02/03

Question 1

Risk factors for osteoporosis ?

Answer 1

Occurs most commonly in postmenopausal women, men over 50, long-term steroids. 
Risk factors:
increasing age
vitamin D deficiency
low calcium intake
lack of physical activity
low BMI 18.5 kg/m²
cigarette smoking
excess alcohol intake
parental history of hip fractures
early menopause
previous fracture at a site characteristic of osteoporotic fractures
reumatoid arthritis and diabetes

Question 2

How should you counsel patients to take alendronic acid tab ?

Answer 2

Tab taken with plenty of water while sitting or standing, on an empty stomach at least 30 min before breakfast ( or other meds) patient should stand or sit upright for at least 30 min after administration

Question 3

What counselling in terms of s/e should you provide to your patients ?

Answer 3

Atypical femoral fractures: report any thigh, hip or groin pain during treatment.
Osteonecrosis of the jaw: maintain good, oral hygiene, receive routine dental checkups, and report any symptoms
Osteonecrosis of the external auditory canal: report any ear pain, discharge from ear or an ear infection during treatment
Oesophageal reactions: stop taking and seek med help ASAP if dysphagia, new or worsening heartburn, pain on swallowing or retrosternal pain

Question 4

1. What is the max amount of salt per day ?

2. Sugar ?

Answer 4

1. 6g

2. 30g of free sugars

Question 5

Febuxostat MHRA warnings ?

Answer 5

Stevens-Johnson syndrome and acute anaphylactic shock with febuxostat
increased risk of cardiovascular death and all-cause mortality in clinical trial in patients with a history of major cardiovascular disease; avoid treatment with febuxostat in patients with pre-existing major cardiovascular disease (e.g. myocardial infarction, stroke, or unstable angina), unless no other therapy options are appropriate

Question 6

Pre-treatment screening with febuxostat ?

Answer 6

Monitor liver function tests before treatment as indicated.

Question 7

What are the pro kinetic drugs used in nausea/vomiting in palliative care ?

Answer 7

metoclopramide domperidone

Question 8

How should nausea and vomiting be treated in palliative care ?

Answer 8

prokinetic antiemetic: 1st line

Nausea and vomiting with opioid therapy: haloperidol or metoclopramide hydrochloride

Question 9

Why drugs with antimuscarinics effects should not be used alongside prokinetic drugs ?

Answer 9

Drugs with antimuscarinic effects antagonise prokinetic drugs for example cyclizine, hyoscine

Question 10

Palliative care patient has vomiting due to metabolic causes such as hypercalcaemia or renal failure, which antiemetic to give ?

Answer 10

haloperidol

Question 11

When is cyclizine used in palliative care ?

Answer 11

nausea and vomiting due to mechanical bowel obstruction, raised intracranial pressure, and motion sickness.

Question 12

Palliative care: patient has pruritus caused by obstructive jaundice, emollients have been tried but no effect, what can you recommend ?

Answer 12

colestyramine

Question 13

Palliative care patient has raised intracranial pressure, what can be given ?

Answer 13

dexamethasone, before 6pm to ensure no insomnia

Question 14

How should restlessness and confusion be treated in palliative care ?

Answer 14

haloperidol or levomepromazine

Question 15

If patient returns CD2, 3 or CD4 ( part 1), is denaturing required ?

Answer 15

Yes, no witness but make a note of returned CD 2 destruction in a returned CD book

Question 16

What blood test results would prompt you to suspect familial hypercholesterolaemia ?

Answer 16

total cholesterol level greater than 7.5 mmol/L and/or
A personal or family history of premature coronary heart disease (CHD, an event before 60 years in an index person or first-degree relative [parents, siblings, children]).

Question 17

What diagnostic tests should be done if it is suspected patient has familial hypercholesterolaemia?

Answer 17

Take two measurements of low-density lipoprotein (LDL) cholesterol concentration.

Question 18

first-line therapy in all patients with familial hypercholesterolaemia ?

Answer 18

A high-intensity statin, defined as the dose at which a reduction in LDL-cholesterol of greater than 40% is achieved.
Patients with primary heterozygous familial hypercholesterolaemia who have contra-indications to, or are intolerant of statins, can be considered for treatment with ezetimibe as monotherapy

Question 19

Name high intensity statins ( dose at which reduction in LDL-cholesterol of greater than 40% is achieved ) ?

Answer 19

Atorvastatin 20, 40, 80 mg
Rosuvastatin 10, 20, 40
Simvastatin 80

Question 20

When should malaria prophylaxis be started for chloroquine and proguanil hydrochloride ?

Answer 20

1 week before travel

Question 21

when should malaria prophylaxis be started for mefloquine ?

Answer 21

2-3 weeks before travel

Question 22

when should malaria prophylaxis be started for atovaquone with proguanil hydrochloride or doxycycline ?

Answer 22

1-2 days before travel

Question 23

Malaria prophylaxis should be continued for 4 weeks after leaving, except for atovaquone with proguanil hydrochloride, how long for these drugs ?

Answer 23

1 week after leaving

Question 24

What is the treatment for acute migraine attacks ?

Answer 24

Monotherapy, with either aspirin, ibuprofen, or a 5HT1-receptor agonist (‘triptan’) is recommended as first-line

Question 25

How should sumatriptan be taken for migraines ?

Answer 25

In patients who experience aura with their migraine, it is recommended that 5HT1-receptor agonists are taken at the start of the headache and not at the start of the aura (unless the aura and headache start at the same time). Treatment with a 5HT1-receptor agonist can be repeated after 2 hours with the same or different drug if there has been an inadequate response to the initial dose.

Question 26

What NSAIDs can be used to treat acute migraine attacks ?

Answer 26

naproxen [unlicensed indication], tolfenamic acid, and diclofenac potassium

Question 27

What drugs are first line in preventative treatment of migraines ?

Answer 27

1st line propranalol
Unsuitable then metoprolol, atenolol (unlicensed), nadolol, timolol. Bisoprolol may be considered in patients already taking it for cardiac reasons.
BB unsuitable then topiramate.

Question 28

What is supply criteria for sumatriptan ? OTC

Answer 28

Migraine must be diagnosed by a doctor or pharmacist
Established pattern of migraine (a history of five or more migraine attacks occuring over a period of at least one year)
Simple analgesics tried and ineffective.

Question 29

Which patient groups should not be supplied with OTC sumatriptan ?

Answer 29

• under 18 or over 65
• pregnancy breastfeeding
• Heart disease risk factors (contraindicated in patients who have three or more risk factors i.e. diabetes, high cholesterol levels, smoking/use of NRT).

Question 30

Which drug usage would prevent you from supplying sumatriptan OTC ?

Answer 30

Ergotamines (methysergide)
MAOIs
Triptans
TCAs
SSRIs/SNRIs

Question 31

If first migraine attack occurs over 50 or has four or more attacks per month or headaches lasting more than 24 h, can you supply OTC sumatriptan ?

Answer 31

NO

Question 32

IF patient experience which symptoms should they discontinue sumatriptan use ?

Answer 32

heat, heaviness, pressure or tightness (including throat and chest) occur.

Question 33

How should maloff protect ( atovaquone 250mg with proguanil hydrochloride 100mg) be taken ?

Answer 33

One tab daily, one to two days prior to entering a malaria-endemic area, continued during period of stay, and for seven days after leaving the area

Question 34

Which interaction drugs would require you to refer a patient who request maloff protect ?

Answer 34

Etoposide
 Rifampicin or rifabutin
 Metoclopramide
 Warfarin or other oral anticoagulants
 Tetracycline
 Indinavir, efavirenz, zidovudine or boosted protease inhibitors

Question 35

Which medical conditions must be referred when requesting maloff protect ?

Answer 35

Patients with a history of depression, or seizures

Patients with tuberculosis

Question 36

Which other patient groups should be referred when requesting maloff protect ?

Answer 36

If needing quantities to cover longer than 12 weeks travel
Patients under 18 years
Patients who weigh less than 40kg

Question 37

What are the counselling points for maloff protect ?

Answer 37

Take at the same time each day
Take with food or a milky drink (to ensure maximum absorption)
If vomiting happens within 1 hour of taking dose, take another
Dizziness has been reported

Question 38

What is a normal BP reading ?

Answer 38

TOP number: systolic: between 90 and 120

Bottom number: diastolic: between 60 and 80

Question 39

Which drugs should not be stopped before surgery ?

Answer 39

antiepileptics, antiparkinsonian drugs, antipsychotics, anxiolytics, bronchodilators, cardiovascular drugs, glaucoma drugs, immunosuppressants, drugs of dependence, and thyroid or antithyroid drugs.

Question 40

Which drugs should be stopped before surgery ?

Answer 40

COC: stop 4 weeks before
HRT: stop 4-6 weeks before, start when mobile
MAOIs gradually withdraw 2 weeks before
Lithium should be stopped 24 hours before major surgery
Potassium-sparing diuretics may need to be withheld on the morning of surgery because hyperkalaemia may develop
Ace - 24 hours before
Warfarin 5 days before elective surgery
Day before surgery: once daily long-acting insulin analogues, which should be given at a dose reduced by 20 %.

Question 41

Gradual withdrawal of systemic corticosteroids should be considered in those whose disease is unlikely to relapse and have …?

Answer 41

• received more than 40 mg prednisolone (or equivalent) daily for more than 1 week;
• been given repeat doses in the evening;
• received more than 3 weeks’ treatment;
• recently received repeated courses (particularly if taken for longer than 3 weeks);
• taken a short course within 1 year of stopping long-term therapy;
• other possible causes of adrenal suppression.

Question 42

Which clinical conditions would prevent use of ulipristal EC ?

Answer 42

severe liver impairment and in patients with severe asthma who are on oral glucocorticoid is not recommended.

Question 43

Which clinical conditions would prevent use of levonorgestrel EC ?

Answer 43

severe liver dysfunction, patients at risk of ectopic pregnancy or who have suffered inflammation of the fallopian tubes, Chrohns disease

Question 44

Which medications use would prevent you to supply ulipristal EC ?

Answer 44

carbamazepine, efavirenz, fosphenytoine, griseofulvin, nevirapine, oxcarbazepine, phenobarbital, phenytoin, primidone, rifabutin, rifampicin, St. John’s wort/Hypericum perforatum, long term use of ritonavir.

Question 45

Patients who have taken CYP3A4 enzyme inducing medicines in the last 4 weeks and would like levonorgestrel what should you suggest ?

Answer 45

offered referral for a copper intrauterine device to be fitted within 5 days of unprotected sex/ failure of a contraceptive method. If this is not an option the woman should take double the usual dose of levonorgestrel
Levonorgestrel can also increase toxicity of ciclopsorin.

Question 46

What is breast-feeding advice regarding ulirpristal and levonorgestrel ?

Answer 46

Ulipristal: do not breastfeed for 7 days
Levonorgestrel: tablet immediately after feeding and avoids nursing at least 8 hours following Levonelle

Question 47

Patient has taken EC of ulipristal and asks you can she return to taking her normal contraceptive pill ?

Answer 47

If ulipristal is used, progestogen-containing drugs should not be restarted for 5 days afterwards. Patients should therefore be advised to use a reliable barrier method until their next period.

Question 48

Patient has taken EC of levonorgestrel and asks your advice about resuming normal contraceptives ?

Answer 48

Patients can continue with their regular contraceptives following the use of levonorgestrel

Question 49

What does Total parenteral nutrition mean ? ( TPN)

Answer 49

administration of nutritionally complete solution via central venous catheter

Question 50

What AMBP/HMBP reading indicates stage 1 and stage 2 hypertension ?

Answer 50

stage 1 : 135/85 mmHg or higher.

stage 2 : 150/95 mmHg or higher.