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Question 1

Which anticonvulsive requires therapeutic monitoring of phenobarbital serum levels in addition to its own?

A- Carbamazepine
B- Clonazepam
C- Ethosuximide
D- Phenytoin
E- Primidone

Answer 1

E- Primidone

Question 2

Which anticonvulsive is most likely to cause kidney stones?

Answer 2

Topiramate

Question 3

Which antiepileptics are likely to cause hyponatraemia?

Answer 3

Carbamazepine
Eslicarbamazepine
Oxcarbamazepine
Sodium valproate

Question 4

If patient reports a sore throat after carbimazole use, what blood test should be ordered?

Answer 4

Neutrophil count

Question 5

Reasons to stop HRT therapy for further investigation

Answer 5

Severe abdominal pain
Swelling or pain in calf muscle
Sudden breathlessness
Prolonged headache

Question 6

Counselling advice for GTN tablets

Answer 6

If symptoms don’t resolve after 3 doses, call an ambulance
May be used as prophylaxis before exercise
Discard 8 weeks after opening
Throbbing headache and flushing are common side effects

Question 7

Aqueous creams

Answer 7

Aqueous creams as leave-on emollients may increase the risk of skin reactions

Question 8

Who is the prophylaxis of meningococcal disease indicated for?

Answer 8

Those with prolonged close contact with a case of meningococcal disease

• during the 7 days before onset of disease
• if they had transient close contact and have been directly exposed to large respiratory droplets/secretions around the time of hospital admission

Question 9

Appropriate antibiotic therapy for patient presenting with cut on arm. The wound is oozing yellow and crusty with localised erythema.

Answer 9

Flucloxacilin 500mg QDS for 7 days

Question 10

Which lab test would confirm if a patient is suffering from a hypersensitivity reaction?

Answer 10

FBC and differential

Question 11

At risk groups for seasonal influenza vaccines

Answer 11

Respiratory conditions- asthma (needing steroid inhaler or tabs), COPD (including emphysema and bronchitis)
Diabetes
Heart conditions
Being very overweight- BMI of 40 or above
CKD
Liver disease e.g. hepatitis
Neurological conditions e.g. Parkinson’s, MS
Learning disability
Problems with the spleen e.g. spleen removal or sickle cell disease
Weakened immune system e.g. due to AIDS or HIV or taking steroid tabs or chemo

Question 12

How is the absolute bioavailability of a drug given as an oral extended release tablet determined?

Answer 12

By comparing it to the bioavailability of the parenteral solution of the drug given as IV bolus or IV infusion

Question 13

What drug can cause weight loss, tachycardia and waking through the night due to stress?

Answer 13

Levothyroxine

Question 14

How long should a child with measles stay off school from when the symptoms first appear?

Answer 14

4 days

Question 15

Complications of measles

Answer 15

1 in 20 people experience ear infections

Other complications:
Bronchitis
Convulsions
Pneumonia
Encephalitis

Question 16

MMR vaccine

Answer 16

May be administered by IM or SC injection.
Administered at 12 months, then a booster shot is given 3 years later.
May be given to children that have had a previous anaphylactic reaction to eggs.

Question 17

Patients of Chinese ethinicity are at greatest risk for genetic polymorphisms in which CYP50 isoenzyme?

Answer 17

CYPD2D6

Question 18

How long can doxycycline be used for the prophylaxis of malaria?

Answer 18

2 years

Question 19

Diethyltoluamide (DEET) 20-50% in lotions, sprays, or roll-on formulations is safe and effective when applied to the skin of adults and children over 2 months of age. True or False?

Answer 19

True

Question 20

Diethyltoluamide (DEET) 20-50% cannot be used during pregnancy and breast-feeding. True or False?

Answer 20

False

Question 21

When sunscreen is needed in addition to DEET, DEET should be applied after the sunscreen. DEET reduces the SPF of sunscreen so a sunscreen should also be applied.

Answer 21

Mosquito nets impregnated with permethrin provide the most effective barrier protection against insects. Mats and vaporised insecticides are also useful.

Question 22

If 24 month old baby has oral thrush, what OTC product can be given?

Answer 22

Daktarin oral gel

Suitable for aged 4 months and over.

Question 23

Which inhaler is a LAMA that is effective for the management of COPD, but cannot be used for relief of acute bronchospasm?

Answer 23

Spiriva (tiotropium)

Question 24

The CHM has advised that this inhaler should be introduced at a low dose and the effect properly monitored prior to dose increase.

Answer 24

Serevent (salmeterol)

Question 25

Which inhaler provide short term relief in mild COPD. Its maximal effect occurs 30-60 mins after use.

Answer 25

Atrovent (Ipratropium)

Question 26

What are symptoms of reactivation of latent TB?

Answer 26

Breathlessness, night sweats, fatigue and weight loss. Anti-TNF therapies- esp. monoclonal antibody preparations- e.g. infliximab are associated with risk of reactivating TB. This usually occurs within 3-6 months of commencing infliximab.

Question 27

What is the antibiotic used to treat pneumonia that is caused by Pneumocystis jirovecii (Pneumocystis carinii)?

Answer 27

Co-trimoxazole (can also be used prophylactically) | If CI, then atovaquone

Question 28

Which antibiotic should not be given with isotretinoin?

Answer 28

Doxycycline Isotretinoin increases the risk of benign intracranial hypertension when given with doxycycline.

Question 29

Which drug can increase the likelihood of thrush and UTI episodes to occur?

Answer 29

Dapagliflozin

Question 30

Which antidiabetic drug can increase the risk of lactic acidosis?

Answer 30

Metformin

Question 31

Which drug can help with insulin resistance as it works by increasing insulin utilisation in the body, thereby helping her lose weight and reduce her insulin dose?

Answer 31

Metformin

Question 32

Which antidiabetic drug should be avoided in chronic heart failure?

Answer 32

Pioglitazone

Question 33

What use of amitriptyline is off-license?

Answer 33

Neuropathic pain

Question 34

Which opioid is less suitable for prescribing?

Answer 34

Kaolin and Morphine Mixture, BP (Kaolin and Morphine Oral Suspension) is less suitable for prescribing.

Question 35

Fluoxetine 10mg tablets

Answer 35

Unlicensed

Question 36

Symptoms of mumps

Answer 36

``` Swelling of the parotid glands headache joint pain feeling sick dry mouth mild abdominal pain feeling tired loss of appetite a high temperature (fever) of 38C or above ```

Question 37

Which antimuscarininc bronchodilators is licensed for twice daily use?

Answer 37

Aclidinium bromide

Question 38

What are signs of anaphylaxis?

Answer 38

Difficulty breathing Dizziness Pale skin Swelling of tongue

Question 39

Questions to ask patient who comes in with primary dysmenorrhoea (period pain)

Answer 39

Age Nature of pain Onset of pain Severity of pain

Question 40

Pseudoephedrine

Answer 40

Dose: ONE tablet every 4-6hrs upto 4 times a day It is licensed from 12 years old It can cause sleep disturbances Can be used in the manufacture of crystal methamphetamine Each tablet has a strength of 60mg. Max OTC sale of 720mg (12 tabs).

Question 41

Dioralyte sachets

Answer 41

Dissolve in 200ml of fresh water or freshly boiled and cooled water Discard an hour after it's been made up, or after 24 hours if kept in the fridge Can be given to 3 months old and over Dose: One sachet after each loose stool, can take upto 5 sachets in 24 hours.

Question 42

What dose of paracetamol should be given to a 26 month old toddler?

Answer 42

7.5ml QDS PRN

Question 43

What time gap would you recommend between hypromellose and lacrilube eye drops?

Answer 43

5 minutes

Question 44

Which inhaler has a dose indicator that changes colour from green to red to show that the dose had been inhaled correctly?

Answer 44

Genuair

Question 45

Which inhaler does not have a dose counter?

Answer 45

Easi-breathe

Question 46

Preparations that do NOT contain which sugars can be classed as sugar free?

Answer 46

Fructose, glucose and sucrose

Question 47

What is the mechanism of action of EllaOne?

Answer 47

Primary mechanism for ellaOne is inhibition or delay of ovulation

Question 48

Driving and diabetes

Answer 48

Check your blood glucose no longer than 2 hours before driving Check your blood every 2 hours if you're on a long journey Travel with sugary snacks and snacks with long-lasting carbs, like a cereal bar or banana If you feel your levels are low: Stop the car when it's safe Remove the keys from the ignition Get out of the driver's seat Check your blood glucose and treat your hypo Do not drive for 45 minutes after you start to feel better

Question 49

What can the dispensing technician do before the RP comes into work?

Answer 49

DIspense prescriptions

Question 50

What are referral points to a Dr for a patient who may have piles?

Answer 50

Sharp stabbing pain on defecation Blood mixed in the stools, giving them a tarry red or black appearance Symptoms present after 1 week OTC treatment Haemorrhoid symptoms with nausea and vomiting

Question 51

Side effects of Buscopan (hyoscine butylbromide)

Answer 51

``` Pupil Dilatation Dry mouth Urinary retention Constipation Blurred vision ```

Question 52

Symptoms of digoxin toxicity

Answer 52

``` Diarrhoea Nausea Palpitations Blurred vision Yellow vision ```

Question 53

Digoxin toxicity

Answer 53

Most common trigger: hypokalemia, which may occur as a result of diuretic therapy. Dosing errors are also a common cause of toxicity in the younger population. Factors that increase the risk of digoxin toxicity include: Hypothyroidism/hyperthyroidism.

Question 54

How long should a thermometer be placed under the tongue for an accurate oral temperature?

Answer 54

3-4 minutes

Question 55

Cause of warts and veruccas

Answer 55

Infection of the skin with the human papilloma virus (HPV).

Question 56

Treatment of warts/veruccas

Answer 56

Topical salicylic acid (15-50%) should be applied daily for up to 12 weeks Cryotherapy with liquid nitrogen can be carried out for a maximum of 6 treatments Without any treatment warts and verrucae may spontaneously resolve within two years.

Question 57

What age group have the highest incidence of warts and veruccas?

Answer 57

16-18 year age group

Question 58

How long do you have immunity from the Yellow Fever vaccine before requiring re-vaccination?

Answer 58

10 years

Question 59

Which drug requires referral to hospital immediately if there is any redness, pain or swelling of the leg?

Answer 59

Tamoxifen

Question 60

What parameter should be monitored 2 weeks after commencing Fluoxetine?

Answer 60

Assessment for signs of suicidal ideation

Question 61

What is the MHRA alert on SSRIs?

Answer 61

Small increased risk of postpartum haemorrhage when used in the month before delivery There is a small increased risk of congenital heart defects when taken during early pregnancy. If used during the third trimester there is a risk of neonatal withdrawal symptoms, and persistent pulmonary hypertension in the newborn has been reported.

Question 62

Common symptoms of abrupt withdrawal of SSRIs

Answer 62

``` Gastro-intestinal disturbances Headache Anxiety Dizziness Paraesthesia Electric shock sensation in the head, neck, and spine Tinnitus Sleep disturbances Fatigue Influenza-like symptoms Sweating ```

Question 63

Within how long can antidepressant withdrawal occur?

Answer 63

Within 5 days of stopping treatment. The risk of withdrawal symptoms is increased if the antidepressant is stopped suddenly after regular administration for 8 weeks or more.

Question 64

Which is the best research methodology for making evidence based clinical decisions, according to the Cochrane Collaboration?

Answer 64

Meta-analysis studies

Question 65

Benzoyl peroxide

Answer 65

Adults and children over 12 years old Takes around 4 weeks to start working Not suitable for very bad acne with nodules (large, hard lumps that build up beneath the surface of the skin and can be painful) or cysts (large, pus-filled lumps that look similar to boils). Can bleach or discolour your hair, as well as clothes, towels and bedding. Keep it away from hair and coloured fabrics. Try to avoid strong sunlight while using benzoyl peroxide gel, wear sunscreen.

Question 66

What can cause neutropenia in a patient?

Answer 66

Viral infection

Question 67

Patient presents with scalp ringworm

Answer 67

If a pet is the source of the fungal infection, then it should be assessed and treated by a vet

Question 68

What requires urgent referral in people with dyspepsia?

Answer 68

Iron deficiency anaemia

Question 69

Advice with the COC

Answer 69

Blood pressure may increase | Studies also show that it decreases risk of ovarian and womb cancer, but can increase the risk of breast cancer

Question 70

If a patient presents with sneezing, rhinorrhoea, congestion and itch and watery, red eyes, what medicine could help to relieve their symptoms?

Answer 70

Nasal beclometasone

Question 71

Reporting your concerns

Answer 71

The Public Disclosure Act exists to protect you should you raise a concern Failure to disclose concerns may constitute a failure of your own fitness to practice You should keep a personal record of the concerns you have and who you have raised them with You should try to maintain confidentiality where appropriate when raising concerns

Question 72

Handling of waste medicines returned to pharmacies in England

Answer 72

Liquid waste should not be decanted into a waste container Waste should not be stored for longer than three months All waste must be stored in a designated area away from medicines that are fit for use No more than 5 cubic meters of hazardous waste can be stored at any one time

Question 73

A prescription for a Veterinary Medicinal Product (VMP) which is also a Schedule 2 Controlled Drug must be written on a Standardised Controlled drug form. True or False?

Answer 73

False

Question 74

Advanced services provided by community pharmacies

Answer 74

Stoma Appliance Customisation New Medicines Service Flu Vaccination Medicines Use Review

Question 75

Drug Driving code

Answer 75

The new offence covers blood levels of specific medicines classified as Controlled Drugs in the body. Drivers can invoke a specific defence, which covers Controlled Drugs taken in accordance with medical advice. A separate offence exists of driving while impaired through drugs – and this applies to driving while impaired by any type of drug. Cannabis is an example of a drug covered by the new legislation According to the new Drug Driving offence legislation, the police DO NOT need to prove impairment case-by-case where a specified drug has been detected above the specified limit.

Question 76

The contactable pharmacist may be the contactable pharmacist for more than one pharmacy at the same time. True or False?

Answer 76

True

Question 77

What can staff do while the RP is not physically present on the premises?

Answer 77

Accuracy checking

Question 78

Concomitant use of clozapine and co-trimoxazole may result in what?

Answer 78

Bone marrow suppression

Question 79

What medication is there legislation for that prohibits you from administering the medicine without instruction from an appropriate practitioner?

Answer 79

Soluble Insulin 100units/mL injection ``` Not legislation is required for: Diazepam 10mg/2. 5mL rectal solution Salbutamol 100mcg inhaler Adrenaline 1mg/mL injection Midazolam 5mg/mL buccal solution ```

Question 80

Pharmacy record

Answer 80

RP must ensure it's correctly mainained Electronic copy must be kept for 5 days from the date it was first created All pharmacy staff have the right to view this record An entry can be made remotely as long as it fulfils all legal requirements.

Question 81

CPDs

Answer 81

A minimum of nine relevant entries per year must be made CPD entries can be stored securely online CPD requirements apply equally to all pharmacy professionals Handwritten records must be written in an approved format

Question 82

What electrolyte imbalance can indapamide cause?

Answer 82

Hypomagnesaemia Hypokalaemia Hyponatraemia Hypokalaemia is dangerous in severe cardiovascular disease and in patients also being treated with cardiac glycosides. In hepatic impairment, hypokalaemia caused by diuretics can precipitate encephalopathy.

Question 83

Why should thiazides and thiazide-like diuretics not be used to treat gestational diabetes?

Answer 83

May cause neonatal thrombocytopenia, bone marrow suppression, jaundice, electrolyte disturbances, and hypoglycaemia; placental perfusion may also be reduced. Stimulation of labour, uterine inertia, and meconium staining have also been reported.

Question 84

To identify signs of agranulocytosis or neutropenia in patients taking clozapine, how often should this particular patient have his blood counts monitored?

Answer 84

Weekly leucocyte and differential blood counts for 18 weeks, then at least every 2 weeks and if clozapine continued and blood count stable after 1 year at least every 4 weeks (and 4 weeks after discontinuation) If leucocyte count below 3000 /mm3 or if absolute neutrophil count below 1500 /mm3 discontinue permanently and refer to haematologist. Patients who have a low white blood cell count because of benign ethnic neutropenia may be started on clozapine with the agreement of a haematologist.

Question 85

In addition to agranulocytosis or neutropenia, what other adverse effects can occur?

Answer 85

Fatal myocarditis (most commonly in first 2 months) and cardiomyopathy reported. Persistent tachycardia especially in first 2 months should prompt observation for other indicators for myocarditis or cardiomyopathy. Impairment of intestinal peristalsis, including constipation, intestinal obstruction, faecal impaction, and paralytic ileus, (including fatal cases) reported.

Question 86

Clozapine dose adjustment

Answer 86

Clozapine dose adjustment might be necessary if smoking started or stopped during treatment.

Question 87

Monitoring for clozapine

Answer 87

Monitor prolactin concentration at the start of therapy, at 6 months, and then yearly. Annual cardiovascular health monitoring Monitor leucocyte and neutrophil count Blood lipids and weight should be measured at baseline, every 3 months for the first year, then yearly. Fasting blood glucose should be measured at baseline, after one months' treatment, then every 4–6 months.

Question 88

Foods to avoid with MAOIs e.g. phenelzine

Answer 88

Potentially life-threatening hypertensive crisis can develop in those taking MAOIs who eat tyramine-rich food (such as mature cheese, salami, pickled herring, Bovril®, Oxo®, Marmite® or any similar meat or yeast extract or fermented soya bean extract, and some beers, lagers or wines) or foods containing dopa (such as broad bean pods).  Avoid tyramine-rich or dopa-rich food or drinks with, or for 2 to 3 weeks after stopping, the MAOI.

Question 89

What treatment would be considered for a 10 year old with major depression?

Answer 89

Fluoxetine

Question 90

Which sulphonylurea carries the greatest risk of hypoglycaemia, so should be avoided in the elderly?

Answer 90

Gilbenclamide

Question 91

Reasons to stop combined hormonal contraceptive

Answer 91

An unusual, severe, prolonged headache Unexplained swelling of calf in one leg Severe stomach pain Sudden breathlessness

Question 92

Adrenaline injection advice

Answer 92

If you still feel unwell after the first injection, use a second injector 5 to 15 minutes after the first. An ambulance should be called after each administration. The individual should lie down with their legs raised (unless they have breathing difficulties, in which case they should sit up) and should not be left alone. Always carry 2 pens with you at all times. Inject (intramuscularly) into the anterolateral aspect of the middle third of the thigh

Question 93

Monitoring parameters for antipsychotics

Answer 93

Blood lipids and weight should be measured at baseline, at 3 months (weight should be measured at frequent intervals during the first 3 months), and then yearly with antipsychotic drugs. Patients taking olanzapine require more frequent monitoring of these parameters: every 3 months for the first year, then yearly. Fasting blood glucose should be measured at baseline, at 4–6 months, and then yearly. Patients taking olanzapine should have fasting blood glucose tested at baseline, after one months’ treatment, then every 4–6 months.

Question 94

Monitoring with statins

Answer 94

Before starting treatment with statins, at least one full lipid profile (non-fasting) should be measured, triglyceride concentrations, thyroid-stimulating hormone, and renal function should also be assessed. NICE suggests that liver enzymes should be measured before treatment, and repeated within 3 months and at 12 months of starting treatment. Those with serum transaminases of more than 3 times the upper limit of the reference range should discontinue statin therapy. Before initiation of statin treatment, creatine kinase concentration should be measured in patients who have had persistent, generalised, unexplained muscle pain. If the concentration is more than 5 times the upper limit of normal, a repeat measurement should be taken after 7 days. If it still remains above 5 times, statin treatment should not be started; if concentrations are still raised but less than 5 times the upper limit, the statin should be started at a lower dose. Patients at high risk of diabetes mellitus should have fasting blood-glucose concentration or HbA1C checked before starting statin treatment, and then repeated after 3 months.

Question 95

Monitoring for ACE inhibitors

Answer 95

Renal function and electrolytes should be checked before starting ACE inhibitors (or increasing the dose) and monitored during treatment (more frequently if side effects mentioned are present).

Question 96

Monitoring for sodium valproate

Answer 96

Monitor liver function before therapy and during first 6 months especially in patients most at risk. Measure full blood count and ensure no undue potential for bleeding before starting and before surgery.

Question 97

Common side effects of beta blockers

Answer 97

Abdominal discomfort; bradycardia; confusion; depression; diarrhoea; dizziness; dry eye (reversible on discontinuation); dyspnoea; erectile dysfunction; fatigue; headache; heart failure; nausea; paraesthesia; peripheral coldness; peripheral vascular disease; rash (reversible on discontinuation); sleep disorders; syncope; visual impairment; vomiting

Question 98

Signs of lithium toxicity

Answer 98

Signs of intoxication require withdrawal of treatment and include increasing gastro-intestinal disturbances (vomiting, diarrhoea), visual disturbances, polyuria, muscle weakness, fine tremor increasing to coarse tremor, CNS disturbances (confusion and drowsiness increasing to lack of coordination, restlessness, stupor); abnormal reflexes, myoclonus, incontinence, hypernatraemia. With severe overdosage seizures, cardiac arrhythmias (including sino-atrial block, bradycardia and first-degree heart block), blood pressure changes, circulatory failure, renal failure, coma and sudden death reported.

Question 99

What are potential side effects of doxorubicin?

Answer 99

Diarrhoea, dehydration, and red colouration of the urine can commonly occur with this cytotoxic antibiotic

Question 100

What is the dosing limit for doxorubicin?

Answer 100

Higher cumulative doses are associated with cardiomyopathy and it is usual to limit total cumulative doses to 450 mg/m2 because symptomatic and potentially fatal heart failure is common above this dose.

Question 101

Which cytotoxic drug can result in progressive pulmonary fibrosis?

Answer 101

Bleomycin This is dose-related, occurring more commonly at cumulative doses greater than 300 000 units. Basal lung crepitations or suspicious chest C-ray changes are an indication to stop therapy with this drug.

Question 102

Which analgesic should be voided if at all possible in patients with a history of epilepsy or susceptibility to seizures?

Answer 102

Tramadol

Question 103

The duration the responsible pharmacist records must be kept for

Answer 103

5 years

Question 104

The duration that CD requisition forms must be kept for.

Answer 104

2 years

Question 105

The duration that CD registers must be kept for, following the final entry and issue of a new register.

Answer 105

2 years

Question 106

Permethrin 5% cream

Answer 106

Apply all over the body including the head (BNF), SPC states to exclude the head

Question 107

Legal requirements

Answer 107

The AGE of patient on prescription if under 12 For an emergency supply at request of a doctor, the prescription must be received within 72 hours

Question 108

Diamorphine is the preferred opioid in palliative care because:

Answer 108

Its greater solubility allows effective doses to be given in a small volume

Question 109

What is the mechanism of action of canagliflozin?

Answer 109

Canagliflozin reversibly inhibits sodium-glucose cotransporter 2 (SGLT2) in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion.

Question 110

Why are tetracyclines contraindicated for under 12s?

Answer 110

Deposition of tetracyclines in growing bone and teeth (by binding to calcium) causes staining and occasionally dental hypoplasia.

Question 111

Consider stopping use of the suspected drug with all ADRs. True or False?

Answer 111

False. Only stop use of the suspected drug if the ADR is serious or at the request of the individual, and avoid its use in future

Question 112

What counts as a missed pill with combined oral contraceptives?

Answer 112

A missed pill is one that is 24 or more hours late Emergency contraception is recommended if 2 or more combined oral contraceptive tablets are missed from the first 7 tablets in a packet and unprotected intercourse has occurred since finishing the last packet.

Question 113

What counts as a missed pill for a woman taking Qlaira® [dienogest with estradiol valerate], or Zoely® [Estradiol with nomegestrol]?

Answer 113

12 hours or more late

Question 114

What to do if you forget to take a progestogen-only contraceptive?

Answer 114

Take it as soon as you remember and take the next pill at the right time. If the pill was more than 3 hours (12 hours for desogestrel) overdue you are not protected.

Question 115

Signs and symptoms of hand, foot and mouth disease

Answer 115

Fever, loss of appetite, sore throat, raised spots on mouth, throat and skin and feeling unwell. After 12 to 36 hours, the red spots develop into yellowy-red ulcers in your mouth, on your tongue and inside your cheeks. After one to two days, sores may start on hands and feet.

Question 116

When to refer for hand, foot and mouth disease

Answer 116

Make a GP appointment if symptoms do not resolve in 10 days

Question 117

What antidiabetic medicine should not be used in patients with a history of bladder cancer?

Answer 117

Pioglitazone

Question 118

In England, Northern Ireland and Wales, what is the automatic age of screening for bowel cancer?

Answer 118

60 years old

Question 119

What should you do if a patient taking Madopar has felt an overpowering urge to buy unnecessary things?

Answer 119

BNF states that review of medication should be sought if worrying psychological changes occur relating to impulse control disorders. So the dose of Madopar may need to be decreased.

Question 120

What is the definition for morbidity rate?

Answer 120

Refers to the incidence rate of disease within a population

Question 121

When is the rotavirus vaccine given?

Answer 121

It is given at 8 and 12 weeks of age. Rotavirus is a common cause of childhood diarrhoea and sickness. The vaccine is administered orally to young infants.

Question 122

Which act protects whistleblowers in the workplace to come forward about negligence and other issues?

Answer 122

Disclosure Act 1998

Question 123

What is a root cause analysis?

Answer 123

A root cause analysis is used to identify all factors that could have contributed to this error for analysis

Question 124

When can Buccastem M be given?

Answer 124

Buccastem M (prochlorperazine) is only licensed for nausea and vomiting in previously diagnosed migraine, in adults aged 18 years and over.

Question 125

Age restrictions for pholcodine 5mg/5mL and dextromethorphan

Answer 125

12 years and over (but pholcodine can be given at 2mg/5ml- Galenphol Paediatric Linctus- from the age of 6)

Question 126

Age limit for Covonia syrup

Answer 126

1 year and over

Question 127

Age limit for Beconase nasal spray

Answer 127

P version can be bought OTC but is only suitable for adults aged 18 and over.

Question 128

Age limit for Cetirizine 5mg/5ml liquid

Answer 128

2 years and over

Question 129

Pseudoephedrine and phenelzine

Answer 129

Pseudoephedrine would not be appropriate – there is a risk of hypertensive crisis when pseudoephedrine is given with Monoamine oxidase inhibitors (MAOIs) avoid pseudoephedrine for at least 2 weeks after stopping MAOI.

Question 130

Patient taking pioglitazone presenting with vomiting and abdominal pain

Answer 130

Seek immediate medical attention as nausea, vomiting, abdominal pain, fatigue and dark urine may indicate liver toxicity

Question 131

Methadone and quetiapine

Answer 131

There is an increased risk of ventricular arrhythmias when antipsychotics that prolong the QT interval are given with methadone

Question 132

Vitamin A in pregnancy

Answer 132

Vitamin A may cause birth defects, women who are (or may become) pregnant are advised not to take vitamin A supplements (including tablets and fish-liver oil drops), except on the advice of a doctor or an antenatal clinic; nor should they eat liver or products such as liver paté or liver sausage.

Question 133

What is given to prevent haemorrhagic disease of newborns?

Answer 133

All newborn babies should receive vitamin K | to prevent vitamin K deficiency bleeding (previously termed haemorrhagic disease of the newborn)

Question 134

Pregnancy prescription exemption

Answer 134

While pregnant and for 12 months after

Question 135

Co-beneldopa

Answer 135

Levodopa helps the Parkinson's symptoms, benserazide prevents the breakdown of levodopa in other parts of the body

Question 136

Supply of unlicensed meds

Answer 136

Record must be kept for 5 years

Question 137

Responsible Pharmacist records

Answer 137

Need to be personally made by the RP themselves

Question 138

Max oral dose of aspirin

Answer 138

4g

Question 139

When to take theophylline levels

Answer 139

5 days after starting | 4-6 hours after a dose

Question 140

Naproxen (1 g daily)

Answer 140

Associated with a lower thrombotic risk

Question 141

Carbimazole

Answer 141

Report sore throat immediately

Question 142

Folinic acid

Answer 142

Suspected methotrexate overdose

Question 143

Mebendazole

Answer 143

Not to be used in children under 2 years

Question 144

CE on licensed devices

Answer 144

Conformite Europeenne

Question 145

Max number of days for methadone prescriptions

Answer 145

14 days

Question 146

Rifampicin-simvastatin

Answer 146

Decreased control of hypercholesterolaemia as rifampicin can induce the metabolism of simvastatin

Question 147

Methotrexate monitoring

Answer 147

Full blood count and renal and liver function tests repeated every 1–2 weeks until therapy stabilised, thereafter patients should be monitored every 2–3 months. Advise to report all symptoms and signs suggestive of infection, especially sore throat

Question 148

Leflunomide-warfarin

Answer 148

Leflunomide inhibits the enzyme that metabolises warfarin, leading to bleeding

Question 149

Prescribing of ciclosporin

Answer 149

Must be brand specific

Question 150

Side effect of ciclosporin

Answer 150

Hypertension

Question 151

Interactions with ciclosporin

Answer 151

Pomelo juice is predicted to increase ciclosporin exposure, and purple grape juice is predicted to decrease ciclosporin exposure.

Question 152

Monitoring for ciclosporin

Answer 152

Liver function, serum potassium (especially in renal dysfunction- risk of hyperkalaemia), serum magnesium, blood lipids before treatment and after the first month of treatment. Monitor kidney function—dose dependent increase in serum creatinine and urea during first few weeks may necessitate dose reduction in transplant patients Monitor blood pressure—discontinue if hypertension develops that cannot be controlled by antihypertensives. In rheumatoid arthritis measure serum creatinine at least twice before treatment. During treatment, monitor serum creatinine every 2 weeks for first 3 months, then every month for a further 3 months, then every 4–8 weeks depending on the stability of the disease, concomitant medication, and concomitant diseases (or more frequently if dose increased or concomitant NSAIDs introduced or increased).

Question 153

How do advanced services work?

Answer 153

Contractors are paid monthly based on the MURs claimed for

Question 154

Doxycycline for malaria prophylaxis

Answer 154

100mg daily, starting 2 days before entering area and continuing for 4 weeks after leaving

Question 155

Monitoring adverse effects of atorvastatin

Answer 155

Alanine transaminase and creatinine kinase

Question 156

Most people are able to use NRT, including:

Answer 156

Adults and children over 12 years of age – although children under 18 should not use the lozenges without getting medical advice first Pregnant women Breastfeeding women

Question 157

Isoniazid co-therapy with pyridoxine

Answer 157

Pyridoxine hydrochloride should be given prophylactically in all patients from the start of treatment. Peripheral neuropathy is more likely to occur where there are pre-existing risk factors such as diabetes, alcohol dependence, chronic renal failure, pregnancy, malnutrition and HIV infection.

Question 158

Isoniazid food/drink interactions

Answer 158

Avoid tyramine-rich foods (such as mature cheeses, salami, pickled herring, Bovril®, Oxo®, Marmite® or any similar meat or yeast extract or fermented soya bean extract, and some beers, lagers or wines) or histamine-rich foods (such as very mature cheese or fish from the scromboid family (e.g. tuna, mackerel, salmon)) with isoniazid, as tachycardia, palpitation, hypotension, flushing, headache, dizziness, and sweating reported.

Question 159

How long do women need to wait after taking ulipristal acetate before starting suitable hormonal contraception?

Answer 159

5 days

Question 160

One missed contraceptive pill dose

Answer 160

Take the last pill you missed now, even if this means taking 2 pills in 1 day Carry on taking the rest of the pack as normal Take your 7-day pill-free break as normal, or if you're on an everyday (ED) pill, take your dummy (inactive) pills

Question 161

Two or more missed contraceptive pill doses

Answer 161

Take the last pill you missed now, even if this means taking 2 pills in 1 day leave any earlier missed pills carry on taking the rest of the pack as normal use extra contraception, such as condoms, for the next 7 days When you come to the end of your pill pack, after missing 2 or more pills: if there are 7 or more pills left in the pack after the last missed pill – finish the pack, take your 7-day pill-free break as normal, or take your inactive pills before you start your next pack if there are less than 7 pills left in the pack after the missed pill – finish the pack and start a new pack the next day; this means missing out the pill-free break or not taking your inactive pills

Question 162

SLS endorsement on Nizoral cream

Answer 162

Nizoral® cream is not prescribable in NHS primary care except for the treatment of seborrhoeic dermatitis and pityriasis versicolor; endorse prescription 'SLS'.

Question 163

Contraindications of antimuscarinics

Answer 163

Angle-closure glaucoma; gastro-intestinal obstruction; intestinal atony; myasthenia gravis (but some antimuscarinics may be used to decrease muscarinic side-effects of anticholinesterases); paralytic ileus; pyloric stenosis; severe ulcerative colitis; significant bladder outflow obstruction; toxic megacolon; urinary retention

Question 164

Quinolones

Answer 164

can prolong the QT interval; conditions that predispose to seizures; diabetes (may affect blood glucose); exposure to excessive sunlight and UV radiation should be avoided during treatment and for 48 hours after stopping treatment; G6PD deficiency; history of epilepsy; myasthenia gravis (risk of exacerbation); psychiatric disorders

Question 165

Lithium-ramipril

Answer 165

Ramipril is predicted to increase the concentration of lithium.

Question 166

Acid reflux OTC treatment in pregnancy

Answer 166

Gaviscon Advance

Question 167

Age for OTC cystitis treatment

Answer 167

16 to 65 (not including 65)

Question 168

Meningitis symptoms

Answer 168

The first symptoms are usually fever, vomiting, headache and feeling unwell. Limb pain, pale skin, and cold hands and feet often appear earlier than the rash, neck stiffness, dislike of bright lights and confusion.

Question 169

Lithium toxicity symptoms

Answer 169

Signs of intoxication require withdrawal of treatment and include increasing gastro-intestinal disturbances (vomiting, diarrhoea), visual disturbances, polyuria, muscle weakness, fine tremor increasing to coarse tremor, CNS disturbances (confusion and drowsiness increasing to lack of coordination, restlessness, stupor); abnormal reflexes, myoclonus, incontinence, hypernatraemia. With severe overdosage seizures, cardiac arrhythmias (including sino-atrial block, bradycardia and first-degree heart block), blood pressure changes, circulatory failure, renal failure, coma and sudden death reported.

Question 170

GLP-1 agonists prescribing

Answer 170

Only if triple therapy with metformin hydrochloride and two other oral drugs is tried and is not effective only for patients who have a BMI of 35 kg/m2 or above (adjusted for ethnicity) and who also have specific psychological or medical problems associated with obesity; or for those who have a BMI lower than 35 kg/m2 but for whom insulin therapy would have significant occupational implications or if the weight loss associated with glucagon-like peptide-1 receptor agonists would benefit other significant obesity-related comorbidities. After 6 months, the drug should be reviewed and only continued if there has been a beneficial metabolic response (a reduction of at least 11 mmol/mol [1.0%] in HbA1c and a weight loss of at least 3% of initial body-weight).

Question 171

Eumovate (clobetasone 0.05%)

Answer 171

Moderate potency | Apply BD for max 7 days

Question 172

GTN SL tabs

Answer 172

Tablets should be discarded after 8 weeks in use

Question 173

Monitoring of aminosalicylates

Answer 173

Renal function should be monitored before starting an oral aminosalicylate, at 3 months of treatment, and then annually during treatment.

Question 174

Maintenance dose of rivaroxaban in AF

Answer 174

20mg OD

Question 175

Treatment of DVT dosing for rivaroxaban

Answer 175

Initially 15 mg twice daily for 21 days, then maintenance 20 mg once daily

Question 176

Prophylaxis of DVT dosing for rivaroxaban

Answer 176

10mg OD

Question 177

Post ACS rivaroxaban (in combo with aspirin or aspirin and clopidogrel)

Answer 177

2.5 mg twice daily usual duration 12 months

Question 178

Common side effects of rivaroxaban

Answer 178

Constipation Diarrhoea Headache Rash

Question 179

Adrenaline anaphylaxis dose for 1 month-5 years

Answer 179

150 micrograms

Question 180

Adrenaline anaphylaxis dose for 6-11 years

Answer 180

300 micrograms

Question 181

Adrenaline anaphylaxis dose for 12-17 years

Answer 181

500 micrograms

Question 182

Adrenaline anaphylaxis dose for adults

Answer 182

500 micrograms

Question 183

Recommended injection site for adrenaline injection

Answer 183

Anterolateral aspect of the middle third of the thigh

Question 184

Which vitamin should be avoided with spironolactone?

Answer 184

Vitamin K

Question 185

Thalidomide

Answer 185

Thromboprophylaxis is recommended for at least the first 5 months of treatment, especially in patients with additional thrombotic risk factors. Patients with pre-existing peripheral neuropathy should not be treated with thalidomide unless the potential clinical benefits outweigh the risk.

Question 186

Thalidomide and women of child-bearing age

Answer 186

A medically supervised pregnancy test should be performed on, or within 3 days prior to, initiation and repeated every 4 weeks thereafter (including 4 weeks after the last dose). Females of childbearing potential must use effective contraception for at least 4 weeks before, during, and for at least 4 weeks after stopping treatment (including during dose interruptions). Oral combined hormonal contraceptives and copper-releasing intrauterine devices are not recommended. Male patients, even after successful vasectomy, must use condoms during treatment (including during dose interruptions) and for at least 1 week after stopping, if their partner is pregnant or is of childbearing potential and not using effective contraception.

Question 187

Bulk forming laxatives onset of action | Ispaghula husk, methylcellulose and sterculia

Answer 187

2-3 days

Question 188

Stimulant laxatives onset of action | Bisacodyl, docusate sodium, glycerol, senna, and sodium picosulfate

Answer 188

6-12 hours Suppositories 15-60 minutes

Question 189

Faecal softeners onset of action | Liquid paraffin

Answer 189

1-2 days

Question 190

Liquid paraffin not recommended for use as faecal softener

Answer 190

Can cause anal seepage and irritation, granulomatous reactions caused by absorption of small quantities of liquid paraffin, lipoid pneumonia, and malabsorption of fat-soluble vitamins

Question 191

Osmotic laxatives onset of action | Lactulose, macrogols and magnesium salts

Answer 191

1-3 days

Question 192

Pramipexole (dopamine-receptor agonist)

Answer 192

Associated with impulse control disorders, including pathological gambling, binge eating, and hypersexuality. Risk of postural hypotension (especially on initiation)—monitor blood pressure. Antiparkinsonian drug therapy should never be stopped abruptly as this carries a small risk of neuroleptic malignant syndrome. Excessive daytime sleepiness and sudden onset of sleep can occur with dopamine-receptor agonists.

Question 193

Review of Parkinson's disease after diagnosis

Answer 193

6-12 months

Question 194

Formulations fo co-beneldopa

Answer 194

When switching from modified-release levodopa to dispersible co-beneldopa, reduce dose by approximately 30%.

Question 195

Apomorphine HCL

Answer 195

SC into lower abdomen

Question 196

Disulfram reaction

Answer 196

Full body rash, feeling and being sick, stomach pain, hot flushes, a pounding heartbeat (palpitations) and a headache

Question 197

Metronidazole with alcohol

Answer 197

Do not drink alcohol while taking a course of metronidazole tablets, liquid, suppositories or vaginal gel, or for 2 days after finishing treatment

Question 198

How often should the need for oxybutynin therapy be reviewed?

Answer 198

Every 4-6 weeks until symptoms stabilise then every 6-12 months

Question 199

Norethisterone dosing

Answer 199

1 tablet TDS

Question 200

When is the most appropriate time to start taking norethisterone?

Answer 200

3 days before menstruation is due

Question 201

When is menstruation likely to start after stopping norethisterone?

Answer 201

2-3 days after stopping

Question 202

Ciprofloxacin-ibuprofen

Answer 202

Increased risk of convulsions

Question 203

Treatment of clindamycin exceeds 10 days

Answer 203

Monitor renal and liver function

Question 204

Vancomycin trough conc

Answer 204

15-20 mg/L

Question 205

Monitoring of vancomycin

Answer 205

renal function, urinalysis and blood counts

Question 206

Treating hypersalivation

Answer 206

Glycopyrronium bromide ``` Unlicensed: antimuscarinic drugs (amitriptyline, atropine, benzatropine, trihexyphenidyl hydrochloride, hyoscine hydrobromide) ``` Beta-blockers Botulinum toxin

Question 207

Mefloquine for malaria

Answer 207

Mefloquine is associated with potentially serious neuropsychiatric reactions. Abnormal dreams, insomnia, anxiety, and depression occur commonly. Psychosis, suicidal ideation, and suicide have also been reported. Psychiatric symptoms such as insomnia, nightmares, acute anxiety, depression, restlessness, or confusion should be regarded as potentially prodromal for a more serious event.

Question 208

Solifenacin-itraconazole

Answer 208

Itraconazole (CYP3A4 inhibitor) is predicted to increase the exposure to solifenacin.

Question 209

Pharmacokinetics of theophylline

Answer 209

Theophylline is metabolised in the liver. The plasma-theophylline concentration is increased in heart failure, hepatic impairment, and in viral infections. The plasma-theophylline concentration is decreased in smokers, and by alcohol consumption.

Question 210

Animal bites

Answer 210

Co-amoxiclav

Question 211

Suspected meningococcal septicaemia with a history of immediate hypersensitivity reactions to penicillins and cephalosporins

Answer 211

Chloramphenicol

Question 212

Too much Vitamin D can result in

Answer 212

Hyperphosphatemia

Question 213

Depo-provera injection

Answer 213

Needs to be administered every 12 weeks, reduction in bone mineral density occurs in first 2 to 3 years of use then stabilises

Question 214

Copper coil

Answer 214

Method of emergency contraception that can be used up to 5 days after earliest likely calculated ovulation, regardless of number of episodes of unprotected intercourse earlier in cycle

Question 215

Furosemide

Answer 215

Symptoms are improved within 1 hour of taking med Hypokalaemia Diuresis does not interfere with sleep

Question 216

HbA1c target for multiple antidiabetic drugs

Answer 216

53 mmol/l

Question 217

Which TB med is most likely to cause deterioration to vision?

Answer 217

Ethambutol

Question 218

TB meds- warfarin

Answer 218

May cause reduction in INR

Question 219

Steroid emergency card should be given to those

Answer 219

those with primary adrenal insufficiency; those with adrenal insufficiency due to hypopituitarism requiring corticosteroid replacement; those taking corticosteroids at doses equivalent to, or exceeding, prednisolone 5 mg daily for 4 weeks or longer across all routes of administration (oral, topical, inhaled, intranasal, or intra-articular); those taking corticosteroids at doses equivalent to, or exceeding, prednisolone 40 mg daily for longer than 1 week, or repeated short oral courses; those taking a course of oral corticosteroids within 1 year of stopping long-term therapy.

Question 220

Clenil vs Qvar

Answer 220

Qvar is twice as potent as Clenil

Question 221

MHRA

Answer 221

Responsible for licensing of new meds and new combinations of active chemicals

Question 222

Migraleve and paracetamol

Answer 222

Migraleve contains paracetamol and codeine so do not give if patient has recently taken paracetamol.

Question 223

Secondary prevention of CV events

Answer 223

Patients should be given DAPT, beta-blocker, ACE inhibitor, nitrate and statin.

Question 224

Mineralocorticoid side effects

Answer 224

Hypertension Hypokalaemia Sodium retention Water retention

Question 225

Impetigo

Answer 225

Impetigo is contagious and risk mitigation measures are needed. Current advice is 48 hours should elapse after initiation of an antibiotic before returning to work

Question 226

Theophylline toxicity

Answer 226

Vomiting (which may be severe and intractable) Agitation Restlessness Dilated pupils Sinus tachycardia- only clear red flag warning sign Hyperglycaemia. More serious effects are haematemesis, convulsions, and supraventricular and ventricular arrhythmias. Severe hypokalaemia may develop rapidly.

Question 227

Post ischaemic stroke

Answer 227

Initial treatment with aspirin 300 mg for 14 days. Secondary prevention with clopidogrel 75 mg daily thereafter.

Question 228

Impetigo

Answer 228

usually only affects the face

Question 229

Measles

Answer 229

face to trunk and only slight itching in some

Question 230

Patient returned CDs

Answer 230

Medication can be destroyed and denatured by the Responsible Pharmacist. A witness is preferable not mandatory and preferably it should be a registered healthcare professional.

Question 231

Warfarin and antibiotics

Answer 231

Rifampicin decreases anticoagulant effect. Clarithromycin, doxycycline, erythromycin and metronidazole increase anticoagulant effect.

Question 232

Common side effect of oxybutynin

Answer 232

Constipation

Question 233

Head lice

Answer 233

Wet combing or dimeticone 4% lotion is recommended first-line for pregnant or breastfeeding women, young children aged 6 months to 2 years, and people with asthma or eczema.

Question 234

OTC omeprazole sale

Answer 234

Omeprazole 10 mg capsules at a maximum dose of 20 mg once a day for four weeks

Question 235

Buccal midazolam administration

Answer 235

Wait five minutes before administering as the seizure may stop on its own

Question 236

What is a biosimilar?

Answer 236

A biosimilar is a biologic medicine that is similar to an already licensed biologic medicine in terms of quality, safety and efficacy. A biosimilar is specifically developed and licensed to treat the same disease(s) as the original innovator product. A biosimilar can only be marketed after the patent protecting the originator product and any period of marketing exclusivity have expired.

Question 237

Which asthma scenario requires referral to GP?

Answer 237

The patient has noticed a cough at night causing waking

Question 238

Being the RP

Answer 238

RP can only be the RP for one pharmacy at any given time

Question 239

Loratidine

Answer 239

2 years+ | >30kg

Question 240

Diagnosis of T2DM

Answer 240

Based on HbA1c of 48 mmol/mol (6.5%) or more, fasting plasma glucose level of 7.0 mmol/L or more or random plasma glucose of 11.1 mmol/L or more in the presence of symptoms or signs of diabetes

Question 241

Metformin mechanism of action

Answer 241

Metformin exerts its effect mainly by decreasing gluconeogenesis and by increasing peripheral utilisation of glucose; since it acts only in the presence of endogenous insulin it is effective only if there are some residual functioning pancreatic islet cells.

Question 242

Symptoms of Vitamin B12 deficiency

Answer 242

Pins and needles in her feet. Fatigued Low mood Mouth ulcers Signs- Good vegetarian diet

Question 243

Treating hypoglycaemia

Answer 243

15–20 g (3–4 heaped teaspoonfuls of sugar dissolved in water, or 150–200 mL pure fruit juice, or 4–7 glucose tablets) repeated after 10–15 minutes if necessary Glucagon only used if patient unresponsive/no oral route

Question 244

Fexofenadine-erythromycin

Answer 244

Co-administration of fexofenadine hydrochloride with erythromycin has been found to result in a 2-3 times increase in the level of fexofenadine in plasma.

Question 245

Senna

Answer 245

Can be sold OTC for aged 12 years and over Contraindicated in intestinal obstruction Safe in pregnancy Licensed as POM > 6 years old.

Question 246

When would a higher dose of folic acid need to be given during pregnancy?

Answer 246

Higher dose recommended for those with history of neural tube defects, diabetic, overweight, antiepileptic medication / antiviral for HIV prescribed

Question 247

The prescription legally requires the particulars of the prescriber

Answer 247

Prescriptions require particulars that indicate the type of appropriate practitioner. Details of medicinal products are not legal prescription requirements under Regulation 217 and 218 Human Medicines Regulations 2012 but may cause issues for reimbursement but also enables pharmacists to identify what to supply.

Question 248

Safe custody of controlled drugs

Answer 248

All CD Schedule 1 All CD Schedule 2 (except quinalbarbitone (secobarbital)). All CD Schedule 3 (except methylphenobarbitone, midazolam, phenobarbitone (phenobarbital), hentermine, tramadol or any stereoisomeric form of the above, or any salts of the above).

Question 249

How often should cervical screening be done?

Answer 249

Women aged 24.5 years should receive their first invitation to ensure they can be screened before they are aged 25 years. Those who are 25–49 years should be offered screening every 3 years. Women who are 50–64 years should be offered screening every 5 years.

Question 250

For OTC benzoyl peroxide, which strength should be given?

Answer 250

Benzoyl peroxide 2.5% gel- start on this strength to minimise side effects before considering 5%

Question 251

Which drug is licensed for acute labour pain?

Answer 251

Levobupivacaine

Question 252

Which drug can cause symptoms like lichen planus?

Answer 252

Thiazide diuretics have reported lichenoid drug eruption as a side effect.

Question 253

Cautions for pseudoephedrine

Answer 253

Diabetes; heart disease; hypertension; hyperthyroidism; ischaemic heart disease (in adults); prostatic hypertrophy (in adults); raised intra-ocular pressure (in children); susceptibility to angle-closure glaucoma (in adults)

Question 254

Common side effect of donepezil

Answer 254

Aggression

Question 255

What is home office specific instalment prescribing instructions if there is a bank holiday?

Answer 255

“Please dispense instalments due on pharmacy closed days on a prior suitable day.”

Question 256

Thiazides and related diuretics can exacerbate

Answer 256

gout, systemic lupus erythematosus, diabetes

Question 257

Schedule 3, 4 and 5 CDs and record keeping

Answer 257

Do not need to be recorded in the register | Invoices for CD 3 and 5 need to be retained for 2 years

Question 258

If patient is in anaphylaxis

Answer 258

Administer adrenaline then call 999 and reporting that there is a case of suspected anaphylaxis.

Question 259

Breakthrough pain formulations

Answer 259

MST Continus, Morphgesic SR and Zomorph MR are all modified release preparations therefore not appropriate for breakthrough pain.

Question 260

Mirabegron

Answer 260

Blood pressure should be monitored before starting treatment and regularly during treatment, especially in patients with pre-existing hypertension with mirabegron

Question 261

Azithromycin monitoring

Answer 261

ECG needed to rule out prolonged QT and LFT’s also required (CT scan and sputum cultures also actioned)

Question 262

Which CDs have a 6 month prescription validity?

Answer 262

CD INV POM and CD INV P

Question 263

Fostair

Answer 263

Fostair has extra fine particle size distribution which can produce a more potent effect

Question 264

Citalopram causes hyponatraemia in elderly

Answer 264

Symptoms of low sodium are confusion and seizures

Question 265

Opioid induced constipation

Answer 265

Osmotic laxative (or docusate sodium to soften the stools) and a stimulant laxative is recommended. Bulk-forming laxatives should be avoided. Naloxegol is recommended for the treatment of opioid-induced constipation when response to other laxatives is inadequate. Methylnaltrexone bromide is licensed for the treatment of opioid-induced constipation when response to other laxatives is inadequate.

Question 266

Which vaccine is given to a neonate at risk of tuberculosis?

Answer 266

BCG (Bacillus Calmette-Guérin) It is a live attenuated strain derived from Mycobacterium bovis which stimulates the development of immunity to M. tuberculosis.

Question 267

Rotavirus

Answer 267

Most common cause of infantile gastroenteritis | Oral vaccine is delivered at two months

Question 268

MMR vaccine

Answer 268

Administered at 12 months and between the ages of 3 – 5 according the immunization schedule. It should not be administered on the same day as yellow fever vaccine; there should be a 4-week minimum interval between the vaccines. When protection is rapidly required, the vaccines can be given at any interval and an additional dose of MMR may be considered.

Question 269

Maximum daily dose of Tramadol

Answer 269

400mg in 24hrs

Question 270

Otomise contains

Answer 270

Otomize and acetic acid

Question 271

Acute otitis externa

Answer 271

Pseudomonas aeroginosa

Question 272

Complication of otitis externa

Answer 272

Malignant or necrotising otitis externa

Question 273

What organisms can cause HAP?

Answer 273

``` MRSA Pseudomonas aeroginasa (doesn’t really cause CAP) ```

Question 274

Nephrotoxicity and Ototoxicity with Aminoglycosides

Answer 274

Nephrotoxicity- reversible | Ototoxicity- irreversible

Question 275

Neomycin

Answer 275

Given orally for bowel sterilisation but not parenterally

Question 276

Vancomycin + gentamicin

Answer 276

Infective endocarditis- synergistic effect

Question 277

When to avoid gentamicin in pregnancy?

Answer 277

Second and third trimesters Auditory and vestibular nerve damage (look out for dizziness, tinnitus, ringing in the ears, deafness)

Question 278

Types of glycopeptides

Answer 278

Vancomycin Teicoplanin Telavancin

Question 279

Vancomycin levels

Answer 279

10-15mg/L trough | 15-20mg/L for endocarditis or less sensitive strain of MRSA or complicated infections

Question 280

When would you use flucloxacillin instead of amoxicillin?

Answer 280

Cellulitis (caused by Staphylococcus aureus)

Question 281

Penicillinase resistant antibiotic

Answer 281

Flucloxacillin

Question 282

Rash 72hrs after penicillin administration

Answer 282

Unlikely to be an allergic reaction

Question 283

Initial phase of TB

Answer 283

RIPE Rifampicin Isoniazid Pyrazinamide Ethambutol

Question 284

Continuation phase of TB

Answer 284

Rifampicin | Isoniazid

Question 285

Ethambutol

Answer 285

Ocular toxicity

Question 286

Rifampicin

Answer 286

Orange-red discolouration of secretions e.g. contact lenses

Question 287

Rifampicin, Isoniazid and Pyrazinamide (RIP)

Answer 287

Liver toxicity

Question 288

Isoniazid

Answer 288

Peripheral neuropathy

Question 289

FP10MDA for instalments

Answer 289

Limited to max 14 days treatment

Question 290

First line for patients for patients with post-menopausal osteoporosis

Answer 290

Oral bisphosphonates, alendronic acid and risedronate sodium HRT can also be used- usually restricted to younger postmenopausal women, due to risks of CV disease and cancer in older postmenopausal women and women on long-term HRT therapy.

Question 291

Teriparatide

Answer 291

Reserved for postmenopausal women with severe osteoporosis at very high risk for vertebral fractures. Treatment is limited to 24 months.

Question 292

Glibenclamide

Answer 292

Caution in the elderly

Question 293

Audit cycle

Answer 293

``` Stage 1 - preparation Stage 2 - select criteria Stage 3 - measuring level of performance Stage 4 - making improvements Stage 5 - maintaining improvements ```

Question 294

Severe hypertension

Answer 294

clinic systolic blood pressure of 180 mmHg or higher, or a clinic diastolic blood pressure of 120 mmHg or higher.

Question 295

Sumatriptan

Answer 295

Not suitable for children | Okay to take with ibuprofen or paracetamol

Question 296

HBPM target

Answer 296

<135/85

Question 297

What to do if INR>8 with no bleeding

Answer 297

stop warfarin sodium; give phytomenadione (vitamin K1) by mouth using the intravenous preparation orally [unlicensed use]; repeat dose of phytomenadione if INR still too high after 24 hours; restart warfarin when INR <5.0

Question 298

INR 5.0–8.0, minor bleeding

Answer 298

stop warfarin sodium; give phytomenadione (vitamin K1) by slow intravenous injection; restart warfarin sodium when INR <5.0

Question 299

What to do if INR<6 but more than 0.5 units above the target value

Answer 299

Reduce dose or stop warfarin

Question 300

If INR >8.0, minor bleeding

Answer 300

stop warfarin sodium; give phytomenadione (vitamin K1) by slow intravenous injection; repeat dose of phytomenadione if INR still too high after 24 hours; restart warfarin sodium when INR <5.0

Question 301

Major bleeding with warfarin

Answer 301

stop warfarin sodium; give phytomenadione (vitamin K1) by slow intravenous injection; give dried prothrombin complex (factors II, VII, IX, and X); if dried prothrombin complex unavailable, fresh frozen plasma can be given but is less effective; recombinant factor VIIa is not recommended for emergency anticoagulation reversal

Question 302

NSAIDs and citalopram

Answer 302

Increased risk of bleeding and hyponatraemia

Question 303

Treating lower back pain

Answer 303

``` NSAID Weak opioid (either alone or with paracetamol) only if NSAID is contraindicated, not tolerated or ineffective ```

Question 304

Vet CD prescriptions

Answer 304

Require prescriber number

Question 305

Hydrochlorothiazide MHRA alert

Answer 305

cumulative, dose-dependent increased risk of non-melanoma skin cancer, particularly in long-term use, and advise patients to regularly check for and report any new or changed skin lesions or moles; advise patients to limit exposure to sunlight and UV rays and use adequate sun protection; reconsider the use of hydrochlorothiazide in patients who have had previous skin cancer; examine all suspicious moles or skin lesions (potentially including histological examination of biopsies).

Question 306

Contraindications of thiazide and thiazide-like diuretics

Answer 306

Addison’s disease; hypercalcaemia; hyponatraemia; refractory hypokalaemia; symptomatic hyperuricaemia

Question 307

Cautions of thiazide and thiazide-like diuretics

Answer 307

Diabetes; gout; risk of hypokalaemia; systemic lupus erythematosus

Question 308

Ipratropium + blurred vision

Answer 308

Acute angle-glaucoma

Question 309

Thiazide-like diuretics- electrolyte imbalances

Answer 309

Hypokalaemia Hypercalcaemia Hyperglycaemia

Question 310

Thiazide-like diuretics in hepatic impairment

Answer 310

Can precipitate encephalopathy

Question 311

Thiazide-like diuretics with digoxin

Answer 311

Can cause hypokalaemie= digoxin toxicity

Question 312

Signs of lactic acidosis (when taking metformin)

Answer 312

dyspnoea, muscle cramps, abdominal pain, hypothermia, or asthenia

Question 313

How long do veterinary prescriptons last for?

Answer 313

6 months unless stated otherwise

Question 314

Which CDs require denaturing?

Answer 314

Schedule 2, 3 and 4 (Part 1)

Question 315

Patient returned CDs

Answer 315

patient returned schedule 2 CDs should be recorded and their subsequent destruction recorded (in a separate record to the CD register). Patient returned CDs should be denatured in the presence of another member of staff, preferably a pharmacist or pharmacy technician if available. Does not require an authorised person

Question 316

Date expired pharmacy CD stock

Answer 316

Obsolete, expired and unwanted Schedule 1 and 2 CDs should be destroyed in the presence of an authorised witness. RPS guidance indicates that for Schedule 3 CDs it would be good practice to have another member of staff witness the denaturing.

Question 317

What activities would need the supervision of a RP present?

Answer 317

Professional check (clinical and legal check) of a prescription Sale/Supply of pharmacy medicines Sale/Supply of prescription-only medicines (e.g. handing dispensed medicines to patient, patient representative or a delivery person) Supply of medicines under a patient group direction (PGD) Wholesale of medicines Emergency Supply of a medicine(s) at the request of a patient or healthcare professional

Question 318

What activities would need the supervision of a RP present but they do not need to be physically present?

Answer 318

The assembly process (including assembly of compliance aids (monitored dosage systems)): Generating a dispensing label Taking medicines off the dispensary shelves Assembly of the item (e.g. counting tablets) Labelling of containers with the dispensing label Accuracy checking

Question 319

What activities would need the RP signed in as in charge of premises but not physically present?

Answer 319

Sale of general sale list (GSL) medicines | Processing waste stock medicines or patient returned medicines (excluding Controlled Drugs)

Question 320

What activities do not require a Responsible Pharmacist to be in charge of the pharmacy?

Answer 320

Ordering stock from pharmaceutical wholesalers Receiving stock from pharmaceutical wholesalers into the building (excluding Controlled Drugs) Putting medicinal stock received from the wholesaler away onto the pharmacy shelves (GSL, P, and POMs, excluding CDs) Date Checking (excluding CDs) Stocking pharmacy with consumables Cleaning of the pharmacy Responding to enquiries (about medicine issues) Accessing the PMR Receiving prescription directly from patients or collecting from a surgery Processing of prescription forms that have been dispensed (eg. Counting number of items dispensed, sorting prior submission for reimbursement) Delivery person conveying medicines to patient Receiving patient returned medicines (excluding controlled drugs)

Question 321

Signed orders

Answer 321

Must contain: Name of the school Purpose that is the product is required for Total quantity required Ideally use headed paper- not a legal requirement Needs to be retained for 2 years from date of supply or an entry made in the POM register

Question 322

What factors can increase the required insulin dose?

Answer 322

Infection stress accidental or surgical trauma

Question 323

What factors can decrease the required insulin dose?

Answer 323

Physical activity Intercurrent illness Reduced food intake Impaired renal function

Question 324

CKS recommends Hedrin® Lotion

Answer 324

for use in pregnant and breastfeeding women and in children aged 6 months to 2 years, and in asthmatics, as it is licensed for use in these groups

Question 325

Isopropyl myristate and cyclomethicone (IPM/C, Full Marks Solution®

Answer 325

Suitable for asthmatics but not enough data for pregnant and breastfeeding women.

Question 326

Isopropyl myristate and isopropyl alcohol (Vamousse®, registered medical device)

Answer 326

Not recommended for asthmatics and not enough data for pregnant and breastfeeding women

Question 327

Malathion 0.5% aqueous liquid (Derbac-M®)

Answer 327

Suitable for people of all ages and people with asthma or skin conditions, as it does not contain alcohol. Can be used in pregnant and breastfeeding women if wet combing and dimeticone are ineffective.

Question 328

Blood pressure target for those with primary hypertension

Answer 328

<140/90 (HBPM: 135/85) <150/90 if over 80 years old

Question 329

Blood pressure target for those with cardiovascular disease

Answer 329

<140/90

Question 330

Blood pressure target for those with diabetes

Answer 330

<140/80 (If they are having any eye, kidney or cerebrovascular complications then it is <130/80)

Question 331

Blood pressure target for those with chronic kidney disease

Answer 331

120-139/<90 If their ACR greater than or equal 70, then 120-129/<80

Question 332

Mild topical corticosteroids

Answer 332

Hydrocortisone 0.1%, 0.5%, 1.0%, 2.5%

Question 333

Moderate topical corticosteroids

Answer 333

Betamethasone valerate 0.025% - Betnovate RD Clobetasone butyrate 0.05% - Eumovate Fluocinolone acteonide 0.00625% - Synalar 1 in 4 dilution

Question 334

Potent topical corticosteroids

Answer 334

Betamethasone valerate 0.1% - Betnovate Mometasone furoate 0.1% - Elocon Hydrocortisone butyrate 0.1% - Locoid

Question 335

Very potent topical corticosteroids

Answer 335

Clobetasol propionate 0.0525% - Dermovate

Question 336

Live vaccines to avoid during pregnancy

Answer 336

``` BCG (vaccination against tuberculosis) MMR (measles, mumps and rubella) oral polio (which forms part of the 5-in-1 vaccine given to infants) oral typhoid yellow fever ```

Question 337

If patient taking clozapine is having constipation

Answer 337

MHRA alert- intestinal peristalsis

Question 338

Supplying CDs to local district nurse

Answer 338

Must get ID- can still supply based on professional discretion Require nurse's name and address to be recorded in the CD register Recommended to get them to sign the back of the prescription

Question 339

Disposing out of date patient-returned POMs

Answer 339

Approve for disposal via approved agent

Question 340

What is suitable for the initial management of DKA?

Answer 340

Soluble insulin injection

Question 341

Metronidazole-warfarin

Answer 341

Increases anticoagulant effect- increases the INR

Question 342

Patient-returned CDs

Answer 342

Accept the tablets and arrange for their disposal without recording in the CD register

Question 343

What is ringworm?

Answer 343

Fungal infection

Question 344

Class of drug of theophylline

Answer 344

Methylxanthine

Question 345

Class of drug of allopurinol

Answer 345

Xanthine oxidase inhibitor

Question 346

Misoprostol

Answer 346

``` Termination of pregnancy Induction of labour Benign gastric ulcer, Benign duodenal ulcer, NSAID-induced peptic ulcer ```

Question 347

Why is misoprostol contraindicated in pregnancy?

Answer 347

Increase uterine growth

Question 348

TB drug likely to cause visual disturbance

Answer 348

Ethambutol

Question 349

Cold sores can be precipitated by

Answer 349

stress

Question 350

Side effects of pseudoephedrine

Answer 350

Trouble sleeping | Feel like his heart is beating too quickly

Question 351

Paracetamol dose for 3 year old

Answer 351

180mg QDS

Question 352

Terbinafine age for cream, gel or spray and solution

Answer 352

Cream, gel or spray: 16 years | Solution: 18 years

Question 353

Ciprofloxacin-theophylline

Answer 353

Cipro increases the concentrations of aminophyllines

Question 354

What to give for hard, dry stools

Answer 354

Macrogol | Docusate

Question 355

Classification of morphine

Answer 355

If above 13 mg per 5 mL the solution becomes a schedule 2 controlled drug. It is usual to adjust the strength so that the dose volume is 5 or 10 mL.

Question 356

Retaining the RP record

Answer 356

5 years

Question 357

Beta blockers are contraindicated in

Answer 357

Severe peripheral vascular disease

Question 358

Influenza vaccine in children

Answer 358

Live, attenuated intranasal vaccine has been shown to give better protection than the inactivated intramuscular vaccine

Question 359

Amoxicillin dose for oral infection for 2 1/2 year old

Answer 359

250mg TDS

Question 360

Amoxicillin dose for oral infection for 5 year old

Answer 360

5 years+ 500mg TDS

Question 361

Amoxicillin dose for oral infection for 11 month old

Answer 361

1-11 months 125mg TDS

Question 362

Dose of orlistat

Answer 362

120mg before, during and up to 1 hour after each meal Max 360mg daily

Question 363

Noticeable diseases

Answer 363

``` Covid 19 Measles TB Yellow fever Scarlet fever ```

Question 364

Common effect of Covid-19

Answer 364

Lymphocytopenia

Question 365

Vancomycin resistant enterococci

Answer 365

Teicoplanin- not appropriate (similar drug class- so likely to be resistant too) Flucloxacillin doesn’t cover enterococci Linezolid

Question 366

Pseudomonas aeroginosa

Answer 366

Can be treated with | Ciprofloxacin

Question 367

Oxazolidone

Answer 367

Linezolid

Question 368

Aspergillosis

Answer 368

Voriconazole | Amphotericin B

Question 369

Candidiasis treatment if fluconazole CI

Answer 369

Itraconazole

Question 370

Invasive candidiasis

Answer 370

A echinocandin (e.g caspofungin)

Question 371

Where to look for up-to-date information on vaccinations

Answer 371

The Green Book has the latest information on vaccines and vaccination procedures, for vaccine preventable infectious diseases in the UK.

Question 372

Treating chickenpox in adults and children

Answer 372

Paracetamol if pain or fever are causing distress (avoid nonsteroidal anti-inflammatory drugs). Note that oral paracetamol is not licensed for use in children under 2 months of age. Topical calamine lotion to alleviate itch. Chlorphenamine for treating itch associated with chickenpox for people 1 year of age or older.

Question 373

What is a cohort study?

Answer 373

A study that identifies a group of people and follows them over a period of time to see how their exposure affects their outcomes. Usually used to look at suspected risk factors that cannot be controlled experimentally.

Question 374

High risk of sepsis

Answer 374

objective evidence of new altered mental state respiratory rate of 25 breaths per minute or above, or new need for 40% oxygen or more to maintain oxygen saturation more than 92% (or more than 88% in known chronic obstructive pulmonary disease) heart rate of more than 130 beats per minute systolic blood pressure of 90 mmHg or less, or systolic blood pressure more than 40 mmHg below normal not passed urine in previous 18 hours (for catheterised patients, passed less than 0.5 ml/kg/hour) mottled or ashen appearance cyanosis of the skin, lips or tongue non-blanching rash of the skin.

Question 375

If patient has run out of supply of isosorbide mononitrate

Answer 375

Can sell as P med

Question 376

When to review warfarin

Answer 376

Two INR values higher than 5, or one INR value higher than 8 within the past 6 months. Two INR values less than 1.5 within the past 6 months. Time in therapeutic range (TTR) is less than 65%.

Question 377

Commencing rivaroxaban/apixaban

Answer 377

Wait till INR<2 before starting

Question 378

Measuring theophylline levels

Answer 378

5 days after initiation | 3 days after dose adjustment

Question 379

Paracetamol dose for Child 1–2 months

Answer 379

30–60 mg every 8 hours as required

Question 380

Paracetamol dose for Child 3-5 months

Answer 380

60 mg every 8 hours as required

Question 381

Paracetamol dose for Child 6-23 months

Answer 381

120 mg every 4–6 hours

Question 382

Paracetamol dose for Child 2-3 years

Answer 382

180 mg every 4–6 hours

Question 383

Paracetamol dose for Child 4-5 years

Answer 383

240 mg every 4–6 hours

Question 384

Paracetamol dose for Child 6-7 years

Answer 384

240–250 mg every 4–6 hours

Question 385

Paracetamol dose for Child 8-9 years

Answer 385

360–375 mg every 4–6 hours

Question 386

Paracetamol dose for Child 10-11 years

Answer 386

480–500 mg every 4–6 hours

Question 387

Paracetamol dose for Child 12-15 years

Answer 387

480–750 mg every 4–6 hours

Question 388

Paracetamol dose for Child 16-17 years

Answer 388

0.5–1 g every 4–6 hours

Question 389

Ibuprofen dose for Child 3–5 months

Answer 389

50 mg 3 times a day

Question 390

Ibuprofen dose for Child 6-11 months

Answer 390

50 mg 3–4 times a day

Question 391

Ibuprofen dose for Child 1-3 years

Answer 391

100 mg 3 times a day, maximum daily dose to be given in 3–4 divided doses

Question 392

Ibuprofen dose for Child 4-6 years

Answer 392

150 mg 3 times a day, maximum daily dose to be given in 3–4 divided doses

Question 393

Ibuprofen dose for Child 7-9 years

Answer 393

200 mg 3 times a day, maximum daily dose to be given in 3–4 divided doses

Question 394

Ibuprofen dose for Child 10-11 years

Answer 394

300 mg 3 times a day, maximum daily dose to be given in 3–4 divided doses

Question 395

Ibuprofen dose for Child 12-17 years

Answer 395

Initially 300–400 mg 3–4 times a day; increased if necessary up to 600 mg 4 times a day

Question 396

First choice laxative during pregnancy

Answer 396

Ispaghula husk (Bulk forming)

Question 397

Can be given for prophylaxis of travellers diarrhoea

Answer 397

Loperamide

Question 398

Potential side effects of theophylline

Answer 398

``` Anxiety Arrhythmias Diarrhoea Dizziness GI discomfort GORD Headache Nausea Palpitations Seizures Skin reactions Sleep disorders Tremors Urinary disorders Vomiting ```

Question 399

Potential side effects of tolterodine

Answer 399

``` Abdominal pain Bronchitis Chest pain Diarrhoea Dry eye Fatigue GI disorders Parasthesia Peripheral oedema Vertigo Weight increased ```

Question 400

Pain relief to avoid in increased risk of falls

Answer 400

Codeine

Question 401

Trigeminal neuralgia symptoms

Answer 401

Trigeminal neuralgia is sudden, severe facial pain. It's often described as a sharp shooting pain or like having an electric shock in the jaw, teeth or gums.

Question 402

How does neuropathic pain present?

Answer 402

The pain is usually described as a burning sensation and affected areas are often sensitive to the touch.

Question 403

NICE clinical guidelines

Answer 403

Recommendations about the appropriate treatment and care of people with specific diseases and conditions within the NHS

Question 404

When OTC sale of hydrocortisone is not appropriate?

Answer 404

Angular chelitis

Question 405

What is legally not required on CD prescription?

Answer 405

Strength of tablet

Question 406

When OTC sale of hydrocortisone is not appropriate?

Answer 406

Angular chelitis

Question 407

Carbimazole

Answer 407

May cause weight gain | Reduce dose

Question 408

Disposing fentanyl patches

Answer 408

Used patches should be folded in half with the adhesive surfaces inwards so that the adhesive is not exposed.

Question 409

How long for an adult to excrete one unit of alcohol?

Answer 409

1 hour

Question 410

Sevelamer

Answer 410

Treating hyperphosphataemia

Question 411

Electrolyte imbalance in CKD

Answer 411

Hyperphosphataemia

Question 412

Vitamin D overdose can cause

Answer 412

Hypercalcaemia

Question 413

Ciprofloxacin on skilled tasks

Answer 413

Can impair performance

Question 414

Effective in treating antibiotic-associated colitis

Answer 414

Vancomycin

Question 415

Ramipril-lithium

Answer 415

Ramipril increases lithium levels- can lead to drowsiness

Question 416

MAOIs eg moclobemide

Answer 416

Hypertensive crisis

Question 417

Thiazide diuretics are ineffective below what eGFR

Answer 417

30

Question 418

Cystitis referral

Answer 418

<16 and >65

Question 419

Procedures for handling cytotoxic medicines

Answer 419

The BNF states that local, rather than national procedures should be use "Use local procedures for dealing with spillages and safe disposal of waste material, including syringes, containers, and absorbent material".

Question 420

Maximum dosing of ramipril based on eGFR

Answer 420

30-60ml/min/1.73m2- 5mg

Question 421

Before meals glucose targets

Answer 421

Non-diabetic: 4.0-5.9mmol/L | Diabetic: 4-7mmol/L

Question 422

Post prandial (at least 90 mins) glucose targets

Answer 422

Non-diabetic: <7.8mmol/L Type 2: <8.5mmol/L Type 1: 5-9mmol/L

Question 423

Dose of ibandronic acid for post-menopausal osteoporosis

Answer 423

150mg once monthly

Question 424

Which antibiotics are contraindicated in myasthenia gravis?

Answer 424

Aminoglycosides | They may impair neuromuscular transmission.

Question 425

Which drugs may cause alopecia?

Answer 425

Methotrexate | Azathioprine

Question 426

Factors that may improve the management of erectile dysfunction

Answer 426

Reduced alcohol consumption Reduction in BMI Regular exercise Smoking cessation

Question 427

Blood glucose threshold for driving

Answer 427

5mmol/l

Question 428

Lithium renal monitoring

Answer 428

Every 6 months

Question 429

What dose of ibuprofen should be given to a 4 year old?

Answer 429

7.5ml TDS

Question 430

Age for sildenafil OTC sale

Answer 430

18 years

Question 431

Licensed age for salmeterol

Answer 431

5 years old and over

Question 432

Which drugs can cause hypertension?

Answer 432

NSAIDs

Question 433

Doxycycline-omeprazole

Answer 433

Doxycyline can cause dyspepsia, oesophagitis and oesophageal irritation

Question 434

Which preparation cannot be in a 'sugar-free' product?

Answer 434

Fructose Hydrogenated glucose syrup, mannitol, sorbitol and xylitol can be in them

Question 435

Signs to look out for with methotrexate

Answer 435

Shortness of breath (can cause lung toxicity) Sore throat, bruising, mouth ulcers (blood disorders) Nausea, vomiting, abdominal discomfort, dark urine (liver toxicity)

Question 436

Insulin requirements

Answer 436

INCREASE- infection, stress, trauma and puberty | DECREASE- endocrine disorders, hepatic impairment and renal impairment

Question 437

Which drugs have a high risk of agranulocytosis?

Answer 437

Trimethoprim | Clozapine

Question 438

Weight restriction of Maloff Protect

Answer 438

Not recommended in patients under 40kg

Question 439

Signs of sepsis

Answer 439

``` Slurred speech or confusion Extreme shivering or muscle pain Passing no urine (in a day) Severe breathlessness It feels like theyre gonna die Skin mottled, pale or discoloured ```

Question 440

Fexofenadine age

Answer 440

POM only | 6 years and over

Question 441

Chlorphenamine age

Answer 441

1 year and over

Question 442

Complete control of asthma

Answer 442

no daytime symptoms no night-time awakening due to asthma no asthma attacks no need for rescue medication no limitations on activity including exercise normal lung function (in practical terms forced expiratory volume in 1 second (FEV1) and/or peak expiratory flow (PEF) > 80% predicted or best), minimal side-effects from treatment

Question 443

Common side effect of verapamil

Answer 443

Constipation

Question 444

What is miliaria?

Answer 444

Heat rash or sweat rash

Question 445

Molluscum contagiosum

Answer 445

Small warty bumps (mollusca) appear on the skin. Caused by a virus that can be passed on by skin contact or from contaminated towels, flannels, soft toys, etc. Not serious and clears up within 12-18 months without any treatment.

Question 446

What to do if patient presents with shingles

Answer 446

Refer to GP

Question 447

What is administered in acute porphyria crisis?

Answer 447

Haem arginate

Question 448

What are the notifiable diseases?

Answer 448

``` Acute encephalitis Acute infectious hepatitis Acute meningitis Acute poliomyelitis Anthrax Botulism Brucellosis Cholera COVID-19 Diphtheria Enteric fever (typhoid or paratyphoid fever) Food poisoning Haemolytic uraemic syndrome (HUS) Infectious bloody diarrhoea Invasive group A streptococcal disease Legionnaires’ disease Leprosy Malaria Measles Meningococcal septicaemia Mumps Plague Rabies Rubella Severe Acute Respiratory Syndrome (SARS) Scarlet fever Smallpox Tetanus Tuberculosis Typhus Viral haemorrhagic fever (VHF) Whooping cough Yellow fever ```

Question 449

Of the MAOIs, which is most likely to cause hypertensive crisis?

Answer 449

Tranylcypromine Isocarboxazid carries the lowest risk

Question 450

``` Which of these are irreversible inhibitors? Phenelzine Moclomebide Reboxetine Escitalopram ```

Answer 450

Phenelzine The rest are reversible inhibitors

Question 451

Mechanism of action of DPP-4 inhibitors

Answer 451

Enhances the activity of GLP-1 thus increasing glucose-dependent insulin secretion and decreasing levels of circulating glucagon and hepatic glucose production.

Question 452

Hyoscine age

Answer 452

4 years

Question 453

Cinnarazine age

Answer 453

5 years

Question 454

Which virus causes viral conjunctivitis?

Answer 454

Adenovirus

Question 455

Holiday longer than how long requires a personal export license for CDs?

Answer 455

more than 3 months’ supply or travelling for less than 3 months with any schedule 2 to 4 (part I) drugs which have been lawfully prescribed to you in your country of habitual residence.

Question 456

Severe anaphylaxis reaction symptoms

Answer 456

``` swelling of the throat and mouth difficulty breathing lightheadedness confusion blue skin or lips collapsing and losing consciousness ```

Question 457

Legal requirements of controlled drug requisition form

Answer 457

``` Signature of the recipient Name of the recipient Address of the recipient Profession or occupation Total quantity of drug Purpose of requisition ``` Mark the requisition indelibly with the supplier’s name and address (i.e. the name of the pharmacy). Where a pharmacy stamp is used this must be clear and legible Send the original requisition form to the relevant NHS agency. (Hospital, care home, hospice, prison or organisation providing ambulance services must, mark and retain the original requisition for two years)

Question 458

OTC Aspirin in pregnancy

Answer 458

Community pharmacies cannot legally sell aspirin as a pharmacy medicine for prevention of pre-eclampsia in pregnancy in England. Aspirin for this indication must be prescribed.

Question 459

Aspirin in pregnancy

Answer 459

Use antiplatelet doses with caution during third trimester; impaired platelet function and risk of haemorrhage; delayed onset and increased duration of labour with increased blood loss; avoid analgesic doses if possible in last few weeks (low doses probably not harmful); high doses may be related to intrauterine growth restriction, teratogenic effects, closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of newborn; kernicterus may occur in jaundiced neonates.

Question 460

Aspirin in breastfeeding

Answer 460

Avoid—possible risk of Reye’s syndrome; regular use of high doses could impair platelet function and produce hypoprothrombinaemia in infant if neonatal vitamin K stores low.

Question 461

How long does opioid withdrawal take?

Answer 461

Complete withdrawal from opioids usually takes up to 4 weeks in an inpatient or residential setting, and up to 12 weeks in a community setting.

Question 462

Methadone vs buprenorphine

Answer 462

Buprenorphine- less sedating, safer when used in conjunction with other sedating drugs (lower risk of overdose), easier to reduce dose due to milder withdrawal symptoms Methadone- preferred in long history of abuse, those who abuse a variety of sedative drugs and alcohol and have increased during withdrawal.

Question 463

Precipitated withdrawal

Answer 463

Precipitated withdrawal can occur in any patient if buprenorphine is administered when other opioid agonist drugs are in circulation. Starts within 1-3 hours of first buprenorphine dose and peaks at 6 hours.

Question 464

When to give first dose of buprenorphine?

Answer 464

6-12 hours after the last dose of heroin (or other short acting opioid) or 24-48 hours after the last dose methadone dose. Can titrate to optimal dose within a week

Question 465

When to initiate methadone?

Answer 465

At least 8 hours after the last heroin dose Takes 3-10 days for plasma concentrations to reach steady state Can titrate to optimal dose takes a couple of weeks.

Question 466

Withdrawal of opioid substitution therapy

Answer 466

Avoid withdrawing during first trimester due to increased risk of spontaneous miscarriage. Can gradually withdraw during second trimester, with dose reductions every 3-5 days. Further withdrawal during 3rd trimester is not recommended (foetal distress, stillbirth, and risk of neonatal mortality)

Question 467

Laxatives for opioid-induced constipation

Answer 467

Osmotic (or docusate to soften the stools) Stimulant laxative AVOID bulk forming Naloxegol and methylnaltrexone (also used in palliative care) are licensed when other laxatives are inadequate.

Question 468

Suboxone

Answer 468

Contains with buprenorphine with naloxone Used when risk of dose diversion for parenteral administration If injected, it precipitates withdrawal but has little effect if taken sublingually.

Question 469

Postherpetic neuralgia

Answer 469

Most common complication of shingles. The condition affects nerve fibers and skin, causing burning pain that lasts long after the rash and blisters of shingles disappear.

Question 470

Treating neuropathic pain

Answer 470

amitriptyline, duloxetine, gabapentin, or pregabalin Consider capsaicin 0.075% cream (Axsain®) for people with localized neuropathic pain who wish to avoid, or cannot tolerate, oral treatments.

Question 471

Weaning corticosteroids

Answer 471

Short courses of oral corticosteroids (less than 3 weeks) can be stopped abruptly. Gradual withdrawal should be considered for people whose disease is unlikely to relapse and who have: Taken more than 40 mg oral prednisolone daily or equivalent for more than 1 week. Taken repeated evening doses of corticosteroids. Received more than 3 weeks of corticosteroid treatment. Recently received repeated courses of corticosteroids (especially if taken for longer than 3 weeks), such as short courses repeatedly prescribed for the treatment of acute exacerbations of asthma. A history of previous long-term therapy (months or years). Other possible causes of adrenal suppression, such as excessive alcohol consumption or stress.

Question 472

Stage 1 hypertension

Answer 472

140/90 mmHg to 159/99 mmHg and subsequent ABPM daytime average or HBPM average blood pressure ranging from 135/85 mmHg to 149/94 mmHg.

Question 473

Stage 2 hypertension

Answer 473

160/100 mmHg or higher but less than 180/120 mmHg and subsequent ABPM daytime average or HBPM average blood pressure of 150/95 mmHg or higher.

Question 474

Stage 3 or severe hypertension

Answer 474

180 mmHg or higher or clinic diastolic blood pressure of 120 mmHg or higher.

Question 475

Which drug should be avoided with potassium citrate?

Answer 475

Ramipril Concomitant use can cause hyperkalaemia

Question 476

Which sweetener can cause abdominal bloating and diarrhoea?

Answer 476

Sorbitol

Question 477

Orlistat- who to refer?

Answer 477

Patients taking medication for diabetes - dose of diabetic medication may need adjusting as weight loss may be accompanied by improved metabolic control. Orlistat 60mg P is not recommended for use by patients who are taking acarbose. Patients taking hypertension or hypercholesterolaemia medication - it may be necessary to adjust the dose as weight loss may be accompanied by an improvement in blood pressure and /or cholesterol levels. Patients taking amiodarone should be informed to liaise with their prescriber before starting treatment with orlistat. The dose of amiodarone may need adjusting. Patients taking levothyroxine. Patients taking antiepileptic medication. There is an increased risk of convulsions when orlistat is given with antiepileptics. Patients who have been using orlistat for 6 months and longer; treatment with orlistat 60mg P should not exceed six months. If a patient has been unable to lose weight after 12 weeks of treatment. If a patient reports rectal bleeding while taking orlistat. Patients with kidney disease should consult their GP before using orlistat 60mg P

Question 478

Which class of antidiabetic drugs can cause pancreatitis?

Answer 478

DPP-4 inhibitors

Question 479

What can green leafy vegetables do to INR?

Answer 479

Decrease INR

Question 480

What can cranberry juice do to INR?

Answer 480

Increase INR

Question 481

GLP-1 agonists

Answer 481

Reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued Needs to be reported to the Yellow Card Scheme

Question 482

Potential side effects of bimatoprost

Answer 482

Dry eye; eye discolouration; eye discomfort; eye disorders; eye inflammation; headache; hypertension; hypertrichosis; skin reactions; vision disorders

Question 483

What can be given for hayfever in open angle glaucoma?

Answer 483

Sodium cromoglicate (Opticrom)

Question 484

Very bad headache in pregnancy

Answer 484

Call your midwife, doctor or hospital straight away if you have a headache and vision problems and sudden swelling on your hands, feet, face or stomach. This could be a sign of pre-eclampsia

Question 485

Risk of cancers with HRT

Answer 485

Breast- increased (higher for HRT) Ovarian- increased and would return back to normal upon treatment cessation Womb (endometrial): HRT- decreases Oestrogen only- increases (only offered to those who have had a hysterectomy) Tibolone also increases womb cancer risk

Question 486

Which EHC should be given if patient is on the pill?

Answer 486

Levonorgestrel If ullipristal needs to be used, progestrogen containing meds should be restarted after 5 days and should be advised to use reliable barrier method till then.

Question 487

Which EHC should be given if patient's BMI>26kg/m2 or weigh over 70kg?

Answer 487

Ullipristal

Question 488

Which condition can increase the likelihood of developing TB?

Answer 488

Diabetes

Question 489

Record of unlicensed specials must be kept for how long?

Answer 489

5 years

Question 490

Restrictions on Nurse Independent Prescribing

Answer 490

Nurse independent prescribers are able to prescribed any Schedule 2, 3, 4 or 5 Controlled Drug (except diamorphine, dipipanone or cocaine for the treatment of addiction), so whether the nurse is an independent or supplementary prescriber does not matter as both are able to prescribe this drug.

Question 491

Disposing of blister packs

Answer 491

Meds should not be removed from blister packs unless they are controlled drugs that required denaturing

Question 492

How much fish should be recommended per week?

Answer 492

2 portions | 1 portion of oily fish

Question 493

Which antiemetic is used for nausea and vomiting associated with Parkinson's medication?

Answer 493

Domperidone

Question 494

Who receives the HPV vaccine?

Answer 494

all boys and girls aged 12 to 13 years are routinely offered the 1st HPV vaccination when they're in Year 8 at school. The 2nd dose is offered 6 to 24 months after the 1st dose.

Question 495

Max dose of escitalopram

Answer 495

Usually 20mg, but 10mg in elderly

Question 496

Usual dose of promethazine

Answer 496

25mg

Question 497

What to do if baby is constantly crying, is red in the face and pulls legs up to chest?

Answer 497

Signs of colic- simethicone (Infacol)

Question 498

Maximum amount time it can take for NSAID to reach its maximum anti-inflammatory effect

Answer 498

21 days

Question 499

How long would PPI need to be stopped before having H pylori test?

Answer 499

14 days

Question 500

Which antidiabetic meds pose increased risk of UTIs?

Answer 500

SGLT2 inhibitors e.g. dapagliflozin

Question 501

Which beta blockers are less likely to cause nightmares?

Answer 501

``` Water soluble BBs: Sotalol Celiprolol Atenolol Nadolol ```

Question 502

Symptoms of hand, foot and mouth disease

Answer 502

o high temperature o general sense of feeling unwell o loss of appetite o abdominal pain o sore throat o red spots on the tongue and inside the mouth after one or two days o rash on the fingers, palms of hand, soles of the feet and occasionally on the buttocks and groins

Question 503

How to treat hand, foot and mouth disease

Answer 503

drink plenty of fluids to avoid dehydration, eat soft foods, analgesics such as paracetamol or ibuprofen

Question 504

How to treat chickenpox

Answer 504

Recommend calamine lotion and paracetamol and avoid ibuprofen

Question 505

Who is eligible for the NHS flu vaccine?

Answer 505

are 50 and over (including those who'll be 50 by 31 March 2021) All people aged between 6 months to under 50 years who are in a clinical risk group, such as people with chronic respiratory, heart, kidney, liver, or neurological disease; people with diabetes mellitus; people who are immunosuppressed or immunocompromised, pregnant women, people with morbid obesity and people who are on the COVID-19 shielded patient list and members of their household. are pregnant are in long-stay residential care receive a carer's allowance, or are the main carer for an older or disabled person who may be at risk if you get sick live with someone who's at high risk from coronavirus (on the NHS shielded patient list) frontline health or social care workers

Question 506

Signs of hypoglycaemia

Answer 506

``` sweating. feeling tired. dizziness. feeling hungry. tingling lips. feeling shaky or trembling. a fast or pounding heartbeat (palpitations) becoming easily irritated, tearful, anxious or moody. ```

Question 507

What is betahistine licensed for?

Answer 507

Vertigo, tinnitus and hearing loss associated with Ménière's disease

Question 508

Which antihypertensive can cause drowsiness?

Answer 508

Methyldopa

Question 509

What is the maximum dose of simvastatin that can be given with amiodarone, amlodipine, verapamil and diltiazem?

Answer 509

20mg

Question 510

What is the maximum dose of simvastatin that can be given with bezafibrate or ciprofibrate?

Answer 510

10mg

Question 511

What is the maximum dose of simvastatin that can be given with lomitapide or ticagrelor?

Answer 511

40mg

Question 512

NSAIDs with the highest risk of gastrointestinal risk

Answer 512

Ketoprofen and ketorolac Naproxen, diclofenac and indometacin have intermediate risk

Question 513

Amitriptyline- amiodarone

Answer 513

Black dot interaction | Can increase the risk of ventricular arrhythmias

Question 514

Signs of bladder cancer

Answer 514

haematuria, dysuria or urinary urgency

Question 515

Risk factor for bladder cancer

Answer 515

Smoking

Question 516

How long before the journey should hyoscine be taken?

Answer 516

Up to 30 mins before | Patches to be applied 5-6 hours before to the area behind the ear

Question 517

Which electrolyte imbalance are those who have a stoma predisposed to?

Answer 517

Hypokalaemia

Question 518

What organisms can cause CAP?

Answer 518

Streptococcus pneumoniae | Haemophilus influenzae type B (Hib)

Question 519

Treating CAP

Answer 519

Amoxicillin 500mg TDS for 5 days | Clarithromycin, Doxycycline, Erythromycin (pregnancy)

Question 520

How long should you wait before using fentanyl patches again?

Answer 520

7 days