4118 MCQs Flashcards
You are called by one of the on-call doctors for the haematology wards who has a patient, Mrs W, with an INR of 8.3. They have withheld her warfarin this evening and plan to review the INR tomorrow. However, the nurses have just reported that Mrs W’s gums have bled after brushing her teeth, which doesn’t normally happen. Which of the following would be the most appropriate action to take?
A Give Mrs W a dose of digoxin-specific antibody fragments
B Give Mrs W a dose of enoxaparin
C Give Mrs W a dose of phytomenadione
D Refer Mrs W for dialysis
E The warfarin has already been stopped and nothing else needs to be done
Answer C - Phytomenadione is vitamin K - see BNF
MrA comes into your pharmacy to pick up a prescription for lorazepam 0.5 mg QDS. He is well known to you and has been using the lorazepam for anxiety for a number of months. He was listening to the news about the drug driving laws and worries he might get arrested. If Mr A were to be pulled over, which of the following instances would NOT be classed as an offence?
A His driving is not impaired, he takes his tablets as prescribed and his serum lorazepam concentration is above the limit
B His driving is not impaired, he takes his tablets as he feels best suits him and his serum lorazepam concentration is above the limit
C His driving is impaired, he takes his tablets as prescribed and his serum lorazepam concentration is above the limit
D His driving is impaired, he takes his tablets as he feels best suits him and his serum lorazepam concentration is above the limit
E All of the above result in a criminal offence because his lorazepam serum concentrations are above the allowed limit
Answer A - RPS drugs and driving legislation
Miss J is one of your regular patients and this afternoon she comes into your pharmacy to buy some multivitamin tablets. Earlier that morning her GP diagnosed her with a number of vitamin deficiencies, notably A, D, E, and K, but she wasn’t prepared to pay another prescription fee as she is on a number of medicines already. Which of the following of her regular medicines may be causing this vitamin deficiency?
A atorvastatin
B captopril
C metformin
D orlistat
E None of the above is the likely cause
D Orlistat - BNF states in cautions - May impair absorption of fat-soluble vitamins
Mr U, a 45-year-old man of African descent with Type 2 diabetes who has recently been admitted to your general medical ward after complaining of general ill health over the past few weeks.
During your visit to the general medical ward you note that Mr U was started on bisoprolol 10 mg for hypertension by the night team. Why should you be cautious of using bisoprolol to treat Mr U’s hypertension?
A Mr U has a higher risk of bradycardia
B Mr U has a higher risk of syncope
C Mr U is unlikely to respond to bisoprolol
D Mr U will be at increased risk from hypoglycaemia
E Mr U will be at increased risk of respiratory distress
Option D - Beta blockers can mask symptoms of hypoglycaemia
Mr U, a 45-year-old man of African descent with Type 2 diabetes who has recently been admitted to your general medical ward after complaining of general ill health over the past few weeks.
While discussing this choice of treatment with the day team, the consultant agrees bisoprolol was a poor choice for this patient. What should be the first-choice agent to treat Mr U’s hypertension?
A amlodipine 5 mg OD
B bendroflumethiazide 2.5 mg OD
C ramipril 2.5 mg OD
D ramipril 2.5 mg OD and bisoprolol 10 mg OD
E ramipril 2.5 mg OD and amlodipine 5 mg OD
C - < 55 or not afro carribean - ACE inhibitor first or if not tolerated ARB.
Then it would be ACE or ARB + CCB or Thiazide diuretic
Mrs E comes into your community pharmacy to collect her regular prescription. While handing out her medicines you note that she is wearing new tinted spectacles. Upon further questioning, you learn she has recently been getting dazzled by car headlights and decided to get her spectacles tinted. Which of her regular medicines, if any, may have contributed to this?
A amiodarone 200 mg OD
B aspirin75mgOD
C atorvastatin 40 mg ON
D ramipril 2.5 mg ON
E None of the above
A - Amiodorone - BNF - Can cause corneal deposits and photosensitivity as common side effects
Mr B is a man on your elderly care ward who is being treated for a fractured bone. While reviewing Mr B’s current treatment you note the nurses have reported that whilst his stools are normal in consistency they are dark in colour but the medical team does not believe it to be malaena. Which of Mr B’s medicines, if any, is likely to have caused this?
A aspirin75mgOM
B ferrous sulfate 200 mg TDS
C itraconazole 200 mg BD
D simvastatin 40 mg ON
E None of the above; he has probably had a gastrointestinal bleed
Option B - Side effect of ferrous sulfate - Malaena ruled out
Josh is a 14-year-old boy on your gastrointestinal surgery ward who has just come round from anaesthetic after having a partial ileal resection. Josh’s father approaches you and the paediatric SHO mentioning that Josh is feeling sick and wondered if there was something he could have. Which of the following should NOT be prescribed for Josh?
A cyclizine
B domperidone
C metoclopramide
D ondansetron
E promethazine
Answer C - Metoclopramide contraindicated 3-4 days after GI surgery
Also should not be used in people under 18 due to risk of dystonias
You are counselling Mrs P, a 65-year-old woman, who has just been diagnosed with postmenopausal osteoporosis. She has been prescribed: Alendronic acid 70 mg (4) Take ONE tablet ONCE weekly on the same day Which ONE of the following is the most appropriate piece of advice to give to Mrs P?
A Chew tablets
B Stand or sit upright for at least 30 minutes after administration
C Take at least 15 minutes before another oral medication
D Take at night
E Take with milk
Answer B
Flurbiprofen (Strefen) is available OTC for the symptomatic relief of sore throats for adults, the elderly and children over the age of 12 years. Which ONE of the following drugs would be most appropriate for use alongside flurbiprofen?
A aspirin75mg
B dabigatran
C lithium
D methotrexate
E pizotifen
Pizotifen - all other medications should be avoided with NSAIDs
Pizotifen - sedating antihistamine used for migraines.
Mrs FJ presents at the pharmacy that you are locuming at for the first time. She says that the pharmacist yesterday gave her MST 100 mg instead of 10mg. Which ONE of the following is the most appropriate thing to do?
A Establish her expectations
B Explain that you cannot make another supply unless she brings in another prescription
C Minimise the seriousness of the error
D Do not apologise as it was not your mistake
E You must retrieve the incorrect medicine from the patient
A - confusing one
Miss W, an 18-year-old young woman, lives next door to your pharmacy and comes in screaming and seeking advice for a burn on her left arm. She received the burn 2 minutes ago from her hair straighteners. The burn is smaller than a 1-inch square and is not a full-thickness burn. It has just started blistering. Which ONE of the following is the most appropriate thing to do first?
A Apply a burn cream such as Acriflex
B Burst the blister
C Cool the burn
D Dress the burn
E Ring for an ambulance
Always cool the burn first then dress it. Never burst the blister and don’t apply creams or ointments.
Mrs L, a 45-year-old woman, brings in a prescription for a urinary tract infection: Trimethoprim 200 mg (6) Take ONE tablet TWICE daily You recall that she is also taking another medicine that interacts and you decide to discuss this with her GP. Which ONE of the following drugs has a significant interaction with trimethoprim?
A digoxin
B enalapril
C lithium
D methotrexate
E warfarin
Trimethoprim and Methotrexate DDI
It is your first day as a responsible pharmacist (RP) and you are about to display your RP notice. Which ONE of the following pieces of information must be included on the RP notice?
A that you are the responsible pharmacist in charge of that registered pharmacy premises
B your superintendent’s name
C your RPS number
D the year you qualified
E the time you signed in
Answer A +. Name and GPHC number.
Mrs AJ is a 35-year-old Polish woman. She has a nut allergy. Which ONE of the following ear drops for wax would be the LEAST appropriate for Mrs AJ?
A chlorobutanol 5%, arachis oil 57.3% (Cerumol)
B urea–hydrogen peroxide complex 5% in glycerol (Exterol)
C olive oil
D urea–hydrogen peroxide 5% (Otex)
E sodium bicarbonate
Answer A - Arichis oil is peanut oil
Mrs JD has been prescribed exenatide 5 mcg BD for the first time. She asks if she will be on it for the foreseeable future. Which ONE of the following statements is the most appropriate thing to say?
A Only if HbA1c is reduced by at least 1% point and a weight loss of at least 3% is achieved within 1 month of starting treatment
B Only if HbA1c is reduced by at least 1% point and a weight loss of at least 3% is achieved within 2 months of starting treatment
C Only if HbA1c is reduced by at least 1% point and a weight loss of at least 3% is achieved within 3 months of starting treatment
D Only if HbA1c is reduced by at least 1% point and a weight loss of at least 3% is achieved within 6 months of starting treatment
E Only if HbA1c is reduced by at least 3% point and a weight loss of at least 30% is achieved within 6 months of starting treatment
Answer D - GLP 1 receptor agonists.- states in BNF
Dr K is concerned about the unavailability of clobetasone butyrate 0.05% (Eumovate) and wants you to recommend an alternative steroid cream with a similar potency. Which ONE is the most suitable?
A alcometasone dipropionate 0.05% (Modrasone)
B betamethasone dipropionate 0.05% (Diprosone)
C betamethasone valerate 0.1% (Betnovate)
D fluticasone propionate 0.05% (Cutivate)
E mometasone furoate 0.1% (Elocon)
MOdrasone has same potency
Miss C was taking oxybutynin for urinary incontinence but got some of the antimuscarinic side-effects. She wants you to recommend a drug that won’t cause those side-effects which she can ask her GP to prescribe. Which ONE would be the most suitable?
A darifenacin
B fesoterodine
C mirabegron
D propiverine
E solfenacin
Mr M has oral thrush and wants to buy some Daktarin oral gel. He gives you his repeat slip. Which ONE of his medications is contraindicated with miconazole?
A bisoprolol
B calcium carbonate 1.25 g/cholecalciferol 10 mcg
C diclofenac
D ezetimibe
E simvastatin
E - BNF interactions section - miconazole increases the exposure of simvastatin and atorvastatin
Mr SD asks to speak to you in private. He has scabies and would like a suitable preparation. You show him a tube of permethrin 5% (Lyclear) cream and counsel him. How long should Mr D leave the cream on for?
A 1–2 hours
B 3–4 hours
C 6–8 hours
D 8–12 hours
E 24 hours
D - should be left on 8-12 hours
Mr SL has a prescription for co-codamol 15/500 mg capsules. Whilst counselling him, you explain to take care when purchasing OTC medications as many contain paracetamol. Which ONE of the following drugs is available in a combination product with paracetamol OTC?
A codeine 30 mg
B dihydrocodeine 20 mg
C hyoscine 100 mcg
D ibuprofen 200 mg
E metoclopramide 5 mg
D - ibuprofen is the only one in there at that strength that can be found OTC
Which ONE of the following is the consequence of the interaction between aspirin and methotrexate? A increased risk of bleeding
B increased risk of NSAID-induced nephrotoxicity
C increased sedation
D renal excretion of methotrexate reduced
E renal excretion of methotrexate increased
D renal excretion of methotrexate is reduced
Mrs OP presents in the pharmacy and wants something for IBS. Which ONE of the following symptoms would lead to a referral to the GP?
A abdominal pain
B bloating
C constipation
D diarrhoea
E vomiting
ABCD common symptoms of IBS, Vomiting is not
Answer E
Mrs DG, 56 years old, stopped smoking 72 hours ago. Which ONE of the following benefits of stopping smoking should she be experiencing?
A Improved circulation, making physical activity easier
B Improved coughing, shortness of breath and wheeziness
C Energy levels have begun to increase
D Risk of lung cancer is half that of a smoker
E Risk of myocardial infarction falls to the same as someone who has never smoked
C
Circulation can begin to improve after 2 weeks
Wheezing and coughing 3- 9 months
Cancer and MI risk much longer
Miss AS is 28 years old and is 32 weeks pregnant having developed hypertension. Which ONE of the following drugs would be the LEAST appropriate for her?
A Adalat Retard (nifedipine)
B Coracten XL (nifedipine)
C Labetalol
D Methyldopa
E Propranolol
E - beta blockers contraindicated in pregnancy except labetalol which is first line.
Mrs M, a 55-year-old woman, is asking for advice. You may find it useful to consult the SPC for this product to answer these questions: https://www.medicines.org.uk/emc/medicine/19778. 35 You ask her if she has any medical conditions. Nytol One-A-Night is cautioned in which of the following?
A diabetes
B hypertension
C indigestion
D narrow-angle glaucoma
E open-angle glaucoma
D - cautioned with narrow angle glaucoma
Nytol One-A-Night
What percentage of a single dose is excreted unchanged in urine?
A 1%
B 2%
C 3%
D 4%
E 5%
1%
Nytol One-A-Night
She asks you after how many hours of a single dose will the sedative effect be at its maximum.
A 1 hour
B 2 hour
C 1–2 hours
D 1–3 hours
E 1–4 hours
1-3 hours
Mr S is a 69-year-old man who has been diagnosed with hypertension and arrhythmia. As the hospital pharmacist on the cardiac ward, you have counselled him on his newly prescribed medicines. The preregistration pharmacist whom you are training has further questions regarding myocardial oxygen demand. Which ONE of the following is least likely to increase myocardial oxygen demand?
A cold temperatures
B exercise
C isoprenaline
D metoprolol
E smoking
Mrs G presents at the pharmacy with constipation and asks you what she can take to relieve her symptoms as quickly as possible. Which ONE of the following OTC products has the quickest onset of action in the treatment of acute constipation?
A bisacodyl
B docusate sodium
C ispaghula husk
D lactulose
E loperamide
Answer A - 10 to 12 hours
Docusate 24-48 hours
Lactulose up to 48 hours
Ispaghula takes days
Miss ZM has just been diagnosed with recurrent migraine headaches and has been prescribed sumatriptan 100 mg for treatment of attacks. Which ONE of the following pre-existing conditions is contraindicated for the use of sumatriptan in this patient?
A gouty arthritis
B irritable bowel syndrome
C ischaemic heart disease
D mild liver impairment
E renal failure
C - Sumatriptan should not be administered to patients with severe hepatic impairment. Liver disease does not indicate severe impairment. Sumatriptan is contraindicated in patients who have ischaemic heart disease or have had a myocardial infarction, coronary vasospasm (Prinzmetal’s angina), peripheral vascular disease, or symptoms or signs consistent with ischaemic heart disease. It should also not be administered to patients with a history of cerebrovascular accident (CVA) or transient ischaemic attack (TIA), or to patients with moderate and severe hypertension and mild uncontrolled hypertension. Sumatriptan causes vasoconstriction; this effect when present in coronary vessels may cause chest tightness as a normal side-effect. However, in patients with ischaemic heart disease, angina or a risk of coronary artery disease, this could precipitate attacks of angina or potentially cause myocardial infarction, and thus should not be used in these patients
Mrs T’s 12-year-old son has permanent yellow-to-greyish stains on his teeth. She tells you that the doctor explained that a medicine was responsible for the pigmentation. Which ONE of the following medicines is most likely to have caused intrinsic staining of the teeth?
A chlorhexidine mouthwash
B co-amoxiclav suspension
C fluoride drops
D sodium feredetate elixir
E tetracycline tablets
E - tetracyclines can cause permanent staining of teeth in children grey - yellow
Miss U is a 33-year-old woman who suffers from recurrent aphthous ulcers that she describes as very painful. You check her patient medication record and notice that she has been taking the prescribed and OTC medicines below although not concomitantly. Which ONE of the following medicines is least likely to cause ulceration of the oral mucosa? A aspirin
B ibuprofen
C methotrexate
D propranolol
E ramipril
Answer D - The oral mucosa is particularly vulnerable to ulceration in patients treated with cytotoxic drugs, e.g. methotrexate. Other drugs that are capable of causing oral ulceration include ACE inhibitors, gold, nicorandil, NSAIDs, pancreatin, pencillamine, proguanil and protease inhibitors. Aspirin tablets allowed to dissolve in the sulcus for the treatment of toothache can lead to a white patch followed by ulceration. Propranolol is a beta blocker that has not been shown to cause aphthous ulcers
A 24-year-old female presents with the following symptoms: weight loss, tachycardia and waking throughout the night due to stress. Which ONE of the following medicines may be contributing to these symptoms?
A co-codamol 30/500 mg TDS PRN B cyclizine 50 mg TDS
C ibuprofen 200 mg TDS PRN
D levothyroxine 125 mcg OD
E microgynon 1 tablet
Levothyroxine has narrow therapeutic index - small dosing errors can induce hyperthyroid side effects such as tremors, weight loss, tachycardia, insomnia, anxiety
Mr D has been prescribed warfarin and has also been seeking complementary and alternative therapies, such as treatment with vitamins, to improve his health. Which ONE of the following vitamins should Mr D avoid?
A vitamin A
B vitamin B
C vitamin D
D vitamin E
E vitamin K
E - vitamin K - See BNF
Mrs F is a 41-year-old woman undergoing treatment for lymphomatous meningitis. Which ONE of the following chemotherapy agents can be administered intrathecally?
A cytarabine
B vinblastine
C vincristine
D vindesine
E vinflunine
Answer - A
Avoid VINCAALKALOIDS intrathecally!
Mrs C has come to your pharmacy seeking advice for her 2-year-old son who is suffering from a cough and cold. Which ONE of the following classes of ingredients is safe to recommend to Mrs C for her son?
A antitussives
B antihistamines
C demulcents
D nasal decongestants
E expectorants
Answer C
Miss H presents at your local pharmacy and would like to purchase tranexamic acid for her heavy periods. Which ONE of the following statements regarding treatment with tranexamic acid is NOT true?
A Treatment with tranexamic acid is initiated only once heavy bleeding has started
B The recommended dosage is two tablets three times daily for a maximum of 4 days
C May be used for women with heavy periods from the age of 16
D May not be used by women taking the oral contraceptive pill
E May not be used by women having more than 3 days of individual variability in their menstrual cycle periods
Answer C - 18+
MrM is a 43-year-old man of Pakistani origin who has been prescribed sitagliptin (Januvia) as an adjunct for better control of his condition. Which ONE of the following statements regarding sitagliptin (Januvia) is NOT correct?
A It is an inhibitor of dipeptidyl peptidase enzyme (DPP-4) which enhances the incretin hormone
B It can cause hypoglycaemia with sulfonylureas
C It is not appropriate for use in type 1 diabetes
D It can be taken with or without food
E It should be continued only if HbA1c concentration is reduced by at least 5 percentage points within 6 months of starting treatment
Answer E - See BNF
Mr AJ is 38 years old and presents at the pharmacy complaining of a rash. It has spread all over his body apart from his face. The rash is most concentrated around the groin and lower buttocks. Upon questioning you discover that the rash consists of tiny red spots, is lumpy and is very itchy particularly at night. He is scratching the spots and crusty sores have started to develop. Which ONE of the following conditions is Mr AJ suffering from?
A chickenpox
B hives
C legionnaire’s disease
D molluscum contagiosum
E scabies
Answer E
The itching that is worse at night (when your skin is warmer) is characteristic of scabies. It is not chickenpox as the face and head are not affected. This is again characteristic of scabies. Men usually have one or more very itchy, lumpy, 3 to 10 mm spots on the skin of the genitals.
Mr BR, a 31-year-old male, has a history of epilepsy and hypersensitivity to tricyclic antidepressants (TCAs). Recently his seizures have worsened and the prescriber is looking to introduce a new anticonvulsant to control Mr BR’s symptoms better. Which ONE of the following anticonvulsants is contraindicated for this patient?
A acetazolamide
B carbamazepine
C ethosuximide
D phenobarbital
E phenytoin
Answer B - Carbamazepine is structurally similar to TCA
Miss A comes to collect her prescription for benzoyl peroxide gel and asks what other measures she can take to reduce her facial acne. Which ONE of the following counselling points will you NOT include in your consultation as the pharmacist?
A Do not squeeze acne lesions
B Exposure to sunlight minimises acne lesions
C Apply gel once or twice daily to the whole face, not just to theactivelesions
D Use water-based non-comedogenic cosmetics
E Benzoyl peroxide has a potent bleaching effect
No conclusive evidence exposure to sunlight improves acne - if taking benzoyl peroxide skin sensitivity to sunlight is increased anyway.
Mrs R has been prescribed clindamycin for the treatment of osteomyelitis. She comes into the pharmacy as she has developed diarrhoea and has been to the toilet four times this morning. Which ONE of the following is the most appropriate course of action for Mrs R?
A Advise her to purchase loperamide capsules
B Advise her to purchase oral rehydration salts
C Advise her to purchase kaolin and morphine mixture
D Advise her that the condition is self-limiting and should resolve on its own
E Advise her to discontinue treatment and contact GP immediately
Answer E
Patients should discontinue immediately and contact doctor if diarrhoea develops because clindamycin has been associated with antibiotic-associated colitis (see BNF, section 1.5), which may be fatal. It is most common in middle-aged and elderly women, especially following an operation. Although antibiotic-associated colitis can occur with most antibacterials, it occurs more frequently with clindamycin
Mrs A is a 46-year-old woman who has suffered a minor stroke and has been admitted to hospital. Her records indicate a history of migraine with aura and type 2 diabetes. Which ONE of her following medicines should be discontinued?
A enoxaparin
B NovoMix 30
C metformin
D trimethoprim
E verapamil
Answer A - enoxaparin contraindicated follwing acute stroke
What would be the first line treatment for a 68 year old man diagnosed with hypertension who has pre- existing type 1 diabetes?
ACE inhibitor regardless age
Under what circumstances should metformin be withdrawn, or treatment interrupted, due to the increased risk of lactic acidosis?
Use with caution in renal impairment—increased risk of lactic acidosis; avoid in significant renal impairment. NICE(1) recommends that the dose should be reviewed if eGFR less than 45 mL/minute/1.73 m2 and to avoid if eGFR less than 30 mL/minute/1.73 m2. Withdraw or interrupt treatment in those at risk of tissue hypoxia or sudden deterioration in renal function, such as those with dehydration, severe infection, shock, sepsis, acute heart failure, respiratory failure or hepatic impairment, or those who have recently had a myocardial infarction
A patient has been admitted to your ward with a severe chest infection. They have had a previous anaphylactic reaction to amoxicillin. Which of the following would be safe to prescribe?
- Augmentin
- Cefradine;cephalosphorin type
- Ciprofloxacin: quinolones
- Clarithromycin:macrolides
- Co-fluampicil : - Flucloxacillin - Tazocin
augmentin: amoxicillin and clavulanic acid
co-fluampicil: flucloxacillin and ampicilin
Tazocin: piperacillin and tazobactam (reated to penicillin)
As patients with a history of immediate hypersensitivity to penicillins may also react to the cephalosporins and other beta-lactam antibiotics, they should not receive these antibiotics; aztreonam may be less likely to cause hypersensitivity in penicillin-sensitive patients and can be used with caution.
not ciprofloxacin because Ciprofloxacin has only moderate activity against Gram-positive bacteria such as Streptococcus pneumoniae and Enterococcus faecalis; it should not be used for pneumococcal pneumonia
answer is Clarithromycin
Mebendazole is the drug of choice for treating threadworm infections in patients over the age of 2 years. It is given as a single dose, but as reinfection is common, a patient may take another dose after how many days?
A 7 days
B 10 days
C 14 days
D 21 days
E 28 days
14
male patient, 32 yrs old, comes into the pharmacy with a Rx of Levothyroxine 25mcg- take 1 OD. he has never had this before and so you proceed to counsel him on the administration of the medication. which of the following is most appropriate?
1) take 2 hours before breakfast
2) take 1 hour before breakfast
3) take 30 mins before breakfast and other medication
4) take 30 mins before breakfast, other medication and caffeine-containing liquids.
4 see cautionary labels BNF
male patient, 32 yrs old, has come into the pharmacy with a Rx for Sulfasalazine 500mg QDS. he informs you that this is the first time he is taking this medication. which of the following cautionary advisory labels is most likely to be associated with sulfalsalazine?
1) warning: do not drink alcohol
2) this medicine may colour you’re urine. this is harmless
3) warning: this medicine may make you sleepy
4) take with or just after food, or a meal
2
you are undertaking a medication review for a female patient. upon discussing her medications, she informs you she has been experiencing recurrent episodes of vaginal thrush. which one of the drugs may be contributing to this?
1) atorvastatin
2) metformin
3) levothyroxine
4) dapagliflozin
Answer 4
male patient, 32 yrs old has just been commenced on a medication to aid a reduction in his HbA1c. upon counselling him you inform him that it can possibly cause a rare SE called diabetic ketoacidosis. which of the following is NOT a clinical feature of this?
1) fruity smelling breath
2) weight gain
3) increased thirst and urinary frequency
4) sunken eyes
ANswer 2
male patient, 32 yrs old has just visited the ANP at the practice, who has sent a Rx for a course of antibiotics over to the pharmacy. he comes in to collect it and informs you that he has never had it before. upon counselling you advise that it is best taking these antibiotics an hour before or 2 hours after food. which of the following is this counselling advise NOT likely to apply to?
1) amoxicillin
2) ampicillin
3) flucloxacillin
4) phenoxymethylpenicillin
Answe 1 - amoxicillin
male patient, 32 yrs old has come into the pharmacy to hand a Rx which has been issued but he consultant endocrinologist. he informs you he is starting his medication to help reduce his thyroid levels. upon counselling you advise that he should seek urgent medical attention is he has any signs or symptoms of an infection, especially a sore that. which medication is this advise most appropriate for?
1) carbimazole
2) liothyronine
3) levothyroxine
4) cyproterone
Answer 1 carbimazole - causes bone marrow suppression
A 68-year-old man has an acute attack of gout. He had an MI three years ago and
has mild osteoarthritis but is otherwise well. He is taking the following medication:
* aspirin 75 mg once daily
* atorvastatin 40 mg once daily
* ramipril 10 mg once daily
* co-codamol 30/500 mg two tablets up to four times a day as required
He has no known drug allergies.
What is the most suitable drug treatment for his acute attack of gout?
A allopurinol
B colchicine
C diclofenac sodium
D etoricoxib
E febuxostat
B - Colchicine
A 54-year-old woman started to take pioglitazone 30 mg once daily one month
ago. She has also been taking metformin 500 mg three times a day for the past
two years. When collecting her repeat prescription, she complains of having dark
urine, nausea and fatigue for the last two weeks. She wonders if her new tablet is
to blame.
What is the most appropriate advice to give to this patient?
A she is experiencing a side-effect of pioglitazone, and whilst safe to continue
taking it, she may wish to see her GP for an alternative
B she should see her GP as the dose of pioglitazone may need to be
increased
C she should see her GP as the dose of pioglitazone may need to be reduced
D stop taking pioglitazone straight away and see her GP as soon as possible
E the symptoms described are not known to be caused by pioglitazone
Answer D
Which of the following drugs is it most important to withhold temporarily in view
of his current blood pressure? BP 98/58
A aspirin
B Clexane
C ramipril
D Relvar Ellipta
E salbutamol
ANSWER C
During his admission, he complains that for several weeks now he has had a sore
mouth.
Which of the following drugs is the most likely cause of his sore mouth?
A aspirin
B isosorbide mononitrate
C ramipril
D Relvar Ellipta
E salbutamol
Answer D
Psorin ointment contains the following active ingredients:
* salicylic acid 1.6%
* coal tar 1%
* dithranol 0.11%
Which of the following gives the correct weights of active ingredients required to
make 350 g of the ointment?
A 56 g salicylic acid; 35 g coal tar; 3.85 g dithranol
B 56 g salicylic acid; 3.5 g coal tar; 38.5 g dithranol
C 5.6 g salicylic acid; 3.5 g coal tar; 0.385 g dithranol
D 5.6 g salicylic acid; 3.5 g coal tar; 3.85 g dithranol
E 0.56 g salicylic acid; 0.35 g coal tar; 0.385 g dithranol
Answer C
A 59-year-old man presents his prescription for oxycodone hydrochloride 40 mg m/r
tablets.
What is the maximum recommended duration of supply on a single prescription
for this medicine?
A 7 days
B 28 days
C 30 days
D 3 months
E 6 months
Answer C
Which of the following drugs started in hospital is the most likely cause of his
abnormal biochemistry results (high serum creatinine, low GFR)?
A co-codamol
B Clexane (enoxaparin sodium)
C flucloxacillin
D fusidic acid
E naproxen
Answer E
You receive a prescription for haloperidol depot injections for one of your
patients. Your PMR system shows that the patient usually takes haloperidol
tablets.
What is the most likely reason in this patient that the haloperidol has been
changed from tablets to a depot injection?
A to improve adherence
B to improve efficacy
C to provide a more rapid response
D to reduce the risk of extrapyramidal side-effects
E to reduce the risk of neuroleptic malignant syndrome
Answer A
A 3-year-old child with no long-term medical conditions requires paracetamol for the
treatment of pyrexia associated with flu-like symptoms.
What is the most appropriate dose of paracetamol to be administered every six
hours?
A 60 mg
B 120 mg
C 180 mg
D 240 mg
E 360 mg
Answer C
A patient with type 2 diabetes needs to commence insulin treatment and would like
to use an insulin preparation that is injected subcutaneously twice daily with meals.
Which of the following is the most suitable insulin preparation for this regimen?
A Actrapid (soluble insulin)
B Apidra (insulin glulisine)
C Humalog Mix25 (biphasic insulin lispro)
D Lantus (insulin glargine)
E NovoRapid (insulin aspart)
Answer C
A patient has received four doses of gentamicin 80 mg by intravenous infusion
over 60 minutes every 12 hours for Gram-positive bacterial endocarditis (target
range for gentamicin: peak 3–5 mg/L, trough <1 mg/L). The peak gentamicin level
is reported as 2.5 mg/L one hour after intravenous administration, and the trough
concentration is 0.8 mg/L just before the next dose.
Which of the following is an appropriate method of dose rationalisation?
A decrease the dose and decrease the dosage interval
B increase the dose and increase the dosage interval
C increase the dose and maintain the same dosage interval
D maintain the same dose and decrease the dosage interval
E maintain the same dose and increase the dosage interval
Answer C
You want to obtain guidance on the record keeping requirements for the
management and monitoring of vaccine stocks in a pharmacy.
Which of the following is the most appropriate reference source to consult for
this information?
A British National Formulary
B British Pharmacopoeia
C Immunisation against infectious disease (known as the Green Book)
D Martindale: The Complete Drug Reference
E Rules and Guidance for Pharmaceutical Manufacturers and Distributors
(known as the Orange Guide)
Answer C
A 76-year-old man is taking the following medicines:
* atorvastatin 40 mg once daily
* dipyridamole m/r 200 mg twice daily
* esomeprazole 40 mg once daily
* metformin m/r 500 mg twice daily
* ramipril 2.5 mg once daily
He has type 2 diabetes and had a transient ischaemic attack two years ago. He has
just been diagnosed with AF and is to commence rivaroxaban 20 mg once daily.
Which of his existing medicines should be stopped due to the commencement of
rivaroxaban?
A atorvastatin
B dipyridamole
C esomeprazole
D metformin
E ramipril
Answer B - dipyridamole
A 45-year-old black man of African family origin has been diagnosed with
hypertension. His BP is 160/100 mmHg. He is starting antihypertensive therapy. He
does not have any other medical conditions and has no known allergies.
What is the most appropriate first-line anti-hypertensive for this man?
A amlodipine
B bisoprolol
C candesartan cilexetil
D indapamide
E ramipril
Answer A - amlodipine
You are to take on the role of the Responsible Pharmacist in the pharmacy you will
be working in.
What is the minimum period of time that the pharmacy record has to be kept?
A 1 year
B 2 years
C 5 years
D 7 years
E 10 years
Answer C - 5 years
Theme: Drug interactions
A bleeding risk increased
B bradycardia
C diarrhoea
D hypertensive crisis
E myopathy
F QT interval prolongation
G reduced eGFR
H thrombosis
A 49-year-old woman has bipolar disorder and has taken lithium carbonate 800 mg
daily for five years. She has been newly prescribed ramipril 2.5 mg daily for
hypertension.
Answer G
Theme: Drug interactions
A bleeding risk increased
B bradycardia
C diarrhoea
D hypertensive crisis
E myopathy
F QT interval prolongation
G reduced eGFR
H thrombosis
An 83-year-old woman takes the following medication:
* isosorbide mononitrate 50 mg m/r daily
* aspirin 75 mg daily
* amlodipine 10 mg daily
She has been newly prescribed simvastatin 40 mg at night.
Answer E
Theme: Drug interactions
A bleeding risk increased
B bradycardia
C diarrhoea
D hypertensive crisis
E myopathy
F QT interval prolongation
G reduced eGFR
H thrombosis
A 64-year-old man takes escitalopram 20 mg daily for generalised anxiety disorder. He
had a transient ischaemic attack 12 years ago and has recently been diagnosed with
non-valvular atrial fibrillation. He has been newly prescribed dabigatran etexilate
150 mg twice daily.
Answer A
