2020

Question 1

A 30-year-old woman who has been diagnosed with H. Pylori infection. She recently received metronidazole
therapy for a dental infection. She has no known allergies.
Which of the following combinations would be the most suitable treatment for this patient?
Select one:
A. Esomeprazole, clarithromycin and amoxicillin
B. Esomeprazole, clarithromycin and metronidazole
C. Lansoprazole, bismuth subsalicylate, amoxicillin and clarithromycin
D. Omeprazole, amoxicillin and tinidazole
E. Omeprazole, bismuth subsalicylate, amoxicillin and metronidazole

Answer 1

A
H. pylori treatment summary –oral first line treatment in those with no penicillin allergy should be a proton pump inhibitor, plus amoxicillin, and either clarithromycin or metronidazole (treatment choice should take into account previous treatment with clarithromycin or metronidazole). As the patient has had recent treatment with metronidazole , the clarithromycin combination should be used

Question 2

A 29-year-old woman was started on fluoxetine two weeks ago for depression. At her follow up appointment with
her GP, she reports that she has felt more anxious since starting the medication and that her mood has not
improved. The GP has called you for advice on the management of this case.
Which one of the following is the most appropriate course of action in relation to the patient’s fluoxetine
therapy?
Select one:
A. Continue fluoxetine and review with the GP again in 3 months
B. Continue fluoxetine for another 2 weeks and reassess whether there has been any improvement
C. Gradually reduce the dose of fluoxetine with the aim of ceasing over the next 2-4 weeks
D. Stop fluoxetine and start a different class of antidepressant
E. Stop fluoxetine and start a different class of antidepressant after 2 weeks

Answer 2

Treatment should be continued for at least 4 weeks (6 weeks in the elderly) before considering whether to switch antidepressant due to lack of efficacy. In cases of partial response, continue for a further 2–4 weeks (elderly patients may take longer to respond

Question 3

A regular patient from your community pharmacy has been discharged from hospital following a fall associated
with hypoglycaemia. He is a 72-year-old man with Type 2 Diabetes who has recently had his medicines changed
due to poor glycaemic control.
When reviewing his prescription list, which of the following medicines would you be most concerned
about in relation to the risk of hypoglycaemia?
Select one:
A. Dapagliflozin
B. Glibenclamide
C. Gliclazide
D. Metformin
E. Pioglitazone

Answer 3

Glibenclamide is a long-acting sulphonylurea and is more prone to causing hypoglycaemia, especially overnight, in the elderly. Gliclazide is a shorter acting sulphonylurea. Other classes of oral antidiabetic agents have a lower risk of hypoglycaemia compared with sulphonylurea

Question 4

A 45-year-old male presents to the pharmacy complaining of redness and pain in his left eye, which started last
night. He tells you that he has used over the counter antibiotic eye drops in the past for conjunctivitis when his
eyes have been ‘uncomfortable and gritty, with sticky discharge’. He asks you about buying these eye drops
again for his current symptoms.
Which of the following is the most appropriate course of action for this patient?
Select one:
A. Cover the eye and rest for a few days
B. Refer him to the GP for further investigation
C. Supply him with chloramphenicol eye drops
D. Supply him with sodium chloride 0.9% solution to irrigate the eye
E. Trial paracetamol or ibuprofen for 48 hours and re-assess

Answer 4

Refer as pain is mentioned

Question 5

Which of the following bronchodilators is licensed for twice daily dosing as chronic obstructive
pulmonary disease (COPD) maintenance therapy?
Select one:
A. Aclidinium / Formoterol (DuaKlir Genuair®)
B. Glycopyrronium / Indacaterol (Ultibro Breezhaler®)
C. Ipratropium (Atrovent Inhaler CFC-Free®)
D. Tiotropium (Spiriva Handihaler®)
E. Triotropium (Spiriva Respimat®)

Answer 5

Aclidnium/Fomoterol

Question 6

A 24-year-old-woman is considering starting the combined oral contraceptive pill (COC).
Which of the following pieces of information or advice is most appropriate to give to this woman?
Select one:
A. Additional contraceptive precautions are required when antibiotics, such as amoxicillin, are used
concurrently
B. For women who are having natural menstrual cycles, the COC pill can be started up to and including day
5 of the menstrual cycle without the need for additional contraceptive protection
C. The 21 day regimen (21 days active tablets followed by 7 days hormone free interval) is safer than
continuous or extended regimens
D. The COC pill is associated with a reduced risk of breast cancer and venous thrombosis
E. With perfect use, the COC pill is 100% effective at preventing pregnancy, which drops to 97% with
typical use

Answer 6

B

Question 7

How often should this patient have their blood counts monitored when clozapine is initiated?
Select one:
A. 3-Monthly
B. 6-Monthly
C. Daily
D. Monthly
E. Weekly

Answer 7

Weekly

Question 8

The patient is stabilised on therapy and has remained on the same dose of clozapine for one year. Now that he
is feeling an improvement in his symptoms, he decides to work on building healthy habits including regular
exercise, and quitting smoking.
Which of the following advice would be the most appropriate in relation to his clozapine?
Select one:
A. Continue with the current dose and increase frequency of blood tests to weekly
B. Continue with the current dose and monthly blood tests
C. Decrease dose and extend frequency of blood tests to 3-monthly
D. Refer to prescriber for a potential dose reduction and monitoring of plasma concentration levels
E. Start nicotine replacement therapy and continue the same dose

Answer 8

D
Cigarette smoking induces metabolism of clozapine, resulting in significant increases in levels when quitting, hence dose adjustment and increased monitoring is required. This is not related to the nicotine component, hence the effect is not negated by NRT.

Question 9

58-year-old woman who is currently taking digoxin 125 micrograms daily for the last
two months. She has no known drug allergies. She has also been taking furosemide 40 mg tablets twice a day
for the past two weeks.
When handing out her medications, the patient tells you that she has not been feeling very well and has been
experiencing nausea, diarrhoea, palpitations and feeling faint. You suspect that she may be experiencing
symptoms of digoxin toxicity.
Question 17
Which of the following is the most likely explanation for these symptoms?
Select one:
A. Cumulative accumulation of digoxin therapy
B. Decompensated heart failure
C. Hypokalemia due to furosemide
D. Reduced renal clearance of digoxin
E. She has been taking her tablets incorrectly

Answer 9

Hypokalaemia, which can be caused by potassium-depleting diuretics such as the loop diuretics, increases the toxicity of the digitalis glycosides

Question 10

What is the most appropriate advice to give to this patient?
Select one:
A. She is experiencing a side-effect of digoxin, and whilst safe to continue taking it, she may wish to see
her GP for a review
B. She should see her GP as the dose of furosemide may need to be decreased
C. She should see her GP so that a digoxin plasma concentration level can be taken
D. Stop taking digoxin straight away and see her GP as soon as possible
E. Stop taking furosemide straight away and continue taking the digoxin

Answer 10

Advise the patient to stop taking digoxin and refer for medical review urgently. The BNF monograph recommends that if toxicity occurs, digoxin should be withdrawn as serious manifestations can occur requiring urgent specialist management. A digoxin plasma concentration within the therapeutic range does not exclude digoxin toxicity.

Question 11

You are due to start work at 9am as the Responsible Pharmacist in a community pharmacy. There are delays on
the train, so you arrive 30 minutes late. The dispensing technician would like to carry out some activities before
you arrive.
Which of the following activities can the dispensing technician carry out when you are not present in the
pharmacy?
Select one:
A. Handing out of dispensed and checked medicines to the delivery driver
B. Making an emergency supply of a medicine at the request of a patient
C. Ordering stock from a wholesaler
D. Supervising the consumption of buprenorphine
E. Wholesaling of medicines

Answer 11

ordering stock from wholesaler

Question 12

A 71-year-old man is having his routine biochemistry tested by his GP. His medical history includes
hypertension and hypercholesterolaemia. His is currently taking amlodipine, bendroflumethiazide, simvastatin,
cholecalciferol, and paracetamol.
The biochemistry test results are as follows:
Value Normal range
Na 133 mmol/L (135 – 145 mmol/L)
K 2.7 mmol/L (3.5 – 5.0 mmol/L)
Ur 4.2 mmol/L (3 – 7 mmol/L)
Cr 75 μmol/L. (59 - 104 μmol/L.)
Which one of the following is the most likely cause of his abnormal biochemistry results?
Select one:
A. Amlodipine
B. Bendroflumethiazide
C. Cholecalciferol
D. Paracetamol
E. Simvastatin

Answer 12

Bendroflumethiazide is a thiazide diuretic that causes hypokalaemia by increasing potassium excretion by the kidney.

Question 13

A 50-year-old man with chronic kidney disease requiring haemodialysis has been discharged from hospital post-
fracture repair.
Which one of the following analgesics would be the most suitable choice for the short-term management
of his acute post-operative pain on discharge?
Select one:
A. Codeine tablets
B. Fentanyl patches
C. Ibuprofen tablets
D. Morphine slow release tablets
E. Oxycodone immediate release tablets

Answer 13

Morphine is metabolised to morphine-6-glucuronide which accumulates in renal impairment, resultingin CNS depression. Similarly, the clearance of codeine, and its metabolites are significantly reduced in renal impairment. The pharmacokinetics of oxycodone is also affected in renal failure, however it may be preferred to morphine in some circumstances. The BNF recommends to avoid codeine in renal failure and to use morphine and oxycodone with caution. The BNF also recommends to avoid ibuprofen (systemic NSAID) in severe renal impairment. Fentanyl patches and slow release tablets are not appropriate for acute pain due to their slow onset of action and long duration of action

Question 14

A 26-year-old female has been diagnosed with microcytic anaemia.
Which one of the following nutritional deficiencies is most likely to be contributing to this diagnosis?
Select one:
A. Folate deficiency
B. Iron deficiency
C. Vitamin B6 deficiency
D. Vitamin B12 deficiency
E. Vitamin D deficiency

Answer 14

iron deficiency

Question 15

7
An 18 year old man has been prescribed metronidazole 400 mg three for seven days by his dentist for a tooth
infection. He wants to know if he can drink alcohol whilst taking the medicine.
Which ONE of the following counselling points is the LEAST appropriate advice to give?
Select one:
A. Tell him to limit alcohol consumption
B. Tell the patient to avoid alcohol consumption for at least two days after stopping the drug
C. Warn him that alcohol consumption might cause a headache
D. Warn him that alcohol consumption might cause flushing
E. Warn him that alcohol consumption might cause nausea and vomiting

Answer 15

Tell him to limit alcohol

Question 16

You are conducting a consultation with your patient, a 40-year-old-man, and he mentions he has recently been
diagnosed with diabetes. After gaining his consent you test his blood glucose levels, the result is 3.7 mmol/L.
Which ONE of the following is the most appropriate next step?
Select one:
A. Advise him to eat some of his diabetic chocolate which he has bought with him
B. Ask him to immediately drink some of his fruit juice that he has got with him
C. Ask the patient if they took their medicines for diabetes this morning as the glucose level is quite high
D. Nothing is needed, as that reading is normal, continue with the review
E. Refer him to his doctor as his diabetic medication is not keeping his blood glucose levels low enough

Answer 16

Fruit juice - patient is epereicing hypo

Question 17

A regular patient comes into the pharmacy and asks for some medicine to treat a wart on their hand.
Which ONE of the following statements about warts is CORRECT?
Select one:
A. Cryotherapy with liquid nitrogen can be carried out to freeze a wart
B. Refer to the GP if the wart is on the hand
C. Topical salicylic acid (15–50%) should be applied once or twice daily for up to 20 weeks
D. Warts are caused by the herpes simplex virus type 2 (HSV-2)
E. Without any treatment, warts may spontaneously resolve but may take 7-10 days

Answer 17

A

Question 18

A 24-year-old lady comes into the pharmacy seeking advice for an itchy, inflamed and painful external right
ear. She has just returned from a regular swimming lesson and has had similar problems before.
Which one of the following is NOT a referral point for her condition?
Select one:
A. Fever
B. Mucopurulent discharge
C. Pain, spreading towards the jaw
D. Some degree of temporary hearing loss
E. Symptoms that are not improving and have been present for 3 or more days

Answer 18

Some degree of temporary hearing loss - otitis externa

Question 19

A father would like you to recommend how much paracetamol is required for his 4-year-old child who has cold
and flu like symptoms.
Which ONE of the following doses is MOST appropriate regarding paracetamol?
Select one:
A. 60 mg every 6 hours
B. 90 mg every 6 hours
C. 120 mg every 6 hours
D. 180 mg every 6 hours
E. 240 mg every 6 hours

Answer 19

240mg every 6 hrs

Question 20

A 34-year-old woman walks into your pharmacy and requests the supply of ellaOne® (ulipristal acetate). She
has read that it is an emergency contraception, which can be taken after unprotected sexual intercourse.
Use the information provided about ellaOne® in the resource pack.
Which ONE of the following statements regarding ellaOne® is CORRECT?
Select one:
A. ellaOne® can be recommended to be taken in pregnancy or suspected pregnancy
B. ellaOne® must be taken within 72 hours of unprotected sex
C. If hormonal contraception is continued after administering ellaOne®, barrier contraception does not need
to be used until the next period or withdrawal bleed
D. One ellaOne® tablet contains 150 micrograms of ulipristal acetate
E. The primary mechanism of action for ellaOne® is inhibition or delay of ovulation

Answer 20

E- ellaOne consists of 30mg of ulipristal acetate.It is not recommended to be used more than once per cycle. ellaOne is not intended for use during pregnancy and should not be taken by any woman suspected or known to be pregnant

Question 21

A 46-year-old woman has been admitted to hospital with a transient-ischaemic attack (TIA). Her records indicate
a history of migraine with aura, hypertension, and Type 2 diabetes.
Her medications on admission were as follows:
Ramipril 2.5 mg daily
Novomix 30 ® 20 units twice a day
Metformin 1 g twice a day
Atorvastatin 40 mg daily
Propranolol 10 mg twice a day
Which of the following antiplatelet agents would be most appropriate for this patient for stroke
prevention?
Select one:
A. Aspirin
B. Aspirin/Dipyridamole (dipyridamole)
C. Clopidogrel
D. Prasugrel
E. Ticagrelor

Answer 21

Aspirin
Clopidogrel is recommended if aspirin is not tolerated. Aspirin/dipyridamole would not be recommended for this patient as it may worsen headaches/migraines. Prasugrel and ticagrelor are not indicated forischaemic stroke/CVA

Question 22

A patient visits your pharmacy to collect his medication. You notice that he would benefit from a flu vaccination.
You need to consider guidance about consent before you provide the vaccination.
Which ONE of the following statements about consent is CORRECT?
Select one:
A. If the patient has previously consented to having a vaccination you would not need to obtain consent this
time round
B. If verbal consent is obtained a record must be kept of this
C. Implied consent would be acceptable here
D. The patient does not need to be made aware about information that will be shared with their GP
E. Written consent must be obtained prior to providing the service

Answer 22

If verbal consent is given a record of this must be kept

Question 23

Which one of the following medicines is most likely to cause neutropenia?
Select one:
A. Dexamethasone
B. Doxorubicin
C. Gentamicin
D. Ibuprofen
E. Rivaroxaban

Answer 23

Doxorubicin neutrophil levels may be the result of a severe infection, liver disease, enlarged spleens or other conditions

Question 24

Prescriptions for Schedule 2 controlled drugs must meet certain legal requirements.
Which ONE of the following statements about supply on a prescription for a Schedule 2 controlled drug
is INCORRECT?
Select one:
A. If the prescription is written by a dentist, it must contain the words ‘For dental treatment only’
B. Pharmacist independent prescribers can issue prescriptions for Schedule 2 controlled drugs
C. The prescription is valid for 30 days after the appropriate date on the prescription
D. The prescription must include a clearly defined dose
E. The total quantity must be written in both words and figures

Answer 24

The prescription is only valid for 28 days not 30

Question 25

A 7-year-old boy is prescribed ibuprofen for the management of fever. He is 122 cm tall and weighs 23 kg. Which of the following is the most appropriate ibuprofen dose for this patient? Select one: A. 5 mL of 100 mg/5 mL syrup three times a day B. 5 mL of 100 mg/5 mL syrup four times a day C. 7.5 mL of 100 mg/5 mL syrup three times a day D. 7.5 mL of 100 mg/5 mL syrup four times a day E. 10 mL of 100 mg/5 mL syrup three times a day

Answer 25

recommend dose for children aged 7-9 is 200mg TDS so the correct answer is 10ml of the 100mg/5ml syrup TDS

Question 26

A 45-year-old woman with oestrogen-receptor positive with breast cancer. She is prescribed tamoxifen 20 mg daily after a total mastectomy. She has a history of depression for which she is taking paroxetine 20 mg every morning. Which of the following is the most appropriate counselling point for this patient? Select one: A. Redness, pain or swelling in the leg can be managed with painkillers and by elevating the leg B. She should see her GP to review her paroxetine as it may increase the chance of her experiencing side effects from the tamoxifen C. Take the tamoxifen at night to reduce symptoms of hot flushes D. Tamoxifen also reduces the risk of endometrial cancer E. Tamoxifen should be taken daily to reduce the risk of the breast cancer returning

Answer 26

Tamoxifen should be taken daily to reduce the risk of the breast cancer returning, with ongoing review of the benefits versus risks of continuing. Tamoxifen may increase the risk of endometrial cancer. Paroxetine reduces the effectiveness of tamoxifen through inhibiting its conversion to its active form. Timing of tamoxifen will not reduce the hot flush which is a common side effect. Tamoxifen increases the risk of venous thromboembolism and a swollen leg could suggest a deep vein thrombosis which requires urgent medical attention in a hospital. Tamoxifen may increase the risk of endometrial cancer. Paroxetine reduces the effectiveness of tamoxifen through inhibiting its conversion to its active form. Timing of tamoxifen will not reduce the hot flush which is a common side effect. Tamoxifen increases the risk of venous thromboembolism and a swollen leg could suggest a deep vein thrombosis which requires urgent medical attention in a hospital. The correct answer is: Tamoxifen should be taken daily to reduce the risk of the breast cancer returning

Question 27

A 70-year-old man with advanced Parkinson’s disease is being started on apomorphine therapy. Which of the following treatment options is the most appropriate for the management of nausea and vomiting as a result of the apomorphine? Select one: A. Domperidone B. Haloperidol C. Metoclopramide D. Ondansetron E. Prochlorperazine

Answer 27

Metroclopramide, haloperidol and prochlorperazine should not be used in Parkinson’s disease as they cross the blood brain barrier and cause dopamine blockade, resulting in worsening of symptoms. Ondansetron is contraindicated with apomorphine due to additive QTc prolongation and risk of serious arrhythmia. The manufacturers of apomorphine recommend the use of domperidone to control nausea and vomiting, however there is still a risk of QT prolongation with this combination , hence an assessment of cardiac risk factors and ECG monitoring is recommended to ensure that the benefits outweight the risks

Question 28

You have serious concerns regarding the conduct of a colleague and are concerned that the safety of patients may be compromised by her actions. Which ONE of the following statements regarding reporting your concerns is INCORRECT? Select one: A. Concerns can be reported to someone outside of the organisation B. The first step is to always contact the General Pharmaceutical Council about your concerns C. The General Pharmaceutical Council Standards for Pharmacy Professionals require pharmacists to speak up when they have concerns D. You can obtain advice from external organisations such as a professional body or union if you are not sure if you should raise a concern E. You should follow the organisation’s policy for raising concerns wherever possible

Answer 28

B

Question 29

A 30-year-old woman comes into the pharmacy and mentions she would like to buy something to help ease her period pain. You suspect her to have primary dysmenorrhoea. You recommend she takes 250 mg naproxen tablets. Which ONE of the following is the CORRECT information to provide the patient? Select one: A. Do not exceed three tablets daily B. Do not store above 30 degrees temperature C. Do not take if you are allergic to Penicillin’s D. It is safe to take if you have a stomach ulcer E. Take an additional anti-inflammatory if the pain worsens

Answer 29

Do not take more than three tablets per day. Max dosage of naproxen OTC IS 250MG tds

Question 30

A 25-year-old man brings in a bag of his unused medicines for your disposal. The bag contains prescribed medicines but also medicines he has purchased over the counter. Which ONE of the following statements about the handling of waste medicines returned to pharmacies is INCORRECT? Select one: A. Pharmacies can accept waste medicines from patients B. Pharmacies cannot accept other household waste such as cosmetics C. Pharmacies should not remove blister strips from their outer packaging D. Schedule 2 controlled drugs should be denatured prior to disposal E. Waste medicines must be kept in secure waste containers in a designated area preferably away from medicines

Answer 30

Pharmacies are able to remove blisters strips from their outer packaging

Question 31

A 54-year-old man presents with acute back pain. He has a family history of cardiovascular disease, has a BMI of 30 kg/m2, and is a smoker. Which one of the following would be most appropriate for this patient? Select one: A. Celecoxib B. Diclofenac C. Etoricoxib D. Meloxicam E. Naproxen

Answer 31

Naproxen is associated with a lower thrombotic risk and low doses of ibuprofen have not been associated with an increased risk of MI, diclofenac and high doses ibuprofen are associated with an increased risk of CVD

Question 32

Clinical audit is a way to find out if healthcare is being provided in line with standards and let’s pharmacists know where their service is doing well, and where there could be improvements. Which of the following statements about audits is CORRECT? Select one: A. Audits can only be conducted on topics where clinical guidance exist B. Data collection is NOT part of the audit cycle C. Ethics approval is required to conduct a clinical audit D. NHS community pharmacies are required to conduct at least one audit per year E. Re-audit performance is part of the audit cycle

Answer 32

E

Question 33

You are supplying a spacer to an adult for use with their newly prescribed Metered Dose Inhaler (MDI). Which of the following is the most appropriate counselling advice in relation to the use of the spacer? Select one: A. Spacers are designed to be used at home rather than outside B. Spacers can be used with dry powder inhalers such as Symbicort Turbohaler® as well C. Spacers do not reduce the risk of side effects from inhaled medicines D. Spacers should be cleaned before initial use, and then once a month afterwards E. Spacers should be cleaned with detergent and dried with a cloth

Answer 33

Care should be taken not to scrub the inside of the spacer as it will affect the way it works. Spacers help improve the distribution of the medicine to the intended site of action and reduce the risk of side effects, hence they should be used wherever possible/feasible, not just indoors. Spacers are only compatible with MDs.

Question 34

A patient has visited your pharmacy to ask for some medicine to help with their cough and sore throat, they have tested NEGATIVE for COVID-19. Which ONE of the following situations would you need to refer to a GP? Select one: A. A 5-year-old boy, not taking any medication B. A 14-year-old asthmatic patient C. A 40-year-old patient taking methotrexate for rheumatoid arthritis D. A 40-year-old, recently diagnosed diabetic patient E. A 42-year-old pregnant woman taking levothyroxine for hypothyroidism

Answer 34

Methotrexate

Question 35

Which ONE of the following statements about an emergency supply at the request of a patient does NOT meet legal requirements? Select one: A. An entry must be made in the POM register within 72 hours B. You have ascertained that the patient previously had the medication dispensed from checking his summary care record C. You have ascertained there is an immediate need for the medication and that it is not practical for the patient to obtain a prescription without undue delay D. You have added the words ‘Emergency Supply’ to the dispensing label E. You have decided to issue enough tablets for 30 days treatment

Answer 35

A

Question 36

Several Prescription Only Medicines (POMs) are now available to purchase by patients as Pharmacy (P) medicines. Which ONE of these POM-P switches are NOT associated with the corresponding common side effect? Select one: A. Orlistat and urgent bowel movements B. Sildenafil and cold hands and feet C. Sumatriptan and tingling sensations in the skin D. Tamsulosin and dizziness E. Tranexamic acid and diarrhoea

Answer 36

B- sildenafil is actually associated with hot flushes

Question 37

Amorolfine 5% nail lacquer can be sold over the counter for the treatment of fungal nail infection. Which ONE of these patients requesting amorolfine 5% nail lacquer could be sold the product if they have been referred to you by their doctor? Select one: A. A 17-year-old male, with no other medical history B. A 28-year-old pregnant female C. A 34-year-old male with diabetes D. A 42-year-old male with three slightly affected nails E. A 61-year-old female with no other medical history

Answer 37

E Amorolfine is licensed from 18 years, should not be used in diabetes or pregnancy. People with 3 affected nails should be referred

Question 38

21-year-old female suffering from mild acne purchases a tube of benzoyl peroxide at your pharmacy. Which one of the following statements is the most appropriate advice for this patient? Select one: A. Apply benzoyl peroxide gel immediately after washing your face whilst it is still damp B. Apply benzoyl peroxide gel only to active lesions on the skin C. During the first few days, the skin is likely to redden and be irritated D. Start with the 10% strength product, and step down to a lower strength once the acne has started to clear E. The acne should start to clear within a few days

Answer 38

C Benzoyl peroxide prevents new lesions rather than shrinking existing ones, and therefore should be applied not just to active lesions. Advise that the face should be washed and left to dry for 20 minutes before applying treatment. Treatment should start with the lower strength product to allow the skin time to adjust to the medication. Acne is notoriously slow to respond to treatment and it can take months to see the maximum benefit.

Question 39

Your counter assistant is going through her minor ailments handbook as she would like to improve her healthcare knowledge about common conditions and infections. She asks you for which ONE of the following conditions a partner sharing the same house should also receive treatment, regardless of whether or not they have any symptoms? Select one: A. Athlete’s foot B. Impetigo C. Ringworm D. Threadworm E. Thrush

Answer 39

Threadworm

Question 40

When a medicine is supplied by a pharmacy for use in an animal under the veterinary cascade, certain details must appear on the dispensing label unless they already appear on the packaging and are not obscured by the dispensing label. Which ONE of the following requirements is NOT required on the dispensing label when making a supply under the cascade? Select one: A. Date of supply B. Name and address of the animal owner C. Name and address of the pharmacy D. The address of the prescribing veterinary surgeon E. The words ‘For animal treatment only’

Answer 40

The address of the prescribing vet surgeon is not required

Question 41

A 45-year-old male presents to the GP with new onset jaundice. He is taking the following medications: * Amlodipine 5 mg daily * Ramipril 2.5 mg daily * Pantoprazole 20 mg daily * Metformin 500 mg twice daily * Co-amoxiclav 500 mg/125 mg three times a day Which of these medicines should be stopped whilst his jaundice is investigated? Select one: A. Amlodipine B. Co-amoxiclav C. Metformin D. Pantoprazole E. Ramipril

Answer 41

Co-amoxiclav is the most likely medication to be causing his jaundice

Question 42

A patient suffering with dyspepsia calls you to discuss some symptoms he has been experiencing. Which of the following symptoms requires urgent referral? Select one: A. Aphthous ulcer B. Dysphagia C. Nausea D. People over 50 years with unexplained and persistent recent onset dyspepsia E. Progressive unintentional weight gain

Answer 42

Dysphagia requires urgent referral. Urgent endoscopic investigation is required for patients with dysphagia, significant acute gastrointestinal bleeding, or in those aged 55 years and over with unexplained weight loss and symptoms of upper abdominal pain, reflux or dyspepsia.

Question 43

An 85-year-old man is receiving palliative care for lung cancer has been prescribed morphine sulfate MR capsules (Zomorph ®) 200 mg twice a day to manage his cancer pain. Over the last few days, he has complained of constipation, which he was not suffering from previously. Which of the following is the most appropriate treatment for this patient’s constipation? Select one: A. Co-dantrhamer B. Glycerol C. Ispaghula husk D. Methylnaltrexone E. Naloxegol

Answer 43

A Opioids reduce peristalsis, increase the anal sphincter tone, and promote absorption of water from the large intestine; this leads to hard stools and constipation. Ispaghula husk, a bulk-forming laxative, can cause obstruction and increase the risk of faecal impaction in opioid-induced constipation especially if fluid intake is inadequate. Constipation from opioid use is best treated with a stimulant laxative, or a stool-softening laxative, or both if necessary. Adequate fluid intake should be maintained. (Source MHRA)

Question 44

It is Summer and you want to ensure your pharmacy staff are have appropriate knowledge on the sale of medicines for the treatment of hay fever. Which ONE of the products below could be sold over the counter for the associated patient? Select one: A. Cetirizine for a 9-month-old B. Cetirizine for a 15-month-old C. Chlorphenamine for a 11-month-old D. Loratadine for a 12-year-old E. Promethazine for a 1-year-old

Answer 44

Loratidine

Question 45

You are the Responsible Pharmacist of your pharmacy working alongside another pharmacist. You plan to be away for an authorised absence for two hours and consider the options available to you during this period of absence. Which ONE of the following statements about Responsible Pharmacist legislation is CORRECT? Select one: A. If the second pharmacist takes over as responsible pharmacist, they can also be absent for two hours during the same day B. If you remain the responsible pharmacist, you do not need to record the absence in the pharmacy record C. Trained pharmacy staff cannot carry on date checking of medicines in your absence D. You can hand over the responsible pharmacist role to the second pharmacist E. You cannot continue to be the responsible pharmacist whilst you are absent

Answer 45

D

Question 46

Which ONE of these patients with thrush, displaying symptoms for the very first time, could be sold a medicine over the counter? Select one: A. A 32-year-old pregnant female who has no diabetes or gestational diabetes B. A 34-year-old male whose female partner has thrush C. A 46-year-old female with a green discharge, who is not pregnant or taking other medicines D. A 59-year-old female who has had thrush three times in the last six months E. A 61-year-old female who has recently been on a course of antibiotics

Answer 46

B????

Question 47

28-year-old patient comes into your pharmacy and says she would like to take some oral rehydration sachets (Dioraltye®) abroad with her in case she suffers from diarrhoea. Use the information about Dioralyte® provided in the resource pack. Which ONE of the following is appropriate advice to give her with regards to oral rehydration sachets? Select one: A. Each sachet should always be dissolved in 200 mL fruit juice B. Half to one sachet after every loose motion C. The solution itself must not be boiled D. The solution should be made up immediately before use and may be stored for up to 48 hours in a refrigerator E. When reconstituting, do not stir

Answer 47

Must not be boiled

Question 48

You are decluttering your pharmacy and organising records and paperwork. What is the minimum period of time you should keep the Responsible Pharmacist pharmacy record for? Select one: A. 6 months B. 12 months C. 2 years D. 5 years E. 10 years

Answer 48

5 years

Question 49

A patient who is a new mother, comes into your pharmacy. Her 5-year-old daughter has been recently diagnosed with epilepsy and she would like to know what factors trigger epileptic seizures. Which one of the following is NOT a trigger for an epilepsy seizure? Select one: A. Flashing lights B. Having an illness causing a low body temperature C. Lack of sleep D. Not taking prescribed epilepsy medicines E. Stress

Answer 49

Only a high temperature can be cause of an anti epileptic seizure and therefore B is incorrect and is not a trigger

Question 50

A 2-year-old girl present with a fever of 38°C. Upon inspection she does NOT have a rash, has not had any other symptoms, and has tested negative for COVID-19. What is the MOST appropriate dose of paracetamol 120 mg/5 mL to recommend for this patient? Select one: A. 5 mL BD PRN B. 7.5 mL BD PRN C. 5 mL QDS PRN D. 7.5 mL QDS PRN E. 10 mL QDS PRN

Answer 50

7.5ml QDS prn

Question 51

A patient is taking hyoscine butylbromide 10 mg, three times a day to treat abdominal cramps. She returns to your pharmacy complaining of side effects due to the medicine. Which of the following is NOT a side effect of hyoscine butylbromide? Select one: A. Diarrhoea B. Dry mouth C. Headaches D. Tachycardia E. Urinary retention

Answer 51

Hyoscine butylbromide causes constipation. Constipation; dizziness; drowsiness; dry mouth; dyspepsia; flushing; headache; nausea; palpitations; skin reactions; tachycardia; urinary disorders; vision disorders; vomiting

Question 52

A 50-year-old woman has just returned from seeing the optician. The optician recommended that she use hypromellose for her dry eyes. She is also taking prescribed latanoprost eye drops. She asks you if she can use them together. What is the most appropriate response? Select one: A. She can administer them at the same time as they do not contain steroids B. She should leave 5 minutes between using each product C. She should leave 10 minutes between using each product D. She should leave 15 minutes between using each product E. She shouldn't be using these two eye-drops together and should be referred to her Optician

Answer 52

Wait 5 mins

Question 53

A 32-year-old mother would like to know what symptoms could be associated with meningitis, as she has just had a baby and would like to be aware. Which of the following statements is LEAST appropriate? Select one: A. Bulging hard spot towards the back of the head B. High temperature with a rash that doesn’t fade under a glass C. Irritable behaviour D. Refusing to eat and being more fussy E. Stiff body or neck

Answer 53

A

Question 54

The Responsible Pharmacist Pharmacy Record is an important document which ensures accountability for pharmacy premises during their operational hours. Which ONE of the following statements about the Pharmacy Record is INCORRECT? Select one: A. If an amendment is made to the record, it should be clear who made this change and when they made it B. If an electronic record is kept, paper records should also be kept C. The Record must be kept for a minimum of five years D. The Record should include the registration number of the responsible pharmacist E. The Responsible Pharmacist is required to personally make entries in the pharmacy record

Answer 54

B

Question 55

A 28-year-old man would like to purchase a treatment for ringworm on their scalp, which appeared a few days ago. Which of the following is the MOST appropriate advice to give? Select one: A. Hydrocortisone 1% cream can be sold and applied thinly for up to seven days B. Refer to the GP to treat the affected patches C. Ringworm cannot be passed on through infected objects such as towels D. Scaling and hair loss are rare symptoms E. Treatment can be stopped once the rash has gone away

Answer 55

Refer Scaling and hair loss are common symptoms. Hydrocortisone cannot be sold in this situation, ringworm is contagious and transferable through objects and often treatment must continue sometime after the rash has disappeared

Question 56

A patient has arrived in your pharmacy for their first smoking cessation appointment. They ask you about the side effects that they might experience with nicotine patches. Which ONE of the following is NOT a side effect of nicotine? Select one: A. Headaches B. Increased sleepiness C. Skin irritation D. Upset stomach E. Vivid dreams

Answer 56

Should not affect sleep Taking oral nicotine can cause insomnia however

Question 57

A customer in the pharmacy, who was recently seen eating a chocolate bar, has suddenly started having a reaction. Which ONE of the following is NOT a sign of anaphylaxis? Select one: A. Bradycardia B. Clammy skin C. Collapse D. Difficulty breathing E. Lightheaded feeling

Answer 57

Bradycardia. Anaphylaxis is associated with a fast heartbeat

Question 58

A customer visits your pharmacy and asked to buy some pseudoephedrine for his congestion. Which of the following statements about pseudoephedrine is CORRECT? Select one: A. If the customer is purchasing the medicines for himself and his partner, he may purchase two packs of products each containing 720 mg pseudoephedrine B. Pseudoephedrine can only be sold from a pharmacy when the responsible pharmacist is present C. The customer may purchase 24 tablets, each tablet containing 60 mg pseudoephedrine D. The customer may purchase a product containing a total of 360 mg ephedrine E. The customer may purchase an ephedrine product and a pseudoephedrine product

Answer 58

Only when RP is present

Question 59

A 16-year-old girl visits your pharmacy and asks to have a private conversation with you about a medical problem. As this is a young person you should consider guidance around consent. Which ONE of the following statements about patient consent is INCORRECT? Select one: A. As the patient is a young person, you should use the same criteria to assess competence as you would for an adult B. If on this occasion it is deemed that the person lacks capacity, you should not assume that they lack capacity to make all future decisions C. If this individual lacked the capacity to consent, the person with parental responsibility for her could give consent if it was in the best interest of the patient to have a health check D. The patient is under 18, therefore they do not have the capacity to give consent E. You can assume the patient has the capacity to make their own decisions unless there is sufficient evidence to suggest otherwise

Answer 59

D is incorrect

Question 60

The Medicines and Healthcare products Regulatory Agency implemented measures in 2020, to support the safe use of stimulant laxatives when sold or supplied over the counter. Which ONE of following statements regarding these changes is INCORRECT? Select one: A. Large packs of laxatives are not available to purchase in newsagents B. One of the reasons these changes have been introduced is due to the misuse and abuse of stimulant laxatives C. Stimulant laxatives available on general sale are recommended for use in people aged 18 years or over D. Stimulant laxatives can be purchased over the counter for children aged 12 or over E. There is no limit on pack sizes that pharmacies can hold for supply under the supervision of a pharmacist

Answer 60

E

Question 61

A 54-year-old female patient presents in your pharmacy to purchase St John’s Wort. Upon asking her more questions, she tells you that she is also taking warfarin tablets. Which ONE of the following statements about St John’s Wort is the most appropriate advice to provide in this situation? Select one: A. St John’s Wort may cause warfarin toxicity, by slowing the breakdown of warfarin B. St John’s Wort may decrease the effectiveness of warfarin, possibly leading to a clot C. Taking the dose at least two hours apart from the time of taking warfarin is recommended, to avoid any interactions D. The St John’s Wort tablets can be taken, just not on the same day as warfarin E. There is no interaction and it is fine to take the two togethe

Answer 61

St John wort might decrease the effectiveness of the warfarin if taken together as it acts as an enzyme inducer

Question 62

You receive a private prescription with the following details. Prescription items Amlodipine 5 mg tablets. Take one a day. Supply 28 tablets Lisinopril 10 mg tablets. Take two tablets daily. Supply 60 tablets Paracetamol 500 mg. Take two tablets four times a day prn. Supply 100 tablets. Repeat x 2 How many tablets would you have supplied in total after all repeats have been fulfilled? Select one: A. 28 of amlodipine tablets, 60 of lisinopril tablets, 100 of paracetamol tablets B. 84 of amlodipine tablets, 168 of lisinopril tablets, 300 of paracetamol tablets C. 84 of amlodipine tablets, 180 of lisinopril tablets, 300 of paracetamol tablets D. 90 of amlodipine tablets, 180 of lisinopril tablets, 300 of paracetamol tablets E. 180 of amlodipine tablets, 84 of lisinopril tablets, 300 of paracetamol tablets

Answer 62

C

Question 63

A 45-year-old woman presents to the pharmacy with symptoms of heartburn and reflux. When counselling this patient, you inform her of symptoms that would indicate that she should contact her doctor, should she experience them. Which of the following would be an example of one of these symptoms? Select one: A. Constipation B. Cough C. Dry mouth D. Loose stools E. Unintentional weight loss

Answer 63

Unintentional weight loss is more serious and requires referral to GP

Question 64

You are observing your patient use their Symbicort Turbohaler® (budesonide/formoterol) device and providing feedback on their inhaler. After you watch them prepare the device, they show you how they inhale their dose. Which of the following best describes the correct technique for inhaler use? Select one: A. Form a tight seal around the mouthpiece with their lips, then breathe in and out slowly and steadily B. Form a tight seal around the mouthpiece with their lips, then breathe in quickly and deeply C. Form a tight seal around the mouthpiece with their lips, then breathe in slowly and steadily D. Place their teeth over the device and inhale quickly and deeply E. Place their teeth over the device, then breathe in and out slowly and steadily

Answer 64

B

Question 65

A 25-year-old male is admitted to hospital feeling unwell with extensive cellulitis caused by methicillin- resistant Staphylococcus areus and is subsequently started on intravenous vancomycin 1.5 g every 12 hours. He weighs 78 kg, his height is 185 cm, and his eGFR is >90 m/min/1.73m2 . Which of the following is the most appropriate advice in relation to managing vancomycin? Select one: A. A vancomycin peak plasma concentration level should be measured after the first dose B. A vancomycin trough plasma concentration level should be measured before the second dose C. A vancomycin trough plasma concentration level should be taken before the 4th dose D. After taking a vancomycin trough plasma concentration level, the next dose should always be withheld until the results are back E. The dose should be administered over 30 minutes

Answer 65

C All patients require serum-vancomycin measurement (on the second day of treatment, immediately before the next dose if renal function normal, earlier if renal impairment—consult product literature). The next vancomycin dose should not be withheld whilst awaiting results unless toxicity is suspected. Administration rate should not exceed 10mg/min to reduce the risk of red-man’s syndrom