T11

Question 1

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?
Codeine
Ephedrine
Kaolin
Loperamide
Pseudoephedrine

Answer 1

Kaolin would need to have additional caution but it is not subject to abuse

Question 2

You are taking on a new role in medical admissions.
Which one of the following pieces of information relating to a patient’s medication is NOT normally required when completing a medication history?

Dietary supplements

Herbal medicines

Medicines purchased OTC

Medicines required only on a prn basis

Medicines stopped 6 months ago

Answer 2

The correct answer was Medicines stopped 6 months ago
Medication history should include medicines that have recently stopped or changed and although the MEP does not define how recent it would have to be, it is unlikely that medicines taken 6 months ago would be relevant to a current medication history.

Question 3

A patient presents in your pharmacy with a prescription.
The patient has been prescribed penicillin V for tonsillitis. She asks whether she will be able to continue breastfeeding her 5-month-old baby whilst she is taking the antibiotic. What is the best advice for the patient?
Penicillin V is considered compatible for breastfeeding but the infant should be monitored
She should avoid feeding the baby for 45 minutes after taking the medicine because concentrations in the blood are highest then
She should stop breastfeeding until after the course is complete
The patient should be referred to her health visitor
The treatment is not compatible with breastfeeding and the patient should be referred back to her GP

Answer 3

The correct answer was Penicillin V is considered compatible for breastfeeding but the infant should be monitored
Penicillin V is considered compatible for breastfeeding but the infant should be monitored for adverse effects.

Question 4

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?
Azathioprine
Ciclosporin
Ketamine
Rifampicin
Ritonavir

Answer 4

Ritonavir îs a protease inhibitor used in the treatment of HIV

Question 5

Which one of the following actions would be the most appropriate for a patient taking sulfasalazine who is experiencing a sore throat with a fever?
Advise the patient to seek medical attention as the dose of the medicine may need to be increased
Advise the patient to see their GP as the medicine may need to be withdrawn
Advise the patient to seek medical attention as the dose of the medicine may need to be reduced
Advise the patient that they are experiencing a side effect of the medicine. It is safe to continue taking the medicine, but they may wish to see their GP for an alternative
Advise the patient to stop taking the medicine straight away and seek medical attention

Answer 5

The correct answer was Advise the patient to stop taking the medicine straight away and seek medical attention
BNF states that the aminosalicylates should be stopped immediately if there is suspicion of blood dyscracias. A sore throat could indicate a blood dyscrasia. Patients should be advised to report a sore throat if this occurs whilst they are being treated with this drug. The drug should be stopped and a blood test performed to check for blood dyscrasias.

Question 6

Mr Singh, a 76-year-old man, comes in to his community pharmacy and asks to speak with the pharmacist. He has a sore right eye. He says that his eye is watering and irritated. The symptoms have been present for quite some time. Upon examination his eye appears normal.
Based on this information, what is the most likely diagnosis?
Blepharitis

Chalazion

Conjunctivitis

Dry eye syndrome

Stye

Answer 6

The correct answer was Dry eye syndrome
Entropion, blepharitis and dry eye syndrome can all cause excessive tearing. However, an eye examination would generally show other symptoms of redness and skin flaking in conjunctivitis and blepharitis. Dry eye syndrome seems the most likely diagnosis. Supporting this is that Mr Singh’s age also fits with this diagnosis.

Question 7

ou are work in a community pharmacy, Ms Bridges, a 28-year-old woman, approaches you and asks for a cough medicine for her chesty cough.
From the following symptoms, which one is most likely to make you refer the patient to the GP?
Associated frontal headaches
Cough present for 10 days
Failure of symptoms to respond to guaifenesin
Occasional episodes of shortness of breath
Sputum that is clear in colour

Answer 7

The correct answer was Occasional episodes of shortness of breath
Associated headaches with cough is a relatively common symptom; duration is classed as acute until 3 weeks has elapsed; failure to respond to treatment doesn’t necessarily require referral but reassessment of symptoms would be advisable; clear sputum colour is not a referral point. Shortness of breath however needs further evaluation

Question 8

You are undertaking some continuing professional development to remind yourself about the schedules of drugs which govern prescribing policies.
Which of the following schedule of drugs does pregabalin come under?
Schedule 1
Schedule 2
Schedule 3
Schedule 4
Schedule 5

Answer 8

3

Question 9

You are updating your pharmacy SOPs with regards to the management and dispensing of gabapentin.
Which of the following is NOT a requirement for gabapentin?
CD register entry
Dose on prescription
Drug strength on prescription
Drug formulation on prescription
Total quantity in words and figures on prescription

Answer 9

The correct answer was CD register entry
Pregabalin and gabapentin are exempt from record-keeping requirements.

Question 10

25-year-old woman is breastfeeding her 5-month-old child and requires pain relief.
Which drug has a risk of overdosing an infant if used in breastfeeding women due to a maternal variation in capacity to metabolise?
Codeine
Ibuprofen
Morphine
Paracetamol
Tramadol

Answer 10

Codiene - genetic polymorphism of enzymes involved in the metabolism of codeine to morphine can lead to increased levels of morphine in the mother

Question 11

A man presents to your pharmacy complaining of a rash all over his body. He tells you that he started taking phenytoin 9 days ago.

The SmPC is available here: https://www.medicines.org.uk/emc/product/7558
What recommendation(s) would you give to this patient?

Continue taking drug as this is a harmless adverse effect of the drug

Refer to GP as dose of drug may need to be increased

Refer to GP as dose of drug may need to be reduced

Stop drug, refer to GP as the patient is experiencing an allergic reaction

Stop drug, urgent referral for medical attention

Answer 11

The correct answer was Stop drug, urgent referral for medical attention
Patients or their carers should be told how to recognise signs of blood or skin disorders, and advised to seek immediate medical attention if symptoms such as fever, rash, mouth ulcers, bruising, or bleeding develop.

Question 12

One of your patients has just started to use Yasmin as a form of contraception. There are several drugs which may interact with this oral contraceptive.
Which of the following drugs reduces the effectiveness of Yasmin?
Naloxone
Paracetamol
Ranolazine
Rifabutin
Selegiline

Answer 12

Rifabutin is predicted to decrease the efficacy of COC - Inducer

Question 13

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?
Administer an EpiPen to the patient in the pharmacy
Ask the assistant to call the patient’s GP for them to request an emergency supply
Ask the assistant to telephone 999, request an ambulance and state anaphylaxis
Start an emergency supply procedure
Take the patient into the consultation room

Answer 13

The correct answer was Ask the assistant to telephone 999, request an ambulance and state anaphylaxis
The 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 14

A patient presents in your pharmacy and asks you for advice.
The patient has been suffering from a mouth ulcer for the past three weeks. It is not causing him any pain. What is the best course of action?
Advise the patient to avoid brushing the area to give it time to recover
Advise the patient to take paracetamol for the pain
Refer the patient to a dentist
Sell the patient an analgesic mouthwash
Sell the patient a topical anaesthetic gel

Answer 14

The correct answer was Refer the patient to a dentist
Patients suffering with a mouth ulcer for more than 2 weeks should be referred to a dentist to exclude oral cancer.

Question 14

Patients should be warned to immediately report any signs of bone marrow suppression (e.g. flu-like symptoms) for a number of drugs in the BNF.
Which of the following drugs is NOT associated with bone marrow suppression?

Azathioprine

Azilsartan

Carbimazole

Methotrexate

Mycophenolate mofetil

Answer 14

The correct answer was Azilsartan
Azilsartan is an angiotensin-II receptor antagonist that is not associated with bone marrow suppression.

Question 15

You attend a group CPD session on ear problems. The group discusses a case of eczematous inflammation in otitis externa.
Which one of the following is indicated in this condition?
Almond oil ear drops
Gentamicin with hydrocortisone ear drops
Olive oil ear drops
Oral aciclovir
Oral chlorphenamine

Answer 15

Gentamicin with hydrocortisone ear drops

Question 16

Mr VK comes to your pharmacy. He says that he is suffering from an allergic reaction to something. On questioning him you find that he started a course of antibiotics two days ago for a chest infection.
Which one of the following is a typical symptom of a drug induced allergic reaction?

Constipation

Diarrhoea

Headache

Nausea and vomiting

Urticaria

Answer 16

Urticaria - skin reactions can be associated with drug reactions

Question 17

Mr JB attends your pharmacy he is suffering from diarrhoea and thinks it is a side effect of his medication. Patients may experience side effects that warrant discontinuation of the medicine.
Which one of the following drugs must be discontinued immediately and the patient advised to contact their doctor if diarrhoea develops?

Clindamycin
D-alpha tocopherol
Magnesium trisilicate
Progesterone
Sulfasalazine

Answer 17

Clindamycin- c diff which can be fatal must discontinue and tell doctor if diarrhoea occurs

Question 18

You are working alongside a foundation trainee and teaching them about hypertension, particularly about the use of bendroflumethiazide for the treatment of high blood pressure.
What is the usual dose used for hypertension?
Bendroflumethiazide 1 mg twice daily
Bendroflumethiazide 2.5 mg once daily
Bendroflumethiazide 2.5 mg twice daily
Bendroflumethiazide 5 mg once daily
Bendroflumethiazide 10 mg once daily

Answer 18

Bendro 2.5mg OD

Question 19

You are running an educational workshop for patients with diabetes in the community. You receive a question from a patient regarding OTC medicines and diabetes.
Which of the following medicines must be cautioned in diabetes due to affects on blood glucose?
Beconase
Dulcolax
Nurofen 200 mg tablets
Sterimar
Sudafed decongestant tablets

Answer 19

The correct answer was Sudafed decongestant tablets
Pseudoephedrine must be used in caution in patients with diabetes. Pseudoephedrine may increase blood glucose levels.

Question 20

You are instructing a trainee pharmacist in the schedules contained in the Misuse of Drugs Regulations. 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?
Schedule 1
Schedule 2
Schedule 3
Schedule 4
Schedule 5

Answer 20

2

Question 21

You have a 23 year-old female patient who is being treated to control her psoriasis. Psoriasis is a chronic condition affecting the skin and joints. The aim of the treatment is to keep the condition controlled as there is currently no known cure.
Which of the following is NOT a characteristic or symptom of plaque psoriasis?

Affects mainly knees, hands, elbow and scalp

Fever

Plaque formation on skin

Red scaly lesions

Silver scales on skin

Answer 21

Psoriasis is a chronic condition which has many aggravating factors such as stress, drugs and infections. Plaque psoriasis is characterised by red scaly lesions on the skin, silver scales on the skin, plaque formation on the skin and most commonly affects the knees, hands, elbows and scalp. Fever is NOT a normal sign or symptom of psoriasis (it may indicate a medical emergency such as pustular psoriasis).

Question 22

A 24-year-old female comes into your pharmacy to ask for a hormonal emergency contraceptive pill. After asking her all of the relevant questions you supply ulipristal and counsel her. She is not currently taking the oral contraceptive pill, she is not taking any other medicines, has no medical conditions and no allergies.
Which one of the following counselling points is the LEAST suitable to tell the patient?

If the next menstrual period is more than 7 days late a pregnancy test should be performed

If you are sick within the first 3 hours of taking this medicine you should come back for a replacement dose.

You may experience lower abdominal pain as a side effect of this medication

Your next period may be earlier or later than usual

You should use a barrier method of contraception until your next period

Answer 22

The correct answer was You may experience lower abdominal pain as a side effect of this medication
Lower abdominal pain may be indicative of an ectopic pregnancy and medical attention should be sought.

Question 23

A 47-year-old female who has been admitted to hospital following a motorbike accident. She has attained numerous injuries including trauma to her spinal cord but her organ function is normal. Her consultant wishes to initiate her on baclofen. She takes the following drugs:

Atenolol 25 mg o.d.
Captopril 25 mg b.d.
Zonisamide 300 mg o.d.
Loperamide 2 mg m.d.u.
Which one of the following is the most suitable intervention for this patient?

Advise her carers that baclofen should be administrated at night

Advise her consultant that baclofen enhances the hypotensive effect of captopril and atenolol

Advise her consultant that baclofen is contra-indicated in epilepsy

Advise her consultant that the use of baclofen with zonisamide is contra-indicated due to an increased risk of the patient developing hyperthermia.

No intervention is required

Answer 23

Baclofen increases the hypotensive effects of ACEI and BB

Question 24

Whilst working in a community pharmacy you receive a phone call from a community nurse practitioner. She wishes to prescribe an Epipen for an adult in case of anaphylaxis. What is the strength of Epipen that is used in adults? 0.015 mg 0.03 mg 0.15 mg 0.3 mg 3 mg

Answer 24

0.3mg

Question 25

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? Develop flu-like symptoms, such as sore throat and swollen glands Future infertility in the woman Lead to premature labour Nothing Organ damage to the foetus during the early stages of the pregnancy

Answer 25

The correct answer was Organ damage to the foetus during the early stages of the pregnancy The 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 26

A 36-year-old woman asks for OTC vaginal thrush treatment for her second outbreak in eight months. She is particularly complaining about vulval itchiness and soreness. What is the most appropriate course of action in this instance? Recommend that the woman visits her local sexual health clinic for a check up Refer the woman to her GP Sell the sodium citrate granules that can be used to help with her vulval discomfort Sell the woman clotrimazole 1% cream to alleviate external symptoms of vaginal thrush Sell the woman hydrocortisone 1% cream to help reduce the vulval itchiness

Answer 26

The correct answer was Sell the woman clotrimazole 1% cream to alleviate external symptoms of vaginal thrush If the patient has more than 2 episodes of thrush in 6 months she should be referred to her GP. As this is not the case - she can be treated with clotrimazole 1% cream.

Question 27

Which of the following is NOT a red flag of a more serious underlying cause for the acute diarrhoea? Abdominal pain Blood in the stool Patient has recently travelled abroad Persistent diarrhoea Unexplained weight loss

Answer 27

The correct answer was Abdominal pain Prompt investigation is required to identify or exclude any serious underlying cause if the child has any red flag symptoms such as unexplained weight loss, rectal bleeding, persistent diarrhoea, a systemic illness.

Question 28

You are providing training on antisecretory and mucosal protection drugs. Which of the following antisecretory and mucosal protectant drugs may cause severe diarrhoea which may require withdrawal of this drug? Cimetidine Lansoprazole Misoprostol Ranitidine Tripotassium dicitratobismuthate

Answer 28

The correct answer was Misoprostol Diarrhoea may occasionally be severe and require withdrawal, reduced by giving single doses not exceeding 200 micrograms and by avoiding magnesium-containing antacids.

Question 29

Which one of the following would you use treat a penicillin-allergic patient with cellulitis near the eyes or nose? The BNF monograph is available here: https://bnf.nice.org.uk/treatment-summaries/skin-infections-antibacterial-therapy/#cellulitis-and-erysipelas Clarithromycin Co-amoxiclav Flucloxacillin Phenoxymethylpenicillin Topical fusidic acid

Answer 29

The correct answer was Clarithromycin From summary of antibacterial therapy under skin, cellulitis needs to be treated with oral or intravenous first line if infection is near the eyes or nose. Clarithromycin is suitable in a patient who is penicillin allergic. Consider referral to hospital or seeking specialist advice if bacteria are resistant to oral antibacterials, patients cannot take oral treatment, or have infection near the eyes or nose.

Question 30

Mrs C is complaining of muscle pain after being discharged from hospital following a myocardial infarction. Which ONE of the following medicines is the most likely drug-related cause? Aspirin Bezafibrate Bisoprolol Clopidogrel Omeprazole

Answer 30

Bezafibrate- Muscle complaints and muscle weakness are a side effect of bezafibrate

Question 31

You are working in a community pharmacy. A patient presents to you with a cough and runny nose. They have had this for two days. The patient asks which antibiotics are best to take for their symptoms. The patient has no other symptoms and have confirmed that they do not have coronavirus. What would the most appropriate advice be to give to the patient? A swab of the nose would identify the most appropriate antibiotic A swab of the throat would identify the most appropriate antibiotic It is likely that they are suffering from a virus and that antibiotics will be ineffective. Self help would be most appropriate currently Their GP will be able to make that decision for them based on their reported symptoms They should ask their GP for amoxicillin

Answer 31

The correct answer was It is likely that they are suffering from a virus and that antibiotics will be ineffective. Self help would be most appropriate currently Pharmacists should demonstrate concepts of health promotion, health education and health improvement programmes based on national and local health priorities and parameters. Public Health England runs campaigns on preventing antibiotic resistance. A patient who has had a cough and runny nose for 2 days is unlikely to need antibiotic treatment at this point

Question 32

A patient asks for advice regarding a skin condition. You notice that the patient has several weeping golden pustules on their face. What is this most likely to be? Conjunctivitis Impetigo Otitis externa Otitis media Varicezella-zoster

Answer 32

Impetigo

Question 33

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? Ipratropium Salbutamol Salmeterol Theophylline Tiotropium

Answer 33

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 34

You have a patient who is taking clozapine. Some medicines are subject to additional monitoring requirements co-ordinated by the manufacturer, including clozapine. Which of the following are monitored under the clozapine patient monitoring service? Red blood cells Full blood count Leucocyte count only Leucocyte and neutrophil counts Neutrophil count only

Answer 34

The correct answer was Leucocyte and neutrophil counts The UK Clozaril Patient Monitoring Service (CPMS) was developed in order to manage the risk of agranulocytosis associated with clozapine. Patients are centrally monitored for their leucocyte and neutrophil counts.

Question 35

A 23-year-old female has just been admitted into hospital following a car accident. She is recovering from a hip fracture. Her consultant prescribes her zoledronic acid. Which one of the following action is the most suitable for you to take? Advise the consultant to add calcium 500 mg daily and vitamin D 400 units daily Advise the patient to eat before her dosage is given Dispense an alternative bisphosphonate Dispense zoledronic acid, no further action is required Zolendronic acid may not be suitable in woman of child bearing age. Contact the consultant to discuss this further.

Answer 35

The correct answer was Zolendronic acid may not be suitable in woman of child bearing age. Contact the consultant to discuss this further. Zolendronic acid has shown toxicity in animal studies and should be avoided in woman of child-bearing potential.

Question 36

You need to dispense a dilution of betnovate cream and you note that this contains 1 part betnovate with 4 parts water-miscible base. How much betnovate is in 250 mg of the diluted cream? 2.5 mg 5 mg 20 mg 50 mg 200 mg

Answer 36

50mg