PAST PAPERS/ONTRACK LEARNING POINTS

Question 1

Child presents with ‘grey-ish white spots. Most likely condition?

Answer 1

Measles.

Question 2

WHAT ARE THE COMMON SYMPTOMS?1) CHICKEN POX2) MEASLES3) MUMPS4) RUBELLA5) SCARLETT FEVER

Answer 2

1) red vesicles/lumps2) white spots, conjunctivitis3) salivary glands swelling4) red, spotty rash, swollen glands back of neck5) sandpaper blanching rash on trunk, strawberry tongueNHS RASH PICTURES

Question 3

What is the mechanism of action of ‘SGLT2s’? Examples?

Answer 3

• inhibits SGLT2 in renal proximal convoluted tubule
• reduce glucose reabsorptions
• increases urinary glucose excretion
• E.g. canaglifloxin, dapagliflozin.

Question 4

What test result must be normal before starting clozapine? MOA? Why? Used in?

Answer 4

Antipsychotic, 2nd-gen. Risk of neutropenia, therefore, leucocyte and diff. blood counts must be normal. Schizophrenia/PD.

Question 5

What are the important tests for ATORVASTATIN?

Answer 5

• Serum transaminase levels >3x upper limit? STOP
• Creatinine kinase >5x upper limit? Repeat in 7d STOP STATIN
• Diabetes risk? Check HBA1c.

Question 6

What does Boostrix-IPV injection protect against?

Answer 6

DPTP?diptheria, pertussis (whooping cough), tetanus & poliomyelitis (polio).

Question 7

Non-bullous impetigo, MOST appropriate treatment?Widespread non-bullous, MOST appropriate treatment?Bullous, systemically unwell, MOST appropriate treatment?

Answer 7

• Non-bullous? Hyrogen peroxide 1% cream
• Widespread non-bullous? Topical- Fusidic acid, L? Mupirocin, L? Oral flucloxacillin, L? (pen allergy) Clari/eryhtromycin.
• Bullous? Oral flucloxacillin–> Clari/erythromycin.

Question 8

TIP: Lithium? Other drugs, formulation switch? Dose?

Answer 8

Divided doses, BE CAREFUL.

Question 9

Influenza vaccine community pharmacy requirements?

Answer 9

18-50 at risk: copd, chd, ckd, cld, asthma>50immunocompromised and relatives long-stay care, allowancehealthcare workers

Question 10

Vet med cascade, dispensing label legal requirements?

Answer 10

1) Keep out of reach of children
2) N+A of animal owner
3) N+A of pharmacy
4) ID+Species of animal
5) vet surgeon still The words: ‘For animal treatment only’
6) The words: ‘Keep out of reach of children’.

Question 11

What antibiotics are associated with C-diff. resistance?

Answer 11

Cefaclor, ciprofloxacin, clindamycin & co-amoxiclavWHY?!

Question 12

Use of folic acid in pregnancy? Higher risk of neural tube defects?

Answer 12

Folic acid 400mcg tabs, pre-conception+till week 12

Higher risk? Epilepsy/diabetic/sickle-cell, give 5mg instead

sickle cell is throughout

Question 13

Depression first-line in CHILDREN?

Answer 13

Fluoxetine, SSRI

Question 14

Hydroxychloroquine key info?

Answer 14

Vision disorders, annual monitoring required in patients taking >5 years.

Question 15

Dalteparin DVT- prophylaxis/treatment no. of units?

Answer 15

Prophylaxis- 5000units/24 hoursTreatment- 10000units/24 hours

Question 16

Coeliac disease, diet?

Answer 16

Gluten free best, chicken, meat, beef.AVOID cheese/bread/pizza/soup/roll wheat,barley, all that

Question 17

Warfarin tablets and colours?

Answer 17

0.5MG WHITE1MG BROwn3MG BLUe5MG PINK

Question 18

Symptoms of meningitis (2yr old)?

Answer 18

Capillary refill time>2s
Cold hands & feet
Drowsiness
sleepiness
Poor urine (dry nappes!)
Rash that does NOT BLANCH under pressure

Question 19

Patient with epilepsy, travelling to malaria region, best treatment?

Answer 19

Atovaquone w/ proguanil. AVOID CHLOROQUINE, can lower seizure threshold, cautioned.

Question 20

Patient, red eye, no trauma, no meds, no symptoms. Best action?

Answer 20

No treatment- self-limiting

Question 21

Hypoglycaemia treatment adult?

Answer 21

> 4mmol/L? Have a snack, bread, meal.

<4mmol/L? 15-20g oral glucose/200ml juice/4 spoons of sugar

Question 22

EXPLAIN HYPERTHYROIDISM

Answer 22

Weight loss, fast heartbeat, tachy. Fast, nervousness. low TSH (HIGH T3/T4), thyroid making too much hormone, TSH stimulates the release of thyroxine, hence HYPER.

Question 23

EXPLAIN HYPOTHYROIDISM

Answer 23

fatigue, cold, dry skin, constipation, hoarseness, weak. High TSH (low T3/T4), thyroid not being stimulated enough to make thyroxine, hence HYPO.goitre- swelling of the neck

Question 24

GTN spray counselling?

Answer 24

• Spray under tongue, close mouth immediately
• Sit down before & after spray (risk of postural hypotension)
• SE- headache & flushing
• Symptoms not resolved after 3 doses? SEEK MEDICAL ATTENTION!

Question 25

Gout Treatment,Acute?Long-term?

Answer 25

Acute? Colchicine or NSAID (naproxen, X aspirin. Be wary of renally cleared drugs & hyponatraemia). Long-term? Allopurinol--> Febuxostat

Question 26

Heartburn Management?

Answer 26

Dietary-->Antacid (Gaviscon)--> Esomeprazole (14days)--> Ranitidine (unlicensed)

Question 27

Eczema management?

Answer 27

Mild? Emollient--> emollient+topical corticosteroid, hydrocortisone.Moderate atopic? Topical pimecrolimus?Severe? Tacrolimus

Question 28

What product is air added for easy removal of liquid inside?

Answer 28

Sealed vial

Question 29

EHC AGES?

Answer 29

Levonelle/levonorgestrel, >16, 72hrsellaOne/ulipristal, any age, 120hrs

Question 30

1) Simple linctus age?2) Fluconazole 150mg age?3) Tamusolsin age?

Answer 30

1) >122) 16-603) 45-75

Question 31

Sildenafil advice?

Answer 31

Take 1hr pre-SE, AVOID with food, can delay onset of effect.

Question 32

digoxin therapeutic range? toxicity and action?

Answer 32

0.7-2ng/mL. 2.5mcg/L toxic? STOP

Question 33

TYPE 2 DIABETES MANAGEMENT? Initial/1st/2nd intensification?

Answer 33

Initial? Metformin **First**? * Metformin+1 of following: * Sulphonylurea (gliclazide/tolbu) * Pioglitazon * DPPI (Linagliptin) * SGLT2 (dapagliflozin)---> only when sulfonylureas contra-indicated or not tolerated, or if patient at significant risk of hypoglycaemia or its consequences **Second** * Metformin+Sulphonylurea+DPPI4 * Metformin+Sulphonylurea+Pioglitazon * Metformin+Sulphonylurea+SGLT2 * Metformin+Pioglitazone+SGLT2 (Note: Dapagliflozin not recommended in TT with pioglitazone).

Question 34

Sereteide (fluticasone with salmeterol) age?

Answer 34

100 Accu/Evohaler? 12-17& adult 50 Evohaler? 4-17 & adult, <4 off-label, lack of alternative

Question 35

Cellulitis treatment?

Answer 35

Flucloxacillin, penicillin allergy? Clindamycin.

Question 36

Side-effects of trimethoprim?

Answer 36

electrolyte imbalance; fungal overgrowth; headache; N,V,D; skin reactions; Leucopenia, thrombo, hyperkalaemia & high plasma Cr concs.

Question 37

Levonorgestrel, Ulipristal breastfeeding?

Answer 37

Levonelle? Nil effectUlipristal? Avoid for 1 week post.

Question 38

Modifiable risk factors CVD?

Answer 38

Smokingnon-HDLactivitydietalcoholobesity.

Question 39

POM requirements?

Answer 39

N+A of patientN+A of prescribersignaturedate (6months)age if under 12.

Question 40

Gestational hypertension?

Answer 40

Labetalol. L? Nifedipine. L? Methyldopa

Question 41

Beta-blockers minimal nightmares?

Answer 41

CANSCeliprololAtenololNadololSotalol

Question 42

LOW RESPIRATORY TRACT INFECTION COPD Low BP Atypical pathogen?

Answer 42

Streptococcus pneumoniae (neither gram - OR +)

Question 43

FENTANYL PATCHES KEY INFO?

Answer 43

EVERY 72 HOURSEXCESSIVE HEAT= SIDE-EFFECT, OD BREATHING L? REMOVE IMMEDIATELYROTATE SITES

Question 44

SPC Qs tipBE CAREFUL CAFFEINE CITRATE IS NOT =/= CAFFEINE BASE

Answer 44

Caffeine citrate 2 mg ≡ caffeine base 1 mg

Question 45

HEARTBURN REFERRAL?

Answer 45

DYSPHAGIA UNEXPLAINED WEIGHT LOSS GI BLEED VOMITING

Question 46

ALLI (Orlistat) COUNSELLING?

Answer 46

LOW FAT, HYPOCALORIC DIETFAT SOLUBLE VITS (ADEK) IMPAIRED BMI>28kg/m^2 180/360mg MAX OTC ALLI, MAX 6 MONTHS

Question 47

16 year old, symptoms of menorrhagia, action?

Answer 47

Refer to GPCan't sell OTC tranexamic acid,18-45 years only

Question 48

MALARIAMEFLOQUINE CONTRA?DOXYCLINE CONTRA?

Answer 48

MEFLOQUINE CONTRA? depressionDOXYCLINE CONTRA? <12 years childrenATO+PROG COMBINED BEST

Question 49

SILDENAFIL+ALPHA BLOCKERS/ACE-i/ARB?

Answer 49

hypotension side effect, significant!

Question 50

Scarlett fever1ST LINE?2ND LINE?

Answer 50

1ST LINE? phenoxymethylpenicillin qds for 10 days2ND LINE? Azithromycin 300 mg once daily for 5 days

Question 51

SLAPPED CHEEK SYNDROME S&S?

Answer 51

FEVERRUNNY NOSERED RASHPLENTY FLUID+PARACETAMOLCAN STILL GO SCHOOL

Question 52

SHINGLES S&S?

Answer 52

BURNINGITCHYONE-SIDED RASHREFER GP ANTIVIRAL

Question 53

CLOPIDOGREL+PPI?

Answer 53

BIG NO NO- OMEPRAZOLEPANTOPRAZOLE IS BESTLANS/RABEP close second

Question 54

STATIN IN SECONDARY PREVENTION OF CVD?

Answer 54

ATORVASTATIN 80MG OD

Question 55

SITAGLIPTIN vs LINAGLIPTIN?

Answer 55

SITA- renal dose adjustment LINA- as you please

Question 56

valproate bipolar pregnant women?

Answer 56

contraindicated

Question 57

NITROFURANTOIN URINE COLOUR?

Answer 57

DARK YELLOW/BROWN

Question 58

RIFAMPICIN URINE COLOUR?

Answer 58

REDDISH-ORANGE

Question 59

LITHIUM MONITORING?

Answer 59

BMI, weight gainELECTROLYTESeGFRTHYROIDnot liver function

Question 60

METHOTREXATE- LIVER TOXICITY S&S?

Answer 60

N&VSTOMACH ACHEAPPETITEFATIGUEYELLOWING

Question 61

METHOTREXATE AND OMEPRAZOLE?

Answer 61

METHOTREXATE CONC. BEZERK

Question 62

AZATHIOPRINE, UNEXPLAINED BLEEDING?

Answer 62

POSSIBLE BONE MARROW SUPPRESSION- GP ASAP

Question 63

SPCPRACTICE FERINJECT Qs?

Question 64

DRUGS CAUSING HYPERTHYROIDISM?

Answer 64

AMIODARONELEVOTHYROXINELIOTHYRONINELITHIUM

Question 65

CALCIUM & LEVOTHYROXINE?

Answer 65

Reduces levo absorption, don't take at same time!

Question 66

HRT RISKS?

Answer 66

BREAST CANCERSTROKEOVARIAN CANCERVTE

Question 67

HRT LEAST LIKELY?

Answer 67

OSTEOPOROSIS, reduced risk with HRT!

Question 68

LEG ULCER1ST LINE?2ND LINE?

Answer 68

1ST LINE? FLUCLOXACILLIN2ND LINE? DOXY/CLARI/ERY PREGNANCY)

Question 69

PRESSURISED MDI technique?

Answer 69

SLOW AND STEADY

Question 70

DPI TECHNIQUE?

Answer 70

QUICK AND DEEP

Question 71

HAS-BLED estimates?

Answer 71

Risk of bleeding in patients with AF who are being offered anticoagulation

Question 72

HAS-BLED RISK FACTORS?Hypertension. Abnormal renal and liver function. Stroke. Bleeding.

Answer 72

AGEALCOHOLHYPERTENSIONLIVER DISEASENOT CONGESTIVE HEART FAILURE, THAT'S CHADVASC SCOREHypertension. Abnormal renal and liver function. Stroke. Bleeding.

Question 73

eGFR<60 flozin?

Answer 73

DAPAGLIFLOZIN NOT RECOMMENDED

Question 74

GLIBENCLAMIDE IN ELDERLY?

Answer 74

NOT RECOMMENDEDHIGHER RISK OF HYPOGLYCAEMIAOLD+RENAL IMPAIRMENTcos longer action

Question 75

METFORMIN POOR RENAL FUNCTION?

Answer 75

NOT RECOMMENDED, HIGH RISK OF LACTIC ACIDOSIS IN AKI

Question 76

SITAGLIPTIN RENAL IMPAIRMENT?

Answer 76

REDUCE DOSE or caution

Question 77

SYMPTOMS OFNEUROLEPTIC MALIGNANT SYNDROME?

Answer 77

MENTAL STATE CHANGE MUSCULAR RIGIDITY HYPERTHERMIA AUTONOMIC INSTABILITY

Question 78

RED/PURPLE RASH SIGN OF?

Answer 78

STEVENS-JOHNSON SYNDROMEANTIEPILEPTIC ASSOCIATED+others

Question 79

WARFARIN TARGETSAF/DVT/PE/HEART VALVE?RECURRENT DVT/PE?MECHANICAL HEART VALVE?

Answer 79

AF/DVT/PE/HEART VALVE? 2.5RECURRENT DVT/PE? 3.5MECHANICAL HEART VALVE? 3-4, even higher

Question 80

ACUTE ISCHAEMIC STROKEINITIAL?ALTERNATIVE?

Answer 80

INITIAL? 300mg aspirin, (first 2 weeks)ALTERNATIVE? clopidogrel 75mg OR 300mg loading dose STEMI vs NSTEMI

Question 81

Behaviours such as smoking, lack of physical activity, unhealthy diet, alcohol consumption, being overweight or obese, and loneliness that can be changed to reduce the risk of developing dementia.

Question 82

SPC- use the info slow!

Question 83

You are running a weight loss clinic and one of your clients explains to you that whilst she knows she needs to start exercising, she just doesn’t have the motivation to start yet. She recently thought about buying an exercise bike to use at home, but then lost her job and can no longer afford it.STAGE OF BEHAVIOUR CHANGE?

Answer 83

Contemplation

Question 84

SCIATICA/CAUDA EQUINA SYNDROME S&S?

Answer 84

BLADDER LsNEUROLOGICAL WEAKNESSBILATERAL RADICULOPATHYINCAPACITATING NIGHT PAINUNRELENTING NIGHT PAINSTEROIDS/IV DRUGS

Question 85

CKS guidelines for suspected cancer pathway referral (for an appointment within 2 weeks) if?

Answer 85

they are aged 40 and over with unexplained weight loss and abdominal pain or• they are aged 50 and over with unexplained rectal bleeding or• they are aged 60 and over with either iron-deficiency anaemia or changes in their bowel habit, or• tests show occult blood in their faeces• Consider a suspected cancer pathway referral for colorectal cancer in adults aged under 50 with rectal bleeding and any of the following unexplained symptoms or findings:- abdominal pain- change in bowel habit- weight loss- iron-deficiency anaemia

Question 86

VINCRINSTINE/VINFLUNINE/VINORELBINEMETHOD OF ADMINISTRATION?

Answer 86

INTRAVENOUS ONLY!INTRAVENOUS ONLY!INTRAVENOUS ONLY!intrathecal-severe neurotoxicity-fatal

Question 87

IMPETIGO BULLOUS TREATMENT?

Answer 87

FLUCLO, THEN CLARI/ERY

Question 88

IMPETIGO NON-BULLOUS TREATMENT?

Answer 88

HYDROGEN PEROXIDETHEN FUSIDIC ACID, THEN MUPIROCINWIDE-SPREAD? SECOND LINE ABOVE

Question 89

ANTIBIOTICS CAUSING C DIFF?

Answer 89

CEPHALOPSORINSCLINDAMYCINCO-AMOXICLAVQUINOLONESNOT AMINOGLYCOSIDESNOT DOXYCYCLINE

Question 90

SEPSIS?

Answer 90

Slurred speech/confusionExtreme shivering/muscle painPassing no urineSevere breathlessnessIt fees like death wthSkin mottled/pale

Question 91

MEDS THAT SHOULD NOT BE STOPPED PRIOR SURGERY?

Answer 91

ANTIEPILEPTICS ANTIPARKINSONS ANTIPSYCHOTICS BRONCHODILATORSGLAUCOMA DRUGSIMMUNOSUPPRESSANTS

Question 92

ALCOHOL MAXIMUM WEEKLY UNITS?

Answer 92

14

Question 93

METHOTREXATE+CLOZAPINE/OLANZAPINE RISK?

Answer 93

NEUTROPENIA/AGRANULO...

Question 94

GPHC 4 CPD ENTRIES

Answer 94

that's TWO planned1 peer discussion1 reflective account

Question 95

CHICKEN POX OTC ITCH PAEDS?

Answer 95

CHLORPHENAMINE 1MG EVERY 4-6HRS

Question 96

CLINICAL AUDIT ETHICS APPROVAL?

Answer 96

NOT NEEDED SILLY, IS NOT A TRIAL

Question 97

FOOD REFERENCE INTAKES?

Answer 97

Saturated fat 30g men, 20g womenSugars 30gSalt 6g

Question 98

PURINE RICH FOOD?

Answer 98

RED MEATSEA FOODAVOID GOUT

Question 99

HEP B VACCINE FACTS?

Answer 99

ACCELERATED SCHEDULESYMPTOMS- JAUNDICE/LOSS OF APPETITE/FEVERDELTOID SITE BEST- IM INJECTIONSTANDARD SCHEDULE- 20MCG- ZERO/ONE/SIX MONTHS

Question 100

HIGH RISK INFECTIONENDEMIC AREASPOOR SANITATION/FOOD HYGIENEVACCINE?

Answer 100

TYPHOID

Question 101

ROSACE SYMPTOMS TRIGGERS?

Answer 101

EMOTIONAL STRESSEXERCISESMOKINGSPICY FOODALCOHOLHOT/COLD TEMP.HOT DRINKS, NOT COLD

Question 102

STEROIDSMILD?MODERATE?POTENT?VERY POTENT?

Answer 102

MILD? HydrocortisoneMODERATE? ClobetasonePOTENT? BetamethasoneVERY POTENT? Clobetasol

Question 103

PPI CAUTIONS?

Answer 103

RISK OF FRACTURESGI INFECTIONSMAY MASK SYMPTOMS OF GASTRIC CANCERMAY REDUCE ABSORPTION OF VITAMIN B12, LONG-TERMPATIENTS AT RISK OF OSTEOPOROSIS

Question 104

ATENOLOL CAUTION?

Answer 104

Sudden cessation of a beta-blocker may cause a rebound worsening of myocardial ischaemia & may cause exacerbation of anginaAnd impotence? ..

Question 105

ADRENALINE ANAPHYLAXIS DOSING?CHILD UP TO 6 MONTHS?CHILD 6 MONTHS–5 YEARS?CHILD 6–11 YEARS?CHILD 12?+every 5 mins

Answer 105

CHILD UP TO 6 MONTHS- 0.1–0.15 mLCHILD 6 MONTHS–5 YEARS- 0.15 mLCHILD 6–11 YEARS- 0.3 mLCHILD 12–17 YEARS- 0.5 mL | 0.3 mL should be given if child is small or prepubertal300 micrograms to be administered if child is small or prepubertal.0.3 mL should be given if child is small or prepubertal300 micrograms to be administered if child is small or prepubertal.ADULT 500 micrograms- 0.5 mL repeat after 5mins if necessary...

Question 106

CARBIMAZOLE MHRA WARNING- AGRANULOCYTOSIS/NEUTROPENIA?

Answer 106

SORE THROATMALAISEFEVERBRUISINGnot diarrhoea!

Question 107

COMMUNITY, HYPOGLYCAEMIA 1ST LINE?

Answer 107

150-200ml fruit juice15-20g glucose/sucroseGlucagon injection ONLY if hypoglcaemic unresponsive/can't use oral route

Question 108

WHAT IS A MISSED PILL?

Answer 108

>/=24 HOURS LATE

Question 109

SCABIES- webbing of fingers/toes, papulesTREATMENT?

Answer 109

permethrin 5% cream over the counter and applies it to the whole body paying special attention to the areas between the fingers and toes and under the nails.

Question 110

NSAIDs warnings?

Answer 110

BLEEDINGBLACK STOOLSCOFFEE GROUND VOMIT!

Question 111

GTN DISCARD?

Answer 111

8 WEEKS AFTER OPENING! G

Question 112

ISPAGHUA HUSK/BULK-FORMING ADVICE?

Answer 112

W/ PLENTY OF FLUIDS, TO AVOID INTESTINAL OBSTRUCTION+DO NOT TAKE BEFORE BED

Question 113

AMINOSALICYLATESSORE THROATFEVERNOSEBLEED?

Answer 113

BLOOD DYSCRASIS? GP ASAP!

Question 114

AMIODARONE-unintended weight losspalpitationshyperactivityBEST TEST?

Answer 114

THYROID TESTSYMPTOMS OF HYPERTHYROIDISM!

Question 115

PATIENT TAKING WARFARINDIZZZINESS DARK STOOLSTEST?

Answer 115

HAEMOGLOBIN- SYMPTOMS OF GI BLEED

Question 116

LITHIUMDIZZINESSCONFUSIONTEST?

Answer 116

SODIUM- risk of hyponatraemia

Question 117

ADULT MALE, ANAPHYLAXIS COMMUNITY?

Answer 117

300MCG???

Question 118

black triangle- limited experience

Answer 118

REPORT ALL ADRs!

Question 119

SEVERE MUSCLE JOINT PAINTTENDONITISADMITTEDCIPRO/QUINOLONES

Answer 119

ESTABLISHED BUT SERIOUS SO REPORT!

Question 120

DOMPERIDONE+FLUCONAZOLE?

Answer 120

INCREASES QT INTERVAL PROLONGATION, AVOID!

Question 121

CLOPIDOGREL+ESCITALOPRAM?

Answer 121

RISK OF BLEEDING!

Question 122

SPIRONOLACTONE+FUROSEMIDE RISK?

Answer 122

K+ sparing and loop?HYPONATRAEMIA RISK!

Question 123

TRANEXAMIC ACID DOSING?

Answer 123

2 TABS TDS 4 DAYS, SYMPTOMS ALLEVIATED

Question 124

ORLISTAT, ADEK?

Answer 124

IMPAIRS ABSORPTION OF FAT SOLUBLE VITAMINS, GIVE MULTIVTAMIN SUPPLEMENT BEDTIME!

Question 125

OMEPRAZOLE MAXIMUM OTC SUPPLY?

Answer 125

2 WEEKS AS P!

Question 126

IBUPROFEN AND CHICKEN POX?

Answer 126

AVOID!SEVERE SKIN/SOFT TISSUE COMPLICATIONS!

Question 127

DRY ITCHY PATCHES KNEES/ELBOWS?

Answer 127

ATOPIC ECZEMA

Question 128

REPEAT TREATMENT TWO WEEKS AFTER INITIAL?

Answer 128

THREADWORM

Question 129

LITHIUM+SERTRALINE/SSRI?

Answer 129

RISK OF SEROTONIN SYNDROME!

Question 130

ISOTRETINOIN FEMALE, PPP, SHORT EXPIRY?

Answer 130

7 DAYS- UNDER PPP, DISPENSE ASAP

Question 131

SATIVEX PRESCRIPTION VALIDITY?

Answer 131

28 DAYS- SCHEDULE 4

Question 132

POM/PRIVATE PRESCRIPTION RECORDS DURATION?

Answer 132

2 YEARS

Question 133

VET PRESCRIPTION DURATION?

Answer 133

5 YEARS!

Question 134

MEDS THAT NEED TO BE STOPPED PRIOR TO SURGERY?

Answer 134

HRTPILLLITHIUMACEANTICOAGMUST NOT BE STOPPED? ANTIEPILEPTICS, cmon

Question 135

COMMON HYPO IN SHORT BOWEL PATIENTS?

Answer 135

HYPOMAGNESAEMIA

Question 136

KIDNEY STONES TREATMENT

Answer 136

PARACETAMOL NSAIDs- check dosing, when is it PR/rectum/when required?OPIOIDSTAMSULOSIN, FEMALE, UNLICENSED

Question 137

ANTIDIABETIC DRUG ACUTE PANCREATITIS?

Answer 137

DULAGLUTIDE

Question 138

DEMENTIA, WITH LEWY BODIES, FIRST LINE?

Answer 138

DONEPEZIL

Question 139

CITALOPRAM, SSRI, FLUOX, PRACTICALLY FIRST LINE

Question 140

RAMIPRIL CAUSES HYPER..?

Answer 140

HYPERKALAEMIA

Question 141

WHICH ANTICOAGULANT NEEDS TO BE TAKEN WITH FOOD?!

Answer 141

RIVAROXABAN, THEREFORE DIET KEY! AAAAH

Question 142

SIMVASTATIN+AMLODIPINE?

Answer 142

RHABDOMYOLYSIS

Question 143

METFORMIN INITIAL DOSING?

Answer 143

OD, increasing to TDS after 2 weeks

Question 144

HYPOGLYCAEMIA TREATMENT?

Answer 144

TWO TUBES OF 40% GLUCOSE GEL

Question 145

HYPERTHYROIDISM TREATMENT?

Answer 145

LOW TSH, HIGH T3/T4

Question 146

HYPOTHYROIDISM TREATMENT?

Answer 146

HIGH TSH, LOW T3/T4

Question 147

Valproate, PPP, best contraceptive?

Answer 147

IUD

Question 148

DOXYCYLINE INAPPROPRIATENESS?

Answer 148

BABIES, TEETH, STAINING, ETC, CMON!12 YEARS+!

Question 149

ORBIT TOOL?

Answer 149

most accurate for predicting the risk of bleeding in people with AFhasbled basically same

Question 150

TRAMADOL+SSRI?

Answer 150

SEROTONIN SYNDROME!

Question 151

VACCINE, POST-IMMUNISATION PYREXIA?

Answer 151

meningitis B

Question 152

MEBENDAZOLEMINIMUM AGEPREGNANCYMAX. SINGLE DOSEMAX. PACK SIZE

Answer 152

2+AVOID100MG800MG

Question 153

RHINITIS TREATMENT?AVOID?

Answer 153

TREATMENT?antihistamineschlorphenaminedecongestantseye dropsAVOID? NASAL STEROIDS- only for 18+, max. 3 months use

Question 154

WARFARIN+DOXYCYCLINE?inhibitor

Answer 154

HIGH INR SKRR

Question 155

DRUG CLASSESCHLORTHALIDONE?INDOMETHACIN?RANOLAZINE?

Answer 155

DIURETICNSAIDfor ANGINAREMEMBER DAMNdiurecticsacemetforminnsaidscan stop top first two safe

Question 156

UTI BACTERIA?

Answer 156

E COLI!

Question 157

CAP/MENINGITIS? UTI? THRUSH? CELLULITIS?

Answer 157

CAP/MENINGITIS? Streptococcus PneumoniaeUTI? Eschericia ColiTHRUSH? Candida AlbicansCELLULITIS? Staphylococcus Aureus

Question 158

NITRATES SIDE-EFFECTS?

Answer 158

DIZZINESSFLUSHINGHEADACHESPALPITATIONSSYNCOPENOT MALIGNANT HYPERTHERMIA!!!

Question 159

METFORMING SELF-MONITORING?

Answer 159

NOT NEEDED G

Question 160

DRUGS THAT CAUSE GORD?

Answer 160

``` A-BLOCKERS BENZODIAZEPINE B-BLOCKERS COCORTICOSTEROIDS NSAIDs NITRATES TCAs ```

Question 161

CAN CAUSE GORD?NOT?

Answer 161

CAN CAUSE GORD? alendronic acidamlodpinenaproxenprednisoloneNOT?indapamide

Question 162

SEDATING ANTIDEPRESSANT?

Answer 162

MIRTAZAPINE!

Question 163

LITHIUM MONITORING?

Answer 163

BMIeGFRThyroidUrea+electrolytesNOT LIVER

Question 164

CCB OD TREATMENT VERAP?

Answer 164

ACTIVATED CHARCOAL in 1hr

Question 165

Iron tablets, consipation, GI, nausea, action?

Answer 165

TAKE THE MEDICATION WITH OR AFTER FOOD

Question 166

PATIENT WITH RECURRENT DEPRESSIONHOW LONG TREATMENT?

Answer 166

AT LEAST 2 YEARS

Question 167

CHILDTEETHINGCHEWING BITING?

Answer 167

Paracetamol suspension calm

Question 168

DYSLIPIDAEMIAPRIMARY?SECONDARY?

Answer 168

PRIMARY? Inherited genetic mutation to LDLR geneSECONDARY?Excessive alcohol consumptionHypothyroidismLiver diseaseUncontrolled diabetes mellitus

Question 169

IBUPROFEN IN CHICKEN POX????

Answer 169

NO WAY!!!!!!!!

Question 170

HEAD LICE ADVICE?

Answer 170

GO SCHOOL KIDCOMBINGTREAT EVERYONE SAME DAYWASH CLOTHES/BED SHEETS HIGH TEMP

Question 171

URTICARIA S&S?

Answer 171

Batches of red/skin-coloured weltsSevere itchingSwelling angio, lips/eyelids/sore throat

Question 172

VITAMIN FORFATIGUE?LETHARGIC?FAINT?

Answer 172

VITAMIN B12

Question 173

FINASTERIDE, CYTOTOXIC, DOSEETE LLOW IT

Question 174

GABAPENTIN, SCHEDULE 3 SO PRIVATE FORM?

Answer 174

NEEDS CORRECT SCRIPT FP10PCD

Question 175

OLANZAPINE, NRT, STOPS SMOKING, ACTION?

Answer 175

REDUCE OLANZAPINE DOSE!

Question 176

OLANZAPINE, NRT, STOPS SMOKING, ACTION?

Answer 176

REDUCE OLANZAPINE DOSE!

Question 177

IMPETIGO NON-BULLOUS FIRST LINE?

Answer 177

HYDROGEN PEROXIDE|||FUSIDIC ACID

Question 178

PHARMACY RECORD BOOK YEARS?

Answer 178

5

Question 179

DPI TECHNIQUE?

Answer 179

STRONG AND DEEP

Question 180

pMDI technique?

Answer 180

SLOW AND DEEP

Question 181

ISOTRETINOIN PPPVALIDITY?

Answer 181

7 DAYS>30 DAYS SUPPLY IS CALM IF NOT UNDER PPP!

Question 182

PATIENT SILDENAFIL ON PRESCRIPTIONCAN GET SUPPLY NEXT WEEKLLOW OTCSALBUTAMOL ISSUE YES BUT ITS PRN?

Question 183

THEOPHYLLINE TOXICITY?

Answer 183

AGITATIONCONVULSIONSDILATED PUPILSVOMITINGNOT BRADYCARDIA

Question 184

LANSOPRAZOLE SUMMARY?

Answer 184

MEASURE MG2+FRACTURESGI INFECTIONSGASTRIC CANCERREDUCE ABSORPTION OF VITAMINB12 W/ treatmentOSTEOPOROSIS

Question 185

OPIOID OD TREATMENT?

Answer 185

NALOXONE

Question 186

MICONAZOLE, FUNGAL DIRECTIONS?

Answer 186

SKIN- apply twice daily continuing for 10 days after lesions have healedORAL- 2.5ml QDS+ 7 days after

Question 187

prednisolone received repeated courses in a year?

Answer 187

a 5-day course of prednisolone 40 mg then wean gradually

Question 188

NUTRITIONAL DEFICIENCYBLEEDING GUMS?

Answer 188

VITAMIN C

Question 189

NUTRITIONAL DEFICIENCYPROLONGED BLEEDING AFTER SMALL CUT?

Answer 189

VITAMIN K

Question 190

NUTRITIONAL DEFICIENCYdermatitis sun-exposed skin/diarrhoea/depressionRECENT TB TREATMENT?

Answer 190

VITAMIN B6 (PYRIDOXINE)

Question 191

BASAL BOLUS REGIMEN, TYPE 1?

Answer 191

NovoRapid (insulin aspart) three times daily with meals and Lantus at night

Question 192

INTERMEDIATE-ACTING REGIMEN?

Answer 192

INSULTARDISOPHANEHUMULIN I

Question 193

MOLLUSCUM CONTAGIOSUM S&S?

Answer 193

PINKISH/PEARLY WHITE PAPULESSWELLINGROUND FIRMMOST COMMON AGED 1-4

Question 194

MILIARIA/HEAT RASH S&S?

Answer 194

RED BUMPSPRICKLY/ITCHY FEELINGTINY BLISTERSINFLAMMATION

Question 195

An infection of the dermis and subcutaneous tissues, commonly in the lower leg. Affected skin feels warm, may look swollen and looks red and inflamed. The infected area may spread and is usually tender. Sometimes blisters occur on the skin.

Answer 195

cellulitis!

Question 196

RUNNY NOSECOUGHFEVERCONJUNCITIVITIS?

Answer 196

MEASLES

Question 197

HEADACHEUNILATERAL PAIN BEHIND EYE, COMES AND GOESWATER EYELID SWELLINGFLUSHINGEVERY 3 MONTHS

Answer 197

CLUSTER!

Question 198

HEADACHE OVER WHOLE HEAD- TIGHT BANDWORSENS AS DAY GOES ONNO NAUSEA/PHOTOPHOBIA (migraine)

Answer 198

TENSION!

Question 199

A 42-year-old man complains of a severe headache of sudden onset 3 hours ago, likened to being kicked in the back of the head. He has vomited twice and is now feeling stiff in his neck

Answer 199

SUBARACHNOID HAEMORRHAGE!

Question 200

SSRI DROWSY CONFUSED, LEVELS?

Answer 200

HYPONATRAEMIA!

Question 201

SALBUTAMOLTIREDFATIGUECONSTIPATION?

Answer 201

HYPOKALAEMIA!

Question 202

CROUP TREATMENT?

Answer 202

STEROID, PREDNISOLONE!

Question 203

PROPYLTHIOURACILHIGH BILIRUBIN LEVELSFATIGUEJAUNDICEABDOMINAL PAIN

Answer 203

LIVER DISORDER!!

Question 204

ROPINIROLE ADR?

Answer 204

BINGE EATING!STOP

Question 205

TRIMETHOPRIM BLOOD DYSCRASIA?

Answer 205

MOUTH ULCERS!

Question 206

ZOLEDRONIC ACID/BISPHOS CAUTION?

Answer 206

OSTEONECROSIS OF JAWREDUCED DENTAL MOBILITYsame thing kinda

Question 207

TAMSULOSIN OTC BPHCAPSULES STRENGTHAGEDURATION?

Answer 207

400mcg caps45-75UP TO 6 WEEKS

Question 208

AIZTHROMYCIN OTC CHLAMYDIAAGEMAXIMUM DOSE/DAILY DOSE/PACK SIZE?

Answer 208

16+1G ONLY!

Question 209

ORLISTAT OTCMINIMUM AGE?

Answer 209

18 YEARS

Question 210

HYDROCORTISONE 1% CREAM OTCMINIMUM AGE?DURATION?

Answer 210

10+1 weekdermatitis/insect bites/mild-moderate eczema

Question 211

A mother brings her 6-year-old son into your pharmacy. The child has had a cold for the past two days, but his symptoms have worsened. He now complains of mild headache, general aches and tiredness. This morning he has developed an itchy rash on his face and body. The child has no other medical conditions and no known allergies?

Answer 211

CHICKEN POXPARACETAMOLAVOID IBUPROFEN NO NEED FOR GP

Question 212

RESPIRATORY TRACT INFECTION ORGANISM

Answer 212

STREPTOCOCCUS PNEUMONIAE!

Question 213

HIGH CREATININELOW EGFRDRUG

Answer 213

NAPROXEN!

Question 214

3 YEAR OLD PARACETAMOL DOSE?

Answer 214

180MG! QDS

Question 215

A woman with type 2 diabetes needs to commence insulin treatment and would like to use an insulin preparation that is injected subcutaneously twice daily with meals. SUITABLE INSULIN?

Answer 215

Humalog Mix25 (biphasic insulin lispro)NOT NovoRapid, that requires another, combo

Question 216

You want to obtain guidance on the record keeping requirements for the management and monitoring of vaccine stocks in a pharmacy.SOURCE?

Answer 216

Immunisation against infectious disease(known as the Green Book)

Question 217

RIVAROXABAN & DIPYRIDAMOLE?

Answer 217

BOTH ANTIPLATELETSHIGHER RISK OF BLEEDING!

Question 218

LOWER BACK PAINWhilst gardeningBest analgesic?

Answer 218

ibuprofen 400mg tablets

Question 219

ESCITALOPRAM (SSRI) & DABIGATRAN (antiplatelet)interaction?

Answer 219

bleeding risk increased

Question 220

METHADONE & CITALOPRAM INTERACTION?

Answer 220

QT-INTERVAL PROLONGATION

Question 221

FLUOXETINEdrowsinessnauseaconfusionSIDE-EFFECT?

Answer 221

HYPONATRAEMIA

Question 222

FUROSEMIDE- worsened heart failurefatiguedizzinessmuscle spamsSIDE-EFFECT?

Answer 222

HYPOKALAEMIA

Question 223

DRUG, BLACK TRIANGLE, mild headache/side-effect?

Answer 223

limited experience of the use of this product– report

Question 224

Purpose of benzalkonium?

Answer 224

it prevents microbial growth in the drops after the bottle is opened

Question 225

A 55-year-old man approaches you regarding his nasal congestion. He tells you in addition to congestion in his facial sinuses, he has a continuously runny nose and can feel mucus in his throat. He is not experiencing other symptoms and OTC medicines haven’t helped. He does not have watery eyes and he is not sneezing very often.MOST likely?Seasonal?Persistent?

Answer 225

MOST likely? persistent allergic rhinitisSeasonal? sneezing and watery eyesPersistent? congestion with post nasal drip

Question 226

Erythromycin, alternative to azithromycin (1g single dose), chlamydiaBUT..?

Answer 226

Needs 14 days

Question 227

Hypokalaemia symptom?

Answer 227

NAUSEAFATIGUETINGLING

Question 228

serum phosphate level?

Answer 228

1.12 to 1.45 mmol/L

Question 229

HOW TO DISPOSE OF CD AEROSOL/SPRAY?

Answer 229

aerosols and pump sprays should be discharged directly into the denaturing kit. Once empty the can or pump spray can be thrown away with the pharmacy waste

Question 230

Drugs that cause confusion?

Answer 230

THINK SEDATIVE/ELECTROLYTE IMBALANCESOxazepamGliclazideCo-codamolBendroflumethiazideNOT Ramipril

Question 231

Chemotherapy, MOST likely N&V?

Answer 231

Platinum, cisplatin

Question 232

A new mother comes to ask for advice about her two-month-old son. She tells you that she is at her ’wits end’ as he won’t stop crying. No matter what she does to console him it doesn’t work. She tells you that this has happened for the last month and that he is worse in the evening. You also find out that her son is bottle fed, drinks well without posseting, is gaining weight as expected and is passing stools regularly. She tells you that she has changed his formula two weeks ago and tried Woodward’s gripe mixture to no effect. She wants to know if there is anything you can do or whether she should go to the GP.

Answer 232

E. The baby is healthy but does cry excessively, try to set up a sleep routine and give him lots of attention. It might be appropriate to signpost her to a support organisation as she appears not to be coping.(A month early for teething)

Question 233

A 19-year-old man has come to ask for advice about his embarrassing hair. He has had to stop using hair products as he has a very dry, itchy and flaky scalp. On examining his scalp you find that the skin is very dry and badly scratched but there are no signs of inflammation or reddening. There are pale yellow-white flakes on the head and in the hairline. He wants to know if there is anything that will treat the problem and wants to know what is causing these symptoms.

Answer 233

seborrhoeic dermatitis

Question 234

renal calculi symptoms?

Answer 234

Larger kidney stones can cause symptoms, including:pain in the side of your tummy (abdomen) or groin – men may have pain in their testicles.a high temperature.feeling sweaty.severe pain that comes and goes.feeling sick or vomiting.blood in your urine.urine infection.

Question 235

Her consultant increased the dose of her atomoxetine again up to 80mg per day which she has been taking for the past month. She says that she has been feeling quite sad and tearful, for the past couple of weeks and often doesn’t want to do anything or see anyone. Today she has thought that everyone would be better off without her.

Answer 235

The correct answer is: she is experiencing a recognised side effect of the medicine, and that she should continue to take this as prescribed, as she will develop tolerance to it but should inform her consultant about how she feels.

Question 236

An 86-year-old woman with low severity community acquired pneumonia has been prescribed amoxicillin to treat the infection. Cultures also revealed presence of staphylococcal involvement and the patient requires additional adjunct therapy. Add-on therapy?

Answer 236

Flucloxacillin can be used as an adjunct in pneumonia for infections due to beta-lactamase-producing staphylococciDoxycycline, clarithromycin and erythromycin are alternative antibiotics for atypical pathogens

Question 237

Serevent drug?

Answer 237

SalmeterolGive the yutes salamol/salbutamol!

Question 238

She explains that the child has a rash on their lower limbs which has spread to the rest of the body. The child has a high temperature which has not responded to doses of paracetamol and the child has been sick.

Answer 238

Meningitis, classic, spreading rash?!

Question 239

A 4-year-old boy has been diagnosed with nocturnal enuresis. Despite following advice on diet and fluid intake given by the GP, his parents are still using absorbent pads on the child’s mattress and the boy goes to bed wearing pull up pants (training pants). The parents are asking for advice about medicines as they are finding it hard to afford the pads and pants on a limited budget.

Answer 239

For children under 5 years, treatment is usually unnecessary as the condition is likely to resolve spontaneously. Reassurance and advice can be useful for some families. an alarm would be the next step but may cause distress for such a young childThe correct answer is: reassurance and advice on management techniques

Question 240

A 45-year-old man has been experiencing tiredness, reduced ability to exercise, breathlessness, occasional light-headedness, chest pain and heart palpitations. He is referred by his GP to hospital where he is diagnosed with atrial fibrillation.Following admission to the cardiology department of his local hospital, the patient is prescribed amiodarone.

Answer 240

Liver and thyroid function should be checked every 6 months not yearly

Question 241

A 65-year-old man was diagnosed with heart failure due to left ventricular systolic dysfunction. He is currently prescribed enalapril 10mg bd and his doctor wishes to add a beta blocker at a very low dose which will be titrated very slowly over a period of weeks.

Answer 241

bisoprolol combined with an ACE inhibitor is the first line treatment for heart failure to reduce morbidity and mortality regardless of age.

Question 242

A 58-year-old man has been admitted to hospital as an emergency patient. He has been diagnosed with a supraventricular arrhythmia (atrial fibrillation). The cardiologist considers prescribing an intravenous emergency loading dose but instead recommends oral therapy for rapid digitalisation.Which of the following statements regarding the use of loading doses of digoxin is least accurate?

Answer 242

Intravenous loading doses do not increase a risk of hypokalemia but may affect electrolyte balance and can affect renal function

Question 243

A 45-year-old man has recently had eye surgery and has been given topical corticosteroids to take home and apply to reduce inflammation. He has read the patient information leaflet and is very concerned about using steroids as he has heard lots of ‘bad things’ about them.

Answer 243

Steroid eye drops do not cause conjunctivitis medicamentosa, glaucoma medication and reaction to other ingredients in a product is a more likely causeDOESN'T HAPPEN-> corneal infiltrates and corneal staining

Question 244

A 66-year-old man has stable angina which is currently managed with sublingual glyceryl trinitrate. He is experiencing an exacerbation of symptoms and his GP decides that regular drug therapy is now required. The patient also has some left ventricular dysfunction.

Answer 244

A 66-year-old man has stable angina which is currently managed with sublingual glyceryl trinitrate. He is experiencing an exacerbation of symptoms and his GP decides that regular drug therapy is now required. The patient also has some left ventricular dysfunction.

Question 245

Side-effects of high dose levothyroxine?

Answer 245

diarrhoeanervousnessinsomniatremors

Question 246

A 46-year-old man has been administered 10 mg of midazolam by slow IV infusion prior to undergoing biopsy removal of a small lump in the side of his neck. Two minutes after commencing the infusion his respiratory rate was noted to be four breaths per minute. It is decided that sedation needs to be reversed urgently.

Answer 246

Flumazenil is the drug of choice for reversal of side effects of benzodiazepines as it is a benzodiazepine antagonist

Question 247

A 46-year-old man with type 2 diabetes currently takes oral antidiabetic drugs. Recently he has been experiencing nocturnal symptoms such as waking with a headache, feeling unusually tired and experiencing seemingly unprovoked sleep disturbance. His doctor suspects that his blood sugar is not well controlled overnight and suggests the addition of insulin therapy.

Answer 247

Insulin glargine is a long-acting human insulin analog often administered at bedtime to patients with type 2 diabetes. It reduces fasting blood glucose levels more efficiently and with less nocturnal hypoglycemic events

Question 248

A 56-year-old woman has acute angle closure glaucoma. She is experiencing stress incontinence when she exercises, coughs or laughs which she finds extremely embarrassing. She is fed up with using Tena lady pads which are expensive, inconvenient and uncomfortable and seeks medical advice. You are asked by her prescriber to recommend an effective treatment.

Answer 248

Duloxetine is effective for stress incontinence and will not affect her glaucoma. Other products are either contraindicated or less effective for stress incontinence

Question 249

A 54-year-old woman is going through the menopause. She tells you that she feels dry 'down there' and that she has recently been experiencing itching. There is no discharge or odour. She tells you that sexual intercourse with her husband is painful as a result.

Answer 249

The patient does not have an infection and appears to be suffering from menopausal atrophic vaginitisA cream containing an oestrogen may be applied on a short-term basis to improve the vaginal epithelium The correct answer is: topical vaginal oestrogens

Question 250

A newborn baby is to have a blood sample taken using a heal prick test after the parent verbally consented to testing

Answer 250

The heal prick test is used to screen for 9 rare conditions: sickle cell, cystic fibrosis, congenital hypothyroidism, phenylketonuria (PKU), medium-chain acyl-CoA dehydrogenase deficiency (MCADD), maple syrup urine disease (MSUD), isovaleric acidaemia (IVA), glutaric aciduria type 1 (GA1), homocystinuria (pyridoxine unresponsive) (HCU)

Question 251

A 65-year-old man has been offered an ultrasound screening test as part of a national screening programme for men age 65 – 74 aimed at reducing mortality

Answer 251

Abdominal Aortic Aneurism screening has been rolled out across the UK for men over 65 who are at the highest risk of problemsThe correct answer is: abdominal aortic aneurism

Question 252

A woman who is 12 weeks pregnant has consented to a blood test after being offered a screening test by her midwife at her first appointment

Answer 252

Screening for Down's syndrome , Edwards' syndrome and Patau's syndrome is available between weeks 10-14 of pregnancyThe correct answer is: Down’s syndrome

Question 253

A 7-year-old child comes into the pharmacy with his mother. The child has one reddened eye with a purulent discharge, he tells you he feels a gritty sensation in his eye. He is not experiencing any pain, there is no sensitivity to light and he does not use contact lenses

Answer 253

The child is exhibiting symptoms of bacterial conjunctivitis and as there are no additional symptoms of concern this can be treated effectively over the counter with a recommendation to refer if symptoms do not improveThe correct answer is: recommendation of an over the counter medicine product, with referral to GP if symptoms persist after 5 days

Question 254

A 3-year-old child comes into the pharmacy with her mother. The child is suffering from nasal congestion and cold symptoms. Her mother tells you that the child has been pulling at her ear and has been withdrawn for the past couple of days

Answer 254

the child is likely to have otitis media which cannot be treated effectively over the counter. the child is likely to be in pain and should be referred to see GP promptlyThe correct answer is: no recommendation of an over the counter medicine sale but immediate referral to GP

Question 255

An 8-year-old child comes into the pharmacy with his father. The father explains the child fell off some play equipment in the park quite heavily about 10 minutes ago and is complaining of a headache. The father also tells you the child had a nosebleed in the park which has now stopped. On talking to the child it becomes apparent that he is experiencing blurred vision to some degree

Answer 255

The parent should take the child to A+E as there is evidence of a concussion. The child is coherent and able to speak so an ambulance is unnecessary unless the parent cannot get to the hospital.The correct answer is: no recommendation of an over the counter medicine sale but immediate referral to secondary care

Question 256

A 7-year-old child requires a reliever medication for their worsening asthma, which reliever medication should not be prescribed for this child unless they were regularly using a steroid inhaler?

Answer 256

Formoterol is a long acting beta2 agonist and should only be prescribed alongside inhaled corticosteroids. a short acting reliever should be prescribed of acute symptoms as formoterol will not act quickly enough in the event of an asthma attackThe correct answer is: formoterol

Question 257

An 8-year-old child has been admitted to hospital exhibiting symptoms of Churg-Strauss Syndrome. Which of the medicines listed above if taken by this child would most likely be responsible for the symptoms?

Answer 257

Churg-Strauss syndrome has occurred very rarely in association with the use of montelukast; in many of the reported cases the reaction followed the reduction or withdrawal of oral corticosteroid therapy.The correct answer is: montelukast

Question 258

A 6-year-old child has been taking an inhaled short acting beta2 agonist, regular high dose inhaled corticosteroid and an inhaled long acting beta 2 agonist. Their asthma has recently worsened and their doctor has decided to trial additional medication for 6 weeks. Leukotriene receptor antagonists and modified release oral beta 2 agonists have been tried without success. Which would be the next appropriate trial option for this patient

Answer 258

If MART therapy fails and other agents are not suitable a trial of an additional drug such as modified release theophylline may be considered. In reality this child needs referring to specialist careThe correct answer is:theophylline

Question 259

A 53-year-old woman takes medication for hypertension which is well controlled. Her GP diagnoses her with depression and decides to prescribe an antidepressant. Which of the above drugs is the most likely to cause hypertension and affect control of her blood pressure?

Answer 259

Venlafaxine is known to commonly affect blood pressure causing hypertension as a side effect. This drug should be avoided in the patient.The correct answer is: venlafaxine

Question 260

A 55-year-old man had a myocardial infarction 3 weeks ago; whilst under his consultants care he was diagnosed with depression The consultant decides it is necessary to treat with medication. Which of the above drugs would be contraindicated for this patient?

Answer 260

Amitriptyline is contraindicated in the immediate recovery period after a myocardial infarction and should not be used.The correct answer is: amitriptyline

Question 261

A 45-year-old female asks to purchase Feminax Ultra for period pain. When asked about prescribed medication she informs you he is taking fluoxetine 20mg OD for depression.

Answer 261

Both naproxen and fluoxetine can increase the risk of bleeding. the answer is A

Question 262

A 52-year-old man asks to purchase pseudoephedrine for nasal congestion, when asked about prescribed medication he informs you he is taking phenelzine 15mg OD for depression.

Answer 262

Pseudoephedrine is predicted to increase the risk of a hypertensive crisis when given with phenelzine. Manufacturer advises avoid and for 14 days after stopping the MAOI.

Question 263

A 76-year-old woman, takes amiodarone for heart failure. She was prescribed domperidone 10mg TDS two days ago for the relief of nausea and vomiting.

Answer 263

Domperidone increases the risk of QT-prolongation when given with amiodarone. Manufacturer advises avoid.The correct answer is: prolonged QT interval

Question 264

TAMSULOSIN OTC SUPPLY?

Answer 264

MALE 45-75MINIMUM 3 MONTHS SYMPTOMSContraindication: glaucoma/cataract

Question 265

OTC MAALOF (ATOVAQUONE W/ PROGUANIL)?

Answer 265

18+, >40KGREPEAT DOSE IN 1HR IF VOMITUP TO 12 WEEKSONE DAILY

Question 266

ANTI-EPLIEPTICSAFE IN PREGNANCYX teratogenicity?

Answer 266

LEVETIRACETAM

Question 267

Fidaxomicin treats C. dif, not increase risk!

Question 268

PPI increase risk of?

Answer 268

C diff

Question 269

osteonecrosisear painpain swallowingwhat drug?

Answer 269

alendronic acid!

Question 270

EllaOne+POP?

Answer 270

Reduces effectiveness, don't start POP yet, use barrier method!

Question 271

Oramorph 10mg/5ml schedule?

Answer 271

schedule 5!

Question 272

CD EMERGENCY SUPPLIES?

Answer 272

SCHEDULE 5 YH3 EXCEPTION, PHENOBARBITAL

Question 273

Inappropriate antibiotic for Candidal vulvitis or Vaginal candidiasis infections?

Answer 273

Metronidazole- NOT fungal, issa fungal infection

Question 274

Tinea cruris?

Answer 274

ThighsButtocksJock itch!

Question 275

ultra-long acting insulin?

Answer 275

Tresiba- DEGLUDEC

Question 276

NOT notifiable disease?

Answer 276

Chicken poxCellulitis

Question 277

Food rich in vitaminb12?

Answer 277

EGGS! N meat, vegans lacking

Question 278

Sevelamer treats?

Answer 278

Hyperphosphataemia

Question 279

Chloramphenicol issues?

Answer 279

AgranulocytosisGrey-baby syndrome

Question 280

CD FAXED SUPPLY?

Answer 280

UNACCEPTABLE!

Question 281

RITONAVIR+OMEPRAZOLE?

Answer 281

NO INTERACTION! HIV

Question 282

SCHEDULE 4 PART 2?

Answer 282

CLENBUTEROL

Question 283

ACICLOVIRVIALS QBREAK IT DOWNSIMPLEST!

Question 284

WHISTLEBLOW FIRST!

Question 285

Bisphosphonates, renal impairmentDO NOT USE?

Answer 285

CrCL <30 mL/min

Question 286

cough with or without sputum, general malaise, and fever?

Answer 286

Viral infection probs

Question 287

CD, LEGAL RESTRICTION ON SUPPLY?

Answer 287

Home Office 'advise' 30 daysNo actual restriction though... clarify if>1month

Question 288

No regular meds, bleeding gums?

Answer 288

Floss your teeth akh

Question 289

Lorazepam, schedule 4, repeatable?

Answer 289

yes

Question 290

Symptoms of psoriasis?

Answer 290

red, scaly lesionssilver scalesplaqueknees/hands/elbow/scalpNOT fever

Question 291

Isosorbide mononitrate side-effect?

Answer 291

Headache

Question 292

BisphosphonatesAvoidCrCl

Answer 292

30ml/min

Question 293

EXENATIDEGLP-1 RECEPTOR..?

Answer 293

AGNOISTNOT ANTAGONIST!

Question 294

Indapamide time of day?

Answer 294

MORNING!

Question 295

What are signs of primary dysmenorrhoea?

Answer 295

back paindull & continouspain decreases once period beginspain starts just before period starts

Question 296

What schedule is Temazepam?

Answer 296

Schedule 3

Question 297

What schedule is Diazepam?

Answer 297

Schedul 4 part 1

Question 298

What b-blocker is NOT good for OD dosing?

Answer 298

Propranolol, acting, etc

Question 299

How do you treat a penicillin-allergic patient with cellulitis near the eyes or nose?

Answer 299

Clarithromycin with metronidazole

Question 300

What are the legal requirements for CD requisitons?

Answer 300

name of recipientpurposesignature of recipienttotal quantity

Question 301

osmotic diuresis- uncontrolled diabetes- hypokalaemia- digoxin toxicity

Question 302

Maximum number of days advised for CDs?

Answer 302

30

Question 303

What is a safe laxative in pregnancy?

Answer 303

Lactulose

Question 304

What is the risk with Simvastatin with bezafibrate?

Answer 304

Rhabdomyolysis

Question 305

What are secondary complications of type 2 diabetes?

Answer 305

Cardiovascular disease, diabetic nephropathy and neuropathy are secondary complications of diabetes.

Question 306

What is the written info needed for patients taking cytotoxic meds?

Answer 306

intended regimentreatment planmonitoring arrangementsprotocolspecialist contact

Question 307

What does MDRD stand for?N

Answer 307

MDRD stands for 'modification of diet in renal disease'.

Question 308

Can we use suppositories in proctitis?

Answer 308

NO, contraindicated, can cause rectal irritation

Question 309

What drug requires a dose reduction with verapamil?

Answer 309

Dabigatran

Question 310

Alendronic acidAVOIDCrCl

Answer 310

35mL/min

Question 311

Tell me about clarithromycin and renal impairment?

Answer 311

For immediate-release preparations, use half normal dose if creatinine clearance less than 30 mL/minute, max. duration 14 days.For modified-release preparations, use half normal dose if creatinine clearance 30–60 mL/minute.

Question 312

What is the best long-term relief in osteoarthritis?

Answer 312

Paracetamol

Question 313

What facilitates absorption of calcium?

Answer 313

Colecalciferol

Question 314

What are some risk factors for coronary heart disease?

Answer 314

diabetesdyslipidaemiahypertensionlack of exercise

Question 315

What are signs of pyelonephritis?

Answer 315

dysuriafeverflank pain

Question 316

What is the advice regarding miconazole and breastfeeding?

Answer 316

Apply to nipples after feeding the baby

Question 317

What is the interaction between amphotericin & digoxin?

Answer 317

Increased risk of digoxin toxicityconfusion/arrhythmias/nausea/visual disturbances

Question 318

What are prednisolone side-effects?

Answer 318

increased appetitite- weight gain

Question 319

Phenytoin injectable form

Answer 319

Risk of death?

Question 320

What is appropriate cream treatment for athlete's foot?

Answer 320

Recommend clotrimazole cream 1% applied twice daily and continuing for two weeks after the infection has cleared1% FOR ATHLETES2% FOR EXTERNAL VAGINAL THRUSH

Question 321

What is age for xylometazoline?

Answer 321

6+

Question 322

P.c meaning?

Answer 322

after food

Question 323

Absorption of what drug is affected by magnesium trisilicate?

Answer 323

Tetracycline

Question 324

Fludrocortisone/mineralcorticoid side-effects?

Answer 324

HYPERTENSIONhigh fluid retention, low anti...

Question 325

GLUCOCORTICOID SIDE-EFFECTS?

Answer 325

AVASCULAR NECROSISDIABETESMUSCLE WASTINGOSTEOPOROSIS

Question 326

Ramipril, tachy or brady?

Answer 326

Tachycardia

Question 327

>55 OR AFRO-CCB culture?

Answer 327

CCB START

Question 328

<55 OR TYPE 2 DIABETIC?

Answer 328

ACE OR ARB

Question 329

What are MHRA check points for avoiding prescribing errors?

Answer 329

right doseright medicineright patientright timeNOT right strength

Question 330

What is yasmin?

Answer 330

Monophasic 21-day preparation

Question 331

What's the risk with fluoxetine+phenelzine?

Answer 331

SEROTONIN SYNDROME!CAN!

Question 332

hypurin porcine neutral INSTRUCTION?

Answer 332

After subcutaneous injection onset of action occurs within 30-60 minutes". Therefore it should be injected 30 minutes before meal.

Question 333

What are symptoms of theophylline toxicity?

Answer 333

TACHYCARDIAVOMITINGAGITATIONRESTLESSNESSHYPERGLYCAEMIACONVULSIONSHYPOKALAEMIA

Question 334

S&S?

Answer 334

Scabies- Babies could develop small blisters (that contain pus on the feet and palms of the hands). Distinct signs of burrowing are not always evident in babies.

Question 335

What drugs can cause falls?

Answer 335

BenzodiazepinesDiureticsOpioidsPhenothiazinesNOT nsaids

Question 336

Common reactions are those that occur in greater than and equal to 1/100, equating to 1% to <10%.U

Question 337

Rifampicin in acute porphyria?

Answer 337

UNSAFE!

Question 338

Mrs Smith has been taking 800 units of ergocalciferol for 2 weeks now because she has a lack of vitamin D.She develops nausea and has now vomited. What is the likely reason for this?

Answer 338

The vitamin D may have led to an increase in serum calcium causing the symptoms

Question 339

What drug can induce convulsions?

Answer 339

Ciprofloxacin is a quinolone. The CSM has warned that quinolones may induce convulsions in patients with or without a history of convulsions; taking NSAIDs at the same time may also induce them.

Question 340

What's the condition?Mrs D administers two sprays of ipratropium bromide into each nostril twice daily for rhinorrhoea associated with allergic rhinitis. She is currently suffering from nose-bleeds secondary to the use of this medication.

Answer 340

Epistaxis

Question 341

What is haematuria?

Answer 341

Blood in urine

Question 342

What's the issue?A patient is prescribed ertapenem for the treatment of a diabetic foot infection and has black, tarry stools as a side effect of this medication.

Answer 342

Melaena

Question 343

What's the issue?A patient is suffering from excessive skin sensitivity to non-noxious stimuli secondary to the use of nilotinib for the treatment of chronic myeloid leukaemia.

Answer 343

Hyperaesthesia

Question 344

Issue presenting?

Answer 344

A 38-year-old male who presents with excruciating pain in his right ankle at night. He described the ankle as being 'red, inflamed and feels warm'.Gout commonly affects the large toe but may also affect the ankles, heels, knees, wrists, fingers and elbows. It commonly occurs at night and may last 3-10 days.

Question 345

S&S of anaphylaxis?

Answer 345

Common immediate signs of anaphylaxis are trouble breathing, reduced blood pressure and syncope. The following symptoms may also present: hives, swelling, a tingling feeling, itchiness, skin rash, nausea, vomiting, dizziness, diarrhoea and stomach cramps.

Question 346

Methotrexate contraception treatment in male/female patient?

Answer 346

Manufacturer advises effective contraception during and for at least 6 months after treatment in men and women.

Question 347

Treatment for alcohol cravings?

Answer 347

AcamprosateAcamprosate is indicated as therapy to maintain abstinence in alcohol-dependent patients. It should be combined with counselling. Disulfiram could be used, however, it acts by causing an acute sensitivity when Mr K drinks alcohol instead of resolving the alcohol cravings.

Question 348

Treatment?Mr S, a 46-year-old security guard, presents with acute confusion, leg tremors and droopy eyelids. He recently been enrolled on an alcohol dependence programme but states that it's a 'waste of time'.

Answer 348

Parenteral thiamineMr S is experiencing effects caused by acute, severe thiamine deficiency, secondary to alcoholism.WERNICKE'S ENCEPHALOPATHY!

Question 349

Potassium chloride and spironolactone issue?POTASSIUM SPARING DUH!!!

Answer 349

Cardiac arrhythmias- Spironolactone is a potassium-sparing diuretic and, taken together with potassium supplements, increases the risk of developing hyperkalaemia which may cause cardiac arrhythmias. This is a well-known drug interaction which may be fatal.

Question 350

Warfarin and oral piroxicam issue?

Answer 350

Warfarin is predicted to increase the risk of bleeding events when given with piroxicam.GASTRO high piro

Question 351

bee venom+ace?

Answer 351

ANAPHYLAXIS!

Question 352

CCB OVERDOSE?

Answer 352

Single activated charcoal within 1hrRepeated if it is MR

Question 353

Key issue with zonisamide?SR

Answer 353

Avoid overheating and ensure adequate hydration especially in children, during strenuous activity or if in warm environment (fatal cases of heat stroke reported in children).

Question 354

BACLOFEN ISSUE?

Answer 354

DROWSINESS!

Question 355

carbimazole serious issues?

Answer 355

Report symptoms including sore throat, mouth ulcers, bruising, fever, tiredness or non-specific illnesses to your doctor immediately

Question 356

Digoxin and quinine issue?

Answer 356

Digoxin and quinineThe BNF states: plasma concentration of digoxin increased by quinine. Nausea and vomiting may be early signs of an excessive dose of digoxin

Question 357

Pimozide and ketoconazole issue?

Answer 357

Pimozide and ketoconazoleKetoconazole is predicted to increase the exposure to pimozide. Manufacturer advises avoid. Ventricular arrhythmias are are potential effect of overdose with pimozide.

Question 358

Sildenafil and isosorbide mononitrate issue?

Answer 358

hypotensive effect which may be fatal

Question 359

This medication is indicated for bacterial vaginosis and is usually given at a dose of one applicatorful daily for 3-7 nights?

Answer 359

Clindamycin

Question 360

MYCOPHENOLATE- MALE, YOU & PARTNER CONTRAMYCOPHENOLATE- FEMALE, TWO TYPES OF CONTRA

Question 361

TreatmentMiss W is a 19-year-old patient who has developed several painful red lumps and patches (that measure 1-5 cm) on her lower legs.

Answer 361

Rest and ibuprofenThese lumps are characteristic of erythema nodosum. Treatment is usually rest and painkillers such as NSAIDs.

Question 362

TreatmentMrs D comes into your pharmacy with her 5-year-old son. She tells you that her husband was diagnosed with ringworm one month ago and shows you a picture of a large swelling on a section of his scalp?

Answer 362

GriseofulvinScalp infection requires systemic treatment. The swelling on his scalp is a kerion, which could develop in severe ringworm infections, in this case tinea capitis. If left untreated it could result in hair loss and permanent scarring. It's treated using griseofulvin.

Question 363

Treatment?Mr A is a 42-year-old man who comes into your pharmacy. He shows you hyperpigmented patches on his trunk and back. They are not red or itchy

Answer 363

Ketoconazole shampooPityriasis versicolor, sometimes called tinea versicolor, is a common condition that causes small patches of skin to become scaly and discoloured (hypo/hyperpigmented). They usually occur on the trunk and back and upper arms. Pityriasis versicolor is caused by a type of yeast called Malassezia and is treated by ketoconazole shampoo.

Question 364

Treatment?Miss Q is a 32-year-old female. She is a regular at your pharmacy. For the past year she has been suffering from a malar rash on her face, facial flushing, burning and itching papules and pustules. She has tried potent corticosteroid creams, which initially helped but then worsened her rash considerably.

Answer 364

was TetracyclineHer symptoms are those of acne rosacea which worsens with the use of topical steroids. The treatment is oral tetracycline.

Question 365

ulipristal warning?!

Answer 365

MHRA/CHM advice: Ulipristal acetate 5 mg (Esmya®): further restrictions due to risk of serious liver injury (February 2021)

Question 366

Haemoptysis

Answer 366

blood in the sputum

Question 367

Measles very conatgious! vac

Question 368

Wake up at on+wet bed?

Answer 368

Mebendazole

Question 369

14 year old girl, inappropraite treatment cold/cough?

Answer 369

Aspirin 300 mg tabletsAspirin is contraindicated for use in children. Owing to an association with Reye's syndrome aspirin containing preparations should not be given to children under 16. In this instance; Paracetamol can be used for mild-moderate pain and pyrexia. Ibuprofen can be used for fever with discomfort and pain. Guaifenesin and levomenthol solution can be used as an expectorant. Xylometazoline 0.1% nasal spray can be used as a decongestant.

Question 370

Impulse disorders, levo or ropi?

Answer 370

RopiniroleImpulse control disorders (compulsive gambling, hypersexuality, binge eating, or obsessive shopping) can develop in a person with Parkinson's disease who is on any dopaminergic therapy at any stage in the disease. Levodopa is also associated with impulse control disorders, however the answer reference given states: 'Conversely, excessive sleepiness, hallucinations, and impulse control disorders are more likely to occur with dopamine-receptor agonists than with levodopa.' Thus ropinirole is the best answer.

Question 371

GLUCO SIDE-EFFECTS?

Answer 371

Glucocorticoid side-effects include diabetes, osteoporosis and muscle wasting. The other listed side-effects are associated with mineralocorticoids.

Question 372

Usual thaizide bendro hypertensions dose?

Answer 372

2.5MG OD

Question 373

Swollen gums, gingival hyperplasia, what drug?

Answer 373

migra

Question 374

What drug?Brush teeth for one minute before spitting out. Avoid drinking or rinsing mouth for 30 minutes after use.

Answer 374

Duraphat®Sodium fluoride

Question 375

It is important to ensure adequate hydration at all times in patients receiving higher-strength preparations of this drug.What drug?

Answer 375

Pancreatin

Question 376

This drug is licensed for use in narcolepsy?

Answer 376

Dexamfetamine sulfateDexamfetamine sulfate is indicated and licensed for narcolepsy. Methylphenidate is indicated for use in narcolepsy but it is an off-licence use. No methylphenidate product is licensed for use in narcolepsy.

Question 377

QT prolongation drugs The Amazing SpiderMan Q

Answer 377

TCA amiodarone SSRIS anti antipsychotics malaria quinine/quinolone

Question 378

SICK DAY RULESSAD MAN

Answer 378

SGLT2ACEiDIURETICSMETFORMINARBsNSAIDs

Question 379

SUPRAVENTRICULAR TACHYCARDIAS ONLY?

Answer 379

VERAPAMIL

Question 380

Interaction with oral contraceptive pill?

Answer 380

St John's Wort extract tabletsSt John's Wort is a drug that induces hepatic enzyme activity. It interacts with the combined oral contraceptive pill and can considerably reduce its effectiveness by increasing its metabolism.INDUCE INHIBIT

Question 381

A woman presents in your pharmacy asking for advice. She has been breastfeeding her child for 5 weeks. She is experiencing pain in both breasts which has recently started. Her baby has been unsettled during this time and also has bad nappy rash, along with white spots on it's tongue.Which of the following is the lady most likely experiencing?

Answer 381

Thrush in the nipple/breastThe symptoms described are those of thrush (candida) infection in the breast. Breastfed babies can also develop thrush in their mouths, a sign for which in some babies is nappy rash that won't clear up.

Question 382

What are symptoms of mastitis?

Answer 382

swollenwedge-shape/hardburning

Question 383

emergency supply prescription prescriber, present within?

Answer 383

72 hours

Question 384

Miss T comes into your Pharmacy. She asks you about contraception. She's on a combined oral contraceptive and wonders whether this is sufficient or if she should take further contraceptive precautions based on her medication.Which of the following medications do NOT result in the need for additional contraceptive precautions?

Answer 384

METOCLOPRAMIDEDoes need additional?Examples of drugs which induce liver enzymes are:antibacterials e.g. rifampicinantiepilepticsantiretroviralsSt John's wort.

Question 385

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?

Answer 385

Unilateral headache with malaise- could be temporal arteritis

Question 386

Unilateral headache with associated nausea suggests?

Answer 386

Migraine

Question 387

bilateral generalised headache and bilateral headache with symptoms that worse as the day progresses suggests?s

Answer 387

tension-type headache

Question 388

unilateral frontal headache which worsens on bending down suggests?

Answer 388

sinusitis

Question 389

METFORMINDIABETES/POLYCYSTIC OVARY SYNDROME DOSING?

Answer 389

500mg OD 1 week500mg BD 1 week500mg TDS 1 week

Question 390

Impetigo organism?

Answer 390

Staphylococcus aureus

Question 391

Which of the following types of literature would be deemed to provide 'the best available evidence'?

Answer 391

Systematic reviewsSystematic reviews take into account all literature created, therefore, provide the best evidence in research.

Question 392

Which one of the following is most likely to increase the anticoagulant effect of warfarin?

Answer 392

Cranberry juiceCranberry juice is an enzyme inhibitor. It slows the metabolism of warfarin, therefore, increasing its anticoagulant effect

Question 393

What would decrease anticaogulant effect of warfarin?

Answer 393

Spinach and kale contain vitamin k which can reduce the anticoagulant effect of warfarin.

Question 394

A mother of a 7-year-old boy asks you to look at her son's sore right eye. On examination you notice that the eyelid has a slight swelling and the eyelid is a little red.Based on this information, what is the most likely diagnosis?

Answer 394

StyeThe most likely condition in this age group is either bacterial conjunctivitis or stye. As the boy has local pain associated with his eyelid, then stye is the most likely condition based on the symptoms listed. Chalazions are not normally associated with pain.

Question 395

Effectiveness of thiazide diuretics is eradicated if eGFR

Answer 395

<30 mLs

Question 396

FP10PCDs+ normal drugs, private scripts?

Answer 396

The doctor should be contacted as the paracetamol should be prescribed on a different prescriptionFP10PCD should be used for CD schedule 2 and 3, then original sent to NHS agency, whereas a private prescription for paracetamol needs to be retained in the pharmacy and therefore should not be prescribed on FP10PCD.

Question 397

A 13-month-old child has bilateral, red, watery eyes with some pus noticeable at the corners of both eyes. Her mother takes her to the GP who diagnoses simple conjunctivitis.Which antibiotic is the most appropriate to treat this patient?

Answer 397

ChloramphenicolSome chloramphenicol preparations may be contraindicated in under 2s in the product literature. However, an MHRA review concluded that the benefits of chloramphenicol eye drops containing borax or boric acid outweigh the potential risk to children, including those aged 0 to 2 years.

Question 398

You are working as the responsible pharmacist in a community pharmacy. A patient presents you with a prescription for oxycodone. The patient's address and the prescriber's address is in Geurnsey.What is the best course of action with this prescription?

Answer 398

Advise the patient to see a local prescriber to get a new prescriptionPrescriptions for schedule 2 and 3 CDs should be written by a prescriber with an address in the UK. The GMC advises that Guernsey is not in the UK. The patient should be advised to see a local prescriber to get a prescription so that they are not left in pain.

Question 399

NSAIDs are commonly used for both their analgesic and anti-inflammatory properties.Which of the following NSAIDs has a maximum daily dose of 600 mg?

Answer 399

Etodolac

Question 400

Mrs G, a 30-year-old female who is 4 months pregnant and lives alone, comes into your pharmacy complaining of persistent perianal pruritis that's been keeping her up all night for the last couple of weeks. She is currently not taking any medicines or has any pre-existing medical conditions but does occasionally take lactulose for pregnancy-induced constipation. Also, one of her children was diagnosed with threadworm a month ago but this was treated successfully. What is the most appropriate advice you should give Mrs G?

Answer 400

Advise her to maintain hygiene measures for six weeks (e.g. cut finger nails and launder bedding and towels on a daily basis)It is likely the patient has caught threadworm from her child, but anthelmintics are not recommended during pregnancy and so the patient should be given advice regarding hygiene measure only, which should be followed for six weeks.

Question 401

A 34-year-old woman has come in with her prescription for carbamazepine 200 mg three times daily. She asks you what the likely reason is for her maintenance dose to be higher than the dose she was started on, as her symptoms have not worsened since the start of treatment.What is the most appropriate explanation to give to this patient?

Answer 401

Carbamazepine is an enzyme autoinducer and thus a lower loading dose is required. Carbamazepine induces its own metabolism and so the maintenance dose is higher than the initial doses

Question 402

You are providing some training on situation where patients may see blood in their faeces.Which of the following conditions does NOT cause rectal bleeding?

Answer 402

Hiatus herniaThe other conditions are associated with rectal bleeding.References:

Question 403

Which schedule includes clenbuterol?

Answer 403

Schedule 4 Part 2

Question 404

Which of the following could you sell to the patient without a prescription if you had a Pharmacy (P) pack of the product?

Answer 404

Atovaquone 250 mg with proguanil hydrochloride 100 mg tabletsMaloff Protect 250 mg/100 mg film-coated tablets (atovaquone with proguanil hydrochloride) was launched as a Pharmacy (P) medicine in June 2017.

Question 405

Benzodiazepine OD treatment?

Answer 405

Flumazenil!

Question 406

19-year-old male with signs of ataxia, dysarthria and nystagmus?

Answer 406

Alcohol

Question 407

25-year-old female with dilated pupils, dry mouth and urinary retention.

Answer 407

Amitriptyline

Question 408

Mr K, an 11-month-old boy, presents with a hoarse barking cough. He has had a cold for the past 2 days and his body temperature is 37.6°C?

Answer 408

Croup (or laryngotracheobronchitis) is a common condition which affects infants between the ages of 3 months and 6 years. Typically, the symptoms include a barking cough.

Question 409

Mr L, a 9-year-old boy, presents with halitosis and dysphagia. His parents tell you that he coughs at night and is complaining of a burning sensation in his upper abdomen.

Answer 409

Gastro-oesophageal reflux disease (GORD) is a clinical condition which results from episodes of reflux of acid. It is characterised by heartburn. Further specialist investigations are required for this patient.

Question 410

ppm=

Answer 410

mg/L

Question 411

Cold sores treatment?

Answer 411

aciclovir 5%, 5 days

Question 412

A 14-year-old boy and his mum ask for your advice as he has a sore mouth. A visual inspection reveals two small circular lesions on the inside of the gums. He says they are painful.Based on this information, what is the most likely diagnosis?

Answer 412

Leuoplakia and lichen planus are seen as patches rather than circular lesions; major ulcers are large; and trauma ulcers are irregular shaped.

Question 413

You are treating Mr P who is a smoker. Medicine doses may have to be adjusted in smokers. Which ONE of the following is likely to require dose adjustment due to a drug interaction if patient starts or stops smoking?

Answer 413

Smokers may require higher doses of theophylline as it is cleared quicker in these patients. Those who stop smoking will need to have their dose adjusted, as they will no longer require the higher doses as in smokers.

Question 414

This is your first shift at a registered pharmacy that prepares unlicensed medicines.With respect to the ingredients used in the preparation of an unlicensed medicine, which of the following is NOT a requirement for the record keeping process?

Answer 414

You should keep detailed records of the preparation of unlicensed medicines in order to safeguard patients (i.e. If there is an incident where a patient's safety is affected, or the medicine should be recalled, the method of preparation could be reconstructed). For the ingredients used in the preparation, the following should be recorded:source (manufacturer, brand, wholesaler/distributor)certificate of conformitycertificate of analysisbatch numberexpiry datequantity used and details of person measuring and person double-checking quantitiesTSE guidance should be followed (where ingredient or product contact material is of animal origin)description of container/closure used (for example, were they were glass/plastic)

Question 415

Mrs R is a patient who has AIDS. She has been diagnosed with mild pneumocystis pneumonia. She is unable to tolerate trimethoprim.Which single medication is the most likely treatment option for her pneumonia?

Answer 415

AtovaquoneAtovaquone is licensed for the treatment of mild to moderate pneumocystis infection in patients who cannot tolerate co-trimoxazole (co-trimoxazole is made up of sulfamethoxazole and trimethoprim - Note that Mrs R can not tolerate trimethoprim). The other options are suitable for severe pneumocystis infection.

Question 416

Mrs S is a 26-year-old female who comes into your pharmacy to ask for your advice. Her doctor has asked her to book an appointment to receive the MMR vaccination. She tells you that she is planning to become pregnant and is worried about having this vaccination.Which one of the following is the most suitable response you can give Mrs S?

Answer 416

Rubella vaccination should be given to individuals who do not have immunity to the condition, including woman of child-bearing age. Avoid pregnancy for at least 1 month after vaccinationThis patient is not pregnant yet so can be given the MMR vaccine with advice regarding when it would be suitable to start trying for a baby (leave 1 month after injection).

Question 417

A mother of a 5-year-old daughter wants some advice. Her daughter has recently developed a red rash on her face after being unwell with cold symptoms.Based solely on this information, which is the most likely condition causing the rash?

Answer 417

Erythema infectiosumPertussis does not have facial rash; psoriasis can have scalp involvement but lesions away from the hairline are rare; pityriasis rosea is associated with a rash on the body. This leaves atopic dermatitis and erythema infectiosum - both could show facial lesions. Based on other 'cold-like' symptoms erythema infectiosum is more likely. Its alternative name is 'slapped cheek disease'.

Question 418

A pregnant woman comes in to your pharmacy. She tells you that her friend has told her that 'she should check if she has had a rubella vaccination and if she is immune to rubella'.What can a rubella infection cause in pregnant patients who DON'T have immunity to rubella?

Answer 418

Organ damage to the foetus during the early stages of the pregnancyThe mother passes the virus on the foetus and it damages their organs as they develop. This is known as congenital rubella syndrome (CRS). This includes the eyes (e.g. cataracts), ears (hearing loss), heart and brain. This could affect the child throughout their life.

Question 419

You are providing a training session on food interactions with medicines.Which of the following is the LEAST likely to interact with grapefruit juice?

Answer 419

WarfarinWarfarin is not noted in the BNF as interacting with grapefruit juice. This gives an indication of the severity of the interaction. As warfarin isn't listed here, it indicates that it is least likely to interact because there isn't as much documented evidence.

Question 420

You have been working on a cytotoxic rotation within your trust and are required to learn the eight side effects of cytotoxic drugs.Which of the following is NOT a side effect of cytotoxic drugs?

Answer 420

Excessive bone marrow productionExcessive bone marrow production is incorrect - cytotoxic drugs can cause bone marrow suppression.YES?alopeciaextravasationbone marrow suppressionhyperuricaemiamucositis

Question 421

A patient newly started on tuberculosis treatment comes into your pharmacy with a bowel complaint.What is the most likely cause of flatulence?

Answer 421

EthambutolEthambutol can cause flatulence (frequency not known).

Question 422

You are a registered pharmacist working in a medicines information role speaking to healthcare professionals and completing the occasional locum shift in a community pharmacy.How do the GPhC Standards for Pharmacy Professionals apply to you?

Answer 422

They apply in all your stated job rolesThe GPhC states: The standards apply to all pharmacists and pharmacy technicians. We know that pharmacy professionals practise in a number of sectors and settings and may use different ways to communicate with the people they provide care to. The standards apply whatever their form of practice.

Question 423

Mr K is a 19-year-old student who presents with a lesion on his lower abdomen. He has been using hydrocortisone 1% cream but says that it hasn't helped and the lesion is getting bigger.Given that Mr K has tinea corporis, which one of the following treatments is the most suitable to treat his lesion?

Answer 423

Terbinafine 250 mg tabletsDermatophyte infections such as tinea corporis may be exacerbated by prolonged use of topical steroids such as hydrocortisone as these exhibit immunosuppressive properties. Terbinafine is indicated in the treatment of tinea corporis.

Question 424

You have just finished using a stock bottle of methadone in the pharmacy. You have dealt with any residue remaining in the bottle.How do you dispose of the bottle?

Answer 424

Remove labels and identifiers and place in recycling or general wasteOnce the contents have been dealt with appropriately the bottle can be placed in recycling or general waste after removing identifiers.

Question 425

You want to obtain guidance on prescribing restrictions for podiatrist independent prescribers.Which of the following is the most appropriate reference source to use to find this information?

Answer 425

Medicines, Ethics and PracticeRestrictions by prescriber types are legal requirements and can be found in the MEP.

Question 426

CALCS tips?

Question 427

Mr L experienced an increase in hair growth and a "ringing in the ears" secondary to the use of diazoxide for the treatment of chronic intractable hypoglycaemia.

Answer 427

Hypertrichosis and tinnitus

Question 428

Mrs R describes herself to you as "constantly active, unable to stop moving and feeling restless all the time", as well as having "involuntary movements of her face". You believe this to be side effects of fluphenazine decanoate she is currently using for schizophrenia.

Answer 428

Akathisia and tardive dyskinesia

Question 429

For each of the following products sold over the counter, select the minimum age that they can be used from. Each option may be used once, more than once, or not at all.Nurofen® for Children 100 mg/5 mL.

Answer 429

3 months

Question 430

Tramadol capsules 50 mg.

Answer 430

Place on the shelves in the dispensaryTramadol is a schedule 3 CD exempt from safe custody requirements.

Question 431

Morphine sulfate oral solution 10 mg/5 mL.

Answer 431

Place on the shelves in the dispensaryMorphine sulfate oral solution 10 mg/5 mL is a schedule 5 CD. The requirement to record in the CD register or keep in the CD cupboard do not apply.

Question 432

Co-codamol 8/500 mg effervescent tablets pack of 32.

Answer 432

Display the product behind the counterCo-codamol 8/500 mg is a schedule 5 CD and in a pack size of 32 tablets can be sold to the public if it has a P licence.

Question 433

A French patient on holiday requesting citalopram usually prescribed by his local doctor.

Answer 433

Consider making an emergency supply if it can be clarified that the item has been prescribed by a valid prescriber beforeEmergency supplies at the request of an EEA or Swiss patient can be made.

Question 434

An American mother on holiday in London requesting a salbutamol inhaler for her 18-year-old son which is usually prescribed by his local doctor. He has forgotten his inhaler but he is not currently having an asthma attack.

Answer 434

Advise the patient to see a local prescriber to get a prescriptionEmergency supplies cannot be made to American citizens. As the patient is at no immediate risk referring them to a local prescriber (rather than A&E) would be appropriate.

Question 435

A Scottish lady in a Scottish pharmacy who is asking for dutasteride for her husband who has taken his last tablet this morning.

Answer 435

Advise that you must speak to the patient themselves before considering further actionThe pharmacist must speak to the patient before an emergency supply at the request of a patient is made.

Question 436

An English patient visiting a pharmacy in the England, requesting morphine sulfate tablets because she will run out of these tomorrow.

Answer 436

Contact the patient's prescriber to see if you can get them to send you an electronic NHS prescriptionCD prescriptions can be transferred via EPS and if the patient’s prescriber is happy to prescribe in this way, that prescription could be electronically transferred to the pharmacy.

Question 437

Daktacort® 30 g cream.

Answer 437

Store at 2-8 °C

Question 438

Ventolin accuhaler®.

Answer 438

Store at or below 30 °C

Question 439

Reconstituted Augmentin® suspension.

Answer 439

Store at 2-8 °C

Question 440

Daktacort® ointment.

Answer 440

Store at or below 25 °C

Question 441

A 60-year-old Caucasian gentlemen with a recent blood pressure reading of 160/100 mmHg that was taken by the nurse in the surgery and a home blood pressure reading of 150/95 mmHg. He is not on any prescribed medication.Supplement: https://www.nice.org.uk/guidance/ng136/resources/visual-summary-pdf-6899919517

Answer 441

Lacidipine

Question 442

A 52-year-old Caucasian lady with a recent blood pressure reading of 160/100 mmHg that was taken in the surgery, who has been taking ramipril at the maximum dose for the past 6 weeks. She has a prior history of low potassium levels.

Answer 442

LacidipineSTEPWISE! freshy!thiazide-like hypokalaemia? :(

Question 443

A 54-year-old Afro-Caribbean gentlemen with a recent blood pressure reading of 160/100 mmHg taken by the nurse in the surgery and a home blood pressure reading of 150/95 mmHg. He is not taking any prescribed medication.

Answer 443

Lacidipine

Question 444

A 50-year-old Caucasian lady who has been taking ramipril and amlodipine for the past 4 weeks at the maximum licensed doses for hypertension. The patient has a blood pressure reading of 170/105 mmHg that was taken in the surgery.

Answer 444

Indapamide

Question 445

A 65-year-old Afro-Caribbean gentlemen with type 2 diabetes and with a recent blood pressure reading of 150/100 mmHg taken in the surgery by the nurse. The patient has been taking losartan and verapamil for the past 4 weeks at the maximum doses.

Answer 445

Indapamide

Question 446

A lady seeks advice regarding an unpleasant condition. The lady complains that her vaginal region is itchy, inflamed with a thick white vaginal discharge.Which of the following would be the most likely causative organism?

Answer 446

Candida albicansThe patient is complaining of symptoms related to vaginal thrush. The common organism causing this kind of condition is candida albicans.

Question 447

You differentially diagnose thrush in a 32-year-old female.Which symptom is LEAST likely experienced with thrush?

Answer 447

Discharge associated with a strong odourIn thrush, itching is the hallmark symptom; a white discharge does occur in a proportion of patients; dyspareunia and dysuria are possible but uncommon. However, discharge with odour is very unlikely.

Question 448

You have a patient who is being treated for HIV. There are a variety of different drugs used in the treatment of HIV, one such class is protease inhibitors.Which of the following drugs is a protease inhibitor?

Answer 448

RitonavirRitonavir is a protease inhibitor used in the treatment of HIV.

Question 449

You are teaching a summer placement student about side effects.Which of the following symptoms is most likely to be attributed to coumarins?

Answer 449

Bruising that may be heavy

Question 450

A 55-year-old man presents his prescription for oxycodone 20 mg m/r tablets.Which of the following directions would be legally acceptable on a prescription for this medicine?

Answer 450

One as directedAs a minimum the directions for a control drug must include the quantity of the medicine to be taken at each dose.

Question 451

An 81-year-old woman comes into the pharmacy seeking advice about a build-up of wax in both ears. She reports that there has been some discharge from both ears, however there is no pain. She has no other medical conditions and is not on any regular medication.What is the most appropriate advice to give to this lady?

Answer 451

The GP will be able to prescribe appropriate medication to treat the ear infectionThe discharge indicates an ear infection which would require further investigation by the GP and treatment with an antibiotic ear drop. Inserting cotton buds in the ear may lead to inner ear damage and it is not appropriate to syringe or use olive oil in the ears if they are infected.

Question 452

You are providing a training session on food interactions with medicines.Which of the following is most likely to interact with grapefruit juice?

Answer 452

CiclosporinGrapefruit juice increases the concentration of ciclosporin. Manufacturer advises avoid.

Question 453

You are writing a standard operating procedure for making CD records in the pharmacy.Which of the following is legally required to be recorded on receipt of a Schedule 2 CD?

Answer 453

Name of wholesalerThe name and address of whom the CD is received from is legally required to be kept in the CD register.

Question 454

A patient on warfarin has had a recent decrease in their INR test result.What is the most likely cause of this?

Answer 454

Phytomenadione

Question 455

A patient is admitted with a upper GI bleed. Which agent is the most likely cause of the bleed in this patient?

Answer 455

ClopidogrelClopidogrel has the highest risk of causing a GI bleed of the drugs listed.

Question 456

Mrs PJ comes into the pharmacy. She asks your advice on the abdominal discomfort she is experiencing. She says she often suffers with diarrhoea and cramps, and that these symptoms seem to be worse when she feels anxious or stressed. Her Doctor has mentioned it is likely to be IBS.

Answer 456

Crampex (colecalciferol, calcium gluconate and nicotinic acid)All the other four options are indicated or suitable for the treatment of various symptoms of IBS - Crampex isn't.

Question 457

A middle aged man presents to the pharmacy complaining of epigastric pain.Which condition is most closely associated with pain seen in this region?

Answer 457

Gastric ulcerAppendicitis 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.

Question 458

You have a patient who has been prescribed naproxen. The prescriber was considering to initiating them on to another medicine but this medicine has a severe interaction with naproxen.Which one of the following medicines has an interaction with naproxen which is graded as severe?

Answer 458

WarfarinThe BNF grades the interaction with warfarin as severe (red) but that with ramipril is graded as less severe (amber).

Question 459

A patient presents in your pharmacy and asks you for advice.When he was cleaning his teeth this morning, he noticed bleeding from his gums. Which of the following is NOT a cause of bleeding gums?

Answer 459

AsthmaDiabetes, poor oral hygiene, pregnancy and smoking are all known causes of bleeding gums

Question 460

When working in your community pharmacy, a patient complains about severe dental pain they have been feeling.Which of the patient's long term regular medications should you flag to the GP as a potential cause of this pain?

Answer 460

Alendronic acidIt is a CHM warning that with bisphosphonates (particularly IV) there is an increased risk of osteonecrosis of the jaw.

Question 461

A 20-year-old woman is going on holiday to Spain.Which of the following would be suitable advice to give her to help prevent her contracting travellers' diarrhoea?

Answer 461

Only consume pasteurised milkAll fruits that can be peeled e.g. bananas are ideal for consumption as they are less likely to carry the bacteria that could lead to travellers' diarrhoea. Uncooked vegetables and fresh salads have a higher chance of carrying bacteria that could lead to travellers' diarrhoea. Tap water in many countries poses the same risk of bacteria, thus bottled mineral water is recommended for holiday makers. Pasteurised milk is safer to drink than unpasteurised milk as there is a lower risk of bacteria thriving in the milk and causing infective diarrhoea.

Question 462

You receive a phone call from a doctor on the ward who is seeking advice regarding prescribing antibiotics. The doctor is unsure which antibiotic must be used with caution in patients with a history of epilepsy.Which of the following antibiotics must be used with caution in patients with a history of epilepsy?

Answer 462

CiprofloxacinQuinolones including ciprofloxacin may induce convulsions in patients with or without a history of convulsions. As such they must be used in caution in patients with a history of epilepsy.

Question 463

You have just finished using a stock bottle of methadone in the pharmacy. You are unable to pour anything out of the bottle, but you can see that there are still traces inside.How do you record the residue liquid in the CD register?

Answer 463

You do not need to make a record of disposal of irretrievable amounts of CDsDisposal of irretrievable amounts of CDs does not need to be recorded.

Question 464

You receive a requisition for a controlled drug.Which one of the following is NOT a legal requirement for the requisition?

Answer 464

Date of requisitionThe legal requirements for a controlled requisition are: signature of the recipient, name of recipient, address of recipient, profession/occupation, total quantity of drug and purpose of requisition.

Question 465

A patient attends anticoagulation clinic for a routine INR check. The target INR for this patient is 2.5-3.5, however in clinic the INR reading is 5.2 with no associated bleeding.What is the most appropriate course of action in this instance?

Answer 465

Withold 1 or 2 doses of warfarin and reduce subsequent maintenance dose

Question 466

Steroid creams are routinely sold over the counter.In which of the following situations can hydrocortisone 1% cream be recommended over the counter?

Answer 466

For contact dermatitis on the neck line of a post-menopausal femaleThis question refers to OTC supply - not prescription. It can be sold to treat allergic contact dermatitis, irritant dermatitis, insect bite reactions and mild to moderate eczema. However it may not be sold to children under 10 or in pregnancy except under medical advice. Contraindications include use on eye or face, anogenital region, broken or infected skin, acne or athletes foot. Use is restricted to a max. of 1 week.

Question 467

You are training a counter assistant on medicines that may cause a dry mouth.Which ONE the following is most likely to cause dry mouth?

Answer 467

IpratropiumIpratropium is an antimuscarinic drug and therefore can cause dry mouth.

Question 468

You have been asked to recommend a beta-blocker for a patient who usually suffers from cold extremities.Which of the following beta-blockers is the most appropriate for the patient concerned?

Answer 468

PindololISA and pindolol is the least cardioselective. ISA stands for intrinsic sympathomimetic activity. Intrinsic sympathomimetic activity (ISA, partial agonist activity) represents the capacity of beta blockers to stimulate as well as to block adrenergic receptors. Pindolol has intrinsic sympathomimetic activity; so it tends to cause less bradycardia than the other beta blockers and may also cause less coldness of the extremities.PACO!!!

Question 469

You are adding some cautionary and advisory labels to medications prior to dispensing. Recommended cautionary and advisory labels are usually added to dispensing labels to inform the patient of key points about their medication. One advisory label tells patients to avoid sunlight and protect skin from exposure to sunlight.Which of the following medications would usually carry the warning to avoid sunlight when taking this medication?

Answer 469

DoxycyclineDoxycyline comes with advisory warnings to protect the skin from sunlight or sunlamps even on a cloudy day. Doxycyline makes the skin more susceptible to UV light and as such more susceptible to UV light damage.

Question 470

The Misuse of Drugs Regulations 2001 (as amended) classify controlled drugs into 5 schedules according to the different levels of control attributed to each.Which schedule includes ketamine?

Answer 470

Schedule 2Ketamine is a Schedule 2 CD.

Question 471

You are labelling prescriptions in your pharmacy.Which of the following is legally required on the dispensing label?

Answer 471

Date of dispensingThe date of dispensing is a legal requirement. All other options are good practice.

Question 472

A 36-year-old woman has been experiencing irregular periods, weight gain and hair loss in the past few months. Her GP has prescribed metformin 500 mg tablets which she has been taking for 2 weeks.She returns to the pharmacy and explains that she is experiencing diarrhoea. What is the most appropriate advice to give to the patient?

Answer 472

She is experiencing a side effect of metformin - slow increases in dose can improve tolerability Gastro-intestinal side-effects are initially common with metformin, and may persist in some patients, particularly when very high doses are given. A slow increase in dose may improve tolerability.

Question 473

Mrs J, a 41 year old, has a non-productive cough. You believe it to be a viral infection. She has hypertension and suffers from type 1 diabetes.What would be the most appropriate treatment/course of action?

Answer 473

Viral infections are self-limiting and no treatment is necessary, therefore it would be a suitable 'recommendation'. A demulcent could be tried. As they are diabetic a sugar-free alternative would be useful but it is unlikely that a few days treatment with a demulcent containing sugar will affect their diabetic control. If a demulcent containing sugar is recommended then the person could be told to monitor their blood sugar more regularly. Cough suppressants and antihistamines have no evidence of efficacy and should not be recommended. An expectorant is only suitable for productive coughs.

Question 474

Measles in community, what do you do?

Answer 474

Go home, call GP ASAP!

Question 475

Adrenaline auto injectorx1 prescription, issue?

Answer 475

Need x2, carry 1, +1 back up, new script!

Question 476

Sign of severe allergic reaction?

Answer 476

Change in voice, laryngitis!

Question 477

Inappropriate TALL-MAN lettering?

Answer 477

GABApentin & preGABAlinbad!

Question 478

Dentists- emergency buccal midazolamSedation for dental procedures should be limited to conscious sedation. Diazepam and temazepam are effective anxiolytics for dental treatment in adults.

Question 479

WHAT ARE T H E L E G A L R E Q U I R E M E N T S F O R A CONTROLLED DRUG REQUISITION?

Answer 479

1 Signature of the recipient2 Name of the recipient3 Address of the recipient4 Profession or occupation5 Total quantity of drug6 Purpose of the requisition

Question 480

Reqs CDsmark the requisition indelibly with the supplier’s name and address (i.e. the name of the pharmacy); where a pharmacy stamp is used this must be clear and legible• Send the original requisition to the relevant NHS agency

Question 481

CD requisitions, original or copy?

Answer 481

As a matter of good practice, pharmacies should retain a copy of the requisition for two years from the date of supply.

Question 482

Aspirin in hypertension?

Answer 482

ABSOLUTE NO NO!

Question 483

Labetalol dosing?

Answer 483

100/200 BD acceptable

Question 484

bupneorphin + naloxone?

Answer 484

Antagonist, deters IV misuse

Question 485

Qeutiapine, ABx to avoid?

Answer 485

ErythromycinINHIBITOR!

Question 486

Neuropathic pain?

Answer 486

GabapentinPregabalinAmitriptylineCapsaicinNOT tramadol

Question 487

WHAT IS MHRA CLASS 2 DRUG ALERT?

Answer 487

The defect may cause mistreatment or harm to the patient, but it is not life-threatening or serious

Question 488

WHAT IS MHRA CLASS 1?

Answer 488

The defect presents a risk of death or disability. Thesealerts will be issued via the Central Alerting System(CAS) as National Patient Safety Alerts.

Question 489

WHAT IS MHRA CLASS 3?

Answer 489

The defect is unlikely to cause harm to the patient, andthe recall is carried out for other reasons, such as noncompliance with the marketing authorisation orspecification.

Question 490

CLASS 2 ACTION WITHIN?IN

Answer 490

48 HOURS

Question 491

domperidone+clarithromycin?

Answer 491

inhibitor g! domp levels up

Question 492

Clear fluid from the wound?

Answer 492

You're healing, you're good

Question 493

Levonelle, high BMI>26 kg/m^2?

Answer 493

DOUBLE THE DOSEOR JUST GIVE ULIPRISTAL!

Question 494

Abdominal bloating+diarrhoea?

Answer 494

Sorbitol, cah it treats constipationa!

Question 495

Animal bites treatment?

Answer 495

Co-amoxiclavDoxycyclineCMON

Question 496

Orlistat+ oral contraceptive? CalmNOT CALM?

Answer 496

Under 18hypothyroidismcolecalciferol, deficinecy? nuts

Question 497

WARFARIN+POMEGRANTE?

Answer 497

INCREASES INR, BAD!

Question 498

WARFARIN+CRANBERRY?

Answer 498

POTENTIALLY INCREASES INR

Question 499

WARFARIN+ SPINACH/KALE, contains vitamin K?MAYBE?

Answer 499

decreases INR!

Question 500

GLP1 AGONISTS,NAUSEA, VOMITING, DKA

Answer 500

REPORT ASAP!

Question 501

MOST likely with prostaglandin or timolol?

Answer 501

dry eyeeye lash growthpigmentationstingingNOT subconjunctival haemorrhage

Question 502

HYPERTHYROIDISM?

Answer 502

YOU'RE ACTIVEYOU LOSE WEIGHT, LET'S GO!

Question 503

GLP-1 agonist step of diabetes?

Answer 503

RIGHT AT THE END!

Question 504

atorvastatin in type 2 diabetes?

Answer 504

Need QRISK>10% akh20mg still na?

Question 505

Tramadol/morphine dosing?

Answer 505

Keep it consistentBD-BD

Question 506

HRT endometrial cancer?

Answer 506

REDUCED!

Question 507

hrt stop asap?

Answer 507

stomach pain, bleed PE :(

Question 508

WHAT CONDITIONS INCREASED RISK OF TB?

Answer 508

Individuals with comorbidities or coexisting conditions (such as HIV, severe liver disease, chronic kidney disease, diabetes, eye disease or vision impairment, a history of alcohol or substance misuse, or who are pregnant or breastfeeding)

Question 509

Consider the situationPatient collapsed, difficulty breathing, methadone can wait, just monitor symptoms of withdrawal

Question 510

Concerns about local supply/record of CDs?

Answer 510

Shout the accountable officer!

Question 511

unlicensed specials/import record keeping?

Answer 511

5 years

Question 512

VET REQUISITION?CD REQUISITON?

Answer 512

VET ORIGINALCD COPY

Question 513

VET CDs?

Answer 513

Veterinary prescriptions for CDs do not need to be written on standardised forms and do not need to be submitted to the relevant NHS agency. Forms must be retained for five years.

Question 514

DOXYCYLINE, SUNNY DAY?

Answer 514

PHOTOSENSITIVITY, AVOID G!

Question 515

INDEPENDENTS CAN'T DO?

Answer 515

DIAMORPHINEDIPIPANONECOCAINEHOME LICENSE G

Question 516

FRIDGE ITEMS OUT, BEEN FEW DAYS, FIRST THING?

Answer 516

quarantine g?

Question 517

tablets in blister packs?

Answer 517

Remove if CD, denature szn!

Question 518

INJECTION NOT ALLOWED BY PHARMACISTS IN COMMUNITY?

Answer 518

FLUMAZENIL INJECTION!

Question 519

bg after eating?

Answer 519

5-9! :D

Question 520

HYPOGLYCAEMIA TREATMENT?

Answer 520

10-20G SUGAR CALM

Question 521

HYPOKALAEMIA HIGH RISK?

Answer 521

SABASALBUTAMOLcheeky terbutaline!

Question 522

CLINICAL AUDIT?

Answer 522

RELATE TO NATIONAL STANDARDS GWho cares about personal data? ras

Question 523

most suitable for mcca?

Answer 523

Bumetanide g

Question 524

2 drugs in IV infusion?

Answer 524

Myna

Question 525

WARFARIN+ALCOHOL?

Answer 525

HEAVY REDUCTION IN INR, PEAK

Question 526

Total cholesterol?

Answer 526

5 OR BELOW G!

Question 527

hyperlipidaemia?

Answer 527

statins, not omega 3- lols,

Question 528

APORMORPHINE RISK?

Answer 528

BINGE EATING :(

Question 529

CICLOSPORIN+ITRACONAZOLE?

Answer 529

CIC LEVELS PEAK!

Question 530

methylphenidate+amfetamine?

Answer 530

cardiac arrhythmias!NO NARCOLEPSY LLOWED G

Question 531

FLUCLOXACILLIN BIG BOY SE?

Answer 531

CHOLESTATIC JAUNDICE

Question 532

SIGNS OF NEPHROTOXICITY?

Answer 532

decreased urination, swelling from fluid retention and high blood pressure

Question 533

SIGNS OF NEUROTOXICITY?

Answer 533

limb weakness or numbness, loss of memory, vision, and/or intellect, uncontrollable obsessive and/or compulsive behaviors, delusions, headache, cognitive and behavioral problems and sexual dysfunction.

Question 534

SIGNS OF OTOTOXICITY?

Answer 534

Dizziness.Unsteady gait.Loss of coordination with movement.Vertigo (dizziness)Oscillating vision (in which objects appear to jump or vibrate)Aural fullness (a feeling that something is stuffed in your ear)Tinnitus (ringing in the ear) LOOP, furosemide!

Question 535

desmopressin hyponatraemia!headachevomitingdisorientated

Question 536

SIGNS OF HYPERCALCAEMIA?

Answer 536

NAUSEACONSTIPATIONPALPITATIONtook vit D silly

Question 537

HPV?

Answer 537

2 dose schedulecheeky follow up

Question 538

INFLUENZA NASAL VAC?

Answer 538

CALM

Question 539

oral typhoid travelling?

Answer 539

calm

Question 540

ESCITALOPRAM ELDERLY MAXIMUM?

Answer 540

10MG OD

Question 541

PROMETHAZINEVERTIGO/NAUSEA MAX. ADULT?

Answer 541

25MG OD

Question 542

nsaid ANTI-INFLAMMATORY EFFECT?

Answer 542

can take up to 21 days

Question 543

PPi H PYLORI TEST?

Answer 543

Discontinue 2 weeksAbx 4 weeks

Question 544

methotrexate monitoring?

Answer 544

have full blood count and renal and liver function tests repeated every 1–2 weeks until therapy stabilised, thereafter patients should be monitored every 2–3 months.

Question 545

atorvastatin monitoring?

Answer 545

liver enzymes should be measured before treatment, and repeated within 3 months and at 12 months of starting treatment+statins, cholesterol, etc

Question 546

uritcaria?

Answer 546

desloratadine

Question 547

folic acid 5mg in old and pregnant? unlikely inappropriate ok

Question 548

insulin lispro brand?

Answer 548

Insulin lispro is a biological medicine. Biological medicines must be prescribed and dispensed by brand name

Question 549

5 year old carbocisteine?

Answer 549

250mg TDS

Question 550

3 YEAR OLD CARBOCISTEINE?

Answer 550

62.5-125 MG QDS

Question 551

sulfadiazine water?

Answer 551

150ml

Question 552

x1 Magnesium citrate with sodium picosulfate/Citrafleet water?

Answer 552

150mLManufacturer advises one sachet of sodium picosulfate with magnesium citrate powder should be reconstituted with 150 mL (approx. half a glass) of cold water; patients should be warned that heat is generated during reconstitution and that the solution should be allowed to cool before drinking.

Question 553

2-year-old child has been prescribed ibuprofen 100mg/5ml for pain from an ear infection. What dose is he most likely to receive?

Answer 553

o One 5 ml spoonful three times a day

Question 554

HRT RISKS?

Answer 554

BREAST CANCEROVARIAN CANCERSTROKEVTENOT ALOPECIA

Question 555

t is a cold winter’s morning and a 9-year-old girl is being reviewed at an asthma clinic. During the review she is complaining of increased breathlessness at breaktimes when playing outside and when she goes for bike rides with her family at the weekend when the weather is cold. She is currently on a salbutamol inhaler which she needs to use daily. Her PEFR is 78% at best. She is on no other medication.Which of the following is the most appropriate to add to her current medication?

Answer 555

Recommendations | Asthma: diagnosis, monitoring and chronic asthma management | Guidance | NICE See under pharmacological treatment pathway for children and young people aged 5-16. Note that the question asks for themost appropriate dose which is the lowest (100mcg) for a child of 9 years.

Question 556

A 40-year-old man is diagnosed with Helicobacter Pylori infection. He has no allergies. Which of the following would be the most suitable treatment regime for this gentleman?

Answer 556

Lansoprazole 30mg capsules B.D, Amoxicillin 1g capsules twice daily and Clarithromycin 500mgtabletstwice daily.

Question 557

A 16-year-old girl brings in a prescription for doxycycline to the pharmacy to treat her acute sinusitis. Her PMR shows that this is her first time. You counsel the patient. Which of the following is the most likely to be mentioned upon handout?

Answer 557

o Protect your skin from sunlight – even on a bright but cloudy day. Do not use sunbeds.

Question 558

SIGNS OF SEPSIS?

Answer 558

CONFUSION FEVERLOW BPHIGH HEART RATESOB

Question 559

Montelukast lickle issue?

Answer 559

Sleep disorders

Question 560

A man returns his 62-year-old wife’s unused Oxynorm liquid to your pharmacy.Which of the following is the most appropriate course of action?

Answer 560

Store in a segregated area of the CD cabinet before rendering irretrievable.

Question 561

thiazide-like diuretic AVOID if eGFR< 30EXCEPT?

Answer 561

Metolazone

Question 562

. A 67-year old man has been recently diagnosed with mild Parkinson’s disease dementia. Which of the following is most likely to be prescribed?

Answer 562

RIVASTIGMINE!

Question 563

which of the following is least likely to lead to deep vein thrombosis?

Answer 563

cancerskin changes- rednesstendernessthrobbing pain

Question 564

WHO SHOULD YOU NOT SELL THRUSH MEDICATION TO?

Answer 564

Patients >60DIabeticPregnantFirst timeRepeatedly within 6 months of treatment should be referred to a doctor.

Question 565

A 57-year-old artist comes to the pharmacy to seek advice from you. Two weeks ago, he noticed that his hands have started to shake, his movement has slowed and his muscles seem to be quite rigid. You ask him whether he has recently started to take any other medicines and he tells you that he has started a new medicine one month ago to reduce nausea and vomiting.Which one of the following medicines is most likely to be the cause of the patient’s symptoms?

Answer 565

Droperidol

Question 566

Carbimazole blood tests?

Answer 566

you'll have blood tests every 6 weeks or so. Once your hormone levels are stable, you'll have a blood test every 3 months, for as long as you continue to take carbimazole

Question 567

A 45-year-old presents at the pharmacy with an itchy patch of skin on their shoulder. They noticed it when they were on holiday in Egypt last month and assumed that they had been bitten by an insect. However, it is still itchy, isn’t healing and they think it may be spreading. They are asking for a cream to help relieve the itch and help it heal.

Answer 567

o Refer the patient to their GP as they may have a form of skin cancer

Question 568

S&S of lyme disease?

Answer 568

a flat, circular rash that looks like a red oval or bull's-eye anywhere on your body.fatigue.joint pain and swelling.muscle aches.headache.fever.swollen lymph nodes.sleep disturbances.

Question 569

35-year-old male with a history of inflammatory bowel disease has been prescribed azathioprine 50 mg tablets at a dose of two tablets once a day, to manage a flare up in his condition. He asks what the common side effects are.

Answer 569

Infections and infestationsIMMUNOSUPPRESSANT!BONE MARROW SUPPRESSION

Question 570

WARFARIN+ CRANBERRY

Answer 570

NOT GRAPEFRUIT!

Question 571

A 30-year-old female patient has been taking lithium for bipolar disorder for the past 18 months. She is currently prescribed Priadel 400 mg at night and her lithium levels have been stabilised at 0.8 mmol/L.Test resultseGFR = 77 (previous results 6 months ago = 82, 12 months ago = 85)Creatinine = 85 (range 45 – 84 µmols/ Litre)

Answer 571

Monitor Lithium plasma concentration levels more frequently and assess deterioration of renal function

Question 572

. A 30-year-old woman comes into the pharmacy and speaks to you about her options for contraception. Following a check on her records you notice she is taking Carbamazepine 400mg tablets twice a day for epilepsyWhich is the most suitable contraceptive for this patient?

Answer 572

Depo-Provera (medroxyprogesterone acetate 150 mg/1 mL) deep intramuscular injectionNOT AFFECTED BY CARBAMAZEPINE enzyme-inducing drugs

Question 573

The local primary school has noticed a recent rise in the number of children suffering with asthma and requiring a salbutamol inhaler. The headteacher has contacted your store by phone to place an order for six Ventolin inhalers. What will be the information you need to tell the headteacher?

Answer 573

o A signed order on appropriately headed notepaper is required before supply can be made- NOT A LEGAL REQUIREMENT BRUH

Question 574

How should I initially manage fungal foot infection?Advise on self-care management strategies:

Answer 574

Wear well-fitting, non-occlusive footwear that keeps the feet cool and dry. Consider replacing old footwear which could be contaminated with fungal spores.Maintain good foot hygiene by wearing a different pair of shoes every 2–3 days.Wear cotton, absorbent socks.Avoid scratching affected skin, as this may spread infection to other sites.After washing the feet, dry thoroughly, especially between the toes.Do not share towels, and wash them frequently, to reduce the risk of transmission.Wear protective footwear when using communal bathing places, locker rooms, and gymnasiums, to reduce the risk of transmission.If a child is affected, it is not necessary to exclude them from school or nursery.

Question 575

A 15-year-old boy has just been started on Sodium Valproate for generalised tonic-clonic seizures.Which of the following counselling points on the use of sodium valproate is most appropriate?

Answer 575

Patients or their carers should be told how to recognise signs and symptoms of blood or liver disorders and advised to seek immediate medical attention if symptoms develop.PancreatitisPatients or their carers should be told how to recognise signs and symptoms of pancreatitis and advised to seek immediate medical attention if symptoms such as abdominal pain, nausea, or vomiting develop.

Question 576

A 42-year-old lady with breast cancer has been diagnosed with bone metastases in her spine and has been prescribed ibandronic acid 50mg tabletsadvice?

Answer 576

taken on an empty stomach at least 30 minutes (for most ibandronic acid tablets, 50 mg) or 1 hour (for Bonviva ® tablets, 150 mg) before first food or drink (other than water) of the day, or another oral medicine; patient should stand or sit upright for at least 1 hour after taking tablet.

Question 577

bonviva counselling? Ibandronic acid

Answer 577

1hr before

Question 578

A 72-year-old woman is stabilised on co-careldopa therapy, however, she regularly experiences “off episodes”. Which of the following is most likely to be prescribed for when she experiences these?

Answer 578

Refractory motor fluctuations in Parkinson's disease

Question 579

SICK DAY RULES?

Answer 579

Just because the patient is ill and not eating does not mean they should stop injecting their insulinill/ infection= stress hormones/ steroids releasedsteroids increase blood glucosestay well hydrated to avoid DKApatient should monitor their BG and urine ketones more frequently and be prepared to inject accordingly

Question 580

A trainee pharmacist asks you to go through the different types of studies conducted in research in order to produce reliable evidence. Which of the following studies is most likely to produce reliable results?

Answer 580

o Systematic Reviews

Question 581

Patient, flushing, face, what med?A 2-month-old boy has been admitted to hospital with suspected bacterial meningitisWhich is the most appropriate treatment for this patient?

Answer 581

CCB, amlodipine

Question 582

A 2-month-old boy has been admitted to hospital with suspected bacterial meningitisWhich is the most appropriate treatment for this patient?

Answer 582

o BENZYL—->Intravenous cefotaxime

Question 583

Qvar and clenil?

Answer 583

Qvar is twice as potent as Clenil

Question 584

Canesten in pregnancy?

Answer 584

Canesten pessaries should not be used during pregnancy without seeking medical advice from her GP or midwifeYou should only sell Canestan to a pregnant woman if it is under the advice of a GP or midwife. Although the advice not to use the applicator found in the box is correct, it is not considered the most appropriate answer in this case as the supply of medication would come prior to the counselling.

Question 585

A 65-year-old woman is due to have a mechanical heart valve replacement in three days. The consultant cardiologist asks for your advice regarding anticoagulation for this patient post-surgery.Which of the following would be the most appropriate to give this patient?

Answer 585

Warfarin

Question 586

Symptoms of serotonin syndrome?

Answer 586

confusiondiarrhoeatachycardiatremorhyperthermia

Question 587

A 60-year-old women is taking the following medication following recurrent deep vein thrombosis:• Amlodipine 10 mg tablets once daily• Apixaban 2.5 mg tablets twice daily• Atorvastatin 20 mg tablets once daily• Bendroflumethiazide 2.5 mg tablets once dailyShe has hypertension which is controlled by her medication. She presents with severe facial pain and is diagnosed with trigeminal neuralgia. She is to commence treatment with Carbamazepine 100 mg tablets twice a day for the pain.Which of her existing medicines, if any, should be avoided when taking carbamazepine?

Answer 587

apixabanCarbamazepine is predicted to decrease the exposure to apixaban. Manufacturer advises use with caution or avoid.

Question 588

A 56-year-old Caucasian woman phones you in the pharmacy for some advice. You are unable to understand what she is saying as her speech is slurred so you invite her for a video consultation instead. When the consultation begins, you notice that her face has drooped on one side and she informs you that since she has woken up, she is unable to lift both arms and keep them there.

Answer 588

alteplaseStroke/tia

Question 589

A 2-year-old child has a high temperature and is refusing to eat. There are a few ulcers in the mouth and a rash with small blisters which appear on the child’s bottom, thighs and toes

Answer 589

handfootmouth

Question 590

A 57-year-old male is a regular patient at your pharmacy. Recently his mum has passed away and he’s confided in you that he’s been struggling the last 2 months he has collected his repeat prescription. He asks for your advice on a very painful rash that has appeared on his right-hand side. The rash appears blotchy and is starting to blister.

Answer 590

shingles

Question 591

A 10-year-old boy has small clusters of raised spots under his left armpit and further down his side. He has had them for around 4 months. They are not painful but can sometimes be itchy. On closer inspection you can see they have a dimple in the middle.

Answer 591

molluscum contagiosum

Question 592

A 17-year-old male has been prescribed Lymecycline 408mg Capsules – Take one daily. Repeat for 6 months and then review symptoms.

Answer 592

acne

Question 593

A 72-year-old man with a history of hypertension, presents with impaired visual acuity and describes seeing halos around lights. His eye is red and he is experiencing pain in it. When palpated it is tender and very hard.

Answer 593

glaucoma

Question 594

An 8-year-old girl whose mother says she is complaining of something in her eye. She says it feels like sand is in it and her vision is blurry. The mother says the eye has been watering and that there has been some sticky discharge.

Answer 594

infective conjunctivitis

Question 595

A A 20-year-old woman presents with localised swelling near the bottom left eyelid. Her eye is watering, but they say there has been no pain or discharge from the eye

Answer 595

Stye

Question 596

Maximum duration of treatment permitted for a controlled drug Schedule 4 under an emergency supply

Answer 596

5 days

Question 597

Length of validity of a prescription for Morphine Sulfate 10mg/5ml oral suspension

Answer 597

6 months

Question 598

Length of time required to keep an invoice for a schedule five controlled drug

Answer 598

2 years

Question 599

A 35-year-old woman with circulatory disease who requires a combined oral contraceptive?

Answer 599

Ethinylestradiol 20 mcg/Gestodene 75 mcg

Question 600

A 31-year old woman who smokes and has high blood pressure who is looking for short term contraception for the next two months

Answer 600

Desogestrel

Question 601

A 47-year-old man reporting general tiredness and frequently feeling thirsty, despite urinating more than was previously normal. This is particularly troublesome at night. Symptoms built up slowly but are starting to become quite noticeable to the patient.

Answer 601

type 2 diabetes

Question 602

A 27-year-old woman reporting persistent tiredness and difficulty sleeping. She also reports nervousness, mood swings, and twitching of her arms and hands, which are becoming more frequent. Recently, she has noticed that her heart rate seems fast, even at rest.

Answer 602

hyperthyroidism

Question 603

A 12-year-old girl reports over the last couple of months recurrent thrush infections, fruit smelling breath with no obvious cause, unintentional weight loss and feeling tired, which she puts down to having to get up in the night more frequently to urinate

Answer 603

type 1 diabetes

Question 604

A 78-year-old man has been taking warfarin for several years for atrial fibrillation. His granddaughter has persuaded him to eat more vegetables and less meat to reduce global warming. Because of the change in his diet, the INR clinic has had to increase his dose of warfarin.

Answer 604

vitamin K

Question 605

A couple in their late 60s ask if they should be taking a daily supplement of this during the autumn and winter each year.

Answer 605

vitamin D

Question 606

34-year-old woman has been admitted to hospital because of loss of feeling in her arms and legs. During the medicines reconciliation process, it has been established that she has been taking 200 mg of this vitamin daily for the last three months as she felt she was run down.

Answer 606

vitamin b6, peripheral neuropathy

Question 607

A first dose of vaccine should be given at 12-13 months of age and a second dose before starting school at 3 years and 4 months to 5 years of age.

Answer 607

MMR

Question 608

A first dose of vaccine should be given at 12-13 months of age and a second dose before starting school at 3 years and 4 months to 5 years of age.

Answer 608

MMR

Question 609

A first dose of vaccine should be given at 2 months of age and the second at 3 months of age. The vaccine should not be started in children of 15 weeks of age or older.

Answer 609

Rotavirus

Question 610

For primary immunisation of children aged between 2 months and 10 years, vaccination is recommended in the form of 3 doses, separated by 1-month intervals and given in a combination vaccine with tetanus, pertussis, hepatitis B, poliomyelitis and haemophilus influenza type b.

Answer 610

diptheria

Question 611

SODIUM VALPROATE

Answer 611

Valproate use by women and girlsThe MHRA advises women and girls should not stop taking valproate without first discussing it with their doctor.Blood or hepatic disordersPatients or their carers should be told how to recognise signs and symptoms of blood or liver disorders and advised to seek immediate medical attention if symptoms develop.PancreatitisPatients or their carers should be told how to recognise signs and symptoms of pancreatitis and advised to seek immediate medical attention if symptoms such as abdominal pain, nausea, or vomiting develop.Pregnancy Prevention ProgrammePharmacists must ensure that female patients have a patient card—see also Important safety information.

Question 612

LYME DISEASERASH?

Answer 612

BUT NOT ITCHY

Question 613

A new medicine is available for the treatment of rheumatoid arthritis. The literature suggests that this medicine is safer with fewer side effects and more efficacious than the current medicines on the market for the same indication. Which of the following sources is the strongest form of evidence to base a clinical decision?

Answer 613

Meta analyses is the strongest form of EBM. A meta-analysis is a statistical analysis that combines the results of multiple clinical trials. When a study compares a placebo against a new medicine it offers a very limited insight as to the safety and efficacy profile compared to other medicines. A direct comparison with other medicines allows to compare the relative safety / efficacy profile and is considered a stronger form of evidence base. It is important to ensure that all medicines are compared fairly with similar dosages.The correct answer is: the medicine was compared to an existing medicine for rheumatoid arthritis in a meta-analysis of five clinical trials with 5000 patients

Question 614

A 21-year-old female who has not been in the sun for 4 months develops redness on her chest after lying in the sun for 15 minutes. The next day she applies sunscreen and develops the same amount of redness on her back in 2.5 hours. Which of the following was the sun protection factor (SPF) of sunscreen she was using?

Answer 614

(Minutes to burn without sunscreen) x (SPF number) = (maximum sun exposure time) SPF = Maximum sun exposure time / min to burn without sunscreen SPF = 150 min/15 min = 10The correct answer is: 10

Question 615

DEPRESSION CITALOPRAM, AF?

Answer 615

would not be suitable because citalopram has been associated with QT prolongation and the patient has existing AF and there is an absolute contraindication between citalopram and amiodarone.

Question 616

A middle-aged man presents in your community pharmacy with a history of a red right eye for the last 24 hours.Which one of the following symptoms should alert you to a more serious condition that requires onward referral?

Answer 616

irregular pupil

Question 617

discomfortexcess wateringmucopurulent dischargeredness located in the forniceissue?

Answer 617

conjunctivitis, myna

Question 618

You have 100 mL of a 4% solution of chlorhexidine in your pharmacy and have been asked by a local vet to produce a 1:500 solution.What is the volume in litres of a 1:500 solution of chlorhexidine can be produced?

Answer 618

100 mL x 4% = 400 1:5000 = 0.2%400 /0.2% = 2000 mL = 2 LThe correct answer is: 2

Question 619

A 35-year-old woman wants some advice about a headache she has been experiencing. She tells you that she has had the symptoms for four or five days. She complains of a dull throbbing pain in the front of her head.Which of the questions listed below would be most discriminatory in assessing if it was a migraine or a tension-type headache?

Answer 619

Nausea?

Question 620

A 35-year-old woman wants some advice about a headache she has been experiencing. She tells you that she has had the symptoms for four or five days. She complains of a dull throbbing pain in the front of her head.Which of the questions listed below would be most discriminatory in assessing if it was a migraine or a tension-type headache?

Answer 620

Nausea?In almost all case of migraine nausea is experienced. Nausea is not a symptom associated with tension-type headache. Severity is subjective and not very discriminatory. Pain, whilst relatively good discriminating question [eg one sided pain in migraine] is not as discriminatory. The correct answer is: do they feel nauseous?

Question 621

A 35-year-old woman wants some advice about a headache she has been experiencing. She tells you that she has had the symptoms for four or five days. She complains of a dull throbbing pain in the front of her head.Which of the questions listed below would be most discriminatory in assessing if it was a migraine or a tension-type headache?

Answer 621

Nausea?

Question 622

A 31-year old woman presents with a self-diagnosis of period pain. On further questioning you ascertain that the aching pain, which can be quite severe, seems to be worse a few days before her period, and during intercourse.Which condition is she most likely to be suffering from?

Answer 622

Carcinomas associated with older women and irregular bleeding; PID shows signs of infection; PD pain is just prior to period and then subsides and is cramping rather than aching in qualityThe correct answer is: endometriosis

Question 623

A young adult, approximately 30 years of age, presents with symptoms of abdominal pain and discomfort in the right lower quadrant. Based only on the location of the symptoms, which one of the following conditions is the most likely cause?

Answer 623

All other options do not present in RLQ as the major presenting symptom. Duodenal and gastric ulcer tends to be epigastric; IBS is usually left lower quadrant and Gall stones right upper quadrant.The correct answer is: appendicitis

Question 624

A 27-year-old woman enters your community pharmacy and asks for advice on a mole that is bothering her. What symptom/sign is least associated with suspected skin malignancy?

Answer 624

. change in sensation B. colour change C. irregular border D. lesion growth E. symmetry FeedbackYour answer is correct.Answer is EAll other options can be seen as ‘sinister’ when using criteria checklists eg ABCDE rules) where changes are seen to mole appearance.The correct answer is: symmetry

Question 625

A 56-year-old woman enters your pharmacy, complaining of severe chest pains. She tells you that having used her GTN spray twice, the symptoms are worsening. She is short of breath and is extremely tired. On further questioning, she tells you she has pain in her jaw and arm as well. She has no known allergies.What is the most appropriate course of action for her?

Answer 625

Refer to St Johns Ambulance website and Medical emergencies in the community BNF. Her symptoms are suggestive of a heart attack. Aspirin 300 mg tablet should be chewed, ensuring she does not have any allergiesThe correct answer is: she is having a heart attack, call 999, supply aspirin 300 mg tablets and get her on the floor leaning against a wall with knees bent and head and shoulders supported

Question 626

A 45-year-old man is unconscious and not breathing in your pharmacy. You are first aid trained so you will need to do CPR (cardiopulmonary resuscitation). What is the current recommended compression‐ventilation ratio for emergency cardiopulmonary resuscitation of an adult with one rescuer present?

Answer 626

The compression‐ ventilation ratio for 1 rescuer adult CPR and 2 rescuer adult CPR is 30:2. Ref – Resus Council Guidelines. (If you are untrained or unable to do rescue breaths, give chest compression only CPR (i.e. continuous compressions at a rate of at least 100–120 min-1))The correct answer is: 30:2

Question 627

QUININE MALARIA?

Answer 627

TREATMENT, NOT PROPHYLAXIS

Question 628

A 42-year-old man enters your pharmacy complaining of a nosebleed. He tells you it only began a few minutes ago and he would like your advice on how to deal with it. Which of the following options is the most suitable course of action?

Answer 628

St John Ambulance website states: If someone is having a nose bleed, your priority is to control the bleeding and keep their airway open.Get them to sit down (not lie down) as keeping the nose above the heart will reduce bleeding.Get them to lean forward (not backwards), to make sure the blood drains out through their nose, rather than down their throat which could block their airway.Ask them to breathe through their mouth and pinch the soft part of the nose, taking a brief pause every ten minutes, until the bleeding stops.Encourage them not to speak, swallow, cough, spit or sniff because this may break blood clots that may have started to form in the nose.If the bleeding is severe, or if it lasts more than 30 minutes, call 999 or 112 for medical help.The correct answer is: sit him down, tilt his head forwards and ask him to pinch above his nostrils

Question 629

A locum pharmacist is spotted by a healthcare counter assistant drinking alcohol during her lunch break, and comes to you for advice. You look at the GPhC Standards for raising concerns, before taking further action. Which of the following statements regarding the GPhC guidance on raising concerns is INCORRECT?

Answer 629

You have a professional responsibility to take action to protect the well-being of patients (not colleagues) and the public. Refer to guidance for raising concerns The correct answer is: you have a professional responsibility to take action to protect the well-being of colleagues

Question 630

Patient returns to your pharmacy to collect his regular diabetes medication. He complains of feeling light-headed and is sweating and mentions he is also feeling very sick. He suddenly collapses. He remains conscious, and you determine that he is suffering from hypoglycaemia. Using information in the resource pack provided, which of the following would be most appropriate to give the patient?

Answer 630

Glucose or sucrose: ADULT and CHILD OVER 2 YEARS: approx. 10–20 g (110–220 mL Lucozade® Energy Original or 100–200 mL Coca-Cola®—both non-diet versions or 2–4 teaspoonfuls of sugar or 3–6 sugar lumps) repeated after 10–15 minutes if necessaryDiet versions of drinks not suitable, 2-4 teaspoonfuls of sugar or 3-6 sugar lumps.The correct answer is: Lucozade Original, 150 mL

Question 631

A woman has come in to the pharmacy to buy Clarinaze allergy control nasal spray (mometasone furoate 50 micrograms/spray) over the counter. After agreeing that the medicine is appropriate for the symptoms described, you begin giving advice on how to use the spray.Which of the following statements regarding the use of the mometasone nasal spray is INCORRECT?

Answer 631

If the patient sees no improvement of their symptoms within 14 days, they should visit their GP. All other options are true statements from the RPS guide to Clarinaze on the RPS website.The correct answer is: if the patient sees no improvement of their symptoms within 5 days, they should visit their GP

Question 632

The owner of an animal brings a prescription from the local vet into your pharmacy. Your counter assistant is unsure whether the prescription is valid and brings it into the dispensary for your attention. You note that the prescription contains a Veterinary Medicinal Product (VMP) which is also a Schedule 2 Controlled Drug. Which of the following criteria for a VMP, which is also a Schedule 2 Controlled Drug, is INCORRECT?

Answer 632

One difference between human and vet Rx’s for CDs is that vet good practice is for 28 days, whereas human is 30 daysThe correct answer is: it is considered good practice for only 30 days’ worth of treatment to be prescribed on veterinary prescriptions

Question 633

A customer visits your pharmacy wishing to buy some medication as he is experiencing congestion. After a consultation, you both decide on a number of products containing systemic decongestants. Which of the possible theoretical combinations would it be acceptable for you to legally sell the patient in one transaction?

Answer 633

Phenylephrine supply is not controlled; ephedrine and pseudo are. Therefore any combo of ephedrine/pseudo is not allowed, any supply above restricted quantity is not allowed, but any combo with phenylephrine is fine as long as the restricted drug is below the legal limit.MEP 43 p39The correct answer is: one pack of 12 tablets, with each tablet containing 60 mg pseudoephedrine and another pack of 12 tablets, with each tablet containing 12 mg phenylephrine

Question 634

OTCPSEUDOEPHEDRINE MAX?

Answer 634

720MG

Question 635

OTCEPHEDRINE MAX?

Answer 635

180MG

Question 636

Strict regulations govern the supply of Schedule 2 and 3 Controlled Drugs. Regarding the use of approved requisition forms when requesting such medicines, which of the following statements is INCORRECT?

Answer 636

GPhC registered pharmacies are not included in this legislation; Home Office wording is that they ‘should’, not ‘must’: legal difference. See MEP p91/92 for more info. The correct wording is in a pink box labelled ‘Practice Issues’ All pharmacies registered by the GPhC are included in the legal requirement to supply a requisition in writing and should do so before CDs can be supplied to them.The correct answer is: pharmacies are exempt from record keeping when lending each other Schedule 2 or 3 Controlled Drugs

Question 637

Mrs S has been admitted into hospital after suffering with convulsions, visual disturbances, confusion and a visible coarse tremor. Mrs S has a history of mania and is treated with lithium carbonate 800 mg daily. Two weeks ago she was diagnosed with hypertension and her GP started bendroflumethiazide 2.5 mg daily. On admission, tests for urine and electrolytes were performed. Which of the following would you expect to be abnormal?

Answer 637

The symptoms the patient is presenting with are indicative of lithium toxicity (additional symptoms include vomiting/diarrhoea, muscle weakness/drowsiness/lack of coordination). Lithium toxicity is made worse by sodium depletion therefore concurrent use of thiazide diuretics should be avoided.BNF 78+ page 357. The correct answer is: sodium

Question 638

Mr FT has come into your pharmacy wanting to discuss a ‘private’ problem with you. You take him into the consultation room and he tells you he may have haemorrhoids. You complete a consultation and agree with his self-diagnosis.Which of the following symptoms would indicate referral to the GP?

Answer 638

Dark tarry stool should be referred to GP to eliminate GI bleed. Slight rectal bleeding is often associated with haemorrhoids and can be visible on the toilet bowl or on the surface of the stool. Usually blood on the stool is a direct referral sign but if the cause is haemorrhoids this can be treated. The other symptoms C, D and E are typical of haemorrhoid.The correct answer is: dark tarry stool

Question 639

Mrs LK, 20 years old, comes into your pharmacy seeking advice about a rash on her arm. She tells you that it appeared 2 weeks ago and is itchy. She has no other symptoms and suffers from no other medical conditions. The appearance of her arm is shown below.

Answer 639

Tinea corporis is a defined infection of the skin surfaces that does not involve the face, hands, groins or scalp. Usual characteristics are itchy pink or red scaly slightly raised patches with well-defined inflamed border. Over time the lesions often show ‘central healing’ as the central area is relatively resistant to colonisation. The correct answer is: tinea corporis

Question 640

Mrs LT presents in your pharmacy wanting to purchase some cystitis treatment. You ask Mrs LT about her symptoms to decide on the most appropriate treatment plan. Which of the following symptoms would suggest referral to the GP?

Answer 640

Flank pain is indicative of infection in the upper urinary tract and can be diagnosed as pyelonephritis which is characterised by signs of systemic infection such as fever, chills, flank or loin pain and possibly nausea and vomiting. Others would not indicate referral.The correct answer is: flank pain

Question 641

You decide to hold a training a session on the sale and supply of Nexium Control (esomeprazole 20mg tablets) with your pharmacy team since it has been recently reclassified from POM to GSL. You decide to focus on when staff can make a supply of this product.What is the most appropriate piece of information to tell your team?

Answer 641

Older patients are at higher risk of stomach cancer and Nexium control can mask symptoms – new symptoms should be investigated with the GP. See SPC for Nexium control section 4.4 - Special warnings and precautions for use.The correct answer is: refer patients to a GP if they are over 55 years of age and present with new symptoms

Question 642

Mrs PO comes into your pharmacy and tells you that she was trimming her hedges 3 days ago when a branch went into her right eye. Since then she has experienced severe pain, with watery discharge and cannot look directly into bright light. On inspecting her eye, you see redness around the iris.Which of the following conditions is this most likely to be?

Answer 642

Ectropion-Is the condition of the eyelid turning outwards exposing the conjunctiva and cornea to the atmosphere. )Episcleritis-Pain is of dull nature, eye can appear red which is segmental and affects only part of the eye.Keratitis- Often results from recent trauma in this case branch in the eye. Severe pain is the prominent feature and patients complains of photophobia and watery discharge. Subconjunctival haemorrhage- is not associated with painViral conjunctivitis- is not associated with painThe correct answer is: keratitis

Question 643

Mrs PK has come into your pharmacy wanting buy something to treat her toenail infection. She has recently seen adverts on TV about Curanail (amorolfine 5% nail lacquer) and was wondering whether this would be suitable. You are satisfied it is a fungal nail infection and proceed to make a supply. Which one of the following statements is true regarding the supply of Curanail (amorolfine 5% nail lacquer)?

Answer 643

Curanail 5% w/v medicated nail lacquer SPC. The product only covers the treatment if up to two toenails are affected and should be used between 6-9 months for optimum effect. It is only licensed for 18 years and over and cannot be used in diabetic or patients with peripheral arterial disease. It is licensed for treatment where fungal infection has originated from the distal or lateral areas of the toenail. The correct answer is: can be sold for mild cases of distal lateral subungual onychomycosis

Question 644

Mr LN has suffered from hay fever for the past 10 years. Usually he manages the symptoms without the need for medication but this year he requires some antihistamines. He tells you that he is a teacher and therefore does not want to be effected by sedation. He does not take any regular medication.Using information in the resource pack provided, which is the most appropriate antihistamine to sell Mr LN?

Answer 644

As the patient teaches the most appropriate treatment option would be a non-sedating antihistamine such as loratadine. All of the other antihistamines are regarded as sedative.The correct answer is: loratadine

Question 645

Mr H has just brought 4-weeks’ worth of unused blister packs to the pharmacy that belonged to his father who died one week ago. All of the tablets in the blister packs were prescription-only. What is the most appropriate course of action for the pharmacy to take?

Answer 645

MEP 43 p.114 states that for tablets and capsules, blister strips can be removed from their inert outer packaging but tablets and capsules should not be de-blistered. Following this advice, the blister packs should not be deblistered.The correct answer is: place the blister packs into a secure waste container without deblistering

Question 646

Which of the following is the least appropriate advice to give as part of the correct technique for a metered dose inhaler?

Answer 646

Patients should inhale gently and slowly with a MDI inhaler. Inhaler technique should be checked at every opportunity with the patient. 10.2.2 Identifying appropriate advice on the use of medicines. See Asthma UK website https://www.asthma.org.uk/advice/inhalers-medicines-treatments/using-inhalers/ The correct answer is: inhaling hard and fast

Question 647

You are counselling Mr Jones on his repeat medication and he tells you that he really enjoys country drives with his wife and children.For which of his repeat medicines would it be most appropriate to tell him about the drug driving offence?

Answer 647

See selegiline SPC section 5.2, MEP 40 page 90 and BNF 72 Guidance on Prescribing page 2It is metabolised to methamphetamine. 10.2.2 Mechanism of action, administration, absorption, distribution, metabolism and excretion of medicines.The correct answer is: selegiline

Question 648

Mrs A, a 53-year-old woman, who is one of your regular patients visits your pharmacy. She is clearly distressed and on further questioning volunteers the information that she has recently started playing cards and using roulette wheels and she constantly uses them.Which of her medicines is the most likely cause of this?

Answer 648

Treatment with dopamine-receptor agonists and levodopa is associated with impulse control disorders, including pathological gambling, binge eating, and hypersexuality. Patients and their carers should be informed about the risk of impulse control disorders. 10.2.2, Recognising and managing adverse effects of medicines. See BNF 72 page 387. The correct answer is: pramipexole

Question 649

You are discussing metformin with your pharmacy technician and its various uses. Which of the following statements about metformin is CORRECT?

Answer 649

Use of licensed, off-label and unlicensed medicines including providing information to patientsA metformin 2000 mg/5 mL oral solution sugar free is an unlicensed preparationC metformin is a biguanideD metformin use in diabetes mellitus is licensedE metformin use in polycystic ovary syndrome is unlicensed thus off-labelSee BNF section 10.2.2The correct answer is: metformin can be used in pregnancy

Question 650

A 56-year-old man would like to purchase some Anadin Extra [aspirin, paracetamol and caffeine]. You recall that he is prescribed lithium on prescription and explain to him why Anadin Extra is not appropriate for him. Which of the following is the correct clinical consequence of the interaction?

Answer 650

Interactions that occur between medicines (either prescribed or purchased), and between these medicines and food or other substances- renal excretion of Lithium is reduced by aspirinA additive toxicity: It is not additive as additive toxicity is when the drugs have the same effect so adding them both together increases the toxic symptoms. Aspirin causes lithium to not be cleared, it does not ADD to its toxic effectsB increased risk of bleeding: yes aspirin increases risk of bleeding but this is not the interaction with lithiumC increased risk of NSAID-induced nephrotoxicity: yes aspirin increases chance of renal impairment but this is not the interaction with lithiumD increased sedation: not a NSAID side effectE aspirin at NSAID dose reduce clearance of lithium through kidney, therefore can cause toxic levelsSee BNF interactions (Appendix 1) or Minor Illness or Major Disease, 6th Edition, page 79. 10.2.2The correct answer is: renal excretion of lithium reduced

Question 651

A 57-year-old man presents in your clinic and is complaining of muscle weakness. He is on atenolol 50 mg, furosemide 20 mg and atorvastatin 40 mg. He has had a blood test and his potassium levels are 2.9 mmol/L. Which of the following is the most appropriate course of action?

Answer 651

Mr NJ is suffering from hypokalaemia. Normal K levels are 3.5-5.0mmol/L. 10.2.2 Normal ranges for test results, and actions to take when results are out of the normal rangeA Hypokalaemia can occur with both thiazide and loop diuretics. The risk of hypokalaemia depends on the duration of action as well as the potency and is thus greater with thiazides than with an equipotent dose of a loop diureticC He is on the lowest dose of furosemideD This would make the hypokalaemia worseE Hypokalaemia could get worse if left untreated See BNF and any clinical biochemistry textbookThe correct answer is: add spironolactone

Question 652

You are working in care home and a doctor is asking for advice as to which anticoagulant to start in a patient who has had a recent diagnosis of atrial fibrillation. Which of the following anticoagulants would be least appropriate if the patient has a poor appetite?

Answer 652

Under rivaroxaban (BNF 78): The MHRA has received a small number of reports suggesting a lack of efficacy (thromboembolic events) in patients taking 15 mg or 20 mg rivaroxaban tablets on an empty stomach. Healthcare professionals are advised to remind patients to take rivaroxaban 15 mg or 20 mg tablets with food. In those who have difficulty swallowing, these tablets can be crushed and mixed with water or apple puree immediately before, and followed by food immediately after, ingestion.The correct answer is: rivaroxaban

Question 653

Mr AJ has moderate COPD and is prescribed a salbutamol MDI when required. Before adding on any other inhaler, which of the following tests would be the most useful?

Answer 653

If the Forced Expiratory Volume in 1 second (FEV1), is 50% of predicted or more, either a long-acting antimuscarinic bronchodilator or a long-acting beta2 agonist should be used. If FEV1 is less than 50% of predicted, either a long-acting antimuscarinic bronchodilator or a long-acting beta2 agonist with a corticosteroid in a combination inhaler should be used. 10.2.2 Selecting appropriate diagnostic or physiological testing techniques for use in clinical decision-making and to promote health. See BNF (NICE)The correct answer is: Forced Expiratory Volume in 1 Second (FEV1)

Question 654

Mr and Mrs K are collecting their monthly repeat prescriptions and you skilfully bring the conversation to smoking cessation. Mr K currently smokes and is thinking about stopping so you direct him to your smoking cessation service. Mrs K stopped smoking 4 weeks ago so you give her advice on fighting cravings. At what stages of the ‘stages of change’ model are they both currently at?

Answer 654

See Kings Fund, Using Information to promote healthy behaviours, 2008. The transtheoretical model was developed by Prochaska and DeClemente. 10.2.2 Behavioural change as a tool to support health promotion.The correct answer is: Mr K contemplation and Mrs K maintenance

Question 655

Mr AB is newly diagnosed with gastric cancer. He has a past medical history of hypothyroidism, hypertension and end-stage chronic kidney disease. He is started on opioids to manage his pain. Which of the following is the most appropriate opioid combination for Mr AB?

Answer 655

Patient should be on MR preparation BD and immediate release preparation for breakthrough PRN, therefore B and E not appropriateAs patient has end stage CKD, morphine should be avoided as per BNF, therefore A, B, C not appropriateD is correct as MR dose BD and immediate release for breakthrough, plus oxycodone preferred over morphine in CKDThe correct answer is: OxyContin MR 10mg BD, Oxynorm 5mg QDS PRN

Question 656

While counselling Mr AB on his newly initiated opioid regimen, which of the following are not side effects that are commonly experienced while taking opioids?

Answer 656

NOT thirstCalm?constipationdry mouthheadacheN&V

Question 657

Which of the following is least aligned with principles of prescribing treatments for infectious diseases?

Answer 657

Avoid broad spectrum due to increased risk of clostridium difficile, MRSA and resistant UTIs. See NICE Management of Infection Guidance for Primary Care for Consultation and Local Adaptation – May 2016The correct answer is: avoid narrow spectrum antibiotics where broad-spectrum antibiotics remain effective

Question 658

A woman who is in the third trimester of pregnancy seeks your advice about receiving a influenza vaccine.Which of the following statements is correct with regards to administration of the flu vaccine in pregnant women?

Answer 658

The flu vaccine is safe during any stage of pregnancy, from the first few weeks up to your expected due date. The vaccine doesn't carry risks for either you or your baby. If you have flu while you're pregnant, it could mean your baby is born prematurely or has a low birthweight. The correct answer is: influenza vaccine given to the mother may provide passive immunity to the infant in the first few months of life

Question 659

Upon receiving new stock into the pharmacy you notice that the packaging of a vaccine has been extensively damaged and suspect particulate contamination of the vaccine. Which one of the following procedures is most appropriate to report the defective vaccine product?

Answer 659

Defects in medicinal products may include errors in the packaging, labels or leaflets, or other product faults, such as particulate contamination of a vaccine. If healthcare professionals suspect that a vaccine is defective, they should not use the product but contact the Defective Medicines Report Centre (DMRC) of the MHRA (see contact details at the end of the chapter). The DMRC assists in the investigation of defective medicines and co-ordinates any action that may need to be taken.The correct answer is: report to the centre of the Medicines and Healthcare products Regulatory Agency

Question 660

Mr PH is a 72-year-old male who has just been initiated on celecoxib for his rheumatoid arthritis. He is a known smoker, drinks 2 units of alcohol on 3-4 days a week and suffers from type 2 diabetes.Which of the following factors do not put Mr PH at a higher risk of developing gastro-intestinal complications?

Answer 660

Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs. (BNF)Corticosteroids can cause GI ulcers (common side effect) and therefore additive severe interaction (BNF)Specialist sources recommend that concurrent use need not be avoided with moderate alcohol intake, but greater caution is warranted in those who drink more than the recommended daily limits.The risk of GI toxicity is higher in the elderly (BNF)Proton pump inhibitors are used to provide GI protectionThe correct answer is: being prescribed celecoxib for arthritic pain instead of naproxen

Question 661

Miss J has been admitted to your acute medical unit with confusion. You complete her medicine history and find she is taking sodium valproate and citalopram. When checking her blood tests you find one of her biochemical markers is out of range, contributing to her confusion. Which of the following biochemistry derangements could her medicines cause?

Answer 661

Numerous anticonvulsants and antidepressants can cause hyponatraemia, which can manifest as confusion. Having the treatment card for Sodium valproate is important here as patient is female.The correct answer is: hyponatraemia

Question 662

Mr F presents to your community pharmacy for his repeat prescription and tells you he has been feeling really tired recently. You assess his symptoms and find his pulse rate to be 47 beats per minute. You believe his tiredness is likely caused by his current medication. Which of the following medicines would you discuss with his GP?

Answer 662

Beta-blockers are well known to cause bradycardia and a symptom of bradycardia is fatigue (tiredness).The correct answer is: atenolol

Question 663

Miss L is being treated for long term depression, which is not responding to fluoxetine. She has previously tried sertraline and citalopram, so her GP has referred her to a specialist. They have decided to try moclobemide instead. You find that Miss L has not been counselled on how to take this new medicine and you decide to contact her GP. Which of the following would be the most important to discuss with the GP?

Answer 663

An MAOI should not be started until at least a week after an SSRI or related antidepressant (at least 5 weeks in the case of fluoxetine) has been stopped. All important, however this is most important at the moment, as meclobemide will not be started for min. 5 weeks The correct answer is: which day the fluoxetine should stop and which day should meclobemide commence

Question 664

Mr Q needs to be prescribed vitamin D supplementation and his medical team ask for your advice. Mr Q has end stage chronic kidney disease and has dialysis three times a week. Which of the following vitamin D regimens is most appropriate for him?

Answer 664

Alfacalcidol is the activated form of Vitamin D, which is needed in patients with end stage renal disease who are not able to activate dietary vitamin D. Some patients will use both colecalciferol and alfacalcidol if there is some residual kidney function. This is because alfacalcidol is more likely to cause hypercalcemia and lead to toxicity so able to use a less dose if some residual function there.NICE guidelines: Short-acting, potent vitamin D analogues should only be prescribed in people with renal impairment that is severe enough to impair the hydroxylation of vitamin D to its active metabolite (specialist initiation only). Short-acting, potent vitamin D analogues (such as alfacalcidol and calcitriol) and annual depot vitamin D treatments (oral or parenteral) are not routinely recommended because they have been shown to cause toxicity or not to work.The correct answer is: alfacalcidol 250 nanograms once daily

Question 665

Which of the following medicine combinations is known to introduce a risk of rhabdomyolysis?

Answer 665

Fluvastatin with Bezafibrate

Question 666

A mother brings her 2-month-old baby into the pharmacy. She asks for advice regarding which vaccinations her baby should have. According to the 2020 immunisation schedule, which of the following vaccinations does her baby require at 8 weeks?

Answer 666

At 2 months the baby requires diptheria, tetanus and polio and the pneumococcal vaccine.The correct answer is: Diptheria, Tetanus and Polio

Question 667

Mrs QP takes digoxin regularly. Her doctor prescribes her furosemide as she is complaining of ankle oedema. The GP pharmacist is tasked with monitoring the patient regularly, as there is a potential interaction between the two medicines.Which of the following is a correct explanation of the mechanism of the interaction?

Answer 667

Furosemide is a loop diuretic. One of the side effects that may occur with furosemide therapy is hypokalemia. Hypokalemia predisposes to digoxin toxicity. Therefore, the patient should be monitored for signs of toxicity, such as nausea and bradycardia.The correct answer is: furosemide given with digoxin may induce digoxin toxicity

Question 668

BT is a 26-month-old toddler, has a fever of 38°C. He has not been sick and does not have a rash.What is the most appropriate dose of paracetamol 120 mg/5 mL to recommend to BT's parents?

Answer 668

The correct answer is: 7.5 mL QDS PRN

Question 669

Mrs P is using hypromellose and latanoprost eye drops and asks if she can use them together. Which of the following is the most appropriate response?

Answer 669

The correct answer is: she should leave 5 minutes in between

Question 670

Mrs P would like an inhaler with a dose counter as she never knows when hers has run out.Which of the following would NOT be suitable for her needs?

Answer 670

The correct answer is: easi-breatheBREATH ACTIVATED FRESHIE

Question 671

Mr NJ attends your clinic and you are examining the results of his blood tests. Blood test resultsCalcium 2.3 mmol/LGlucose 18 mmol/LMagnesium 0.8 mmol/LPotassium 5 mmol/LSodium 140 mmol/LWhich of the following is the most appropriate drug to prescribe?

Answer 671

Patient has hyperglycaemia. 10.2.2 Normal ranges for test results, and actions to take when results are out of the normal rangeA used to treat hyperkalaemiaB used to treat hypoglycaemia D used to treat hypomagnesaemiaE used to treat hyperphosphataemiaSee BNF 73 and any clinical biochemistry textbookThe correct answer is: insulin

Question 672

A 49-year-old male is prescribed cisplatin for lung cancer. Cisplatin may cause toxicity in up to 31% of patients treated with a single dose of cisplatin 50 mg/m2 and is manifested by tinnitus.

Answer 672

Ototoxicity has been observed in up to 31% of patients treated with a single dose of cisplatin 50 mg/m2, and is manifested by tinnitus and/or hearing loss in the high frequency range (4000 to 8000 Hz). Cisplatin can also cause nephrotoxicity but as the question states that the toxicity is “manifested by tinnitus” this rules out nephrotoxicity.The correct answer is: ototoxicity

Question 673

A 56-year-old male has been prescribed doxorubicin for lymphoma. The oncologist requests various tests for monitoring because there is a risk of developing toxicity with doxorubicin. It is recommended not to exceed a maximum cumulative dose of 550 mg/m2

Answer 673

Cardiotoxicity is a risk of anthracycline treatment that may be manifested by early (i.e. acute) or late (i.e. delayed) events.The correct answer is: cardiotoxicity

Question 674

A 22-year-old has been prescribed bleomycin for Hodgkin Lymphoma. The earliest sign and symptom associated with dose and age related toxicity caused by bleomycin are fine rales and dyspnoea respectively.

Answer 674

Pulmonary toxicity of bleomycin is both dose-related and age-related. The earliest symptom associated with pulmonary toxicity of bleomycin is dyspnoea. Fine rales (crackles in the lungs) are the earliest sign. If pulmonary changes are noted, treatment should be discontinued until it can be determined if they are drug related.The correct answer is: pulmonary toxicity

Question 675

A neonate at risk of tuberculosis receives a live attenuated strain derived from Mycobacterium bovis.

Answer 675

BCG vaccine is given at birth to babies that are at risk only. The correct answer is: bacillus calmette-guérin (bcg) vaccine

Question 676

A 75-year-old male receives a vaccine to prevent a skin condition.

Answer 676

Varicella Zoster Vaccine - A shingles vaccination programme was introduced for selected people aged between 70 and 79 years in September 2013 with the aim of reducing the incidence and severity of shingles in older people. The correct answer is: varicella zoster vaccine

Question 677

A 25-year-old humanitarian relief worker is prescribed an oral vaccine before her travels. You advise her to mix the vaccination with water, and avoid eating, drinking or taking oral medication for an hour before and after having the vaccination.

Answer 677

The cholera vaccine is available to patients while travelling, although most people won't need it because food and water hygiene precautions are usually enough to prevent infection. The correct answer is: cholera vaccine

Question 678

The first dose of this live, oral vaccine is delivered at two months to protect young children against gastro-enteritis.

Answer 678

Rotavirus is the most common cause of infantile gastroenteritis. Almost every child in the UK will have an infection before their fifth birthday. Infection in adults is uncommon because immunity is long lasting. An oral rotavirus vaccine, is currently offered as part of the UK national childhood immunization programme. The correct answer is: rotavirus vaccine

Question 679

A 12-month-old child receives their first dose of this vaccine, with a second booster dose scheduled between 3 – 5 years. This vaccine should not be administered on the same day as yellow fever vaccine and there should be a 4-week minimum interval between the vaccines.

Answer 679

MMR vaccine is administered at 12 months and between the ages of 3 – 5 according the immunization schedule. It should not be administered on the same day as yellow fever vaccine; there should be a 4-week minimum interval between the vaccines. When protection is rapidly required, the vaccines can be given at any interval and an additional dose of MMR may be considered.The correct answer is: measles, mumps, rubella (mmr) vaccine

Question 680

An adjunct test is ordered for a 79-year-old male with liver disease and who is on a protein restricted diet.

Answer 680

A blood urea nitrogen (BUN) test measures the amount of nitrogen in your blood that comes from the waste product urea. Urea is made when protein is broken down in your body. Urea is made in the liver and passed out of your body in the urine. Levels may be lower in a patient with liver disease. The correct answer is: blood urea nitrogen (bun)

Question 681

A 36-year-old male who has been diagnosed with human immunodeficiency virus HIV.

Answer 681

A CD4+ count is a blood test to determine how well the immune system is working in people who have been diagnosed with HIV.The correct answer is: cd4+

Question 682

A 65-year-old male who is at high risk for heart failure.

Answer 682

C-reactive protein (CRP) is an inflammatory marker and predicts the chance of having cardiovascular problems, at least as well as well cholesterol levels.The correct answer is: c-reactive protein

Question 683

A test is ordered for 68-year-old female with metabolic acidosis. Her results fall out outside of the normal range which is between 60 and 125 micromol/L.

Answer 683

Creatinine levels are measured to give an indication of kidney function and is one of the most frequent tests requested. The correct answer is: creatinine

Question 684

A 55-year-old female with a suspected case of helicobacter pylori infection.

Answer 684

A stool antigen test can be used to detect H. pylori infection (H. pylori antingens) are present in faeces. Stool antigen testing may be done to help support a diagnosis of H. pylori infection or to confirm whether treatment for an H. pylori infection has been successful.The correct answer is: stool antigen test

Question 685

A 3-year-old is prescribed fusidic acid to be used three to four times daily, for 7 days. You advise the parent to remove the crusted areas on skin by soaking in soapy water before applying the topical antibiotic.

Answer 685

Impetigo is a common contagious pyogenic infection of the superficial layers of the skin. For more severe cases oral antibiotics can be used.

Question 686

A moderate-to-highly contagious acute viral infection caused by a paramyxovirus and is spread by direct contact with saliva. Clinical presentations may include swollen parotid glands alongside low-grade fever, headache, earache, malaise, muscle ache, and loss of appetite.

Answer 686

Mumps

Question 687

A 53-year-old male develops kidney stones while taking this antiepileptic medicine.

Answer 687

topirimate

Question 688

Patient and carers should be counselled on the signs and symptoms of pancreatitis.

Answer 688

Pancreatitis, which may be severe and result in fatalities, has been very rarely reported. Patients experiencing nausea, vomiting or acute abdominal pain should have a prompt medical evaluation (including measurement of serum amylase). Young children are at particular risk; this risk decreases with increasing age

Question 689

A 33-year-old male requires treatment for a seizure that has lasted longer than 5 minutes.

Answer 689

Seizures lasting longer than 5 minutes should be treated urgently with intravenous lorazepam (repeated once after 10 minutes if seizures recur or fail to respond). Intravenous diazepam is effective but it carries a high risk of thrombophlebitis (reduced by using an emulsion formulation). Absorption of diazepam from intramuscular injection or from suppositories is too slow for treatment of status epilepticus. Patients should be monitored for respiratory depression and hypotension.The correct answer is: lorazepam

Question 690

A 23-year-old female should avoid this antiepileptic unless there is no safer alternative.

Answer 690

Valproate is associated with teratogenic risks and should not be used in females of child-bearing potential unless there is no safer alternative—this should be fully considered and discussed before prescribing for females of child-bearing age. The correct answer is: sodium valproate

Question 691

Mr TG is 75 years of age and is starting medication for type 2 diabetes. Mr TG has a serum creatinine of 250 micromol/L, and his weight is 75 kg. This is his baseline creatinine. The doctor has asked you to calculate Mr TG’s creatinine clearance and identify which of these medicines should not be started. His creatinine clearance is 24 mL/min.

Answer 691

Metformin – should be avoided in eGFR less than 30 (works out to be approx 24 mL/min - exact 23.99 mL/min)Gliclazide – used with care/lowest dose – careful monitoring Insulin- dose reduction in renal impairmentMetformin – avoided in egfr less than 30 mL/minute/1.73 m2.Pioglitazone – ok Repaglinide - use with caution Sitagliptin – dose reduction to 25mg if egfr 30 mL/minute/1.73 m2 not stoppedThe correct answer is: metformin

Question 692

Miss KB is 67 years old, overweight and has type 2 diabetes, alongside other comorbidities including previous MI. She is currently taking a combination of oral anti-diabetic therapy and insulin, all that are listed above. Miss KB has now been admitted to hospital with shortness of breath and pitting oedema, and has been diagnosed with heart failure. Which of the drugs listed, if Miss KB was taking them all, should be discontinued immediately?

Answer 692

Incidence of HF is increased when pioglitazone is combined with insulin, especially in patients with predisposing factors (eg. MI). Patients taking pioglitazone should be closely monitored for signs of HF, and treatment should be discontinued if any deterioration in cardiac status occurs.The correct answer is: pioglitazone

Question 693

Mrs DF has epilepsy and takes lamotrigine 100 mg daily. She wants to purchase Feminax Ultra (naproxen 250 mg tablets) to manage her period pain. She recently contracted a severe respiratory tract infection and was prescribed some ciprofloxacin 500 mg bd.

Answer 693

Naproxen potentially increases the risk of seizures when given with ciprofloxacin.The correct answer is: increased risk of seizures

Question 694

Mr PV has been taking phenelzine 15 mg tds but the doctor has decided to switch him to citalopram 20 mg once daily. The doctor has advised Mr PV to stop treatment with phenelzine and start citalopram immediately.

Answer 694

MAOIs increase CNS effects of SSRIs - increased risk of serious toxicity – (serotonin syndrome). Antidepressants should not be started for 2 weeks after treatment with MAOIs has been stopped.The correct answer is: haematological toxicity risk increased

Question 695

Mrs TH has a chest infection and is taking clarithromycin 500 mg bd. She requests an OTC supply of fluconazole 150 mg capsule to treat her vaginal candidiasis infection.

Answer 695

Both fluconazole and clarithromycin prolong the QT interval. Most manufacturers advise avoiding the use of two or more drugs that are associated with QT prolongation.The correct answer is: qt interval prolongation

Question 696

A customer requests treatment for her 4-month-old baby’s sore mouth. After asking the appropriate questions and looking into the baby’s mouth, you diagnose oral thrush.

Answer 696

Daktarin oral gel – Oral thrush is a fungal infection. It can be used in infants over 4 months of age. Miconazole is the active ingredient of daktarin oral gel and can be used in the mouth.

Question 697

A 45-year-old lady, enters your pharmacy. She has gritty, sticky eyes since yesterday morning. She has not yet tried anything and does not wear contact lenses. Her vision is not affected and there is no pain in her eye apart from irritation.

Answer 697

Chloramphenicol 0.5% drops is licensed for bacterial conjunctivitis.The correct answer is: chloramphenicol 0.5% eye drops

Question 698

A 30-year-old man requests treatment for a fungal infection between his toes, which appears as flaky skin which is very itchy. You diagnose athletes foot.

Answer 698

Miconazole 2% cream is an anti-fungal cream. Topical application of an anti-fungal would be appropriate.The correct answer is: miconazole 2% cream

Question 699

A 62-year-old woman, asks to speak to you in the consultation room. She tells you she has a thick white discharge and is very itchy in the vaginal area, which she has never experienced before. There are no other symptoms.

Answer 699

Women over 60, or under 16 - vaginal thrush is rarer in this group of women and the doctor should be consulted to exclude other possible causes before thrush is diagnosed.The correct answer is: no product – refer to GP

Question 700

ella one action?

Answer 700

ellaOne

Question 701

With regards to patient confidentiality, which ONE of the following statements is TRUE?

Answer 701

The correct answer is: For disclosures required by law, pharmacists should be satisfied that those requesting confidential information have a legitimate interest

Question 702

A 46-year-old woman has been admitted to hospital with a transient-ischaemic attack (TIA). Her records indicate a history of migraine with aura, hypertension, and Type 2 diabetes.Her medications on admission were as follows:Ramipril 2.5 mg dailyNovomix 30 ® 20 units twice a dayMetformin 1 g twice a dayAtorvastatin 40 mg dailyPropranolol 10 mg twice a dayWhich of the following antiplatelet agents would be most appropriate for this patient for stroke prevention?

Answer 702

Clopidogrel is recommended if aspirin is not tolerated. Aspirin/dipyridamole would not be recommended for this patient as it may worsen headaches/migraines. Prasugrel and ticagrelor are not indicated for ischaemic stroke/CVA.REF: https://www.nice.org.uk/guidance/ng128/chapter/RecommendationsThe correct answer is: Aspirin

Question 703

DOXORUBICIN NEUTROPENIA?

Answer 703

Decreased neutrophil levels may be the result of severe infection, liver disease, enlarged spleens or other conditions, such as responses to various medications or chemotherapy

Question 704

Which ONE of the following statements about supply on a prescription for a Schedule 2 controlled drug is INCORRECT?

Answer 704

The correct answer is: The prescription is valid for 30 days after the appropriate date on the prescription

Question 705

A 7-year-old boy is prescribed ibuprofen for the management of fever. He is 122 cm tall and weighs 23 kg.Which of the following is the most appropriate ibuprofen dose for this patient?

Answer 705

The recommended dose for children aged 7-9 years is 200 mg 3 times a day.Ref: https://bnf.nice.org.uk/drug/ibuprofen.html#indicationsAndDosesThe correct answer is: 10 mL of 100 mg/5 mL syrup three times a day

Question 706

A 45-year-old woman with oestrogen-receptor positive with breast cancer. She is prescribed tamoxifen 20 mg daily after a total mastectomy. She has a history of depression for which she is taking paroxetine 20 mg every morning.Which of the following is the most appropriate counselling point for this patient?

Answer 706

Tamoxifen should be taken daily to reduce the risk of the breast cancer returning, with ongoing review of the benefits versus risks of continuing. Tamoxifen may increase the risk of endometrial cancer. Paroxetine reduces the effectiveness of tamoxifen through inhibiting its conversion to its active form. Timing of tamoxifen will not reduce the hot flush which is a common side effect. Tamoxifen increases the risk of venous thromboembolism and a swollen leg could suggest a deep vein thrombosis which requires urgent medical attention in a hospital.Tamoxifen may increase the risk of endometrial cancer. Paroxetine reduces the effectiveness of tamoxifen through inhibiting its conversion to its active form. Timing of tamoxifen will not reduce the hot flush which is a Page 18 of 46common side effect. Tamoxifen increases the risk of venous thromboembolism and a swollen leg could suggest a deep vein thrombosis which requires urgent medical attention in a hospital.The correct answer is: Tamoxifen should be taken daily to reduce the risk of the breast cancer returning

Question 707

A 70-year-old man with advanced Parkinson’s disease is being started on apomorphine therapy.Which of the following treatment options is the most appropriate for the management of nausea and vomiting as a result of the apomorphine?

Answer 707

Metroclopramide, haloperidol and prochlorperazine should not be used in Parkinson’s disease as they cross the blood brain barrier and cause dopamine blockade, resulting in worsening of symptoms. Ondansetron is contraindicated with apomorphine due to additive QTc prolongation and risk of serious arrhythmia. The manufacturers of apomorphine recommend the use of domperidone to control nausea and vomiting, however there is still a risk of QT prolongation with this combination , hence an assessment of cardiac risk factors and ECG monitoring is recommended to ensure that the benefits outweight the risks.Ref: https://bnf.nice.org.uk/treatment-summary/parkinsons-disease.htmlThe correct answer is: Domperidone

Question 708

A 30-year-old woman comes into the pharmacy and mentions she would like to buy something to help ease her period pain. You suspect her to have primary dysmenorrhoea. You recommend she takes 250 mg naproxen tablets.Which ONE of the following is the CORRECT information to provide the patient?

Answer 708

The maximum dosage for Naproxen OTC, is one 250 mg tablet 3 times per dayRef: NHS, UK Naproxen, how and when to take, https://www.nhs.uk/medicines/naproxen/The correct answer is: Do not exceed three tablets daily

Question 709

A 25-year-old man brings in a bag of his unused medicines for your disposal. The bag contains prescribed medicines but also medicines he has purchased over the counter.Which ONE of the following statements about the handling of waste medicines returned to pharmacies is INCORRECT?

Answer 709

REF: MEP p113 and further reading (esp Safe Management of Healthcare Waste V 1.0 DoH-link from PSNC website)The correct answer is: Pharmacies should not remove blister strips from their outer packaging

Question 710

A 54-year-old man presents with acute back pain. He has a family history of cardiovascular disease, has a BMI of 30 kg/m2, and is a smoker.Which one of the following would be most appropriate for this patient?

Answer 710

Naproxen (1 g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2 g daily or less) have not been associated with an increased risk of myocardial infarction. COX-2 inhibitors), diclofenac and high dose ibuprofen are associated with increased CVD riskREF: https://bnf.nice.org.uk/treatment-summary/non-steroidal-anti-inflammatory-drugs.htmlThe correct answer is: Naproxen

Question 711

Clinical audit is a way to find out if healthcare is being provided in line with standards and let’s pharmacists know where their service is doing well, and where there could be improvements.Which of the following statements about audits is CORRECT?

Answer 711

Knowledge of audit process from pre-reg year, PSNC Clinical auditThe correct answer is: Re-audit performance is part of the audit cycle

Question 712

You are supplying a spacer to an adult for use with their newly prescribed Metered Dose Inhaler (MDI).Which of the following is the most appropriate counselling advice in relation to the use of the spacer?

Answer 712

Care should be taken not to scrub the inside of the spacer as it will affect the way it works. Spacers help improve the distribution of the medicine to the intended site of action and reduce the risk of side effects, hence they should be used wherever possible/feasible, not just indoors. Spacers are only compatible with MDs.REF: https://www.asthma.org.uk/advice/inhalers-medicines-treatments/inhalers-and-spacers/spacersThe correct answer is: Spacers should be cleaned before initial use, and then once a month afterwards

Question 713

AIR DRY SPACERS, NO CLOTH!

Question 714

A patient has visited your pharmacy to ask for some medicine to help with their cough and sore throat, they have tested NEGATIVE for COVID-19.Which ONE of the following situations would you need to refer to a GP?

Answer 714

Possible Methotrexate toxicity – urgent referral symptomRef: BNF Methotrexate, patient carer advice, https://bnf.nice.org.uk/drug/methotrexate.html#indicationsAndDosesThe correct answer is: A 40-year-old patient taking methotrexate for rheumatoid arthritis

Question 715

It is a bank holiday and a 40-year-old patient has run out of his metformin 500 mg tablets and asks for an emergency supply.Which ONE of the following statements about an emergency supply at the request of a patient does NOT meet legal requirements?

Answer 715

Legal and professional requirements for prescriptions, to enable the safe and legal supply of medicines; MEP p59The correct answer is: An entry must be made in the POM register within 72 hours

Question 716

POM-P switches, ODD one out?A. Orlistat and urgent bowel movementsB. Sildenafil and cold hands and feetC. Sumatriptan and tingling sensations in the skinD. Tamsulosin and dizzinessE. Tranexamic acid and diarrhoea

Answer 716

B. Sildenafil and cold hands and feetCORRECTION: Sildenafil is commonly associated with flushes/hot flushes

Question 717

Which ONE of these patients requesting amorolfine 5% nail lacquer could be sold the product if they have been referred to you by their doctor?

Answer 717

61 year old female is correct. Amorolfine is licensed from 18 years, should not be used in diabetes or in pregnancy. People with three affected nails should be referred. The doctor referring them doesn’t override the licensing

Question 718

A 21-year-old female suffering from mild acne purchases a tube of benzoyl peroxide at your pharmacy.Which one of the following statements is the most appropriate advice for this patient?

Answer 718

Benzoyl peroxide prevents new lesions rather than shrinking existing ones, and therefore should be applied not just to active lesions. Advise that the face should be washed and left to dry for 20 minutes before applying treatment. Treatment should start with the lower strength product to allow the skin time to adjust to the medication. Acne is notoriously slow to respond to treatment and it can take months to see the maximum benefit.Ref: Symptoms in the pharmacy ebook (Can access via RPS e-library)The correct answer is: During the first few days, the skin is likely to redden and be irritated

Question 719

When a medicine is supplied by a pharmacy for use in an animal under the veterinary cascade, certain details must appear on the dispensing label unless they already appear on the packaging and are not obscured by the dispensing label.Which ONE of the following requirements is NOT required on the dispensing label when making a supply under the cascade?

Answer 719

The correct answer is: The address of the prescribing veterinary surgeon

Question 720

A patient suffering with dyspepsia calls you to discuss some symptoms he has been experiencing.Which of the following symptoms requires urgent referral?

Answer 720

Dysphagia requires urgent referral. Urgent endoscopic investigation is required for patients with dysphagia, significant acute gastrointestinal bleeding, or in those aged 55 years and over with unexplained weight loss and symptoms of upper abdominal pain, reflux or dyspepsia.Ref: BNF, Dyspepsia https://bnf.nice.org.uk/treatment-summary/dyspepsia.htmlThe correct answer is: Dysphagia

Question 721

An 85-year-old man is receiving palliative care for lung cancer has been prescribed morphine sulfate MR capsules (Zomorph ®) 200 mg twice a day to manage his cancer pain. Over the last few days, he has complained of constipation, which he was not suffering from previously.Which of the following is the most appropriate treatment for this patient’s constipation?

Answer 721

Opioids reduce peristalsis, increase the anal sphincter tone, and promote absorption of water from the large intestine; this leads to hard stools and constipation. Ispaghula husk, a bulk-forming laxative, can cause obstruction and increase the risk of faecal impaction in opioid-induced constipation especially if fluid intake is inadequate. Constipation from opioid use is best treated with a stimulant laxative, or a stool-softening laxative, or both if necessary. Adequate fluid intake should be maintained. (Source MHRA)Methylnaltrexone and naloxegol are reserved for where first line therapies have failed.http://www.mhra.gov.uk/opioids-learning-module/con143740?usesecondary=&showpage=6.The correct answer is: Co-dantrhamer

Question 722

It is Summer and you want to ensure your pharmacy staff are have appropriate knowledge on the sale of medicines for the treatment of hay fever.Which ONE of the products below could be sold over the counter for the associated patient?

Answer 722

Loratadine is the correct product according to licensing which can be sold in the above situations. All other options are unlicensed due to inappropriate age groupsRef: BNF for childrenThe correct answer is: Loratadine for a 12-year-old

Question 723

You are the Responsible Pharmacist of your pharmacy working alongside another pharmacist. You plan to be away for an authorised absence for two hours and consider the options available to you during this period of absence.Which ONE of the following statements about Responsible Pharmacist legislation is CORRECT?

Answer 723

REF: Further information available in the RPS Responsible pharmacist toolkitThe correct answer is: You can hand over the responsible pharmacist role to the second pharmacist

Question 724

A 6-year-old boy presents to the pharmacy with his mother. He has a rash around his knee (see image below). He has just come back from vacation with his family where they spent their time playing outdoors in the countryside.Use the image (image c) provided in the resource pack.Which one of the following conditions is most likely to be the cause of this rash?

Answer 724

hives

Question 725

1Which ONE of these patients with thrush, displaying symptoms for the very first time, could be sold a medicine over the counter?

Answer 725

34 year old male who has symptoms and whose female partner also has thrush. Over 60’s need referral to the GP, also the presence of green discharge maybe an infection that needs GP referral specifically.Ref: NHS conditions, thrush in men and women https://www.nhs.uk/conditions/thrush-in-men-andwomen/#:~:text=You'll%20usually%20need%20antifungal,partners%20unless%20they%20have%20symptomsThe correct answer is: A 34-year-old male whose female partner has thrush

Question 726

A patient who is a new mother, comes into your pharmacy. Her 5-year-old daughter has been recently diagnosed with epilepsy and she would like to know what factors trigger epileptic seizures.Which one of the following is NOT a trigger for an epilepsy seizure?

Answer 726

Having a high temperature can be a cause of an epileptic seizureRef: Seizure triggers, https://www.epilepsy.org.uk/info/triggers, on lots of common epilepsy websitesThe correct answer is: Having an illness causing a low body temperature

Question 727

Regarding medicines which come in tablet form, your dispenser would like to ask what they are commonly made up of.Which of the following is INCORRECT regarding common excipients?Select one:A. Binders are used to help ingredients come togetherB. Colouring agents are used to improve patient acceptabilityC. Diluents are used to provide bulk and accurate dosingD. Film coatings are used to protect the tablet from the environmentE. Glidants are used to allow the tablet to be swallowed with ease

Answer 727

Glidants are used to improve flow of powders during tablet manufacturing (GENERAL knowledge)The correct answer is: Glidants are used to allow the tablet to be swallowed with ease

Question 728

A 2-year-old girl present with a fever of 38°C. Upon inspection she does NOT have a rash, has not had any other symptoms, and has tested negative for COVID-19.What is the MOST appropriate dose of paracetamol 120 mg/5 mL to recommend for this patient?

Answer 728

7.5 mL QDS PRNRef: BNFc https://bnf.nice.org.uk/drug/paracetamol.html#indicationsAndDosesThe correct answer is: 7.5 mL QDS PRN

Question 729

One of your diabetic patients has recently passed his driving test. He tells you that he will be visiting his parents this weekend. You advise him that diabetic patients taking insulin to help manage their diabetes are required to notify the Driver and Vehicle Licensing Agency (DVLA).Use the information about diabetes provided in the resource pack.Which of the following statements regarding diabetics receiving insulin and driving is INCORRECT?Select one:A. Diabetics receiving insulin, driving on long journeys should test their blood glucose every four hoursB. Drivers should monitor their blood glucose more frequently when their meal routine has been alteredC. Drivers treated with insulin should ensure that a supply of sugar is always available in the vehicleD. If hypoglycaemia occurs, stop the vehicle in a safe place, wait until 45 minutes after blood glucose has returned to normal before continuing journeyE. If hypoglycaemia occurs, then drivers must stop the vehicle in a safe place and switch off the engine and move from the driver’s seat

Answer 729

They should test their blood glucose every 2 hours.Ref: BNF section on driving/diabetesDetailed guidance is available: https://www.gov.uk/guidance/diabetes-mellitus-assessing-fitness-todrive#impaired-awareness-of-hypoglycaemia--hypoglycaemia-unawarenessThe correct answer is: Diabetics receiving insulin, driving on long journeys should test their blood glucose every four hours

Question 730

A patient is taking hyoscine butylbromide 10 mg, three times a day to treat abdominal cramps. She returns to your pharmacy complaining of side effects due to the medicine.Which of the following is NOT a side effect of hyoscine butylbromide?

Answer 730

Hyoscine butylbromide causes constipation. Constipation; dizziness; drowsiness; dry mouth; dyspepsia; flushing; headache; nausea; palpitations; skin reactions; tachycardia; urinary disorders; vision disorders; vomitingNOT DIARRHOEA

Question 731

A 50-year-old woman has just returned from seeing the optician. The optician recommended that she use hypromellose for her dry eyes. She is also taking prescribed latanoprost eye drops. She asks you if she can use them together.What is the most appropriate response?

Answer 731

She should leave 5 minutes in between. No issues with using both togetherRef: BNF Eye drops and eye ointments (two different preparations used) https://bnf.nice.org.uk/treatmentsummary/eye.htmlThe correct answer is: She should leave 5 minutes between using each product

Question 732

A 32-year-old mother would like to know what symptoms could be associated with meningitis, as she has just had a baby and would like to be aware.Which of the following statements is LEAST appropriate?Select one:A. Bulging hard spot towards the back of the headB. High temperature with a rash that doesn’t fade under a glassC. Irritable behaviourD. Refusing to eat and being more fussyE. Stiff body or neck

Answer 732

Bulging soft spot on the top of the head Ref: BNF for children and NICE CKS, https://cks.nice.org.uk/topics/meningitis-bacterial-meningitismeningococcal-disease/diagnosis/when-to-suspect/The correct answer is: Bulging hard spot towards the back of the head

Question 733

A 28-year-old man would like to purchase a treatment for ringworm on their scalp, which appeared a few days ago.Which of the following is the MOST appropriate advice to give?

Answer 733

Must refer to GP to treat scalp ringworm.Scaling and hair loss are common symptoms. Hydrocortisone cannot be sold in this situation, ringworm is contagious and transferable through objects and often treatment must continue sometime after the rash has disappearedRef: Fungal infections https://cks.nice.org.uk/topics/fungal-skin-infection-scalp/The correct answer is: Refer to the GP to treat the affected patches

Question 734

A mother comes in to buy a thermometer. Her 12-month-old baby has recently received some vaccinations. She asks how she should use the thermometer for the most accurate oral temperature reading.Which ONE of the following statements would be MOST appropriate?

Answer 734

Oral temperature is taken by inserting the bulb of the thermometer under the tongue and sealing the lips around the thermometerRef: How do I take a temperature? https://www.nhs.uk/common-health-questions/accidents-first-aid-andtreatments/how-do-i-take-someones-temperature/The correct answer is: Place the thermometer tip under the tongue

Question 735

A patient has arrived in your pharmacy for their first smoking cessation appointment. They ask you about the side effects that they might experience with nicotine patches.Which ONE of the following is NOT a side effect of nicotine?

Answer 735

Shouldn’t effect sleep, however if taking oral nicotine occasionally insomnia can occurRef: BNF, Nicotine https://bnf.nice.org.uk/drug/nicotine.html#sideEffectsPage 31 of 46The correct answer is: Increased sleepiness

Question 736

You sell a patient glyceryl trinitrate 400 micrograms spray over the counter for the treatment of acute angina pectoris.Which of the following is the CORRECT advice regarding use of glyceryl trinitrate 400 micrograms spray?

Answer 736

Administer and close mouth, repeat dose again after 5 minutes if no control of symptomsRef: Glyceryl trinitrate indications and dose, https://bnf.nice.org.uk/drug/glyceryltrinitrate.html#indicationsAndDosesThe correct answer is: Spray directly under the tongue and close mouth immediately after use

Question 737

A customer in the pharmacy, who was recently seen eating a chocolate bar, has suddenly started having a reaction.Which ONE of the following is NOT a sign of anaphylaxis?Select one:A. BradycardiaB. Clammy skinC. CollapseD. Difficulty breathingE. Lightheaded feeling

Answer 737

Anaphylaxis is associated with a fast heartbeat. All the others are common signs of anaphylaxis.Ref: Symptoms of Anaphylaxis https://www.nhs.uk/conditions/anaphylaxis/The correct answer is: Bradycardia

Question 738

A customer visits your pharmacy and asked to buy some pseudoephedrine for his congestion.Which of the following statements about pseudoephedrine is CORRECT?

Answer 738

The correct answer is: Pseudoephedrine can only be sold from a pharmacy when the responsible pharmacist is present

Question 739

The Medicines and Healthcare products Regulatory Agency implemented measures in 2020, to support the safe use of stimulant laxatives when sold or supplied over the counter.Which ONE of following statements regarding these changes is INCORRECT?

Answer 739

The correct answer is: There is no limit on pack sizes that pharmacies can hold for supply under the supervision of a pharmacist

Question 740

A 54-year-old female patient presents in your pharmacy to purchase St John’s Wort. Upon asking her more questions, she tells you that she is also taking warfarin tablets.Which ONE of the following statements about St John’s Wort is the most appropriate advice to provide in this situation?

Answer 740

Taking St Johns wort might decrease the effectiveness of the Warfarin if taken together, as it acts as an enzyme inducer

Question 741

A 45-year-old woman presents to the pharmacy with symptoms of heartburn and reflux. When counselling this patient, you inform her of symptoms that would indicate that she should contact her doctor, should she experience them.Which of the following would be an example of one of these symptoms?

Answer 741

Unintentional weight loss can be a sign of something more serious, and requires referral to a GP.

Question 742

Pharmacists may engage in wholesale dealing without a Wholesale Dealer’s License (WDL). When conducting such supplies, pharmacies must comply with several requirements.Which ONE of the following statements about wholesale dealing of medicines from pharmacies is CORRECT?Select one:A. Pharmacies with a WDL do not need any additional licences for commercially trading controlled drugsB. The requirements for wholesale dealing without a WDL still apply if there is exchange of stock between two pharmacies that are part of the same legal entityC. There is an exemption in UK law for pharmacies to hold a WDLD. When supplying a medicine without a WDL, any amount of profit can be made on the supplyE. When supplying

Answer 742

MEP p77-79 wholesale dealingThe correct answer is: When supplying a medicine without a WDL, the supply must not be for onward wholesale distribution

Question 743

You are observing your patient use their Symbicort Turbohaler® (budesonide/formoterol) device and providing feedback on their inhaler. After you watch them prepare the device, they show you how they inhale their dose.Which of the following best describes the correct technique for inhaler use?

Answer 743

The correct answer is: Form a tight seal around the mouthpiece with their lips, then breathe in quickly and deeply

Question 744

A 25-year-old male is admitted to hospital feeling unwell with extensive cellulitis caused by methicillinresistant Staphylococcus areus and is subsequently started on intravenous vancomycin 1.5 g every 12 hours. He weighs 78 kg, his height is 185 cm, and his eGFR is >90 m/min/1.73m2.Which of the following is the most appropriate advice in relation to managing vancomycin?

Answer 744

See the BNF: All patients require serum-vancomycin measurement (on the second day of treatment, immediately before the next dose if renal function normal, earlier if renal impairment—consult product literature). The next vancomycin dose should not be withheld whilst awaiting results unless toxicity is suspected. Administration rate should not exceed 10mg/min to reduce the risk of red-man’s syndrome.The correct answer is: A vancomycin trough plasma concentration level should be taken before the 4th dose

Question 745

A 31-year-old male patient who presents at the pharmacy to collect his prescription for propranolol to help with his anxiety symptoms

Answer 745

Fatigue is a lesser known side effect of beta blockers but important to mention in counselling. Causes bradycardia rather than tachycardia.The correct answer is: Fatigue

Question 746

A 32-year-old male patient who has been prescribed clindamycin to treat a staphylococcal bone and joint infection

Answer 746

Abdominal Pain. Specific side effects Common or Very Common Abdominal pain, Antibiotic associated colitis, diarrhoea.https://bnf.nice.org.uk/drug/clindamycin.htmlThe correct answer is: Abdominal pain

Question 747

A 32-year-old male patient who is travelling to India and has been prescribed doxycycline as malaria prophylaxis.

Answer 747

Photosensitivity

Question 748

A 66-year-old female patient has been prescribed glyceryl trinitrate sublingual spray for the prophylaxis and treatment of angina. You counsel her on the most common side effects associated with nitrates.

Answer 748

Tahycardia - Side effects of GTN include postural hypotension, tachycardia (but paradoxical bradycardia also reported); throbbing headache, dizziness; less commonly nausea, vomiting, heartburn, flushing, syncope, temporary hypoxaemia.The correct answer is: Tachycardia

Question 749

An 81-year-old woman has been prescribed Trimethoprim 100mg once a day at night for the prophylaxis of recurrent urinary tract infections.

Answer 749

Trimethoprim may cause fungal overgrowth – classed as a common adverse reaction.REF: BNF https://bnf.nice.org.uk/drug/trimethoprim.html#sideEffectsThe correct answer is: Fungal overgrowth

Question 750

A 45-year-old male patient has schizophrenia and has been prescribed olanzapine to prevent the recurrence of his bipolar disorder. He has no other significant past medical history. Identify the parameters that must be reviewed and recorded before commencing treatment.

Answer 750

Fasting blood glucose – patients taking antipsychotics, particularly olanzapine are susceptible to hyperglycaemia and diabetes therefore fasting BG must be tested at baseline and at regular intervals thereafter.The correct answer is: Fasting blood glucose

Question 751

A 23-year-old female patient has been taking an oral contraceptive pill (containing ethinylestradiol and levonorgestrel) for the past 4 years. She is not taking any other medicines and has no significant past medical history. She is due a review with the prescriber. Identify the parameter which should be measured before prescribing a repeat prescription

Answer 751

Blood pressure should be measured as hypertension is a known risk factor that increases the risk of arterial disease associated with oral contraceptives.The correct answer is: Blood pressure

Question 752

A 60-year-old female patient comes into the pharmacy for an NHS health check. Following the assessment, you discover that she has 10-year cardiovascular risk of 25.5 %. You refer her to the GP who prescribes simvastatin 20 mg to be taken at night. Identify the parameter that should be measured before commencing treatment with simvastatin.

Answer 752

(Transaminases (ALT/AST) should be checked 3 and 12 months after commencing treatment by requesting LFTS. Statins should be used with caution in patients with a history of liver disease as they are metabolized by the liver, so hepatic impairment will increase their levels and thus the risk of myopathy. Simvaststin is contraindicated in active liver disease or if transaminases ALT & AST are raised more than 3 times the normal range.The correct answer is: Serum alanine transaminase (ALT)

Question 753

A 67-year-old male patient has been diagnosed with persistent stage 2 hypertension despite attempting to change their lifestyle. A decision is made with the patient to start antihypertensive drug treatment. He is started on ramipril 1.25 mg once daily. Identify the parameter that should be monitored at regular intervals.

Answer 753

Use clinic blood pressure measurements to monitor the response to lifestyle changes or drug treatment in people with hypertension. NICE NG136: Hypertension in adults: diagnosis and management.The correct answer is: Blood pressure

Question 754

A 55-year-old male patient suffers from generalised seizures. He has been prescribed sodium valproate and also uses a salbutamol inhaler once or twice a year. Identify the parameter that should be measured before commencing treatment.

Answer 754

Serum ALT – Sodium Valproate is associated with hepatotoxicity therefore liver function should be measured at baseline and at regular intervals throughout therapy.The correct answer is: Serum alanine transaminase (ALT)

Question 755

A 50-year-old man takes folic acid 5 mg once weekly, methotrexate 10 mg once weekly. He has been newly prescribed amoxicillin 500 mg three times a day for seven days.

Answer 755

Amoxicillin is predicted to increase the risk of toxicity when given with methotrexate. Manufacturer advises monitor.Ref: https://bnf.nice.org.uk/interaction/methotrexate-2.htmlThe correct answer is: Toxicity of either or both drugs

Question 756

A 63-year-old man takes lisinopril 10 mg daily, amlodipine 10 mg daily. He has been newly prescribed simvastatin 40 mg at night.

Answer 756

Amlodipine slightly increases the exposure to simvastatin. Manufacturer advises adjust simvastatin dose to a max. 20 mg daily with concurrent use of amlodipineRef: https://bnf.nice.org.uk/drug/simvastatin.htmlThe correct answer is: Toxicity of either or both drugs

Question 757

A 45-year-old woman takes methadone 1 mg/mL oral solution 65 mg daily for opioid addiction. She has been prescribed domperidone 10 mg, three times a day by her GP.

Answer 757

Domperidone increases the risk of QT-prolongation when given with methadone. Manufacturer advises avoid.https://bnf.nice.org.uk/interaction/methadone.htmlThe correct answer is: QT interval prolongation

Question 758

Which analgesic would be most suitable for the effective treatment of neuropathic pain in an 82-year-old man with diabetes?

Answer 758

REF: BNF, https://bnf.nice.org.uk/drug/gabapentin.htmlThe correct answer is: Gabapentin 300 mg capsules

Question 759

Which analgesic can be sold to a 24-year-old for the treatment of primary dysmenorrhea?

Answer 759

The correct answer is: Naproxen 250 mg tablets

Question 760

Which analgesic is contraindicated for a 42-year-old with uncontrolled epilepsy?

Answer 760

The correct answer is: Tramadol 50 mg capsules

Question 761

A 5-years-old boy, presents with exanthema behind the ears which spread to the face and later to the trunks and extremities and after three days, it begins to fade.

Answer 761

Rubella rash tends to start behind ears and on face before spreading to the rest of the body.REF: https://cks.nice.org.uk/topics/rubella/The correct answer is: Rubella

Question 762

A 18-month-old girl, presents with general malaise, loss of appetite. She has small erythematous macules on her stomach and arms, and a few some pustules.

Answer 762

Chickenpox is associated with red spots that typically look like blisters. The spots can appear on any part of the body.REF: https://cks.nice.org.uk/topics/chickenpox/The correct answer is: Chickenpox

Question 763

A 6-month-old boy, presents with sudden onset of a seal-like barking cough with stridor and sternal recession at rest.

Answer 763

Croup is characterised by the sudden onset of a seal-like barking cough, often accompanied by stridor, voice hoarseness, and respiratory distress.REF: https://cks.nice.org.uk/topics/croup/The correct answer is: Croup

Question 764

A 4–year-old girl, presents with sore throat, low-grade fever and tender lesions in the mouth and papulovesicular lesions of the distal limbs

Answer 764

Hand, foot, and mouth disease is an acute viral illness characterized by vesicular eruptions in the mouth and papulovesicular lesions of the distal limbs. It is not to be confused with foot and mouth disease of animals, which is caused by a different virus. REF: https://cks.nice.org.uk/topics/hand-foot-mouth-disease/The correct answer is: Hand foot and mouth disease

Question 765

A 2-week-old baby, presents with excessive crying, inconsolable crying which occurs in late afternoon or evening and draws its knees up to abdomen when crying

Answer 765

Classic signs of colic which starts in the first weeks of life and resolves by around 3–4 months of age.REF: https://cks.nice.org.uk/topics/colic-infantile/The correct answer is: Colic

Question 766

A 68-year-old man, who is taking citalopram for depression, presents with drowsiness, confusion, and convulsions.

Answer 766

Hyponatraemia

Question 767

A 46-year-old woman, who has recently been prescribed spironolactone 100 mg once daily for oedema in congestive heart failure

Answer 767

Hyperkalaemia

Question 768

A 25-year-old man is discharged from hospital with lamotrigine 25 mg tablets which he is taking for epilepsy.

Answer 768

The correct answer is: Warning. Do not stop taking this medicine unless your doctor tells you to stop

Question 769

a 14-year-old boy is discharged from hospital with Penicillin V tablets which he must take for 5 days in order to treat acute sinusitis.

Answer 769

The correct answer is: Take this medicine when your stomach is empty. This means an hour before food or 2 hours after food

Question 770

A 48-year-old male is discharged from hospital with mirtazapine 15 mg tablets for major depression.

Answer 770

Warning: This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol

Question 771

A 26-year-old is written a prescription by his GP sulfasalazine 500 mg tablets for maintenance of remission of mild ulcerative colitis.

Answer 771

The correct answer is: This medicine may colour your urine. This is harmless.

Question 772

A 56-year-old woman taking lithium carbonate 400 mg for prophylaxis for bipolar disorder.

Answer 772

The correct answer is: Warning: Read the additional information given to you with this medicine

Question 773

A 56-year-old woman taking lithium carbonate 400 mg for prophylaxis for bipolar disorder.

Answer 773

The correct answer is: Warning: Read the additional information given to you with this medicine

Question 774

A 77-year-old male patient presents at the emergency department complaining of an episode of haematuria. A medical history identifies that he been takes warfarin for atrial fibrillation. His INR is measured and reported as 7.2. A week earlier he started treatment with a course of oral antibiotics for the treatment of a lower respiratory infection. You suspect that the raised INR is due to a drug interaction.Select one:A. AmoxicillinB. BenzylpenicillinC. CiprofloxacinD. ClarithromycinE. ClindamycinF. Co-amoxiclavG. NitrofurantoinH. Trimethoprim

Answer 774

While amoxicillin, benzylpenicillin, clindamycin, ciprofloxacin, co-amoxiclav, tigecycline and trimethoprim all have the potential to interact with warfarin Clarithromycin is in the BNF as a potentially serious interaction. BNF Appendix 1 Interactions.The correct answer is: Clarithromycin

Question 775

A 61-year-old male patient has been prescribed a course of oral antibiotics for a moderate diabetic foot infection. During the counselling you discover that the patient has a history of tendon disorders. You advise the prescriber that this treatment is contraindicated.

Answer 775

Ciprofloxacin. quinolones are contra-indicated in patients with a history of tendon disorders related to quinolone use. https://bnf.nice.org.uk/drug/ciprofloxacin.html#importantSafetyInformationsThe correct answer is: Ciprofloxacin

Question 776

A female patient is due to commence a course of fludarabine phosphate at 40 mg/m2for five days. She is 1.68 m tall and weighs 71 kg.How many fludarabine phosphate 10 mg tablets that should be supplied for the five day course? Give your answer to the nearest whole tablet.DOSE*5 day course

Answer 776

Note: Remember to convert height in m to cm (1.68m => 168cm) for the formula.Using the formula = √([71 x 168] ÷ 3600) = √3.313333 = 1.820256 m2Dose is 40 mg x 1.820256 m2 = 72.81024 mgCalculate tablets for one day. You have 10 mg tablets = 70 mg = 7 tabletsSo for five days: 7 X 5 = 35 tabletsTOPIC: Using provided formulae

Question 777

70-year-old man been diagnosed with pneumonia is prescribed intravenous amoxicillin. He also suffers from chronic kidney disease and his serum creatinine is currently 182 micromol/L. He weighs 58 kg.The Cockcroft and Gault formula for estimating creatinine clearance is provided below:

Answer 777

Convert 1g STAT to 1000MG BOY!

Question 778

You want to find out the number needed to treat (NNT) for a valproate based migraine treatment. You find the following information from a meta-analysis paper.Valproate was used to treat migraine in five trials. It was found that the number of patients having at least a 50% reduction in the number of migraine attacks over 28 days. The review of the trials showed the following results:• Patients treated with valproate, 241/520 (46 %) patients had the number of migraine attacksreduced by at least half.• With placebo, 69/341 (20 %) had the same outcome.Use the extract about NNT provided in the resource packWhat is the NNT for valproate treatment? Give your answer to the nearest whole number.

Answer 778

sing the formula:AAR = 0.46 - 0.2= 0.26NNT = 1/0.26 => 100/26 = 3.64615.Rounded up (all NNT rounded up) to 4.

Question 779

NNT?

Answer 779

ROUND UP

Question 780

NNH?

Answer 780

ROUND DOWN

Question 781

A patient weighing 82 kg is administered a dose of 50 mg in 2 mL levomepromazine by intramuscular injection.It has been calculated that the volume of distribution of levomepromazine is 15 L/kg. It is also estimated to have a half-life of 20 hours and an effective bioavailability of 80% when given by intramuscular injection.Assuming the patient is not administered any further doses, what is the blood concentration in mcg/L after 60 hours? Give your answer to one decimal place.

Answer 781

80% bioavailability means 50 x 0.8 = 40 mg (40,000 mcg) availableVolume of distribution = 15 x 82 = 1230 LTherefore, the concentration will be 40000 mcg ÷ 1230 LWhich is 32.52 mcg/LThen calculate half-life:At hour 0, there will be 32.52 mcg/LAt hour 20, there will be 16.26 mcg/LAt hour 40, there will be 8.13 mcg/LAt hour 60, there will be 4.065 mcg/LTOPIC: Pharmacokinetics

Question 782

A solution of benzalkonium chloride is available in a concentration of 1:750 w/v.How many mL of purified water is required to be added to 30 mL of the solution to prepare a 1:5000 solution of benzalkonium chloride for use as a wet dressing for the skin?

Answer 782

1:750 = 1g in 750mL.Therefore there will be 40 mg in 30 mL of benzalkonium solution.Target solution is 1:5000. This is equivalent to 1 g in 5000 mL.We need to have 40 mg in our final solution. So the total volume needed is 200 mL40 mg/200 mL is equivalent to a 1:5000 solution.Started with a 30 mL volume. Need to add 170 mL of water.TOPIC: DilutionThe correct answer is: 170

Question 783

A 29-year-old lady has been taking ferrous fumarate 210 mg tablets, three tablets daily. Oral bioavailability is 70%. Due to an operation, she is now unable to swallow the tablets and has been changed to Sytron Elixir® (sodium feredetate trihydrate) twice daily, which as an oral bioavailability of 90%.Ferrous fumarate 210 mg tablets contain the equivalent of 70 mg elemental iron.Sytron Elixir® contains sodium feredetate trihydrate 190 mg equivalent to 27.5 mg elemental iron in each 5 mL.What is the equivalent single dose of Sytron Elixir® to be given? Give your answer to the nearest 5 mL.

Answer 783

Patient has 70 mg x 3 = 210 mg of elemental iron per day.Total bioavailable iron = 210 x 0.7 = 147 mgSytron bioavailability is 90%.Therefore 147 mg = 90% of total oral dose.100% = (147 ÷ 90) x 100 = 163.33333 mg iron needed per day of Sytron.Sytron has 27.5 mg elemental iron per 5 mL = 5.5 mg/mLTherefore 163.33333 ÷ 5.5 = 29.69697 mL per dayPatient will need 29.69697 ÷ 2 = 14.84848 mL of Sytron per doseRound to nearest 5 mL => 15 mLTOPIC: Dose and dose regimeThe correct answer is: 15

Question 784

H PYLORI TREATMENT CHOICE TAKE INTO ACCOUNT?

Answer 784

(treatment choice should take into account previous treatment with clarithromycin or metronidazole).

Question 785

A 29-year-old woman was started on fluoxetine two weeks ago for depression. At her follow up appointment with her GP, she reports that she has felt more anxious since starting the medication and that her mood has not improved. The GP has called you for advice on the management of this case.Which one of the following is the most appropriate course of action in relation to the patient’s fluoxetine therapy?

Answer 785

Treatment should be continued for at least 4 weeks (6 weeks in the elderly) before considering whether to switch antidepressant due to lack of efficacy. In cases of partial response, continue for a further 2–4 weeks (elderly patients may take longer to respond).Ref: https://bnf.nice.org.uk/treatment-summary/antidepressant-drugs.htmlThe correct answer is: Continue fluoxetine for another 2 weeks and reassess whether there has been any improvement

Question 786

Which ONE of the following record keeping requirements is NOT required for a supply of a POM-V and POM-VPS?

Answer 786

The expiry date of the product

Question 787

A 57-year-old female, of African-Caribbean family origin, has just been diagnosed with Stage 1 hypertension. She has type 2 diabetes, and a QRISK2 score of 13%. She has no known allergies and renal function tests are within the normal range.Which of the following drugs is the most appropriate first-line therapy according to national guidance?

Answer 787

NICE guidance NG136 recommends ACE or ARB as step 1 therapy for diabetics of any age or family origin. NICE also recommends an angiotensin II receptor blocker (ARB), in preference to an angiotensin-converting enzyme (ACE) inhibitor in adults of black African or African-Caribbean family origin.The correct answer is: Candesartan

Question 788

A regular patient from your community pharmacy has been discharged from hospital following a fall associated with hypoglycaemia. He is a 72-year-old man with Type 2 Diabetes who has recently had his medicines changed due to poor glycaemic control.When reviewing his prescription list, which of the following medicines would you be most concerned about in relation to the risk of hypoglycaemia?

Answer 788

Glibenclamide is a long-acting sulphonylurea and is more prone to causing hypoglycaemia, especially overnight, in the elderly. Gliclazide is a shorter acting sulphonylurea. Other classes of oral antidiabetic agents have a lower risk of hypoglycaemia compared with sulphonylureas.Ref: https://bnf.nice.org.uk/treatment-summary/type-2-diabetes.htmlThe correct answer is: Glibenclamide

Question 789

A 45-year-old male presents to the pharmacy complaining of redness and pain in his left eye, which started last night. He tells you that he has used over the counter antibiotic eye drops in the past for conjunctivitis when his eyes have been ‘uncomfortable and gritty, with sticky discharge’. He asks you about buying these eye drops again for his current symptoms.Which of the following is the most appropriate course of action for this patient?

Answer 789

It can cause a gritty, uncomfortable sensation but should not be painful. Patients should be referred to the GP if it is painful. Conjunctivitis is usually viral in nature, and bacterial conjunctivitis is frequently self-limiting.Ref: Symptoms in the pharmacy (ebook available on RPS e-library)The correct answer is: Refer him to the GP for further investigation

Question 790

An 84-year-old woman telephones the pharmacy and explains she had the Oxford/AstraZeneca COVID-19 vaccine yesterday. She has been suffering from a headache this morning and believes it’s a side effect. She would like you to report it to her GP.What is the most appropriate course of action in this scenario?

Answer 790

As this is a new medicine is it important to ensure all side effects, no matter how mild are reported using in accordance with usual reporting procedures. This includes known side effects. In this case, the vaccine is known to cause headaches - see SmPC for more information. The Yellow Card Scheme is a national scheme for reporting side effects with any medicine, which can be used by patients and healthcare professionals.REF: MHRA https://yellowcard.mhra.gov.uk/ and Information about Oxford/AztraZeneca COVID-19 Vaccine https://www.gov.uk/government/publications/regulatory-approval-of-covid-19-vaccine-astrazenecaThe correct answer is: Report the side effect using the Yellow Card Scheme

Question 791

Which of the following bronchodilators is licensed for twice daily dosing as chronic obstructive pulmonary disease (COPD) maintenance therapy?

Answer 791

A summary of licensed agents and dosing schedules for COPD can be found here: https://www.pcrsuk.org/sites/pcrs-uk.org/files/TableofInhaledDrugsFINAL.pdfThe correct answer is: Aclidinium / Formoterol (DuaKlir Genuair®)

Question 792

Standardised controlled drugs requisition forms are a legal requirement when requisitioning certain controlled drugs in the community.Which ONE of the following statements about standardised controlled drug requisition forms is INCORRECT?

Answer 792

REF: MEP p 93-94.The correct answer is: Supplies made against faxed requisitions are legally acceptable

Question 793

A 24-year-old-woman is considering starting the combined oral contraceptive pill (COC).Which of the following pieces of information or advice is most appropriate to give to this woman?

Answer 793

For women who are having natural menstrual cycles, the COC pill can be started up to and including day 5 of the menstrual cycleThere is a possible small increase in risk of developing breast cancer, which returns to no increased risk within 10 years after stopping the COC. The estimated failure rate for typical use of COCs is 9% at 1 year. Additional Page 6 of 46contraceptive precautions are not required when antibiotics that do not induce enzymes are used in conjunction with CHCs.REF: https://www.fsrh.org/documents/fsrh-ceu-guidance-recommended-actions-after-incorrect-use-of/fsrhguidance-recommended-actions-after-incorrect-use-of-chc-march-2020.pdfThe correct answer is: For women who are having natural menstrual cycles, the COC pill can be started up to and including day 5 of the menstrual cycle without the need for additional contraceptive protection

Question 794

How often should this patient have their blood counts monitored when clozapine is initiated?

Answer 794

For the first 18 weeks, blood counts should be monitored every week.REF: https://bnf.nice.org.uk/drug/clozapine.html#indicationsAndDosesThe correct answer is: Weekly

Question 795

The patient is stabilised on therapy and has remained on the same dose of clozapine for one year. Now that he is feeling an improvement in his symptoms, he decides to work on building healthy habits including regular exercise, and quitting smoking.Which of the following advice would be the most appropriate in relation to his clozapine?

Answer 795

Cigarette smoking induces metabolism of clozapine, resulting in significant increases in levels when quitting, hence dose adjustment and increased monitoring is required. This is not related to the nicotine component, hence the effect is not negated by NRT.REF: https://bnf.nice.org.uk/drug/clozapine.html#interactionsThe correct answer is: Refer to prescriber for a potential dose reduction and monitoring of plasma concentration levels

Question 796

A 21-year old woman presents to the pharmacy with a prescription for metronidazole 2 g orally as a single dose.Which of the following is the most likely indication for her metronidazole prescription?

Answer 796

The recommended metronidazole doses for the above conditions can be found in the BNF.The correct answer is: Bacterial vaginosis

Question 797

You are dispensing a new prescription for glyceryl trinitrate patch (Transiderm Nitro®), to be applied once a day, for a 65-year-old male for the management of his angina.Which of the of the following would be the most appropriate advice for this patient on how to apply the patch?

Answer 797

The patch should be applied to the lateral chest every 24 hours. It does not need to be removed for showering/bathing and should be used regularly to prevent angina rather than when required.

Question 798

Which of the following is the most likely explanation for these symptoms?

Answer 798

Hypokalaemia, which can be caused by potassium-depleting diuretics such as the loop diuretics, increases the toxicity of the digitalis glycosides.REF: Stockley’s drug interactionsThe correct answer is: Hypokalemia due to furosemide

Question 799

You are due to start work at 9am as the Responsible Pharmacist in a community pharmacy. There are delays on the train, so you arrive 30 minutes late. The dispensing technician would like to carry out some activities before you arrive.Which of the following activities can the dispensing technician carry out when you are not present in the pharmacy

Answer 799

In a NHS pharmacy, there must be a pharmacist present whenever pharmaceutical services are being provided. Activities A-D can only take place when the responsible pharmacist is in charge of the pharmacy and need to take place under the supervision of a pharmacist and the supervising pharmacist will need to be physically present at the pharmacy. Further information also available in the RPS Responsible pharmacist toolkit,MEP pg 137-139 and at www.psnc.org.ukThe correct answer is: Ordering stock from a wholesaler

Question 800

A 50-year-old man with chronic kidney disease requiring haemodialysis has been discharged from hospital postfracture repair.Which one of the following analgesics would be the most suitable choice for the short-term management of his acute post-operative pain on discharge?

Answer 800

Morphine is metabolised to morphine-6-glucuronide which accumulates in renal impairment, resulting in CNS depression. Similarly, the clearance of codeine, and its metabolites are significantly reduced in renal impairment. The pharmacokinetics of oxycodone is also affected in renal failure, however it may be preferred to morphine in some circumstances. The BNF recommends to avoid codeine in renal failure and to use morphine and oxycodone with caution. The BNF also recommends to avoid ibuprofen (systemic NSAID) in severe renal impairment. Fentanyl patches and slow release tablets are not appropriate for acute pain due to their slow onset of action and long duration of action.REF: https://www.sps.nhs.uk/wp-content/uploads/2018/12/SW_QA_402-4_Nov17_Final.docThe correct answer is: Oxycodone immediate release tablets

Question 801

She is complaining of nausea and loose stools since starting on methotrexate.Which of the following is the most appropriate strategy to prevent the side effects that the patient is experiencing?

Answer 801

Folic acid is indicated for the prevention of side effects from methotrexate however it needs to be taken on a different day to the methotrexate, otherwise it will reduce the effectiveness of the methotrexate. The use of folinic acid is reserved for use as a part of treatment protocols for methotrexate infusions.The correct answer is: Folic acid 5 mg once a week, taken on a different day to methotrexate

Question 802

A 26-year-old female has been diagnosed with microcytic anaemia.Which one of the following nutritional deficiencies is most likely to be contributing to this diagnosis?

Answer 802

Microcytic Anaemia (low MCV) most commonly due to iron deficiency.

Question 803

megaloblastic anaemia?

Answer 803

folic acid OR b12 deficiency

Question 804

Summary Care Records (SCR) are an electronic record of important patient information. They can be seen and used by authorised staff in other areas of the health and care system involved in the patient's direct care.Which ONE of the following statements about the SCR is CORRECT?

Answer 804

Pharmacists currently do not have write access to SCR although this may change soon. There is a consent form however verbal consent is also accepted. The use of SCR in the pharmacy setting is linked to quality payment scheme in community pharmacies and is available to technicians. Must seek consent unless in emergency e.g. unconscious patient.See RPS guidance on SCR: http://www.rpharms.com/unsecure- support-resources/summary-care-records.aspThe correct answer is: To access the SCR consent needs to be gained for each patient, at each pharmacy, on a need-by-need basis

Question 805

An 18 year old man has been prescribed metronidazole 400 mg three for seven days by his dentist for a tooth infection. He wants to know if he can drink alcohol whilst taking the medicine.Which ONE of the following counselling points is the LEAST appropriate advice to give?

Answer 805

Patients should to avoid alcohol drugs while taking metronidazole and for at least 48 hours after stopping the drug. Monitor for flushing, nausea, and vomiting if the combination is used.REF: https://www.medicines.org.uk/emc/medicine/21216#CLINICAL_PRECAUTIONSThe correct answer is: Tell him to limit alcohol consumption

Question 806

A 23-year-old woman presents to her GP complaining of heavy and irregular menstrual bleeding. She has a past medical history of antiphospholipid syndrome, for which she is treated with warfarin. After conducting investigations, the GP did not find any abnormal uterine pathology.Use the information provided about antiphospholipid syndrome in the resource pack.Which one of the following treatment options would be most appropriate?

Answer 806

Levonorgestrel-releasing intrauterine system.This will also provide contraception which may be important for this patient as she is on warfarin.Page 13 of 46NSAIDs would be contra-indicated as they increase the risk of bleeding when given with warfarin. Tranexamic acid and the combined oral contraceptive pill are also contra-indicated in antiphospholipid syndrome due to the additive increase in thrombosis risk.REF: BNF monographsThe correct answer is: Levonorgestrel-releasing intrauterine system

Question 807

You are conducting a consultation with your patient, a 40-year-old-man, and he mentions he has recently been diagnosed with diabetes. After gaining his consent you test his blood glucose levels, the result is 3.7 mmol/L.Which ONE of the following is the most appropriate next step?

Answer 807

The patient requires sugar immediately as they are experiencing hypoglycaemia (any reading less than 4 mmol/L). Diabetic chocolate would not contain enough sugar required to increase the sugar level quick enough Ref: BNF Treatment of hypoglycaemia https://bnf.nice.org.uk/treatment-summary/hypoglycaemia.htmlThe correct answer is: Ask him to immediately drink some of his fruit juice that he has got with him

Question 808

A 38-year-old man presents at the pharmacy with the following symptoms: moderate; nasal itching, congestion, sneezing and rhinorrhoea. The symptoms have lasted over a month. He has had a NEGATIVE COVID-19 test.Which ONE of the following would be the most suitable first line over the counter treatment, to alleviate the patient’s symptoms?

Answer 808

The patient is suffering from allergic rhinitis, therefore the most appropriate treatment is nasal irrigation with saline (local treatment is recommended as first line).Ref: BNF, Rhinitis, drugs used in nasal allergy https://bnf.nice.org.uk/treatment-summary/nose.htmlThe correct answer is: Nasal saline solution

Question 809

A regular patient comes into the pharmacy and asks for some medicine to treat a wart on their hand.Which ONE of the following statements about warts is CORRECT?

Answer 809

The other options are incorrect - Topical salicylic acid (15–50%) should be applied once or twice daily for up to 12 weeksPage 14 of 46Warts are caused by infection in the outer layer of the skin (epidermis) with a virus called the ‘human papilloma virus’. refer to GP for facial warts. Without any treatment, warts may spontaneously resolve but may take many months or even yearsref: BNF, Warts and Calluses https://bnf.nice.org.uk/treatment-summary/warts-and-calluses.htmlThe correct answer is: Cryotherapy with liquid nitrogen can be carried out to freeze a wart

Question 810

Pharmacies can legally make a supply of adrenaline auto-injectors to schools under certain conditions.Which ONE of the following statements about the supply of adrenaline auto-injectors to schools is CORRECT?

Answer 810

Legal and professional requirements for prescriptions, to enable the safe and legal supply of medicines; see MEP p62The correct answer is: A written signed order signed by principal/headteacher at the school must be provided

Question 811

A 24-year-old lady comes into the pharmacy seeking advice for an itchy, inflamed and painful external right ear. She has just returned from a regular swimming lesson and has had similar problems before.Which one of the following is NOT a referral point for her condition?

Answer 811

Temporary hearing loss is a common symptom of Otitis Externa and therefore is not a referral point.Ref: NICE CKS, Otitis externa diagnosis https://cks.nice.org.uk/topics/otitis-externa/diagnosis/diagnosis/The correct answer is: Some degree of temporary hearing loss

Question 812

A father would like you to recommend how much paracetamol is required for his 4-year-old child who has cold and flu like symptoms.Which ONE of the following doses is MOST appropriate regarding paracetamol?

Answer 812

240 mg every 4-6 hours, maximum 4 times per dayRef: https://bnfc.nice.org.uk/drug/paracetamol.htmlThe correct answer is: 240 mg every 6 hours

Question 813

Emergency supplies at the request of an EEA or Swiss patient can be made.

Question 814

ellaOne action

Answer 814

prevents ovulation

Question 815

Miss L is a 29-year-old bank assistant who is reported to have thyroid dysfunction. You review her current medications and you think this effect may be attributed to one of the drugs.Which one of the following drugs is most likely to have caused Miss L's thyroid dysfunction?

Answer 815

Amiodarone has been associated with causing thyroid dysfunction and may cause hyper- or hypothyroidism.

Question 816

A doctor contacts you asking you to suggest a drug to treat a patient who has contracted meningococcal disease.Which drug would be suitable to be given via intravenous infusion in this patient?

Answer 816

Benzylpenicillin sodium is indicated for use in meningococcal disease and is only available in an IV preparation.

Question 817

Mr R is a 48-year-old male of African family origin. He was previously diagnosed with stage one hypertension. After trying to reduce his blood pressure through changes in diet and physical activity levels, it is still raised. Today he has brought in a prescription for a medication to reduce his blood pressure. He has no other medical conditions.Which one of the following antihypertensives is Mr R most likely to have been prescribed to manage his hypertension?

Answer 817

For patients over 55 years, and patients of any age who are of African or Caribbean family origin and do not have diabetes step 1 in the drug management of hypertension is a calcium-channel blocker (CCB). Amlodipine is the only CCB listed in the answer options.

Question 818

A patient requires a 500 mL infusion bag containing dopamine 0.1% w/v.Using a 40 mL vial of dopamine 1.25% w/v, what volume of glucose 5% is required to make up the infusion bag?

Answer 818

1.25% solution means 1.25 g in 100 mL or 1250 mg of dopamine in 100 mL of dopamine solution; therefore 500 mg in the 40 mL vial. To make the 500 mg into a 0.1% w/v solution we must dilute it by x 1000. Thus, the vial contents will make 500 mL at this concentration, and so we need to add 460 mL to the 40 mL from the vial. Fortuitously, 500 mL fills the bag specified in the question exactly without leaving a surplus or needing augmentation.

Question 819

A 28-year-old woman comes into the pharmacy requesting a plaster to help heal the raised hardened skin on her foot that has formed a corn. Upon further questioning you find that the patient must be referred to her GP for further investigation.Which one of the following medical conditions is most likely to warrant this action?

Answer 819

Patients with diabetes are at an increased risk of developing diabetic foot complications, wherein attempting to treat a simple corn could lead to introduction of bacteria and an infection. Due to nerve damage and loss of sensation in the feet this may go undetected, leading to a spread of infection and in severe cases gangrene. Referral is required.

Question 820

Opiates are known drugs of abuse. You are running a training work shop to educate community pharmacists on the abuse potential of these drugs.Which of the following is NOT a symptom of opioid toxicity?

Answer 820

Incorrect answer ComaIncorrect answer Pinpoint pupilsYou chose the correct answer Pupil dilationIncorrect answer Respiratory depressionIncorrect answer UnconsciousnessYou were correct.The correct answer was Pupil dilationPupil narrowing or 'miosis' is an effect of opiate toxicity; pupil dilation is not.

Question 821

You have just finished using a stock bottle of methadone in the pharmacy. You are unable to pour anything out of the bottle, but you can see that there are still traces inside.In what way should you deal with the disposal of the remaining liquid inside the bottle?

Answer 821

Rinse the bottle with water and pour into a denaturing kitWaste medicines should not be disposed of in the sink. The rinsings should be added to a denaturing kit and disposed as pharmaceutical waste.

Question 822

You have a new member of staff starting on your pharmacy counter team. You are providing them with training on the sale of over-the-counter (OTC) medicines.Which of the following components of OTC medicines would you NOT require him to exercise additional cautions to sell due to the risk of misuse?

Answer 822

KaolinKaolin and morphine would need to have additional caution, but kaolin itself is not subject to abuse.

Question 823

You are teaching a trainee about medical terminology.Which of the following terms describes 'asbestos-like' scales on the scalp?

Answer 823

Pityriasis amiantaceaPityriasis amiantacea describes 'asbestos-like' scales on the scalp.

Question 824

You have a patient who is diabetic. Some medicines may need to be used with caution in patients with diabetesWhich ONE of the following is most likely to cause ketoacidosis?

Answer 824

Intravenous salbutamolBeta 2 agonists must be used with caution in patients with diabetes. Intravenous salbutamol can cause ketoacidosis.

Question 825

Miss C is joining your pharmacy team as a work experience student. You receive the morning order of medications and preparations and she is keen to help put them out on the pharmacy shelves.She asks you which one of the following substances is a prescription only medicine?

Answer 825

Mometasone furoate 0.1% cream

Question 826

A patient presents to the community pharmacy in which you are the Responsible Pharmacist. Upon discussing with the patient you ascertain that she is 28 weeks pregnant and suffers with severe hypertension.Which of the following medications is NOT appropriate to sell OTC to this patient?

Answer 826

Pseudoephedrine tabletsPseudoephedrine is contraindicated in patients suffering with severe hypertension.

Question 827

A mother brings her 3 year-old child to your pharmacy. They are suffering from the symptoms associated with otitis media, a common complaint in young children.Which of the following symptom groups best describe the signs and symptoms of otitis media in this age group?

Answer 827

Irritability, crying, fever and painPain is the most common symptom and so eliminates options A and B. Crying is also prominent and thus eliminates option C. D and E are both possible but fever is often seen; thus E is the correct option.

Question 828

You are trying to prevent prescribing errors in your pharmacy.Which of the following is NOT a recommended check point for avoiding prescribing errors?

Answer 828

Right quantityDouble checking when prescribing or administering any medicine is important to avoid any medication errors. You can double check it is the: right medicine, right patient, right dose, right route, right time.

Question 829

An 18-year-old girl enters your pharmacy and asks for your advice regarding a sore throat, tiredness and swollen glands in her neck. What do you suspect may be her condition and most likely cause?

Answer 829

Glandular fever caused by Epstein-Barr virus

Question 830

You are working in a community pharmacy on a Saturday. Your counter assistant makes you aware that there is a lady asking for an emergency supply of an EpiPen. On questioning the patient you establish that she is allergic to bees and has been stung. She does not have an EpiPen with her. She reports feeling breathless and having a tight chest.What is the most appropriate initial step in your course of action?

Answer 830

Ask the assistant to telephone 999, request an ambulance and state anaphylaxisThe patient is demonstrating signs of anaphylaxis. She will need emergency assistance so it is important to make this call asap. As you have other staff available to do this, it would be appropriate to get them to do this instantly while you then deal with the emergency. The MEP states that: "If a pharmacist administers adrenaline they must also ensure that an ambulance is called by​ dialling 999 and reporting that there is a case​ of suspected anaphylaxis." EpiPen training provides similar guidance. When managing anaphylaxis it is crucial that the ambulance gets to the patient as soon as possible. Therefore, the initial first step to get the assistant to phone 999 would be prudent while you are in the process of locating and administering the adrenaline pen in order to avoid undue delay in the patient getting the next step in their care.

Question 831

You are training a summer student on the use of medicines.Which of the following non-prescription topical preparations is an antiviral agent?

Answer 831

Zovirax® 5% cream

Question 832

You are providing training on side effects of medicines.Which of the following can be a side-effect of ciclosporin?

Answer 832

Hypomagnesaemia

Question 833

You are training your trainee pharmacist on food interactions with warfarin.Drinking which of the following is most likely to lead to a bleeding event in patients?

Answer 833

Cranberry juiceThere is a possible interaction between warfarin and cranberry juice, in most cases leading to an increase in INR or bleeding event.

Question 834

For each of the following statements, select the drug that fits most closely. Each option may be used once, more than once or not at all.This drug is commonly used in the treatment of seizure-related medical conditions.

Answer 834

Ethosuximide is indicated in the treatment of absence seizures, atypical absence seizures (adjunct) and myoclonic seizures.

Question 835

For each of the following statements, select the drug that fits most closely. Each option may be used once, more than once or not at all.This drug may be used in the treatment of cellulitis. It can be administered orally or intravenously for this condition.

Answer 835

ClindamycinClindamycin is indicated in soft tissue infections such as cellulitis. It may be administered orally or via the IM or IV routes.

Question 836

Indications for this drug include parkinsonism and tremors related to Parkinson's disease.

Answer 836

Co-beneldopa is a mixture of benserazide hydrochloride and levodopa. It is indicated for parkinsonism and tremors related to Parkinson's disease.

Question 837

This medication is cautioned for use in those who suffer with asthma. This drug is also a Schedule 5 controlled substance.

Answer 837

Pholcodine 5 mg/5 mL linctus

Question 838

A patient walks into the pharmacy in which you work. They wish to discuss symptoms with the pharmacist. Upon consulting with the patient it is apparent the patient has red, scaly and cracked feet. The patient asks if you can recommend some treatment to help resolve the symptoms.

Answer 838

Clotrimazole 1% creamThese symptoms suggest that the patient has athlete's foot (tinea pedis). Clotrimazole cream can be sold OTC for this indication.

Question 839

For each question in this section select one answer from the list of eight options above it. Each option may be used once, more than once, or not at all.This medication must not be sold to patients under the age of 16. It can cause Reye's syndrome and as such is contraindicated in those under the age of 16.

Answer 839

Aspirin 75 mg tabletsAspirin and aspirin containing products are contraindicated in under 16s as it may precipitate Reye's syndrome which may be fatal.

Question 840

This medication is most often prescribed by a doctor. If you are to sell this medication OTC to a patient, the indication must be confirmed first and the indication previously diagnosed by a qualified doctor.

Answer 840

Sumatriptan succinate 50 mg tablets

Question 841

This medication is a sympathomimetic which if used for more than seven days can cause rhinitis medicamentosa.

Answer 841

Xylometazoline 0.1% nasal spray

Question 842

A patient presents to you complaining of an array of symptoms including achy joints and describes flu like symptoms and pyrexia. What would you recommend the patient takes to help alleviate the symptoms?

Answer 842

Paracetamol 500 mg tabletsParacetamol has analgesic and anti-pyretic properties.

Question 843

A patient presents to the pharmacy you work at complaining of vulvo-vaginal itching and pain with no discharge. She has previously been treated for this via her GP but is on vacation and wishes to purchase something over the counter. What is the most suitable OTC medication to help alleviate the pain and itching?

Answer 843

Clotrimazole 1% cream is indicated for use in vaginal thrush. It is licensed for sale for this condition.

Question 844

Adult patients who weigh less than 50 kg should use this drug with caution or adjust the dose as they may be at increased risk of toxicity.

Answer 844

Some patients may be at increased risk of experiencing toxicity at therapeutic doses, particularly those with a body weight under 50 kg.

Question 845

This medication must be used with caution in patients who have a sensitivity to sulfonamides.

Answer 845

Sumatriptan succinate 50 mg tabletsSumatriptan should be used with caution in patients with sensitivity to sulfonamides.

Question 846

This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol.

Answer 846

Amitriptyline

Question 847

This medicine may colour the urine dark red.

Answer 847

Co-careldopaNote that triamterene can also colour the urine - it may look slightly blue in some lights.

Question 848

A patient presents in the pharmacy asking for your advice about red eyes. Both his eyes are affected and there is a purulent discharge, which made his eyelids stick together this morning. He describes his eyes as feeling 'gritty'. He does not have any eye pain and his vision is not affected.

Answer 848

Bacterial conjunctivitisSymptoms stated indicative of bacterial conjunctivitis - sticky discharge, both eyes affected, gritty feeling in the eye.

Question 849

A patient asks you to look at his left eye. You can see that a small segment of the white of his eye is bright red. He thinks it happened when he coughed. There is no pain and his vision is not affected.

Answer 849

Subconjunctival haemorrhageNon-painful blood shot eye that came on suddenly is an indication of subconjunctival haemorrhage.

Question 850

A lady comes into the pharmacy and asks you to look at her eye lids. Both eye lids appear to have skins flakes around the eyelashes. She says that both eyelids feel irritated and her eyes are quite watery.

Answer 850

BlepharitisSkin flakes around eye lashes accompanied by watery eyes is indicative of blepharitis.

Question 851

A lady visits your pharmacy. She is just recovering from flu and has noticed that both of her eyes appear red. She tells you that she has a watery discharge coming from each eye.

Answer 851

Viral conjunctivitisViral conjunctivitis usually associated with a cold or flu. Watery discharge reported.

Question 852

A man asks you to look at his right eye. His upper eyelid is swollen. He describes it as being painful and sensitive to touch.

Answer 852

StyeIndicative of a stye - painful swollen eye lid.

Question 853

A 15-year-old boy asks to speak to you about his eye. You notice that his left eyeappears red and is watering. The boy informs you that his eye has been like this sincewaking up this morning. His vision has not been affected but his eye is causing himsome pain and he is squinting due to the lights in the pharmacy.

Answer 853

Conjunctivitis is usually associated with a yellow sticky discharge and is described asfeeling ‘gritty’ rather than being painful. Red watery eyes can be signs of dry eye or hayfever; however, eye pain and photophobia are red flag symptoms and require referralto either an optician or a GP for assessment.

Question 854

Chloramphenicol use?

Answer 854

Bacterial conjunctivitis

Question 855

Hypromellose use?

Answer 855

Dry eyes

Question 856

Sodium cromoglicate use?

Answer 856

Seasonal/allergic conjunctivitis

Question 857

A 35-year-old woman has presented to accident and emergency with signs ofhaemolytic anaemia secondary to G6PD deficiency.Which one of her medications is most likely to have caused her symptoms?

Answer 857

G6PD deficiency is a genetic disorder that some individuals may have, it is commonin males and those originating from Asia, Africa, the Middle East and theMediterranean region. G6PD is an enzyme that supports the functioning of red bloodcells. Individuals with this deficiency are susceptible to haemolytic anaemia whenthey take a number of common drugs. From the options, nitrofurantoin is the onlymedication that is contra-indicated in G6PD deficiency.

Question 858

what is haemolytic anaemia?

Answer 858

RBCs destroyed rapidly!!

Question 859

A 28-year-old man presents in the pharmacy asking for information about the smokingcessation service.Which one of the following is most suitable to advise regarding smoking cessation?

Answer 859

The only correct and appropriate option is for a quit date to be agreed to keep thepatient motivated.Combination intervention is better than single intervention when considering smokingcessation options. It should be noted that bupropion is not first line treatment forsmoking cessation; various options should be explored included non-pharma logicalinterventions. E-cigarettes are not licensed for use in smoking cessation, andvarenicline is a POM therefore cannot be supplied to the patient over the counter.Drug treatments for smoking cessation should be made on an individual basis, andconsider:• The individual's previous experience of smoking cessation drugs.• Their preference for treatment.• Contraindications, cautions, possible interactions and risk of adverse effects of thetreatment

Question 860

The next two questions relate to a 63-year-old man, who comes into yourpharmacy to ask about a rash that has developed over the past 24 hours.You take him into the consultation room, and he shows you the rash on the left side ofhis abdomen. He says that he is recovering from a heavy cold and feels a bit run down.He has no spots anywhere else on his body. He describes the area as itchy, painfuland burning. You check his medication records and find that he currently takesamlodipine 5mg daily and indapamide M/R 1.5mg daily for hypertension.What is the most likely cause of the patient’s rash?

Answer 860

The symptoms suggest shingles rash caused by varicella zoster. There is usually aprodromal phase with abnormal skin sensations and pain in the affected dermatome(area of skin served by an individual nerve). Within 2–3 days, a rash typically appearsin a dermatomal distribution. It starts as maculopapular lesions then develops intoclusters of vesicles, with new vesicles continuing to form over 3–5 days. The rash isusually painful, itchy, and/or tingly, and, unlike other rashes, does not cross the midlineof the body.

Question 861

A 58-year-old woman is admitted to hospital following persistent chest pains. Afterroutine investigations, she is diagnosed with angina and prescribed glyceryl trinitrate400 microgram sublingual spray. You have been asked by the nurse to counsel thepatient on how to use the glyceryl trinitrate spray. Which of the following instructions are you most likely to advise the patient?

Answer 861

400–800 micrograms, to be administered under the tongue and then close mouth,dose may be repeated at 5-minute intervals if required; if symptoms have notresolved after 3 doses, medical attention should be sought.

Question 862

You receive a private prescription for a controlled drug and note that the prescriber isbased in Portugal.Which of the following controlled drugs can legally be supplied on this prescription?

Answer 862

The address of prescriber is required to be within the UK on prescriptions for controlleddrugs, but not for Schedule 4 (part 1 and 2) or Schedule 5 controlled drugs. Codeine isSchedule 5 controlled drug, all other options are Schedule 2 controlled drugs.

Question 863

A 58-year-old woman is currently taking digoxin 125micrograms daily for the past twomonths. She has no known drug allergies. She has also been taking furosemide 40mgtablets twice a day for the past two weeks. The patient tells you that she has not beenfeeling very well and has been experiencing nausea, diarrhoea, palpitations and feelingfaint.

Answer 863

Advise the patient to stop taking digoxin and refer for medical review urgently. The BNFmonograph recommends that if toxicity occurs, digoxin should be withdrawn as seriousmanifestations can occur requiring urgent specialist management. A digoxin plasmaconcentration within the therapeutic range does not exclude digoxin toxicity.

Question 864

A patient visits the pharmacy and asks to purchase some chloramphenicol eye dropsf or bacterial conjunctivitis.How would you advise the patient to store the eye drops for the course they are on?

Answer 864

medicine needs to be stored uprightbetween 2-8oC in a refrigerator and protected from light and must be used within fourweeks of opening.

Question 865

Responsible Pharmacist (RP) regulations mean that the owner of a retail pharmacybusiness must appoint an RP to be in charge of the registered pharmacy.You are discussing the regulations with your pre-registration trainee pharmacist to helpthem with their revision.Which one of the following statements is the most accurate in relation to the RPregulations?

Answer 865

RP, pharmacy, one at a time!!Pharmacy record needs to be kept for 5 years. The RP can be absent for maximum of2 hours. The sale of GSL medicines do need an RP to be in charge. The RP needs todisplay a notice whilst RP.

Question 866

Parkinson's patient, N&V?

Answer 866

Dompe!!!Metoclopramide, haloperidol and prochlorperazine should not be used in Parkinson’sdisease as they cross the blood brain barrier and cause dopamine blockade, resultingin worsening of symptoms. Ondansetron is contraindicated with apomorphine due toadditive QTc prolongation and risk of serious arrhythmia. The manufacturers of apomorphine recommend the use of domperidone to control nausea and vomiting,however there is still a risk of QT prolongation with this combination, hence anassessment of cardiac risk factors and ECG monitoring is recommended to ensure thatthe benefits outweigh the risks.

Question 867

FOLATE DEFICIENCY TREATMENT?

Answer 867

folic acid 5 mg daily for 4 months. Folic acid 400micrograms is usually recommended to women of child-bearing age, to be taken beforeconception and until week 12 of pregnancy, for the prevention of neural tube defects.

Question 868

A 65-year-old man has been admitted into hospital after a referral from his GP. He issuffering from symptoms that have been getting gradually worse. These include but arenot limited to: swollen ankles, which are worse in the evening; breathlessness, which isworse after walking for 30 minutes; fatigue, which has not improved with multivitamins.BEST TEST?

Answer 868

This patients’ symptoms indicate they have developed heart failure. A pro B-typenatriuretic peptide will measure cardiac function and will be raised in heart failure.HbA1c is a diagnostic for diabetes. Thyroid function test will indicate hyper orhypothyroidism. A CT pulmonary angiogram will help diagnose a pulmonary embolism(PE). Patient does not have any chest pain which may indicate a PE. B12 levels willhelp identify deficiencies – patient does not have any symptoms which may indicateB12 deficiency.

Question 869

Med, hypokalaemia/hyponatraemia?

Answer 869

Bendroflumethiazide is a thiazide diuretic that causes hypokalaemia by increasingpotassium excretion by the kidney.

Question 870

Sepsis investigation test?

Answer 870

C-reactive protein is marker for inflammation which is often associated with sepsis.Full blood counts will usually be undertaken, which will include haemoglobin, however,haemoglobin levels are not usually measured in isolation without other blood markers.Anaemia is often present during sepsis which affected haemoglobin levels.A chest x-ray and urine dipstick may help diagnose specific infections, for example,pneumonia or a urinary tract infection, respectively. Sepsis can lead to liver injury,which will require liver function tests.

Question 871

A 32-year-old-man has recently changed his diet to incorporate more fibre. His stoolsare not as loose, but he has been experiencing more wind, which he findsembarrassing. He therefore asks you to recommend a product to combat the increasedwind.Best treatment?

Answer 871

Simeticone is an anti-foaming agent and is most appropriate for these symptoms. Theother listed options are usually used for other symptoms and conditions.

Question 872

A 26-year-old man asks for your advice regarding a rash on his knee. The rashappeared two weeks ago and is itchy, burns and sore. He has no other medicalconditions but has recently been feeling quite stressed due to work prioritiesCondition?

Answer 872

Psoriasis often occurs on extensor surfaces (elbows and knees), trunk, flexures, sacraland natal cleft, scalp and behind the ears, and umbilicus. This is an image of plaquepsoriasis, which generally presents as large plaques. There is usually a cleardelineation between normal and affected skin. May be pink or red, but in people withpigmented skin this may not be obvious. Scale is typically silvery in colour.Psoriasis may be caused by infection, drugs (including corticosteroid withdrawal),ultraviolet light exposure, trauma, hormonal changes, stress, smoking, and alcohol.

Question 873

LEGAL REQUIREMENTSDISPENSING LABELS?

Answer 873

It is a legal requirement for the following to appear on dispensed medicinal products:• Name of the patient• Name and address of the supplying pharmacy• Date of dispensing• Name of the medicine• Directions for use• Precautions relating to the use of the medicine.The Royal Pharmaceutical Society also recommends the following also appears on thedispensing label:• ‘Keep out of the reach and sight of children’• ‘Use this medicine only on your skin’ where applicable

Question 874

ANTI-EPILEPSY DRUGSWITHDRAWING?

Answer 874

specialist supervision. Avoid abrupt withdrawal, particularly of barbiturates and benzodiazepines, because this can precipitate severe rebound seizures. Reduction in dosage should be gradual and, in the case of barbiturates, withdrawal of the drug may take months.The decision to withdraw antiepileptic drugs from a seizure-free patient, and its timing, is often difficult and depends on individual circumstances. Even in patients who have been seizure-free for several years, there is a significant risk of seizure recurrence on drug withdrawal. In patients receiving several antiepileptic drugs, ONLY ONE DRUG SHOULD BE WITHDRAWN AT A TIME2 YEARS, NUTS

Question 875

Private CD,What details of the supply NEED need to be recorded in the prescription onlymedicines (POM) register?

Answer 875

Date of supply, prescription date, medicine details (name, quantity, formulation andstrength), prescribed details and patient details should all be recorded in the POMregister. YOU DO NOT NEED TEMAZEPAM BRAND!!!

Question 876

A 52-year-old man has recently started a new job role that requires extensive use ofthe computer, which has resulted in his eyes feeling dry, irritated and sometimeswatery. He reports that he also suffers from occasional hay fever, which mainly causesa runny nose.

Answer 876

Dry eyes with a known cause such as excessive use of computer screens does notnecessarily warrant a referral to another healthcare professional, thus option B isincorrect.Xailin eye ointment is not the best choice as ointment use can cause temporary blurredvision following administration and is generally recommended at night. Thus, this maynot be ideal for the patient who is likely to be working during the day.Loratadine and avoiding the outdoors would support hay fever symptoms, howeverthese are not the patient’s principal problem and reason for visiting the pharmacy. Thequestion also outlines that he only has a runny nose from hayfever.Note that his eyes sometimes feel watery which can be a symptom of hayfever,however dry eyes can over stimulate the lacrimal eye glands and cause watery eyes

Question 877

You have been asked to conduct an audit about the prescribing and administration ofantibiotics on your hospital ward so that you can identify areas for improvement. Youhave set yourself an aim of identifying whether local prescribing protocols are beingmet.Which of the follow processes is most appropriate to complete as part of an auditcycle?

Answer 877

Data collection is a key step in an audit cycle. Collecting and analysing data on theadministration of medicines will provide evidence of whether standards are being metand enable you to achieve your aim.Ethics approval is not usually required for audits, however if your evaluation includespatients, you may require approval. If in doubt check with the National Institute forHealth and Care Research (NIHR) Also looking for errors is not usually part ofaudit/improvement process.It is good practice to re-audit after a certain period, however doing this after one monthwould be too soon and is unlikely to provide new or useful results. It is unusual toupdate guidelines and protocols before an audit takes place. This may be arecommendation you action after the audit.

Question 878

A 28-year-old woman suffering from abdominal pain and dyspepsia has beendiagnosed with a gastric ulcer.Which one of the following medicines is contraindicated in women of childbearing ageunless effective contraception is used?

Answer 878

MISOPROSTOL CMONNNNNNMisoprostol should not be used in women of childbearing potential unless pregnancyhas been excluded. It can be used to terminate pregnancies.

Question 879

METFORMIN PCOS?

Answer 879

UNLICENSED

Question 880

A 56-year-old man presents himself at the pharmacy you are working in. He would likesome painkillers after hurting his ankle playing football. He is weight bearing althoughlimping slightly. He has tried nothing so far for the pain in his ankle. You ask the patientif he is on any regular medication, he tells you he takes:• Multivitamins• Omeprazole 20mg once daily• Folic acid 5mg daily (four-month course)• Symbicort turbohaler two puffs twice a day and when requiredbest action?

Answer 880

This patient does not need referring to the GP or the walk in centre as he is able toweight bear, which indicates that an over the counter medicine will be able to help himmanage his symptoms.The patient is using a symbicort inhaler, on a SMART/MART regime which indicates hehas respiratory disease such as asthma or COPD, therefore an NSAID such asibuprofen or diclofenac would not be the most appropriate. Also, he is takingomeprazole which indicates that NSAIDs, in particular, ibuprofen, would not besuitable.

Question 881

A 40-year-old woman visits your community pharmacy and asks to purchase travelsickness tablets, as she is going on a long-haul flight next week. The counterassistant tells you that she has hypertension, type 2 diabetes and occasional backpain, which are all adequately managed by her regular medication.Which of the following options are you most likely to take next?

Answer 881

The patient’s medical conditions do not interfere or relate to travel sickness and thuscan be supported without referral. Hyoscine HYDRObromide is used for travel sicknessand available to purchase without a prescription and is the most appropriate option.Cinnarizine 15 mg tablets are also suitable and indicated for travel sickness, howeverthis pack size is not reality available as a P medicine (usually sold as Stugeron 15, packsize 15), and selling a pack of 100 is excessive. You may have also chosen to sellhyoscine butylbromide 10 mg tablets, however hyoscine butylbromide is licensed totreat abdominal cramps/spasms and IBS like symptoms. Encouraging fluidconsumption is unlikely to prevent travel sickness, thus is not a suitable cause of actionfor the patient.

Question 882

A 28-year-old woman has recently undergone surgery to insert a metallic heart valve.She needs to be prescribed an anticoagulant to manage the risk of thrombosis on thevalve and possible embolism.Which of the following medicines is the most appropriate option for this patient?

Answer 882

Warfarin is commonly prescribed as prophylaxis in patients with prosthetic valvereplacements and is the only medicine from the list of options indicated for this use.It should be taken initially at a dose of 5–10 mg on day 1, and subsequent dosesshould be adjusted dependent the patient’s INR reading. The recommended target INRdepends on the type and location of the valve, and patient-related risk factors.

Question 883

A 33-year-old woman visits your pharmacy and asks to speak to you privately about asensitive issue. She explains that she is experiencing a sharp pain when going to thetoilet.She is finding it difficult to pass stools and on occasions has noticed blood in the toilet.She has been experiencing these symptoms for two weeks. She is otherwise well anddoes not take any other medication.MOST LIKELY?

Answer 883

The symptoms are suggestive of an anal fissure. Typical symptoms are anal painwhich always occurs with passing a stool; the pain is severe and sharp, sometimesdescribed as a tearing sensation, and often followed by deep burning pain that canpersists for some hours. Bleeding may also occur with defecation, which is usuallyseen as a small quantity of bright red blood on the stool or toilet paper.

Question 884

A woman brings a bag of unused medication to your community pharmacy for disposaland informs you that her husband has recently died. You notice fentanyl 25microgrampatches amongst the medication.Which one of the following actions regarding the destruction of patient-returnedcontrolled drugs would you take?

Answer 884

pharmacist can destroy+tech witnessAn Accountable Officer is only required to witness the destruction of out-of-datecontrolled drugs. Patient-returned controlled drugs should be stored in the controlleddrug cabinet whilst awaiting destruction, clearly segregated from other stock. Thepatient-returned controlled drugs received and destroyed should be recorded in aseparate register kept for this purpose.

Question 885

A 34-year-old woman visits the pharmacy and asks for advice regarding a cold sorethat appeared two days ago. She experienced similar symptoms about 3 months agobut did not use anything. She would like to purchase a medicine that may help speedup the recovery for her current symptoms.Which of the following products would be most appropriate to supply to manage thepatient’s symptoms?

Answer 885

From the list above, Zovirax 5% cream would be the most appropriate product tosuggest. Zovirax 5% cream contains aciclovir which can treat herpes simplex virusserotype 1 (HSV-1) of the mouth, lips, and eye. Zovirax 5% is only licensed for thetreatment of herpes simplex virus present on the lips and face.

Question 886

A 36-year-old man visits the pharmacy for advice on his symptoms. He has just eatenat a new restaurant and now feels wheezy and lightheaded with clammy skin and a fastheartbeat. Upon questioning him about his medical conditions, you find out he has anut allergy.Question Which of the following actions is the most appropriate to take?

Question 887

A 36-year-old man visits the pharmacy for advice on his symptoms. He has just eatenat a new restaurant and now feels wheezy and lightheaded with clammy skin and a fastheartbeat. Upon questioning him about his medical conditions, you find out he has anut allergy.Which of the following actions is the most appropriate to take?

Answer 887

Regulation 238 of the Human Medicines Regulations 2012 allows adrenaline to beadministered by anyone for the purpose of saving life in an emergency. Therefore,pharmacists using their professional and clinical judgement can administer adrenalinein an emergency to persons presenting with symptoms of anaphylaxis.If a pharmacist administers adrenaline, they must also ensure that an ambulance iscalled by dialling 999 and reporting that there is a caseof suspected anaphylaxis. Adrenaline should be given as soon as possible so youwould administer adrenaline before phoning 999.

Question 888

MOST LIKELY CAUSE OF ANAL FISSURES+SYMPTOMS?

Answer 888

Anal fissures are most commonly caused by damage to the lining of the anus or analcanal, the last part of the large intestine. In many cases, no clear cause can beidentified, however most cases occur in people who have constipation, when aparticularly hard or large poo tears the lining of the anal canal. A low carbohydrate dietcan cause constipation.Other possible causes of anal fissures include persistent diarrhoea; inflammatory boweldisease (IBD), such as Crohn's disease and ulcerative colitis; colorectal cancer;dermatological conditions such as psoriasis and pruritus ani; bacterial, fungal, or viralskin infections; or a sexually transmitted infection (STI), such as syphilis or herpes,which can infect and damage the anal canal, however the patient’s history does notsuggest any of these causes. In some cases, having unusually tight anal sphinctermuscles can increase the tension in your anal canal, making it more susceptible totearing.

Question 889

A patient is admitted into medical admissions following urgent referral by their GP, asthey have symptoms that suggest abnormal potassium levels. The patient’s bloodpotassium level is taken and are found to be 6.2mmol/L (3.5–5.3mmol/L).BEST TREATMENT?

Answer 889

Patiromer calcium is used to manage hyperkalaemia. It is a non-absorbed cationexchange polymer that acts as a potassium binder in the gastro-intestinal tract. Thedose is initially 8.4 g once daily; adjusted in steps of 8.4 g as required. Doseadjustments should be made at intervals of at least one week; maximum 25.2 g perday.Magnesium aspartate is used for hypomagnesaemia. Potassium chloride used forhypokalaemia. Sevelamer and calcium acetate are used for hypophosphatemia.

Question 890

A patient comes into the pharmacy complaining of trouble sleeping since coming offnightshift. They have tried good sleep hygiene techniques, which do not seem to beworking.Which of the following is the most appropriate product to recommend?

Answer 890

Diphenhydramine (Nytol) is the only medication which is licensed for insomnia. Theother options are licensed for other conditions and the management of othersymptoms.Valerian extract (Nytol Herbal) could also be considered, however there is lack ofevidence for its effectiveness compared to medicinal products, therefore is not the mostappropriate option in this scenario.

Question 891

digoxin, antibiotic, L?

Answer 891

ClarithromycinMacrolides are potent enzyme inhibitors, causing increased serum levels of digoxinand therefore increasing the likelihood of digoxin toxicity.

Question 892

Add-on therapy? A 54-year-old man with type 2 diabetes requires an add on medication to hismetformin, as his HbA1c is not at his agreed target. He has a past medical history ofbladder cancer. He is currently overweight and needs to lose around 20 kg. He has nohistory of cardiovascular disease.

Answer 892

Based on NICE guidelines, the next step add on therapy (with no history ofcardiovascular disease) is a dipeptidyl peptidase-4 inhibitor (DDP4), pioglitazone, flozinor sulphonylurea.The patient’s history of bladder cancer rules out pioglitazone; sulphonylureas causeweight gain; and DDP4 are neutral. Therefore, a flozin, such as canagliflozin is themost appropriate as this promotes weight loss, and this patient needs to lose weight.Repaglinide can cause mild weight gain and can be associated w

Question 893

Symptoms of sepsis?

Answer 893

CONFUSION(PRODUCTIVE COUGH)FAST RESP RATEPALE/BLOTCHY SKINSKIN RASH DOES NOT FADE PRESS GLASS

Question 894

A 66-year-old man started on dapagliflozin 10 mg once a day for two weeks. He hasalso been taking metformin 500 mg three times a day and gliclazide 40 mg twice a dayfor the past four years. When collecting his repeat prescription, he complains of havingstomach pain, feeling sick and frequent urination in the last few days. His blood sugarlevel is normal. He believes that the new tablet may be the reason for his symptoms.BEST ACTION?

Answer 894

Euglycemic diabetic ketoacidosis (EDKA) is a clinical triad comprising increased aniongap metabolic acidosis, ketonemia or ketonuria and normal blood glucose levels<200 mg/dL.It is considered as a serious adverse effect of sodium-glucose cotransporter 2 (SGLT2)inhibitors. Patient should stop the associated medication and receive urgent medicaltreatment in hospitaldka!!!

Question 895

Sulfasalazine, sore throat, best action?

Answer 895

Sulfasalazine can cause blood disorders - patients receiving aminosalicylates, andtheir carers, should be advised to report any unexplained bleeding, bruising, purpura,sore throat, fever, or malaise that occurs during treatment.GP BRUH!

Question 896

ANTIBIOTIC FORINFECTIVE COPD?

Answer 896

For adults aged 18 years and over, the first-choice antibiotic for the management of aninfective exacerbation of COPD are amoxicillin, doxycycline or clarithromycin.Doxycycline is prescribed at a dose of 200 mg on first day, then 100 mg once a day for5‑day course in total.

Question 897

You are reviewing an NHS prescription for methadone. It is coming up to a BankHoliday and the pharmacy will be closed. You need to ensure that the prescriptioncontains appropriate approved wording for you to make a supply to cover the closeddays.Which of the following is the most appropriate wording for supplying methadone onclosed days?

Answer 897

Please dispense instalments due on pharmacy closed days on a prior suitable day.”Also note “If an instalment’s collection day has been missed, please still dispense theamount due for any remaining day(s) of that instalment.”NB: If you decide to supply against a prescription that uses wording not approved bythe Home Office, it will not provide the same protection from enforcement when makingthe supply. In this instance, if practical, you should try to get the prescription amendedby the prescriber to include the approved Home Office wording.

Question 898

Meds interaction with ciprofloxacin?

Answer 898

Ibuprofen interacts with ciprofloxacin to reduce seizure threshold. This is listed as asevere interaction and the manufacturer advises caution

Question 899

A 52-year-old woman with hypertension and bipolar disorder, is admitted into hospitaldue to a seizure which she experienced for the first time. According to the patientnotes, no recent dose changes of lithium have been reported however, she wasrecently prescribed a combination preparation enalapril with hydrochlorothiazide. Hermoods have been stable however, the patient complains of constant fatigue. Best action?

Answer 899

The levels of lithium are above normal range, and the presentation of a new seizureindicates severe lithium toxicity, which requires urgent treatment. Furthermore, lithiumexcretion is reduced by angiotensin-converting enzyme inhibitors (ACEI) (enalapril) andby thiazides (hydrochlorothiazide). Creatinine levels are raised indicating reducedrenal function, therefore the most appropriate course of action here is to stop lithiumand stop enalapril/hydrochlorothiazide.It should be noted that lithium salts have a narrow therapeutic/toxic ratio and shouldtherefore not be prescribed unless facilities for monitoring serum-lithium concentrationsare available (as noted in the BNF).

Question 900

Which of the following scenarios does not require an entry to be made in theprescription only medication (POM) register?

Answer 900

Medicines prescribed on NHS prescriptions do not need to be recorded in a POMregister, however in this case, a controlled drug register entry is legally requiredbecause morphine tablets are a Schedule 2 controlled drug. Lower strengths ofmorphine, such as morphine oral solution 10 mg/5 mL (Oramorph), are Schedule 5controlled drugs, which does not need to be recorded in the controlled drugs register.Although the supply of salbutamol inhalers on a written order does not require POMregister it is good practice for audit purposes.

Question 901

Which of the following insulins is suitable for once daily administration?

Answer 901

Detemir can be BD or OD?

Question 902

HUMALOG MIXNOVOMIX?

Answer 902

BIPHASIC, GIVE WITH MEALS, NOT OD!!

Question 903

TrimethoprimMethotrexateFolic acidL?

Answer 903

Trimethoprim is another anti-folate drug and concomitant use can result in bonemarrow suppression resulting in life threatening infections, anaemia or spontaneoussevere bleeding.

Question 904

A 79-year-old woman comes into your pharmacy. She has osteoporosis and has beenin hospital for 8 weeks due to a hip fracture and has been discharged on co-codamol8/500mg tablets. She would like to take a medication to help strengthen her bones toreduce the risk of another fracture.BEST treatment?

Answer 904

Calcium and colecalciferol (vitamin D) are recommended for people at high risk ofosteoporotic fracture

Question 905

A woman calls your community pharmacy as she is concerned about her husband. Heunderwent his first cycle of chemotherapy for lung cancer last week and has begun tofeel unwell. His symptoms include: lethargy; a temperature of 39°C; complaining offeeling hot and cold.ACTION?

Answer 905

This patient could be exhibiting signs of neutropenic sepsis possibly caused bychemotherapy. Symptoms include dysuria, diarrhoea, a productive cough, chills,shivers, rigors, a temperature greater than 38°C.Neutropenic sepsis is a medical emergency and he needs to seek medical attentionimmediately. In this case the fastest option would be to ring 999 for an ambulance.

Question 906

Cellulitis antibiotic, penicillin allergy?

Answer 906

Doxycycline is most suitable for this patient due to their allergies.Both flucloxacillin and co-amoxiclav are penicillin antibiotics, therefore are notappropriate for this patient.Cefuroxime is only available as intravenous preparation and the pharmacology issimilar to penicillin, which may not be suitable in a true allergy. Cephalexin is availableas an oral formulation but is a cephalosporin, which may result in a cross-sensitivityreaction, and should be used with caution.

Question 907

A regular patient comes in and asks for advice regarding their pet. They explain thatthey have run out of repeat medication for their cat and would like some more. Theyshow you an empty bottle of hypromellose eye drops that they administer to their catBEST action?

Answer 907

You should refuse the request and refer the individual to the vet.It is not legal to make an emergency supply in this situation, also the licensing of P andGLS products is for human use not animals and pets. It should be noted that the dosein humans is not equivalent to in doses of medicines used in animals; and a vet wouldbe the most appropriate person to advise on clinical appropriateness.Furthermore, there are specific labelling requirements for veterinary products when theprepared medicine is for animal use, which has been prescribed by a veterinarypractitioner under the cascade

Question 908

A 33-year-old woman is due to undergo cholecystectomy, a major surgery in 2 months’time. She is currently taking a regular contraceptive that should be stopped at least 4weeks before the procedure.

Answer 908

Levonorgestrel/ethinylestradiol is a combined hormonal contraceptive which increasesthe risk of thrombosis in patients undergoing major surgery and should be discontinuedat least 4 weeks prior to major surgery.Progestogen-only pills, injections, implants, and intra-uterine systems are suitable foruse as contraceptives in females undergoing surgery. Combined hormonecontraceptive may be recommenced 2 weeks after full remobilisation.

Question 909

Phenytoin enteral feeding?

Answer 909

Enteral feeding (interrupt feeding for 2 hours before and after dose; more frequent monitoring may be necessary); may exacerbate absence and myoclonic seizures

Question 910

Antidepressants hyponatraemia L?

Answer 910

Falls, stress

Question 911

WITH EXTRACT Qs ALWAYS CONSIDER THE MAXIMUM, BE CAREFUL!

Answer 911

A

Question 912

Meningococcal infections treatmetn?

Answer 912

For the treatment of meningococcal diseases benzylpenicillin is recommended,cefotaxime (if allergic to penicillin). If there is history of immediate hypersensitivityreaction (including anaphylaxis, angioedema, urticaria, or rash immediately afteradministration) to penicillin or to cephalosporins, chloramphenicol can be used.Tigecycline (tetracycline antibiotic) is contraindicated in children under the age of 8years old due to the risk of deposition in growing bones and teeth.Teicoplanin should not be given by mouth for systemic infections because it is notabsorbed significantly. It is also not indicated to treat meningitis.

Question 913

Sildenafil, refuse sale, condition?

Answer 913

There are several precautions for the sale and supply of sildenafil. Contraindications foruse of sildenafil include severe cardiovascular disorder such as recent (6 months)acute myocardial infarction (AMI) or stroke, unstable angina, or severe cardiac failure,sexual activity may be inadvisable. These patients should be referred this their GP,even if they have been prescribed his previously to ensure that they can resume sexualactivity. Consider referring the patient if they are already using a different dose ofsildenafil, or a different treatment for erectile dysfunction.

Question 914

Sildenafil+antibiotic L?

Answer 914

Sildenafil metabolism is principally mediated by the cytochrome P450 (CYP) isoforms3A4 (major route) and 2C9 (minor route). Therefore, inhibitors of these isoenzymesmay reduce sildenafil clearance and inducers of these isoenzymes may increasesildenafil clearance.Both sildenafil and erythromycin prolong the QT interval. This noted as a severeinteraction and most manufacturers advise avoiding the use of two or more drugs thatare associated with QT prolongation.

Question 915

CAUSE of symptoms?A 34-year-old man is taking moclobemide 150 mg twice a day for depression and hasrecently been prescribed amitriptyline 25 mg for neuropathic pain. In the next few days,the patient presents with tremor and mental confusion and is rapidly deteriorating. Hispartner asks if the tremor is a sign that his epilepsy is no longer under control andwhether this could be linked with his binge drinking.

Answer 915

The presenting symptoms suggest a drug interaction. Simultaneous administration ofamitriptyline and moclobemide may cause serotonin syndrome (a combination ofsymptoms, possibly including agitation, confusion, tremor, myoclonus, andhyperthermia). The interaction is listed as severe and the manufacturer advised toavoid concomitant use

Question 916

What is a biosimilar medicine?

Answer 916

A biosimilar is a biologic medicine that is similar to an already licensed biologicmedicine in terms of quality, safety and efficacy. A biosimilar is specifically developedand licensed to treat the same disease(s) as the original innovator product. A biosimilarcan only be marketed after the patent protecting the originator product and anyperiod of marketing exclusivity have expired

Question 917

A 38-year-old man with type 2 diabetes visits your community pharmacy to collect hisrepeat medication. You overhear him conversing with the counter assistant aboutulceration on his left foot.

Answer 917

Poor diabetes control can increase the likelihood of foot infections due to neuropathy –a long-term complication of type 2 diabetes. The patient should be referred to the footprotection service for review of the patient’s foot symptoms and appropriatemanagement.It is also important to refer the patient to their GP for a review of their medicines and torequest blood glucose levels to ensure adequate glycaemic control, however this is asecondary intervention; foot ulceration should be the prime concern here.The other listed options are not appropriate as they will not adequately manage thesymptoms or could make them worse.

Question 918

You are a GP practice pharmacist conducting an asthma review. The adult patient youare currently reviewing is still symptomatic despite being on salbutamol 100micrograminhaler one to two puffs when required and a Qvar 100microgram inhaler two puffstwice a day. You have confirmed they have the appropriate inhaler technique, so it isdecided to step up treatment.NEXT step?

Answer 918

According to the BTS/SIGN guidelines you would add an inhaled LABA (salmeterol) tolow or medium dose ICS as initial add on therapy for asthma management.

Question 919

Acne first-line?

Answer 919

. Both benzoyl peroxide and isotretinoin gel areindicated for the treatment of acne, however isotretinoin is prescription only.Clotrimazole, Diprobase, and E45 are not indicated for acne, and therefore notappropriate.

Question 920

UTIPREGNANT- 10 WEEKSPENICILLIN ALLERGYTREATMENT?

Answer 920

Nitrofurantoin is usually first choice and should be prescribed for 7 days in pregnancy(additional info: Nitrofurantoin should be avoided at term (36-42 weeks)).Amoxicillin & pivmecillinam would be inappropriate due to penicillin allergy.Manufacturers advise to avoid trimethoprim during pregnancy, particularly in the firsttrimester due risk of teratogenicity.Cefalexin is safe to use in pregnancy and duration of 7 days is appropriate for pregnantwomen but there is around a 10% a risk of allergy in cephalosporins with penicillinallergic patients. Although the previous reaction was mild, cefalexin is best avoided inthis patient.

Question 921

ULCERATIVE COLITIS COLONOSCOPY?

Answer 921

Inflammation and continuous partial thickness in the rectum that extends throughthe colonBOWEL INFLAMMATION

Question 922

anti-epilepticdehydrationoverheatingwhat drug?

Answer 922

ZONISAMIDE!

Question 923

A 42-year-old man with a past medical history of asthma has been admitted to hospitalwith difficulty speaking, body weakness, and tremor. They are also repetitively cleaningand washing their hands.Which of the following medicines is most likely to have caused this patient’ssymptoms?

Answer 923

MONTELUKAST!!!!Uncommon and rare adverse effects of montelukast include akathisia, asthenia,abnormal behaviour, and obsessive-compulsive symptoms.An adverse effect of steroids, such as fluticasone and prednisolone, is also abnormalbehaviour. However, the other symptoms experienced by the patient are not reportedadverse effects of fluticasone or prednisolone

Question 924

A 38-year-old woman with a past medical history of asthma is exhibiting symptoms ofsevere vomiting, appears agitated and has a racing heartbeat.Which of the following medicines is most likely to have caused this patient’ssymptoms?

Answer 924

T for tachycardia/theophylline!!!Theophylline in overdose can cause vomiting (which may be severe and intractable),agitation, restlessness, dilated pupils, sinus tachycardia, and hyperglycaemia. Moreserious effects are haematemesis, convulsions, and supraventricular and ventriculararrhythmias. Severe hypokalaemia may develop rapidly.

Question 925

A 61-year-old man recently had a stroke. He is now having difficulty swallowing hismedicines and asks for your advice on what to do.Which of the following healthcare professionals would be the most appropriate to referthis patient to?

Answer 925

Speech and language therapists can aid patients who have swallowing difficultiesensuring they are suffering no form of aspiration. This can help pharmacists advise onthe most appropriate forms of medication

Question 926

A 96-year-old woman is scheduled to be discharged from hospital. She lives alone afterher husband passed away and her two children live abroad. You are slightly concernedthat she may struggle to adjust to being on her own again after discharge.Which of the following healthcare professionals would be the most appropriate to referthis patient onto?

Answer 926

Social workers help their patients to live their lives more successfully by findingsolutions to their problems.

Question 927

A 33-year-old man currently in the first month of tuberculosis treatment is reportingsymptoms of muscle aches, weakness and pins and needles in his feet. He takesisoniazid, rifampicin, pyrazinamide and ethambutol.Which of the following medicines is most suitable for managing these adverseeffects?

Answer 927

Typical symptoms of isoniazid induced neuropathy. Pyridoxine is licensed to managethis.

Question 928

A 42-year-old woman with a history of gastro-oesophageal reflux disease who hasbeen taking omeprazole 40mg once daily for the past six months is reporting nauseaand vomiting, pins and needles, fatigue and muscle twitches.Which of the following medicines is most suitable for managing these adverseeffects?

Answer 928

MAGNESIUM ASPARTATE SACHETSA known side effect of omeprazole is hypomagnesaemia, which these are typicalsymptoms of.

Question 929

A patient has suspected unstable angina and a glyceryl trinitrate spray is ineffective.Which of the following medicines is most suitable to manage the emergency situation?

Answer 929

Dispersible aspirin is used in addition to GTN sprat for the treatment of unstable angina

Question 930

A patient has presented at their GP surgery with photosensitivity, a non-blanching rashand a stiff neck. The patient has a documented skin rash allergy to amoxicillin.Which of the following medicines is most suitable to manage the emergency situation?

Answer 930

Can give cefotaxime injectionSigns of meningitis. 1st line is benzylpenicillin but unsuitable due to penicillin allergy.Cefotaxime can be used as no history of immediate anaphylactic reaction to penicillins.

Question 931

Cephalosporins/cefotaxime ideal to avoid, penicillins, but if minor rash, calmIMMEDIATE/ANAPHYLACTIC REACTION, YH AVOID!

Question 932

SIGNS OF VERRUCA?

Answer 932

Verrucae are also known asplantar warts and usually appear on the sole of the feet. They often have central darkdots (thrombosed capillaries) and may be painful.

Question 933

A 45-year-old man has skin condition affecting his toes. The nail on two toes of his leftfeet are discoloured and look a bit flaky. The surrounding skin is a little red. There is nopain or itching. He is diabetic and takes metformin to manage his condition.CONDTION?

Answer 933

Fungal nail infection

Question 934

A 26-year-old man has the following foot condition. He has been using an emollientcream on the area as the skin is flaky and cracks.CONDITION?

Answer 934

athlete's footThe main symptoms areitchy white patches between the toes, usually between the fourth and fifth toes, but itcan affect others. The skin may also appear red, cracked, scaly or macerated. Thearea under the exposed peeling skin can sometimes be sore. Some patients describethe skin as looking wet.

Question 935

An 18-year-old woman has a rash on her lower legs which has been for two days. Therash is red, sore, itchy, and there appears to be small, raised bumps. She mentionsthat she recently had hair removal treatment.CONDITION?

Answer 935

The symptoms indicate dermatitis which is most likely to be associated with the hairremoval treatment the patient has had. Acute contact dermatitis typically presents witherythema and vesiculation, dryness, scaling and bullae may also be present.

Question 936

A 35-year-old man has a growth on his right index finger. It appeared two weeks ago.The growth is firm, raised and skin coloured. He is experiencing minor pain and itchingwhere the growth is.

Answer 936

The symptoms suggest a wart. They can appear on palms, knuckles, knees, andfingers, and occur in clusters. Warts are firm to touch, have raised papules with a roughsurface that resembles a cauliflower, and are usually skin coloured but may appeardarker on dark skin; they sometimes itch and cause minor pain. They will often resolveon their own but may take months or even years.

Question 937

A 34-year-old woman, with a BMI of 32, requests an over-the-counter medication. Shealso takes levothyroxine 100 micrograms and desogestrel 75 micrograms. You adviseher that this medicine is not recommended because of potential interactions.MED CONTRAINDICATED?

Answer 937

orlistat!!!- Hypothyroidism and/or reduced control of hypothyroidism may occur when orlistat andlevothyroxine are co-administered. Patients taking levothyroxine should consult adoctor before starting treatment with Alli, as orlistat and levothyroxine may need to betaken at different times and the dose of levothyroxine may need to be adjusted.- Orlistat may indirectly reduce the availability of oral contraceptives and lead tounexpected pregnancies in some individual cases. The use of an additionalcontraceptive method is recommended to prevent possible failure of oral contraceptionthat could occur in case of severe diarrhoea.

Question 938

A 65-year-old man requests an over the counter medicine. He also takes co-beneldopadispersible tablets for Parkinson’s disease. You advise him that this medicine is notsuitable for him because of his medical condition.CONTRAINDICATED?

Answer 938

PROCHLORPERAZINE!! EPSE :(

Question 939

WHAT IS THIS?!

Answer 939

PSORIASIS!

Question 940

A 56-year-old man presents himself at the pharmacy you are working in. He would likesome painkillers after hurting his ankle playing football. He is weight bearing althoughlimping slightly. He has tried nothing so far for the pain in his ankle. You ask the patientif he is on any regular medication, he tells you he takes:• Multivitamins• Omeprazole 20mg once daily• Folic acid 5mg daily (four-month course)• Symbicort turbohaler two puffs twice a day and when requiredBEST ACTION?

Answer 940

Sell him paracetamol 500 mg capsules and advise him to rest the joint This patient does not need referring to the GP or the walk in centre as he is able toweight bear, which indicates that an over the counter medicine will be able to help himmanage his symptoms.The patient is using a symbicort inhaler, on a SMART/MART regime which indicates hehas respiratory disease such as asthma or COPD, therefore an NSAID such asibuprofen or diclofenac would not be the most appropriate. Also, he is takingomeprazole which indicates that NSAIDs, in particular, ibuprofen, would not besuitable.

Question 941

A doctor contacts you asking you to suggest a drug to treat a patient who has contracted meningococcal disease.Which drug would be suitable to be given via intravenous infusion in this patient?

Answer 941

Benzylpenicillin sodium is indicated for use in meningococcal disease and is only available in an IV preparation.

Question 942

You have just finished using a stock bottle of methadone in the pharmacy. You are unable to pour anything out of the bottle, but you can see that there are still traces inside.In what way should you deal with the disposal of the remaining liquid inside the bottle?

Answer 942

Rinse the bottle with water and pour into a denaturing kitWaste medicines should not be disposed of in the sink. The rinsings should be added to a denaturing kit and disposed as pharmaceutical waste.

Question 943

You are teaching a trainee about medical terminology.Which of the following terms describes 'asbestos-like' scales on the scalp?

Answer 943

Pityriasis amiantaceaPityriasis amiantacea describes 'asbestos-like' scales on the scalp.

Question 944

Miss C is joining your pharmacy team as a work experience student. You receive the morning order of medications and preparations and she is keen to help put them out on the pharmacy shelves.She asks you which one of the following substances is a prescription only medicine?

Answer 944

Mometasone furoate 0.1% cream

Question 945

A mother brings her 3 year-old child to your pharmacy. They are suffering from the symptoms associated with otitis media, a common complaint in young children.Which of the following symptom groups best describe the signs and symptoms of otitis media in this age group?

Answer 945

Irritability, crying, fever and pain

Question 946

You are working in a community pharmacy on a Saturday. Your counter assistant makes you aware that there is a lady asking for an emergency supply of an EpiPen. On questioning the patient you establish that she is allergic to bees and has been stung. She does not have an EpiPen with her. She reports feeling breathless and having a tight chest.What is the most appropriate initial step in your course of action?

Answer 946

Ask the assistant to telephone 999, request an ambulance and state anaphylaxisThe patient is demonstrating signs of anaphylaxis. She will need emergency assistance so it is important to make this call asap. As you have other staff available to do this, it would be appropriate to get them to do this instantly while you then deal with the emergency. The MEP states that: "If a pharmacist administers adrenaline they must also ensure that an ambulance is called by​ dialling 999 and reporting that there is a case​ of suspected anaphylaxis." EpiPen training provides similar guidance. When managing anaphylaxis it is crucial that the ambulance gets to the patient as soon as possible. Therefore, the initial first step to get the assistant to phone 999 would be prudent while you are in the process of locating and administering the adrenaline pen in order to avoid undue delay in the patient getting the next step in their care.

Question 947

This drug may be used in the treatment of cellulitis. It can be administered orally or intravenously for this condition.

Answer 947

ClindamycinClindamycin is indicated in soft tissue infections such as cellulitis. It may be administered orally or via the IM or IV routes.

Question 948

This medication must be used with caution in patients who have a sensitivity to sulfonamides.

Answer 948

Sumatriptan succinate 50 mg tabletsSumatriptan should be used with caution in patients with sensitivity to sulfonamides.

Question 949

DOACSDirect thrombin?Factor Xa inhibitor?

Answer 949

Direct thrombin? Dabigatran Factor Xa inhibitor? Rivaroxaban

Question 950

DOAC for dyspepsia?

Answer 950

Edoxaban/apixabanRivaroxaban/dabigatran can cause it!

Question 951

DOACs+vitamin K?

Answer 951

DOESN'T MATTER, INR silly

Question 952

doacs+inr?

Answer 952

not needed, just monitor for blleding/anaemia

Question 953

METHOTREXATE MISSED DOSINGWITHIN 2 DAYS?>/= 3 DAYS?DOUBLE DOSE?

Answer 953

METHOTREXATE MISSED DOSINGWITHIN 2 DAYS? take asap+next dose as normal>/= 3 DAYS? doctor/specialistDOUBLE DOSE? NEVER to make up missed dose

Question 954

What is a serious shortage protocol?

Answer 954

The protocols, for use in the event of a serious shortage of a medicine, may give community pharmacies the ability to dispense less, or give a different strength, or pharmaceutical form, or provide an alternative generic product, or provide an alternative product; following appropriate discussions with the patient.

Question 955

Aspects of a SSP?

Answer 955

proposed on opinion of ministerclinicians involvedissued only in exceptional circumstancesmore likely for alnterative strength blah blahless likely to be for generic/therapeutic substituion

Question 956

What chemo agents cause bone marrow suppression?

Answer 956

ALLExceptvincristine & bleomycin

Question 957

ISSUES WITH VINCRISTINE?

Answer 957

HYPERURICAEMIAALOPECIATHROMBOEMBOLISMEXTRAVISATION OF IV DRUGSMUCOSITISTERATOGENIC (1st trimerster) LHIGHLY EMETOGENIC, n&v (cisplatin/dacarbazine/lots of cyclophosphamide)

Question 958

FLUCLOXACILLIN ADVERSE EFFECTS?

Answer 958

CHOLESTATIC JAUNDICEDIARRHOEAHYPERSENSITIVITYSKIN REACTIONSTHROMBOCYTOPENIA

Question 959

WHAT IS THIS?

Answer 959

STYE

Question 960

FEATURES OF A STYE?

Answer 960

small, painful lump on or inside the eyelid or around the eye.skin around the stye may be swollen and red and the stye may be filled with yellow pus.eye may be red and watery, but the vision should not be affected.

Question 961

advice on treating a stye?

Answer 961

1. Soak a clean flannel in warm water.2. Hold it against your eye for 5 to 10 mins.3. Repeat this 3 or 4 times a day.warm compress

Question 962

stye...

Answer 962

the cause is bacterial, but antibiotic therapy is not usually needed. A warm compress should be applied for 5-10 minutes three to four times a day to reduce swelling

Question 963

stye referral?

Answer 963

very painful/swollendoes not get better in a few weeksaffects vision

Question 964

WHEN IS MORPHINE SCHEDULE 2?

Answer 964

ABOVE 13MG/5ML

Question 965

CARBIMAZOLE BLOOD DISORDERS REFERAL?

Answer 965

sore throat, mouth ulcers, bruising, fever, malaise, or non-specific illness develops

Question 966

ISONIAZID ADVICE?

Answer 966

PERIPHERAL NEUROPATHY, PYRIDOXINE VITAMIN B6LIVER DISORDER, JAUNDICEAVOID TYRAMINE-RICH FOODS- TACHY/PALPI/FLUSHI L

Question 967

MICROVASCULAR COMPLICATIONS?

Answer 967

Retinopathy Visual disability and blindnessNeuropathy Peripheral neuropathyAutonomic neuropathyNephropathy Renal failureFoot problems MetabolicDyslipidaemiaKetoacidosis Hyperosmolar hyperglycaemic state (HHS

Question 968

MACROVASCULAR COMPLICATIONS?

Answer 968

Coronary heart disease Cardiomyopathy ArrhythmiasCerebrovascular disease Peripheral artery disease

Question 969

pseudoephedrine in diabetse/hypertension?

Answer 969

The question shows that the patient is being treated for hypertension and therefore the use of sympathomimetic agents is contraindicated and not advised without a prescriber’s supervision. It is best to recommend another OTC remedy

Question 970

extravasation injury, cytotoxic drug?xtravasation management1. The infusion should be stopped immediately but the cannula should not be removed until after an attempt has been made to aspirate the area (through the cannula) in orderto remove as much of the drug as possible.2. Corticosteroids are usually given to treatinflammation. Hydrocortisone or dexamethasone can be given either locally or intravenously3. Antihistamines and analgesics may be required for symptom relief

Answer 970

Stop the infusion immediately, administerhydrocortisone and analgesia

Question 971

extravasation management?

Answer 971

xtravasation management1. The infusion should be stopped immediately but the cannula should not be removed until after an attempt has been made to aspirate the area (through the cannula) in orderto remove as much of the drug as possible.2. Corticosteroids are usually given to treatinflammation. Hydrocortisone or dexamethasone can be given either locally or intravenously3. Antihistamines and analgesics may be required for symptom relief

Question 972

levothyroxine advice?

Answer 972

The medication needs to be taken in the morning at least 30-60 minutes before any food, caffeine-containing liquids (e.g. coffee, tea) or other medications.

Question 973

Patients with a confirmed proximal DVT or PE duration?

Answer 973

At least 3 months, 3-6 months if active cancer

Question 974

provoked DVT or PE duration?

Answer 974

3 months, 3-6 months if active canceror when provoking factor gone

Question 975

unprovoked DVT or PE?

Answer 975

beyond 3 months, beyong 6 months for those with active cancer

Question 976

warfarin+miconazole? Absolute Lalternative?

Answer 976

nystatin, but it's a POM!!! so refer to GP

Question 977

blood glucose driving conc?

Answer 977

>5

Question 978

ASTHMA INHALERSFLIXOTIDE EVOHALER?SYMBICORT TURBOHALER?SERETIDE EVOHALER?FOSTAIR NEXT?RELVAR ELLIPTA?

Answer 978

FLIXOTIDE EVOHALER? pMDISYMBICORT TURBOHALER? cylindricalSERETIDE EVOHALER? pMDIFOSTAIR NEXT? glock, not redRELVAR ELLIPTA? blue, egg

Question 979

ACCUHALER?

Answer 979

DPI, breathe in quickly and deeply

Question 980

Easi-breathe/BAI/Autohaler/pMDI/Evohaler?

Answer 980

breathe in slowly and steadily

Question 981

METRONIDAZOLE KEY LABELLING?

Answer 981

Warning: Do not drink alcoholSpace the doses evenly throughout the day. Keep taking this medicine until the course is finished, unless you are told to stopTake with or just after food, or a mealSwallow this medicine whole. Do not chew or crushTake with a full glass of water

Question 982

Why metronidazole with meals? spaced dosing?

Answer 982

Improves absorbance+maximises bacterial death

Question 983

NMS serviceELIGIBLE CONDITIONS?

Answer 983

.Asthma and COPD:2.Diabetes (Type 2);3.Hypertension;4.Hypercholesterolaemia;5.Osteoporosis;6.Gout;7.Glaucoma;8.Epilepsy;9. Parkinson’s disease;10. Urinary incontinence/retention;11. Heart failure;12. Acute coronary syndromes;13. Atrial fibrillation;14. Venous thromboembolism/embolism;15. Stroke / transient ischemic attack; and16. Coronary heart diseaseNOT TYPE 1 SADLY!! :(

Question 984

ADULTS 19-64 PHYSICAL ACTIVITY ADVICE?

Answer 984

At least 150 minutes of moderate intensity activity a week or 75 minutes of vigorousintensity activity a weekAdults should aim to do strengthening activities on at least 2 days a week – this must work all the major muscle groups

Question 985

ANGINA MANAGEMENT ORDER?

Answer 985

B-BLOCKER OR RATE-LIMITING CCBTHENB-BLOCKER+STANDARD CCBTHENLONG-ACTING NITRATE

Question 986

WHAT VITAMIN DO YOU AVOID IN PREGNANCY?

Answer 986

VITAMIN A, RETINOL, E.G. COD LIVER OIL

Question 987

NSAIDS+GI RISKS?HIHEST TO LOWEST?

Answer 987

PIROXICAM/KETOPROFEN/KETOROLACINDOMETACIN/DICLOFENAC/NAPROXEN (>1G)/ IBUPROFEN (>1.2G)IBURPROFEN (<1.2G)/NAPROXEN(<1G)

Question 988

DISPENSED LABEL LEGAL REQUIREMENTS?

Answer 988

NAME OF PATIENTNAME+ADDY OF PHARMACYDATENAME OF MEDDIRECTIONS/DOSEPRECAUTIONSEXTERNAL USE ONLY+REACH/SIGHT CHILDREN NOT A LEGAL REQUIREMENT

Question 989

What is medicines optimisation?

Answer 989

Medicines optimisation looks at how people use medicines and acknowledges that the way people use medicines over time may change. It may involve stopping some medicines as well as starting others and considers opportunities for lifestyle changes and non-medical therapies to reduce the need for medicines.

Question 990

Loperamide serious OD?

Answer 990

QT prolongation!

Question 991

Patient has been reinitiated on lithium therapy for the management of bipolar disorderfollowing a relapse 2 weeks ago which required her to be admitted into a secure psychiatric unit.As part of the Trust guidelines, the patient will need to undertake therapeutic dose monitoring toensure that her serum lithium concentration remains within the desired rangeWhich of the following is the most appropriate target concentration for Mrs Hʼs serumlithium level?

Answer 991

0.8-1

Question 992

Lithium 0.8-1mmol/L?

Answer 992

A target serum-lithium concentration of 0.8–1 mmol/litre is recommended for acute episodes of mania, and for patients who have previously relapsed or have sub-syndromal symptoms. It is important to determine the optimum range for each individual patient.

Question 993

This should be done weekly after initiation and after each dose changeuntil concentrations are stable • Then every 3 months for the first year• Then every 6 months thereafter

Answer 993

A target serum-lithium concentration of 0.8–1 mmol/litre is recommended for acute episodes of mania

Question 994

Alendronic acid advice?

Answer 994

Manufacturer advises tablets should be swallowed whole and oral solution should be swallowed as a single 100 mL dose. Doses should be taken with plenty of water while sitting or standing, on an empty stomach at least 30 minutes before breakfast (or another oral medicine); patient should stand or sit upright for at least 30 minutes after administration.

Question 995

vet prescriptions as direct?

Answer 995

not acceptable

Question 996

WHEN/WHAT TO REPORT TO MHRA?

Answer 996

everything that is serious, medically significant, or result in harm.Anaphylaxis, blood disorders, endocrine disturbances, effects on fertility, haemorrhage from any site, renal impairment, jaundice, ophthalmic disorders, severe CNS effects, severe skin reactions, reactions in pregnant women, and any drug interactionsopioid constipation/TCA dry mouth mynaaaa

Question 997

clinical bp 200/130?

Answer 997

HOSPITAL/SAME DAY ASAP?

Question 998

TOUJEO TO LANTUS?

Answer 998

GLARGINE20% DOSE REDUCTIONRISK OF HYPOGLYCAEMIA

Question 999

CHEMOMILD N&V?

Answer 999

FLUOURACILETOPOSIDEMETHOTREXATE

Question 1000

CHEMOMODERATE N&V?

Answer 1000

TAXANESDOXORUBICINLIL CYCLOPHOSPHAMIDELOTS OF METHOTREXATE

Question 1001

CHEMOSEVERE N&V?

Answer 1001

CISPATINDACARBAZINELOTS OF CYCLOPHOSPHAMIDE

Question 1002

EVIDENCE HIERARCHYSYSTEMATIC REVIEW AT THE TOP!!!

Question 1003

gradual withdrawal of corticosteroids?

Answer 1003

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;• other possible causes of adrenal suppression.

Question 1004

Patient, valproate, unplanned pregnancy, advice?

Answer 1004

Continue taking, just refer asap

Question 1005

STATINS & NON-HDL CHOLESTEROL % REDUCTION?

Answer 1005

Atorvastatin 80mg once daily is an example of a high-intensity statin, to be a high-intensity statin it has to produce a minimum reduction in LDL- cholesterol of 40% or greater.Medium- intensity – 30%Low-intensity - 20 %

Question 1006

CELLULITIS TREATMENT?

Answer 1006

FLUCLO 1G 7 DAYS

Question 1007

RIFAMPICIN CAUTIONS?

Answer 1007

Hepatotoxicity, colors soft contact lenses and urine red/orange, enzyme-inducer, effectiveness of hormonal contraceptives is reduced. Monitor liver function.

Question 1008

PYRAZINAMIDE CAUTIONS?

Answer 1008

C/I in acute attack of gout• Hepatotoxicity • Monitor renal and hepatic function

Question 1009

ETHAMBUTOL CAUTIONS?

Answer 1009

C/I in optic neuritis & poor vision• Ocular toxicity• TDM: peak (2-6 mg/L) and trough (<1mg/L)

Question 1010

ISONIAZID CAUTIONS?

Answer 1010

C/I in drug-induced liver disease, given with Pyridoxine to prevent peripheral neuropathy.• Enzyme inhibitor, avoid tyramine-rich foods, or histamine-rich foods. • Monitor liver function.

Question 1011

Excessive alcohol drinking?--> Thiamine deficiencySIGNS?

Answer 1011

Fatigue Loss of appetite Weight lossGastrointestinal upset Nausea Weakness

Question 1012

SEVERE THIAMINE DEFICIENCY?

Answer 1012

mental confusion Paralysis of extremitiesHeart problemsLoss of appetite

Question 1013

sources of thiamine?

Answer 1013

enriched white rice or egg noodlesfortified breakfast cerealtroutblack beanssunflower seedsacorn squashyogurt

Question 1014

Relvar elipta shelf-life?

Answer 1014

6 weeks, 42 days

Question 1015

PATIENT PREGNANTSICKLE CELL DISEASEFOLIC ACID?

Answer 1015

5MG DAILYBEFORE AND THROUGHOUT PREGNANCY!

Question 1016

INITIAL ACS MANAGEMENT?MONA

Answer 1016

M – morphine for pain O – oxygen if requiredN – GTN/ Nitrate spray A – Loading dose of Aspirin should be given asap

Question 1017

symptoms of ACS?

Answer 1017

ain in the chest or other areas (for example the arms, back, or jaw) lastslonger than 15 minutes.Chest pain is: • Dull, central, and/or crushing.• Associated with nausea and vomiting,sweating or breathlessness, or acombination of these

Question 1018

ACS, LOW RISK OF BLEEDINGASPIRIN+?

Answer 1018

ASPIRIN+TICAGRELOR

Question 1019

ACS HIGH BLEEDING RISK?

Answer 1019

CLOPDIOGREL+ASPIRINORASPIRIN ALONE

Question 1020

prasugrel? for pciclopi? for high bleeding riskaspirin? for high bleeding risk

Question 1021

Patient taking combined pillMissed 2 days during week 1 following HFI+UPSIAction?

Answer 1021

Provide emergency contraception. A barrier method should be used for the next 7 daysfrom the last missed pill

Question 1022

Patient taking desogestrel, missed their 8am pill, it's 4pm now, advice?

Answer 1022

<12hours so it's calmTake the missed pill as soon as possible and continue todayʼs pill at its normal time. Nobarrier method is necessary

Question 1023

What's in microgynon?

Answer 1023

Combined, ethinylestradiol+levonorgestrel

Question 1024

Patient taking microgynon,missed 2 doses in last week of pack, prior to HFI, advice?

Answer 1024

The most recent pill should be taken, and she should skip her pill free week (omit HFI) and move onto the next pack immediately

Question 1025

Norehisterone, what is it? Missed dose?

Answer 1025

Standard POP3hrs

Question 1026

Patient, norehisterone, missed dose by 12hours, advice?

Answer 1026

Take the missed pill as soon as possible and continue today’s pill at its normal time. Use a barrier method for the next 48 hours

Question 1027

RED MAN SYNDROME= MACULOPAPULAR RASH!!!VANC, ENDOCARDITIS, ETC

Question 1028

VANCOMYCIN FAT PARA

Answer 1028

Vancomycin can be used in the treatment of Complicated skin and soft tissue infections, bone infections, joint infections, community-acquired pneumonia, hospital-acquired pneumonia, infective endocarditis, acute bacterial meningitis, bacteraemia, and Clostridium difficile infection.Infusion-related reactionsRapid bolus administration (i.e. over several minutes) may be associated with exaggerated hypotension (including shock and, rarely, cardiac arrest), histamine like responses and maculopapular or erythematous rash (“red man's syndrome” or “red neck syndrome”).Vancomycin should be infused slowly in a dilute solution over a period not less than 60 minutes to avoid rapid infusion-related reactions.Monitoring: auditory function, blood count, hepatic and renal function, leucocyte count

Question 1029

adult, asthma, SABA+ICS, next step, BTS guideline?

Answer 1029

LABA, salmeterol, done before increasing corticosteroid dose or adding LTRA by the way

Question 1030

Patient, COPD, symptoms not controlled with ipratropium, SAMA, next step up?

Answer 1030

In patients who continue to be breathless or have exacerbations, offer a longacting beta2 agonist (LABA) and a long-acting muscarinic antagonist (LAMA). Discontinue SAMA treatment if a LAMA is given. Treatment with a SABA as required may be continued in all stages of COPD

Question 1031

EPILEPSY TERATOGENIC RISK?HIGHEST?

Answer 1031

SODIUM VALPROATE

Question 1032

EPILEPSY TERATOGENIC RISK?INTERMEDIATE?

Answer 1032

CARBAPAZEMINEPHENYTOINPHENOBARBITALTOPIRAMATE

Question 1033

EPILEPSY TERATOGENIC RISK?LOWEST?

Answer 1033

LAMOTRIGINELEVETIRACETAM

Question 1034

diltiazem+bisoprolol interaction?

Answer 1034

CARDIODEPRESSION!!! (bradycard+hypotension)

Question 1035

sertraline+tramadol interaction?

Answer 1035

serotonin syndrome

Question 1036

RAMIPRIL RENAL IMPAIRMENT DOSING30-60mL/min?<30mL/min?

Answer 1036

30-60mL/min? max. 5mg OD<30mL/min? max. initial 1.25mg OD, do not exceed 5mg OD

Question 1037

Metformin, eGFR is 25 mL/min/1.73 m?

Answer 1037

DO NOT START IF(eGFR) is less than 30 mL/min/1.73 m2.During treatment with metformin monitor renal function:• At least once a year in people with normal renal function.• At least twice a year in people with additional risk factors for renal impairment,such as the elderly, or if deterioration in renal function is suspected.• Review the dose of metformin if eGFR is less than 45 mL/min/1.73 m2.Stop treatment with metformin:• If eGFR is less than 30 mL/min/1.73 m2.• In people at risk of tissue hypoxia orsudden deterioration in renal function

Question 1038

INDAPAMIADE, <30mL/min?

Answer 1038

AVOID!!!

Question 1039

Patients whose Hb1Ac rises to 58mmol/mol or higher should have their treatment intensified

Question 1040

HbA1c is 75 mmol/mol or higher, type 2?

Answer 1040

Neutral Protamine Hagedorn (NPH) insulin• NPH + Short-acting insulin

Question 1041

WHEN DO YOU USE GLP-1?

Answer 1041

When triple therapy is an L but... have a body mass index (BMI) of 35 kg/m2 or higher (adjust accordingly for people from Black,Asian and other minority ethnic groups) and specific psychological or other medical problemsassociated with obesity or• have a BMI lower than 35 kg/m2 and:– for whom insulin therapy would have significant occupational implications or– weight loss would benefit other significant obesity related comorbidities.

Question 1042

VIGABATRIN? VISUALTOPIRAMATE? GLAUCOMA

Question 1043

MIGRAINE PROPHYLAXIS?

Answer 1043

PROPRANOLOLMETOPROLOLNADOLOLAMITRIPTYLINEVALPROATEPIZOTIFENNOT TRIPTAN- TREATS IT!

Question 1044

nicotine hyperglycaemia?

Question 1045

nrt diabetes caution, not contra

Question 1046

PAROXETINE TIME OF DAY?

Answer 1046

MORNING

Question 1047

PIOGLITAZONE HEPATIC IMPAIRMENT?

Answer 1047

AVOID

Question 1048

PHENYTOIN, RASH?

Answer 1048

BLOOD/SKIN DISORDER, A&E ASAP! LIFE THREATENING

Question 1049

antidepressants, SSRIs?

Answer 1049

best taken int he AM!

Question 1050

Codeine maximum dose/day?

Answer 1050

240mg

Question 1051

How many days of co-codamol 30/500mg tablets could you give maximum as an emergency supply?

Answer 1051

5 days maxAs co-codamol contains codeine 30mg which is a schedule 5 CD!

Question 1052

Diazepam/Temazepam dental?

Answer 1052

Hypnotic of choice

Question 1053

metoclopramide?

Answer 1053

diarrhoea

Question 1054

ferrous sulphate?

Answer 1054

constiaption/diarrhoeamore so constipation

Question 1055

common pneumonia causes?

Answer 1055

steptohaemophilus

Question 1056

FENTANYL PATCH COUNSELLING?

Answer 1056

WATERPROOF PATCH, no need to remove in showerDO NOT CUT, don't touch adhesive bitdry, flat, undamaged skin, avoid hairy areaSAvoid sunlightThe same area can be used after 7 daysFold patch in half, adhesive inwards, BIN

Question 1057

What is pharmaceutical care?

Answer 1057

the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve the patient's quality of life

Question 1058

what is medicines management?

Answer 1058

A system of processes and behaviours that determines how medicines are used by the NHS and patients

Question 1059

what is patient-centred care

Answer 1059

Providing care that supports people to achieve the health outcomes that give them the best opportunity to lead the life that they want.

Question 1060

rifampicin pancreatitis?

Answer 1060

rare

Question 1061

dry, irritating cough, no mucus, 7 yr old kid, first line?

Answer 1061

pholcodine linctus

Question 1062

Coughs and meds

Question 1063

s&s of rosacea?

Answer 1063

redness nose, cheek, forehead, chin, comes n goesburning/stinging with water/skincarebroken blood vessels, don't go

Question 1064

risedronate counselling?

Answer 1064

Swallow tablets whole with a full glass of water; on rising 30 minutes before the first food or drink of the day

Question 1065

High tsh, low t3, t4, hypothyroidism, give levothyroxine. But then low TSH happens?

Answer 1065

reduce levo dose

Question 1066

levothyroxine monitoring?

Answer 1066

tsh every 3 months till stable, then yearly

Question 1067

levothyroxine in pregnancy?

Answer 1067

higher dose requiredLevothyroxine may cross the placenta.Excessive or insufficient maternal thyroid hormones can be detrimental to fetus.Levothyroxine requirement may increase during pregnancy.

Question 1068

bmi ranges

Answer 1068

Healthy weight — BMI of 18.5–24.9 kg/m2• Overweight — BMI of 25–29.9 kg/m2• Obesity l — BMI of 30–34.9 kg/m2• Obesity ll — BMI of 35–39.9 kg/m2• Obesity lll — BMI of 40 kg/m2 or more

Question 1069

coronary heart disease modifiable risk factors?

Answer 1069

Obesity• Hypertension• High cholesterol (high LDL, low HDL)• Lack of exercise • Diabetes

Question 1070

CD MAXIMUM QUANTITY?

Answer 1070

30 DAYS!

Question 1071

RISK FACTORS FOR AKI?

Answer 1071

65+LIVER DISEASEDIABETESSEPSISOLIGURIA

Question 1072

Patient feels r S feels lethargic, low mood, skin colour has a paler yellow tinge?

Answer 1072

give vitamin b12

Question 1073

Management of osteoarthritic pain?

Answer 1073

Topical/oral NSAID+exerciseparacetamolexercise, weight lossDO NOT USE RUBBEFACIENTS/GLUCOSAMINE FOR OSTEROARTHRITISDO NOT OFFER ACCUPUNTURE EITHER

Question 1074

WARTS/VERRUCA VIRUS CAUSE?

Answer 1074

HUMAN PAPILLOMA VIRUS!

Question 1075

WARTS/VERRUCA REFERRAL?

Answer 1075

KEEPS COMIN BACKVERY LARGE/PAINFULBLEEDS/CHANGESFACE/GENITALS

Question 1076

BUPRENORPHINE W/ NALOXONE/SUBOXONE DRUG CLASS?

Answer 1076

3, NO REG

Question 1077

COC/POP/PATCH/VAGINAL RING/EHC efficacy?

Answer 1077

REDUCES SIGNIFICANTLY WITH INDUCERS• Carbamazepine• Eslicarbazepine• Nevirapine• Phenobarbital• Primidone• Ritonavir• St John's wort • TopiromateETCbarrier/depo/IUD IS ADVISED

Question 1078

PREGABALIN TREATMENT CESSATION?

Answer 1078

Avoid abrupt withdrawal (taper over at least 1 week).

Question 1079

LAMOTRIGINE TAPERING?

Answer 1079

2 WEEKS OR LONGER!

Question 1080

WHEN TO STOP HRT (not give aspirin lol)?

Answer 1080

CHEST PAINBREATHLESSNESSSWELLING/LEG PAINSTOMACH PAINBP 160>HEPATITISIMMOBILITY SURGERY

Question 1081

tiaprofenic acid indication?

Answer 1081

Pain and inflammation in rheumatic disease and other musculoskeletal disorders

Question 1082

PPI side-effect?

Answer 1082

hypomagnesaemia

Question 1083

SICK DAY, diarrhoea, vomiting?

Answer 1083

THINK SADMAN!!!!

Question 1084

4 year old child, burn on hand, blistering?

Answer 1084

A&E ASAP!

Question 1085

SYMPTOMS OF STROKE?

Answer 1085

numbness, weakness, slurred speech, or visual disturbanceVISION LOSS THAT IS

Question 1086

LEVOTHYROXINE, DAMN, SPC USE WHOLE TEXT

Answer 1086

If necessary, Levothyroxine Oral Solution can be administered via a nasogastric feeding tube that should be rinsed twice with 10 ml of water immediately after administration.

Question 1087

3 year old, nystatin, oral thrush?

Answer 1087

1ml QDS, 7 days+2 days after lesions have healed

Question 1088

HPV VACCINE?

Answer 1088

Children aged 9-14 yrs:• A 2-dose schedule is recommended for children who receive the first dose before the age of 15 yrs• The first dose is usually given at 11 yrs old and the second dose 6-24 months after. If given less than 6 months apart it should not be considered adequate to provide long-term protection. A third dose should be given in that case.Children and adults aged 15-25 yrs:Individuals remain eligible to receive the HPV vaccine up to the age of 25 years if they did not receive the vaccine when scheduled. A 3-dose schedule is recommended, with the second and third dose given 1 month and 4–6 months after the first dose, respectively. All 3 doses should be given within a 12-month period

Question 1089

HPV PROTECTION YEARS?

Answer 1089

AT LEAST 10

Question 1090

VILDAGLIPTINS LIVER?

Answer 1090

HEPATOXIC REPORT!

Question 1091

cd 3/4/5 emergency supply max days?

Answer 1091

5but phenobarbital no max if prescriber

Question 1092

B-BLOCKER MASKS SYMPTOMS OF HYPOYGLYCAEMIA, EXCEPT SWEATING! CRAZY Q

Answer 1092

Beta blockers mask signs and symptoms of hypoglycaemia (e.g. tachycardia, tremor, blurred vision, hunger & headache) except sweating; also impair insulin release and glycogenolysis; cardioselectiv

Question 1093

HYPOGLYCAEMIA?

Answer 1093

3-4 TEASPOONS OF SUGAR CALM,150-200 MLL JUICE FRULLY

Question 1094

threadworms does not require referral to gp, can treat OTC, only refer if under2/breast feeding

Answer 1094

Recommend that Miss Y's son wears under wear at night, which she should change in the morning

Question 1095

Sildenafil+tamsulosin?

Answer 1095

risk fo hypotension

Question 1096

BABIES, DEHYDRATION?

Answer 1096

DRY NAPPIES! REFER

Question 1097

KIDS WITH DEHYDRATION?

Answer 1097

seem drowsybreathe fasthave few or no tears when they cryhave a soft spot on their head that sinks inwards (sunken fontanelle)have a dry mouthhave dark yellow pee or have not had a pee in last 12 hourshave cold and blotchy-looking hands and feet

Question 1098

HRT, INCREASES RISK WITHIN 1 YEAR OF STARTING BUT DECREASES WITHIN 5 YEARS OF STOPPING?

Answer 1098

BREAST CANCER!

Question 1099

valproate, prescriber, ppp?

Answer 1099

dispense+take regs

Question 1100

immunisation w/ yellow fever?

Answer 1100

take at least 10 days before travelling!

Question 1101

Pregnant lady, gphc renewal looming, action?

Answer 1101

She can still renew her GPhC registration without submitting all the records if she contacts the GPhC to explain her circumstances as soon as possible

Question 1102

METHOTREXATE+TRIMETHOPRIM?

Answer 1102

anti folate, haematological toxicity!

Question 1103

doxycycline capsules?

Answer 1103

swallow wholeplenty of fluidsit/stand

Question 1104

SIGNS OF HYPERCALCAEMIA?

Answer 1104

Loss of appetite• Nausea and vomiting• Constipation and abdominal (belly) pain• The need to drink more fluids and urinate more• Tiredness, weakness, or muscle pain• Confusion, disorientation, and difficulty thinking• Headaches• Depression

Question 1105

hyponatraemia sign?

Answer 1105

muscle weaknessconfusion Weakness• fatigue or low energy• Headache• Nausea• Vomiting• Muscle cramps or spasms• Confusion • Irritability

Question 1106

signs of hyperkalaemia?

Answer 1106

Feeling very tired or weak• Stomach pain or nausea• Dizziness• Muscle pain or cramps• Trouble breathing• Weakness in the arms and/or legs• Unusual heartbeat or chest pains

Question 1107

hypomagnesaemia range?

Answer 1107

0.8-1 somethings

Question 1108

Lithium+NSAIDs/ACE?

Answer 1108

Increases lthium conc

Question 1109

Naproxen+cipro?

Answer 1109

lowers seizure threshold, convulsions risk!

Question 1110

AVOID NSAIDS/B-BLOCKERS IN ASTHMA

Question 1111

migraine, nsaids, need quick treatment?

Answer 1111

soluble paracetamol!

Question 1112

For swelling and inflammation (throbbing with pain) of an injury, an NSAID would be a more suitable option.

Answer 1112

IBUPROFEN

Question 1113

back+knees, painful and stiff, gardner, first line?

Answer 1113

paracetamol, then up the ladder

Question 1114

LTHIUM+AMITRIPTYLINE INTERACTION?

Answer 1114

NEUROTOXICITY

Question 1115

cd prescriptions 'twice a day' insufficientbe clear!

Question 1116

gestational hypertension, yes labetalol, etc but other advice?

Answer 1116

top ACE inhibitors, ARBs, thiazide or thiazide-like diuretics due to an increased risk of congenital abnormalities.

Question 1117

pyelonephritis management?

Answer 1117

cefalexin or ciproORsensitivity known? co-amoxiclav or trimethoprim

Question 1118

impetigo systemic?

Answer 1118

fluclo->clari

Question 1119

SINUSITIS TREATMENT?

Answer 1119

PHENOXYMETHYLPENICILLINVery unwell? Co-amoxiclav(pen allergy? Doxycycline/Clarithromycin/Ery in pregnancy

Question 1120

Chronic eczema, tried betamethasone 0.25%, next best option in primary care setting?

Answer 1120

Hydrocortisone butyrate 0.1% cream

Question 1121

Scarlett fever in OTC?

Answer 1121

Gotta refer, Abx treatment, not paracetamol silly

Question 1122

Pregnant, severe itching, atnight?

Answer 1122

REFER, GP, CHOLESTATSIS SOMETHINGS!

Question 1123

sidenafil+sickle-cell disease?

Answer 1123

caution :?

Question 1124

headlice, only treat on live heads

Question 1125

permethrin whole body, wash after12hours, repeat after a week

Question 1126

contact dermatitis, itchy, rash, cleaning?

Answer 1126

emollient+steroid

Question 1127

What is solpadeine?

Answer 1127

co-codamol, containing codeine, 3 days max

Question 1128

pseudoside-effects?

Answer 1128

sleep Lheart quick

Question 1129

dry sore patches, knees, elbows?

Answer 1129

atopic eczema

Question 1130

deodorant, skin irritated?

Answer 1130

use hydrocortisone 1%

Question 1131

HYDROCORTISONE NOT FOR ANGULAR CHELLITISce

Answer 1131

ON THE FACE OBVS

Question 1132

17 year old hayfeversneezing, nasal Ltreatmetn?

Answer 1132

cetirizine tablets

Question 1133

HEAD LICES KILLED, STILL EGG CASES?

Answer 1133

IT's fine

Question 1134

patient promethazine, hay fever, has glaucoma?

Answer 1134

give alternative

Question 1135

3 thrush attacks in 6 months= refer

Question 1136

smoking cessation in asthmatics?

Answer 1136

not gum?

Question 1137

CD on VET form?

Answer 1137

NOT standardised form, private, charge and keep 5 years!

Question 1138

only tabs/caps CDs needing denaturing should be debilisterd!

Question 1139

patient fails to collect their methadone, when do i contact prescriber?

Answer 1139

after 3 days L

Question 1140

fmp10mda methadone duration?

Answer 1140

2 weeks

Question 1141

vet prescription calm?

Answer 1141

yes, dispense

Question 1142

NO RPNO SIGN INNADA CAN DO?

Answer 1142

ORDER STOCKRECEIVE STOCK/RETURNS (excluding CDs)PUT STOCK AWAY (excluding CDs)

Question 1143

CD pick up, on behalf, MUST?

Answer 1143

REQUEST PROOF OF IDENTITY?

Question 1144

HCP acting on behalf, schedule 2 CD?

Answer 1144

nameaddressrequest evidence of identity

Question 1145

family member/representative on behalf, sch 2 CD?

Answer 1145

upto pharmacist

Question 1146

patient returned sch 2 CD?

Answer 1146

just dispose as directed, no-one cares, staff witness is good practice

Question 1147

diazepamtemazepam Schedule?

Answer 1147

43

Question 1148

CD2 TECHNICAL ERRORS?

Answer 1148

Where a prescription for a Schedule 2 or 3 CD contains a minor typographical error or spelling mistake, or where either the words or figures (but not both) of the total quantity has been omitted, a pharmacist can amend the prescription indelibly so that it becomes compliant with legislation.

Question 1149

patient requests their data?

Answer 1149

may be charged a fee

Question 1150

ACCOUNTABLE OFFICER ROLE?

Answer 1150

they don't personally supervise destruction, they appoint witnesses, and otehr thigns

Question 1151

haemorrhoids likely?

Answer 1151

nausea, acupressure bands

Question 1152

PPIs do not make stools black!

Question 1153

ALENDRONIC ACID REFERRAL SERIOUS?

Answer 1153

Severe oesophageal reactions (oesophagitis, oesophageal ulcers, oesophageal stricture and oesophageal erosions) have been reported; patients should be advised to stop taking the tablets and to seek medical attention if they develop symptoms of oesophageal irritation such as dysphagia, new or worsening heartburn, pain on swallowing or retrosternal pain.

Question 1154

STOOLS, HARD, DRY, FIBRE FLUID, TREATMENT?

Answer 1154

stool softner

Question 1155

omeprazole starting dose?

Answer 1155

10mg OD?

Question 1156

lansoprazole, peptic ulcer treatment?

Answer 1156

hypomagnesaemia

Question 1157

spasmodic, cramping?

Answer 1157

giveatropinehyoscine hydrobromide- no CNS effects

Question 1158

dompierdone 7 days max, not appropriate for long jourenys

Question 1159

alternative to mebeverine?

Answer 1159

hyoscine

Question 1160

hard stools Faecal impactionprescription?

Answer 1160

macrogol

Question 1161

pregnant, lifestyle, advice, L, constipatedfirst line?

Answer 1161

bulk forming, ispag, standard

Question 1162

diarrhoea, kid, 24 hrs, bug?

Answer 1162

rehydration sachets!

Question 1163

traveller's diarrhoea, standby?

Answer 1163

loperamideazibismus?

Question 1164

end stage renal failure?

Answer 1164

there's elevated phosphate

Question 1165

eGFR <15mL/min, biochemical abnormality?

Answer 1165

hypocalcaemia!

Question 1166

yellow-brown urine, Abx?

Answer 1166

nitrofurantoin

Question 1167

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.

Answer 1167

UNDER 18S, REFER!!!

Question 1168

TRANEXAMIC ACID- BLEEDINGPERIOD PAIN- IBUPROFEN 12+, FEMINAX ULTRA 15-50

Question 1169

ramipril dosing eGFR of 58ml/min?

Answer 1169

5mg OD

Question 1170

Max. daily dose 5 mg if creatinine clearance 30–60 mL/minute; max. initial dose 1.25 mg once daily (do not exceed 5 mg daily) if creatinine clearance less than 30 mL/minute. See

Answer 1170

RAMIPRIL!

Question 1171

Which of the following statements is INCORRECT in relation to the treatmentfailure of NuvaRing?.

Answer 1171

A if the ring was out of the vagina for an unknown amount of time, you may not be protectedfrom pregnancy.B if the ring has been out of the vagina for less than 2 hours, you are not protected againstpregnancy. ANSWER!!C if the ring has been out of the vagina for more than 3 hours during the 1st and 2nd week, itmay not protect you from pregnancy. You should put the ring back in the vagina as soon as youremember and leave the ring in place without interruption for at least 7 days.D if the ring has been out of the vagina for more than 3 hours in the 3rd week it may not protectyou from pregnancy. You should discard that ring and insert a new ring immediately.E if the ring has been out of the vagina for less than 3 hours, it will still protect you frompregnancy. You should put the ring back in as soon as possible but only if the ring has been outof the vagina for less than 3 hours.

Question 1172

cleft palate preg 12 weeks?

Answer 1172

MHRA/CHM advice: Ondansetron: small increased risk of oral clefts following use in the first 12 weeks of pregnancy (January 2020)Epidemiological studies have identified a small increased risk of cleft lip and/or cleft palate in babies born to women who used oral ondansetron during the first trimester of pregnancy. Healthcare professionals are advised that if there is a clinical need for ondansetron in pregnancy, patients should be counselled on the potential benefits and risks, and the final decision made jointly.

Question 1173

CLOTRIMAZOLE CREAM+CARBAMAZEPINE?

Answer 1173

yh avoid, epssary

Question 1174

A 22-year-old female has come to the pharmacy asking for your advice regarding her painfulperiods that has started a few months ago. Upon questioning the patient, you find out thatshe is suffering from lower abdominal pain and backache, which starts several days beforeher period begins. She tells you that her menstrual cycle used to be very regular but nowtends to vary and some occasions she has 2-3 weeks between her periods. She alsomentions that her pain continues throughout menstruation and it is quite severe in nature.She has tried ibuprofen and has had no effect on her pain symptoms. Which of the followingconditions best describes the patient’s symptoms?

Answer 1174

secondary dysmenorrhiae

Question 1175

GLP rapidly discontinued?

Answer 1175

DKA!

Question 1176

H PYLORI REGIME, PENICILLIN ALLERGY?

Answer 1176

CLARI 250 BD!

Question 1177

H PYLORI

Question 1178

A 10-year-old boy is brought into the Pharmacy by his father. He thinks that his son has hurt his ankle whilst playing rugby yesterday. The boy looks to be in pain although he denies any discomfort. On examination, there seems to be some bruising and mild swelling.

Question 1179

A 10-year-old boy is brought into the Pharmacy by his father. He thinks that his son has hurt his ankle whilst playing rugby yesterday. The boy looks to be in pain although he denies any discomfort. On examination, there seems to be some bruising and mild swelling.

Answer 1179

Recommend the application of frozen peas to the ankleno pain management needed

Question 1180

sulphonylureas, G6PD deficiency

Question 1181

ST JOHN WORT+THEOPHYLLINE? POTENTIALLYSMOKING BIG NO NO

Question 1182

A 30-year-old lady comes to your pharmacy and asks to speak to you in private. She says that she haƐ iƚchiŶg ͞dŽǁŶ belŽǁ͟ aŶd ƐaLJƐ ƚhaƚ ƚheƌe iƐ a lŽƚ Žf diƐchaƌge ǁhich iƐ fƌŽƚhLJ͕ ƐŵellLJ aŶd iƐ yellow-green in colour. She has been delaying getting any medical attention as she is very embarrassed

Answer 1182

Trichomoniasis Vaginalis

Question 1183

bacterial vag

Answer 1183

fishy smelly

Question 1184

BV

Answer 1184

The most common symptom of bacterial vaginosis is unusual vaginal discharge that has a strong fishy smell, particularly after sex. You may notice a change to the colour and consistency of your discharge, such as becoming greyish-white and thin and watery.

Question 1185

TRICH VAG

Answer 1185

Women with trich may notice: Itching, burning, redness or soreness of the genitals; Discomfort when peeing; and. A clear, white, yellowish, or greenish vaginal discharge (i.e., thin discharge or increased volume) with a fishy smell.

Question 1186

A patient safety incident report which details the dispensing error that resulted in the death of a patient last month

Answer 1186

KEEP THE RECORD, LONGER THAN VET!

Question 1187

INFECTED EYES, GLAUCOMA?

Answer 1187

REFER, DON'T TREAT SILLY

Question 1188

A lady comes into your pharmacy to buy some Optrex® for her eye. On questioning she tells you that her eyelids are itchy, sore, and always swollen. She is always having to wipe away the crust on her eyelashes and has noticed that they have started to fall out. She has a medical history of glaucoma, arthritis and seborrhoeic dermatitisTreat?

Answer 1188

Advise her to wipe lids twice a day with cotton wool dipped in diluted baby shampoo

Question 1189

finasteride, female handling?

Answer 1189

Risk to the male foetus

Question 1190

hyoscine butylbromide side-effects?inf

Answer 1190

bronchial Ldry mouthurinary retentionconstipationNOT? dilated pupils

Question 1191

77-year-old retired primary school teacher enters your pharmacy requesting treatment for a mouth ulcer that he has now had for 3 weeks. He explains that he bit his tongue a few weeks ago which he thinks may be the cause. On questioning you find out that he is not experiencing any pain from the ulcer, and there is a single ulcer 1 cm in diameter?

Answer 1191

SQUAMOUS CELL CARCINOMA

Question 1192

PAINLESS ULCER?

Answer 1192

CANCER, REFER!

Question 1193

pioglitazone MOA?

Answer 1193

reduces peripheral insulin resistance+reduces glucose in bloodstream

Question 1194

A 14-year schoolboy has just been administered the Men ACWY vaccine. He is experiencing neurally mediated syncope due to a psychogenic response to the needle injection. He has collapsed to the ground.AC

Answer 1194

RAISE LEGS

Question 1195

COPDLAMA NOT LICENSE FOR OD DOSING?

Answer 1195

Maintenance treatment of chronic obstructive pulmonary diseasefor aclidinium bromideBy inhalation of powderAdult375 micrograms twice daily.

Question 1196

ANTIBIOTICS CAUSING C DIFF?

Answer 1196

CEPHALOPSORINSCLINDAMYCINCO-AMOXICLAVQUINOLONESNOT AMINOGLYCOSIDESNOT DOXYCYCLINE

Question 1197

c diff morbidities, risk factors, L

Question 1198

A 75-year old patient comes to the community pharmacy to collect her repeat medication. She started taking prednisolone 40mg OD three days ago, for a period of 10 days. She tells you that she has been feeling very irritable and 'seeing things' that are not there. She asks you if her feelings have been brought on by the new tablet

Answer 1198

She is experiencing prednisolone side effects so should see her GP as soon as possible

Question 1199

PREDNISOLONE, CORTICOSTEROID BAD REACTION?

Answer 1199

Psychiatric reactionsSystemic corticosteroids, particularly in high doses, are linked to psychiatric reactions including euphoria, insomnia, irritability, mood lability, suicidal thoughts, psychotic reactions, and behavioural disturbances. These reactions frequently subside on reducing the dose or discontinuing the corticosteroid but they may also require specific management. Patients should be advised to seek medical advice if psychiatric symptoms (especially depression and suicidal thoughts) occur and they should also be alert to the rare possibility of such reactions during withdrawal of corticosteroid treatment. Systemic corticosteroids should be prescribed with care in those predisposed to psychiatric reactions, including those who have previously suffered corticosteroid–induced psychosis, or who have a personal or family history of psychiatric disorders.STOP, GP GO

Question 1200

sulfasalazine breast feeding?

Answer 1200

AVOIDBreast feedingBreast feedingFor sulfasalazineSmall amounts in milk (1 report of bloody diarrhoea); theoretical risk of neonatal haemolysis especially in G6PD-deficient infants.

Question 1201

nicorandil, heart burn?

Answer 1201

GP review

Question 1202

NICORANDIL SE

Answer 1202

Side-effects, further informationNicorandil can cause serious skin, mucosal, and eye ulceration; including gastrointestinal ulcers, which may progress to perforation, haemorrhage, fistula or abscess. Stop treatment if ulceration occurs and consider an alternative.

Question 1203

most URGENT QUERY DOCTOR/

Answer 1203

woman prescribed an increased dose of Zomorph® capsules from 10mg BD (prior to hospital admission) to 100mg BD (post discharge) mad increase

Question 1204

DESMOPRESSIN, TREATS URINARY INCONTINENCE, SO OFCOURSE YOU GNNA PEE A LOT!

Question 1205

CODEINE USELESS IN BONE METASTASES, CANCER

Question 1206

TUMOUR NERVE PAIN FINE OPTIONS?

Answer 1206

AMITRIPTYLINEGABAPENTINDEXAMETHASONEIMIPRAMINE

Question 1207

25 with a 12 patchit's allowed!!

Question 1208

Diamorphine 30mgx Hyoscine hydrobromide 40mg?

Answer 1208

iamorphine 30mgx Hyoscine hydrobromide 40mg

Question 1209

A 27-year-old woman presents with nausea and vomiting, diarrhoea, constipation, weight loss, polyuria, sweating, headache, thirst, vertigo, and raised concentrations of calcium and phosphate in plasma and urine. She is thought to have overdosed vitamin?

Answer 1209

Calcitriol

Question 1210

A 68-year-old has been diagnosed with mild heart failure which has been exacerbated by an additional treatment resistant chronic condition. You are also given the following information:creatinine clearance is 89 ml/min, blood sugars: 5mmol/ml; alanine transaminase and bilirubin within range

Answer 1210

AnaemiaAnemia is a frequent comorbidity of heart failure and is associated with poor outcomes. Anemia in heart failure is considered to develop due to a complex interaction of iron deficiency, kidney disease, and cytokine production, although micronutrient insufficiency and blood loss may contribute.

Question 1211

A 68-year-old lady is collecting her regular repeat prescription for osteoporosis. You ask how she and the family are and she tells you that several members of the family have been suffering with diarrhoea on and off since their recent trip to Pakistan. They have all been given a course of antibiotics to take. She says they will not visit whilst they are unwell

Answer 1211

GiardiasisHow do you get giardiasis?You can get giardiasis if you swallow Giardia germs. Giardia spreads easily and can spread from person to person or through contaminated water, food, surfaces, or objects. The most common way people get sick is by swallowing contaminated drinking water or recreational water (for example, lakes, rivers, or pools).

Question 1212

A customer wants advice regarding her son aged 11 who is going on a school trip to London. He has had diarrhoea and she is worried that the other school children or his 2 younger siblings may also get it. His diarrhoea started yesterday; he went to the toilet about 6 times and was sick once but has not been sick since. He has cramping pains but is generally well and anxious not to miss his trip. Yesterday he had pie and chips from the local chip shop whilst his siblings had sausage and chips.

Answer 1212

Salmonella

Question 1213

SPUTUMA twenty-nine-year-old lady has an acute infection and exacerbation of bronchiectasis for the last 3 days and has started a course of co-amoxiclav this morning. She is short of breath and bilateral basal crackles are present during auscultation.THEO

Answer 1213

Thick bright yellow/green mucus

Question 1214

A 64-year-old woman who is overweight and a smoker has had 2 weeks off work as she has sprained her ankle and her sister has come to stay with her to look after her. She is on the HRT Premarin® and Ibuprofen 400mg three times a day for the sprain. Recently she has been experiencing shortness of breath and chest pain and her usual cough has changed

Answer 1214

Rust coloured mucus

Question 1215

A 78-year-old man who has undergone a cardiac bypass operation has developed malignant hyperthermia due to the muscle relaxant used alongside the general anaesthetic

Answer 1215

A 78-year-old man who has undergone a cardiac bypass operation has developed malignant hyperthermia due to the muscle relaxant used alongside the general anaesthetic

Question 1216

ANAESTHESIA IN CAESARIAN?

Answer 1216

ISOFLURANE

Question 1217

An eighty-year-old retired doctor has been admitted to hospital for a total hip replacement. He requires an opioid in his syringe driver, but his renal function has deteriorated over the last 24 hours.

Answer 1217

go for alfentanyl

Question 1218

The doctor who is reviewing an 88-year-Žld͛Ɛ pain management wants to prescribe an opioid with mixed agonist and antagonist activity at opioid receptors as she has chronic respiratory disease.

Answer 1218

MEPTAZINOL

Question 1219

A patient has been complaining of pins and needles since starting chemotherapy for pancreatic cancer. He is experiencing peripheral paraesthesia, loss of tendon reflexes, abdominal pain, and constipation.

Answer 1219

VINCRISTINE

Question 1220

On examination by the oncologist, a lady is found to have cƌeƉiƚaƚiŽŶ͛Ɛ at both lung bases. The medical team think that her symptoms may be associated with her current chemotherapy, which is associated with dose-related progressive pulmonary fibrosis.

Answer 1220

BLEOMYCIN

Question 1221

A twenty-three-year-old collapsed in your pharmacy and has been having a seizure for the last 6 minutes with no sign of improvement. She is epileptic and has had a convulsive seizure 3 weeks ago after deterioration of her condition. The ambulance is on its way.

Answer 1221

Diazepam rectal solution(OR buccal midazolam)THINK ,DO NOT RUSH

Question 1222

A male type 2 diabetic patient has been admitted to hospital with acute exacerbation of asthma due to a chest infection. He also has mild heart failure for which he takes an angiotensin 2 inhibitor, beta blocker and loop diuretic. His blood sugars are measured at 24mmol/L. He is commenced on a variable rate insulin infusion. What is the MOST likely effect of his condition and subsequent treatment on his electrolytes?

Answer 1222

Hypokalaemia

Question 1223

Prochlorperazine in PD?

Answer 1223

Absolute L, avoid

Question 1224

Patient with cold, run down, itchy, painful, burning?

Answer 1224

The symptoms suggest shingles rash caused by varicella zoster. There is usually aprodromal phase with abnormal skin sensations and pain in the affected dermatome(area of skin served by an individual nerve). Within 2–3 days, a rash typically appearsin a dermatomal distribution. It starts as maculopapular lesions then develops intoclusters of vesicles, with new vesicles continuing to form over 3–5 days. The rash isusually painful, itchy, and/or tingly, and, unlike other rashes, does not cross the midlineof the body

Question 1225

SHINGLES TIP?

Answer 1225

NEVER CROSSES MIDLINE OF BODY

Question 1226

Patient is experiencing post-herpetic neuralgia, best option?

Answer 1226

Amitriptyline ON

Question 1227

TCA what level to look at, experienced fall?

Answer 1227

sodium levels!

Question 1228

heart failure/cardiac function test?

Answer 1228

PEPTIDE TING

Question 1229

hba1c test?

Answer 1229

diabetes

Question 1230

thyroid test?

Answer 1230

hyper/hypothyroidism

Question 1231

CT pulmonary test?

Answer 1231

PE

Question 1232

b12 fatigue test

Question 1233

MENINGOCOCCAL DISEASE/MENINGITIS?

Answer 1233

BENZYLPENICILLIN---> CEFOTAXIME----> CHLORAMPHENICOLdon't forget penicillin allergy, cross-sen

Question 1234

Tigecycline AGE?

Answer 1234

Tigecycline (tetracycline antibiotic) is contraindicated in children under the age of 12years old due to the risk of deposition in growing bones and teeth

Question 1235

oRAL Teicoplanin?

Answer 1235

should not be given by mouth for systemic infections because it is notabsorbed significantly. It is also not indicated to treat meningitis

Question 1236

ADULT ASTHMAICS+SABA, LNEXT STEP?

Answer 1236

Replace Qvar inhaler with Fostair (beclomethasone/formoterol)

Question 1237

LEGAL REQUIREMENT FOR CD RECORDING?

Answer 1237

It is a legal requirement to keep CD registers (paper and electronic) for two years fromthe date of the last entry.The other options are not legal requirements. It is not necessary to have both writtenand electronic CD registers. Registers in general shouldn’t be amendable at a laterdate, however there may be some instances where an error has been made with anentry therefore an amendment will be required. For most organisations stock checksshould be at least once a week but may be more or less frequent based on risk.Keeping a running balance in a CD register is good practice requirement not yetmandatory

Question 1238

Chloramphenicol storage?L

Answer 1238

Chloramphenical information leaflet states that the medicine needs to be stored uprightbetween 2-8oC in a refrigerator and protected from light and must be used within fourweeks of opening.

Question 1239

RARE SIDE-EFFECT OF CISPLATIN?

Answer 1239

CONVULSION

Question 1240

AUDIT SUMMARY?

Answer 1240

Data collection is a key step in an audit cycle. Collecting and analysing data on theadministration of medicines will provide evidence of whether standards are being metand enable you to achieve your aim.Ethics approval is not usually required for audits, however if your evaluation includespatients, you may require approval. If in doubt check with the National Institute forHealth and Care Research (NIHR) Also looking for errors is not usually part ofaudit/improvement process.It is good practice to re-audit after a certain period, however doing this after one monthwould be too soon and is unlikely to provide new or useful results. It is unusual toupdate guidelines and protocols before an audit takes place. This may be arecommendation you action after the audit.

Question 1241

A 40-year-old woman visits your community pharmacy and asks to purchase travelsickness tablets, as she is going on a long-haul flight next week. The counterassistant tells you that she has hypertension, type 2 diabetes and occasional backpain, which are all adequately managed by her regular medication. Which of the following options are you most likely to take next?

Answer 1241

SELL APCK OF 12 HYOSCINE HYDRO, 300MCG TABSThe patient’s medical conditions do not interfere or relate to travel sickness and thuscan be supported without referral. Hyoscine HYDRObromide is used for travel sicknessand available to purchase without a prescription and is the most appropriate option.Cinnarizine 15 mg tablets are also suitable and indicated for travel sickness, howeverthis pack size is not reality available as a P medicine (usually sold as Stugeron 15, packsize 15), and selling a pack of 100 is excessive. You may have also chosen to sellhyoscine butylbromide 10 mg tablets, however hyoscine butylbromide is licensed totreat abdominal cramps/spasms and IBS like symptoms. Encouraging fluidconsumption is unlikely to prevent travel sickness, thus is not a suitable cause of actionfor the patient.

Question 1242

amiodarone does not need?

Answer 1242

full blood count!

Question 1243

what drugs are used in urgency urinary incontinence?

Answer 1243

oxybutynin, tolterodinemirabegronduloxetine, stress

Question 1244

DRUG WITH LEAST ANTICHOLINERGIC SIDE-EFFECTS?

Answer 1244

MIRABEGRON

Question 1245

Gout, acute, can't tolerate nsaids or colchicine?

Answer 1245

A short course of oral corticosteroid or a single injection of intramuscular corticosteroid are effective alternatives in those who cannot tolerate NSAIDs or colchicine

Question 1246

Quinolones, cipro+ibuprofen?

Answer 1246

tendons, it's peak

Question 1247

patient with swelling, elderly, no ccb, next up?

Answer 1247

indapamide 2.5 mg dailyoedema ramipril L

Question 1248

A 72-year-old woman presents to A&E with a tingling sensation in the hands and feet which gradually progresses to pain. Onexamination, the palms and soles are noted to be swollen and tender on palpation. The patient has recently completed her first cycleof chemotherapy 3 days ago for breast cancer.Which chemotherapy agent is most likely to be causing the patients symptoms?

Answer 1248

fluorouracil?

Question 1249

statins remember, check hba1c prior if diab

Question 1250

ramipril no effect on sugar levels, least likely, just potassium

Question 1251

inappropriate way to manage statin intolerance?

Answer 1251

discontinuing it, silly

Question 1252

Mrs M, a 32-year-old woman who had her first child last year, decides she would like to lose weight in a healthy way. She has not beenlooking after herself and has stopped exercising and is constantly snacking. She is hoping to get back to her pre-maternity weight andhas today signed up to her local gym and a local weight loss support programme.Which of the following stages of behavioural change is Mrs M at?

Answer 1252

Preparation

Question 1253

How long after stopping fluoxetine must the patient wait before starting phenelzine?

Answer 1253

5 weeks g

Question 1254

A pharmacist is checking a prescription for carbamazepine tablets for an 80-year-old patient with trigeminal neuralgia. The patient hasbeen taking carbamazepine for 6 months and had their dose slowly raised so that they are no longer suffering any pain.An extract from the SmPC for carbamazepine 100 mg tablets is shown below.Which of the following dosages and monitoring would be most appropriate for this patient?https://www.medicines.org.uk/emc/product/1040/smpc#gref

Answer 1254

carbamazepine 200 mg TDS, no levels/monitoring required

Question 1255

APPROPRIATE empirical treatment of an infective exacerbation of COPD?

Answer 1255

AMOXICILLIN/DOXYCYCLINECLARITHROMYCINCO-AMOXICLAVCO-TRIMOXAZOLELEVOFLOXACINTHAT ORDER

Question 1256

A man is on the medical ward being treated for COVID-19. The guideline recommends dexamethasone 4 mg OD for a total of 10 days.Information on the equivalent anti-inflammatory doses of corticosteroids is shown below.prednisolone 5mg- dexamethason 750mcgequivalent 10 day dose?

Answer 1256

267 mg

Question 1257

A 12-year-old child requires amoxicillin 500 mg TDS for 10 days, for a lower respiratory tract infection. She has no known drug allergiesand takes no regular medication.Which of the following quantities of amoxicillin 250 mg/5 mL suspension is the most suitable to supply for her to complete thecourse?

Answer 1257

3 bottles, 100ml/ bottle?

Question 1258

A patient with known epilepsy is at home and having her third seizure within one hour. The family have removed their glasses andmoved harmful objects out of reach.Having made sure the patient is safe from injury, which of the following would be the most appropriate treatment for theseizure?

Answer 1258

midazolam given buccally

Question 1259

what does neonate mean?

Answer 1259

birth to 28 days

Question 1260

An acutely ill 80-year-old man has been admitted to your medical ward. You are reviewing his medications and decide he requirespharmacological venous thromboembolism (VTE) prophylaxis.Which of the following medications would be most appropriate for VTE thromboprophylaxis in this patient?

Answer 1260

ENOXAPARIN IS STANDARD, YOU SEE ON CHARTS ALL THE TIME!

Question 1261

Answer 1261

Zomorph 200 mg BD

Question 1262

reason for proton pump inhibitor is often prescribed for patients peri-operatively?

Answer 1262

to reduce the risk of regurgitation and aspiration of gastric contents

Question 1263

NHS fruit n veg advice?

Answer 1263

30g (1 heaped tablespoon) of dried fruit such as raisins and apricots also count as one portiona portion of fruit of vegetables is 80g or a slice of a large fruit such as a melon or a bowl of mixed saladover a third of the diet should come from fruit and vegetablesthree tablespoons of cooked vegetables would count as one portion

Question 1264

LFTs, we don't care in lithium!! onyly...

Answer 1264

BMI RENAL ELECTROLYTES THYROID

Question 1265

WHEN WOULD YOU REPORT ON YELLOW CARD SCHEME?

Answer 1265

amoxicillin- diarrhoeast john's wort- jaundiceviagra- fakeamitriptyline, hospital- dizzinesNOT? codeine constipation

Question 1266

Which of the following drugs should not be used in combination with methotrexate due to the increased risk ofagranulocytosis?

Answer 1266

Olanzapine, antipsychotic, erghhh

Question 1267

CHC missed pill?

Answer 1267

>/= 24hrs L

Question 1268

vet cd SUPPLY?

Answer 1268

28 days is good practice, weird don't ask

Question 1269

You receive a phone call from a worried mother, who tells you that her son, aged 7, looks unwell and appears confused. You ask furtherquestions and establish that the child is breathing rapidly and hasnʼt passed urine for the last 36 hours.

Answer 1269

sepsis call 999 peak

Question 1270

A man has come into the pharmacy to buy Allevia (fexofenadine) 120 mg tablets. He has used them before for himself and would like totake a pack on holiday for his family.Which of the following statements regarding the use of Allevia 120 mg tablets is correct?

Answer 1270

12+Apple juice and orange juice decrease the exposure to fexofenadine.120mg in adults and children!

Question 1271

A woman has come into the pharmacy to purchase Hana (desogestrel) 75 microgram tablets over-the-counter. Before making thesupply, you decide to refresh your knowledge on the use of Hana to ensure you have all the required information. The woman hasnever used them before and is buying them for the first time.Which of the following statements regarding the use of Hana is the most appropriate advice to give?

Answer 1271

the woman should start taking Hana on day 1 of her period. She can start on days 2-5 but will need to use an additional barrier method(e.g. condom) for the first 7 days

Question 1272

This medicine should be prescribed with caution in patients with lactose intolerance as it may cause diarrhoea.

Answer 1272

LACTOSE INTOLERANCE!

Question 1273

The method of emergency contraception that is suitable for a 15-year-old child who had unprotected sexual intercourse 2days ago with a boy of a similar age. No safeguarding concerns were identified, and the patient prefers not to have an invasiveprocedure.

Answer 1273

ulipristal acetate 30 mg tablets5mg is fibroids smh!!!

Question 1274

A parent presents to the pharmacy with their 5-year-old child who is complaining of dry, itchy, cracked skin on the backs oftheir knees and on their hands which they have had for two weeks now. The child has asthma and the only medication theytake is a Clenil Modulite 50 microgram per actuation inhaler and Ventolin 100 microgram Evohaler. They have no known drugallergies and have not tried anything.

Answer 1274

EMOLLIENT FIRST CMON! UNDER 10 AS WELL LOL

Question 1275

ALWAYS ELIMINATE, GIVE REASONS AND RATIONALISE!GO WITH GUT BUT SLOW

Question 1276

A concerned parent presents to the pharmacy with their 4-year-old child as they are concerned about a red blanching rashthat has recently developed on the childʼs chest and tummy. They explain that initially, a couple of days ago, they had a hightemperature (39 degrees centigrade) and a sore throat. A white coating has started to develop on the childʼs tongue thismorning which the parent describes as “looking like a strawberry”. The rash has now spread to the rest of the body and has arough texture. They are not on any medication, have no known allergies and have not tried anything.

Answer 1276

SCARLETT FEVER?GP :

Question 1277

You dispense a prescription for an antibiotic. Upon handing out the antibiotic, you counsel the patient on the warning labelthat states “Do not take milk, indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take thismedicine”

Answer 1277

cipro!

Question 1278

A 23-year-old patient presents to your minor ailment clinic in a GP practice with an insect bite. They think they were bitten lastnight but they are not sure what insect has bitten them, and there is no recent travel abroad. You look at the bite, and there isno visible infection. It is not visibly a tick bite. The patient does not have any other allergies, and takes only the combinedcontraceptive pill. Information on antimicrobial prescribing in insect bites and stings is shown below.

Answer 1278

no antibiotic treatment required

Question 1279

A 28-year-old woman who has been taking quetiapine for the last two years has been given a course of clarithromycin to treatacute otitis media.

Answer 1279

QT interval prolongation

Question 1280

Hydroxylated derivatives are required for patients with severe renal impairment?

Answer 1280

vitamin D!

Question 1281

Vitamin D requires hydroxylation by the kidney to its active form, therefore the hydroxylated derivatives alfacalcidol or calcitriol should be prescribed if patients with severe renal impairment require vitamin D therapy. Calcitriol is also licensed for the management of postmenopausal osteoporosis.Vitamin D requires hydroxylation by the kidney to its active form, therefore the hydroxylated derivatives alfacalcidol or calcitriol should be prescribed if patients with severe renal impairment require vitamin D therapy. Calcitriol is also licensed for the management of postmenopausal osteoporosis.

Question 1282

Vitamin D requires hydroxylation by the kidney to its active form, therefore the hydroxylated derivatives alfacalcidol or calcitriol should be prescribed if patients with severe renal impairment require vitamin D

Question 1283

INR, 9.4, MINOR BLEEDING, BEST ACTION?

Answer 1283

stop warfarin, iv phytomenadioneIN A MAJOR BLEED- IV PHYTOMENADIONE+DRIED PROTHROMBIN

Question 1284

Alendronci acid, ear pain?

Answer 1284

osteneocrosis, GP referral, not A&E, not life-threatening

Question 1285

DRUGS AND SAFE CUSTODY? TALK TO ME

Answer 1285

ALL SCHEDULE 1+2, buprenorphine, temazepam and sativexEXCEPTIONS:PregabalinGabapentin

Question 1286

ACS, STEMI, WHAT'S DISCONTINUED?

Answer 1286

CLOPI, ONLY 12 MONTHA

Question 1287

1st line, diabetes, afro-caribbean?

Answer 1287

ARB, LOSARTAN!

Question 1288

haloperidol, levomepromazine, what drug next?

Answer 1288

aripiprazole, second gen, first gens were an L, give clozapine if aripiprazole is an L

Question 1289

theophylline measuring levels?

Answer 1289

10-20mg/L4-6hrs after a dose5 days after starting3 days after changing dose

Question 1290

we do not sell amorolfine in pregnant/breastfeeding!

Question 1291

WHAT DRUGS TO DENATURE?

Answer 1291

2/3/4 part, 5 NO

Question 1292

first line constipation in children, no faecal impaction?L?Still hard stools?

Answer 1292

first line constipation in children, no faecal impaction? diet+macrogolL? stimulantStill hard stools? lactulose/docusate

Question 1293

ANAPHYLAXIS DOSE+FREQUENCY?-6MONTHS?-5YEARS?-11YEARS?12+?

Answer 1293

-6MONTHS? 100-150MCG-5YEARS? 150MCG-11YEARS? 300MCG12+? 500MCG (300mcg if small/prepubertal)/5 MINS

Question 1294

CHILD, DIARRHOEA, PAST 2 DAYS, NO FLUIDS, BEST ACTION?

Answer 1294

HOSPITAL, HYDRATVE, IV FLUIDS

Question 1295

ATORVASTATIN ALT MONITORING?

Answer 1295

/3 MONTHS/12 MONTHS

Question 1296

HRT BEFORE SURGERY?

Answer 1296

STOP 4-6 WEEKS BEFORE

Question 1297

GESTATIONAL DIABETESFasting BG<7mmol/L?

Answer 1297

1. Diet+Exercise. L?2. Metformin (unlicensed). L?3. InsulinIF REQUIREMENTS NOT MET IN 1-2 WEEKS!

Question 1298

GESTATIONAL DIABETESFasting BG>7mmol/L?

Answer 1298

diet, exercise, insulin and MAYBE metforminno longer glinbeclamide!

Question 1299

ANTIBITOCIS WITH FOOD?

Answer 1299

METRNOIDAZOLENITROFURANTOINCLARITHROMYCIN MRPIVMECILLINAM

Question 1300

Test for DVT?

Answer 1300

D-dimer

Question 1301

preferred dvt home, pregnancy?

Answer 1301

LMWH!

Question 1302

DONEPEZIL SIDE-EFFECTS? ACH/DEMENTIA DRUGS? THINK DUMBBELLS!

Answer 1302

DUMB BELSDiarrhoeaUrinary IncontinenceMuscle WeaknessBradycardiaBronchospasmsEmesisLacrimationSalivation

Question 1303

ACID REFLUX SYMPTOSM/GORD REFERRAL?

Answer 1303

GI BLEED55+UNEXPLAINED WEIGHT LOSSDYSPHAGIA

Question 1304

ORLISTAT, FAT SOLUBLE VITAMINS DEPRIVED?

Answer 1304

ADEK

Question 1305

1st gen antihistamines?

Answer 1305

APC^2alimemazinepromethazinechlorphenaminecyclizine

Question 1306

WHAT TYPE OF PILL IS NOREHISTERONE?WHEN IS ADDITIONAL PRECAUTIONS NEEDED?

Answer 1306

WHAT TYPE OF PILL IS NOREHISTERONE? Progestogen-only, take everyday, no pill-free periodWHEN IS ADDITIONAL PRECAUTIONS NEEDED?Take in first 5 days of cycle, nothing else neededAfter 5 days? 2 days precaution

Question 1307

h pyloritests?ppi?abx?

Answer 1307

tests? urea 13c, SATppi? 2 weeksabx? 4 weeks

Question 1308

MINERALCORTICOSTEROID S-E?

Answer 1308

high fluid retention, low anti-inflammatory effectoedemahypertensionhypokalaemiahypocalcaemia

Question 1309

rifampicin?

Answer 1309

colour urine, stains lenseshepatotoxic- fatigue, yellowing of skin

Question 1310

ABSENCE SEIZURES, STEPS?

Answer 1310

ETHOSUXIMIDE (only if absence)SODIUM VALPROATE (only high risk of generalsied tonic-clonic/other seizures)LAMOTRIGINE when above 2 an L

Question 1311

DOSE CHANGE IN EPILEPTIC, DRIVING?

Answer 1311

6 MONTHS BAN :(

Question 1312

Patient,headache, blurred vision, BP 184/127?

Answer 1312

A&E, BP>180/120 EEK

Question 1313

MHRA DRUGS TO REPORT?

Answer 1313

BLACK TRIANGLESERIOUS SIDE-EFFECTSDEVICESE-CIGSVACCINESHERBALS

Question 1314

MEDS WITH RISK OF FALLS?

Answer 1314

BenzodiazepinesDiureticsOpioidsPhenothiazinesZ-drugs, etcNOT nsaids, NOT CODEINE LOL

Question 1315

PPI, gord, fatigue, muscle spasm, electrolyte L?

Answer 1315

HYPOMAGNESAEMIA

Question 1316

CD REGISTER, EXPIRED STOCKNOT DENATURED?DENATURED/PATIENT RETURNED?

Answer 1316

CD REGISTER, EXPIRED STOCKNOT DENATURED? 2 YEARSDENATURED/PATIENT RETURNED? 7 YEARS

Question 1317

REPEATS OF VET PRESCRIPTIONS MUST BE DISPENSED WITHIN?

Answer 1317

6 MONTHS OF PRESCRIPTION DATE

Question 1318

EDOXABAN+PREDNISOLONE INTERACTION?

Answer 1318

risk of bleed :/any DOAC imma just hit bleed i thinkQT prolongation does not exist, silly

Question 1319

ondansetron+quetiapine?

Answer 1319

increased QT prolongation

Question 1320

DRUGS THAT CAUSE QT PROLONGATION?

Answer 1320

ANTIARRHYTHMICSMACROLIDESQUETIAPINEHALOPERIDOLSSRIsTCAsDOMPERIDONEHALOPERIDOLANTIFUNGALS

Question 1321

GLYCOPEPTIDES+INFUSION?

Answer 1321

ANAPHYLACTIC RISK, AVOID RAPID INFUSION, MONITOR ISTE, ETC

Question 1322

METHOTREXATE GI SIDE-EFFECTS SO../

Answer 1322

DIARRHOEA/STOMATITIS TELL-TALE SIGNS

Question 1323

METHOTREXATE BIG BOY SIDE-EFFECTS?

Answer 1323

BPLGBLOOD DISORDERS- sore throat/bruising/mouth ulcersLIVER - nausea/vomiting/abdominal discomfort/jaundice/dark urine/itchy skinPULMONARY - SOB/coughingG-I - stomatitis/diarrhoea

Question 1324

ANTIDOTESNALOXONE?PROCYCLIDINE?FLUMAZENIL?DESFERRIOXAMINE?ACETYLCYSTEINE?PHYTOMENADIONE?PROTAMINE?ANDEXANET ALFA?IDARUCIZUMAB?ACTIVATED CHARCOAL?

Answer 1324

NALOXONE? OpioidsPROCYCLIDINE? Phenothiazine- prochlorperazineFLUMAZENIL? Benzodiazepines, unless within an hour- activated charcoalDESFERRIOXAMINE? IroACETYLCYSTEINE? ParacetamolPHYTOMENADIONE? WarfarinPROTAMINE? Enoxaparin/heparinANDEXANET ALFA? ApixabanIDARUCIZUMAB? DabigatranACTIVATED CHARCOAL? Aspirin/TCAs/SSRIs/second-gen antipsychotics/benzos/b-blockers/CCB/theophylline

Question 1325

preferred sulphonylurea in elderly?

Answer 1325

gliclazide, SHORT-ACTING

Question 1326

Name three bile acid sequestrats and when other meds can be taken in relation to them

Answer 1326

Colesvelam - 4h before or after | Colestipol & cholestyramine - 1 hour before or 4-6 hours after

Question 1327

Which schedules of CDs can be dispensed from an EEA Rx?

Answer 1327

Schedule 4

Question 1328

Minimum age for OTC amorolfine

Answer 1328

18

Question 1329

Chloramphenicol minimum age for OTC use

Answer 1329

2 years

Question 1330

Hydrocortisone cream minimum age for OTC

Answer 1330

10 years

Question 1331

Levonorgestrel minimum age for OTC sale

Answer 1331

16

Question 1332

Naproxen minimum age for OTC sale

Answer 1332

16 years

Question 1333

What to avoid up to a month after PO isotretinoin

Answer 1333

Blood donation

Question 1334

S/e of isotretinoin (5)

Answer 1334

``` Psychiatric effects Visual disturbance Peeling of skin Haemorrhagic diarrhoea Pancreatitis of triglycerides are over 9mmol/l ```

Question 1335

Pregnancy PRESCRIPTION rules for isotretinoin

Answer 1335

Prescription limited to 30 days supply, to be dispensed within 7 days of date started

Question 1336

Pregnancy TESTING rules for isotretinoin

Answer 1336

Exclude preg 3 days before treatment, every month during treatment and 5 weeks after stopping

Question 1337

pregnancy SAFE SEX rules for isotretinoin

Answer 1337

At least one mode of contraception - better if 2. oral POP is not considered effective Barrier methods alone are not enough

Question 1338

How long before and after treatment with isotretinoin should preg be avoided

Answer 1338

1 month before and after

Question 1339

What should not be done for 6 months after isotretinoin | PO

Answer 1339

Waxing and dermabrasion

Question 1340

Counselling for isotretinoin apart from pregnancy

Answer 1340

- avoid exposure to UV | - symptoms of anxiety and depression

Question 1341

Minimum age for daktarin oral gel OTC

Answer 1341

3 months

Question 1342

Minimum age for piriton syrup OTC

Answer 1342

12 months

Question 1343

Germoloid HC spray minimum age

Answer 1343

16 years

Question 1344

Becomsase hayfever relief nasal spray licenced from what age OTC

Answer 1344

18 years

Question 1345

Regaine for men extra strength is licensed for what age OTC

Answer 1345

Up to 65 years

Question 1346

OTC licensed dose of esomeprazole

Answer 1346

20 mg OD - nexium control- for short term reflux symptoms

Question 1347

Total gastetoctomy requires what vitamin supplementation

Answer 1347

Vit b12 (hydroxycobalamin)

Question 1348

Four vaccines that should not be received by patients with HIV

Answer 1348

BCG Influenza nasal spray (unless stable infection and receiving antiretroviral therapies) Typhoid Yellow fever

Question 1349

Fluenz tetra or fularix tetra is a live vaccine? Administered how?

Answer 1349

Fluenz tetra is intranasal live attenuate flue vaccine

Question 1350

Fluenz tetra or fluarix is contraindicated in on who come into close proximity with HIV

Answer 1350

Fluenz tetra

Question 1351

Name an every day Monophysic COC

Answer 1351

Femodene ED Microgynon 30 ED Zoley

Question 1352

What type of prep is qlaira

Answer 1352

Phasic ever day COC

Question 1353

Substance misuse treatment that should be stopped after 7 weeks of abstinence is not achieved

Answer 1353

Bupropion

Question 1354

Substance misuse treatment that can't be used with alcohol containing mouthwash

Answer 1354

Disulfuram

Question 1355

Misuse treatment that might be appropriate for a high risk drinker who does not experience withdrawal symptoms

Answer 1355

Nalmefene

Question 1356

Licenced for opioid withdrawal symptoms

Answer 1356

Lofexidine

Question 1357

What substance misuse type treatment should be discontinued with new onset depression or suicidal thoughts

Answer 1357

Varenicline

Question 1358

OTC directions and dose for naproxen | Ages you can use this for

Answer 1358

2x250mg tabs initially plus another 250mg tab if pain persists 6-8 hours later Max 3x250mg in a day Women 15-50years

Question 1359

OTC directions and doe for ibuprofen

Answer 1359

400mg TDS | Max 1200mg in a day

Question 1360

OTC ranitidine directions What is the minimum age

Answer 1360

75mg prn, if symptoms persist take another 75mg Max 150mg in 24 hours

Question 1361

Drugs that prolong the QT interval 8

Answer 1361

``` Antidepressants - TCAs, citalopram/ecitalopram Antiarrhythmics - amiodarone, sotalol Domperidone antiphycotics Macorlides Quinilones antimalarials Methadone ```

Question 1362

INJECTION TECHNIQUE?

Answer 1362

IM 90 DEGREES, COOL

Question 1363

TESOTGEL HORMONE SCHEDULE?

Answer 1363

4, PART 2

Question 1364

lucozade orginal 110-220ml?

Answer 1364

hypogylcaemia

Question 1365

A 22-year-old female has come to the pharmacy asking for your advice regarding her painful periods that has started a few months ago. Upon questioning the patient, you find out that she is suffering from lower abdominal pain and backache, which starts several days before her period begins. She tells you that her menstrual cycle used to be very regular but now tends to vary and some occasions she has 2-3 weeks between her periods. She also mentions that her pain continues throughout menstruation and it is quite severe in nature. She has tried ibuprofen and has had no effect on her pain symptoms. Which of the following conditions best describes the patient’s symptoms

Answer 1365

SEONDARY DYSMONERRHOEA

Question 1366

private scripts only, not vet?

Answer 1366

The first dispensing must be made within six months of the appropriate date, following which there is no legal limit for the remaining repeats.

Question 1367

sumatriptan gap?

Answer 1367

2hrs

Question 1368

test for heart failure?

Answer 1368

-terminal pro-B-type natriuretic peptide

Question 1369

over 70 HF start?

Answer 1369

Ramipril 1.25 mg OD & Nebivolol 1.25 mg OD

Question 1370

eye L in tuberculosis, what drug?

Answer 1370

ethambutol

Question 1371

NOT legal on label?

Answer 1371

'sight and reach' OF CHILDREN

Question 1372

medical waste?

Answer 1372

nacl nebules

Question 1373

red urine?

Answer 1373

doxorubicin rifamp- reddish orange danthron

Question 1374

Dulcolax?

Answer 1374

OSMOTIC

Question 1375

) Mrs Barbara Reid is one of your regular patients who passed away two weeks ago, and her daughter returned six morphine 30mg ampoules and a sealed 500 mL bottle of Oramorph 10 mg/5mL. Which one of the following statements is legally correct?

Answer 1375

Record the return of morphine amps in sperate register and store in the CD cabinet away from existing stock until a member of staff can witness their destruction. Place the bottle of Oramorph solution into the pharmaceutical waste. oramorph schedul 5, no-one cares, no need for dentauring

Question 1376

A

Question 1377

Amoxicillin child dose?

Answer 1377

250mg TDS

Question 1378

procyclidine?

Answer 1378

YOU DON'T GET BRADY

Question 1379

A 45-year-old man has attended the emergency department at the hospital with shortness of breath and tachycardia. He has recently been on a business travel from America and landed in the country yesterday. After examination and laboratory testing the junior doctor confirms that the man has pulmonary embolism and will need to commence on anticoagulants as soon as possible but is unsure which anticoagulant should be used. Which of the following anti-coagulant regimen should be used in the initial management of a suspected pulmonary embolism?

Answer 1379

ENOXAPARIN 1.5MG/KG 24 hrs, low risk preferred L:/

Question 1380

SULFSALAZINE FERTILITY L

Question 1381

. Which of the following is the | recommend dose for starting a patient for the treatment of vitamin d deficiency?

Answer 1381

800 units colecalciferol

Question 1382

leflunomide contraception?

Answer 1382

during+2 years after

Question 1383

STAPHYLO INFECTION?

Answer 1383

GIVE FLUCLO

Question 1384

fusidic acid osteomyelitis? okay

Question 1385

Take this medicine when your stomach is empty. This means an hour before food or 2 hours after food?– Do not take indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine

Answer 1385

propantheline bromide

Question 1386

levofloxacin instruction?

Answer 1386

– Do not take indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine

Question 1387

tamsulosin instruction?

Answer 1387

Warning: This medicine may make you sleepy. If this happens, do not drive or use tools or machines

Question 1388

MYOCLONIC?

Answer 1388

TOPRAIMATE, don't give valp without PPP

Question 1389

A 55-year-old male has come to the pharmacy complaining of a troublesome cough that has occurred over the past week. The patient also mentioned that this morning his temperature was 38.9°C and feels her mouth is sore. The patient mentions that this occurred after being started on a new medication.

Answer 1389

METHOTREXATE

Question 1390

anti-depressant, appetite increased?

Answer 1390

mirtazapine

Question 1391

A 35-year-old male has been recently diagnosed with severe depression accompanied by post-traumatic stress disorder as a veteran in the army. The patient has tried multiple antidepressant medication, but all his therapies have failed to help with his sleep. He requires an antidepressant that will help manage his depression and help with his sleep.

Answer 1391

trazodone :/

Question 1392

A 31-year-old female has been recently prescribed an antidepressant. She has come to your pharmacy complaining of troublesome side effects. The patient mentions that after being started on this new antidepressant they have notice their mouth is always dry, feeling cold all the time and tends to overreact with sudden arm movements.

Answer 1392

DOSULEPIN, TCA, ETC

Question 1393

duloxetine class?

Answer 1393

SNRI

Question 1394

COLD FT ARE THE OFFENSIVE DRUGS!

Question 1395

"MEDICAL DEFENCE"?

Answer 1395

E Ms P taking prescribed morphine, whereby the drug level is higher than specified limits and driving is not impaired.

Question 1396

rash cause?

Answer 1396

co-amoxiclav

Question 1397

fexofenadine pom to gsl!

Question 1398

you don't need quantity on label!

Question 1399

Owingds?

Answer 1399

from date of prescription

Question 1400

AMISULPRIDE, NMS, TACHYCARDIA, TREMO ETC

Question 1401

Lithium level?

Answer 1401

12 hours psot dose

Question 1402

SEBORRHOEIC dermatitis, scalp, OTc, shampoo, oil, etc

Question 1403

QUETIAPINE?

Answer 1403

WEIGHT GAIN STILL OK, COWQ

Question 1404

EYE REFER?

Answer 1404

Red flags which indicate the need for urgent ophthalmological assessment such as: - Soft contact lens use with corneal symptoms (such as photophobia and watering). - Reduced visual acuity. - Marked eye pain, headache or photophobia - always consider serious systemic conditions such as meningitis in a person presenting with photophobia. - Red sticky eye in a neonate (within 30 days of birth). - History of trauma (mechanical, chemical or ultraviolet) or possible foreign body. - Copious rapidly progressive discharge - may indicate gonococcal infection. - Infection with a herpes virus.

Question 1405

ST JOHN+VENLA?

Answer 1405

SERONONT...

Question 1406

CONTRAINDICATION IS WORSE THAN CAUTION, BE CAREFUL! DOUBLE CHECK ANSER

Question 1407

VELAN, MIRTAZ SWITCH?

Answer 1407

A. Gradually reduce the dose of the venlafaxine, while starting mirtazapine at a low dose and then gradually increase this dose as the venlafaxine is withdrawn

Question 1408

sertraline, diarrhoea, advice?

Answer 1408

side-effects, yes, continue

Question 1409

DIARRHOEA SERTRALINE? NOT DOSE-RELATED

Question 1410

55+, oedema L, hypertension, give?

Answer 1410

thiazide-like, indapamide

Question 1411

LONG-TERM LOOP SIDE-EFFECT?

Answer 1411

hyperuricaemia n the rest | hyponataraemia/magnesamiea/kalaemia

Question 1412

DIGOXIN TOICITY RISK?

Answer 1412

hypomagnesamia

Question 1413

rales- lung clicking?

Answer 1413

heart failrue

Question 1414

COPD, not improved after 3months?

Answer 1414

step down from triple!

Question 1415

Symptoms of cauda equina syndrome

Answer 1415

* Severe low back pain. * Motor weakness, sensory loss, or pain in one or commonly both legs. * Saddle anaesthesia (unable to feel anything in the body areas that sit on a saddle) * Bladder dysfunction (such as urinary retention or incontinence) * Bowel incontinence.

Question 1416

SILDENAFIL INCORRECT STATEMENT?

Answer 1416

E when taken with food the onset of activity may be delayed compared to a fasted state so it doesn't delay hm

Question 1417

Which of the following statements regarding gout and the use of colchicine is INCORRECT? A. Certain drugs can increase the risk of developing gout by raising plasma urate levels, such as ACE inhibitors, beta-blockers and diuretics. B. Colchicine should be avoided in people with an eGFR less than 10, women who are pregnant or breastfeeding, or those with severe hepatic impairment. c. Mr R should have 500 micrograms of colchicine, two to four times a day, until pain relief is achieved, or diarrhoea or vomiting occurs. D. Mr R should be advised to not exceed a total dose of 6 mg of colchicine and to not repeat treatment within three days. E. Purine-rich foods, such as green leafy vegetables, increase the risk of gout, as higher purine intake is associated with uric acid levels above 150 micromol/L.

Answer 1417

Answer: E (Purine-rich foods, particularly red meat and seafood, increase the risk of gout as higher purine intake is associated with higher uric acid levels. For maintenance treatment, the aim is for serum uric acid levels below 300 micromol/L.)

Question 1418

PIOGLITAZONE CMMON SE?

Answer 1418

FRACTURES!!!!!

Question 1419

AVOID TRIMETHOPRIM IN FIRST TRIMESTER!

Question 1420

68. A GS-year-old patient has been reviewed by a GP following a fracture of the radius bone. The risk of osteoporotic fracture depends on the person's risk of falls, their bone strength (determined by bone mineral density [BM DJ), and other risk factors. Which of the following factors reduces bone strength WITHOUT reducing BMD? A chronic kidney disease B Crohn's disease C diabetes mellitus D immobility E smoking

Answer 1420

Answer: E ( Smoking) Factors that do NOT reduce BMD include: - Age - risk increases with age and is at least partly independent of BMD. - Oral corticosteroids (dependent on the dose and duration of treatment). - Smoking. - Alcohol (3 or more units daily). - Previous fragility fracture (risk increases with increasing number of fractures). Risk is highest for previous hip fractures and lowest for previous vertebral fractures. - Rheumatological conditions such as rheumatoid arthritis, and other inflammatory arthropathies. - Parental history of hip fracture.

Question 1421

Following a bone scan, the patient has been identified to be osteopenic, with a T-score of -2.5. The GP has prescribed risedronate 35mg tablets as new a medication. Which of the following counselling points would be the most appropriate to mention concerning the new medication? A if a dose is missed, take on the day that the tablet is remembered and then return to the original schedule B remain upright for 30 minutes before taking the tablet C swallow the tablet whilst standing or lying down D take the tablet at the same time every day E take the tablet with breakfast to reduce the risk of gastrointestinal irritation

Answer 1421

Answer: A ( if a dose is missed, take on the day that the tablet is remembered and then return to the original schedule) - Need to take tablet sitting or standing as the medication can cause oesophageal reactions. - Patient should stand or sit upright for at least 30 minutes after administration. - Tablet should be swallowed whole not crushed or dissolved with plenty of water. - Tablet needs to be taken on an empty stomach 30 minutes before breakfast or another oral medicine. - Two tablets should NOT be taken on the same day. Patients should return to taking one tablet once a week, as originally scheduled on their chosen day. * Risedronate should be taken before breakfast; however, if this is not practical, it can be taken between meals or in the evening at the same time each day

Question 1422

ALENDRO/RISED, HEART BURN?

Answer 1422

OESOPHAGITIS, GP ASAP!!

Question 1423

73. Baby D, aged 13 months and weighing 13 kg, has reflux oesophagitis. She has been prescribed ranitidine liquid 75 mg/5 ml at a dose of 4 mg/kg twice daily for 14 days. What volume of ranitidine liquid, in ml, will Baby D receive per day?

Answer 1423

6.9ml Dose= 4 mg/kg BD = 4 mg x 13 kg= 52 mg BD = 104 mg/day The product contains ranitidine 75 mg/5 ml, which is the same as 15 mg/ml Therefore, if there is 75 mg in 5 ml, there will be 104 mg in just under 7 ml, as there is 15 mg/1 ml (i.e.7 ml would therefore contain 105 mg) Without a calculator, we can see that the answer must be 6.9 ml.

Question 1424

74. A 48-year-old female and has been experiencing menopausal symptoms and would like to trial hormone replacement therapy (HRT). Her medical record shows a previous hysterectomy. After assessing the patient's family history and physiological health parameters, the patient satisfies the criteria for HRT. Which of the following would be the most appropriate choice of HRT for this patient? A Desomono 75microgram tablets (Desogestrel 75 microgram) B Estraderm MX 25 patches (Estradiol 25 microgram per 24 hour) C Evorel Conti patches (Estradiol 50 microgram & Norethisterone 170 microgram per 24 hour) D FemSeven Sequi (Estradiol 50 microgram& Levonorgestrel 7 microgram per 24 hour) E Femoston-conti 0.5mg/2.5mg tablets (Dydrogesterone 2.5 mg & Estradiol 500 microgram)

Answer 1424

B (Estraderm MX 25 patches) An oestrogen alone is suitable for continuous use in women without a uterus. - Women with a uterus should use a HRT with small doses of an oestrogen together with a progestogen (endometrial cancer is reduced by a progestogen) - Options C, D and E contain a progesterone. - Desogestrel (alone) is progesterone indicated for contraception.

Question 1425

testogel pump vs pump, be carefulgive

Answer 1425

alfacalcidol or calcitrol

Question 1426

VITAMIN D DEFIENCYE, KIDNEYS?

Answer 1426

ALFACALCIDOL | CALCITROL

Question 1427

89. A parent has come into the pharmacy to buy a cough syrup for their 4-year-old daughter. Which of the following ingredients found in over-the-counter cough preparations would be most appropriate to recommend? ``` A. citric acid monohydrate B. dextromethorphan C. guaifenesin D. pholcodine linctus E. pseudoephedrine ```

Answer 1427

A (Paediatric simple linctus, containing citric acid monohydrate.)

Question 1428

90. A mother contacts the community pharmacy by telephone to seek further advice regarding an antibiotic prescription that had been supplied for her 3-year-old daughter. Her daughter has been diagnosed with scarlet fever and is required to commence flucloxacillin 125 mg/5 ml oral suspension, at a dose of 5 ml QDS for 10 days. Which of the following statements regarding flucloxacillin is INCORRECT? A. cholestatic jaundice may occur very rarely, up to 6 months after treatment with flucloxacillin has been stopped. B. flucloxacillin can cause gastro-intestinal disturbances, which are common side effects. C. flucloxacillin should be used with caution in patients with hepatic impairment. D. flucloxacillin should be taken on an empty stomach, which means one hour before food or two hours after food. E. if the patient vomits within 30 minutes of taking a dose of flucloxacillin, they should receive the same dose again.

Answer 1428

A (Cholestatic jaundice may occur very rarely, up to 2 months after treatment with flucloxacillin has been stopped. There is an important safety information warning under the fluelox monograph which trainees should be familiar with.)

Question 1429

91. A 82 year old man who presents to hospital with jaundice. His liver function tests show raised bilirubin and alkaline phosphatase.

Answer 1429

CO AMOXICLAV

Question 1430

92. A 68 year old woman with newly diagnosed pulmonary fibrosis

Question 1431

A 54-year-old woman who has recently completed a 7-day course of ciprofloxacin develops diarrhoea. Clostridium difficile infection is confirmed and oral metronidazole is commenced. She also takes the following medication: • Allopurinol • Atorvastatin • Lansoprazole • Ramipril • Sertraline In light of her recent diagnosis which of her current medication would you recommend be stopped if possible?

Answer 1431

PPI C DIFF!

Question 1432

A 54-year-old woman whose has a BMI of 34 kg/m2 has asked you for some diet advice as she wishes to lose weight. You explain that she should eat at least 5 portions of fruit and veg each day. She asks for examples of what a portion of fruit and vegetables consists of. What would be the most appropriate answer?

Answer 1432

1 PEAR www.nhs.ukLinks to an external site. - A portion is: • 80 g of fresh, canned or frozen fruit and vegetables • 30 g of dried fruit • 150 mL glass of fruit juice Just 1 apple, banana, pear or similar sized fruit is 1 portion A slice of pineapple or melon is also 1 portion, and 3 heaped tablespoons of vegetables is another portion Adding a tablespoon of dried fruit, such as raisins, to your morning cereal is an easy way to get 1 portion

Question 1433

A 46-year-old woman, who weighs 50 kg, takes hydroxychloroquine 400mg tablets each day (Mondays to Fridays only) as part of her treatment regimen for rheumatoid arthritis. She has no renal impairment or any additional risk factors for retinal toxicity. She has taken the drug for 3 months and has had a baseline ophthalmology assessment and asks when she will next require an eye examination.

Answer 1433

The SPC states - All patients should have an ophthalmological examination before initiating treatment with Hydroxychloroquine sulfate . Thereafter, ophthalmological examinations must be repeated at least every 12 months. Please note that the BNF now states the following for monitoring for retinopathy. A review group convened by the Royal College of Ophthalmologists has updated guidelines on monitoring for chloroquine and hydroxychloroquine retinopathy (Hydroxychloroquine and Chloroquine Retinopathy: Recommendations on Monitoring 2020). Recent data have highlighted that hydroxychloroquine retinopathy is more common than previously reported.

Question 1434

A mother of an 18-month-old child requests treatment for head-lice. She has found live lice in her daughter’s hair and has tried the wet combing method. However, her daughter hates it when she is trying to remove the lice in this way and gets very distressed and cries until she is sick. Therefore, the mother wishes to purchase an OTC treatment. Which of the following would be the most appropriate to recommend? A Derbac M® (Malathion) 0.5% liquid B Full Marks® (Cyclomethicone, isopropyl myristate) Solution C Hedrin® (dimeticone) 4% solution You Answered D Lyclear® (Permethrin) cream rinse E Vamousse® (isopropyl Myristate, Isopropyl Alcohol) Mouss

Answer 1434

Hedrin® (dimeticone) 4% solution is licensed from 6 months of age. Full Marks Solution is recommended from 2 years of age. Vamousse® is recommended from 2 years of age. Lyclear® and Derbac M® are licensed from 6 months. Resistance has developed to permethrin, in addition to this the administration of Lyclear® cream rinse means there is insufficient contact time, so it would be ineffective. Therefore, Derbac M® is the only insecticide recommended in the UK now but resistance has developed. Therefore, CKS recommend either wet combing or dimeticone 4% solution first-line for pregnant or breastfeeding women, young children aged 6 months to 2 years, and people with asthma

Question 1435

A 35-year-old man who normally takes Tegretol® (carbamazepine) 600 mg twice daily for epilepsy has come to collect his repeat prescription. He only has 2 days treatment of Tegretol® left at home. You do not have any Tegretol® in stock and there is none available locally due to a manufacturing delay. You have both the Medreich and Novartis pharmaceutical brands of carbamazepine in stock. What would be the most appropriate action to take? A - contact the prescriber to inform them of the issue and gain agreement to dispense an alternative brand to maintain continuity of supply Correct! B discuss the manufacturing delay with the patient and the prescriber to gain agreement to supply an alternative brand to maintain continuity of supply C discuss the manufacturing delay with the patient to gain agreement to supply an alternative brand to maintain continuity of supply D dispense the carbamazepine you have in stock to maintain continuity of supply and endorse the prescription with the details of what you supplied E Inform the patient that you do not have any stock, produce an owing slip and tell the patient you will give them a call once they are back in stock

Answer 1435

BNF. The CHM concluded that reports of loss of seizure control and/or worsening of side-effects around the time of switching between products could be explained as chance associations, but that a causal role of switching could not be ruled out in all cases. Carbamazepine is classed as a category 1 antiepileptic where doctors are advised to ensure that their patient is maintained on a specific manufacturer’s product. Dispensing pharmacists should ensure the continuity of supply of a particular product when the prescription specifies it. If the prescribed product is unavailable, it may be necessary to dispense a product from a different manufacturer to maintain continuity of treatment of that antiepileptic drug. Such cases should be discussed and agreed with both the prescriber and patient (or carer).

Question 1436

A 67-year-old woman who has Parkinson’s Disease. She is having selegiline 10 mg daily added to her co-careldopa therapy as she has developed motor fluctuations. She currently takes: • Sinemet® (carbidopa (as carbidopa monohydrate) 25 mg, levodopa 250 mg) tablets, One tablet four times a day • Fluoxetine 20 mg capsules, one capsule each day • Normacol® (sterculia 620 mg per 1 g) granules, one heaped 5 mL spoon twice daily Resource: Eldepryl (selegiline) SmPC (Links to an external site.) The prescriber asks if any alterations need to be made to her current medication given her new prescription. How would you respond? A a gradual reduction of 300 mg levodopa will be needed over the next month and fluoxetine should be discontinued at least 1 week before initiation B a gradual reduction of 500 mg levodopa will be needed over the next month and fluoxetine should be discontinued at least 2 weeks before initiation C fluoxetine should be discontinued on initiation Correct! D initially a reduction of 100 mg levodopa should be made to her daily dose and the fluoxetine should be discontinued at least 5 weeks before initiation E no adjustments are required

Answer 1436

Selegiline is predicted to increase the effects of levodopa the SmPC states: When selegiline is added to a levodopa regimen it is possible to reduce the levodopa dosage by an average of 10 -30%. Reduction of the levodopa dose should be gradual in steps of 10% every 3 to 4 days. An initial 10% reduction would be 100 mg of levodopa. The SPC also states ‘Since fluoxetine has a very long elimination half-life, at least 5 weeks should be allowed after stopping fluoxetine and before starting selegiline.’

Question 1437

A 22-year-old man has been initiated on topiramate for generalised tonic-clonic seizures. Which of the following would be appropriate counselling to give him? A different formulations of oral preparations may vary in bioavailability. He must be maintained on a specific manufacturer’s product B He will need to have his eyes tested annually during treatment C to be alert for symptoms and signs of bone marrow failure, such as anaemia, bruising or infection D to seek immediate medical attention if symptoms such as fever, rash, mouth ulcers, bruising or bleeding develop as they could be a sign of blood, liver or skin disorder Correct! E to seek medical attention if he has any mood changes, distressing thoughts, or feelings about suicide or self-harming develop

Answer 1437

Topiramate is a category 2 antiepileptic so the need for continued supply of a particular manufacturer's product should be based on clinical judgement and consultation with the patient and/or carer. The advice in A would be necessary for category 1 antiepileptics. Topiramate is not one of the antiepileptic drugs associated with bone marrow suppression and does not have the warning about blood, liver or skin disorders. Although topiramate is associated with ocular side-effects there is no requirement to have regular eye examinations.

Question 1438

MARTINDALE?

Answer 1438

WHOLE DRUG WORDL

Question 1439

tiotropium, antimuscarinic, dry mouth!

Question 1440

rivaroxaban, crcl 15-49?

Answer 1440

15mg OD

Question 1441

A 35-year-old woman requests treatment for her skin. She has inflammatory papules and pustules in the centrofacial region, with persistent centrofacial redness. She said that she also experiences flushing of the face when she goes out in either hot or cold weather or goes to the gym. She is currently breastfeeding her 4-month-old daughter. What would be the most appropriate treatment to recommend? Correct answer A azelaic acid 15% gel You Answered B benzoyl peroxide 5% gel C ivermectin 10mg/g cream D oral doxycycline E oral oxytetracycline

Answer 1441

Answer - A Rationale BNF - Benzoyl peroxide is licensed for acne not rosacea. Ivermectin, doxycycline and oxytetracycline are not suitable as this woman is breastfeeding.

Question 1442

Combined oral contraceptives (COCs) are contraindicated in patients who have migraine with aura. Progesterone only contraceptives are more appropriate. Choices B-E are all COC.

Question 1443

This question relates to the same 65-year-old man in the previous question, with severe heart failure, who has just been diagnosed with his first acute attack of gout. He currently takes the following medicines: • Bisoprolol 10 mg daily • Furosemide 80 mg daily • Losartan 100 mg daily • Spironolactone 50 mg twice daily He has been stable on his current medication for the last the last 6 months. How often should his serum potassium and renal function be monitored?

Answer 1443

BNF - Once the target, or maximum tolerated dose is achieved, treatment should be monitored monthly for 3 months and then at least every 6 months.

Question 1444

A 4-year-old girl, who is complaining of pain in her right ear, visits you with her mom for advice. The mom says she has been off colour for the past few days with symptoms of a cold. She also has eczema and asthma. On examination you diagnose acute otitis media. What would be the most appropriate advice?

Answer 1444

Paracetamol, control the pain Symptoms usually resolve within 3-7 days. Earcalm® is not licensed for children under 12 and is not used for this indication, it is indicated for otitis externa. Most simple cases of acute otitis media resolve without antibiotic therapy, pain and fever should be managed with paracetamol or ibuprofen, as this child has asthma paracetamol would be the most appropriate choice.

Question 1445

A 5-year-old boy has developed constipation. His mom said he has had symptoms for the last 6 days and has only managed to go to the toilet 3 times in 6 days. He has stomach pain and when he does go to the toilet his stools are hard and small. She has increased the fruit in his diet but would like to buy something OTC to also help him go. What would be the most appropriate advice?

Answer 1445

Children under the age of 12 should be referred to their GP. Children under 12 should be treated first line with macrogol in combination with a balanced diet, fluids and behavioural interventions. Stimulant laxatives are second line treatments. The laxatives listed are not available to purchase over the counter for this age group.

Question 1446

A 35-year-old woman hands over a veterinary prescription for diazepam for her dog. Which of the following statements are NOT true about the prescription and record keeping for this prescription?

Answer 1446

The declaration ‘prescribed for the treatment of an animal or herd under my care’ is only required for schedule 2 and 3 CDs. Diazepam is a schedule 4 CD.

Question 1447

An 18-month-old boy who has a fever and a bright red rash on both cheeks.

Answer 1447

slapped cheek

Question 1448

A 4-year-old child who initially had cold-like symptoms has now developed sore red eyes that are sensitive to the light and a red-brown, slightly raised rash.

Answer 1448

measles!

Question 1449

A 2-year-old child who has had a high temperature for a few days and has lost their appetite has developed red spots, initially on their trunk and they are now spreading to all parts of their body

Answer 1449

chicken pox

Question 1450

A 55-year-old woman, with breast cancer and taking tamoxifen, is prescribed this antidepressant for menopausal symptoms as per the BNF recommended dose. It is not licensed for this indication.

Answer 1450

Venlafaxine is used for menopausal symptoms, but it is not licensed for this indication. Fluoxetine and paroxetine are also used but not for those women on tamoxifen (due to interaction).

Question 1451

A 67-year-old man, who has Parkinson’s Disease, who has had ropinirole added to their regular treatment

Answer 1451

For ropinirole the BNF states: Hypotensive reactions can occur in some patients taking dopamine-receptor agonists; these can be particularly problematic during the first few days of treatment and care should be exercised when driving or operating machinery.

Question 1452

A 45-year-old man, who has been initiated on lithium

Answer 1452

For lithium the BNF states: Patients should be advised to report signs and symptoms of lithium toxicity, hypothyroidism, renal dysfunction (including polyuria and polydipsia), and benign intracranial hypertension (persistent headache and visual disturbance).

Question 1453

TB MEDS RIP? Hepatotoxic E? Visual

Question 1454

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?

Answer 1454

stop tibolone!

Question 1455

Which of the following statements regarding the faxed prescription is correct?

Answer 1455

The faxed copy of the prescription is not a legally valid prescription

Question 1456

Which of the following is not a notifiable disease in the UK? a) Food poisoning b) Zika virus c) Malaria d) Smallpox e) Coronavirus (COVID-19)

Answer 1456

ZIKA VIRUS

Question 1457

Mr Smith, a 65-year-old patient who has been admitted to hospital with symptoms of tachycardia, confusion, lightheadedness and blurred vision. The doctor has informed him that this has been caused by an imbalance in one of his serum electrolyte levels, potentiating the side effects of one of his medications

Answer 1457

HYPOKALAEMIA--> POTENTIATES DIGOXIN TOXICITY

Question 1458

Before proceeding, the surgeon and anaesthetist want to check the severity of Lateysha’s renal function. Her estimated glomerular filtration rate (eGFR) is 20ml/min/1.73 m2. What level of renal function does Lateysha have?

Answer 1458

SEVERE REDUCTION

Question 1459

first trimester, pregnancy, exempt, DOUBLE CHECK ANSWERS!!! SELECTED!

Question 1460

NAPROXEN+PREDNISOLONE?

Answer 1460

GI BLEED!!!

Question 1461

bisphosphonates contraindicated in?

Answer 1461

hypocalcaemia

Question 1462

cabergoline side-effect?

Answer 1462

gambling as well, ergot derived, etc

Question 1463

Mr Bains asks you if he can buy anything to relieve his symptoms of acute gout, until he can get an appointment with his doctor. He has had gout before but it has been a long time since his last attack. On looking at his PMR, you notice that there have been a number of changes to his medicines recently and you suspect that one of them may have precipitated this attack of gout. Which of the following drugs is the most likely cause of Mr Bains’ current episode of gout?

Answer 1463

FUROSEMIDE!

Question 1464

A 12-year-old girl was admitted to hospital following a focal seizure. She was initiated on phenytoin and is now stabilised at a dose of 200mg twice daily. Three weeks after her seizure, she experienced a high fever and was prescribed paracetamol and erythromycin tablets for seven days. She soon developed a rash and flu-like symptoms. A blood test was carried out. What is the best course of action?

Answer 1464

WITHDRAW PHENYTOIN, RASH, DYSCRASIA, ETC!

Question 1465

Mrs Levi has recently become very confused and forgetful since the death of her husband. She is not taking care of herself and often forgets to take her medication. You discuss your concerns with her son and you both agree that Mrs Levi may benefit from a monitored dosage system (MDS). Which of the following would not be safe to put in an MDS?

Answer 1465

Hydroxycarbamide 500mg capsuleS?

Question 1466

Mr Thomas comes into the pharmacy on Monday with a rash that is very itchy, he has a high temperature above 38°C, aches, pains and a general feeling of being unwell. You have established that he has chicken pox

Answer 1466

urgent care, not paracetamol

Question 1467

Liothyronine is more rapidly metabolised than levothyroxine

Question 1468

Lawrence has just turned 50 recently and has decided to book a health check in your pharmacy. He feels he hasn’t been leading a very healthy lifestyle recently and would like to see what impact this has had. Lawrence’s results from the health check are: Blood pressure: 138/80 mm/Hg Total Cholesterol: 6 BMI: 29.5 Given the results above, what is the most suitable advice that you would give to this patient?

Answer 1468

Explain to Lawrence that his blood pressure and cholesterol are high and BMI is in the overweight range. Advise him to reduce his salt intake, recommend a balanced diet and ask him to maintain regular exercise to help get all of these measures within the healthy range. Also recommend that he books an appointment with his GP

Question 1469

Mr Wilkins, a 27-year-old man, comes into your pharmacy for advice. He initially had a headache, then developed a burning, tingling rash that is moderately painful. He has no other medical conditions. What is the best drug treatment option for Mr Wilkins?

Answer 1469

Valaciclovir

Question 1470

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?

Answer 1470

7 days and continued for 48 hours after the lesions have resolved

Question 1471

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?

Answer 1471

She will not be able to take the combined oral contraceptive as she has two risk factors for venous thromboembolism and/or arterial disease

Question 1472

Mr Kolosov has a discussion with you on diabetic ketoacidosis from his research. You decide to use this to further test your pre-registration student. A patient weighing 74kg suffering from diabetic ketoacidosis will require soluble insulin to be diluted in sodium chloride 0.9% and administered by intravenous insulin. How much insulin will be administered after two hours if the concentration is 1 unit/mL and the dose is 0.1 units/kg/hr?

Answer 1472

14.8ml

Question 1473

Tony, a 50-year-old regular patient of yours, comes into your pharmacy presenting with symptoms of yellowing of his skin and the whites of his eyes. He also has started to feel bloated lately and his stomach is distinctly larger than usual. You check his PMR to see his medication history; he takes atenolol 50mg tablets once daily, aspirin 75mg tablets once daily and terbinafine tablets 250 mg once daily. He also had a yellow fever vaccine in your pharmacy two weeks ago. Which of the following is the most likely cause of his symptoms?

Answer 1473

Side effects from the terbinafine tablets

Question 1474

TERBINAFINE IS HEPATOXIC, YELLOW VISION ,EC

Question 1475

You are conducting a presentation to train pharmacy support staff on high risk medicines. You are including a section on non-steroidal anti-inflammatory drugs (NSAIDs). Regarding NSAIDS, which of the following would be incorrect information to include in the presentation? a) All patients using NSAIDs should receive gastro-protective treatment b) Naproxen 1g daily is associated with a lower thrombotic risk than ibuprofen 2.4g daily c) All NSAID use is associated with an increased risk of thrombotic events d) Naproxen is associated with a higher risk of gastro-intestinal events than ibuprofen e) Oral piroxicam use is associated with serious skin reactions

Answer 1475

All patients using NSAIDs should receive gastro-protective treatment

Question 1476

Mrs Atkins’ recent blood test shows raised levels of T3 and T4, and an extremely low TSH level. She has noticed excessive sweating and diarrhoea for the last few weeks. What is the most appropriate advice to give her?

Answer 1476

Stop taking the amiodarone tablets and see her doctor urgently THYROID DISORDER OII

Question 1477

Tim has been taking Priadel® 400mg tablets at a dose of one tablet daily, for the last 2 months. He has recently started experiencing side effects of a skin rash, nausea and muscle weakness. He has come to the hospital for a blood test. Which of the following blood serum levels of lithium is Tim most likely to have?

Answer 1477

1.2-1.6, COOL

Question 1478

Dante, a 53-year-old man, has already tried psychological therapy. He is going through a divorce which is causing him to feel guilty and have low self-esteem. He has stopped joining his friends for the weekly pub quiz. He is not enjoying his job and he feels a lack of motivation to start the day every morning. He currently takes aspirin 75mg tablets, digoxin 125mcg tablets, simvastatin 10mg tablets and ramipril 2.5mg capsules.

Answer 1478

Mirtazapine

Question 1479

Sandra, who is 38-years-old, should be advised not to drive as this medication causes drowsiness.

Answer 1479

METHYLDOPA!

Question 1480

Suky has been experiencing symptoms of Raynaud’s syndrome since she was 18-years-old, but it has recently been getting worse, despite her taking precautions to prevent her hands and feet from getting cold. Her GP has suggested a trial of this drug as prophylaxis, starting at 5mg three times a day

Answer 1480

NIFEDIPINE

Question 1481

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

Answer 1481

Oxycodone?

Question 1482

Mrs Ella Feather, a 42-year-old woman, has come into the pharmacy suffering from low back pain and would like some recommendations to manage her condition. She cannot take non-steroidal anti-inflammatory drugs. She has tried applying a heat patch to the area but remains uncertain of how beneficial the approach was. She is considering a visit to the doctor to obtain a prescription. She asks you what you can recommend.

Answer 1482

manual?

Question 1483

A 16-year-old girl with a stoma has been suffering from iron deficiency anaemia so she has been initiated on ferrous fumarate oral solution. She takes 10mLs once a day. However, she has started to experience troublesome loose stools and soreness.

Answer 1483

WITHDRAW GRADUALLY

Question 1484

Chris, a 5-year-old boy, suffers from seasonal hay fever. He does not like oral antihistamines so his mother would prefer another option. You suggest a suitable product to Chris’ mother that his GP will need to prescribe for him.

Answer 1484

azelastine wow

Question 1485

Chloe, a 19-year-old customer, is suffering from itchy eyes and has puffy eyelids for the first . Her doctor has prescribed lodoxamide eye drops for allergic conjunctivitis, and recommended a medicine for her to purchase over the counter, but she cannot remember what it was. Her symptoms are mild and she has not tried anything else. You provide the most appropriate recommendation

Answer 1485

Sodium cromoglicate eye drops

Question 1486

APOMORPHINE, OFF PERIODS!