T4 Flashcards
Whilst working as a community pharmacist, a young adult male in his twenties presents with the complaint of a ‘burning sensation’ in the centre of his chest, that particularly gets worse when he lies down.
What would be the best over-the-counter medication to recommend?
Co-codamol
Ibuprofen 200 mg
Loperamide 2 mg
Mebeverine 135 mg
Solution containing sodium alginate
Burning sensation that worsens when lying down, particularly in young males is a tell-tale sign of acid reflux (heart burn). Therefore you would give sodium alginate solution 15 mLs QDS. However, if there are signs like coffee ground vomit then you would have to refer the patient immediately.
Which of the following conditions is associated with a rash which is not itchy?
Dermatitis herpetiformis
Impetigo
Lyme disease
Nappy rash
Ringworm
Lyme disease
You are the superintendent pharmacist employed by a group of pharmacies to ensure procedures are up to date.
Which one of the following is NOT true with regards to raising concerns?
Locums know how to raise concerns and where to find procedures
Only senior level staff must be aware of and have access to procedures
There must be fair and robust policies in place to deal with concerns raised
There should be evidence that concerns raised have been properly investigated and all staff are kept informed of the progress
There should be systems in place to protect staff who raise concerns
Only senior staff must be aware and have access to procedures
You dispense a prescription for a 70-year-old lady for a Durogesic DTrans (fentanyl) 12 mcg/hour transdermal patch.
What is an appropriate counselling point for the patient?
Apply the next patch at the same site
Do not have a long hot bath whilst wearing the patch
Replace every 48 hours
Shave prior to application
Wash the area with soap before applying
Exposure of fentanyl patches to heat sources can increase concentrations of fentanyl which have been associated with serious adverse reactions and death.
You are explaining to a new member of staff that some medicines are subject to additional monitoring requirements co-ordinated by the manufacturer.
Which of the following medicines is subject to such a programme?
Clozapine
Fluoxetine
Olanzapine
Quetiapine
Sertraline
The use of Clozaril (clozapine) is restricted to patients who are registered with the Clozaril Patient Monitoring Service. The UK Clozaril Patient Monitoring Service (CPMS) was developed in order to manage the risk of agranulocytosis associated with clozapine. Similar schemes are run by generic makers of the medicine.
One of your patients has been prescribed Diazepam. Diazepam belongs to the benzodiazepine class of drugs.
To which schedule of controlled drugs does diazepam belong to?
Schedule 2
Schedule 3
Schedule 4 Part 1
Schedule 4 Part 2
Schedule 5
4.1
You are working in a pharmacy based in England. Under which circumstance are you most likely to be legally obliged to report a case of female genital mutilation to the police?
When an adult female reports female genital mutilation having taken place to them
When a child is at risk of female genital mutilation
When a child reports it having happened to their friend
When a child reports it having happened to themselves
When a pharmacist suspects that female genital mutilation has taken place to a child
The correct answer was When a child reports it having happened to themselves
Although for all situations consideration should be given to reporting to the police, the legal obligation is: “All pharmacy professionals now have a legal duty to report, orally or in writing, to the police if: they observe physical signs that female genital mutilation (FGM) may have taken place in a girl under the age of 18, or a child or young person tells them that they have had FGM.”
She gave birth recently and is suffering from constipation. She is asking for advice on treatment. She is breastfeeding and had an uncomplicated delivery. She has tried altering her diet. What is the best option for this lady?
Refer her to her GP as you cannot sell a treatment over the counter because she is breastfeeding
Sell her ispaghula husk
Sell her lactulose
Sell her loperamide
Sell her senna
A bulk forming laxative is the first line treatment for constipation in breast feeding women. It is suitable for OTC sale.
Which of the following is the LEAST likely to interact with grapefruit juice?
Budesonide
Lercanidipine
Simvastatin
Tacrolimus
Warfarin
Warfarin is not noted in the BNF as interacting with grapefruit juice. This gives an indication of the severity of the interaction. As warfarin isn’t listed here, it indicates that it is least likely to interact because there isn’t as much documented evidence.
A female patient comes to collect her prescription for candesartan regularly from your pharmacy. She has recently been prescribed lithium for the treatment of depression. She comes into your pharmacy disorientated and complains of diarrhoea and vomiting.
What do you suspect may be the most likely cause of her presentation?
Candesartan could cause hypernatraemia which is causing lithium toxicity
Gastro-intestinal disturbances are a side effect of candesartan
Lithium toxicity secondary to the patient taking extra doses of lithium
She has an infection
Taking candesartan could lead to lithium toxicity due to increased lithium concentrations
The correct answer was Taking candesartan could lead to lithium toxicity due to increased lithium concentrations
Candesartan potentially increases the concentration of lithium. Manufacturer advises monitor concentration and adjust dose.
severity: Severe
evidence: Anecdotal
Which of the following symptoms is most likely to be attributed to codeine?
Black stools
Bruising that may be heavy
Constipation
Myositis
Weight gain
Constipation
A doctor in A&E is seeing a patient with a history of alcohol misuse and is querying which laxative can be used for hepatic encephalopathy.
Which of the following laxatives can be used for this indication?
Bisacodyl
Co-danthramer
Docusate sodium
Lactulose
Senna
Lactulose as through its MOA it prevents the reabsorption of ammonia and other toxins through faecal matter in the gut which can cause hepatic encephalopathy
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 LSD?
Schedule 1
Schedule 2
Schedule 3
Schedule 4
Schedule 5
1
You are the Responsible Pharmacist and you are helping your trainee to revise about Controlled Drugs. Due to abuse potential, a re-classification of certain drugs took place in 2019.
Which of the following drugs was reclassified to Schedule 3?
Codeine phosphate
Diazepam
Gabapentin
Melatonin
Sodium risedronate
Gabapentin
A patient has recently been initiated on a new medication and is complaining of bad side effects. Upon questioning they tell you the most severe side effect is general fatigue.
Which of the following drugs is most likely to cause this side effect?
Bisacodyl
Clindamycin
Ibuprofen
Isphagula husk
Tramadol
Fatigue is listed as a common side effect of tramadol
A patient presents with a prescription that states ‘Flucloxacillin 500 mg q.d.s. for 7/7’. Upon questioning the patient informs you the antibiotic is for impetigo.
What is the most likely causative organism for this infection?
Canidida albicans
Escherichia coli
Gardnerella vaginalis
Sacromyces cerivusea
Staphylococcus aureus
Impetigo is a common contagious pyogenic infection of the superficial layers of the skin, usually caused by Staphylococcus aureus.
You are instructing a trainee pharmacist about the reconstitution of cytotoxic drugs in the aseptic unit at the hospital that you are working at.
Which of the following is NOT true with regards to the handling of cytotoxic medicines?
Pregnant staff should avoid exposure to cytotoxic drugs
Protective clothing (including gloves, gowns, and masks) should be worn
Reconstitution should be carried out in designated pharmacy areas
Trained personnel should reconstitute cytotoxics
Use national procedures for dealing with spillages and safe disposal of waste material, including syringes, containers, and absorbent material
The correct answer was Use national procedures for dealing with spillages and safe disposal of waste material, including syringes, containers, and absorbent material
The BNF states that local, rather than national procedures should be use ‘Use local procedures for dealing with spillages and safe disposal of waste material, including syringes, containers, and absorbent material’
You have a patient who has been prescribed metronidazole. Metronidazole is an antimicrobial drug with a high activity against anaerobic organisms. It is important that when taking this medication patients are advised to avoid alcohol until after treatment completion.
What is the reason for advising patients to avoid alcohol when taking metronidazole?
Alcohol increases the potency of metronidazole
Alcohol reduces the efficacy of metronidazole
Alcohol renders the use of metronidazole ineffective
Alcohol should be avoided when taking any course of antibiotics
Metronidazole produces a disulfiram like reaction with alcohol
Metronidazole produces a disulfiram like reaction with alcohol resulting in facial flushing, nausea and vomiting
Which of the following symptoms is most likely to be attributed to prednisolone?
Black stools
Bruising that may be heavy
Constipation
Myositis
Weight gain
weight gain increased appetite is a pronounced side-effect of Prednisolone. Myositis reflects inflammation in the muscle possibly resulting from muscle damage. That is distinct from degradation of the muscle through chronic steroid use and is therefore not the correct answer.
Whilst working on a hospital acute medicines ward you determine that a patient had a low level of leukocytes in their blood.
Which of the following medications may be causing this?
Amiloride
Clozapine
Naloxone
Paracetamol
Sodium docusate
Leucopenia is a common or very common side effect of clozapine treatment. Leukocytes are white blood cells and leucopenia is a reduction in white blood cells.
You are trying to prevent prescribing errors in your pharmacy.
Which of the following is NOT an MHRA recommended check point for avoiding prescribing errors?
Right dose
Right medicine
Right patient
Right strength
Right time
Double checking when prescribing or administering any medicines is important to avoid any medication errors. You can double check it is the: right medicine, right patient, right dose, right route, right time.
You have a patient who suffers with asthma. This patient must avoid certain medications which may aggravate their condition.
Which of the following medications is contraindicated in patients with asthma?
Amlodipine
Atenolol
Cefuroxime
Haloperidol
Nitrofurantoin
Atenolol is a beta blocker. BB can precipitate bronchospasm and should therefore be avoided in patients with a hx of asthma
Latin abbreviations are commonly seen on prescriptions in both hospital and community pharmacies. A patient presents you with a prescription with the word ‘a.c’ included in it.
What does the Latin abbreviation ‘a.c.’ stand for?
After food
Before food
On an empty stomach
Take in the evening
With food
Before food
A patient has recently been admitted onto your ward with a gastrointestinal bleed. Upon doing a drug history, you find that the patient is on some medication.
Which of these drugs is most likely to have caused the GI bleed?
Atenolol 50 mg OD
Bendroflumethiazide 2.5 mg OD
Fluoxetine 20 mg OM
Isosorbide mononitrate 10 mg BD
Piroxicam 20 mg ON
Piroxicam 20 mg ON
NSAIDs can cause serious gastrointestinal events including bleeding, ulceration and perforation of the stomach, small intestine or large intestine, which can be fatal. These serious adverse events can occur at any time, with or without warning symptoms. Piroxicam is particularly gastro-toxic.
