T14 Flashcards
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?
Benzylpenicillin sodium
Erythromycin
Linezolid
Metronidazole
Phenoxymethylpenicillin
Benzylpenicillin sodium is indicated for use in meningococcal disease and is only available in an IV preparation
You are running a workshop for trainee pharmacists regarding controlled drugs and clinical governance. A student has a question regarding the recording of controlled substances in the controlled drug register.
Which of the following is NOT true regarding entries into the controlled drug register?
A separate register is used for each class of drugs
Entries must be in chronological order
Entries must be in indelible ink if written
Entries must be made on day of the transaction or within the following five days
The register must not be removed from the premises at any time during use
Entries into the CD register must be made either on the day of transaction or the FOLLOWING day.
A patient presents to the community pharmacy asking for advice. They are complaining of dyspeptic symptoms.
Which of the following symptoms in patients would NOT warrant referral to their GP when presenting along with dyspeptic symptoms?
Anorexia
Excessive gas
Persistent vomiting
Referred pain
Weight loss
Excessive gas does not warrant referral to the GP. The rest of the symptoms alongside dyspeptic symptoms must be referred to the GP.
A patient visits the pharmacy on a Saturday afternoon for advice. They have had a cough for 2 weeks. When it first started they were unwell with other cold symptoms, but apart from the cough persisting they are now otherwise well. They have confirmed that they do not have coronavirus.
What would you advise the patient to do?
To follow self-care treatments and visit the GP if the cough still persists after 4 weeks from its start
To follow self-care treatments and visit the GP if the cough still persists after 8 weeks from its start
To go to A & E
To go to the out of hours GP today
To make an appointment with their GP this week
Acute cough is usually self-limiting and gets better within 3 to 4 weeks without antibiotics. Coughs are most commonly caused by a viral upper respiratory tract infection, such as a cold or flu.
A 4-year-old child with asthma has a chest infection.
Which is the most appropriate drug to manage the temperature?
Aspirin
Codeine
Ibuprofen
Paracetamol
Tramadol
Paracetamol
Codeine and tramadol are analgesics not anti-pyretics. Aspirin and ibuprofen are less suitable as they have additional risks compared with paracetamol.
It is late on a Friday evening and a regular patient enters your pharmacy worried that she has run out of fentanyl patches. On questioning she informs you that she applied her last one at 6pm today.
What would be the most appropriate course of action?
Advise the patient to go to A&E because you can not supply her with any
Make an emergency supply
Sell the patient co-codamol over the counter
Supply the patient with a box of fentanyl patches, you’ll ask the prescriber for a prescription on Monday
Tell the patient that you’ll have it ready for her to pick up by 5pm Monday after contacting her GP
Fentanyl patches are applied every 72 hours. Mrs SA applied her patch at 6pm, therefore, should not need to apply a patch until 6pm Monday so supplying a prescription by 5pm Monday would be sufficient.
You are advising a patient who has been prescribed clozapine on the key side effects to look out for.
Which of the following side effects of clozapine should be reported due to the risk of fatality?
Blurred vision
Constipation
Headache
Nausea
Tiredness
Clozapine has been associated with varying degrees of impairment of intestinal peristalsis - see Cautions and Contraindications for further information. Patients and their carers should be advised to seek immediate medical advice before taking the next dose of clozapine if constipation develops.
Which schedule is cannabis in when it is not being used as a medicinal product?
Schedule 1
Schedule 2
Schedule 3
Schedule 4
Schedule 5
1
Which of the following symptoms is most likely to be attributed to rosuvastatin?
Anxiety
Black stools
Bruising that may be heavy
Myositis
Weight gain
Myositis
You are giving a training session on the use of antibiotics in children. Certain antibiotics can cause problems if used in children or adolescents and may cause side effects such as dental hypoplasia.
Which antibiotic is a causative factor in dental hypoplasia and as such is usually avoided in children under 12?
Amikacin
Ceftazidime
Co-trimoxazole
Doxycycline
Ertapenem
Tetracyclines may cause dental hypoplasia in children under the age of 12. As such, this antibiotic class is not usually indicated in children under the age of 12.
Which of the following laxative agents is only indicated for constipation in terminally ill patients?
Co-danthramer
Lactulose
Liquid paraffin
Movicol®
Sodium docusate
Co-danthramer
A 52-year-old patient is diagnosed with angina after complaining of chest pain and has also been recently diagnosed with T2DM. After taking his newly prescribed medication, he comes into your community pharmacy to complain of severe headaches.
Which of the following newly prescribed medication is most likely causing these headaches?
Aspirin
Gliclazide
Isosorbide mononitrate
Paracetamol
Simvastatin
A well-known side of nitrates is ‘throbbing headache’. The only nitrate in the list above is isosorbide mononitrate.
ou are working in a community pharmacy and a prescription comes in for a drug you are not familiar with.
The patient is waiting and you feel pressured to do this item quickly as it is busy. What should you do?
Ask the patient to take it to another pharmacy
Briefly read the BNF section related to the drug to familiarise yourself with it
Refuse to dispense it
You should dispense it and make a mental note to look it up later
You should start a CPD entry right now
The correct answer was Briefly read the BNF section related to the drug to familiarise yourself with it
In situations in practice it would be down to the pharmacist to make professional decisions and justify them. It is not the patient’s fault or responsibility that the pharmacist is not aware of the drug and it may not be appropriate for the patient to go elsewhere or cause a delay to treatment. The dispensing pharmacist should do all they can to support their own ability to dispense the prescription.
You are preparing some medications for dispensing. Cautionary and advisory labels must be clear on all medication you dispense.
Which of the following tablets or capsules should contain the advice: ‘Take with a full glass of water’ on the dispensing label?
Dabigatran
Doxycycline
Dutasteride
Ethambutol
Imipramine
Doxycycline
A 29-year-old woman 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 this patient’s thyroid dysfunction?
Aminophylline
Amiodarone
Glucosamine
Loperamide
Sodium bicarbonate
Amiodarone has been associated with causing thyroid dysfunction and may cause hyper- or hypothyroidism.
You are working on a ward in the hospital and you have had several interactions with a nurse who quite clearly is not competent to deal with the patients and their medication.
Which of the following actions is NOT appropriate to do?
Find the policy on raising concerns within the hospital
Report to the Nursing and Midwifery Council
Speak to a senior member of the nursing team
Tell your senior manager what your thoughts are
Warn all the patients who are being looked after by this nurse
Warn all the patients who are being looked after by this nurse
Miss K is a 21-year-old female who presents with a round, red, bloated, moon-like face and stretch marks on her abdomen.
These signs are associated with high doses of which one of the following drugs?
Aspirin
Clindamycin
Folic acid
Magnesium trisilicate
Methylprednisolone
The correct answer was Methylprednisolone
High doses of any corticosteroid is associated with Cushing’s syndrome which presents with red puffy face and striae
Which one of the following is NOT a legal requirement for the requisition?
Address of recipient
Date of requisition
Occupation
Purpose of the requisition
Signature of the recipient
The correct answer was Date of requisition
The 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.
A patient attends your community pharmacy and you identify their symptoms as primary dysmenorrhoea. Primary dysmenorrhoea is a common presenting symptom seen by community pharmacists and has a well described set of symptoms.
Which of the following statements is FALSE with regard to primary dysmenorrhoea?
Back pain is often experienced
Can be associated with pain during sex
Is always caused by an underlying condition
Pain is described as dull and continuous
Pain typically starts just before the period starts
The correct answer was Is always caused by an underlying condition
Period pain usually begins around the onset of menstruation; pain is seen prior to the period starting; not all, but a substantial number of women, experience back pain. It is painful cramping and usually throbbing. If can cause pain during sex. It is relatively uncommon for period pain to be caused by an underlying medical condition.
Mrs W is a 75-year-old lady with a leg ulcer who is on your ward. She has acute pain over the weekend in her knee and the doctor thinks it might be gout.
You check her renal function on Monday and it has considerably deteriorated. Her doctor asks you to have a look at her medication history and determine which one, if any, of her medicines is most likely to be related to a decline in renal function.
Ibuprofen 400 mg QDS
Flucloxacillin 500 mg QDS
Penicillin VK 500 mg QDS
Paracetamol 1 g QDS
What would be the most appropriate response?
Likely to be caused by the ibuprofen
Likely to be caused by the paracetamol
Likely to be caused by the penicillin VK
Not likely to be related to any of the medicines
Related to a drug interaction between the medicines
Ibuprofen is associated with renal impairment
35-year-old man attends your pharmacy, he is worried about the abdominal pain, nausea and vomiting he has recently been suffering from. You know he is usually prescribed sodium valproate for the management of his epilepsy.
The BNF monograph is available here: https://bnf.nice.org.uk/drugs/sodium-valproate/
What is the most appropriate advice you should give him?
Advise him to go to his GP, as the dose of sodium valproate might need to be decreased
Advise him to go to his GP, as the dose of sodium valproate might need to be increased
Seek immediate medical attention
There is no connection between his medication and the symptoms he’s describing, you could suggest over the counter symptomatic relief
These are normal side effects of the medication, nothing to worry about
The correct answer was Seek immediate medical attention
He should seek immediate medical attention, as the symptoms he describes may be indicative of sodium valproate-induced pancreatitis.
Mr M visits your pharmacy to ask about getting some sleep aids as he has been struggling to get a good night of sleep.
Which of the following conditions is most likely to be disturbing his sleep pattern?
Frozen shoulder
Housemaid’s knee
Lateral epicondylitis (tennis elbow)
Medial epicondylitis (golfer’s elbow)
Rotator cuff syndrome
The correct answer was Frozen shoulder
Pain is observed in all conditions. Epicondylitis are not associated with night pain, and neither is housemaid’s knee. Rotator cuff and frozen shoulder can wake the patient, but it is frozen shoulder that is the more likely of the two to cause this problem
A man comes into your pharmacy asking for your advice regarding over the counter products for a cough. On further investigation, he tells you that he has a productive cough that has lasted nearly four weeks (not Covid related).
What is the most appropriate advice you should give him?
A cough usually occurs because of an upper respiratory tract infection and is self-limiting, so no further intervention will need to be taken
A cough usually occurs because of an upper respiratory tract infection and is self-limiting, so you could recommend over the counter products for symptomatic relief
Ask about his medication history to see if any drugs that he is taking may be causing this cough
Refer him to his GP
This may be an indicator of uncontrolled asthma and so you should enquire about asthma medication
Any cough that persists for longer than three weeks should be referred for a GP appointment.
