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Question 1

Clonidine is used in the treatment of hypertension and the prevention of recurrent migraine
attacks. There has been a national shortage with the 25mcg tablet and oral solution. A
female patient requires clonidine 50mcg tablet, twice a day for the prophylaxis of migraine
attacks. You have clonidine 100mcg tablet in stock which is licensed for hypertension. She
does not take any other medication and has an intolerance to propranolol, topiramate and
amitriptyline.
Which one of the following is the most appropriate action in relation to the shortage of
clonidine?
A Supply clonidine 100mcg tablet and a tablet cutter explaining to the patient it is
unlicensed use
B Contact the prescriber and request an alternative medication for migraine
prophylaxis
C Explain to the patient the medication is unavailable and she will receive a text
when the medication is back in stock
D Supply the patient with OTC sumatriptan for the prevention of a migraine attack
as an alternative
E Supply the patient with OTC migraleve to help with her recurrent migraine
attacks

Answer 1

The correct answer is A, Supply clonidine 100mcg tablet and a tablet cutter,
explaining to the patient it is unlicensed use.
In the case of a national shortage of clonidine 25mcg tablet and oral solution, and
considering the patient’s specific needs for migraine prophylaxis, the most
appropriate action is to provide clonidine 100mcg tablet and a tablet cutter. This
allows the patient to accurately cut the higher strength tablet into the prescribed dose
of 50mcg. Although this use is unlicensed, it can be considered in situations where
the recommended formulation is not available. It is important to inform the patient
about the unlicensed use and provide clear instructions on how to use the tablet
cutter to achieve the required dose

Question 2

A 26-year-old pregnant woman visits the pharmacy for advice. She tells you she has been
itching her head for the past week, and believes she has head lice. She is generally fit and
well and does not have any allergies. She would like to purchase an OTC remedy which
she can apply to her hair.
Which one of the following is the most appropriate to recommend to this patient?
A Malathion lotion (Derbac M®)
B Permethrin (Lyclear® cream rinse)
C Electric comb
D Wet combing
E Tea tree oil

Answer 2

The correct answer is D, Wet combing.
For a pregnant woman with suspected head lice, wet combing is the most
appropriate option to recommend. Wet combing involves using a fine-toothed comb
to comb through wet hair, removing lice and nits (eggs) manually. It is a safe and
chemical-free method that can be used during pregnancy without any concerns
about the use of medications or chemicals.
Another suitable option would be the use of dimeticone 4% lotion, which can be used
for pregnant or breastfeeding women, young children aged 6 months to 2 years, and
people with asthma or eczema

Question 3

Mrs H visits your pharmacy on a Saturday and requests an emergency supply for her
medicines. She is on a road trip to Glasgow and has just realised she left her medicines
at home. She has a repeat prescription slip which shows the medication she takes on a
regular basis. She takes lisinopril, metformin, gabapentin, diazepam and atorvastatin.
Which one of the following medications cannot be given to Mrs H as an emergency
supply?
A Lisinopril
B Metformin
C Gabapentin
D Diazepam
E Atorvastatin

Answer 3

Gabapentin as it is a cd

Question 4

A 36-year-old man presents to the GP with symptoms of anxiety, mood swings, polyuria
and muscle weakness for the past 3 weeks. On physical examination, his neck is swollen
and is has a mild twitch. A blood sample is taken.
Which one of the following results would indicate hyperthyroidism?
A Low TSH, raised FT4 and FT3
B Low TSH and FT3, Raised FT4
C High TSH, Low FT4 and FT3
D Low TSH, Low FT3 and FT4
E High TSH and FT4, low FT3

Answer 4

A

Question 5

A 24-year-old female has recently been diagnosed with absence seizures. She has been
commenced on first line treatment for this form of epilepsy. She does not take any other
regular medication and has no known drug allergies.
Which one of the following is the most appropriate 1st line treatment for this patient?
A Lamotrigine
B Sodium valproate
C Ethosuximide
D Gabapentin
E Clobazam

Answer 5

The correct answer is C, Ethosuximide.
Ethosuximide is considered the most appropriate first-line treatment for absence
seizures. Absence seizures, also known as petit mal seizures, are characterized by
brief episodes of loss of consciousness or “blanking out.”

Question 6

A 35-year-old male visits your pharmacy with a prescription written in Welsh. You confirm
the prescription is legally valid and has been issued by a legitimate practitioner. As a non-
welsh speaker, you are struggling to understand the contents of the prescription.
Which one of the following is the most appropriate course of action?
A Dispense the prescription to the best of your ability
B Ask the patient what they have been prescribed and dispense the medication
accordingly
C Inform the patient to try another pharmacy as you don’t have the medication in
stock
D Put patient safety first and do not dispense a prescription you don’t understand,
find the best possible solution to help the patient.
E Inform the patient the prescription can only be dispensed in Wale

Answer 6

D

Question 7

A 22-year-old university student with allergic rhinitis visits your pharmacy. He would like to
purchase a non-sedating antihistamine to help control his symptoms as his exams begin
next week. He has tried loratadine 10mg tablets, with no response.
Which one of the following antihistamines is the most appropriate to recommend?
A Alimemazine tartrate
B Cyclizine
C Promethazine
D Acrivastine
E Chlorphenamine

Answer 7

The correct answer is D, Acrivastine.
In the scenario described, where the patient has not responded to loratadine, the
most appropriate antihistamine to recommend would be acrivastine. Acrivastine is a
non-sedating antihistamine that is known for its fast-acting and effective relief of
allergic rhinitis symptoms. It can provide quick relief from symptoms such as
sneezing, itching, and nasal congestion

Question 8

You are the responsible pharmacist working in a busy community pharmacy. The trainee
pharmacist working with you would like to know how long the responsible pharmacist
record must be retained for electronically.
What is the recommended minimum period the responsible pharmacist record should
be kept?
A 1 year
B 2 years
C 3 years
D 4 years
E 5 years

Answer 8

According to the Medicines (Pharmacies/Responsible Pharmacist) Regulations
2008, responsible pharmacist records must be kept for at least 5 years. The records
can be kept in electronic or hard copy form.

Question 9

Mrs J brings in a prescription for methylphenidate 10mg tablets and seems very anxious
and nervous. She has been prescribed 30 tablets by her GP, however there are only 10
tablets in stock. Mrs J agrees to take the 10 tablets and is issued an owing slip for the
remainder.
Which one of the following is the correct time period within which Mrs J must collect
the remainder of her prescription?
A 10 days from the appropriate date
B 18 days from the appropriate date
C 28 days from the appropriate date
D 30 days from the appropriate date
E 6 months from the appropriate date

Answer 9

The correct answer is C, 28 days from the appropriate date.
When a patient receives a partial supply of a prescription due to limited stock or
availability, they are issued an owing slip for the remaining quantity. The patient then
has 28 days to collect the controlled drug.

Question 10

An 8-year-old girl has sprained her ankle whilst playing outside with her friends 2 days
ago. After speaking to NHS 111, her mother was advised to visit the pharmacy and
purchase ibuprofen oral suspension, to help with the pain and inflammation.
Which one of the following is the correct individual dose of ibuprofen that should be
administered to this child?
A 50mg
B 75mg
C 100mg
D 150mg
E 200mg

Answer 10

The correct answer is E, 200mg.
For an 8-year-old girl, the appropriate individual dose of ibuprofen is 200mg. This
dose can be given up to a maximum of 3 times within a 24-hour period.

Question 11

Mrs P is 76 years old and comes to visit the pharmacy to collect her repeat prescription.
She complains of a productive cough which first occurred a week ago. Upon further
questioning, she tells you the colour of her sputum is pink. She has also been feeling more
breathless when walking up the stairs. She takes the following medication: amlodipine,
atorvastatin, Gaviscon chewable tablets and ferrous sulphate.
Which one of the following is the most likely cause of Mrs P signs and symptoms?
A Asthma
B Heart failure
C Tuberculosis
D Cystic fibrosis
E Pneumonia

Answer 11

The correct answer is B, Heart failure.
Based on the patient’s symptoms of a productive cough with pink-coloured sputum
and increased breathlessness, along with her medical history of cardiovascular
disease and the medications she is taking, the most likely cause of her signs and
symptoms is heart failure.
In heart failure, the heart is unable to pump blood effectively, leading to fluid
accumulation in the lungs. This can result in symptoms such as cough, pink-tinged
sputum (indicating blood-tinged secretions), and breathlessness, especially with
exertion.

Question 12

A 42-year-old female with Crohn’s disease is to be initiated on azathioprine. The clinician
has requested a blood test to ensure the patient does not develop severe side effects due
to a lack of an enzyme which helps remove thiopurine drugs.
Which one of the following enzymes will cause severe side effects during thiopurine
treatment if found to be deficient?
A Thiopurine methyltransferase (TPMT)
B Xanthine oxidase
C Dihydrofolate reductase
D Angiotensin converting enzyme
E Folylpolyglutamate synthase (FPGS)

Answer 12

The correct answer is A, Thiopurine methyltransferase (TPMT).
Thiopurine drugs, such as azathioprine, are metabolised in the body by the enzyme
thiopurine methyltransferase (TPMT). If a patient is deficient in TPMT activity, they
are at a higher risk of developing severe side effects from thiopurine treatment. This
is because TPMT helps in the detoxification of thiopurines, and without sufficient
activity, the drug can accumulate to toxic levels.
Testing for TPMT deficiency before initiating thiopurine treatment is important to
identify patients who may be at risk of developing severe adverse effects. If a patient
is found to have TPMT deficiency, alternative treatment options or dose adjustments
may be considered to minimise the risk of toxicity.

Question 13

A 59-year-old male with newly diagnosed bipolar disorder has been initiated on lithium
carbonate 400mg modified release capsules. His GP has advised him to avoid certain
medication as they interact with lithium and may cause toxicity.
Which one of the following medicines should be avoided with lithium treatment?
A Mebendazole
B Pholcodine
C Ibuprofen
D Pseudoephedrine
E Lactulose

Answer 13

The correct answer is C, Ibuprofen.
When taking lithium, it is important to avoid certain medications that can interact with
lithium and potentially increase its levels in the blood, leading to toxicity. One such
medication to avoid is ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID).
NSAIDs, including ibuprofen, can decrease the excretion of lithium by the kidneys,
resulting in increased lithium levels in the body.

Question 14

Mr T is 66 years old and suffers from GORD, hypertension and musculoskeletal pain. He
attends his GP presenting with a loss of appetite, fatigue, muscle cramps and numbness.
He states he has been experiencing these symptoms for the past 2 weeks. He takes the
following medication: amlodipine 5mg tablet OD, paracetamol 500mg tablets QDS,
lansoprazole 30mg capsules OD. He also takes over the counter medication, including
vitamin D tablets and St Johns Wort.
Which one of the following medications is most likely causing Mr T’s symptoms?
A Amlodipine
B Paracetamol
C Lansoprazole
D Vitamin D
E St Johns Wort

Answer 14

The correct answer is C, Lansoprazole.
Lansoprazole is a proton pump inhibitor (PPI) commonly used to reduce stomach
acid production in conditions such as gastroesophageal reflux disease (GORD).
However, long-term use or high doses of PPIs like lansoprazole can lead to vitamin
and mineral deficiencies, including vitamin B12, calcium, and magnesium. These
deficiencies can manifest as symptoms such as loss of appetite, fatigue, muscle
cramps, and numbness

Question 15

Apixaban is a direct oral anticoagulant (DOAC) used in the treatment of deep vein
thrombosis and pulmonary embolism. A loading dose schedule is initiated for the treatment
of acute DVT and PE.
Which one of the following is the most appropriate dosing schedule for the treatment
of acute DVT and PE?
A 5mg twice a day for the first 7 days
B 5mg twice a day for the first 14 days
C 10mg twice a day for the first 5 days
D 10mg twice a day for the first 7 days
E 15mg twice a day for 5 days

Answer 15

The correct answer is D, 10mg twice a day for the first 7 days.
For the treatment of acute deep vein thrombosis (DVT) and pulmonary embolism
(PE), apixaban is commonly initiated with a loading dose schedule. The
recommended dosing regimen is 10mg of apixaban taken orally twice a day for the
first 7 days. Following the initial 7-day period, the maintenance dose is reduced to
5mg taken orally twice a day

Question 16

Mrs C visits the pharmacy for advice. She tells you she has been experiencing nightmares
and vivid dreams for the past couple of weeks and she suspects it may be related to her
medication. She has a history of migraines, hyperlipidaemia, hypertension and anxiety.
She takes the following medication; atorvastatin, amlodipine, diazepam, propranolol and
paracetamol.
Which one of the following medicines may be the cause of Mrs C’s nightmares and vivid
dreams?
A Atorvastatin
B Amlodipine
C Diazepam
D Propranolol
E Paracetamol

Answer 16

The correct answer is D, Propranolol.
Propranolol, being lipophilic and capable of crossing the blood-brain barrier, has a
higher likelihood of causing side effects such as vivid or unusual dreams compared
to some water-soluble beta-blockers like celiprolol, atenolol, nadolol and sotalol
(Water CANS

Question 17

Mr O is 56-years-old and has been initiated on warfarin treatment for recurrent VTE. He
visits the pharmacy to pick up his prescription and is counselled on how food, alcohol and
other medicines may affect his INR and subsequent warfarin dose. He is told to take his
medication at the ‘same time each day at around 6pm’.
Which one of the following is the most appropriate reason for counselling a patient to
take their medication at the same time each day at around 6pm?
A Blood clotting intrinsic factors are more active in the evening
B Blood clotting intrinsic factors are less active in the evening
C To ensure a consistent effect on INR if taken the following morning
D INR levels begin to fall in the evening
E INR levels being to rise in the evening

Answer 17

The correct answer is C, to ensure a consistent effect on INR if taken the following
morning.
Taking warfarin at the same time each day, around 6pm, helps maintain a consistent
level of the drug in the body. This consistency is important for achieving a stable
anticoagulant effect and maintaining the target INR (International Normalised Ratio)
range. By taking the medication at the same time every day, it helps to ensure that
the INR test results accurately reflect the patient’s response to warfarin therapy.

Question 18

an elderly woman with a malignant sarcoma who has been
initiated on a course of chemotherapy. A few weeks into treatment, she complains of
dysuria and the presence of blood in her urine.
What is the most likely diagnosis of this patient’s signs and symptoms?
A Diverticulitis
B Pyelonephritis
C Cystitis
D Uncomplicated UTI
E Haemorrhagic cystitis

Answer 18

The correct answer is E, Haemorrhagic cystitis.
The patient’s symptoms of dysuria and presence of blood in the urine are consistent
with haemorrhagic cystitis, which is an inflammation of the bladder characterised by
bleeding.

Question 19

The patient is prescribed Mesna for cytotoxic induced urothelial toxicity.
Which one of the following cytotoxic drugs was this patient most likely taking?
A Mercaptopurine
B Cyclophosphamide
C Cisplatin
D Bleomycin
E Oxaliplatin

Answer 19

Mesna is a drug used for the prevention and treatment of urothelial toxicity caused
by cyclophosphamide, a commonly used cytotoxic drug. Cyclophosphamide can
cause damage to the bladder lining, leading to urothelial toxicity and the
development of haemorrhagic cystitis. Mesna helps to protect the bladder by binding
to and detoxifying the harmful metabolite (acrolein), thus reducing the risk of
urothelial toxicity.

Question 20

A 17-year-old female visits the pharmacy to purchase tranexamic acid for heavy menstrual
bleeding. She tells you the heavy bleeding began 2 days ago, and she has been having
her period every 21-23 days for the past 6 months. She is generally fit and well and does
not take any other medication.
Which one of the following is the most appropriate course of action?
A Supply a box of tranexamic acid and counsel the patient to take two tablets
three times a day
B Supply a box of tranexamic acid and counsel the patient to take one tablet four
times a day
C Supply a box of Feminax Ultra (naproxen) and counsel the patient to take two
tablets three times a day
D Supply a box of Feminax Ultra (naproxen) and counsel the patient to take one
tablets three times a day
E Refuse supply and refer the patient to their GP

Answer 20

The correct answer is E, refuse supply and refer the patient to their GP.
According to the guidance for over-the-counter (OTC) sale of tranexamic acid, it
should not be sold to women under 18 years of age or those over 45 years of age.
Since the patient is 17 years old, it would be inappropriate to supply tranexamic acid
without a prescription.

Question 21

An 8-year-old child has been admitted into the acute admissions unit with a presenting
complaint of an asthma attack. His symptoms include breathlessness and chest tightness,
with little response to salbutamol. He takes the following medication:
Salbutamol 100mcg inhaler – one to two puffs up to four times a day when required
Clenil Modulite 100mcg - two puffs twice a day
Which one of the following would be the most appropriate 1st line treatment for an acute
asthma attack?
A Intravenous magnesium sulphate
B Intravenous aminophylline
C Nebulised salbutamol and oral prednisolone
D Intravenous salbutamol and oral prednisolone
E Intramuscular methylprednisolone

Answer 21

The correct answer is C, Nebulised salbutamol and oral prednisolone.
For the management of an acute asthma attack in an 8-year-old child with symptoms
of breathlessness and chest tightness, the most appropriate 1st line treatment is
nebulised salbutamol and oral prednisolone. Nebulised salbutamol helps to open up
the airways and alleviate the symptoms of the asthma attack. Oral prednisolone, a
corticosteroid medication, is administered to reduce inflammation in the airways.

Question 22

Mr C has been newly diagnosed with type 2 diabetes mellitus. He was unable to achieve
adequate glycaemic control through diet alone and a decision has been made to initiate
him on antidiabetic treatment. He has a BMI of 29.9 kg/m2
Which one of the following would be the most appropriate to initiate in Mr C?
A Gliclazide
B Metformin
C Pioglitazone
D Exenatide
E Acarbose

Answer 22

The correct answer is B, Metformin.
For Mr. C, who has been newly diagnosed with type 2 diabetes mellitus and a BMI of
29.9 kg/m2, the most appropriate antidiabetic medication to initiate would be
metformin.
Metformin is considered the first-line treatment for type 2 diabetes in most cases. It is
an oral medication that improves insulin sensitivity, reduces glucose production in
the liver, and enhances glucose uptake in the muscles. Metformin is effective in
managing blood sugar levels and has additional benefits such as potential weight
loss and cardiovascular benefits.

Question 23

Mrs L is 65 years old and visits her GP with dyspepsia. She states the pain occurs in her
upper abdomen at different times of the day, which is worse after eating or drinking. She
tells you she began to vomit yesterday, which looked like “coffee grounds” and the pain
has become progressively worse. She takes the following medication; amlodipine,
atorvastatin, aspirin, paracetamol and bendroflumethiazide.
Which one of the following drugs should be withheld in Mrs L until further
investigations are carried out?
A Amlodipine
B Atorvastatin
C Aspirin
D Paracetamol
E Bendroflumethiazide

Answer 23

The correct answer is C, Aspirin.
In the case of Mrs. L, a 65-year-old patient presenting with dyspepsia, progressively
worsening upper abdominal pain, vomiting resembling “coffee grounds,” and a
medication history that includes amlodipine, atorvastatin, aspirin, paracetamol, and
bendroflumethiazide, it is important to consider the possibility of gastrointestinal
bleeding.
Given the symptoms and the presentation, it would be prudent to withhold aspirin
until further investigations are carried out.
Aspirin, a nonsteroidal anti-inflammatory drug (NSAID), can increase the risk of
gastrointestinal bleeding, especially in older adults. With the presence of upper
abdominal pain, vomiting, and the appearance of “coffee grounds,” which could
indicate the presence of blood, it is crucial to investigate and rule out potential
gastrointestinal complications before continuing aspirin therapy.

Question 24

A 54-year-old man with a history of diabetes currently takes metformin 500mg tablets and
has been advised to implement an exercise regimen. He has an increased risk of
cardiovascular disease due to his diabetes, being overweight, smoking 20 cigarettes a day
and having a past family history of myocardial infarction (MI) related deaths.
Which one of the following drugs is least likely to reduce the risk of cardiovascular
disease?
A ACE inhibitors
B Low-dose aspirin
C Lipid-regulating drugs
D Smoking cessation
E Biguanides

Answer 24

The correct answer is E, Biguanides
Biguanides, such as metformin, primarily help in controlling blood glucose levels in
diabetes but are less effective at reducing the risk of cardiovascular disease
compared to ACE inhibitors, low-dose aspirin, lipid-regulating drugs, and smoking
cessation, which directly target cardiovascular risk factors.

Question 25

A 50-year-old man presents at the pharmacy complaining of a red blistering rash which starts from the right side of his torso, following around his belt-line, and stopping before his belly button. He describes he felt lethargic and feverish and had an intense itching sensation around the area a few days before the rash appeared accompanied by a “tingling” sensation. Which one of the following is the MOST likely diagnosis? A Contact dermatitis B Impetigo C Psoriasis D Eczema E Shingles

Answer 25

Shingles is a viral infection that causes a painful rash. The rash usually appears on one side of the body, and it can be accompanied by fever, headache, and muscle aches. Shingles is caused by the same virus that causes chickenpox. Once a person has chickenpox, the virus remains dormant in the body. It can reactivate later in life, causing shingles. The rash associated with shingles is typically red and blistered. It can be very painful, and it can sometimes be accompanied by itching. The rash usually starts on one side of the body and follows a nerve pathway. In the case of the 50-year-old man, the rash started on the right side of his torso and followed around his belt-line, stopping before his belly button. This is a classic presentation of shingles.

Question 26

A 19-year-old woman with moderate inflammatory acne has not responded to topical treatment. She is generally fit and well and uses a contraceptive patch (Evra®) Which one of the following is the most appropriate second line treatment for this patient? A Benzoyl peroxide 5% gel B Benzoyl peroxide 10% gel C Oxytetracycline tablets D Erythromycin tablets E Isotretinoin capsules

Answer 26

Oxytetracycline tablets are a second-line treatment for moderate inflammatory acne. They are a type of antibiotic that can help to kill the bacteria that cause acne. Oxytetracycline tablets can be effective in treating moderate acne, but they are not as effective as isotretinoin. Here are some additional details about Oxytetracycline tablets: * Oxytetracycline tablets work by killing the bacteria that cause acne. * Oxytetracycline tablets are usually taken twice a day for 8-12 weeks. * Oxytetracycline tablets can cause side effects, such as diarrhoea, nausea and vomiting.

Question 27

You are asked to run a workshop on clinically significant drug interactions for a group of junior doctors. You are asked to give some examples of commonly used drugs that inhibit liver enzymes. Which one of the following drugs inhibit hepatic enzymes? A Cimetidine B Rifampicin C Phenytoin D Carbamazepine E Primidone

Answer 27

The correct answer is A, Cimetidine Cimetidine is a known inhibitor of hepatic enzymes, particularly the cytochrome P450 system, which can lead to increased levels of drugs metabolised by these enzymes. Rifampicin, phenytoin, carbamazepine, and primidone are enzyme inducers, which increase the metabolism of other drugs.

Question 28

A 33-year-old male visits your pharmacy for advice on weight loss. He understands he is able to purchase a medication which aids weight loss (Orlistat) and would like more information. Which one of the following BMI’s would allow the sale of orlistat? A 23 kg/m2 B 24 kg/m2 C 26 kg/m2 D 27 kg/m2 E 28kg/m2

Answer 28

E

Question 29

Mrs C brings in a prescription for verapamil 40mg tablets. She was newly diagnosed with supraventricular arrythmias and is concerned about her medicines side effects. She has no known drugs allergies and also takes amitriptyline 10mg tablets. Which one of the following is a common side effect associated with verapamil? A Pruritus B Constipation C Gingival hyperplasia D Headaches E Erythema

Answer 29

Constipation is a common side effect associated with verapamil. Other side effects can include dizziness, fatigue, and sometimes headaches, but constipation is notably frequent with verapamil use

Question 30

You receive a prescription for Canesten combi 500mg pessary and 2% cream. The patient would like to wait whilst the prescription gets ready and is not exempt from prescription charges. How many prescription charges are payable for this prescription? A 1 B 2 C 3 D 4 E 5

Answer 30

The correct answer is B, 2. Different formulations or presentations of the same drug or preparation, such as a pessary and cream, are considered separate items and therefore incur two prescription charges. In the UK, prescription charges are payable for each item on a prescription, regardless of whether the items are combined in a single pack. Therefore, a prescription for Canesten combi pessary and cream would attract two prescription charges.

Question 31

Mrs P is 45 years old and has been admitted into hospital after taking an overdose. Drug Z has a half-life of 30 minutes and her current drug plasma concentration is found to be 200mcg per ml. How many minutes would it take for her drug plasma concentration to fall to 25mcg per ml? A 30 minutes B 60 minutes C 90 minutes D 120 minutes E 150 minutes

Answer 31

C

Question 32

Mr J has been experiencing leg cramps and constipation for the past couple of days. His potassium level is 2.9mmol/L and he takes the following medicines: ramipril, salbutamol, furosemide, amlodipine and digoxin. Which one of the following drugs is most likely to have caused the effect? A Ramipril B Salbutamol C Furosemide D Amlodipine E Digoxin

Answer 32

The correct answer is C, Furosemide. Furosemide is a loop diuretic that is used to treat high blood pressure and oedema. It works by increasing the amount of water and salt that is excreted in the urine. This can lead to a decrease in potassium levels, which can cause symptoms such as leg cramps and constipation.

Question 33

relate to Mrs T who has been prescribed latanoprost eye drops for ocular hypertension. During counselling, she informs you she also regularly uses carbomer 0.2% eye gel for dry eyes. What is the most appropriate time interval that should be maintained between the drops and gel? A 2 minutes B 3 minutes C 5 minutes D 7 minutes E 10 minutes

Answer 33

It is recommended to wait at least 5 minutes between using different eye drops or eye gels. This is because the first eye drop or gel can wash away the second eye drop or gel if instilled in the eye too quickly. Waiting 5 minutes allows the first eye drop or gel to be absorbed into the eye before the second eye drop or gel is instilled.

Question 34

A patient comes into your pharmacy on a Saturday morning and requests an emergency supply of her medication. She also takes: - Zolpidem 5mg tablet – one at night - Amlodipine 10mg tablet – one daily You are happy the request is genuine and there is an immediate need for the medication. Which one of the following would be the most appropriate course of action? A Ask the patient to call NHS 111 and arrange a prescription B Inform the patient they can wait until Monday and request the medicines with their GP C Supply 5 days treatment D Supply 7 days treatment E Provide the medicines as a loan

Answer 34

The correct answer is C, Supply 5 days treatment. Given that zolpidem is a Schedule 4 controlled drug, the appropriate course of action is to supply no more than 5 days' treatment in an emergency supply situation. Although amlodipine is not a controlled drug and could be supplied for up to 30 days, the supply should be limited to 5 days to ensure consistency and patient safety.

Question 35

A 62-year-old patient presents at the pharmacy for advice. He is upset his warfarin has been stopped and a new medication, apixaban, has been prescribed instead. He was used to taking his warfarin at 6pm daily and does not like changing his medication as it confuses him. He also enjoyed attending the INR clinic for his appointment as it gave him a reason to leave the house, as well as making a number of friends. What is the most appropriate advice you would give to this patient? A You will still need to attend a weekly clinic for blood testing B You will now be able to drink alcohol at your leisure C The dose of warfarin should have been gradually titrated down D There will be a lower risk of bleeding with apixaban compared with warfarin E Apixaban has a lower incremental cost effectiveness ratio compared to warfarin

Answer 35

The correct answer is D, there will be a lower risk of bleeding with apixaban compared with warfarin. Apixaban generally has a lower risk of bleeding compared to warfarin, which is an important advantage. It also does not require regular INR monitoring, which can be a significant lifestyle change for the patient. However, it's crucial to provide reassurance and support for the transition to ensure the patient understands the benefits and adjusts to the new medication regimen

Question 36

A 56-year-old woman with increasing breathlessness and chronic back pain presents at her GP. She reports chest pain that started in the last 24 hours. She has a history of hypertension for which she takes amlodipine 10mg daily and hypercholesterolaemia for which she takes atorvastatin 20mg daily. She smokes 20 cigarettes per day and weighs 86kg. On examination her blood pressure is 160/100 mmHg, her pulse rate is 95 bpm and her oxygen saturation is 96%. Her GP calls an ambulance. Which of the following would you expect the paramedics to offer the patient on the way to hospital? A Oxygen 60% B Tinzaparin 14,000 units C Aspirin 300mg D Bisoprolol 2.5mg E Ramipril 2.5mg

Answer 36

The correct answer is C, Aspirin 300mg. In a patient presenting with symptoms suggestive of acute coronary syndrome (chest pain, history of hypertension, smoking, and hypercholesterolemia), the paramedics would typically administer aspirin 300mg. Aspirin is given to reduce the risk of further blood clot formation, which is important in the management of potential myocardial infarction. Oxygen is not indicated unless oxygen saturation is below 94%.

Question 37

A 46-year-old man with newly diagnosed Atrial Fibrillation (AF) has been started on amiodarone for which you have to counsel him on, prior to discharge. Which one of the following is an essential counselling point for this patient? A Avoid consumption of cranberry juice B Avoid travelling to hot countries C Report any changes in vision D Take in a standing or sitting position E The dose will remain the same permanently post-discharge

Answer 37

The correct answer is C, Report any changes in vision. Amiodarone can cause several significant side effects, including vision changes due to corneal microdeposits or more serious conditions like optic neuropathy. It is essential to counsel patients to report any changes in vision promptly.

Question 38

A 5-year-old child presents with fever, cold-like symptoms, conjunctivitis, cough, irritability and small greyish, irregular lesions surrounded by an erythematous base on the inside of his cheeks. These symptoms followed after 3 to 5 days by a maculopapular rash appearing firstly behind the ears, then spreading down the body, becoming confluent and fading by the third day. Which one of the following childhood infectious diseases is most likely characterised by these symptoms? A chicken pox B Impetigo C Measles D Meningitis E Pneumonia

Answer 38

Question 46 – The correct answer is C The correct answer is C, Measles Measles is characterised by an initial presentation of fever, cold-like symptoms, conjunctivitis, cough, irritability, and Koplik spots (small greyish lesions with an erythematous base on the inside of the cheeks). This is followed by a maculopapular rash that starts behind the ears and spreads down the body.

Question 39

A young woman currently giving her 7-month-old daughter formula milk is keen to switch her to full-fat cow’s milk. What is the minimum age recommended for a child to be changed from formula milk to cow’s milk? A 9 months B 12 months C 18 months D 2 years E 3 years

Answer 39

The correct answer is B, 12 months It is recommended to switch a child from formula milk to full-fat cow’s milk at 12 months of age. Before this age, a child's digestive system is not fully developed to handle the nutrients in cow’s milk adequately.

Question 40

A female neonate, born at 30 weeks gestation and weighing 767 grams was delivered via emergency caesarean section after her mother suffered a hypertensive crisis. The baby is tachypnoeic and has been diagnosed with respiratory distress syndrome. Which of the following is the most appropriate medication to be seen on the baby’s drug chart in the first few hours of her life? A Betamethasone B Caffeine citrate C Doxapram D Oral Vitamin K E Proactant alfa

Answer 40

The correct answer is D, Oral Vitamin K Oral Vitamin K is administered to neonates shortly after birth to prevent Vitamin K deficiency bleeding, which can be a significant risk in preterm infants. This is a standard preventive measure in the first few hours of life.

Question 41

A patient presents at the pharmacy to buy Calpol® for her 5-year-old child who has developed a fever. She asks for advice regarding temperature measurement. How long should a thermometer be placed under the tongue for an accurate oral temperature reading? A 1 – 2 minutes B 3 – 4 minutes C 5 – 6 minutes D 7 – 8 minutes E > 9 minutes

Answer 41

The correct answer is B, 3 – 4 minutes For an accurate oral temperature reading, a thermometer should be placed under the tongue for 3 to 4 minutes. This duration allows the thermometer to accurately measure the body's temperature.

Question 42

. An 18-year-old female approaches the healthcare counter and asks to speak with the pharmacist in private. You both go to the consultation room and she explains she has developed thrush after completing a short course of antibiotics prescribed by her dentist. You understand that antibiotics can alter the bacteria levels in the vagina, which allows the naturally present candida to over develop. The customer would like to purchase Canesten thrush cream. Which of the following symptoms would necessitate a referral instead of selling Canestan® over the counter due to suspected bacterial vaginosis? A Odourless white curd-like vaginal discharge B Itching and soreness around the outside of the vagina C Fish odour white or gray watery vaginal discharge D Stinging or burning sensation upon urination E Pain during intercourse

Answer 42

The correct answer is C, Fish odour white or gray watery vaginal discharge A fishy odor and gray or watery discharge are characteristic symptoms of bacterial vaginosis, which would necessitate a referral to a healthcare professional rather than self-treatment with over-the-counter thrush medication like Canesten.

Question 43

77-year-old patient presents with a 2-month history of cough and sore throat. He tells you that he has not been able to shift the cough and asks to buy some cough mixture. Upon further questioning, you discover he has smoked for most of his life and has lost a lot of weight over the last few months, despite not trying to. What is the most appropriate course of action to recommended? A Sell him a cough mixture and tell him to return in two weeks if it has not subsided B Advise him that this is a normal smoker’s cough and it will not go away unless he stops smoking C Refer him to an out of hours service for a prescription for antibiotics D Refer him to A&E services E Advise him to book an appointment with his GP as soon as possible

Answer 43

The correct answer is E, advise him to book an appointment with his GP as soon as possible. A persistent cough lasting for two months, coupled with significant weight loss and a long history of smoking, raises concerns for potential serious conditions, such as lung cancer. It is important that he sees his GP promptly for further evaluation and investigation.

Question 44

A patient's wife called to report that her husband has been experiencing worsening chest pain for over 20 minutes. The pain is primarily on the left side and radiates to his back. Which one of the following would you advise them to do? A Give the husband 2 paracetamol tablets B Give the husband an aspirin tablet C Call the GP surgery and ask for an emergency appointment D Wait for another 20 minutes to see if the symptoms subside E Call 999 and seek emergency medical help

Answer 44

The correct answer is E, Call 999 and seek emergency medical help Worsening chest pain lasting over 20 minutes, especially with radiation to the back, could indicate a serious condition such as a heart attack. Immediate emergency medical assistance is necessary

Question 45

A lady comes in to the pharmacy and tells you that she has period pain. You suspect her to have primary dysmenorrhoea. Which of the following is the least appropriate question to ask with regards to this diagnosis? A Age B Any vaginal discharge C Nature of pain D Onset of pain E Severity of pain

Answer 45

Vaginal discharge is not typically associated with primary dysmenorrhea, which is characterised by cramping pain during menstruation without an underlying pelvic pathology. Therefore, asking about vaginal discharge is the least appropriate question for diagnosing primary dysmenorrhea.

Question 46

A 24-year-old lady presents at the pharmacy with episodes of throbbing headaches. She has been suffering from these headaches for a few weeks, usually after going to the gym. The headaches are usually one-sided, and last for a few hours. Which of the following is the most appropriate diagnosis? A Cluster headache B Migraine C Tension headache D Giant cell arteritis E Sinusitis

Answer 46

Migraines are often characterised by throbbing, one-sided headaches that can last for several hours. They can be triggered by physical exertion, such as going to the gym. Other common symptoms of migraines can include nausea, vomiting, and sensitivity to light and sound.

Question 47

Which of the following medicines is the most likely to be responsible for the digoxin toxicity? A Simvastatin B Ramipril C Omeprazole D Clarithromycin E Paracetamol

Answer 47

The correct answer is D, Clarithromycin Clarithromycin is a known inhibitor of the cytochrome P450 3A4 enzyme, which can increase the levels of digoxin in the body, leading to toxicity. This interaction is most likely responsible for the patient's digoxin toxicity

Question 48

Mrs T visits your pharmacy complaining about diarrhoea. She would like to purchase a box of loperamide capsules to help ease her symptoms. She would like to know whether any of her existing medicines may be the cause of her diarrhoea. Which one of the following drugs taken by Mrs T does not commonly cause diarrhoea? A Amitriptyline B Amoxicillin C Ferrous sulphate D Magnesium trisilicate E Metformin

Answer 48

Amitriptyline, a tricyclic antidepressant, does not commonly cause diarrhoea. In fact, it often causes constipation. Amoxicillin, ferrous sulphate, magnesium trisilicate, and metformin are all known to potentially cause diarrhoea.

Question 49

You are teaching a current trainee pharmacist about common drug interactions which they should be able to spot and amend accordingly. When the second drug is added to the first, which combination does not cause a clinically significant drug interaction? A Digoxin; amiodarone B Lithium; Bendroflumethiazide C Simvastatin, clarithromycin D Verapamil, Metoprolol E Warfarin, ramipril

Answer 49

The correct answer is E, Warfarin; ramipril Warfarin and ramipril do not have a clinically significant drug interaction. The other combinations listed have notable interactions that can lead to significant clinical effects: * Digoxin and amiodarone can increase digoxin levels and risk of toxicity. * Lithium and Bendroflumethiazide can increase lithium levels and risk of toxicity. * Simvastatin and clarithromycin can increase the risk of myopathy and rhabdomyolysis. * Verapamil and metoprolol can cause additive effects on heart rate and AV conduction, potentially leading to bradycardia or heart block.

Question 50

While preparing a compliance aid box for a patient, you notice that your dispenser is handling a medication that typically should not be touched with bare hands. Which one of the following drugs should not be handled by women of childbearing age? A Zuclopenthixol B Ciclosporin C Finasteride D Sodium valproate E Methotrexate

Answer 50

The correct answer is C, Finasteride Finasteride should not be handled by women of childbearing age, especially if they are or could become pregnant, as it can be absorbed through the skin and cause abnormalities in a developing male fetus.

Question 51

The MHRA is an executive agency sponsored by the Department of Health and social care with a variety of roles and responsibilities, including protecting and improving public health and supporting innovation. Which of the following statements regarding the Medicine and Healthcare Products Regulatory Agency (MHRA) is correct? A The MHRA is responsible for providing clinicians with evidence-based guidance on prescribing B The MHRA is responsible for licensing new medicines and new combinations of active chemicals C The MHRA is a representative body for the pharmaceutical industry D The MHRA offers advice and support to the Department of Health on NHS budgets E The MHRA have no legal powers to prevent the manufacture of a medicinal product should they find it to be harmful

Answer 51

B

Question 52

All medicines have side effects which are unwanted symptoms caused by medical treatment. They are classified according to the likely occurrence and frequency, namely, very common, common, uncommon, rare and very rare. Which one of the following pieces of advice or warnings is FALSE? A For the treatment of depression in patients under 18 years old, only fluoxetine has been shown in clinical trials to be effective for treating this age group B Patients taking sulfasalazine should report any signs of unexplained bleeding, bruising, purpura, sore throat, fever or malaise C Regarding the treatment of infections, quinolones are contraindicated in patients with a history of tendon disorders D When prescribing NSAIDs, prescribers should be aware that the risk of GI toxicity is higher in the elderly E When taking statins, concomitant treatment with drugs that decrease plasma statin concentration increase the risk of muscle toxicity

Answer 52

The correct answer is E, when taking statins, concomitant treatment with drugs that decrease plasma statin concentration increase the risk of muscle toxicity. Concomitant treatment with drugs that increase plasma statin concentration (such as certain CYP3A4 inhibitors) increases the risk of muscle toxicity, not drugs that decrease plasma statin concentration.

Question 53

43-year-old regular patient presents at the pharmacy complaining of pain in his right shoulder. He tells you he thinks the pain was caused by lifting heavy boxes over the weekend. He asks you to recommend a suitable analgesic to ease his pain and tells you that he has not taken anything as of yet. His PMR shows that he is currently taking the following medication: * Ramipril 10mg * Amlodipine 5mg Which one of the following over the counter analgesics would be the most appropriate to recommend? A Soluble paracetamol tablets B Ibuprofen capsules C Naproxen tablets D Co-codamol tablets E Paracetamol caplets

Answer 53

Paracetamol is the safest option for pain relief in this patient. Given his current medications (ramipril and amlodipine), NSAIDs like ibuprofen and naproxen are not recommended due to the potential risk of renal impairment and adverse cardiovascular effects. Co-codamol, which contains codeine, may cause additional side effects and is not necessary for this level of pain. Soluble paracetamol tablets contain a high amount of sodium, which is not advisable for a patient on antihypertensives. Thus, paracetamol caplets are the most appropriate choice.

Question 54

Amorolfine is a topical antimycotic agent licensed as a Pharmacy (P) medication indicated for the treatment of mild cases of fungal infections affecting the nail. Which one of the following patients requesting amorolfine 5% nail lacquer could be sold the product OTC? A 17-year-old male B 27-year-old breastfeeding female C 37-year-old male with diabetes D 47-year-old male with three affected nails E 61-year-old female

Answer 54

The correct answer is E, 61-year-old female Amorolfine 5% nail lacquer can be sold OTC to treat mild cases of fungal infections affecting the nail in those 18 years and over, and provided there are no complicating factors such as diabetes or immunosuppression, and the patient is not pregnant or breastfeeding. A 61-year-old female with no additional contraindications meets the criteria for OTC treatment with amorolfine.

Question 55

A mother presents at the pharmacy with her young baby asking for advice about colic. She tells you this is a recurring problem for her son. You give her advice regarding prevention and provide a product licensed for infantile colic. Which one of the following is the most likely active ingredient in the product? A Alginic acid B Aluminium hydroxide C Simeticone D Magnesium trisilicate E Hydroaltacite

Answer 55

The correct answer is C, Simeticone Simeticone is commonly used in products for infantile colic to help reduce gas bubbles in the stomach and intestines, relieving symptoms associated with colic.

Question 56

A 19-year-old woman presents at the pharmacy requesting emergency hormonal contraception (EHC). She takes phenytoin capsules on a daily basis. You are not accredited to supply Levonelle 1500® via a patient group direction. Which one of the following is the most appropriate course of action to take? A Sell her two boxes of Levonelle 1500® tablets B Sell her three boxes of Levonelle 1500® tablets C Sell her barrier contraception D Fit her an intrauterine device E Refer the patient to her GP

Answer 56

The correct answer is E, Refer the patient to her GP Phenytoin is an enzyme inducer and can reduce the effectiveness of Levonelle 1500®. In this case, the best course of action is to refer the patient to her GP, who can provide an alternative method of emergency contraception, such as a copper intrauterine device (IUD) or a different hormonal option that may be more effective.

Question 57

Mrs C asks to purchase paracetamol 120mg/5mL suspension for her 2-month-old son who has just received his MenB vaccination. What is the most suitable dose of paracetamol 120mg/5mL suspension should he require an antipyretic? A 2.5mL once daily B 2.5mL every 4 – 6 hours, maximum three doses in 24 hours C 2.5mL every 4 – 6 hours, maximum four doses in 24 hours D 5mL every 4 – 6 hours, maximum three doses in 24 hours E 5mL every 4 – 6 hours, maximum four doses in 24 hours

Answer 57

The correct answer is B, 2.5mL every 4 – 6 hours, maximum three doses in 24 hours For a 2-month-old baby who has received the MenB vaccination, the recommended dose of paracetamol 120mg/5mL suspension is 2.5mL (30mg) every 4-6 hours, with a maximum of three doses in 24 hours.

Question 58

A young mother visits the pharmacy with her infant and would like advice on teething, as her 3-month-old son seems to be in a lot of pain and is struggling to sleep at night. Which one of the following OTC treatments would be the least appropriate to recommend? A Bonjela Cool Mint® B Calgel® C Ashton and Parsons Infant Powder® D Anbesol® Teething gel E Teetha®

Answer 58

Bonjela Cool Mint® is not recommended for infants under 3 months due to its formulation, which contains choline salicylate, an ingredient similar to aspirin. This ingredient is not suitable for young infants due to the risk of serious side effects, such as Reye's syndrome

Question 59

The conditions for a lawful supply of a General Sale List (GSL) medicine are set out in the Human Medicines Regulations 2012. These conditions cover where and how the products may be sold including the requirement to be sold in unopened packaging. Which of the following methods of sale would be the least appropriate legally? A Sale from a market stall by a trader with a market stall license B Sale in registered pharmacies by trained staff working under appropriate standard operating procedures C Sale from a garage forecourt shop by the proprietor or his staff D Sale from a vending machine in an open area accessible 24 hours a day E Sale over the internet from a registered business with a physical business address

Answer 59

The correct answer is D, Sale from a vending machine in an open area accessible 24 hours a day. Selling General Sale List (GSL) medicines from a vending machine in an open area accessible 24 hours a day would be the least appropriate legally. This method lacks proper control and supervision to ensure the medicines are sold in a safe and appropriate manner, which is a requirement under the Human Medicines Regulations 2012. However, vending machine sales are acceptable as long as the machine is located within an area that can be closed off to the public and controlled.

Question 60

As the Responsible Pharmacist, you are planning to be away from your pharmacy for an hour later in the day and discuss with your staff what activities they can legally perform while you are away. Which of the following processes can your staff undertake while you are not physically present on the premises? A Labelling and assembling of a prescription B Handing out already checked and bagged medications to a delivery person C Supply of a medicine under a Patient Group Direction D Supply of an over-the-counter Pharmacy medicine E Wholesale supply of a medicine to the dentist next door (you have agreed to supply the medicine to her in a conversation earlier in the day)

Answer 60

The correct answer is A, Labelling and assembling of a prescription. Staff can legally perform labelling and assembling of a prescription while the Responsible Pharmacist is away from the premises for up to 2 hours. These tasks do not involve the final clinical check or the actual supply of the medicine, which must be done by the Responsible Pharmacist.

Question 61

A 29-year-old man regularly uses your pharmacy’s needle exchange service. He asks to speak to you and admits that he recently overdosed on heroin and the shock of this has made him realize that his drug-use problem is getting worse. He tells you that he has already contacted a local drug rehabilitation centre and has scheduled his first appointment for next week. He asks you for some advice about what to expect from the treatment process. Which one of the following would best describe the stage in the cycle of change he is currently at? A Action B Contemplation C Lapse D Relapse E Pre-contemplation

Answer 61

The correct answer is A, Action The patient has moved beyond recognising the problem and has taken concrete steps towards addressing it by scheduling an appointment with a drug rehabilitation centre. This indicates he is in the Action stage of the cycle of change.

Question 62

A 48-year-old male has been prescribed co-codamol 15/500mg for severe back pain which occurred after a back injury. He is generally fit and well and does not take any regular medication. He visits the pharmacy and complains of a side effect which he started to experience a couple of days ago. He has been prescribed a 10-day course of co-codamol, with a follow-up appointment. Which one of the following side effects is commonly associated with co-codamol treatment? A Confusion B Ototoxicity C Hepatic failure D Constipation E Skin rash

Answer 62

The correct answer is D, Constipation Constipation is a common side effect associated with co-codamol (a combination of codeine and paracetamol). Opioids like codeine can slow down bowel movements, leading to constipation.

Question 63

A man has been invited to his GP surgery for his annual flu vaccination. The nurse checks his medical record and identifies him as being eligible for the herpes zoster vaccine for shingles under the NHS routine vaccination scheme. Which one of the following is the minimum age at which the herpes zoster vaccine is routinely offered to people under the NHS? A 36 years B 45 years C 60 years D 65 years E 70 years

Answer 63

The correct answer is D, 65 years The herpes zoster vaccine is routinely offered to people turning 65 years old, those aged 70 to 79, and those aged 50 and over with a severely weakened immune system, according to the updated NHS vaccination scheme

Question 64

Mrs T, a 54-year-old patient who has been prescribed carbimazole 5mg tablets, one tablet to be taken three times a day for hyperthyroidism. She is worried about her new medicines side effects, as her friend takes the same medication and was found to be deficient in her white blood cells a few weeks after starting treatment. Which one of the following is the most likely adverse drug reaction associated with carbimazole treatment? A Pneumonia B Anaemia C Neutropenia D Diabetes E Emphysema

Answer 64

The correct answer is C, Neutropenia Carbimazole can cause neutropenia, which is a decrease in the number of white blood cells, specifically neutrophils. This is a known and potentially serious adverse effect of carbimazole treatment for hyperthyroidism. Patients are usually advised to report any signs of infection or unusual symptoms promptly.

Question 65

In the event Mrs T experiences symptoms suggestive of bone marrow suppression, what is the most appropriate course of action she should take? A She should reduce her dose to 5mg twice a day B She should reduce her dose to 5mg daily C She should continue her normal dose and take paracetamol 500mg tablets, one tablet every 4 – 6 hours as required D She should continue her normal dose and take ibuprofen 300mg tablets, one tablet every 8 hours as required E She should stop taking her medicine and should seek urgent medical advice from her GP

Answer 65

The correct answer is E, she should stop taking her medicine and should seek urgent medical advice from her GP. If Mrs T experiences symptoms suggestive of bone marrow suppression, such as a sore throat, she should stop taking carbimazole immediately and seek urgent medical advice from her GP to prevent any serious complications.

Question 66

Miss R, an 18-year-old female who has been taking phenytoin for focal seizures for the past 2 years. She has been compliant with her treatment and has been seizure free for the past 8 months. She visits the pharmacy and would like to know more information about her medication, including side effects. Which one of the following is not a symptom that would occur in the event of an overdose? A Hypoglycaemia B Nystagmus C Ataxia D Confusion E Diplopia

Answer 66

The correct answer is A, Hypoglycaemia Hypoglycaemia is not a symptom of phenytoin overdose. Symptoms of phenytoin overdose typically include nystagmus (uncontrolled eye movements), ataxia (loss of coordination), confusion, and diplopia (double vision).

Question 67

Miss R would like to begin taking driving lessons and tells the dispenser she understands she must inform the DVLA about her medical condition prior to applying for a provisional licence or she may be fined a substantial amount. What is the maximum fine Miss R may be required to pay if she does not inform the DVLA about her epilepsy? A £200 B £500 C £800 D £1000 E £2500

Answer 67

D

Question 68

A few weeks later, Miss R visits the pharmacy and seems upset. She tells the dispenser her application for a provisional driving licence was not accepted and she must re-apply again at a later date as she did not meet the minimum seizure free period. Which one of the following is the correct seizure free period set by the DVLA which must be met before Miss R can learn to drive a car or motorbike? A 6 months B 8 months C 12 months D 18 months E 24 months

Answer 68

12 MONTHS

Question 69

Mrs B presents at your pharmacy with a prescription for flucloxacillin 500mg capsules, one to be taken 4 times a day. Which one of the following cautionary and advisory labels would you expect to see on the label of this medication which you should also inform the patient about verbally? A Warning: This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol B Warning: Do not drink alcohol C Do not take indigestion remedies 2 hours before or after you take this medicine D Warning: Do not stop taking this medicine unless your doctor tells you to stop E Take this medicine when your stomach is empty. This means an hour before food or 2 hours after food

Answer 69

The correct answer is E, take this medicine when your stomach is empty. This means an hour before food or 2 hours after food. Flucloxacillin should be taken on an empty stomach to enhance its absorption and effectiveness. This means taking it an hour before food or 2 hours after food. This is the cautionary and advisory label you would expect to see and should inform the patient about verbally.

Question 70

Mrs H has been admitted to the gynaecology ward with hyperemesis gravidarum and has been recovering well for the past 3 days. You notice she should be offered thromboprophylaxis as per the RCOG (Royal College of Obstetricians & Gynaecologist) guidelines. You speak to the consultant about a VTE review. Which one of the following drugs would be the most appropriate to offer Mrs H as thromboprophylaxis as an in-patient? A Aspirin B Clopidogrel C Warfarin D Heparin E Edoxaban

Answer 70

Heparin, specifically low molecular weight heparin (LMWH), is the recommended thromboprophylaxis for pregnant women, including those with hyperemesis gravidarum, according to RCOG guidelines. It is preferred due to its safety profile in pregnancy compared to other anticoagulants like warfarin, which is contraindicated, and other oral anticoagulants like edoxaban, which are not recommended during pregnancy.

Question 71

21-year-old female who has been prescribed microgynon ED which is a combined hormonal contraceptive (CHC). She is curious to know if these tablets possess any extra health benefits as she has been reading blogs online which mention they have some health benefits. Which one of the following health benefits is not associated with CHC use? A Reduced risk of endometrial cancer B Reduced dysmenorrhoea C Improvement of acne D Reduced menopausal symptoms E Reduced risk of dementia

Answer 71

The correct answer is E, Reduced risk of dementia Combined hormonal contraceptives (CHCs) are associated with various health benefits, including a reduced risk of endometrial cancer, reduced dysmenorrhea, improvement of acne, and management of menstrual-related symptoms. However, they are not associated with a reduced risk of dementia.

Question 72

Which one of the adverse drug reactions would necessitate stopping the oral contraceptive immediately? A Mild Headache B Sudden disturbance of vision C Fever D Diarrhoea E Increased libido

Answer 72

The correct answer is B, Sudden disturbance of vision A disturbance of vision is a serious adverse drug reaction that can indicate conditions such as a migraine with aura or a potential thrombotic event, which necessitates stopping the oral contraceptive immediately and seeking medical advice. The other side effects listed are generally less serious and do not typically require immediate discontinuation of the medication.

Question 73

You are the responsible pharmacist when a doctor calls your pharmacy on a Friday evening at 7pm and requests an emergency supply for a salbutamol inhaler for Master A who is 10 years old. You assess the need for an immediate supply and are content the doctor cannot provide an immediate prescription due to the surgery being closed. Which one of the following is the most appropriate timeframe within which a doctor must legally provide a prescription? A 12 hours B 24 hours C 48 hours D 72 hours E 120 hours

Answer 73

When an emergency supply of medication is provided at the request of a prescriber, the doctor must legally provide a prescription within 72 hours.

Question 74

Mr H visits his GP for a routine check-up and medication review. He explains he feels ‘ok’ and has been getting on well with his medication, and rarely forgets to take his tablets. He states he has had a lot going on recently at home and has started smoking to help him cope with the pressure. He insists he is not a regular smoker and will quit once things get back to normal. He takes the following medicines: amlodipine, levothyroxine, atorvastatin, theophylline and fexofenadine. Which one of Mr H’s medicines may need a dose adjustment due to smoking? A Amlodipine B Levothyroxine C Atorvastatin D Theophylline E Fexofenadine

Answer 74

Smoking can increase theophylline clearance, and increased doses of theophylline are therefore required; dose adjustments are likely to be necessary if smoking is started or stopped during treatment.

Question 75

A 60-year-old Caucasian male with chronic hypertension has been taking candesartan 16mg daily and amlodipine 10mg daily for a number of years. His blood pressure today at the Hypertension Clinic is 200/140 mmHg. He shows signs of papilloedema and retinal haemorrhage. Which of the following medications is most appropriate for immediate blood pressure reduction in this hypertensive emergency? A Amlodipine B Indapamide C Labetalol D Lifestyle advice E Losartan F Methyldopa G Nicardipine H Ramipril

Answer 75

The correct answer is C, Labetalol. In the context of a hypertensive emergency, such as the situation described with a blood pressure of 200/140 mmHg, signs of papilloedema, and retinal hemorrhage, immediate blood pressure reduction is necessary. Labetalol is a combined alpha and beta-blocker that can be administered intravenously and is effective for rapid blood pressure control in hypertensive emergencies. It is recommended for its quick onset of action and the ability to be titrated to achieve the desired blood pressure reduction. According to NICE guidelines and other clinical resources, Labetalol is a preferred agent in hypertensive emergencies due to its efficacy and safety profile in rapidly reducing blood pressure.

Question 76

A 30-year-old asthmatic woman who is 25 weeks’ pregnant has a home blood pressure of 158/107 mmHg. She currently takes Clenil Modulite 200 micrograms inhaled twice daily, and salbutamol MDI 100 micrograms inhaled when required. Which medication is most appropriate for managing her blood pressure in this situation? A Amlodipine B Indapamide C Labetalol D Lifestyle advice E Losartan F Methyldopa G Nicardipine H Ramipril

Answer 76

The correct answer is F, Methyldopa Methyldopa is commonly used to manage high blood pressure in pregnant women because it has a well-established safety profile during pregnancy. It is effective in controlling blood pressure without causing significant harm to the mother or fetus. Labetalol cannot be used in this case because it may exacerbate asthma symptoms due to its non-selective beta-blocking properties.

Question 77

Which one of the following conditions is a contraindication for a 48-year-old man prescribed ramipril 5 mg daily for hypertension? A Angina B Asthma C Bilateral renal artery stenosis D Gastric ulcer E Heart failure F Myasthenia gravis G Neutropenia H Parkinson’s disease

Answer 77

The correct answer is C, Bilateral renal artery stenosis Ramipril, an ACE inhibitor, is contraindicated in patients with bilateral renal artery stenosis as it can significantly worsen renal function in these individuals.

Question 78

A 36-year-old man has recently been started on amiodarone for tachyarrhythmias associated with Wolff-Parkinson-White (WPW) syndrome. He reports feeling unreasonably cold and sluggish. Which of the following is the most important serum biochemical parameter to measure in order to determine if these symptoms are related to the patient’s drug? A Creatine kinase B Creatinine C Glucose D Leucocytes E pH F Potassium G Sodium H T3 & T4 and thyroid stimulating hormone (TSH)

Answer 78

The correct answer is H, T3 & T4 and thyroid stimulating hormone (TSH) Amiodarone can affect thyroid function, potentially causing hypothyroidism, which could explain the patient's symptoms of feeling cold and sluggish. Measuring T3, T4, and TSH levels will help determine if these symptoms are related to thyroid dysfunction induced by amiodarone.

Question 79

. A 60-year-old man with asthma and documented allergy to aspirin requires antiplatelet therapy following a recent transient ischaemic attack (TIA). Which one of the following is the most appropriate agent for this man? A Apixaban B Clopidogrel C Dabigatran D Dalteparin E Enoxaparin F Heparin (unfractionated) G Rivaroxaban H Tinzaparin

Answer 79

The correct answer is B, Clopidogrel Clopidogrel is an antiplatelet agent that is suitable for patients who are allergic to aspirin. It is commonly used to reduce the risk of stroke and other cardiovascular events following a TIA.

Question 80

A palliative care patient is receiving diamorphine for pain control and has been vomiting for the past 24 hours despite the use of haloperidol. Which one of the following is the most appropriate antiemetic to use in this situation? A Metoclopramide B Domperidone C Cyclizine D Ondansetron E Levomepromazine F Dexamethasone G Haloperidol H Promethazine

Answer 80

The correct answer is E, Levomepromazine Levomepromazine is a broad-spectrum antiemetic often used in palliative care when other antiemetics are ineffective. It can be particularly useful in managing complex or refractory nausea and vomiting in palliative care patients.

Question 81

Mr C has a creatine clearance of 13ml/min and has been feeling nauseous accompanied with 2 episodes of vomiting. Which one of the following is the most appropriate antiemetic to use in this situation? A Metoclopramide B Domperidone C Cyclizine D Ondansetron E Levomepromazine F Dexamethasone G Haloperidol H Promethazine

Answer 81

The correct answer is D, Ondansetron Ondansetron is a suitable antiemetic for patients with renal impairment. It is effective for controlling nausea and vomiting and does not require dose adjustment in patients with reduced creatinine clearance.

Question 82

Mrs Y is an 83-year-old with Parkinson’s disease. The medical team would like to initiate a treatment with an anti-emetic in order to control her nausea and vomiting. A Metoclopramide B Domperidone C Cyclizine D Ondansetron E Levomepromazine F Dexamethasone G Haloperidol H Promethazine

Answer 82

The correct answer is B, Domperidone Domperidone is preferred for patients with Parkinson’s disease because it does not cross the blood-brain barrier as readily as other antiemetics, thus minimising the risk of exacerbating parkinsonian symptoms.

Question 83

A 33-year-old male has been taking bendroflumethiazide 5mg daily for peripheral oedema for the past month and he is complaining of this side effect. A Swollen ankles B Rhabdomyolysis C Anxiety D Hair loss E Erectile dysfunction F Nightmares G Hypoglycaemia H Hyperhidrosis

Answer 83

The correct answer is E, Erectile dysfunction Bendroflumethiazide, a thiazide diuretic, can cause erectile dysfunction as a side effect. This is a recognised common adverse effect associated with the use of thiazide diuretics.

Question 84

This medicine may make you sleepy. If this happens, do not drive or use tools or machines. A Sumatriptan B Simvastatin C Flucloxacillin D Alendronic acid E Methotrexate F Sodium valproate G Digoxin H Doxycycline

Answer 84

A

Question 85

Doses should be taken with plenty of water while sitting or standing, on an empty stomach at least 30 minutes before breakfast or another oral medicine; patient should stand or sit upright for at least 30 minutes after administration. A Sumatriptan B Simvastatin C Flucloxacillin D Alendronic acid E Methotrexate F Sodium valproate G Digoxin H Doxycycline

Answer 85

D

Question 86

Do not take indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine. A Sumatriptan B Simvastatin C Flucloxacillin D Alendronic acid E Methotrexate F Sodium valproate G Digoxin H Doxycycline

Answer 86

H

Question 87

A 65-year-old man has been started on lisinopril 4 weeks ago. Which one of the following adverse drug reactions can potentially occur with this medication? A Candida infection B Chronic fatigue C Constipation D Dry cough E Hypertension F Insomnia G Papular rash H Skin thinning

Answer 87

Dry cough

Question 88

A 49-year-old Caucasian woman has been diagnosed with essential hypertension after consistent blood pressure readings of 143/96 mmHg. She is prescribed an antihypertensive drug. A Amlodipine B Atenolol C Bendroflumethiazide D Candesartan E Furosemide F Irbesartan G Labetalol H Ramipril

Answer 88

Ramipril, an ACE inhibitor, is commonly prescribed for essential hypertension, especially in patients who are under 55 years old and not of African or Caribbean descent. It helps to lower blood pressure by relaxing blood vessels and reducing the workload on the heart.

Question 89

A 51-year-old man who is overweight has developed a pain in his calf following a flight from London to Los Angeles. Diagnostic tests using a D-dimer blood test and Doppler ultrasound confirmed the presence of deep vein thrombosis. Which of the following is the least suitable choice to treat his deep vein thrombosis? A Apixaban B Clopidogrel C Dabigatran D Dalteparin E Enoxaparin F Heparin (unfractionated) G Rivaroxaban H Tinzaparin

Answer 89

Clopidogrel is an antiplatelet agent, not an anticoagulant. It is not suitable for the treatment of deep vein thrombosis, which requires anticoagulant therapy to prevent clot extension and embolisation. Anticoagulants like apixaban, dabigatran, dalteparin, enoxaparin, heparin (unfractionated), rivaroxaban, and tinzaparin are used to treat DVT.

Question 90

A 38-year-old man has been prescribed spironolactone 200mg daily for ascites associated with cirrhosis of the liver. Which one of the following conditions is a contraindication for a patient prescribed spironolactone? A Acute porphyria B Asthma C Diabetes mellitus D History of tuberculosis E Hyperkalaemia F Hyperthyroidism G Hypophosphataemia H Ulcerative colitis

Answer 90

Spironolactone is a potassium-sparing diuretic, and its use can increase potassium levels in the blood. Therefore, hyperkalaemia is a contraindication for patients prescribed spironolactone, as it can exacerbate the condition and lead to serious complication

Question 91

A patient has been admitted to the cardiology ward. He takes warfarin for atrial fibrillation on a variable dose regimen. He presents on admission with severe bruising and haematuria. Which one of the following is the most appropriate course of action to take? Counsel patient on correct use of medicine B Recommend the doctor to reduce the dose C Recommend the doctor to increase the dose D Recommend the doctor to change the drug E Recommend the doctor to change the formulation F Recommend the doctor to stop the drug immediately G Refer the patient for blood tests H No action required

Answer 91

The correct answer is F, Recommend the doctor to stop the drug immediately Severe bruising and haematuria are signs of significant bleeding, likely due to over- anticoagulation with warfarin. Immediate cessation of warfarin is necessary to prevent further bleeding complications, and the patient may require reversal of anticoagulation and further medical evaluation.

Question 92

A 65-year-old man with type 2 diabetes requires additional treatment to his metformin therapy to improve his HbA1C, which is currently 65 mmol/L. He has chronic kidney disease (CKD) with an eGFR of 50 mL/min. Which one of the following is the most appropriate sulphonylurea agent for this patient? A Glibenclamide B Insulin Actrapid C Insulin Humalog Mix 25 D Insulin Lantus E Metformin F Pioglitazone G Sitagliptin H Tolbutamide

Answer 92

The correct answer is H, Tolbutamide Tolbutamide is a suitable sulphonylurea for patients with chronic kidney disease as it has a shorter duration of action and a lower risk of prolonged hypoglycaemia.

Question 93

An elderly patient in the Acute Admissions Ward describes his “diabetes medication” as a cloudy liquid in a vial. A Glibenclamide B Insulin Actrapid C Insulin Humalog Mix 25 D Insulin Lantus E Metformin F Pioglitazone G Sitagliptin H Tolbutamide

Answer 93

The correct answer is C, Insulin Humalog Mix 25 Insulin Humalog Mix 25 is a pre-mixed insulin that appears cloudy due to the presence of both rapid-acting and intermediate-acting insulin components. This fits the description provided by the patient.

Question 94

A 58-year-old patient with diabetes presents at his GP surgery complaining of pain on urinating with the occasional presence of blood in his urine. He takes a medication which carries a risk of a certain type of cancer. A Glibenclamide B Insulin Actrapid C Insulin Humalog Mix 25 D Insulin Lantus E Metformin F Pioglitazone G Sitagliptin H Tolbutamide

Answer 94

Pioglitazone is associated with an increased risk of bladder cancer. The patient's symptoms of pain on urinating and the presence of blood in the urine are concerning and should be investigated further, particularly given the known risks associated with pioglitazone.

Question 95

he following sulfonylurea has been discontinued in tablet form. Only an oral suspension currently exists for the treatment of neonatal diabetes mellitus for use in newborns, infants and children A Glibenclamide B Insulin Actrapid C Insulin Humalog Mix 25 D Insulin Lantus E Metformin F Pioglitazone G Sitagliptin H Tolbutamide

Answer 95

Glibenclamide tablets have been discontinued for general use and are now available as an oral suspension specifically for the treatment of neonatal diabetes mellitus in newborns, infants, and children.

Question 96

A patient with chronic heart failure has developed increased breathlessness and oedema. He is prescribed a diuretic to help relieve fluid retention. He has normal liver and kidney function. Lisinopril B Bendroflumethiazide C Furosemide D Bisoprolol E Nebivolol F Carvedilol G Hydralazine + nitrates H Ivabradine

Answer 96

Furosemide

Question 97

Mr A is 68 years old and has diagnosed with chronic heart failure. He has been taking a loop diuretic for peripheral oedema and has been prescribed a beta blocker at an initial dose of 3.125mg twice daily. A Lisinopril B Bendroflumethiazide C Furosemide D Bisoprolol E Nebivolol F Carvedilol G Hydralazine + nitrates H Ivabradine

Answer 97

Carvedilol is a beta blocker that is commonly prescribed for heart failure. The initial dose of 3.125 mg twice daily is typical for starting treatment with carvedilol, which helps improve heart function and reduce symptoms in patients with heart failure.

Question 98

A newly diagnosed patient with heart failure with pre-existing hypertension developed a persistent dry cough with ACEi and has a known intolerance to angiotensin receptor blockers. What is the most suitable first line treatment for this patient? A Lisinopril B Bendroflumethiazide C Furosemide D Bisoprolol E Nebivolol F Carvedilol G Hydralazine + nitrates H Ivabradine

Answer 98

Hydralazine in combination with nitrates is a suitable alternative treatment for heart failure in patients who cannot tolerate ACE inhibitors or angiotensin receptor blockers due to side effects such as a persistent dry cough or known intolerance. This combination can help manage heart failure symptoms and control blood pressure.

Question 99

. A high risk of liver damage exists when an overdose of this medication occurs, with the potential occurrence of encephalopathy, hypoglycaemia and right subcostal pain and tenderness. A Paracetamol B Ibuprofen C Codeine D Dihydrocodeine E Tramadol F Morphine G Naproxen H Aspirin

Answer 99

Paracetamol overdose is associated with a high risk of liver damage, which can lead to complications such as encephalopathy, hypoglycaemia, and right subcostal pain and tenderness.

Question 100

Codeine 240mg is metabolised to approximately 30mg of this metabolite. A Paracetamol B Ibuprofen C Codeine D Dihydrocodeine E Tramadol F Morphine G Naproxen H Aspirin

Answer 100

The correct answer is F, Morphine Codeine is metabolised in the liver to morphine, which is responsible for much of its analgesic effect. Approximately 10% of codeine is converted to morphine in individuals with normal CYP2D6 enzyme activity.

Question 101

The medication should be avoided in children under the age of 16 due to Reye’s syndrome. A Paracetamol B Ibuprofen C Codeine D Dihydrocodeine E Tramadol F Morphine G Naproxen H Aspirin

Answer 101

Aspirin is contraindicated in children under the age of 16 due to the risk of Reye’s syndrome, a rare but serious condition that can cause swelling in the liver and brain

Question 102

A patient with COPD has been informed to take six tablets immediately as one dose, followed by six tablets every morning for 7 days in the event of increased breathlessness or chest tightness. His medication has been labelled as "rescue pack" A Salbutamol B Formoterol C Ipratropium bromide D Tiotropium E Seretide F Symbicort G Carbocisteine H Prednisolone

Answer 102

The correct answer is H, Prednisolone Prednisolone is a corticosteroid that is often used in a "rescue pack" for COPD patients to manage acute exacerbations. The dosing regimen described is typical for a course of oral steroids to reduce inflammation and improve symptoms during an exacerbation.