T1 Flashcards
Which option, when stopped suddenly, is the most likely to cause withdrawal symptoms?
You chose the incorrect answer 10 mg prednisolone daily for 21 days 20 mg prednisolone daily for 10 days
25 mg prednisolone daily for 14 days
40 mg prednisolone daily for 5 days
50 mg prednisolone daily for 10 days
The correct answer was 50 mg prednisolone daily for 10 days
Gradual withdrawal should be considered for patients receiving more than 40 mg prednisolone (or equivalent) daily for more than 1 week.
You run a travel advice service in your community pharmacy.
Which one of the following statements is NOT correct regarding malaria prophylaxis?
A. Chloroquine is unsuitable for malaria prophylaxis in individuals with a history of epilepsy.
B. Mefloquine has an increased risk of QT-prolongation when used with amiodarone.
C. Prophylaxis is not absolute and therefore infection can occur with any of the drugs recommended.
D. Prophylaxis should be continued for 4 weeks after leaving the area, with the exception of Malarone®.
E. Travel to malarious areas should be avoided during pregnancy; if travel is unavoidable, then only use personal protection (such as mosquito nets), as proguanil is contraindicated in pregnancy.
The correct answer was Travel to malarious areas should be avoided during pregnancy; if travel is unavoidable, then only use personal protection (such as mosquito nets), as proguanil is contraindicated in pregnancy.
Atovaquone with proguanil hydrochloride should be avoided during pregnancy, however it can be considered during the second and third trimesters if there is no suitable alternative. Folic acid (dosed as a pregnancy at ‘high-risk’ of neural tube defects) should be given for the length of time that atovaquone with proguanil hydrochloride is used during pregnancy
Which of the following is NOT known to cause an increased risk of a foetus developing spina bifida?
A. Lack of folic acid
B. Obesity
C. Taking carbamazepine
D. Taking sodium valproate
E. Taking vitamin B9
Vitamin B9 is folic acid - taking this during the pregnancy reduces the risk of developing spina bifida. The following increase the risk of spina bifida:
Lack of folic acid (vitamin B9)
Family history
Medications e.g. valproate and carbamazepine
Obesity
Diabetes
You are working in a community pharmacy and a 29-year-old woman asks for your advice about her teeth. She has started to notice a ‘brown staining’ on her teeth and wishes to know whether any of her medications could be the cause of this.
Which of the following medications is most likely to be the causative factor of the brown staining?
A. Alendronic acid
B. Chlorhexidine mouthwash
C. Doxycycline
D. Methotrexate
E. Omeprazole
Chlorexidine - Brown staining of the teeth frequently follows the use of chlorhexidine mouthwash, spray or gel, but can readily be removed by polishing. Deposition of tetracyclines in growing bone and teeth (by binding to calcium) causes staining and occasionally dental hypoplasia, and they should not be given to children under 12 years but are unlikely to cause staining in adults.
You are working in Medicine’s Information when a newly qualified doctor contacts you to discuss the treatment of chlamydia.
Which of the following antibiotic drugs is normally given as a ‘1 gram as a single dose followed by 500 mg daily for 2 days’ dose in uncomplicated genital chlamydial infections?
A. Azithromycin
B. Amoxicillin
C. Clarithromycin
D. Doxycycline
E. Nitrofurantoin
A- 1 gram azithromycin STAT is a first-line treatment option for uncomplicated chlamydia.
Mrs Smith has been taking 800 units of ergocalciferol because she has a lack of vitamin D.
She develops nausea and has now vomited. What is the likely reason for this?
A. If ergocalciferol is given without calcium, it may cause this symptom
B. The preparations of ergocalciferol are generally not well tolerated
C. These symptoms are unrelated to Mrs Smith’s therapy
D. The vitamin D may have led to an increase in serum calcium causing the symptoms
E. The vitamin D therapy may have decreased serum calcium causing the symptoms
D
A 48-year-old woman comes into your pharmacy for advice. She tells you that she is experiencing pain in her right ear. After further discussion you find that the pain started after she cleaned it with a cotton bud earlier today and that there is swelling and blood in the same ear.
Which one of the following actions is the most suitable to take in this situation?
A. Advise her to gently clean the blood and the pain will go naturally with time
B. Ask her to request ear syringing from her GP’s practice nurse
C. Refer her to a doctor
D. Supply olive oil ear drops
E. Supply sodium bicarbonate ear drops
The correct answer was Refer her to a doctor
Cotton ear buds may have caused injury in the woman’s right ear. The use of cotton ear buds is not recommended as they push ear wax further down the ear canal and may also cause injury or infection.
A patient is admitted into hospital with newly diagnosed tuberculosis. The patient has also been on warfarin for atrial fibrillation for the past 6 years.
Which of the following medicines may reduce the effect of the patient’s regular warfarin?
Ethambutol Isoniazid Omeprazole Pyrazinamide Rifampicin
Rifampicin is a potent enzyme inducer and therefore will increase the metabolism of certain drugs metabolised by the same enzyme, such as warfarin.
A local doctor asks you about how to prescribe controlled drugs for a patient she has seen privately.
To be a valid prescription for a schedule 2 CD from a doctor who has seen a patient privately, how must the prescription be presented?
Be computer generated
Be hand written
Be on an approved form
Be on letter-headed paper
Be prescribed on the NHS only
Be on an approved form
You have a patient who has been newly diagnosed with COPD, they ask you for some information about the condition. Chronic obstructive pulmonary disease (COPD) is a progressive obstructive airways disease.
Which of the following is NOT true regarding COPD?
All smokers will eventually develop COPD
COPD sufferers may also suffer swollen ankles
Environmental pollution can be a causative factor
It is less common in women as it is in men
The main causative factor is smoking
A
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?
Carbamazepine is removed by the kidneys at a high rate and so the dose must be increased over time
Carbamazepine is removed by the liver at a high rate and so the dose must be increased over time
Carbamazepine itself increases how quickly the body processes it so the maintenance dose is higher than the initial dose
Disease progression is taking place despite no change in symptoms and so the dose has been increased
Drug tolerance may have developed and so the dose has been increased
The correct answer was Carbamazepine itself increases how quickly the body processes it so the maintenance dose is higher than the initial dose
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.
ou are contacted by a carer for advice on administering medicines to a patient.
What is the correct advice for the administration of Mezolar Matrix (fentanyl) 12 mcg/hour transdermal patch?
Apply the next patch at the same site
Avoid touching the adhesive side of patches and wash hands after application
Replace every 48 hours
Shave prior to application
Wash the area with soap before applying
Avoid touching
You are the pharmacist on duty in a community pharmacy. A woman presents to your pharmacy. She has just turned 17 and would like to give blood. She has seen on the NHS website that when people are on certain medicines they may not be able to give blood. She asks you about her medicine, isotretinoin.
What is the most appropriate advice?
She can give blood without any concerns
She can never give blood
She must not give blood until 4 weeks after the last dose of the medicine
She must not give blood until 8 weeks after the last dose of the medicine
She must not give blood until 2 years after the last dose of the medicine
4 weeks
Which colours urine pink/orange
Warfarin
Phenindoine
Apixiban
Rivaroxaban
The correct answer was Phenindione
An adverse effect of phenindione is that it can colour urine pink/orange
A 26-year-old female comes into your pharmacy to ask for 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 this patient?
a) Ask your doctor for an alternative vaccination
b) Delay taking the vaccine until after you become pregnant
c) Don’t take the vaccination, it is not necessary
d) No vaccine affects pregnancy
e) Rubella vaccination should be given to individuals who do not have immunity to the condition, including women of child-bearing age. Avoid pregnancy for at least 1 month after vaccination
The correct answer was 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 vaccination
This 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).
Which of the following is a toxic effect of theophylline
Tachycardia
Watering eyes
Drowsiness
Bruising
Goitre
Tachycardia
A patient comes into your pharmacy and is concerned about a change in the colour of their urine.
Which is the LEAST likely to have caused this?
Co-beneldopa
Co-careldopa
Co-danthramer
Co-danthrusate
Co-fluampicil
Co-fluampicil
You are a foundation trainee working in a community pharmacy. You notice that the pharmacist makes many mistakes and regularly takes longer for lunch than is allowed. Occasionally, he returns from lunch smelling of alcohol.
Regarding raising a concern for this behaviour, which of the following is NOT true?
Failing to raise concerns about poor practice could result in harm to patients
Foundation trainees are not able to raise concerns
The Public Interest Disclosure Act 1998 will protect you if you raise a concern
This pharmacist might be struck off if you tell someone
Your own fitness to practice may be called into question if you don’t raise this
Foundation pharmacists can raise concerns
In which of the following situations can hydrocortisone 1% cream be recommended over the counter?
For a 9-year-old child with an insect bite on the arm
For acne on the back of a 14-year-old male
For a patient who has tried it for 7 days and would like to continue for a further 7 days
For contact dermatitis on the neck line of a post-menopausal female
For the external treatment of chicken pox in an adult
The correct answer was For contact dermatitis on the neck line of a post-menopausal female
This 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.
A patient presents with poor renal function. You calculate her eGFR as 27 mL/minute.
Which of the following drugs would be ineffective for use in the patient?
Amiodarone
Bendroflumethiazide
Piperacillin with Tazobactam
Pseudoephedrine
Ursodeoxycholic Acid
The correct answer was Bendroflumethiazide
Effectiveness of thiazide diuretics is eradicated if eGFR <30 mLs per minute.
You are doing some research into treatment options for pruritus.
Which of the following medications are listed in the BNF as suitable for treatment of pruritus?
Carbamazepine
Cinnarizine
Hydroxyzine hydrochloride
Ketotifen
Loratadine
Hydroxyzine hydrochloride is indicated for use in pruritus.
Which ONE of the following drugs is NOT suitable for both supraventricular and ventricular arrhythmias?
Amiodarone
Flecainide
Propafenone
Sotalol
Verapamil
Verapamil is usually effective for supraventricular tachycardias only.
Mrs J, a 41-year-old woman, 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 initial treatment/course of action?
A cough suppressant
A demulcent
An antihistamine
An expectorant
No treatment
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
Miss SJ has been prescribed orlistat as part of a regime to help her lose weight. Orlistat can affect absorption of vitamins.
The absorption of which one of the following vitamins is NOT decreased by orlistat?
The SmPC is available here: https://www.medicines.org.uk/emc/product/2592
Vitamin A
Vitamin B
Vitamin D
Vitamin E
Vitamin K
Vitamin ADEK are fat soluble and orlistat may reduce the absorption
