X2 Flashcards
A 68-year-old man with type 2 diabetes presents with tiredness and reduced appetite. He has
recently been started on ramipril. His current medicines include:
* Metformin 1g twice daily
* Atorvastatin 20mg once daily
Recent blood test results show:
* eGFR: 28mL/min/1.73m²
* creatinine: 184micromol/L
* potassium: 5.2mmol/L
Which one of the following is the most appropriate action?
A Stop metformin and refer to prescriber due to impaired renal function
B Reassure the patient and repeat blood tests in 3 months
C Continue metformin and advise to take with food
D Reduce metformin dose to 500mg twice daily
E Stop ramipril and increase fluid intake
The correct answer is A, stop metformin and refer to prescriber due to impaired renal
function.
Metformin is contraindicated in patients with an eGFR less than 30mL/min/1.73m²
due to the risk of lactic acidosis. In this case, the patient has renal impairment and
elevated creatinine, both indicating a need to stop metformin immediately. Reducing
the dose or delaying action is unsafe. The prescriber must be contacted to initiate a
suitable alternative treatment.
A 62-year-old man with a history of type 2 diabetes and hypertension presents to his GP
complaining of muscle pain and weakness. He states the symptoms began about a week ago.
His current medicines include:
* Simvastatin 40mg at night
* Metformin 1g twice daily
* Ramipril 5mg once daily
He recently started taking clarithromycin for a chest infection prescribed by an out-of-hours
service.
Which one of the following is the most appropriate action?
A Advise the patient to stop clarithromycin and complete his course with a probiotic
B Advise the patient to continue both medicines and monitor symptoms
C Stop simvastatin immediately and refer to prescriber
D Advise the patient to halve his dose of simvastatin for the rest of the antibiotic course
E Recommend taking both medicines at least 12 hours apart
The correct answer is C, stop simvastatin immediately and refer to prescriber.
Simvastatin is metabolised by CYP3A4. Clarithromycin is a potent inhibitor of this
enzyme, increasing the risk of statin accumulation and subsequent muscle toxicity,
including potentially serious rhabdomyolysis. This patient has developed new muscle
pain and weakness, which is a red flag for statin-induced myopathy. Simvastatin
should be stopped immediately and the prescriber informed to reassess ongoing
treatment and consider an alternative antibiotic or statin if needed.
A 29-year-old woman presents to the pharmacy requesting emergency hormonal
contraception. She had unprotected sexual intercourse 4 days ago. She has no allergies and
is generally fit and well. On further questioning, she reveals that she takes carbamazepine
400mg twice daily for epilepsy.
Which one of the following is the most appropriate action?
A Supply levonorgestrel 1.5mg tablet with advice to take immediately
B Supply ulipristal acetate 30mg tablet with advice to take immediately
C Refer the patient to a prescriber for consideration of a copper intrauterine device
D Supply double dose of ulipristal acetate due to enzyme induction
E Supply double dose of levonorgestrel due to enzyme induction
The correct answer is C, refer the patient to a prescriber for consideration of a
copper intrauterine device.
Carbamazepine is a strong enzyme inducer and reduces the efficacy of both
levonorgestrel and ulipristal acetate, including double-dose regimens. The copper
intrauterine device (Cu-IUD) is not affected by enzyme inducers and remains the
most effective method of emergency contraception, especially when more than 72
hours have passed since unprotected intercourse. Referral for Cu-IUD is the most
appropriate option in this scenario to ensure optimal contraceptive protection.
A 41-year-old man with a history of bipolar disorder has been taking lithium carbonate 400mg
twice daily for the past 6 months. He visits the pharmacy reporting new symptoms of nausea,
metallic taste in the mouth, and slight hand tremors. He has recently been started on
bendroflumethiazide 2.5mg daily by his GP to help manage raised blood pressure.
Which one of the following is the most appropriate action?
A Advise the patient that tremor is a normal side effect of lithium
B Recommend that the patient drinks more water to dilute lithium levels
C Advise the patient to continue taking both medicines and monitor symptoms
D Refer the patient urgently to the prescriber for possible lithium toxicity
E Suggest switching lithium carbonate to valproate as an alternative
The correct answer is D, refer the patient urgently to the prescriber for possible
lithium toxicity.
The patient’s symptoms are consistent with early signs of lithium toxicity, which can
be triggered or worsened by the addition of thiazide diuretics, such as
bendroflumethiazide. Thiazides reduce lithium excretion, increasing serum levels.
Prompt referral to the prescriber is essential for review, possible monitoring of serum
lithium, and adjustment of treatment. Delaying action may risk progression to severe
toxicity.
A 32-year-old woman presents at the pharmacy with symptoms of vaginal discharge and
irritation. She reports that the discharge is white, thick, and odourless. She has no fever, no
abdominal pain, and no history of STIs. On questioning, she mentions that she recently
completed a course of broad-spectrum antibiotics for a urinary tract infection. She has no
known allergies and is otherwise fit and well.
Which of the following is the most likely cause of her symptoms?
A Bacterial vaginosis
B Chlamydia infection
C Trichomoniasis
D Vulvovaginal candidiasis
E Pelvic inflammatory disease
The correct answer is D, vulvovaginal candidiasis.
This patient presents with typical signs of vulvovaginal candidiasis, including thick
white discharge that is odourless, accompanied by irritation. These symptoms are
commonly triggered by antibiotic use, which disrupts normal vaginal flora, allowing
overgrowth of Candida albicans. Bacterial vaginosis typically presents with thin, grey,
fishy-smelling discharge, and STIs such as chlamydia or trichomoniasis usually
involve a coloured discharge, odour, or systemic symptoms such as pain or fever;
none of which are present here.
A 74-year-old woman has been newly diagnosed with atrial fibrillation. She is prescribed
warfarin and referred to the anticoagulation clinic. She returns to your pharmacy after her first
INR appointment, concerned about what foods she can and cannot eat while taking warfarin.
Which of the following statements is the most appropriate advice to give?
A Avoid all foods containing vitamin K, including green leafy vegetables
B Maintain a consistent intake of foods containing vitamin K
C Consume large amounts of cranberry juice to help stabilise INR
D Eat more protein to balance the effects of warfarin
E Take warfarin with grapefruit juice to reduce fluctuations in INR
The correct answer is B, maintain a consistent intake of foods containing vitamin K.
Patients taking warfarin should not avoid vitamin K entirely, but rather maintain a
consistent dietary intake to avoid fluctuations in INR levels. Sudden increases or
decreases in consumption of green leafy vegetables (which are rich in vitamin K) can
affect warfarin’s anticoagulant effect. Cranberry juice potentially increases the
anticoagulant effect of warfarin and should be avoided. Protein intake does not
directly stabilise INR.
A 26-year-old woman attends the pharmacy with symptoms of cystitis. She reports a burning
sensation when passing urine and increased frequency of urination. She is otherwise fit and
well, not pregnant, and has no relevant medical history or allergies. She has no fever, flank
pain or vaginal discharge.
Which one of the following is the most appropriate recommendation?
A Advise the patient to increase fluid intake and take paracetamol for symptom relief
B Supply potassium citrate sachets to ease discomfort and review in 48 hours
C Recommend cranberry juice and ensure she avoids caffeine
D Refer the patient immediately to her GP for antibiotics
E Advise the use of sodium bicarbonate powder to reduce urinary acidit
The correct answer is A, advise the patient to increase fluid intake and take
paracetamol for symptom relief.
According to CKS guidance, uncomplicated lower urinary tract symptoms in women
can initially be managed with self-care and simple analgesia such as paracetamol or
ibuprofen, unless contraindicated. Encouraging adequate hydration (around 1.5
litres/day) is also advised. The use of cranberry products or urine alkalinising agents
such as potassium citrate or sodium bicarbonate is not recommended due to lack of
consistent evidence. Referral may be necessary if symptoms persist or worsen after
48 hours.
A 65-year-old man has recently been discharged from hospital after suffering a transient
ischaemic attack (TIA). He presents a new prescription at your pharmacy for clopidogrel 75mg
once daily. He asks whether he needs to continue taking his daily aspirin, which he was
prescribed following a myocardial infarction 2 years ago.
What is the best advice to give in this situation?
A Continue taking both aspirin and clopidogrel long-term
B Stop aspirin and take clopidogrel as monotherapy
C Take aspirin in the morning and clopidogrel in the evening to reduce bleeding risk
D Take aspirin regularly and clopidogrel only when symptoms reappear
E Stop both medicines and discuss lifestyle modification with the GP
The correct answer is B, stop aspirin and take clopidogrel as monotherapy.
For secondary prevention following a TIA, the standard treatment is clopidogrel
75mg once daily.
Aspirin should be discontinued when clopidogrel is initiated unless there is a specific
secondary care indication for short-term dual antiplatelet therapy.
If clopidogrel is not tolerated, an alternative regimen is aspirin 75mg daily plus
modified-release dipyridamole 200mg twice daily. If both clopidogrel and aspirin are
unsuitable, modified-release dipyridamole alone may be considered. If all other
options are contraindicated, aspirin alone can be used.
Dual therapy with aspirin and clopidogrel (up to 90 days), or aspirin with ticagrelor
(for 30 days), may be initiated in secondary care for certain high-risk patients, such
as those with intracranial stenosis or recurrent TIAs. However, this is short-term only
and typically followed by monotherapy. In this case, clopidogrel monotherapy is the
correct step, and the aspirin should be stopped
A 54-year-old woman with a history of osteoporosis presents to the pharmacy to collect a
repeat prescription for alendronic acid 70mg once weekly. She mentions that she sometimes
takes it after breakfast as she finds it difficult to take on an empty stomach due to nausea. She
also reports occasional indigestion.
What is the most appropriate advice to give this patient?
A Continue taking the medicine after breakfast to reduce nausea
B Take the tablet at bedtime to avoid symptoms during the day
C Crush the tablet and mix it with water if swallowing is difficult
D Take the tablet with plenty of water while sitting or standing, on an empty stomach at
least 30 minutes before breakfast
E Take it with a calcium supplement to help absorption
The correct answer is D, take the tablet with plenty of water while sitting or standing,
on an empty stomach at least 30 minutes before breakfast.
Alendronic acid should be taken with plenty of water, while the patient is sitting or
standing upright, and on an empty stomach at least 30 minutes before breakfast or
any other oral medicine.
The patient must remain upright for at least 30 minutes after taking the dose to
reduce the risk of oesophageal irritation, which is a common adverse effect. Taking it
after food, with supplements, or while lying down can significantly impair absorption
and increase the risk of GI side effects. The tablet should not be crushed or taken at
bedtime.
A 64-year-old man has been prescribed amiodarone 200mg daily for atrial fibrillation. He
attends your pharmacy for a medication review and mentions that he has recently developed
a dry cough and breathlessness on exertion. He is otherwise stable and has been adherent to
his medication. He is not taking any other medicines.
What is the most appropriate course of action?
A Advise the patient to monitor symptoms for another week
B Recommend a short course of salbutamol to relieve the cough
C Reassure the patient that cough is a common side effect of ageing
D Refer the patient to the prescriber for urgent review
E Suggest taking the medicine with food to reduce pulmonary symptoms
The correct answer is D, refer the patient to the prescriber for urgent review.
A new onset of dry cough and breathlessness in a patient taking amiodarone could
indicate pulmonary toxicity, a potentially serious adverse effect. This requires urgent
referral for clinical assessment and possibly a chest X-ray or pulmonary function
tests.
Amiodarone-induced lung disease may present insidiously and is more likely in older
patients or those on long-term therapy. Delaying action could lead to progressive
lung damage. Symptomatic treatment or reassurance alone is not appropriate.
A 74-year-old man with a past medical history of stable angina and chronic obstructive
pulmonary disease (COPD) visits his GP with worsening ankle swelling and breathlessness
on exertion. On examination, his blood pressure is 145/88 mmHg, and he has bilateral pitting
oedema up to the mid-calf. Auscultation reveals basal lung crackles. A diagnosis of worsening
heart failure is made.
He is currently taking the following medication:
* Bisoprolol 5 mg once daily
* Salbutamol inhaler as required
* Glyceryl trinitrate sublingual tablets as required
* Simvastatin 40 mg once daily at night
The GP decides to initiate loop diuretic therapy.
Which one of the following laboratory parameters must be monitored regularly after
starting treatment?
A Platelet count
B Serum calcium
C Serum potassium
D INR
E C-reactive protein
Loop diuretics, such as furosemide or bumetanide, can cause electrolyte
disturbances, particularly hypokalaemia. This can increase the risk of cardiac
arrhythmias, especially in patients with heart failure who are likely to be on other
cardiovascular medications such as beta-blockers. Regular monitoring of serum
potassium and renal function is essential following initiation and during dose
adjustments of loop diuretics.
A 30-year-old man presents to A&E with confusion and rapid heartbeat. His friend reports that
he has type 1 diabetes and has not eaten all day. On examination, he is agitated, sweating,
and has a capillary blood glucose reading of 2.4mmol/L. He is conscious but unable to follow
instructions or take anything orally.
Which one of the following is the most appropriate immediate management?
A Administer long-acting insulin to stabilise blood sugar
B Give rapid-acting insulin to correct hyperglycaemia
C Administer 10% glucose intravenously
D Administer 20g of glucose orally in the form of glucose tablets
E Give 1mg of intramuscular glucagon
The correct answer is C, administer 10% glucose intravenously.
The patient is hypoglycaemic, conscious but unable to follow commands, meaning
oral glucose is unsafe due to the risk of choking or aspiration. In such cases,
intravenous glucose (e.g. 10%) is the preferred route for rapid correction. IM
glucagon is typically used when IV access is not available and the patient is
unconscious. Insulin of any kind is inappropriate in hypoglycaemia.
You are the responsible pharmacist in a community pharmacy. A patient presents with a
prescription for a Schedule 4 Controlled Drug (diazepam 5mg tablets). The prescription was
issued 30 days ago. The patient states they were unable to collect it earlier due to travel
abroad.
According to current legal requirements, which one of the following is the most
appropriate course of action?
A Dispense the medication as long as the patient has valid ID
B Refuse to supply and advise the patient to return to their prescriber
C Amend the date on the prescription with your signature and GPhC number
D Contact the prescriber to verify the delay, then dispense the medication
E Dispense the medication as long as the prescription is signed and dated
The correct answer is B, refuse to supply and advise the patient to return to their
prescriber.
Schedule 4 Controlled Drugs (e.g. diazepam) must be dispensed within 28 days of
the appropriate date on the prescription. After this period, the prescription is no
longer valid, and supply is not legally permitted. Unlike Schedule 2 and 3 CDs, there
is no requirement to record in the CD register, but the 28-day limit still applies.
Pharmacists cannot amend the date or make retrospective changes. The correct
course is to refuse the supply and advise the patient to obtain a new prescription.
A 34-year-old woman visits your pharmacy asking to purchase chloramphenicol eye drops for
her 15-month-old baby, who has developed a sticky eye and mild conjunctival redness. She
reports no other symptoms and that the baby was born full term. She has previously used
chloramphenicol for her older child and would like the same for her baby.
According to current licensing restrictions, which one of the following is the most
appropriate action?
A Supply chloramphenicol 0.5% eye drops and provide counselling
B Supply chloramphenicol 1% eye ointment and advise on administration
C Refer the patient to a prescriber as OTC chloramphenicol is not licensed under 2 years
D Refer the patient to a prescriber as OTC chloramphenicol is not licensed under 3 years
E Recommend lubricating eye drops and monitor symptoms for 5 days
The correct answer is C, refer the patient to a prescriber as OTC chloramphenicol is
not licensed under 2 years.
Although chloramphenicol is an effective treatment for bacterial conjunctivitis, OTC
chloramphenicol eye drops and ointment are not licensed for children under the age
of 2 years. The correct course of action is to refer the child to a prescriber, such as a
GP or prescribing pharmacist.
A 22-year-old woman taking a combined oral contraceptive (COC) presents at the pharmacy
for advice. She tells you that she forgot to take her last pill and is now 14 hours late taking it.
She is in the third week of her current pill packet. She has taken all previous pills correctly and
is otherwise well.
Which one of the following is the most appropriate advice?
A Take the missed pill now, continue the pack as normal, and use extra contraception
for 7 days
B Discard the missed pill, continue with the next pill, and start a new pack immediately
after this one
C Take the missed pill now, continue the pack, and omit the 7-day pill-free interval
D Stop taking the pack, use condoms for 7 days, and restart after the pill-free interval
E Take the missed pill now, continue the pack as usual, and take the 7-day break as
normal
The correct answer is E, take the missed pill now, continue the pack as usual, and
take the 7-day break as normal.
A combined oral contraceptive pill that is less than 24 hours late (i.e. taken within 24
hours of the usual time) is not classed as a missed pill. The advice is to take the last
missed pill immediately, even if that means taking two pills in one day, and then
continue the pack as normal, including the 7-day break if applicable. No additional
contraception is required, and emergency contraception is not needed.
A 76-year-old man with stage 4 chronic kidney disease (eGFR 22 mL/min/1.73m²) has been
diagnosed with atrial fibrillation. The prescriber plans to initiate an oral anticoagulant for stroke
prevention and asks for your advice on appropriate choice.
Which one of the following anticoagulants would be contraindicated for this patient
based on his renal function?
A Apixaban
B Edoxaban
C Rivaroxaban
D Warfarin
E Dabigatran
Dabigatran is contraindicated when eGFR is below 30 mL/min, due to its renal
excretion and increased risk of accumulation and bleeding. This patient has an
eGFR of 22 mL/min, which places him in stage 4 CKD, making dabigatran
unsuitable.
Other DOACs such as apixaban, rivaroxaban, and edoxaban may still be used with
dose adjustments and caution, while warfarin remains a safe and effective option in
severe renal impairment as it is not renally excreted.
A 62-year-old woman has been prescribed methotrexate for rheumatoid arthritis. She collects
her medication from the pharmacy and mentions this is her first time taking it. She has also
been prescribed folic acid.
Which one of the following is the most important counselling point to provide?
A Take methotrexate daily with folic acid to reduce side effects
B Avoid leafy green vegetables to prevent interference with methotrexate
C Take methotrexate once weekly and report any signs of sore throat or mouth ulcers
D Take methotrexate on an empty stomach first thing in the morning
E Avoid all alcohol while taking folic acid
The correct answer is C, take methotrexate once weekly and report any signs of sore
throat or mouth ulcers.
Methotrexate must only be taken once weekly, and wrong daily dosing is a serious
and sometimes fatal error. Patients must be advised clearly about the dosing
schedule and to report symptoms such as sore throat or mouth ulcers, which may
indicate bone marrow suppression. Folic acid is usually taken on separate days to
reduce side effects, but not on the same day as methotrexate.
You are reviewing a prescription for rivaroxaban 20mg once daily for a 68-year-old man with
non-valvular atrial fibrillation and an eGFR of 48 mL/min/1.73m². The prescriber has also noted
that the patient struggles to swallow tablets and wants to know if rivaroxaban can be given
with food or crushed if necessary.
Refer to the SPC for Xarelto (rivaroxaban) at the following link:
https://www.medicines.org.uk/emc/product/8419/smpc
Based on the information provided, which one of the following statements is correct?
A Rivaroxaban must be taken on an empty stomach to avoid reduced absorption
B Rivaroxaban tablets must be swallowed whole and should not be crushed under any
circumstances
C Rivaroxaban should only be administered via a nasogastric tube in patients with
swallowing difficulties
D Rivaroxaban must be taken in the morning to reduce bleeding risk
E Rivaroxaban can be crushed and mixed with water or apple puree and taken orally,
followed by food
The correct answer is E, rivaroxaban can be crushed and mixed with water or apple
puree and taken orally, followed by food.
According to the SPC, Xarelto 15mg and 20mg tablets must be taken with food to
optimise absorption. In patients with swallowing difficulties, the tablet can be crushed
and mixed with water or apple puree, then administered immediately followed by
food. It can also be given via a nasogastric tube with enteral feeding; however, this is
not the only option as stated in option C.
A 4-year-old child weighing 20kg is prescribed paracetamol oral suspension 250mg/5mL for
pain relief. The dosing guidance recommends 15mg/kg per dose, to be given every 6 hours
when required, with a maximum of four doses in 24 hours.
What is the maximum total volume of paracetamol oral suspension the child can receive
in one 24-hour period?
A 20mL
B 24mL
C 28mL
D 30mL
E 32mL
24ml
A 45-year-old woman has been prescribed nitrofurantoin 100mg modified-release capsules
twice daily for a 3-day course to treat uncomplicated lower urinary tract infection. She has
normal renal function and no drug allergies. She returns to the pharmacy 2 days later
concerned that her urine has turned dark yellow-brown.
Which one of the following is the most appropriate response to the patient’s concern?
A Advise the patient to stop taking the capsules and return to the GP immediately
B Explain that urine discolouration is a harmless and expected side effect of
nitrofurantoin
C Report the urine discolouration to the MHRA as a serious adverse reaction
D Switch the patient to trimethoprim as nitrofurantoin is contraindicated in this case
E Advise the patient to increase fluid intake to flush out the medication faster
The correct answer is B, explain that urine discolouration is a harmless and expected
side effect of nitrofurantoin.
Nitrofurantoin can cause brown or yellow urine, which is a well-documented, benign
side effect due to the drug’s chemical structure and excretion in the urine. It is
important to reassure the patient that this is not a sign of harm or treatment failure.
No action or reporting is required unless additional symptoms suggest
hypersensitivity or liver involvement.
A 32-year-old man presents a prescription for tramadol 50mg capsules, quantity 30, written
and signed by an NHS GP. The date on the prescription is 20 March 2025. He tells you that
this is the first time he is collecting the medication. Today’s date is 21 April 2025.
Which one of the following is the most appropriate course of action?
A Dispense the medication in full and counsel the patient appropriately
B Supply a maximum of 30 days’ treatment and issue an owing for the rest
C Refuse to dispense as the prescription has expired under CD regulations
D Contact the prescriber for a new prescription due to quantity exceeding 30 days
E Supply the medication but inform the patient this is the final repeat allowed
The correct answer is C, refuse to dispense as the prescription has expired under
CD regulations.
Tramadol is a Schedule 3 controlled drug, and prescriptions for Schedule 2, 3, and 4
CDs are valid for 28 days from the appropriate date. In this case, a prescription
dated 20 March 2025 becomes invalid after 17 April 2025. Since today’s date is 21
April 2025, the prescription has expired and must not be dispensed. A new
prescription is required from the prescriber.
A 19-year-old woman has been prescribed oral isotretinoin 20mg daily for severe acne by a
consultant dermatologist. She visits your pharmacy to collect her first supply. She confirms
she is not pregnant and is currently taking a progestogen-only contraceptive pill as
contraception.
Which one of the following is the most appropriate advice before supplying this
medicine?
A She must use at least one highly effective method or two complementary user-
dependent forms of contraception for 1 month before, during, and 1 month after
treatment
B She should avoid alcohol during treatment and for 48 hours after stopping
C She must stop the progestogen-only pill and use emergency contraception before
starting
D She should take the first dose on an empty stomach and remain upright for 30 minutes
E She must provide written consent before the first supply is issued from the pharmacy
The correct answer is A, she must use at least one highly effective method or two
complementary user-dependent forms of contraception for 1 month before, during,
and 1 month after treatment.
Isotretinoin is highly teratogenic, and strict pregnancy prevention measures must be
followed. A highly effective user-independent method (such as an IUD or implant) is
preferred. Alternatively, two complementary user-dependent methods (such as the
COC and condoms) may be used. The progestogen-only pill alone is not considered
reliable enough for isotretinoin users.
A 60-year-old woman with rheumatoid arthritis presents to your pharmacy with a new
prescription for ibuprofen 400mg four times daily for joint pain. On checking her PMR, you
notice she is already taking the following regular medication:
* Ramipril 10mg once daily
* Furosemide 40mg once daily
* Methotrexate 15mg once weekly
* Folic acid 5mg once weekly
Which one of the following is the most clinically significant concern when supplying
her new ibuprofen prescription?
A Reduced antihypertensive effect of ramipril
B Increased risk of folic acid deficiency
C Increased risk of gastrointestinal upset
D Risk of methotrexate toxicity
E Development of fluid retention due to furosemide
The correct answer is D, risk of methotrexate toxicity.
Ibuprofen and other NSAIDs can reduce the renal clearance of methotrexate,
especially at high doses or in older patients. This increases the risk of serious
methotrexate toxicity, including bone marrow suppression and renal impairment. The
interaction is potentially fatal, and co-prescribing should be done with caution,
particularly in patients also taking other nephrotoxic drugs like furosemide and
ramipril.
A parent visits your pharmacy with their 8-week-old baby who has developed a fever after
receiving their MenB vaccination earlier in the day. The baby is otherwise well and has no
drug allergies. The parent asks if they should give anything to bring the temperature down.
Which one of the following is the most appropriate course of action?
A Advise against giving any medicine and monitor the baby overnight
B Recommend paracetamol 120mg/5mL, 5mL every 4–6 hours, up to 4 doses
C Recommend paracetamol 120mg/5mL, 2.5mL every 4–6 hours, up to 4 doses
D Recommend paracetamol 120mg/5mL, 2.5mL every 4–6 hours, maximum 3 doses in
24 hours
E Refer the child to the GP immediately as paracetamol is contraindicated under 3
months of age
The correct answer is D, recommend paracetamol 120mg/5mL, 2.5mL every 4–6
hours, maximum 3 doses in 24 hours.
For babies aged up to 3 months, paracetamol can be given for post-immunisation
fever, specifically after the MenB vaccine, which is known to cause higher rates of
fever in infants. The recommended dose is 2.5mL of 120mg/5mL oral suspension,
given up to three times in 24 hours, with a minimum 4–6 hours between doses. This
advice is supported by both the BNF for Children and NHS guidance on post-vaccine
care.
