T13 Flashcards
You are counselling a patient on the use of her newly prescribed conventional DMARD.
How long is it until she is most likely to see an effect from her treatment?
2-3 days
1-2 weeks
2-3 weeks
1-2 months
2-3 months
2-3 months
You have a patient who has been prescribed warfarin. Warfarin is a drug that is high risk and requires detailed patient management. A patient requires regular blood tests which monitor the INR.
Which of the following conditions does NOT have a target INR of 2.5?
Deep vein thrombosis
Dilated cardiomyopathy
Mechanical prosthetic heart valves
Myocardial infarction
Pulmonary embolism
The correct answer was Mechanical prosthetic heart valves
Mechanical prosthetic heart valves: the recommended target INR depends on the type and location of the valve, and patient-related risk factors consider increasing the INR target or adding an antiplatelet drug, if an embolic event occurs whilst anticoagulated at the target INR.
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?
Inserting cotton buds into the ears will help remove the ear wax
No action is required as the condition is self-limiting
The ears will need to be syringed
The GP will be able to prescribe appropriate medication to treat the ear infection
Using olive oil in the ears will help to soften the ear wax
The correct answer was The GP will be able to prescribe appropriate medication to treat the ear infection
The 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.
You have a patient who has been prescribed lithium salts. Lithium salts have a narrow therapeutic index, therefore, serum lithium levels need to be closely monitored. Changes in dietary intake of electrolytes can affect serum lithium levels.
Which of the following electrolytes is most likely to have an adverse effect on this patient’s serum lithium levels?
Calcium
Magnesium
Phosphate
Potassium
Sodium
The correct answer was Sodium
The sodium-lithium channels cannot differentiate between sodium and lithium, therefore, changes in the diet that reduce or increase sodium intake affect serum lithium levels resulting in sub-therapeutic or toxic levels. Raised calcium levels also need to be monitored but have less impact than sodium. BNF states that patients should not do anything that affects their sodium levels.
A patient has the following prescription items from you on a monthly basis:
Paracetamol 500 mg tablets 2 QDS,
morphine sulfate 10 mg SR tablets 2 BD,
lactulose 10 mL BD.
The patient presents you with a prescription for two months’ supply. What is the most appropriate course of action and the explanation for this course of action?
Dispense the prescription as it is ok to do so
Do not dispense the prescription because it is not legal to supply more than 100 paracetamol
Do not dispense the prescription because it is not legal to supply two months’ worth of morphine
Speak to the prescriber to clarify if there is a reason for giving the patient two months’ supply
Tell the patient you’ll give them half of the morphine now and half in a months time
The correct answer was Speak to the prescriber to clarify if there is a reason for giving the patient two months’ supply
There is no legal restriction on how many months supply of a CD can be prescribed; however, Home Office guidance says it should be restricted to 30 days. Therefore it is appropriate to clarify with the prescriber why two months’ supply has been prescribed.
A patient with tuberculosis requires antibiotic treatment.
Which antibiotic is the primary reason for pyridoxine supplementation?
Capreomycin
Ethambutol
Isoniazid
Pyrazinamide
Rifampicin
The correct answer was Isoniazid
Peripheral neuropathy can occur as a result of isoniazid especially in those at highest risk (see BNF) and in these patients pyridoxine should be prescribed when treatment with isoniazid is started.
A 41-year-old woman has been prescribed fludrocortisone for adrenal insufficiency and is unclear about its possible side-effects. She lists different conditions which she may develop as a result and asks you if they are correct.
Which one of the following is most likely to develop with fludrocortisone use?
Avascular necrosis
Diabetes
Hypertension
Muscle wasting
Osteoporosis
The correct answer was Hypertension
Mineralocorticoid side effects, listed in the BNF, are most marked with fludrocortisone. The other side effects listed are glucocorticoid steroid effects.
You are supporting a hospital outpatient service for patients with Parkinson’s disease.
Which of the following is the most appropriate treatment option for daytime sleepiness in Parkinson’s patients?
Amantadine
Domperidone
Levodopa
Midodrine
Modafinil
The correct answer was Modafinil
If reversible pharmacological and physical causes have been excluded, modafinil should be considered to treat excessive daytime sleepiness, and treatment should be reviewed at least every 12 months.
A patient is prescribed amitriptyline at night and is worried about side effects.
Which side effect is LEAST likely to be caused by amitriptyline?
Constipation
Drowsiness
Dry eyes
Dry mouth
QT prolongation
Dry eyes
A 62-year-old woman has been initiated on hormone replacement therapy (HRT). She has heard many rumours from her friends and is concerned about any serious effects which her new medication may cause. During your discussion, you mention that there are some instances when HRT should be stopped immediately.
Which one of the following is a reason for this patient to stop her HRT immediately?
Alopecia
Exfoliative dermatitis
Nausea
Severe stomach pain
Severe unexplained sore throat, fever or malaise
Severe stomach pain
You work within a community pharmacy that has very long opening hours.
One afternoon you realise that you are getting tired and are making mistakes. What should you do?
Call a locum to take over
Drink a cup of coffee
Send the patients away
Shut the pharmacy
Take a break
Take a break
The responsible pharmacist has left the pharmacy to deliver a medication to the nearby nursing home.
Given that the responsible pharmacist is allowed to be away from the Pharmacy for up to 2 hours, and that they are the only pharmacist working at the pharmacy, which one of the following activities could you do in their absence?
Hand over medications to a patient, which had been dispensed and checked earlier in the day
Provide insulin, as an emergency supply, to a diabetic patient
Supply Beconase® Hayfever relief for adults nasal spray 0.05% 100 dose pack to a patient with hayfever
Supply chloramphenicol eye drops to a patient with conjunctivitis
Supply 2 packs of 32 tablets of paracetamol to a patient with osteoarthritis
The correct answer was Supply Beconase® Hayfever relief for adults nasal spray 0.05% 100 dose pack to a patient with hayfever
Which of the following would be suitable advice to give her to help prevent her contracting travellers’ diarrhoea?
Avoid eating peelable fruits
Drink tap water only
Eat plenty of fresh salad
Only consume pasteurised milk
Uncooked vegetables are ideal for consumption
The correct answer was Only consume pasteurised milk
All 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.
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 Guernsey.
What is the best course of action with this prescription?
Advise the patient to see a local prescriber to get a new prescription
Call a local prescriber to ask if they will write a prescription and send it to you
Confirm the prescriber’s details and that the prescription meets prescription requirements and dispense
Do not dispense the prescription as it is not a valid prescription in the UK
Speak to the prescriber in Guernsey and make an emergency supply at their request
The correct answer was Advise the patient to see a local prescriber to get a new prescription
Prescriptions 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.
Amphetamines belong to which schedule of controlled drugs?
Schedule 1
Schedule 2
Schedule 3
Schedule 4
Schedule 5
2
One of your patients has recently been diagnosed with gout. Clinical conditions often have associated risk factors.
Which of the following increases the risk of developing gout?
A diet high in green leafy vegetables
Being female
Being underweight
Low triglycerides
Renal impairment
The correct answer was Renal impairment
Risk factors for gout include: meat, seafood, alcohol (10 or more grams per day), diuretics, obesity, hypertension, coronary heart disease, diabetes mellitus, chronic kidney disease, high triglycerides, heart failure and male gender
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?
Date order was placed
Name of patient it will be dispensed to
Name of pharmacy staff member accepting the order
Name of pharmacy staff member that ordered it
Name of wholesaler
Name of wholesaler
Which one of the following doses would be most likely to reduce LDL cholesterol by more than 40%?
Atorvastatin 20 mg
Fluvastatin 80 mg
Pravastatin 40 mg
Rosuvatatin 5 mg
Simvastatin 40 mg
Atorva 20mg
Mr K, a 40-year-old man, enters the community pharmacy at which you work, he wants some advice about a sore ear he has had for the last 3 days. He describes having some local itching and pain.
What is the most likely diagnosis?
Local inflammation of the pinna
Meniere’s disease
Otitis externa
Otitis media
Perichondritis
The correct answer was Otitis externa
Perichondritis should exhibit outer ear structure swelling; otitis media presents with pain but no itching; Meniere’s disease exhibits dizziness. This leaves A and C as the more likely options, but local inflammation is unlikely to present with itching.
A 36-year-old patient visits his GP initially complaining of a dry cough. His blood results show he is hyperkalaemic. His GP contacts you to ask if this effect may be a consequence of one of the drugs he is taking. He has not had any changes in his lifestyle and he has been taking the following medications for at least 2 months:
Aspirin
Simvastatin
Glyceryl trinitrate
Bendroflumethiazide
Enalapril
Which of the following drugs is most likely to have caused his side effects?
Aspirin
Bendroflumethiazide
Enalapril
Glyceryl trinitrate
Simvastatin
Enalapril
You have a patient who is being treated for HIV. They have been prescribed Ritonavir which is a protease Inhibitor for use in HIV.
Which of the following drugs will NOT interact with ritonavir?
Omeprazole
Rosuvastatin
Tacrolimus
Tadalfil
Zopiclone
Omeprazole
Which statement is the LEAST appropriate for this patient?
It is taken once a week
It may cause blood problems
It may cause hearing disturbances
It may cause liver problems
It may cause respiratory effects
May cause hearing disturbances - other counselling points are more important
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?
Amoxicillin
Chloramphenicol
Flucloxacillin
Linezolid
Metronidazole
Some 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.
A 27-year-old woman comes to collect her combined oral contraceptive pill, Microgynon® 30. As she leaves the pharmacy you notice that she takes time to look at your selection of herbal remedies.
Which one of the following herbal remedies is most likely to reduce the effectiveness of her contraceptive pill?
Agnus Castus fruit extract tablets
Echinacea drops
Ginseng extract tablets
St John’s Wort extract tablets
Valerian root extract tablets
St 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.
