T5 Flashcards
A patient newly started on tuberculosis treatment comes into your pharmacy with a bowel complaint.
What is the most likely cause of flatulence?
Ethambutol
Isoniazid
Pyrazinamide
Rifampicin
Streptomycin
Ethambutol can cause flatulence (frequency not known)
A 48-year-old man of African family origin was previously diagnosed with stage one hypertension. After trying to reduce his blood pressure through changes in diet and physical activity levels, it is still raised. Today he has brought in a prescription for a medication to reduce his blood pressure. He has no other medical conditions.
Which one of the following antihypertensives is this patient most likely to have been prescribed to manage his hypertension?
Amlodipine
Bisoprolol
Candesartan
Ramipril
Spironolactone
For patients over 55 years, and patients of any age who are of African or Caribbean family origin and do not have diabetes step 1 in the drug management of hypertension is a calcium-channel blocker (CCB). Amlodipine is the only CCB listed in the answer options.
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 growth hormones?
Schedule 1
Schedule 2
Schedule 3
Schedule 4 Part 1
Schedule 4 Part 2
4.2
You are adding some cautionary and advisory labels to medications prior to dispensing. Recommended cautionary and advisory labels are usually added to dispensing labels to inform the patient of key points about their medication. One advisory label tells patients to avoid sunlight and protect skin from exposure to sunlight.
Which of the following medications would usually carry the warning to avoid sunlight when taking this medication?
Amoxicillin
Doxycycline
Flucloxacillin
Flurbiprofen
Remifentanyl
Doxycyline comes with advisory warnings to protect the skin from sunlight or sunlamps even on a cloudy day. Doxycyline makes the skin more susceptible to UV light and as such more susceptible to UV light damage.
A 36-year-old woman has been experiencing irregular periods, weight gain and hair loss in the past few months. Her GP has prescribed metformin 500 mg tablets. She presents in the pharmacy with her new prescription.
The instructions on the prescription are to take ‘as directed for one week, then return to GP’, however the patient cannot remember the dosage her GP advised. What is the recommended daily dosage of metformin 500 mg tablets that should be taken over the first week for her condition?
0.5 g
1 g
2 g
4 g
5 g
The patient has polycystic ovary syndrome and the initial recommended dose of metformin 500 mg immediate release tablets in 500 mg once daily for 1 week, then 500 mg twice daily for one week. This can then be increased between 1.5-1.7 g daily in 2-3 divided doses.
Mrs F is a 34-year-old lady who is breast feeding her 6-month-old baby. She is diagnosed with low-severity community acquired pneumonia by her GP. The GP phones you to recommend an antibacterial for Mrs F as she wishes to continue to breast feed whilst on treatment.
Which one of the following antibacterials would you recommend for Mrs F?
Amoxicillin
Ciprofloxacin
Clarithromycin
Flucloxacillin
Trimethoprim
Amoxicillin is indicated in low-severity community acquired pneumonia. Amoxicillin is appropriate to use in breastfeeding according to the BNF. Although clarithromycin can be indicated in some instances for low-severity community acquired pneumonia, the BNF states that it should be avoided in breastfeeding.
Emergency supplies of medication can be made at the request of either a patient or a prescriber.
A doctor requests an emergency supply of a drug for a patient, when must the doctor present the prescription to the pharmacy?
Within 24 hours
Within 48 hours
Within 72 hours
Within 84 hours
Within 96 hours
A doctor must agree to supply the dispensing pharmacy with a prescription inside 72 hours if the doctor requests an emergency supply on the behalf of a patient.
You have a patient ask you about purchasing sumatriptan for migraines.
Which of the following medicines is known to interact with sumatriptan, increasing the risk of serotonin syndrome?
Aspirin
Ibuprofen
Mefenamic acid
Paracetamol
Tramadol
Tramadol
You are acting as the Responsible Pharmacist in a community pharmacy. The Responsible Pharmacist regulations came into effect in October 2009 and requires a Responsible Pharmacist to be accountable for a pharmacy during opening hours.
Which of the following is NOT required to be recorded into the Responsible Pharmacist record?
Date of birth of the Responsible Pharmacist
Date that person became the Responsible Pharmacist
Name of the Responsible Pharmacist
Registration number of the Responsible Pharmacist
Time that person became Responsible Pharmacist
DOB
An adult presents to the community pharmacy with a rash on their lower left leg.
Which condition is classically associated with the lower extremities?
Discoid eczema
Ringworm
Seborrhoeic dermatitis
Shingles
Urticaria
Shingles is usually back and face; ringworm is usually body; seborrhoeic dermatitis is face and chest. This leaves urticarial and discoid eczema as the two likely right answers. Urticaria can affect any body part including the legs, but discoid eczema is classically associated with lower extremities.
Mr PR, 22-year-old man, comes into your community pharmacy seeking advice about a white/silver rash on his arm. He tells you that it started 10 days ago and has increased in size since and does not bother him too much, although it is mildly itchy occasionally. He has no other symptoms and suffers from no other medical conditions.
What is the most likely cause of his symptoms?
Atopic dermatitis
Contact dermatitis
Discoid eczema
Psoriasis
Tinea corporis
Concentrating on mild itch, then contact and atopic dermatitis and discoid eczema can be eliminated as they have itch as a prominent symptom. Tinea corporis is also itchy and varies from mild to severe. Psoriasis is the correct answer as it tends to be a condition that does not cause itch or is sometimes mildly itchy.
Which of the following AED would you need to consult the prescriber to establish if the same brand is required (category 2)
Carbamazepine
Gabapentin
Lamotigine
Leviracetam
Virabatrin
Lamotrigine is category2
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 of the following classifications require no licence to import or export the controlled drug?
Schedule 2
Schedule 3
Schedule 4 Part 1
Schedule 4 Part 2
Schedule 5
5
Which of the following non-prescription topical preparations is an antiviral agent?
Canesten® soft gel pessary
Clotrimazole 2% cream
Daktarin® oral gel
HC45® hydrocortisone 1% cream
Zovirax® 5% cream
Zovirax
A 72-year-old man visits your pharmacy complaining of a sore mouth and throat. He wears dentures but describes seeing white spots behind them when he removes them. His patient medication record contains the following medicines: Combivent® nebuliser solution - 2.5 mL (one vial) three or four times daily, Seretide 500 Accuhaler® - one inhalation twice daily, warfarin - according to book.
Refer him to his dentist
Refer him to his GP for further investigation and/or treatment
Refer him to his GP urgently
Sell him a throat lozenge
Send him to the Accident and Emergency department
The correct answer was Refer him to his GP for further investigation and/or treatment
The man’s symptoms suggest he is suffering from oral thrush, which he is more susceptible to if he does not rinse his mouth after using the Seretide inhaler. Although miconazole gel is available over the counter, this would not be appropriate in this situation due to the patient taking warfarin and he should be referred to his GP for further treatment.
A 6-month-old child with no long-term medical conditions requires paracetamol for the treatment of pyrexia associated with flu-like symptoms.
What is the most appropriate dose of paracetamol to be administered every six hours?
60 mg
120 mg
180 mg
240 mg
360 mg
120mg
You receive a phone call from a doctor on the ward who is seeking advice regarding prescribing antibiotics. The doctor is unsure which antibiotic must be used with caution in patients with a history of epilepsy.
Which of the following antibiotics must be used with caution in patients with a history of epilepsy?
Ciprofloxacin
Co-trimoxazole
Demeclocycline Hydrochloride
Flucloxacillin
Lymecycline
Quinolones including ciprofloxacin may induce convulsions in patients with or without a history of convulsions. As such they must be used in caution in patients with a history of epilepsy.
Based on the information on interactions given in the BNF, which of the following is most likely to interact with warfarin and increase the INR?
Apple juice
Grapefruit juice
Pineapple juice
Pomegranate juice
Tomato juice
Pomegranate juice increases the INR in response to warfarin
A patient comes into your pharmacy complaining of a very tender big toe. He discloses that he has asthma. You suspect that it might be gout and refer him to his GP.
To help alleviate his pain while he waits for a GP appointment, what would be the most appropriate pain relief for you to recommend with the information you have been provided?
Arnica tablets
Diclofenac gel
Ibuprofen gel
Ibuprofen tablets
Paracetamol tablets
Paracetamol tablets are the most appropriate from these choices as there is a risk of bronchospasm with NSAIDs in asthmatics. Along with the paracetamol tablets, referral to the GP is necessary as paracetamol is a temporary measure.
You have just finished using a stock bottle of methadone in the pharmacy. You are unable to pour anything out of the bottle, but you can see that there are still traces inside.
In what way should you deal with the disposal of the remaining liquid inside the bottle?
Arrange for a specialist disposal company to dispose of the bottle and contents
Place the bottle and remaining contents in the dupe bin
Pour the remaining contents into the dupe bin
Rinse the bottle with water and pour down the sink
Rinse the bottle with water and pour into a denaturing kit
Waste medicines should not be disposed of in the sink. The rinsings should be added to a denaturing kit and disposed as pharmaceutical waste.
Which of the following drugs on her PMR is known to precipitate migraine?
Benzodiazepines
Beta-blockers
GI motility stimulants
NSAIDs
Oral contraceptives
Oral contraceptives
A 70-year-old female patient, comes into your pharmacy and tells you that she is in pain. When you inquire further, she tells you that the pain is in her eye. She describes it as ‘constant aching pain in her right eye that goes to her forehead’. She also tells you that she ‘cannot see properly out of that eye’. When you look at her eye you notice that it is red and the pupil is dilated, but there is no discharge and her eye isn’t itchy. She usually wears glasses for her hyperopia.
Which of the following is the likely cause of her signs and symptoms?
Acute angle closure glaucoma
Cluster headache
Conjunctivitis
Migraine
Tension headache
Her signs and symptoms are indicative of acute angle closure glaucoma which is more common in elderly patients who have hyperopia (i.e. are long-sighted). Acute angle-closure glaucoma occurs when the outflow of aqueous humour from the eye is obstructed by bowing of the iris against the trabecular meshwork.
A 5-year-old child has been diagnosed with a bacterial chest infection.
Which is the LEAST appropriate antimicrobial agent to use in a 5-year-old child?
Azithromycin
Ciprofloxacin
Co-amoxiclav
Co-trimoxazole
Doxycycline
Tetracyclines should not be given to patients under the age of 12.
Which one of the following medicines does NOT stimulate the pancreas to release insulin?
The drug monographs are available here:
Canagliflozin: https://bnf.nice.org.uk/drug/canagliflozin.html
Exenatide: https://bnf.nice.org.uk/drug/exenatide.html
Gliclazide: https://bnf.nice.org.uk/drug/gliclazide.html
Repaglinide: https://bnf.nice.org.uk/drug/repaglinide.html
Vildagliptin: https://bnf.nice.org.uk/drug/vildagliptin.html
Canagliflozin
Exenatide
Gliclazide
Repaglinide
Vildagliptin
Canagliflozin reversibly inhibits SGLT2 in the kidney to reduce glucose reabsorption and increase urinary glucose excretion.
