g QDS PRN, GTN spray 400 mcg S/L PRN.
Which of the following antibiotics would NOT be an appropriate treatment to consider?
1. Amoxicillin
2. Fosfomycin
3. Nitrofurantoin
4. Pivmecillinam
5. Trimethoprim
5. Trimethoprim
interacts with warfarin
169
Miss KL, aged 26, has been prescribed Yasmin® tablets for contraception. She has been taking this medication for the last 12 months. She currently has no contraindications to this medication.
Which of the following changes to Miss KL’s health would warrant a referral to the GP?
1. BMI >28 kg/m2
2. BP increases to 140/90
3. Migraine with aura
4. Miss KL stops smoking
5. Missed pill at the beginning of the cycle
3. Migraine with aura
Rational:
- VTE
- Stoke
- Liver dysfunction
- Blood pressure above 160/95
- Prolonged immobility after surgery or leg injury (DVT risk)
- Detection of a risk factor which CI treatment (look under SE)
Increased risk of VTE; risk factors that increase it:
- Type of progestogen: desogestrel, gestodene, drosperinone
- Obesity BMI >30
- Smoking
- Primary relative under 45 with VTE
- Superficial thrombophlebitis
- Long-term immobilisation
- Age >35 years
Increased risk of ATE with:
- diabetes mellitus
- Hypertension
- Migraine without aura
AVOID IF 2 OR MORE RISK FACTORS PRESENT
170
Miss FR, aged 34, has known polycystic ovary syndrome (PCOS). She is a regular patient at your community pharmacy and was hoping you could advise her on medication which may improve the symptoms of her PCOS.
What would be the most appropriate medication to suggest?
1. Combined hormonal contraceptive pill
2. Combined hormone replacement therapy
3. Oestrogen-only hormone replacement therapy
4. Progestogen-only contraceptive pill
5. Progestogen-only hormone replacement therapy
1. Combined hormonal contraceptive pill
171
Which of the following medicine requires monitoring due to dyslipidaemia?
1. Acamprosate calcium
2. Alprostadil
3. Isotretinoin
4. Moxifloxacin
5. Ramipril
3. Isotretinoin
Rational:
Serum lipids (fasting values) should be checked before treatment,
1 month after the start of treatment, and subsequently at 3-monthly
intervals unless more frequent monitoring is clinically indicated.
Elevated serum lipid values usually return to normal on reduction
of the dose or discontinuation of treatment and may also respond to
dietary measures. Isotretinoin has been associated with an increase
in plasma triglyceride levels. Isotretinoin should be discontinued if
hypertriglyceridaemia cannot be controlled at an acceptable level or
if symptoms of pancreatitis occur. Source: https://www.medicines
.org.uk/emc/product/3870/smpc#UNDESIRABLE_EFFECTS
172
Which of the following best describes the term ‘cost utility analysis’ in
the context of a pharmacoeconomic study?
1. Is a measurement of the benefit foregone when selecting one
therapeutic alternative over the next best alternative
2. Is a method for assessing the economic efficiency of proposed public policies through the systematic prediction of social costs and social benefits
3. Is an analytical technique intended for the systematic comparative
evaluation of the overall cost and benefit generated
by alternative therapeutic interventions for the management of a disease
4. Is an economic analysis comparing the cost of two similar interventions based on cost
5. Is an economic analysis in which the incremental cost of a program from a particular point of view is compared to the incremental health improvement expressed in the unit of quality adjusted life years (QALYs)
5. Is an economic analysis in which the incremental cost of
a program from a particular point of view is compared to
the incremental health improvement expressed in the unit
of quality adjusted life years (QALYs)
173
Which of the following adverse effects is a patient with a solid cancerous
tumour most likely to experience after 1–2 weeks after chemotherapy
treatment?
1. Cardiotoxicity
2. Emesis
3. Nephrotoxicity
4. Neutropenia
5. Ototoxicity
4. Neutropenia
174
A consultant has asked you to review a new drug to treat diabetes.
You review information available on this new drug that is based on
a 4-month, placebo-controlled, randomised study of 1000 adults that
showed a statistically significant average decrease in Hb1AC from
52 mmol/L to 47 mmol/L. The most common adverse reactions were
gastrointestinal symptoms such as abdominal cramping and diarrhoea.
Which of the following is the most significant limitation of this study?
1. Hb1AC is a surrogate outcome
2. Long-term safety and efficacy were not assessed
3. Placebo is not an appropriate comparator
4. The patients did not achieve guideline targets for diabetes
5. The sample population was too small to assess efficacy
2. Long-term safety and efficacy were not assessed
175
Which of the following best describes a type II error in a study
comparing two different medicines as an intervention?
1. The exclusion criteria are not restrictive enough
2. The exclusion criteria are too restrictive
3. The p level is >0.05
4. The statistical conclusion is a false negative stating that there is no difference between the two treatment regimens when there is in fact a difference
5. The statistical conclusion is that there is a difference between
the two treatments when it does not actually exist
4. The statistical conclusion is a false negative stating that there is no difference between the two treatment regimens when there is in fact a difference
176
A randomised, controlled trial conducted over 3 years demonstrated
that a serious cardiovascular event (primary outcome) occurred in
12% of the patients who received the new drug, whereas the primary
outcome occurred in 20% of the patients who received a placebo.
What is the relative risk reduction achieved with the new drug?
1. 10%
2. 15%
3. 25%
4. 40%
5. 50%
4. 40%
Rational:
RRR (relative risk reduction) = (ARC* − ART*) / ARC
(20 − 12) / 20 = (8 / 20) = 0.4 × 100 = 40%
Source: [https://bestpractice.bmj.com/info/us/toolkit/learn-ebm/howto-](https://bestpractice.bmj.com/info/us/toolkit/learn-ebm/howto-)
calculate-risk/
**AR (absolute risk)**
= the number of events (good or bad) in treated or control groups, divided by the number of people in that group
**ARC**
= the AR of events in the control group
**ART**
= the AR of events in the treatment group
**ARR (absolute risk reduction)**
= ARC – ART
**RR (relative risk)**
= ART / ARC
**RRR (relative risk reduction)**
= (ARC – ART) / ARC
**RRR**
= 1 – RR
**NNT (number needed to treat)**
= 1 / ARR
177
Which one of the following is the most appropriate product to treat a
case of diagnosed corneal oedema?
1. Antihistamine
2. Artificial tears
3. Hyperosmotic agent
4. Vasoconstrictor
5. Vasodilator
3. Hyperosmotic agent
Rational:
A drug that makes blood plasma hypertonic thus drawing fluid out of the eye and leading to a reduction in intraocular pressure.
178
Which of the following antineoplastic treatments is DNA-binding?
1. Docetaxel
2. Doxorubicin
3. Trabectedin
4. Vinblastine
5. Vincristine
2. Doxorubicin
179
Which of the following cancer treatments is NOT a type of immunotherapy?
1. Degarelix (FirmagoN)
2. Interferon
3. Ipilimumab (Yervoy)
4. Nivolumab (Opdivo)
5. Tisagenlecleucel (Kymirah)
1. Degarelix (FirmagoN)
180
Which of the following best describes the frequency of rarely reported
side effects?
1. ≥1/100 to <1/10
2. ≥1/1000 to <1/100
3. ≥1/10,000 to <1/100
4. ≥1/100,000 to <1/10,000
5. <1/100,000,000
3. ≥1/10,000 to <1/100
Rational:
The SPC classifies side effects as: Very common (≥1/10); common
(≥1/100 to <1/10); uncommon (≥1/1,000 to <1/100); rare
(≥1/10,000 to <1/1,000); very rare (<1/10,000).
181
An 80-year-old female inpatient with schizophrenia has been on
haloperidol long term with no previous issues. She has recently been prescribed another medication to control her symptoms. She has developed a temperature of 38.6◦C and increasing muscle rigidity.
Which is the single most likely cause of her symptoms?
1. Amitriptyline
2. Diazepam
3. flupentixol
4. Sertraline
5. zopiclone
2. Diazepam
182
You are the pharmacist working in the oncology / haematology department and during a MDT meeting the consultant discusses a particular patient with non-Hodgkin lymphoma. The patient is currently receiving the chemotherapy regime “RCHOP”.
What medication does the ‘C’ stand for?
Select one:
a. Cyclophosphamide
b. Carboplatin
c. Cytarabine
d. Cladribine
e. Cisplatin
a. Cyclophosphamide
```
Rational:
R = Rituximab
C = Cyclophosphamide
H = Doxorubicin Hydrochloride (Hydroxydaunomycin)
O = Vincristine Sulfate (Oncovin)
P = Prednisone
```
183
You are the pharmacist working in the oncology / haematology ward and during a MDT meeting the consultant discusses a particular patient with Hodgkin lymphoma. The patient is currently receiving the chemotherapy regime “ABVD”.
What medication does the ‘V’ stand for?
Select one:
a. Vinblastine
b. Vincristine
c. Vinflunine
d. Vinorelbine
e. Vindesine
a. Vinblastine
```
Rational:
doxorubicin hydrochloride (Adriamycin), bleomycin sulfate, vinblastine sulfate, and dacarbazine
```
184
You are the pharmacist working in the oncology / haematology department and during a MDT meeting the consultant discusses a particular patient’s cytotoxic-induced side effect. The chemotherapy regime prescribed has caused the patient to develop acute hyperuricaemia.
Which ONE of the following would be the choice of medication to treat this patient’s side effect?
Select one:
a. Levofolinic Acid
b. Folinic Acid
c. Dexrazoxane
d. Mesna
e. Rasburicase
e. Rasburicase
185
Mrs L is under your care on the ward and has been complaining of a dry mouth recently to a visiting relative. Her medication chart is as follows:
* Enalapril 20mg OD
* Amiodarone 200mg OD
* Spironolactone 12.5mg OD
* Phenobarbital 30mg OD
* Carvedilol 12.5mg BD
Which ONE of Mrs L’s drugs is the MOST likely cause of her complaint?
Select one:
a. Enalapril
b. Phenobarbital
c. Amiodarone
d. Spironolactone
e. Carvedilol
a. Enalapril
Rational:
Ace inhibitors cause dry mouth
186
A 21-year-old female student presents with abdominal pain in the right upper quadrant. She has had multiple, casual, sexual partners with whom she has not always used regular barrier protection. When questioned further she admits to having a burning sensation on passing urine and you note a temperature of 38.8oC.
Which ONE of the following antibiotics is the MOST suitable treatment as a single dose?
Select one:
a. Ceftriaxone (i/m)
b. Ciprofloxacin (p/o)
c. Benzathine benzylpenicillin (p/o)
d. Azithromycin (p/o)
e. Doxycycline (p/o)
d. Azithromycin (p/o)
Rational:
ymptoms of chlamydia can appear in both men and women, including:
pain or burning while peeing.
pain during sex.
lower belly pain.
abnormal vaginal discharge (may be yellowish and have a strong smell)
bleeding between periods.
pus or a watery/milky discharge from the penis.
swollen or tender testicles.
First line treatment is azithromycin as a single dose or doxycycline for seven days
187
Miss Y is a 9-year-old female. She has been newly diagnosed with type 1 diabetes. Her father is diabetic and she feels overwhelmed with the number of different types of insulin available She wants to know which of the following regimens offers the best blood glucose control for a 9-year-old child who has been newly diagnosed with type 1 diabetes?
Select one:
a. Linagliptin 2.5mg with metformin 1000mg BD
b. Levemir and Lantus
c. Gliclazide 80mg tablets OD
d. Novorapid and Humulin M3
e. Humalog and Novorapid
d. Novorapid and Humulin M3
188
A patient has been diagnosed with acute kidney injury with an associated high potassium level (6.9 mmol / L).
Which ONE of the following would be the MOST appropriate treatment for that patient?
Select one:
a. Calcium gluconate
b. Colecalciferol
c. Cinacalcet
d. Sodium polystyrene sulfonate
e. Menadiol sodium phosphate
d. Sodium polystyrene sulfonate
Rational:
The calcium gluconate doesn't actually treat the hyperkalemia. It's part of a number of drugs you give in hyperkalaemia (the insulin / glucose does that job pushing the potassium back into the intracellular space).
The calcium gluconate protects the heart from getting too "excited" from the excess potassium. It doe not have an actual direct effect on potassium levels. Where as Resonium A (sodium polystyrene sulfonate) does.
It's a bit of a tricky question! If one of the answers was "Calcium Gluconate alongside insulin / glucose" then this would definitely be the right answer.
But calcium gluconate on it's own would not reduce potassium levels.
189
Mrs S, a 31-year old woman is going to Kenya (Africa) to see family she hasn’t seen for a long time. She attends a travel clinic where you work as an independent prescriber. She is 8 weeks pregnant with no health conditions.
Which ONE of the following medicines is the MOST appropriate malaria prophylaxis for her?
Select one:
a. Bite prevention
b. Chloroquine
c. Mefloquine
d. Proguanil
e. Doxycycline
b. Chloroquine
190
You are the pharmacist working in a hospital outpatient dispensary. Mrs I is issued a prescription for a drug at a dose of 20mg daily. Mrs I tells you that she recently had a mastectomy due to a confirmed malignant tumour in her breast and has now been prescribed this medication.
Which ONE of the drugs below is most likely to have been prescribed?
Select one:
a. Bicalutamide
b. Letrozole
c. Anastrozole
d. Exemestane
e. Tamoxifen
e. Tamoxifen
191
Mr RJ is 44 year-old male. He is planning to take a trip abroad and has seen he requires some prophylactic antimalarial medication for his chosen location.
Which ONE of the following antimalarial prophylactic medications are usually taken ONCE WEEKLY?
Select one:
a. Proguanil
b. Doxycycline
c. Atovaquone
d. Quinine
e. Mefloquine
e. Mefloquine
192
Miss T, a 24-year-old female with a blood pressure of 120/80mm/hg has presented in your pharmacy to purchase some paracetamol. Whilst doing so she asks if she can speak to you about her options for contraception. She has previously experienced adverse effects with her contraceptive method and subsequently stopped taking it 2 years ago. She would now like to restart.
All of the following are adverse effects associated with either the combined oral contraceptive (COC) or the progestogen only pill (POP) except which ONE?
Select one:
a. Amenorrhoea
b. Headache
c. Breakthrough bleeding
d. Venous thromboembolism
e. Pruritus
e. Pruritus "itchy skin"
Rational:
193
Your pharmacy is to begin a new service involving the supply of a medicine under a PGD. You prepare a short training session for your pharmacy team to help them become familiar with the regulations regarding Patient Group Directions (PGD)s.
Which ONE of the following statements regarding the supply of medicine under a PGD is correct?
Select one:
a. Any patient can access medication under a PGD
b. The patient does not need the patient information leaflet if the medicine is administered in the pharmacy
c. Controlled drugs can be included in a PGD
d. Any member of the pharmacy staff deemed by the pharmacists to be suitably trained can supply medicines under a PGD
e. PGDs can only be used to authorise supply of medicines from a registered pharmacy premises
c. Controlled drugs can be included in a PGD
Rational:
Review MEP 3.3.10.1
PATIENT GROUP DIRECTIONS (PGDS)
A PGD is a written direction that allows the supply and/or administration of a specified medicine or medicines, by named authorised health professionals, to a well-defined group of patients requiring treatment for a specific condition.
It is important that pharmacists involved with PGDs understand the scope and limitations of PGDs as well as the wider context into which they fit to ensure safe, effective services for patients.
The supply and administration of medicines under a PGD should only be reserved for those limited situations where this offers an advantage for patient care, without compromising patient safety.
A PGD should only be developed after careful consideration of all the potential methods of supply and/or administration of medicines, including prescribing, by medical or non-medical prescribers.
Pharmacists can supply, offer to supply and administer diamorphine or morphine under a PGD for the immediate, necessary treatment of sick or injured persons.
The correct answer is: Controlled drugs can be included in a PGD
194
Mr R is a 59-year-old male who has previously been diagnosed with prostate cancer. When he was first diagnosed 3 years ago his PSA level was 27ng/ml. He is now being started on biclutamide and asks you about common side effects.
Which ONE of the following would be the MOST appropriate response?
Select one:
a. Anxiety
b. Hepatic failure
c. Alopecia
d. Hypercalcaemia
e. Angioedema
c. Alopecia
195
For which ONE of the following drugs is it not necessary to prescribe by brand to avoid unnecessary switching?
Select one:
a. tacrolimus
b. mycofenolate
c. ciclosporin
d. sirolimus
e. belatacept
d. sirolimus
196
Baby L is 6 months old, and has presented to the GP with a fever of 38.6C and symptoms of lethargy and poor feeding.
The GP suspects an upper UTI, and sends a urine sample off for microscopy, which shows bacteriuria. Baby L has no other medical conditions, and this is the first time he has had a suspected UTI. Baby L has NKDA.
Which ONE of the following would be the MOST appropriate treatment for Baby L?
Select one:
a. Co - Amoxiclav 125/31mg per dose: 0.25ml/Kg TDS for 7 days.
b. Cefixime 200mg OD for 7 days.
c. Nitrofurantoin 750mcg/Kg QDS for 3 days.
d. Trimethoprim 50mg BD for 3 days.
e. Amoxicillin 125mg TDS for 3 days.
a. Co - Amoxiclav 125/31mg per dose:
197
Match the following:
1. A patient suffering from alcohol dependence who is at risk of developing Wernicke’s encephalopathy
2. A patient with chronic kidney disease (not on dialysis) who has developed a high phosphate level (1.8 mmol / L)
3. This drug is one of a range of compounds that possesses the property of preventing or curing rickets
4. This drug is useful in the treatment of secondary hyperparathyroidism in patients with end stage renal disease
Answer 1- Pabrinex (parenteral vitamins B & C)
Answer 2- Sevelamer " phosphate binding medication used to treat hyperphosphatemia in patients with chronic kidney disease"
Answer 3- Colecalciferol
Answer 4- Cinacalcet
198
Match the following with the below options:
1. A patient suffering from alcohol dependence who is at risk of developing Wernicke’s encephalopathy
2. A patient with chronic kidney disease (not on dialysis) who has developed a high phosphate level (1.8 mmol / L)
3. This drug is one of a range of compounds that possesses the property of preventing or curing rickets
4. This drug is useful in the treatment of secondary hyperparathyroidism in patients with end stage renal disease
```
Options:
Phytomenadione
Pabrinex (parenteral vitamins B & C)
Sevelamer
Cinacalcet
Colecalciferol
Menadiol sodium phosphate
Sodium polystyrene sulfonate
Calcium gluconate
```
Answer 1- Pabrinex (parenteral vitamins B & C)
Answer 2- Sevelamer " phosphate binding medication used to treat hyperphosphatemia in patients with chronic kidney disease"
Answer 3- Colecalciferol
Answer 4- Cinacalcet
199
Match the following with the below options:
1. 83-year-old man with hypertension and angina. Current medication includes: ISMN 50mg M/R OD, aspirin 75mg OD and amlodipine 10mg OD. Newly started on simvastatin 40mg ON.
4. 35-year-old woman who has been taking ciclosporin for the past 2 years to manage psoriasis. Today she has been prescribed bezafibrate 400mg BD.
2. 64-year-old man with general anxiety disorder who has been taking escitalopram 20mg for 10 years. Suffered a TIA 12 years ago. Has just been diagnosed with non valvular AF, and newly prescribed dabigatran 150mg OD
3. 65-year-old woman who has been taking verapamil 120mg TDS for the past 5 years to control an arrhythmia. Today she has been prescribed simvastatin 40mg ON
```
Options:
Increased bleeding risk
Bradycardia
Drowsiness
Hypertensive crisis
Myopathy
QT interval prolongation
Reduced eGFR
Thrombosis
```
Answer 1- Myopathy
Answer 2- Myopathy
Answer 3- Increased bleeding risk
Answer 4- Myopathy
200
Match the following with the below options:
1. The first drug of choice for hyperthyroidism; it inhibits thyroid peroxidase and coupling of iodinated tyrosine
2. Replaces the thyroid hormones in a ‘blocking-replacement’ regimen for treatment of hyperthyroidism.
3. Can be considered in all hyperthyroid patients except women who are pregnant, breastfeeding or in contact with small children.
4. The treatment of choice for hypothyroidism. Used to replace or boost levels of T4.
5. Is secreted in response to low blood serum calcium levels
```
Options:
Levothyroxine
Liothyronine
TSH
Parathyroid hormone
Carbimazole
Propylthiouracil
β-blockers
Radioactive iodine (131I)
```
Answer 1
Carbimazole
Answer 2
Levothyroxine
```
Answer 3
Radioactive iodine (131I)
```
Answer 4
Levothyroxine
Answer 5
Parathyroid hormone
201
Mrs Timms, a patient who has been seen in the dermatology clinic today. She would like to speak with you about a new drug she has been prescribed.
Of the following statements select the single MOST correct statement when considering methotrexate
A. Patients should have full blood count, TFTs and LFTs before starting treatment.
B. Treatment with ferrous sulphate may be required in acute toxicity.
C .It is given as a daily dose
D. Methotrexate can be used in pregnancy if there is no suitable alternative
E. Sore throat may be a sign suggestive of infection and must be reported.
The correct answer is E- Sore throat may be a sign suggestive of infection and must be reported.
Rational:
Sore throat is a sign of bone marrow suppression along side bruising, mouth ulcers, fever and rash
Monitoring requirements for methotrexate are FBC, RF, LF. Tested every 1-2 weeks until stable. Once stable its every 2-3 months
202
Mrs Quinn has recently seen her GP for a trapped nerve and some pain and was prescribed some diazepam tablets.
Mrs Quinn asks what will happen if she is stopped by the police. What is the LEAST appropriate response?
Select one:
a. She will be asked to show the evidence she has from her GP that she has been legitimately prescribed diazepam.
b. The police will use a roadside test to check her diazepam levels.
c. She will need to explain that she is taking the medicine according to the instructions from the prescriber.
d. She is not likely to be affected by the legislation, which says that a majority of those taking medicines in accordance with advice are unlikely to be above the specified limit.
e. If the police suspect that she is under the influence of drugs, she will be asked to go to the police station for a blood test.
b. The police will use a roadside test to check her diazepam levels.
203
Jack Jones is a 12-year-old child who has come into the surgery with his mother today. He has been experiencing symptoms of an uncomplicated lower urinary tract infection, his GP asks for your advice on the most appropriate treatment for him.
What would the MOST appropriate response be?
Select one:
a. Amoxicillin 250mg TDS for 7 days.
b. Nitrofurantoin SR 100mg BD for 3 days
c. Trimethoprim 200mg BD for 3 days.
d. Trimethoprim 200mg BD for 7 days.
e. Amoxicillin 500mg TDS for 3 days.
c. Trimethoprim 200mg BD for 3 days.
Rational:
According to NICE guideline treatment for lower UTI in children under 16 but over 3 month is Trimethoprim
204
Mrs Bates has received the results of a swab that was taken from an infected wound to identify the causative agent for the infection. It is found to be staphylococcus aureus.
Which of the following is a narrow spectrum antibiotic used for the treatment of staphylococcal infections?
Select one:
a. Fusidic acid
b. Chloramphenicol
c. Ciprofloxacin
d. Azithromycin
e. Gentamicin
a. Fusidic acid
Rational:
Narrow spectrum antibiotics include Pen G, macrolides and vancomycin
Fusidic acid is narrow spectrum for staph infections
205
Mr Potts and his wife have presented at the genito-urinary medicine clinic with some symptoms that they suspect are due to a sexually transmitted infection.
Which ONE of the following is NOT a symptom of chlamydia infection?
Select one:
a. Dysuria
b. Pain in the lower abdomen
c. Vaginal bleeding during sexual intercourse
d. Vulvovaginal sores
e. Penile discharge
d. Vulvovaginal sores
```
Rational:
Signs and symptoms of chlamydia include:
- pain when urinating.
- unusual vaginal discharge.
- pain in the tummy or pelvis.
- pain during sex.
- bleeding after sex.
- bleeding between periods.
- white, cloudy or watery discharge from the tip of the penis
- burning or itching in the urethra (the tube that carries urine out of the body)
- pain in the testicles
```
206
Mr. Moss has recently been switched to ticagrelor 180mg once daily from clopidogrel. Over the summer, he was bitten by a tick and has been exhibiting signs of Lyme’s disease.
Which of the following antibiotics would be LEAST appropriate for Mr. Moss?
Select one:
a. Erythromycin
b. Telithromycin
c. Azithromycin
d. Cefotaxime
e. Clarithromycin
e. Clarithromycin
Rational:
Clarithromycin is predicted to markedly increase the exposure to ticagrelor. Manufacturer advises avoid.
207
A 68-year-old female has recently been diagnosed with early invasive breast cancer. Her tumour is found to be oestrogen-receptor-positive.
Which of the following is recommended for initial hormonal management?
Select one:
a. Letrozole 2.5mg OD
b. Anastrazole 1mg OD
c. Megestrol 160mg OD
d. Exemestane 25mg OD
e. Tamoxifen 20mg OD
b. Anastrozole 1mg OD
208
Mrs Peters is a 54-year-old woman whose BMI is 28. She comes into the pharmacy and explains that she is feeling unwell – she has spoken to a friend who is a nurse and her friend suspects that she is experiencing the effects of an interaction between aspirin and methotrexate.
Which ONE of the following is the consequence of the interaction between aspirin and methotrexate?
Select one:
a. Renal excretion of methotrexate increased
b. Increased risk of NSAID-induced nephrotoxicity
c. Renal excretion of methotrexate reduced
d. Increased sedation
e. Increased risk of bleeding
c. Renal excretion of methotrexate reduced
Rational:
Interactions of methotrexate include:
- Increased plasma concentration and risk of hepatotoxicity with acitretin - avoid
- Renal Excretion reduced by NSAIDs and penicillin therefore increased risk of toxicity
- Increased risk of toxicity with ciprofloxacin, doxycycline, tetracycline, sulphonamides, ciclosporin, PPI, leflunomide
- Increased risk of haematological toxicity when given with co-trimoxazole or trimethoprim
209
Mrs Mahmood, a 32-year-old female with an 18-month old son has been prescribed colecalciferol capsules 10000units OD. She has NKDA and is otherwise healthy.
Which of the following pieces of advice would be MOST appropriate to give to Mrs Mahmood?
Select one:
a. Advise her to avoid pregnancy as therapeutic doses may be teratogenic
b. Check to see if she is breast-feeding as there is a risk of hyperkalaemia in infants
c. Phosphate levels in plasma and urine may reduce
d. Monitor U&Es due to risk of renal impairment
e. Monitor plasma-calcium concentrations
e. Monitor plasma-calcium concentrations
210
Mr H is 74-years-old, has osteoporosis and uncontrolled heart failure.
```
Which ONE of the following should be avoided in his treatment regime?
Select one:
a. Latanoprost
b. Pilocarpine
c. Dorzolamide
d. Timolol
e. Brinzolamide
```
d. Timolol
211
A 55-year old overweight pub property owner who has a several-year history of episodic acute joint swelling that started in his big toe and now affects his knees. His symptoms improve with diclofenac. Gout was diagnosed on his first hospital visit, however this now appears recurrent. He developed an acute attack in his right knee 2 days ago
The senior house officer (SHO) asks you what the best plan of prophylaxis would be.
Select one:
a. Keep on long-term diclofenac with gastric protection.
b. Start allopurinol now with NSAID cover to provide immediate pain relief.
c. Switch to long-term colchicine.
d. Switch to the use of depot steroid injections.
e. Start allopurinol at least 2 weeks after the acute attack has settled with NSAID cover to provide relief.
e. Start allopurinol at least 2 weeks after the acute attack has settled with NSAID cover to provide relief.
212
A 75-year old woman is suffering from osteoarthritis of the hips and knees and paracetamol is not touching the pain. You want to recommend she starts using a NSAID.
```
Which of the following is NOT a relative or absolute contraindication to NSAID use?
Select one:
a. Concomitant aspirin use.
b. Congestive heart failure.
c. Asthma.
d. Previous gastric ulcers.
e. Concomitant steroid use.
```
e. Concomitant steroid use.
213
An 83-year old man was diagnosed as having Parkinson’s disease 3 years ago has been treated with levodopa (L-DOPA). Whilst he initially responded well to therapy, he has started to be increasingly still, and has fallen more in the last 4 months despite no undercurrent illness or change in his therapy.
Which ONE of the following is the best management option?
Select one:
a. Increase L-DOPA therapy.
b. Add a dopamine agonist (e.g. ropinerole).
c. Decrease L-DOPA therapy.
d. Stop L-DOPA therapy.
e. Add a peripheral dopamine antagonist (e.g. domperidone).
b. Add a dopamine agonist (e.g. ropinerole).
214
Which ONE of the following is indicated in phenytoin toxicity?
Select one:
a. Nystagmus is a late complication
b. Alopecia is a complication
c. atrial conduction depression with oral use
d. tonic seizure with oral use
e. 'purple glove' syndrome is a complication
e. 'purple glove' syndrome is a complication
Purple glove syndrome usually occurs with IV phenytoin use it presents with oedema, pain and discolouration at the injection site
Other signs of phenytoin toxicity include:
- Suicidal thoughts
- Skin disorders such as rash, toxic epidermal necrolysis
- Blood disorders
- Risk of low vitamin D resulting in rickets and softening of the bones
215
You are undertaking a clinical audit whilst working as a pharmacist in general practice, The key aims of the audit are to review the practice's systemic
corlicusteroid prescribing policy. You have identified 5 patients who have recently received oral corticosteroids.
In which of the following patients was it appropriate to stop the corticosteroid treatment abruptly?
A Miss J who received 4 weeks' worth of prednisolone 10mg daily
B Mr D who was prescribed 5 days of prednisolone 30mg and was on long-term
maintenance therapy with prednisolone 8 months ago
C Mr K who has received 50 mg prednisolone daily for a week
D Mrs P who is taking prednisolone 1mg daily for past 3 years
E Ms N who has been prescribed four courses of prednisolone 40ring daily for
15 days in the past 12 months
Answer: C Rationale:
Gradual withdrawal of systemic corticosteroids should be considered in those whose disease is unlikely to relapse and have:
- Received more than 40 mg prednisolone (or equivalent) daily for more than 1 week;
- Been given repeat doses in the evening;
- Received more than 3 weeks' treatment;
- Recently received repeated courses (particularly if taken for longer than 3
weeks);
- Taken a short course within 1 year of stopping long-term therapy:
216
Mr B is 50 years old and has COPD. Following an annual assessment, the
respiratory nurse intends to intensify Mr B's COFD maintenance therapy. Mr B's FEy1 is found to be 38% and he currently uses the following inhalers:
• Atrovent' 0mcg (ipratropium): 1-2 puffs FOUR times a day when required
• Seretide0 250 Accuhaler 50/250mcg (salmeterol fluticasorie propionate) 1
puff twice a day
Which of the following would be the most appropriate next step in intensifying Mr B's regime?
A Add Bricanylt turbohaler 50Cmcg (terbutalirle) B Add Spiriva® larricg {tiotropium)
C Continue with the current inhalers and prescribe prednisolone 40mg once
daily for 5 days
D Replace Atrovent with Bricany10 turbohaler 500mcg (terbutaline) and add
Soiriva® 18mcg (tiotropium)
E Replace Seretide Accuhalea with Flutiforme 250/10mcg p1V1DI
(fiuticasonelformeterol)
Answer: D
Rationale: Based on the current medications and FEV1 value being <50% the
next step would be to add a long acting muscarinic antagonist (spriva tiotropium). When a long acting anti-muscarinic is started the short acting anti-muscarinic
(ipratropium) must be discontinued (this can be replaced with a Betel agonist e.g. terbutaline).
217
Mr C is 72 years old and has been admitted to hospital following accidental
overdose of Dabigatran. He suffers from atrial fibrillation and was started on
Dabigatran 3 months ago. You are the on-call pharmacist and have been asked to recommend a suitable antidote_
Which of the following agents would be the MOST appropriate to recommend?
A Flumazenil
B Idarucizurnab
C Naloxone
D Phytomenadione
E Protamine
Answer: B
-Dabigatran: (iclarucizurnab) is the only DOAC antidote available specifically for Dabigatran at the moment
-Fiumazenil: Benzodiazepine overdoses
- Naloxone: opioid overdose.
Phytomenadione: vitamin K for warfarin reversal. Protamine = heparin reversal
218
You are undertaking a medicines reconciliation on the oncology ward for Mrs G who 45 years old and has ovarian cancer. She has been prescribed a cytotoxic drug
which is classified as highly ernetogenic and you advise the doctor to prescribe a suitable antiernetic alongside this treatment.
Which of the following cytotoxic drugs is Mrs G most likely to have been prescribed?
A Cispiatin
B Doxorubicin
C Florouracil
D Methotrexate
E Vincristine
Answer: A Rationale:
- Mildly ernetogenic treatment—ftuorouracil, etoposide, methotrexate, the vincai alkaloids, and abdominal radiotherapy.
- Moderately emetogeric treatment—the taxanes, doxorubicin hydrochloride,
intermediate and low doses of cyclophosphamide, mitoxantronen and high doses of methotrexate.
- Highly ernetogenic treatment—cisplatin, dacarbazine, and high doses of cyclophospnarnicle.
219
Mr B is 60 years old and has developed haematuria following treatment for leukaemia using a cytotoxic drug. The oncology consultant suspects that Mr B is experiencing iatrogenic urottielia[ toxicity and asks for your advice on a suitable treatment.
Which of the following would be most appropriate to recommend?
A Calcium folinate
B Cyclophosphamide
C Folic acid
D Ifosfamide
E Mesna
E Mesna
220
You are a clinical pharmacist working in the medicines information department at a hospital. You receive a call from a doctor on the oncology ward asking for advice on treating hyperuricaemia in a patient with high-grade leukaemia.
Which of the following drugs would be most appropriate to recommend?
A Bendroflumethiazide
B Calcium folinate
C Colchicine
Furosemide
E Rasburicase
E Rasburicase
221
Mrs G is 78 years old and has been experiencing muscle spasms, cramps,
numbness and tingling in the fingers and around her mouth. In view of her age and current medication you suspect she is experiencing symptoms of hypocalcaemia.
Which of the following of her regular medications is most likely to cause hypocalcaemia?
A Atorvastatin
B Bendroflumethiazide
C Denosumab
D Ramipril
E Risedronate
Answer: C
Rationale: MIHRAICHM advice: Denosumab: risk of osteonecrosis of the jaw and hypocalcaemia. All patients should be advised to report symptoms of
hypocalcaemia to their doctor (e.g. muscle spasms, twitches, cramps, numbness or tingling in the fingers, toes, or around the mouth).
Risedronate is contraindicated in hypocalcaemia states but does not cause hypocalcaemia as an adverse effect as per SmPC.
Additional information: Hypocalcaernia usually occurs in the first weeks of
denosumab treatment, but it can also occur later in treatment.
222
You are running a training session for your pharmacy technicians on opioid use for treatment of
mild to moderate pain. You are discussing the use of codeine containing preparations and have
given them some examples of different patient groups. In each case, the person has no known
drug allergies and is otherwise fit and healthy.
In which of the following cases would it be MOST appropriate to use a codeine containing
preparation?
A A 17-year-old girl who has had her tonsils removed due to obstructive sleep apnoea
B A 19-year-old Ethiopian man with a ligament injury from a Jiu-Jitsu match
C A 26-year-old breast-feeding mother with post-caesarean pain who is hypersensitive
to ibuprofen
D A 31-year-old Norwegian man with a dry painful cough that has not improved with the
use of local anaesthetic lozenges
E An 11-year-old child who has a toothache but his appointment with the dentists is in
two days time
D A 31-year-old Norwegian man with a dry painful cough that has not improved with the
use of local anaesthetic lozenges
223
A patient comes in to your pharmacy and asks you to recommend a mouthwash. Over the last
cle f eek he ha deeled a e h ad bleedig g She hik i de a
new firm bristle toothbrush she has been using. Her PMR lists the following medications:
Aspirin 75mg dispersible tabs, 1 OD
Betahistine 8mg tabs, 1 TDS
Carbamazepine 200mg tabs, 1 BD
Simvastatin 40mg tabs, 1 ON
Which ONE of the following is the MOST appropriate course of action?
A Refer her to the doctor as she may be suffering from carbamazepine side effects
B Sell chlorhexidine 0.5% mouthwash with additional mouth hygiene advice
C Sell Oragel® Dental Gel (benzocaine 10% w/w) with additional mouth hygiene advice
D Suggest an alternative to betahistine which can cause dry mouth leading to sore and
bleeding gums
E Tell her to stop the aspirin as bleeding gums leading to soreness is a recognised a side
effect of antiplatelet medications
A Refer her to the doctor as she may be suffering from carbamazepine side effects`
224
a patient who is admitted to hospital with community acquired
pneumonia. He has a medical history of osteoarthritis, hypothyroidism, iron deficiency anaemia and
BPH and reports a rash with penicillins. The aie medication history is listed below:
The doctors decide to start the patient on a broad spectrum antimicrobial drug which has activity
particularly against atypical bacteria.
3. Which ONE of the following antimicrobials would be the MOST appropriate treatment for him?
A Amoxicillin
B Ciprofloxacin
C Clarithromycin
D Co-amoxiclav
E Metronidazole
C Clarithromycin
225
One week after his hospital admission, the patient develops diarrhoea. A stool sample confirms
the presence of Clostridium difficile infection. Doctors decide to stop the lansoprazole and review
the antibiotic for his infection.
Which ONE of this patients medications listed below is MOST likely to require temporary
discontinuation in view of his Clostridium difficile infection?
A Ferrous sulphate
B Finasteride
C Ibuprofen
D Levothyroxine
E Paracetamol
A Ferrous sulphate
