Regional Flashcards
(28 cards)
1) A 25-year-old woman hands you a prescription for folic acid 5mg tablets, with the instruction ‘take
one daily’
. The back of the prescription has been marked for maternity exemption.
Which of the following conditions would require the patient to continue using folic acid
throughout the entire pregnancy?
A. Coeliac disease
B. Epilepsy
C. Haemoglobin S Disease
D. Obesity
E. Pre-eclampsia
ROB CORRECTION: to take folic acid 400mcg for obesity patients and pre-eclampsia
Answer: C (Haemoglobin S Disease)
Rationale: Pregnant patients that are obese, epileptic or have coeliac disease are recommended to
take folic acid 5mg up to 12 weeks of gestation. Only Haemoglobin S disease (also commonly
known as sickle-cell disease) requires folic acid to be taken throughout the whole of pregnancy.
Although pre-eclampsia itself does not increase the risk of neural tubular defects, it is still
recommended to take folic acid 400mcg supplements conceptually and up to 12 weeks of
pregnancy.
3-year-old girl has been brought into A&E with suspected meningitis. She has a
temperature of 39°C, tiny purple spots that are firm, and is very lethargic. The patient is
allergic to cephalosporins; the last time she took this type of antibiotic, her airways swelled
up. You are the on-call hospital pharmacist and have been asked to recommend an
appropriate antibiotic for this patient.
Which of the following antibiotics would be the most appropriate to recommend?
A. Benzylpenicillin IV
B. Cefotaxime IV
C. Chloramphenicol IV
D. Gentamicin SC
E. Teicoplanin IV
Answer: C (Chloramphenicol IV)
Rationale: For the treatment of meningococcal diseases benzylpenicillin is recommended,
however due to cross-sensitivity between Benzylpenicillins and Cephalosporins this would not be
an appropriate treatment option. If there is a history of hypersensitivity reactions (excluding rash)
to penicillin’s and cephalosporins, then chloramphenicol is recommended
Which of the following dietary factors can affect the absorption of sine met that a patient should be made aware of?
Alcohol
Broccoli
Cranberry Juice
Grapefruit Juice
High protein diet
Answer: E (High protein diet)
Rationale: Since levodopa competes with certain amino acids, the absorption of ‘Sinemet’ may be
impaired in some patients on a high protein diet.
A 4-year-old child has been rushed into your community pharmacy after a wasp sting a
few minutes ago. The child’s lips are swollen, and they are experiencing difficulty breathing.
Suspecting an anaphylactic reaction, you decide to administer adrenaline using an
appropriate syringe.
Which of the following strengths of adrenaline would be appropriate to administer to this
child?
A 150 milligrams, then repeated after 5–15 minutes as required
B 150 micrograms, then repeated after 5–15 minutes as required
C 300 micrograms, then repeated after 5–15 minutes as required
D 500 micrograms, then repeated after 5–15 minutes as required
E 500 milligrams, then repeated after 5–15 minutes as required
B
A 40-year-old woman has recently started a diabetic medication. She complains of
recurrent flu-like symptoms since starting the medication and recalls stopping the same
medication years ago for the same reason.
Which of the following antidiabetic medications can increase the risk of upper respiratory
tract infections?
A. Canagliflozin
B. Gliclazide
C. Insulin
D. Metformin
E. Sitagliptin
Sitagliptin and other DPP4 have the common side effects of respiratory tract infections and nasopharyngitis
A 40-year-old man has a moon-shaped face and a buffalo hump. The doctor suspects
Cushing’s syndrome and has asked you to recommend a suitable test to diagnose this
condition.
Which of the following tests is the most appropriate to recommend?
A. Alanine aminotransferase (ALT) test
B. C-Reactive Protein Test
C. D-Dimer Test
D. Overnight Dexamethasone Suppression Test
E. Thyroid-Hormone Stimulating (TSH) Test
Answer: D (Overnight Dexamethasone Suppression Test)
Rationale:
- Dexamethasone overnight suppression test is used to diagnose Cushing syndrome.
Dexamethasone suppresses cortisol secretion overnight. If the level remains high in the morning,
this would indicate Cushing syndrome.
- Alanine aminotransferase (ALT) test is a blood test that checks for liver damage (high levels
indicate liver damage).
- TSH test is used to diagnose underactive or overactive thyroid gland.
- C-reactive protein test: This protein is found in the blood and is correlated with the amount of
inflammation in the body for example during an infection.
- D-Dimer test: This test detects pieces of blood clot that have been broken down and are loose in
your bloodstream. A negative result is more reliable than a positive result and is useful tool to rule out VTE
A 50-year-old asthmatic patient with persistently poor control is taking:
- Salbutamol 100mcg, two puffs when required
- Seretide (fluticasone and salmeterol) 250mcg, one puff twice daily
- Montelukast 10mg at night
A nurse independent prescriber at the surgery has recently started the patient on:
- Slo-phyllin (Theophylline) 250mg every 12 hours
The patient has been booked for a blood test after 5 days of starting this new medication, as
per local guidelines.
Which of the following factors can increase the plasma level of theophylline?
A. Alcohol
B. Grapefruit juice
C. Heart failure
D. Smoking
E. St John’s Wort
Answer: C (Heart failure)
Rationale: Theophylline is metabolised by the liver, consequently any effect on this process would
affect the plasma levels. Options A and C are incorrect because the plasma concentration of
theophylline is decreased in smokers and in those that consume alcohol, due to an increased
clearance. St John’s wort is an inducer of the hepatic enzymes (cytochrome P450) and would
therefore reduce the plasma concentration levels, hence option B is incorrect. Option E is not
correct because it does not affect the plasma theophylline levels. The plasma concentration is
increased in heart failure, hepatic impairment and in viral infections, due to a decreased level of
clearance of theophylline.
A 45-year-old woman has severe osteoarthritis. Her pain has been managed with
intra-articular steroid injections to the knee and analgesics, but without success. She is due
to have a knee operation in 24 hours. Undergoing major surgery sometimes requires
alterations to a patient’s medication.
Which of the following medications should be stopped temporarily before the surgery?
A. Sodium Valproate
B. Lithium
C. Rotigotine
D. Flupentixol
E. Levothyroxine
LITHIUM should be stopped 24 hrs before major surgery, however in minor surgery the usual dose can be continued with careful monitoring. Other drugs that should be stopped before surgery including: Hormone contraceptives, MAOI, ACEI/ARBS
A 70-year-old man who is being treated for open-angle glaucoma. He complains that his
eyelashes have grown longer and that his eye colour has changed since using an eye drop.
Which of the following anti-glaucoma medications could be responsible for this adverse
effect?
A. Acetazolamide
B. Brimonidine
C. Latanoprost
D. Pilocarpine
E. Timolo
Lantanoprost- pro staglandin analogues can cause brown pigmentation of the iris and can cause hair growth
A GPhC inspector asks you regarding the upholding of data protection and information
governance.
Which of the following statements regarding data protection and information governance
is false?
A. General Data Protection Regulation (GDPR) does not apply to anonymous data
B. Implied consent is when a patient provides a statement in writing for their personal
information to be used
C. Processing data is any action related to collecting, storing, analysing and passing on
personal to someone else.
D. There must be legal grounds for using and sharing information
E. You should only collect, use and share the information you need.
Answer: B (An example of implied consent is when a patient provides a statement in
writing for their personal information to be used)
Rationale: Implied consent is when a patient provides indirect consent for example when
a patient hands their prescription to be dispensed in a pharmacy. Explicit consent is when
consent is clearly given in either writing or verbally form.
A 67-year-old man has been experiencing muscular pains. His medical history includes
ischaemic heart disease, hypertension, and hyperlipidaemia, making him at high risk of
cardiovascular events. The patient has found paracetamol ineffective. You have been asked
to recommend an NSAID that has the lowest risk of causing thrombosis whilst the patient
awaits physiotherapy.
Which of the following NSAIDs has the lowest risk of cardiovascular events?
A. Celecoxib 100 mg twice daily
B. Diclofenac 50mg TDS
C. Ibuprofen 2.4g/day
D. Naproxen 500mg BD
E. Piroxicam 20 mg daily
Answer: D (naproxen)
Rationale: All NSAIDs increase risk of thrombotic events, however Naproxen 1g/day poses
a low risk and Ibuprofen (1.2g/day or less) has not been associated with an increased risk
of MI.
- COX-2 selective inhibitors, diclofenac and ibuprofen 2.4g/day have been associated with
an increased risk of thrombotic events.
-Piroxicam (by mouth) should only be initiated by a specialist and has a high risk of GI
toxicity.
Additional information:
⮚ In patients with severe heart failure avoid all NSAIDs.
⮚ CVD risk: (high) COX-2, Diclofenac, Ibuprofen 2.4g/day → Naproxen →Ibuprofen
1.2g (low)
GI risk: (high) Piroxicam, Ketoprofen, Ketorolac → (intermediate) Indometacin, Diclofenac,
Naproxen →(low) Ibuprofen 1.2g/day → (lowest) COX-2 selective inhibitors
An 18-year-old woman is taking isotretinoin 20mg three times daily. She has been taking
this medication for the past 4 weeks. She regularly participates in the pregnancy prevention
programme and has consistently had negative pregnancy tests. She can see that the
medication is working but has been feeling down recently and is having thoughts of
self-harm.
Which of the following would be the most appropriate advice to give?
A. Continue taking isotretinoin and inform to your GP and your dermatology team
B. Continue taking isotretinoin and inform your dermatologist at your next appointment
C. Continue taking isotretinoin as this adverse effect improves with time
D. Stop taking isotretinoin and inform to your GP and your dermatology team
E. Withdraw isotretinoin slowly to prevent rebound acne
Answer: D (Stop taking isotretinoin and inform to your GP and your dermatology team)
Rationale:
As per British Association of Dermatologists (BAD) patient guide - If mood or behaviour is changing
and showing any signs of a mental illness:
1. Stop the medication immediately
2. Inform GP and dermatology team.
3. If under the care of a mental health service
You are the Responsible Pharmacist (RP) of a community pharmacy and noticed that you
have no stock of Espranor (buprenorphine) tablets for an MDA prescription. You decide to
request the medication from a local pharmacy using a CD requisition.
Which of the following is not a legal requirement for a CD requisition form?
A. Name of the medication
B. Name of the recipient
C. Purpose of the requisition
D. Signature of the recipient
E. Total quantity of drug
Answer: A (Name of medication)
Rationale: Legal requirements of the CD requisition:
1. Name of the recipient
2. Address of the recipient
3. Profession or occupation
4. Total quantity of drug
5. Purpose of the requisition
6. Signature of the recipient
A woman gave birth to her first child 6 weeks ago. She enters the pharmacy and tells you
that her baby is due to have their first injections in two weeks’ time. She would like more
information about what vaccinations her child will receive throughout their lifetime. The
baby was born at term and is in good health.
Which one of the following immunisation schedules is correct?
A. At 6 week of life MMR (Measles, Mumps and Rubella) live vaccine should be given
B. BCG (Bacillus Calmette-Guerin vaccine) should be given at age 3 months of life
C. Diphtheria with haemophilus influenza, poliomyelitis, pertussis and tetanus should be
administered at 2 months of life.
D. Pneumococcal polysaccharide vaccine should be given at the age of 75
E. Varicella-zoster virus vaccine should be given at the age of 65
ROB CORRECTION: 65 FOR SHINGLES
Answer: C (Diphtheria with haemophilus influenza, poliomyelitis, pertussis and tetanus
should be administered at 2 months of life)
Rationale:
●
MMR vaccine should be given at 1 years of age
●
Diphtheria with tetanus, pertussis, hepatitis B, poliomyelitis and haemophilus
influenzae type b vaccine should be given at 8 weeks of birth
●
Varicella-zoster vaccination should be administered at age 70
●
Pneumococcal polysaccharide should be given at age 65
●
BCG should be administered within 4 weeks of life
A man with structural heart disease has been diagnosed with atrial fibrillation. His
medical history includes hypertension and prostate enlargement. A doctor intends to trial
amiodarone for rhythm control but wishes to know the monitoring required for this
medication.
Which of the following monitoring requirements is incorrect?
A. Chest x-ray is required before treatment
B. Liver function test must be done before treatment and then every 3 months
C. Monitoring ECG is recommended during treatment
D. Serum potassium level must be measured before treatment
E. Thyroid function test must be done before treatment and then every 6 months
(Liver function test must be done before treatment and then every 3 months)
Rational: Liver function test should be performed every 6 months, not every 3 months. All
the other options are correct
A 35-year-old man has had an exacerbation of psoriasis. You suspect the flare-up may
have been triggered by a newly started medication.
Which of the following drugs is NOT known to exacerbate psoriasis?
A. Amlodipine
B. Atenolol
C. Hydroxychloroquine
D. Lithium
E. Naproxen
Amlodipine
Drugs can provoke/exacerbate psoriasis include lithium, chloroquine, hydroxychloroquine, beta blockers, NSAIDS, ACEI
60-year-old man has atrial fibrillation, hypertension, and diabetes. He weighs 65kg
and is currently taking the following medication:
●
Atorvastatin 40mg once daily
●
Bisoprolol 5mg once daily
●
Digoxin 250microgram daily
●
Metformin 500mg once daily
He complains that his vision has turned yellow and is struggling to drive due to tremors in his
hands. You suspect the symptoms could be a result of a drug-drug interaction.
Which of the following is likely to contribute to these symptoms when taken
concomitantly with the patient’s current medication?
A. Diclofenac
B. Eplerenone
C. Furosemide
D. Meloxicam
E. Warfarin
Answer: C (Furosemide)
Rationale:
- The symptoms of digoxin toxicity include anorexia, nausea, vomiting, yellow vision and
arrhythmias. These symptoms may not all manifest in a patient but in this scenario the
yellow vision is a good indicator of toxicity.
- Often digoxin toxicity is a result of a change in electrolyte level such as hypokalemia,
hypomagnesaemia, hypercalcemia and can also be caused by hypoxia.
- Loop diuretics decreases the reabsorption of sodium, potassium and magnesium in the
Loop of Henle, resulting in fluid loss, hypokalemia and hypomagnesaemia.
- Warfarin, meloxicam, eplerenone and diclofenac do not interact severely with digoxin.
A 24-year-old woman has had a flare-up of eczema. A GP would like to prescribe a
moderate-potency corticosteroid but cannot recall a corticosteroid cream of this potency.
Which of the following would be suitable to recommend?
A. Hydrocortisone 1% (HC45®)
B. Clobetasone butyrate 0.05% (Eumovate®)
C. Mometasone furoate 0.1% (Elocon®)
D. Hydrocortisone butyrate 0.1% (Locoid®)
E. Clobetasol propionate 0.0525% (Dermovate®)
Also hydrocortisone butyl is mod potent
Answer: B (Clobetasone butyrate 0.05% (Eumovate®)
Rationale:
Clobetasone butyrate 0.05% (Eumovate) is of moderately potency.
Hydrocortisone 0.1%, 0.5%, 1.0%, 2.5% is mild
and Mometasone 0.1% are potent corticosteroid.
Clobetasol propionate 0.0525% is a very potent corticosteroid.
A 4-year-old child has chickenpox with a fever. His mother has come to the pharmacy to
purchase Calpol 2+ months (paracetamol 120mg/5ml) and calamine lotion. Upon selling the
medication, the patient’s mother asks what dose of paracetamol to give the child.
Which of the following paracetamol doses is suitable for the child??
A. 2.5ml and if necessary, after 4-6 hours, give a second 2.5 ml dose.
B. 2.5ml every 4–6 hours (maximum 4 doses per day)
C. 5ml every 4–6 hours (maximum 4 doses per day)
D. 7.5ml every 4–6 hours (maximum 4 doses per day)
E. 10ml every 4–6 hours (maximum 4 doses per day)
Answer: E (10ml every 4–6 hours (maximum 4 doses per day)
Rationale: 2-3 months: 60mg and If necessary, after 4-6 hours, give a second 2.5 ml
(60mg) dose.
For Child 3–5 months: 60 mg every 4–6 hours; (maximum 4 doses per day)
For Child 6 months–1 year: 120 mg every 4–6 hours (maximum 4 doses per day)
For Child 2–3 years: 180 mg every 4–6 hours (maximum 4 doses per day)
For Child 4–5 years: 240 mg every 4–6 hours (maximum 4 doses per day)
For Child 6–7 years: 240–250 mg every 4–6 hours (maximum 4 doses per day)
For Child 8–9 years: 360–375 mg every 4–6 hours (maximum 4 doses per day)
For Child 10–11 years: 480–500 mg every 4–6 hours (maximum 4 doses per day)
For Child 12–15 years: 480–750 mg every 4–6 hours (maximum 4 doses per day)
Additional information: Learn the dosages of common medication for example
paracetamol, ibuprofen and amoxicillin.
A 45-year-old man drinks alcohol heavily. He started drinking when he was 18 years old,
but since losing his wife to breast cancer two months ago, he has been drinking more
heavily. The doctor believes the patient is at risk of Wernicke’s encephalopathy.
Which of the following vitamins can be used to prevent Wernicke’s encephalopathy?
A. Vitamin A
B. Vitamin B1
C. Vitamin B12
D. Vitamin E
E. Vitamin K
Answer: B (vitamin B1)
Rationale: Vitamin A (retinol); Vitamin B1 (thiamine); Vitamin B12 (cyanocobalamin);
Vitamin E (tocopherol); Vitamin K (phytomenadione)
Alcohol reduces the absorption of thiamine in a person’s diet. Persistent low levels of
thiamine can lead to Wernicke’s encephalopathy, a neurological condition characterised by
impaired concentration and delirium.
You are conducting research on the benefit of using hydroxychloroquine in managing
systemic lupus erythematous as evidence of your planned continuing professional
development (CPD).
Which of the following study designs has the greatest quality of evidence?
A. Cohort studies
B. Expert opinion
C. Meta-analysis
D. Non-randomised controlled trials
E. Randomised controlled trials
Meta analysis
Quality of evidence: (high to low)
●
Meta-analysis
●
Systematic review
●
Critically appraised literature
(evidence cased practice)
●
Randomized controlled trial
●
Non-randomized controlled trial
●
Cohort studies
●
Case series or studies
●
Individual case reports
●
Expert opinion
A 30-year-old woman presents to the pharmacy complaining of persistent fatigue,
dizziness, and shortness of breath. She also mentions that her nails have become brittle. A
recent blood test shows low haemoglobin and low ferritin levels
A. Folate deficiency
B. Haemolytic anaemia
C. Iron deficiency anaemia
D. Megaloblastic anaemia
E. Sickle cell anaemia
F. Vitamin A (retinol) deficiency
G. Vitamin B12 (cobalamin) deficiency
H. Vitamin D (colecalciferol) deficiency
Answer: C (Iron deficiency anaemia)
Rationale: Iron deficiency is the most likely cause of the patient’s symptoms, as it is a common
cause of fatigue, dizziness, and shortness of breath due to decreased oxygen-carrying capacity of
the blood. Low haemoglobin and ferritin levels are key indicators of iron deficiency anaemia.
Additional symptoms, such as brittle nails (koilonychia) and cravings for non-food substances like
ice (pica), are also characteristic of iron deficiency
A 55-year-old woman presents to her GP with complaints of fatigue, numbness in her
hands and feet, and difficulty maintaining balance. Blood tests reveal macrocytic anaemia
with low haemoglobin and an elevated mean corpuscular volume (MCV).
A. Folate deficiency
B. Haemolytic anaemia
C. Iron deficiency anaemia
D. Megaloblastic anaemia
E. Sickle cell anaemia
F. Vitamin A (retinol) deficiency
G. Vitamin B12 (cobalamin) deficiency
H. Vitamin D (colecalciferol) deficiency
Answer: G (vitamin B12 deficiency)
Rationale:
Vitamin B12 deficiency is the correct answer because it commonly presents with macrocytic
anaemia (elevated MCV) and neurological symptoms, such as numbness, tingling, and balance
difficulties. This occurs due to its role in red blood cell formation and myelin synthesis.
Iron deficiency anaemia: Typically causes microcytic, hypochromic anaemia rather than
macrocytic anaemia. It presents with fatigue and pallor but does not usually cause neurological
symptoms.
Folate deficiency: Also leads to macrocytic anaemia, but it does not cause the neurological
deficits seen in vitamin B12 deficiency like in this case causing balance impairment.
A. Hypermagnesemia
B. Hypomagnesemia
C. Hyperkalaemia
D. Hypercalcemia
E. Hypernatremia
F. Hypocalcaemia
G. Hyperglycaemia
H. Hypoglycaemia
A 74-year-old patient has been taking lansoprazole 30mg once daily for the past 20 years
to manage a hernia. Following a blood test, the doctor noticed a change in their electrolyte
levels
Answer: B (hypomagnesemia)
Rationale: Proton pump inhibitors (PPI’s) are known to decrease magnesium levels (usually after
one year of treatment) and can also increase the risk of osteoporosis.
