T8

Question 1

A patient calls into the community pharmacy in which you are working, complaining that the soft contact lenses they wear keep becoming discoloured. The patient wants to know if any of the medications they are taking may be a causing this.
Which of the patient’s medications is likely to be causing the discolouration of the contact lenses?
Amiloride
Azithromycin
Codeine
Finastaride
Rifampicin

Answer 1

Rifampicin

Question 2

She is breastfeeding her four week old baby and the baby has oral thrush. Her and her baby are being treated for the condition. She asks you about expressing milk. What is the best advice to give the lady?
Advise her that expressing milk is not advised when treating oral thrush
Advise her to freeze the expressed milk before using it
Advise her to refrigerate the expressed milk before using it
Advise her to use the expressed milk only while she and the baby are undergoing treatment
Refer her to her health visitor

Answer 2

The correct answer was Advise her to use the expressed milk only while she and the baby are undergoing treatment
Expressed milk should be taken and used while the mother and baby are undergoing treatment to prevent re-infection

Question 3

You are labelling prescriptions in your pharmacy.
What is NOT legally required to appear on the dispensing label?
Date of dispensing
Directions for use

‘Keep out of the sight and reach of children’
Name and address of dispensing pharmacy
Name of medicine

Answer 3

Keep out of sight and reach of children

Question 4

You are required to dispense a prescription for sodium valproate to a woman who is 28 years of age.
Which counselling point is best practice when dispensing this prescription?

Advise the patient that they will need weekly monitoring of the plasma-drug levels

Advise the patient to avoid eating food for 30 minutes after taking the medicine
Advise the patient to take at the same time as food
Check that the patient in enrolled in a Pregnancy Prevention Programme
Tell the patient to ensure she has the same brand dispensed each time

Answer 4

Check PPP

Question 5

A patient comes into your pharmacy complaining of a very tender big toe. You consider that it might be gout.
Which OTC drug or action would be the most appropriate?

Arnica tablets

Diclofenac gel

Ibuprofen gel

Paracetamol tablets

Refer to GP

Answer 5

Refer - high dose NSAIDS usually given and this is not a suitable recommendation for NSAID OTC sale

Question 6

You receive a prescription from a podiatrist. Podiatrists can become independent prescribers (IP) and prescribe a limited range of POMs.
Which of the following medicines can a podiatrist IP prescribe for oral administration?
Diazepam
Morphine sulfate concentrated oral solution
Morphine sulfate tablets
Oxycodone normal release
Oxycodone prolonged release

Answer 6

Diazepam - can also prescribe dihydrocodiene, lorazepam and temazepam only for oral administration

Question 7

A 55-year-old man presents his prescription for oxycodone 20 mg m/r tablets.
Which of the following directions would be legally acceptable on a prescription for this medicine?

As directed

Decrease dose by one every fortnight

One as directed
PRN
Weekly

Answer 7

One as directed

As a minimum the directions for control drug must include the quantity of the medicine to be taken at each dose

Question 8

A 14-year-old boy and his mum come to your community pharmacy and ask for your advice as he has a sore mouth. A visual inspection reveals two small circular lesions on the inside of the gums. He says they are painful.
Based on this information, what is the most likely diagnosis?
Leukoplakia
Lichen planus
Major aphthous ulcers
Minor aphthous ulcers
Trauma-related ulcers

Answer 8

The correct answer was Minor aphthous ulcers
Leuoplakia and lichen planus are seen as patches rather than circular lesions; major ulcers are large; and trauma ulcers are irregular shaped.

Question 9

A patient is initiated on a medication for which they will need to take extra precautions to protect their skin from sunlight whilst taking it.
Which of the following drugs when given at higher doses does this advice apply to?
Indapamide
Lithium carbonate
Pizotifen
Promazine
Ramipril

Answer 9

Promazine makes the skin more susceptible to the UV rays from the sun. As such, a patient on promazine therapy is more susceptible to burning/sun burn and must take precaution in sunlight. The BNF entry for promazine lists a specific advice warning on photosenitivity whereas the BNF entry for indapamide does not, and that is why it was chosen in this instance.

Question 10

You have a patient who has diabetes. Some medicines may need to be used with caution in patients with diabetes
Which ONE of the following is most likely to cause ketoacidosis?

Inhaled salbutamol

Intravenous salbutamol

Ipratropium

Salmeterol

Tiotropium

Answer 10

Beta 2 agonists must be used with caution in patients with diabetes. Intravenous salbutamol can cause ketoacidosis.

Question 11

You are providing training on antisecretory and mucosal protection drugs.
Which of the following antisecretory and mucosal protectant drugs is a proton pump inhibitor?
Cimetidine
Misoprostol
Lansoprazole
Ranitidine
Tripotassium dicitratobismuthate

Answer 11

Lansoprazole is a proton pump inhibitor

Question 12

When working in your community pharmacy, a patient complains about severe dental pain they have been feeling.
Which of the patient’s long term regular medications should you flag to the GP as a potential cause of this pain?
Alendronic acid
Bisoprolol
Glyceryl trinitrate
Ibuprofen
Ranitidine

Answer 12

The correct answer was Alendronic acid
It is a CHM warning that with bisphosphonates (particularly IV) there is an increased risk of osteonecrosis of the jaw.

Question 13

Which of the following statements regarding side effects is correct?

Amiodarone causes pin point pupils

Digoxin causes alopecia

Ferrous sulphate causes raised intraocular pressure

Morphine causes dry mouth

Propranolol causes hypothermia

Answer 13

Morphine is a common side effect of morphine

Question 14

A 27-year-old woman presents with red scaly patches on her cheeks, eyebrows and hairline. She has had these patches for 2 years now.
Which one of the following conditions is she most likely to have?
Atopic eczema
Candidiasis
Psoriasis
Seborrhoeic dermatitis
Tinea faciei

Answer 14

Seborrhoeic dermatitis presents with red rash typically affecting the central regions of the face, eyebrows and scalp.

Question 14

A 46-year-old woman was commenced on lithium 400 mg once daily by her GP three months ago for treatment of bipolar disorder. Today she has come in to get a prescription for amoxicillin 500 mg three times a day to treat a dental abscess. She complains of feeling nauseous and has had severe diarrhoea over the last few hours. Upon further questioning you find that she may have accidentally taken a double dose of her lithium tablets yesterday.
What is the most appropriate advice to give to this patient?
Sell her loperamide capsules and advise her that she should start feeling better within 24 hours
She is experiencing a side-effect of lithium, and whilst safe to continue taking it, she may wish to see her GP for an alternativeÂ
She should see her GP as the dose of lithium may need to be reduced
Stop taking lithium straight away and go to her nearest accident and emergency department as soon as possible
The symptoms described are not known to be caused by lithium

Answer 14

The correct answer was Stop taking lithium straight away and go to her nearest accident and emergency department as soon as possible
The symptoms described are signs of lithium toxicity which is likely as the patient may have taken a double dose the day before. Due to the narrow therapeutic range and the severity of potential poisoning the patient requires urgent medical attention and should be referred to her nearest accident and emergency department.

Question 15

A young man visits the pharmacy and asks you to look at an inward growth on the sole of his foot. You notice that the lesion has tiny black dots on its surface. He says that it is painful when he walks.
Which of the following conditions is he most likely to be suffering from?

Athlete’s foot
Basal cell carcinoma
Corn
Molluscum contagiosum
Verruca

Answer 15

Verruca

Question 16

A patient attends anticoagulation clinic for a routine INR check. The target INR for this patient is 2.5-3.5, however in clinic the INR reading is 4.4.
Which of the following medications is most likely causing this deviation in INR range?
Carbamazepine
Cimetidine
Dabrafenib
Fosaprepitant
Phenobarbital

Answer 16

Cimetidine increases the anticoagulant effect of warfarin

Question 17

This is your first shift at a registered pharmacy that prepares unlicensed medicines.
With respect to the ingredients used in the preparation of an unlicensed medicine, which of the following is NOT a requirement for the record keeping process?
Batch number
Certificate of analysis
Certificate of conformity
Ingredient manufacture date
Manufacturer, brand and wholesaler/distributor

Answer 17

The correct answer was Ingredient manufacture date
You should keep detailed records of the preparation of unlicensed medicines in order to safeguard patients (i.e. If there is an incident where a patient’s safety is affected, or the medicine should be recalled, the method of preparation could be reconstructed). For the ingredients used in the preparation, the following should be recorded:
source (manufacturer, brand, wholesaler/distributor)
certificate of conformity
certificate of analysis
batch number
expiry date
quantity used and details of person measuring and person double-checking quantities
TSE guidance should be followed (where ingredient or product contact material is of animal origin)
description of container/closure used (for example, were they were glass/plastic)

Question 18

A 27-year-old pregnant woman comes into the pharmacy to purchase some nicotine replacement therapy (NRT) to help her to quit smoking. She is otherwise healthy, with no other medical conditions, and she is not taking any other medication. She is, however, suffering from pregnancy-related nausea and vomiting.
Which one of the following is the most suitable formulation of NRT for this patient?
Nicotine gum
Nicotine lozenge
Nicotine mouth spray
Nicotine nasal spray
Nicotine patch

Answer 18

The correct answer was Nicotine patch
Normally intermittent therapy recommended for pregnant women e.g. gum, lozenge etc, but with morning sickness a patch is more appropriate - taken off before bed and put on first thing in morning.

Question 19

You are visited by a representative from Apharma who make a drug called Nufen, a drug for pain. The representative tells you that if you can increase sales on this drug by recommending it, he will donate any profits direct to you so you can use it in the shop for other services.
Which of the following professional standards gives guidance on this type of situation?

Behave in a professional manner

Communicate effectively
Demonstrate leadership
Maintain, develop and use their professional knowledge and skills
Work in partnership with others

Answer 19

Behave in a professional manner

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 ecstasy?
Schedule 1
Schedule 2
Schedule 3
Schedule 4
Schedule 5

Answer 20

1

Question 21

Mr B brings his 8-year-old son into your pharmacy. After examination, it is clear that he is suffering from athlete’s foot.
Which of the following treatments would NOT be recommended for the 8 year old for OTC supply?

Canesten® cream

Canesten® dermatological spray

Clotrimazole 1% cream

Hydrocortisone 0.1%

Miconazole 2% cream

Answer 21

Hydrocortisone - steroid cream are not recommended in this setting as they can worsen the fungal infection with immunosuppressant effects

Question 22

The local community nurse phones you to say her patient has run out of medicines. The nurse would like to know which of the patient’s medicines she can prescribe for the patient. She is not an independent or supplementary prescriber.
Which of the patient’s medicines could the nurse prescribe?
Atenolol
Bendroflumethiazide
E45 cream

Morphine sulphate 20 mg tablets

Timodine cream®

Answer 22

E45

Question 23

A registered midwife calls and asks for advice. The midwife wishes to use a midwife supply order to order an opiate based analgesic.
The opiate they wish to obtain is pethidine. Which of the following is INCORRECT regarding the supply order?
It must contain the name and address of the midwife
It must contain the occupation of the midwife
It must contain name of the patient for which the controlled drug is being obtained
It must contain the total quantity of drug to be obtained
It must contain the signature of an appropriate medical officer

Answer 23

The correct answer was It must contain the name and address of the midwife
It is not a pre-requisite for a midwife to state their address on a midwife supply order.

Question 24

A 12-year-old girl is taken to see her GP by her mother to discuss prevention of cervical cancer. Which vaccine is indicated for this patient? BCG vaccine Hepatitis A vaccine Human papilloma virus vaccine Intradermal seasonal influenza vaccine Poliomyelitis vaccine for oral use

Answer 24

Human papilloma virus

Question 25

A woman comes into your pharmacy. She tells you that her 13-year-old child suffers from Leber’s Hereditary Optic Neuropathy and asthma. Her urine is red-brown in colour. She usually takes the following medication: Salbutamol 2 puffs when required Beclometasone 2 puffs twice daily Idebenone 300 mg three times daily Which of the following explanations is the most likely to be the cause of the red-brown urine? An interaction between salbutamol and idebenone Chromaturia is a side effect of beclometasone Chromaturia is a side effect of idebenone Menstruation Urinary tract infection

Answer 25

The metabolites od idebenone may cause red brown discolouration of the urine. This effect is harmless

Question 26

A 23-year-old man presents his prescription for fentanyl 25 mcg patches. What is the maximum recommended duration of supply on a single prescription for this medicine? 7 days 14 days 28 days 30 days 6 months

Answer 26

30 days

Question 27

Which of the following products is specified in the law as having a defined allowable level when driving unless there is a medical reason for it being higher? Chlorphenamine Lorazepam LSD Paracetamol Warfarin

Answer 27

The correct answer was Lorazepam Lorazepam is on the list and may have medical uses (LSD is on the list but unlikely to have medical uses).

Question 28

You discover some out of date morphine sulfate tablets 20 mg in your CD cupboard. What is the most appropriate course of action for destruction of the CD? Contact your authorised person for destruction to be witnessed Contact your superintendent pharmacist for destruction to be witnessed Denature with your technician as a witness and put in CD cupboard Denature yourself and put in CD cupboard Denature yourself and put in the doop bin

Answer 28

The correct answer was Contact your authorised person for destruction to be witnessed Destruction of CD stock must be witnessed by an authorised person.

Question 29

A 4-year-old child has chronic asthma and he has been taking Salbutamol MDI 100 micrograms 1-2 puffs when required for the last 6 months. Three months ago the GP started the child on beclometasone MDI but this was found to be ineffective and this was stopped two weeks ago when the GP started him on montelukast 4 mg chewable tablets 4 mg once daily. The child’s mother, who picks up his son’s medicines from your pharmacy regularly, tells you that he does not like chewing the montelukast tablets and spits it out. She asks you if there is an alternative to the chewable tablets. Which one of the following is the most appropriate reply to the mother? The BNF monograph is available here: https://bnf.nice.org.uk/drugs/montelukast/#indications-and-dose Ask Ahmed to swallow the chewable tablet whole Crush the tablet and mix with cold food and take immediately You will contact the GP and ask to switch to montelukast granules You will contact the GP to find out if Ahmed has tried an inhaled corticosteroid and, if not, suggest that this is prescribed instead of montelukast There is no alternative

Answer 29

The correct answer was You will contact the GP and ask to switch to montelukast granules Asking the patient to swallow the chewable tablet whole or crushing the tablet and mixing into food would be an unlicensed method of administration hence contacting the GP and asking to switch to montelukast granules is the correct answer.

Question 30

A woman comes into your Pharmacy. She asks you about contraception. She is on a combined oral contraceptive and wonders whether this is sufficient or if she should take further contraceptive precautions based on her medication. Which of the following medications do NOT result in the need for additional contraceptive precautions? Carbamazepine Metoclopramide Rifampicin St John’s wort Topiramate

Answer 30

Metoclopramide does not affect combined oral contraceptives. Drugs which are liver enzyme inducers could reduce the efficacy of combined oral contraceptives and hence additional contraceptive precautions must be taken whilst on these medications. Examples of drugs which induce liver enzymes are: antibacterials e.g. rifampicin antiepileptics antiretrovirals St John’s wort.