T9 Flashcards
(24 cards)
A female patient is usually prescribed insulin for her diabetes, as well as warfarin and digoxin for atrial fibrillation. She complains of an increased frequency of urination over the past few days, nausea and vomiting and a headache. She compliments you on your yellow shirt, which is in fact white.
What is the most appropriate advice you should give her?
She should make an appointment with an optometrist as she may be suffering from cataracts
She should be referred as osmotic diuresis is a sign of uncontrolled diabetes
She should be referred as she is exhibiting signs of digoxin toxicity and uncontrolled diabetes
This should resolve over the next few days
You should suggest over the counter products for a possible urinary tract infection
The correct answer was She should be referred as she is exhibiting signs of digoxin toxicity and uncontrolled diabetes
Osmotic diuresis (a sign of uncontrolled diabetes) is associated with hypokalaemia, which would result in digoxin toxicity (which is presenting in this case as nausea and vomiting, headache and xanthopsia).
A patient requires calcium supplements.
What will facilitate the absorption of calcium?
Ascorbic acid
Colecalciferol
Hydroxocobalamin
Pyridoxine
Phytomenadione
Colecalciferol
A 27-year-old woman is admitted into hospital following signs of infection. The doctor requests non-specific laboratory tests to identify the infectious disease.
Which one of the following is LEAST likely to be used in the identification of an infectious disease?
C-reactive protein
Erythrocyte sedimentation rate
Serum complement
Serum ferritin
White blood cell count
Serum ferritin
A woman attends your pharmacy and explains that her 5-year-old niece has sores around her mouth and nose that quickly burst to leave a yellow-brown crust.
Which bacterium do you suspect could have caused this infection?
Escherichia coli
Helicobacter pylori
Sarcoptes scabiei
Streptococcus pneumoniae
Streptococcus pyogenes
The description the woman has given is that of impetigo secondary to infection with bacteria, usually Staphylococcus aureus or Streptococcus pyogenes.
Certain controlled substances such as morphine are subject to much more stringent controls than a normal POM medicine such as simvastatin. You need to make a new entry in the controlled drug register.
Which of the following does NOT have to be recorded when making an entry into the controlled drugs register in respect to the supply of a controlled drug?
Address of prescriber
Amount supplied
Date of supply
Details of the prescriber’s authority to possess
Name of patient
Address of prescriber
What is the appropriate wording to meet legal requirements for the total quantity on the prescription when the prescriber wants you to give a total of 60 tablets?
60 tablets
Sixty tablets
Two (2) packs of 30 (thirty) tablets
Two packs of 30 (thirty) tablets
Two (2) packs of 30 tablets
Two (2) packs of 30 (thirty) tablets
Which of the following can be a side-effect of intravenous salbutamol?
The SmPC is available here: https://www.medicines.org.uk/emc/product/853
Hypercalcaemia
Hyperglycaemia
Hypermagnesaemia
Hypernatraemia
Hyperphosphataemia
HYPERGLYCAEMIA
A 45-year-old patient, who works on the night shift, is prescribed a 10-day supply of temazepam 10 mg when required to help sleep.
Which counselling point is the most appropriate for this patient for them to get the best effect from their medicine?
Do not take with food
Do not use for more than 3 weeks
Take at night
Take 30-60 minutes before you want to sleep
This medicine may make you drowsy
Take 30-60 minutes before you want to sleep
this medicine may make you drowsy is less important
Ms AL suffers from depression and has been taking phenelzine 15 mg three times daily for the last 6 months. As she is not responding to treatment her doctor has decided to change her to fluoxetine capsules.
The SmPC is available here: https://www.medicines.org.uk/emc/product/13515
How soon after stopping the phenelzine can Mrs AL start taking the fluoxetine?
Immediately
1 week
2 weeks
3 weeks
4 weeks
2 weeks
You are dispensing a prescription for a patient for an emollient which contains 40% paraffin.
The patient tells you he’s seen on the television that such emollients can catch fire. What advice would you give him?
He should not smoke or go near naked flames when clothing or bedding has been in contact with an emollient.
The product contains less than 50% paraffin so there is no fire risk.
There is no risk of fire with paraffin-containing products.
There is only a risk of fire if you’re a smoker.
Washing his clothing and bedding regularly will ensure there is no emollient present.
The correct answer was He should not smoke or go near naked flames when clothing or bedding has been in contact with an emollient.
When recommending, dispensing or selling emollient products to patients, instruct them not to smoke or go near naked flames because clothing or fabric such as bedding or bandages that have been in contact with an emollient or emollient-treated skin can rapidly ignite. Washing clothing or fabric at a high temperature may reduce emollient build-up but not totally remove it.
You have a prescription for a patient who is newly started on verapamil.
Which of the following requires a dose reduction with concomitant use of verapamil?
Apixaban
Dabigatran
Phenindione
Rivaroxaban
Warfarin
The correct answer was Dabigatran
Verapamil may increase the plasma concentration of dabigatran therefore increasing its effects. For this reason, the manufacturer advises that the dose is adjusted in patients taking verapamil.
A patient reports finding a piece of plastic in their sachet of medicine.
What is the most appropriate first course of action?
Complete a Yellow Card
Complete internal monitoring systems
Establish if the patient has taken the medicine
Notify the manufacturer
Notify the patient’s GP
The correct answer was Establish if the patient has taken the medicine
In a potential medicines safety situation, the most important thing to do is establish if the patient is at any risk
An 18-year-old girl enters your pharmacy and asks for your advice regarding a sore throat, tiredness and swollen glands in her neck.
What do you suspect may be her condition and most likely cause?
Drug-induced blood dyscrasias
Glandular fever caused by Epstein-Barr virus
Glandular fever caused by varicella-zoster virus
Quinsy secondary to tonsillitis
Tonsillitis caused by rhinovirus
The correct answer was Glandular fever caused by Epstein-Barr virus
Glandular fever caused by Epstein-Barr virus.
You are undertaking some CPD to refresh yourself on the different classes of anti-depressive medication. There are several classes of anti-depressive medications available. One such class is the selective serotonin re-uptake inhibitors or the SSRIs.
Which of the following anti-depressive medications is NOT an SSRI?
Citalopram
Escitalopram
Fluoxetine
Fluvoxamine Maleate
Phenelzine
Phenelzine is a MAOI
You are the pharmacist working on an orthopaedic ward. A 71-year-old male has been admitted to the ward with an atypical femoral fracture. You review his medical record and he tells you that he has been taking the same medications for over 8 years now.
Which one of his following medications are the most likely cause of his fracture?
Alendronic acid
Amlodipine
Aspirin
Atenolol
Metformin
Alendronic acid- atypical femoral factors may occur with patients receiving long term bisphosphonate therapy
You are providing training on side effects of medicines.
Which of the following can be a side-effect of fludrocortisone?
The SmPC is available here: https://www.medicines.org.uk/emc/product/11457
Hypocalcaemia
Hypokalaemia
Hypomagnesaemia
Hyponatraemia
Hypophosphataemia
Hypokalaemia
Your are the regular pharmacist in a local community pharmacy. A work experience student comes across the term ‘audit’. He asks what an audit is.
Which statement best defines a clinical audit?
A continuous cycle of learning and development throughout the life of a professional against professional competencies
Analysis of staff performance indicators
A systematic review of care (including procedures and services) against explicit standards and best practice. This allows for the improvement of standards of service
A systematic review of the literature available, summarising it to suit a specified criteria
A systematic review that identifies all studies and assess the validity of the findings using statistical software
The correct answer was A systematic review of care (including procedures and services) against explicit standards and best practice. This allows for the improvement of standards of service
Mr King, a 44-year-old male, presents with symptoms of nasal congestion, slight sore throat, headache and general loss of smell. He has had these symptoms for 10 days and feels unwell. The patient has been tested to confirm they do not have coronavirus.
The pharmacist decides to make a referral to the doctor because of a potential differential diagnosis. Which of the following suggests is the most likely suspected diagnosis causing the referral?
Glandular fever
Influenza
Post-nasal drip
Perrenial rhinitis
Sinusitis
The correct answer was Sinusitis
Nasal congestion and sore throat are hallmark symptoms of the common cold. However, loss of smell in association with these symptoms is more likely to suggest sinusitis.
A middle aged man presents to the pharmacy complaining of epigastric pain.
Which condition is most closely associated with pain seen in this region?
Appendicitis
Diverticulitis
Gastric ulcer
Irritable bowel syndrome
Renal colic
The correct answer was Gastric ulcer
Appendicitis has central or right lower quadrant pain; diverticulitis and irritable bowel syndrome are associated with left lower quadrant pain; renal colic pain is usually in the loin area.
you have a patient who you suspect may have coronary heart disease. This clinical condition can be associated with a number of risk factors.
Which of the following is NOT a risk factor for coronary heart disease?
Diabetes
Dyslipidemia
Haematoma
Hypertension
Lack of exercise
Haematoma
You are supporting a hospital outpatient service for patients with Parkinson’s disease.
Impulse control disorders are most likely a side effect of which of the following medicines?
Domperidone
Levodopa
Midodrine
Modafinil
Ropinirole
The correct answer was Ropinirole
Impulse control disorders (compulsive gambling, hypersexuality, binge eating, or obsessive shopping) can develop in a person with Parkinson’s disease who is on any dopaminergic therapy at any stage in the disease. Levodopa is also associated with impulse control disorders, however the answer reference given states: ‘Conversely, excessive sleepiness, hallucinations, and impulse control disorders are more likely to occur with dopamine-receptor agonists than with levodopa.’ Thus ropinirole is the best answer.
You are training a summer student on the use of medicines.
Which of the following non-prescription topical preparations is to be used with caution in patients taking phenytoin?
Benzoyl peroxide 4% cream
Clotrimazole 2% cream
Daktarin® oral gel
HC45® hydrocortisone 1% cream
Zovirax® 5% cream
Miconazole enhances anticonvulsant effect of phenytoin (plasma concentration enhanced) although with topical use, the risk is lower.
A doctor wants your advice on what to prescribe a patient with low severity community-acquired pneumonia who has a history of hypersensitivity to penicillin.
Which one of the following is the most suitable option for this patient?
Cefaclor
Cefuroxime
Clarithromycin
Co-amoxiclav
Co-fluampicil
The correct answer was Clarithromycin
Clarithromycin or doxycycline or azithromycin or erythromycin are listed as alternatives to amoxicillin for low severity community-acquired pneumonia. Clarithromycin is the only one of those options listed in the answers.
A 29-year-old pregnant woman is experiencing suprapubic pain over the past 4 days and a ‘burning’ sensation on urination.
Given that this in her first trimester of pregnancy and is not on any other medication, which one of the following antibiotics is the most appropriate for her condition?
Ciprofloxacin 250 mg twice daily
Doxycycline 200 mg once daily
Nitrofurantoin 50 mg four times a day
Ofloxacin 200 mg daily
Trimethoprim 200 mg twice daily
The correct answer was Nitrofurantoin 50 mg four times a day
The patient has a urinary tract infection (UTI). Trimethoprim should not be given to her (folate antagonist and teratogenic in the first trimester). Ciprofloxacin and ofloxacin are quinolone antibiotics and should thus be avoided in pregnancy (shown to cause arthropathy in animal studies and there are safer alternatives available. Doxycycline is a tetracycline that should not be given to pregnant women (effects on skeletal development being documented in the first trimester in animal studies). Note that nitrofurantoin should be avoided in pregnant mothers at term and in those who are breastfeeding. Therefore, it is the most appropriate.
