4118 MCQs Flashcards
1
Q
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
A
Answer C - Phytomenadione is vitamin K - see BNF
2
Q
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
A
Answer A - RPS drugs and driving legislation
3
Q
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
A
D Orlistat - BNF states in cautions - May impair absorption of fat-soluble vitamins
4
Q
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
A
Option D - Beta blockers can mask symptoms of hypoglycaemia
5
Q
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
A
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
6
Q
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
A - Amiodorone - BNF - Can cause corneal deposits and photosensitivity as common side effects
7
Q
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
A
Option B - Side effect of ferrous sulfate - Malaena ruled out
8
Q
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
A
Answer C - Metoclopramide contraindicated 3-4 days after GI surgery
Also should not be used in people under 18 due to risk of dystonias
9
Q
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
A
Answer B
10
Q
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
A
Pizotifen - all other medications should be avoided with NSAIDs
Pizotifen - sedating antihistamine used for migraines.
11
Q
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
A - confusing one
12
Q
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
A
Always cool the burn first then dress it. Never burst the blister and don’t apply creams or ointments.
13
Q
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
A
Trimethoprim and Methotrexate DDI
14
Q
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
A
Answer A +. Name and GPHC number.
15
Q
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
A
Answer A - Arichis oil is peanut oil
16
Q
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
A
Answer D - GLP 1 receptor agonists.- states in BNF
17
Q
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)
A
MOdrasone has same potency
18
Q
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
A
19
Q
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
A
E - BNF interactions section - miconazole increases the exposure of simvastatin and atorvastatin
20
Q
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
A
D - should be left on 8-12 hours
21
Q
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
A
D - ibuprofen is the only one in there at that strength that can be found OTC
22
Q
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
A
D renal excretion of methotrexate is reduced
23
Q
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
A
ABCD common symptoms of IBS, Vomiting is not
Answer E
24
Q
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
A
C
Circulation can begin to improve after 2 weeks
Wheezing and coughing 3- 9 months
Cancer and MI risk much longer
25
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.
26
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
27
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%
28
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
29
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
30
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
31
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
32
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
33
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
34
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
35
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
36
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!
37
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
38
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+
39
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
40
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.
41
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
42
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.
43
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
44
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
45
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
46
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
47
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
48
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
49
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
50
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
51
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
52
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
53
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
54
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
55
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
56
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
57
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
58
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
59
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
60
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
61
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
62
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
63
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
64
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
65
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
66
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
67
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
68
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
69
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
70
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
71
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
72
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
73
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 37-year-old man takes methadone 1 mg/mL oral solution 90 mg daily for opioid
addiction. He has been diagnosed with depression by his GP who has prescribed
citalopram 20 mg daily. The man has no other relevant medical history and has no
known allergies.
Answer F
74
Theme: Electrolyte abnormalities
A hypercalcaemia
B hyperkalaemia
C hypermagnesaemia
D hypernatraemia
E hypocalcaemia
F hypokalaemia
G hypomagnesaemia
H hyponatraemia
For the patients described, select from the list above, the most likely drug-induced cause
of the patient’s symptoms. Each option may be used once, more than once, or not at all.
28. A 66-year-old woman is reviewed in A&E following a two-day history of increasing
drowsiness, nausea and confusion. She was diagnosed with moderate depression three
weeks previously and has been taking fluoxetine 40 mg once daily.
Answer H - Hyponatraemia
75
What is the most appropriate formulation to put in an NG tube?
Effervescent tablets, normal tablets, dispersible tablets, solutions, suspensions
Answer - Solution
1. Solutions best option for NG tube
2. Tablet that disperses
3. Effervescent tablet
4. Suspension - due to viscosity and size of granules
5. Crushed tablet - tablet dust , amount loss difficult to account for
76
An 86-year-old man is admitted to hospital with increasing confusion. You are asked to review his medication and identify which may be affecting his cognitive state.
Which of the following medication would you prioritise for review?
(1 Point)
Atenolol
Oxybutynin
Paracetamol
Ranitidine
Simvastatin
77
What is the appropriate target clinic BP for an 80-year-old patient for primary prevention of end organ damage?
(1 Point)
140/80 mmHg
135/85 mmHg
120/80 mmHg
130/80 mmHg
150/80 mmHg
135/85 mmHg for end-organ damage in BNF, however Target for 80 year olds in general hypertension is below150/90.
78
For each of the following 3 questions choose the most appropriate option from the list below. Each option may be used once, more than once, or not at all
The most appropriate treatment for neuropathic pain
(1 Point)
Pregabalin
Ibuprofen
Metoclopramide
Midazolam
Cyclizine
Glycopyrronium bromide
Pregablin
79
For each of the following 3 questions choose the most appropriate option from the list below. Each option may be used once, more than once, or not at all
Contraindication for patients with bowel obstruction
(1 Point)
Pregabalin
Ibuprofen
Metoclopramide
Midazolam
Cyclizine
Glycopyrronium bromide
Metoclopramide
80
Which is NOT a counselling point for atorvastatin 80mg once daily?
(1 Point)
Atorvastatin has a long acting effect and can be taken at any time of day that will help you remember to take it.
Avoid cranberry juice.
Check with your GP or Pharmacist before taking any new medicines or supplements as they may interact with atorvastatin.
Replacing saturated fats with olive oil, rapeseed oil or spreads based on these oils is recommended.
Report any muscle aches, cramps, weakness or lethargy to your GP or Pharmacist.
Avoiding cranberry juice is not a counselling point for statins. It is to avoid grapefruit juice instead.
81
A 60kg female patient requires a maintenance infusion of the GP 2b/3a inhibitor tirofiban at 0.1microgram/kg/min after a PCI. If the infusion concentration is 12.5mg in 250ml sodium chloride 0.9%, which is the correct rate?
(1 Point)
0.1 ml/hour
6 ml/hour
7.2 ml/hour
50 ml/hour
360 ml/hour
7.2ml/hour
82
For each of the following 3 questions, choose ONE most appropriate option from the list below. Each option may be used once, more than once, or not at all.
Which medication is recommended as a first line therapy for angina in a patient with asthma?
(1 Point)
Bisoprolol
Ramipril
Amlodipine
Nicorandil
Indapamide
Verapamil
Verapamil - Certain Calcium channel blockers used if beta blockers contraindicated
83
For each of the following 3 questions, choose ONE most appropriate option from the list below. Each option may be used once, more than once, or not at all.
Which antihypertensive would be used 1st line in a 60year old patient with type 2 diabetes?
(1 Point)
Bisoprolol
Ramipril
Amlodipine
Nicorandil
Indapamide
Verapamil
Ramipril - ACE inhibitors still first line despite age and ethnicity in diabetes
84
For each of the following 3 questions, choose ONE most appropriate option from the list below. Each option may be used once, more than once, or not at all.
Which antianginal can cause GI ulceration as an ADR?
(1 Point)
Bisoprolol
Ramipril
Amlodipine
Nicorandil
Indapamide
Verapamil
Nicorandil
85
During an annual physical health check the following ECG result was obtained for a 76-year-old female patient.
QTc 502m/s
She is prescribed the following medication:
Lansoprazole 15mg daily
Clopidogrel 75mg daily
Bisoprolol 2.5mg daily
Ramipril 5mg daily
Citalopram 20mg daily
Which of the patient’s medication is most likely to have contributed to the patient’s prolonged QTc?
(1 Point)
Bisoprolol
Citalopram
Clopidogrel
Lansoprazole
Ramipril
Citalopram
85
A 37-year-old female is admitted with a manic episode to the mental health unit.
She is prescribed the following medication:
Lansoprazole 15mg daily
Gaviscon advance 10mls four times a day when required
Which of the following medication to treat mania is contraindicated in this patient?
(1 Point)
Lamotrigine
Lithium
Olanzapine
Risperidone
Valproic acid
Valproic acid - patient female and child bearing age
86
A 30-year-old male patient has been admitted with acute opioid toxicity to the local medical admission unit. He been given three slow IV boluses of 400micrograms naloxone, his RR has returned to normal, and he is improving. The medical team recommend a continuous IV naloxone infusion.
What dose of naloxone would you recommend for the first hour of the infusion?
(1 Point)
720micrograms
7.2mg
720mg
400micrograms
1200micrograms
Rate may be set at 60% the initial recuscitative intravenous injection dose per hour
720mcg
87
For each question (4-6), choose ONE most appropriate option from the list below. Each option may be used once, more than once, or not at all.
The most appropriate treatment for Wernicke’s encephalopathy
(1 Point)
Pabrinex® (Vitamins B and C intravenous infusion)
Lactulose
Chlordiazepoxide
Neomycin
Metronidazole
Propranolol
Pabrinex vit B and C
88
For each question (4-6), choose ONE most appropriate option from the list below. Each option may be used once, more than once, or not at all.
Used to prevent and treat symptoms of acute alcohol withdrawal
(1 Point)
Pabrinex® (Vitamins B and C intravenous infusion)
Lactulose
Chlordiazepoxide
Neomycin
Metronidazole
Propranolol
Chlordiazepoxide - see BNF
89
For each question (4-6), choose ONE most appropriate option from the list below. Each option may be used once, more than once, or not at all.
Used for prophylaxis of variceal bleeding in portal hypertension
Pabrinex® (Vitamins B and C intravenous infusion)
Lactulose
Chlordiazepoxide
Neomycin
Metronidazole
Propranolol
Propanolol
90
Which of the following statements relating to the use of a GTN spray is CORRECT?
(1 Point)
Avoid using before planned exercise
The spray is used via the sublingual route
Constipation is a known side effect
If pain continues after the 1st dose then call 999
Sit down where possible before use as it can cause an increase in BP
The spray is used via the subligual route
91
A patient is taking Tramadol 100mg QDS, and has required three additional doses of 10mg morphine sulphate solution 10mg/5ml each day for the last two days. Convert the patient’s current analgesics requirement to an equivalent dose of subcutaneous morphine for infusion over 24 hours
(1 Point)
70mg
50mg
45mg
35mg
20mg
35mg
92
or each question (3-5) , choose ONE most appropriate option from the list below. Each option may be used once, more than once, or not at all.
Which is the recommended antiplatelet option to continue for life for patients diagnosed with an ACS.
(1 Point)
Abciximab
Aspirin
Aspirin + ticagrelor
Atorvastatin
Clopidogrel + ticagrelor
Morphine
Aspirin
93
For each question (3-5) , choose ONE most appropriate option from the list below. Each option may be used once, more than once, or not at all.
Which should be discontinued if creatine kinase levels are > 5 times the upper normal limit.
(1 Point)
Abciximab
Aspirin
Aspirin + ticagrelor
Atorvastatin
Clopidogrel + ticagrelor
Morphine
Atorvastatin - Rabdo and all that
94
For each question (3-5) , choose ONE most appropriate option from the list below. Each option may be used once, more than once, or not at all.
Which has vasodilating, anxiolytic properties when administered for the acute treatment of ACS?
(1 Point)
Abciximab
Aspirin
Aspirin + ticagrelor
Atorvastatin
Clopidogrel + ticagrelor
Morphine
Morphine
95
You are conducting a medication review for a 78-year-old woman. On reviewing her latest routine blood tests, the following results are noted:
High calcium
relatively high alkaline
She is prescribed the following medication:
Sertraline 50mg daily
Furosemide 40mg daily
Lithium carbonate MR 400mg at night
Omeprazole 20mg daily
Ramipril 5mg daily
Which of the patient’s medications is most likely to have contributed to the patient’s abnormal blood result?
Furosemide
Lithium
Omeprazole
Ramipril
Sertraline
96
Patient A is in hospital and has been prescribed the medication below. Which of the below medications are MOST LIKELY to cause the following side effect?
Ankle Swelling
Spironolactone tablets 100mg OD
Allopurinol tablets 200mg OD
Clindamycin capsules 300mg QDS (started on admission for a skin infection)
Aspirin 75mg OD
Amlodipine tablets 5mg OD
Ankle swelling
97
Patient A is in hospital and has been prescribed the medication below. Which of the below medications are MOST LIKELY to cause the following side effect?
Diarrhoea
Spironolactone tablets 100mg OD
Allopurinol tablets 200mg OD
Clindamycin capsules 300mg QDS (started on admission for a skin infection)
Aspirin 75mg OD
Amlodipine tablets 5mg OD
Clindamycin
98
Which of the drugs listed below (A-E) would be the most appropriate to be prescribed for treatment of hypertension in patients (1) to (3)?
A: Valsartan 80mg tablets
B: Amlodipine 5mg tablets
C: Bendroflumethiazide 2.5mg tablets
D: Ramipril 2.5mg capsules
E: Propranolol 80mg tablets
1) A 47-year-old black African male patient who has been newly diagnosed with hypertension (150/95 mmHg in clinic and 145/90 mmHg ambulatory). His 10 year cardiovascular risk is calculated at 10%. He is also asthmatic (on Step 2 of asthma treatment).
140/90-159/99 clinic and ABPM avg 135/85-149/94 = stage 1. 10 y CV risk >=10% discuss starteing medication. Hypertension w/o t2dm in Black African patient = Ca blocker 1st choice. Then add ARB or indapamide. (Black African consider ARB over ACEi). Go for b - amlodipine
99
Which of the drugs listed below (A-E) would be the most appropriate to be prescribed for treatment of hypertension in patients (1) to (3)?
A: Valsartan 80mg tablets
B: Amlodipine 5mg tablets
C: Bendroflumethiazide 2.5mg tablets
D: Ramipril 2.5mg capsules
E: Propranolol 80mg tablets
A male patient aged 52 years, of Bangladeshi origin, who has been newly diagnosed with hypertension (175/105 mmHg in clinic and 160/95 mmHg home monitoring). He suffers from cholestasis.
ACEi or ARB. Valsartan is C/I due to cholestasis so go for D - ramipril
99
Which of the drugs listed below (A-E) would be the most appropriate to be prescribed for treatment of hypertension in patients (1) to (3)?
A: Valsartan 80mg tablets
B: Amlodipine 5mg tablets
C: Bendroflumethiazide 2.5mg tablets
D: Ramipril 2.5mg capsules
E: Propranolol 80mg tablets
2) A 48-year-old female Caucasian patient with current blood pressure of 106/105mmHg and who has been taking enalapril for six weeks. She has no other medical conditions.
Under 55, no t2dm = ACEi or ARB then add Ca blocker or thiazide like. No thiazide like on list so go for b - amlodipine
100
Which of the following outcomes could result from the high dose drug regimens / drug combinations described in EACH question (4) to (6) below?
A: Hyperglycaemia
B: Hyperkalaemia
C: Hypoglycaemia
D: Hypokalaemia
E: Hyponatraemia
4) Prednisolone (40mg once daily for 5 days) and high-dose salbutamol. (1 mark)
D - Hypokalaemia
101
Which of the following outcomes could result from the high dose drug regimens / drug combinations described in EACH question (4) to (6) below?
A: Hyperglycaemia
B: Hyperkalaemia
C: Hypoglycaemia
D: Hypokalaemia
E: Hyponatraemia
Omeprazole at a dose of 40mg twice daily
E - Hyponatraemia, stated for all general PPis as rare side effect in general drug monograph
102
Which of the following outcomes could result from the high dose drug regimens / drug combinations described in EACH question (4) to (6) below?
A: Hyperglycaemia
B: Hyperkalaemia
C: Hypoglycaemia
D: Hypokalaemia
E: Hyponatraemia
6) Sodium picosulfate and carbamazepine
E - Hyponatraemia
103
Using the advice in the BNF, state the dose (A - E) that would be appropriate in situations (7) to (9) below.
A: 15mg
B: 20mg
C: 24mg
D: 48mg
E: 100mg
7) A patient taking MST (Slow release morphine) tablets at a dose of 30mg bd is no longer to take medication by mouth; what dose of diamorphine should be used in a continuous subcutaneous infusion (via syringe driver) over 24 hours?
B - 60mg morphine a day = 20mg of diamorphine - see prescribing in palliative care guidance, continuous sc infusions section.
104
Using the advice in the BNF, state the dose (A - E) that would be appropriate in situations (7) to (9) below.
A: 15mg
B: 20mg
C: 24mg
D: 48mg
E: 100mg
8) A patient has been taking codeine 30mg tablets at a dose of 2 QDS. What is the equivalent daily dose of oral morphine?
D - 100mg codeine po equivalent to 10mg morphine po. Taking 240mg in a day; therefore = 24mg morphine see prescribing in palliative care guidance, pain management with opioids section
105
Using the advice in the BNF, state the dose (A - E) that would be appropriate in situations (7) to (9) below.
A: 15mg
B: 20mg
C: 24mg
D: 48mg
E: 100mg
9) 10mg of diamorphine is being mixed with cyclizine in a syringe driver containing 10ml of water for injections for subcutaneous administration over a 24 hour period. What is the maximum amount of cyclizine which can be used without risking precipitation?
E - not above 10mg/ml or can precipitate so 100mg in 10ml - see prescribing in palliative care guidance, continuous sc infusions section.
106
A patient is taking the medication (A-E) shown in the list below. Which drug is MOST LIKELY to be responsible for each of the electrolyte abnormalities stated in questions (13)-(15)?
A: Co-codamol 30/500 tablets 2 QDS
B: Folic acid tablets 5mg once weekly
C: Furosemide tablets 80mg in the morning
D: Methotrexate tablets 20mg once weekly
E: Ramipril capsules 5mg in the morning, started 5 days ago
13) Potassium of 3.1mmol/L (3.5-5.0mmol/L)
C: Furosemide tablets 80mg in the morning
107
A patient is taking the medication (A-E) shown in the list below. Which drug is MOST LIKELY to be responsible for each of the electrolyte abnormalities stated in questions (13)-(15)?
A: Co-codamol 30/500 tablets 2 QDS
B: Folic acid tablets 5mg once weekly
C: Furosemide tablets 80mg in the morning
D: Methotrexate tablets 20mg once weekly
E: Ramipril capsules 5mg in the morning, started 5 days ago
E: Ramipril capsules 5mg in the morning, started 5 days ago
108
A patient is taking the medication (A-E) shown in the list below. Which drug is MOST LIKELY to be responsible for each of the electrolyte abnormalities stated in questions (13)-(15)?
A: Co-codamol 30/500 tablets 2 QDS
B: Folic acid tablets 5mg once weekly
C: Furosemide tablets 80mg in the morning
D: Methotrexate tablets 20mg once weekly
E: Ramipril capsules 5mg in the morning, started 5 days ago
15) White cell count of 3.1 x 109/L (4.0-11.0 x 109/L)
D: Methotrexate tablets 20mg once weekly
109
Which of the (A-E) is the most appropriate meropenem dose for IV infusion for the following patients (19)-(21)? You can assume no allergies or medical conditions / medication other than those stated.
A: 0.5g every 8 hours
B: 0.5g every 12 hours
C: 1g every 24 hours
D: 2g every 8 hours
E: 2g every 12 hours
19) A 25-year-old woman with meningitis, she has an eGFR of 45 ml/min/1.73m2
E: normal dose (2g) but given every 12h rather than 8 hourly as eGFR 26-50
110
Which of the (A-E) is the most appropriate meropenem dose for IV infusion for the following patients (19)-(21)? You can assume no allergies or medical conditions / medication other than those stated.
A: 0.5g every 8 hours
B: 0.5g every 12 hours
C: 1g every 24 hours
D: 2g every 8 hours
E: 2g every 12 hours
20) A 56-year-old man with hospital acquired septicaemia. He has no allergies. He has slightly raised blood pressure currently being managed with lifestyle changes. He has an eGFR of 95 ml/min/1.73m2
A - normal renal function, dose is 0.5-1g every 8 hours
111
Which of the (A-E) is the most appropriate meropenem dose for IV infusion for the following patients (19)-(21)? You can assume no allergies or medical conditions / medication other than those stated.
A: 0.5g every 8 hours
B: 0.5g every 12 hours
C: 1g every 24 hours
D: 2g every 8 hours
E: 2g every 12 hours
A 19-year-old man with hospital acquired septicaemia. He has mild asthma and an eGFR of 22 ml/min/1.73m2
B: half normal dose (=0.25-0.5g) and given every 12h rather than 8 hourly as eGFR 10-25
Half normal dose every 24h if eGFR <10ml/min/1.73m2
Half normal dose every 12h if eGFR 10-25
Normal dose every 12h if eGFR 26-50
Hosp aq septic - 0.5-1g q8h
Meningitis 2g every 8h
112
What is the most appropriate quantity of the relevant dosage forms to dispense for the following three patients (22)-(25)? Use the recommended BNF dose to calculate where necessary.
A: 14
B: 21
C: 28
D: 42
E: 84
22) A 17-year-old is just being started on gabapentin as an adjunctive therapy for their focal seizures. Their specialist has decided to take a cautious approach, using the slowest titration recommended by the BNF. They want you to provide enough 300mg gabapentin capsules until the patient’s review which is in a week’s time.
. B: 300mg day one, 300 bd day 2, 300 tds from day 3. Monday 1+ Tues 2+ Weds 3+ Thurs 3+ Fri 3+ Sat 3+ Sun 3+ Monday (day of appt) 3 - give 21 (ensures enough for Monday’s dose - depending on appointment time might need 1 or 2 doses)
113
A: 14
B: 21
C: 28
D: 42
E: 84
An adult patient with pernicious anaemia with neurological involvement requires 4 weeks’ initial treatment of hydroxocobalamin. How many Cobalin-H® ampoules are required?
A: 1mg od on alt days - 14 x 1mg. Comes as 1mg/ml ampoule so need 14
114
A: 14
B: 21
C: 28
D: 42
E: 84
An adult patient with microscopic colitis is prescribed a 4-week supply of budesonide to induce remission of their flare up. How many Budenofalk® capsules are required?
E: Budenofalk comes as a 3mg GR capsule so need 3 per day - 3x7x4=84
115
You are working in a community pharmacy. One of the receptionists from the local dental surgery, Morgan, comes in for some advice about a “rash” on their foot. On examination, you diagnose athlete’s foot affecting Morgan’s right foot. The infection is not severe or extensive and the toenails are not affected. Morgan has no strong preference about which product you give them “as long as it clears it up fast, because I’m rubbish at remembering to take medicines”. Morgan has epilepsy for which they take levetiracetam tablets. They have no allergies and no other medical conditions or medications.
What is the most appropriate recommendation?
a. Canesten Dual Action® 1% cream
b. Daktacort Hydrocortisone® cream
c. Daktarin Aktiv® 2% cream
d. Lamisil AT® 1% cream
e. Mycota® cream
D - Terbinafine preferable as once daily for one week; although other products are treatments for athlete’s foot and are not contraindicated, they are either less effective or there may be compliance issues with them as they need to be used more frequently.
116
Question 26
You are working as a community pharmacist. One of the local GPs rings you to ask for some prescribing advice for one of their patients. The patient is a 28-year-old woman who has just been diagnosed with familial hypercholesterolaemia. She is currently 20 weeks pregnant.
What is the most appropriate recommendation?
a. Atorvastatin 20mg – Take 1 nocte
b. Ezetimibe 10mg – Take 1 nocte
c. Fenofibrate 160mg – Take 1 nocte
d. No drug should be prescribed
e. Simvastatin 20mg – Take 1 nocte
D - No drug. All are normally appropriate choices, but in this case the patient is pregnant and all say avoid (embryotoxicity / congenital anomalies) except ezetimibe. However ezetimibe says only to use if benefit outweighs risk - in this case the patient can wait to begin treatment - the risk to the pregnancy outweighs any CV risk to her.
117
A female patient in their mid-30s has presented at your community pharmacy and asked for some advice. She describes experiencing some abdominal pains but has no other symptoms of note. On further probing you elicit that the pain is localised epigastric pain. When asked about timings she says it has been present for the past few days; she has not experienced it before. When asked what she thinks is the cause she says she can’t think of anything obvious - the only thing she has noticed is that it always seems to come on around an hour after eating. With regard to medical history, she says she has no medical conditions and her only medication is naproxen tablets which she takes for period pain (her last menstrual period was around two weeks ago) and the oral contraceptive pill (Yasmin®).
What is the most likely diagnosis?
a. Ectopic pregnancy
b. Gastric cancer
c. Gastro-Oesophageal Reflux Disease
d. Irritable Bowel Syndrome
e. Peptic ulcer
E - All of these conditions can cause abdominal pain, but the timescale / symptoms suggest that a peptic ulcer is the most likely diagnosis
118
While you are working as a hospital pharmacist, one of the junior doctors (F1) asks your advice about the choice of antibacterial to prescribe for a patient who has begun to develop cellulitis. The patient is a 55-year-old man who is in hospital after an operation yesterday morning on a badly broken ankle. The patient is otherwise healthy - he has no medical conditions and no allergies. He does not have a fever. His only medication is analgesia for the pain after his operation (paracetamol 2 x 500mg tabs qds, plus codeine 30mg tabs prn up to qds).
What is the most suitable recommendation? (You may assume that all options are appropriate to cultures / hospital treatment guidelines)
a. Clarithromycin intravenously
b. Clarithromycin orally
c. Co-amoxiclav orally
c. Flucloxacillin intravenously
d. Flucloxacillin orally
D fluclocacillin orally - First line treatment is flucloxacillin, give oral if patient is able to swallow and infection is not severe (clarithromycin if fluclox unsuitable, co-amoxiclav if near eyes or nose).
Note that since this question was written, a severe anecdotal interaction between flucloxacillin and paracetamol has been highlighted (re metabolic acidosis – manufacturer advises caution) – as such oral clarithromycin may be a better choice unless patient is being carefully monitored / paracetamol withheld. Will update this question for future but too late to do so now!
119
Question 29
A 40-year-old male comes to your community pharmacy and asks for “something for my stomach”. They are experiencing persistent epigastric pain and have recently vomited. They have no allergies and are taking the following medications:
* Atorvastatin
* Metformin
* Ramipril
* Sitagliptin
Which of the following would be the most appropriate action?
a. Advise patient to maintain hydration by drinking plenty of fluids and using rehydration sachets
b. Advise patient to use Gaviscon Advance® after meals and at bedtime
c. Advise patient to use Nexium Control® and see GP if no improvement within 14 days
d. Advise patient to use Rennie® tablets when required, up to 10 tablets in a day
e. Refer patient for urgent medical assessment
E - Symptoms are suggestive of pancreatitis which is a rare S/E of sitagliptin. Urgent medical assessment required.
120
A patient in their late 40s has presented to their local surgery with an extremely painful big toe. They have not injured it, but yesterday it suddenly went very red, with redness and swelling around the toe joint. The GP diagnoses acute gout. The patient has high blood pressure, for which they take ramipril, and high cholesterol, for which they take simvastatin. They do not smoke but do drink around 18 units of alcohol a week and have a fairly sedentary lifestyle. Their diet is more healthy since they started taking statins but is predominantly composed of lean red meat with vegetables. The GP needs to identify a suitable initial treatment for this acute attack, but plans to review the patient once the attack has subsided.
What is the most appropriate initial treatment option?
a. Allopurinol 100mg od
b. Aspirin 600mg every 4-6 hours
c. Colchicine 500mcg tds
d. Diclofenac 50mg tds
e. Paracetamol 1g every 4-6 hours
D - Allopurinol is prescribed for gout but for prevention so is not appropriate for an acute attack. Aspirin and paracetamol are both analgesics but aspirin is not indicated in gout and paracetamol is not suitable first line treatment on its own (although can be added to NSAID). Colchicine appropriate for acute attack but there is a DDI with statin (suggests exercise caution or monitor), this would be manageable but since diclofenac is an option which is appropriate and does not have the DDI issue this would be the best option.
121
Miss JS, aged 38, visits the community pharmacy and requests
beclometasone nasal spray. She informs you she has a history of allergic
rhinitis and also suffers from seasonal allergy. She has been advised to
use this spray but is unsure how long she can use the spray for. She has
no known other medical conditions and no known drug allergies. You
decide to supply the spray and explain the maximum usage.
What is the recommended maximum duration of the nasal spray?
A 7 days
B 14 days
C 1 month
D 2 months
E 3 months
122
Mrs GB, aged 32, has visited the community pharmacy seeking advice
regarding her daughter, OJ who is 6 years old. After reviewing her
symptoms, you decide she needs to be treated with mebendazole due to
a diagnosis of threadworm.
Which of the following statements is correct regarding mebendazole?
A If you are re-infected, it may be appropriate to take a further
course after 2 weeks
B It is recommended to treat all family members who are
infected
C It is suitable to provide this to pregnant patients
D Mebendazole is licensed in children over the age of 1 year
E Treatment is usually once daily over a course of 7 days
123
Mr TS, aged 29, presents to the pharmacy with a red eye. He has not
previously experienced these symptoms and woke up this morning with
a red left eye. He would like your advice. On examining the eye, you
note redness on the area of the left eye. The right eye is unaffected. Mr
TS reports nil pain and nil discharge. He does not have a temperature
and states he feels fit and well otherwise.
What is the likely diagnosis?
A Bacterial conjunctivitis
B Haemorrhagic conjunctivitis
C Keratitis
D Subconjunctival haemorrhage
E Viral conjunctivitis
124
Mr CK, aged 52, presents to the pharmacy requesting Sudafed® tablets.
Upon questioning you note that he has taken this medication in the past
for a blocked nose and he found it useful in clearing his symptoms.
Which of the following statements is correct regarding Sudafed®?
A The active ingredient in each tablet is pseudoephedrine 6 mg
B This medication is for the use in adults and children aged
12 years and above
C This medication is safe to use in diabetes
D This medication is safe to use in hypertension
E This medication is used for blocked noses, sinuses, runny
nose, catarrh and epistaxis
125
Mr GF, aged 22, visits the pharmacy with a concern regarding pain
when opening his bowels. You decide to discuss his symptoms with him,
and he informs you the pain occurs whilst his bowels move. He has also
noticed a small speck of fresh blood upon wiping. He was constipated
1 week ago but this has now resolved. He has not experienced these
symptoms in the past.
Which of the following is the most appropriate way to manage Mr GF?
A Manage with AnuSol® ointment
B Manage with ibuprofen gel 5%
C Manage with 1 g glyceryl suppositories PR
D Refer to A & E
E Refer to GP
126
Which of the following medications should be prescribed and dispensed by brand due to differences in bioavailability between various
formulations?
A Amlodipine
B Aripiprazole
C Fluoxetine
D Hyoscine butylbromide
E Tacrolimus
127
Miss SK, aged 55, presents to the community pharmacy wanting some
advice regarding her pain relief medication. She recently purchased
ibuprofen 400 mg tablets 2 days ago and has been experiencing pain in
her abdomen and noticed dark stools when she visited the toilet. She is
unsure how to proceed.
Which of the following is the most appropriate recommendation?
A Reassure patient and advise to continue with ibuprofen
B Refer to A & E
C Refer to GP to issue a proton pump inhibitor
D Stop ibuprofen and wait 24 hours for symptoms to resolve
E Stop ibuprofen, replace with paracetamol and wait 24 hours
for symptoms to resolve
128
Mr DF, aged 48, visits the pharmacy with a localised rash on his
left arm. Upon examining you note that there is a red round circular
presentation. There is a sharp margin and raised edges. Mr DF explains
it is quite itchy and has been present for 2 days.
What is the most appropriate way to manage Mr DF?
A Refer to A & E
B Refer to GP
C Supply clobetasone butyrate 0.05% cream
D Supply miconazole 2% powder
E Supply OTC clotrimazole 1% cream
129
Mr DG, aged 48, presents to the pharmacy requesting management of
a lesion on his foot. Mr DG takes the following medication: ramipril
5 mg OD, paracetamol 1 g QDS, atorvastatin 80 mg ON, aspirin 75 mg
OD, bisoprolol 5 mg OD, metformin 500 mg TDS, glimepiride 2 mg
OD and lansoprazole 15 mg OD.
Upon examining the lesion, you note tiny black dots collected under
the surface of hard skin. The lesion is approximately 5 mm wide.
What is the most appropriate way to manage this patient?
A Refer to GP
B Supply Bazuka™ gel
C Supply Iglu® gel
D Supply 1% clotrimazole cream
E Supply 2% miconazole cream
130
GPT
Question: A 55-year-old male with a history of chronic heart failure is prescribed digoxin. His current serum digoxin level is 1.5 ng/mL, and he is exhibiting signs of toxicity. The therapeutic range for digoxin is 0.5-2.0 ng/mL. Which of the following electrolyte imbalances is most likely to exacerbate digoxin toxicity?
A) Hyperkalemia
B) Hypocalcemia
C) Hypokalemia
D) Hypernatremia
C) Hypokalemia
131
GPT A patient with renal impairment (CrCl < 30 mL/min) is being treated for deep vein thrombosis (DVT) with enoxaparin. The standard dosing is 1 mg/kg subcutaneously every 12 hours. What adjustment should be made to the dosing regimen?
A) Continue with the same dose
B) Change to 1 mg/kg subcutaneously every 24 hours
C) Change to 0.5 mg/kg subcutaneously every 12 hours
D) Discontinue enoxaparin and use unfractionated heparin
Answer: B) Change to 1 mg/kg subcutaneously every 24 hours
132
GPT A patient with atrial fibrillation is being initiated on dabigatran. The patient has a creatinine clearance (CrCl) of 25 mL/min. What is the recommended dose of dabigatran for this patient?
A) 150 mg twice daily
B) 110 mg twice daily
C) 75 mg twice daily
D) Dabigatran is contraindicated
Answer: B) 110 mg twice daily (dose adjustment required due to renal impairment)
133
GPT A pharmacist is preparing a 3% w/v solution of potassium chloride (KCl). The stock solution available is 10% w/v KCl. How much of the stock solution is required to prepare 500 mL of the 3% w/v solution?
A) 100 mL
B) 150 mL
C) 200 mL
D) 250 mL
150ml
134
GPT A 30-year-old female patient with epilepsy is taking carbamazepine. She becomes pregnant unexpectedly. Which of the following is the most appropriate course of action?
A) Discontinue carbamazepine immediately
B) Switch to valproate
C) Continue carbamazepine and start folic acid 5 mg daily
D) Switch to lamotrigine
C) Continue carbamazepine and start folic acid 5 mg daily (Carbamazepine is a known teratogen, but sudden discontinuation can be dangerous; folic acid supplementation is recommended to reduce the risk of neural tube defects.)
135
GPT Question: A patient is receiving an infusion of norepinephrine at a rate of 5 mL/hour. The concentration of the infusion is 4 mg in 50 mL. What is the dose of norepinephrine the patient is receiving in micrograms per minute?
A) 6.67 mcg/min
B) 8.33 mcg/min
C) 10.00 mcg/min
D) 12.50 mcg/min
B) 8.33 mcg/min
136
GPT Question: A patient is started on lithium for bipolar disorder. What is the target serum lithium concentration for maintenance therapy, and which laboratory test should be routinely monitored due to a potential adverse effect?
A) 0.1-0.5 mmol/L; Thyroid function tests
B) 0.6-1.0 mmol/L; Renal function tests
C) 0.8-1.2 mmol/L; Liver function tests
D) 1.2-1.5 mmol/L; Complete blood count (CBC)
Answer: B) 0.6-1.0 mmol/L; Renal function tests (Lithium has a narrow therapeutic index and can affect renal function.)
137
GPT Question: A patient with a history of stroke is on aspirin and clopidogrel. The patient experiences gastrointestinal bleeding. Which of the following is the most appropriate course of action?
A) Discontinue both aspirin and clopidogrel
B) Continue aspirin only
C) Discontinue clopidogrel and start a proton pump inhibitor (PPI)
D) Switch to warfarin
Answer: C) Discontinue clopidogrel and start a proton pump inhibitor (PPI)
138
GPT Question: A patient undergoing chemotherapy for cancer develops severe neutropenia. Which of the following agents is most appropriate to manage this condition?
A) Filgrastim
B) Epoetin alfa
C) Oprelvekin
D) Romiplostim
Answer: A) Filgrastim (Filgrastim is a granulocyte colony-stimulating factor (G-CSF) that stimulates the production of neutrophils.)
138
GPT Question: A patient with chronic obstructive pulmonary disease (COPD) is prescribed tiotropium and salmeterol. Which statement best describes the pharmacological class and mechanism of action of these medications?
A) Both are short-acting beta-agonists (SABAs) that dilate bronchial smooth muscle.
B) Tiotropium is a long-acting muscarinic antagonist (LAMA) and salmeterol is a long-acting beta-agonist (LABA).
C) Both are inhaled corticosteroids that reduce airway inflammation.
D) Tiotropium is a LABA and salmeterol is a LAMA.
Answer: B) Tiotropium is a long-acting muscarinic antagonist (LAMA) and salmeterol is a long-acting beta-agonist (LABA).
139
Question: A patient with chronic kidney disease (CKD) stage 4 is prescribed metformin for type 2 diabetes. The patient’s estimated glomerular filtration rate (eGFR) is 28 mL/min/1.73m². What is the most appropriate action regarding the metformin therapy?
A) Continue metformin at the current dose
B) Reduce the dose of metformin by half
C) Discontinue metformin immediately
D) Switch to insulin therapy
Answer: C) Discontinue metformin immediately
Explanation: Metformin is contraindicated in patients with an eGFR below 30 mL/min/1.73m² due to the increased risk of lactic acidosis, a rare but serious side effect. For patients with an eGFR of 30-45 mL/min/1.73m², metformin should be used with caution, often at a reduced dose, but in this case (eGFR of 28), it should be discontinued immediately to prevent lactic acidosis.
140
Question: A patient is being treated with phenytoin for epilepsy. The patient has also started taking fluconazole for a fungal infection. How might the interaction between these drugs affect the patient?
A) Increased risk of seizures
B) Decreased effectiveness of fluconazole
C) Increased risk of phenytoin toxicity
D) No significant interaction
Answer: C) Increased risk of phenytoin toxicity
Explanation: Fluconazole is a potent inhibitor of the CYP2C9 enzyme, which is responsible for the metabolism of phenytoin. Inhibition of this enzyme leads to higher plasma levels of phenytoin, increasing the risk of toxicity, which can manifest as ataxia, nystagmus, and confusion.
141
Question: A 70-year-old male with a history of atrial fibrillation and mechanical heart valve replacement is prescribed warfarin. He is also taking amiodarone for rhythm control. How should his warfarin therapy be adjusted?
A) Increase warfarin dose by 50%
B) Continue the same dose of warfarin
C) Reduce warfarin dose by 30-50%
D) Discontinue warfarin and switch to direct oral anticoagulant (DOAC)
Answer: C) Reduce warfarin dose by 30-50%
Explanation: Amiodarone inhibits the metabolism of warfarin through the CYP2C9 pathway, leading to an increased INR and higher risk of bleeding. Therefore, it is recommended to reduce the warfarin dose by 30-50% when initiating amiodarone. Regular monitoring of INR is essential to adjust the dose accordingly.
142
Question: A patient presents with severe hypercalcemia due to malignancy. Which of the following is the most appropriate initial treatment to lower calcium levels?
A) Furosemide
B) Intravenous bisphosphonates
C) Calcitonin
D) Hydration with normal saline
Answer: D) Hydration with normal saline
Explanation: The initial treatment for severe hypercalcemia is aggressive hydration with normal saline to promote renal calcium excretion. Bisphosphonates and calcitonin are also used but are typically administered after rehydration. Furosemide can be used in certain cases after adequate hydration to further promote calcium excretion, but it is not the initial treatment.
143
Question: A 45-year-old female with rheumatoid arthritis is started on methotrexate. What is the most important supplementation that should be prescribed alongside methotrexate to reduce toxicity?
A) Vitamin B12
B) Folic acid
C) Iron
D) Vitamin D
Answer: B) Folic acid
Explanation: Methotrexate inhibits dihydrofolate reductase, leading to a deficiency in folate, which is essential for DNA synthesis and repair. This can cause side effects such as bone marrow suppression, gastrointestinal toxicity, and liver damage. Folic acid supplementation (usually 5 mg once weekly) is recommended to mitigate these adverse effects without reducing the efficacy of methotrexate in rheumatoid arthritis.
144
Question: A patient with atrial fibrillation is prescribed dabigatran but is experiencing significant gastrointestinal side effects. Which of the following anticoagulants is least likely to cause gastrointestinal issues and could be considered as an alternative?
A) Rivaroxaban
B) Apixaban
C) Warfarin
D) Edoxaban
Answer: B) Apixaban
Explanation: Apixaban has been shown to have a lower incidence of gastrointestinal side effects compared to other direct oral anticoagulants (DOACs) like dabigatran and rivaroxaban. It is often preferred in patients who experience GI intolerance with other anticoagulants. Warfarin could be an option, but it requires frequent monitoring and has a different side effect profile.
145
Question: A patient with a history of deep vein thrombosis (DVT) is on warfarin therapy. He is diagnosed with a urinary tract infection (UTI) and prescribed trimethoprim-sulfamethoxazole. How might this antibiotic affect his INR?
A) INR will decrease
B) INR will increase
C) No effect on INR
D) INR will become unpredictable
Answer: B) INR will increase
Explanation: Trimethoprim-sulfamethoxazole inhibits the metabolism of warfarin via CYP2C9 inhibition, leading to an increase in INR and a higher risk of bleeding. Patients on warfarin who start this antibiotic require close monitoring and potential dose adjustments to avoid excessive anticoagulation.
146
Question: A patient taking lithium for bipolar disorder develops polyuria and polydipsia. His serum sodium level is normal. Which of the following conditions is most likely responsible for these symptoms?
A) Lithium-induced diabetes insipidus
B) Hyperglycemia
C) Hyponatremia
D) Lithium toxicity
Answer: A) Lithium-induced diabetes insipidus
Explanation: Lithium can impair the kidney’s ability to concentrate urine, leading to nephrogenic diabetes insipidus, characterized by polyuria (excessive urination) and polydipsia (excessive thirst). Despite normal sodium levels, the patient may develop a significant electrolyte imbalance if the condition persists. Monitoring and potential adjustment of lithium therapy are required.
147
A 65-year-old male with chronic obstructive pulmonary disease (COPD) is prescribed theophylline. He is also a chronic smoker. How might smoking affect the pharmacokinetics of theophylline?
A) Decreased clearance of theophylline
B) Increased clearance of theophylline
C) No effect on theophylline levels
D) Decreased absorption of theophylline
Answer: B) Increased clearance of theophylline
Explanation: Smoking induces the CYP1A2 enzyme, which increases the metabolism and clearance of theophylline. As a result, smokers often require higher doses of theophylline to achieve therapeutic levels. If the patient quits smoking, the theophylline dose may need to be reduced to avoid toxicity.
148
A patient is prescribed a medication that is a strong inhibitor of the CYP3A4 enzyme. Which of the following drugs is most likely to require a dose adjustment due to this interaction?
- A) Metformin
- B) Atorvastatin
- C) Lisinopril
- D) Warfarin
Explanation: Atorvastatin is metabolized by the CYP3A4 enzyme. A strong inhibitor of CYP3A4 will reduce the metabolism of atorvastatin, leading to increased plasma levels and a higher risk of side effects, such as myopathy or rhabdomyolysis. Therefore, the dose of atorvastatin may need to be adjusted or monitored closely when a strong CYP3A4 inhibitor is introduced.
149
1. Question: A 62-year-old female with a history of osteoarthritis is prescribed naproxen for pain management. She is also taking lisinopril for hypertension. What is a potential risk of combining these two medications?
A) Hyperkalemia
B) Hypotension
C) Acute kidney injury (AKI)
D) Hypokalemia
Answer: C) Acute kidney injury (AKI)
Explanation: Nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen can reduce renal blood flow by inhibiting prostaglandin synthesis, leading to decreased glomerular filtration. When combined with ACE inhibitors like lisinopril, which also reduce glomerular filtration pressure, there is an increased risk of acute kidney injury. Patients on this combination should be monitored for renal function.
150
2. Question: A 45-year-old patient with hyperlipidemia is prescribed simvastatin. They are also prescribed clarithromycin for a respiratory infection. What is the primary concern with this drug combination?
A) Increased risk of myopathy
B) Decreased efficacy of simvastatin
C) Increased risk of hepatotoxicity
D) Decreased absorption of clarithromycin
Answer: A) Increased risk of myopathy
Explanation: Clarithromycin is a strong inhibitor of CYP3A4, the enzyme responsible for the metabolism of simvastatin. This inhibition can lead to significantly increased levels of simvastatin, raising the risk of myopathy or rhabdomyolysis. It’s generally advised to avoid this combination or use an alternative statin not metabolized by CYP3A4.
151
Question: A patient with type 2 diabetes is prescribed dapagliflozin. Which of the following conditions would be a contraindication for the use of this medication?
A) Hypertension
B) Heart failure
C) Chronic kidney disease (eGFR < 30 mL/min/1.73 m²)
D) Hyperlipidemia
Answer: C) Chronic kidney disease (eGFR < 30 mL/min/1.73 m²)
Explanation: Dapagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor, which requires adequate kidney function to be effective. It is contraindicated in patients with severe renal impairment (eGFR < 30 mL/min/1.73 m²) because it is ineffective at such low levels of renal function and may increase the risk of adverse effects, such as acute kidney injury.
152
A patient is being treated for tuberculosis with rifampicin, isoniazid, pyrazinamide, and ethambutol (RIPE regimen). Which of the following adverse effects is most commonly associated with ethambutol?
A) Hepatotoxicity
B) Optic neuritis
C) Peripheral neuropathy
D) Hyperuricemia
Answer: B) Optic neuritis
Explanation: Ethambutol is known to cause optic neuritis, a potentially serious side effect that can lead to vision loss if not identified early. Patients on ethambutol should be monitored for visual changes, and the drug should be discontinued if optic neuritis is suspected. Hepatotoxicity is more associated with isoniazid and pyrazinamide, peripheral neuropathy with isoniazid, and hyperuricemia with pyrazinamide.
153
Question: A patient with Parkinson’s disease is prescribed levodopa/carbidopa and also takes a multivitamin. Which component of the multivitamin could interfere with the effectiveness of levodopa?
A) Iron
B) Vitamin D
C) Calcium
D) Folic acid
Answer: A) Iron
Explanation: Iron supplements can bind to levodopa in the gastrointestinal tract, reducing its absorption and, consequently, its effectiveness in managing Parkinson’s disease symptoms. Patients should be advised to take levodopa at least 2 hours apart from any iron-containing supplements to avoid this interaction.
154
Question: A patient with atrial fibrillation is on warfarin therapy and presents with an international normalized ratio (INR) of 8.0 without major bleeding. What is the most appropriate management strategy?
A) Continue warfarin at the same dose
B) Withhold warfarin and administer oral vitamin K
C) Administer intravenous vitamin K and fresh frozen plasma
D) Increase the warfarin dose
Answer: B) Withhold warfarin and administer oral vitamin K
Explanation: An INR of 8.0 is significantly elevated, indicating a high risk of bleeding. In the absence of major bleeding, the appropriate management is to withhold warfarin and administer oral vitamin K to reduce the INR. Intravenous vitamin K and fresh frozen plasma are reserved for cases with life-threatening bleeding or a need for rapid reversal.
155
A patient with chronic heart failure is prescribed spironolactone. Which laboratory parameter should be closely monitored due to the risk of a common adverse effect?
A) Serum sodium
B) Serum potassium
C) Serum creatinine
D) Serum calcium
Answer: B) Serum potassium
Explanation: Spironolactone is a potassium-sparing diuretic that can lead to hyperkalemia, particularly in patients with compromised renal function or those taking other medications that increase potassium levels (e.g., ACE inhibitors). Regular monitoring of serum potassium is essential to avoid hyperkalemia, which can be life-threatening.
156
A 72-year-old male with benign prostatic hyperplasia (BPH) is prescribed tamsulosin. He also has a history of cataracts and is scheduled for cataract surgery. What potential complication should the surgeon be aware of?
A) Increased intraocular pressure
B) Intraoperative floppy iris syndrome (IFIS)
C) Retinal detachment
D) Delayed wound healing
Answer: B) Intraoperative floppy iris syndrome (IFIS)
Explanation: Tamsulosin, an alpha-1 adrenergic antagonist used to treat BPH, is associated with intraoperative floppy iris syndrome (IFIS), a condition that can complicate cataract surgery. The surgeon should be informed about the patient’s use of tamsulosin so they can take appropriate precautions during the procedure.
157
A patient with a history of venous thromboembolism (VTE) is on rivaroxaban. They develop a severe infection and are prescribed rifampicin. How might this antibiotic affect the anticoagulant therapy?
A) Increased anticoagulant effect
B) Decreased anticoagulant effect
C) No effect on anticoagulant therapy
D) Increased risk of bleeding
Answer: B) Decreased anticoagulant effect
Explanation: Rifampicin is a potent inducer of CYP3A4 and P-glycoprotein, both of which are involved in the metabolism of rivaroxaban. Induction of these pathways leads to increased clearance of rivaroxaban, reducing its anticoagulant effect and increasing the risk of thromboembolism. Alternative anticoagulation strategies or careful monitoring of clotting parameters may be required.
158
Question: A patient is prescribed an antidepressant and soon after develops serotonin syndrome. Which of the following combinations of drugs is most likely to have caused this condition?
- A) Sertraline and tramadol
- B) Amitriptyline and ibuprofen
- C) Fluoxetine and propranolol
- D) Citalopram and atenolol
A) Sertraline and tramadol
Explanation: Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonergic activity in the central nervous system. It is most likely to occur with the combination of two or more serotonergic agents. Both sertraline (a selective serotonin reuptake inhibitor) and tramadol (an opioid with serotonergic activity) can increase serotonin levels, and when used together, they significantly raise the risk of serotonin syndrome. Symptoms include agitation, confusion, rapid heart rate, high blood pressure, dilated pupils, and muscle rigidity.
159
A patient on warfarin should be advised to avoid excessive consumption of which of the following?
A) Grapefruit juice
B) Green leafy vegetables
C) Dairy products
D) Bananas
Answer: B) Green leafy vegetables
Explanation: Green leafy vegetables are high in vitamin K, which can interfere with the anticoagulant effects of warfarin by promoting blood clotting.
160
Which of the following insulin types is typically used for basal (long-acting) insulin coverage?
A) Lispro
B) Aspart
C) Glargine
D) Regular insulin
Answer: C) Glargine
Explanation: Insulin glargine is a long-acting insulin used to provide basal insulin coverage throughout the day and night.
161
Which medication is the first-line treatment for generalized anxiety disorder (GAD)?
A) Diazepam
B) Sertraline
C) Amitriptyline
D) Haloperidol
Answer: B) Sertraline
Explanation: Sertraline, a selective serotonin reuptake inhibitor (SSRI), is commonly used as a first-line treatment for generalized anxiety disorder.
162
Which of the following medications is used to treat opioid overdose?
A) Flumazenil
B) Naloxone
C) Atropine
D) Protamine sulfate
Answer: B) Naloxone
163
Which of the following is a common side effect of loop diuretics like furosemide?
- A) Hypokalemia
- B) Hyperkalemia
- C) Hypercalcemia
- D) Hyponatremia
A) Hypokalemia
Explanation: Loop diuretics like furosemide can cause hypokalemia (low potassium levels) due to increased potassium excretion in the urine.
164
Which of the following vaccines is recommended for preventing shingles in older adults?
- A) MMR vaccine
- B) Varicella vaccine
- C) Zoster vaccine
- D) HPV vaccine
C) Zoster vaccine
Explanation: The zoster vaccine is recommended for older adults to prevent shingles, which is caused by the reactivation of the varicella-zoster virus.
165
Which of the following drugs is used to treat hyperthyroidism?
- A) Levothyroxine
- B) Carbimazole
- C) Metformin
- D) Hydrocortisone
B) Carbimazole
Explanation: Carbimazole is an antithyroid drug used to treat hyperthyroidism by inhibiting the synthesis of thyroid hormones.
166
Which of the following is the antidote for benzodiazepine overdose?
- A) Naloxone
- B) Flumazenil
- C) Protamine sulfate
- D) Vitamin K
B) Flumazenil
Explanation: Flumazenil is a benzodiazepine antagonist used to reverse the sedative effects of benzodiazepine overdose.
167
What is the primary side effect associated with the use of orlistat for weight loss?
- A) Constipation
- B) Dry mouth
- C) Gastrointestinal disturbance
- D) Drowsiness
C) Gastrointestinal disturbance
Explanation: Orlistat can cause gastrointestinal side effects, including oily stools, flatulence, and frequent bowel movements due to its mechanism of action in inhibiting fat absorption.
168
Question: Which of the following is a contraindication for the use of combined oral contraceptives?
- A) History of deep vein thrombosis (DVT)
- B) Dysmenorrhea
- C) Acne
- D) Irregular menstrual cycles
A) History of deep vein thrombosis (DVT)
Explanation: Combined oral contraceptives increase the risk of thromboembolism and are contraindicated in patients with a history of deep vein thrombosis (DVT).
169
Question: Which medication is used as a first-line treatment for Helicobacter pylori infection?
- A) Metronidazole and ciprofloxacin
- B) Amoxicillin and omeprazole
- C) Clarithromycin and omeprazole
- D) Doxycycline and lansoprazole
C) Clarithromycin and omeprazole
170
Which of the following is an appropriate counseling point for a patient starting on bisphosphonates like alendronate for osteoporosis?
- A) Take it with food
- B) Take it at bedtime
- C) Remain upright for 30 minutes after taking it
- D) Crush the tablet if it is hard to swallow
C) Remain upright for 30 minutes after taking it
Explanation: Patients taking bisphosphonates should remain upright for at least 30 minutes after taking the medication to reduce the risk of esophageal irritation
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Question: A 24-year-old woman presents with symptoms of a urinary tract infection (UTI). Which of the following antibiotics is most appropriate for first-line treatment of uncomplicated UTIs in women?
A) Amoxicillin
B) Ciprofloxacin
C) Nitrofurantoin
D) Metronidazole
Answer: C) Nitrofurantoin
Explanation: Nitrofurantoin is typically the first-line antibiotic for uncomplicated urinary tract infections in women, particularly because of its effectiveness against common uropathogens and low resistance rates.
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Question: Which of the following is the recommended antibiotic for the treatment of Clostridium difficile infection?
A) Metronidazole
B) Ciprofloxacin
C) Vancomycin (oral)
D) Ceftriaxone
Answer: C) Vancomycin (oral)
Explanation: Oral vancomycin is recommended for the treatment of Clostridium difficile infection due to its ability to remain in the gut and target the bacteria directly.
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Question: Which of the following antimicrobials is the first-line treatment for Streptococcus pneumoniae meningitis in an adult patient?
A) Amoxicillin
B) Ceftriaxone
C) Vancomycin
D) Gentamicin
Answer: B) Ceftriaxone
Explanation: Ceftriaxone is used as first-line treatment for bacterial meningitis caused by Streptococcus pneumoniae, often in combination with vancomycin to cover resistant strains.
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Question: A patient is diagnosed with acute otitis media caused by Haemophilus influenzae. Which of the following antibiotics is most appropriate?
A) Azithromycin
B) Amoxicillin
C) Ciprofloxacin
D) Metronidazole
Answer: B) Amoxicillin
Explanation: Amoxicillin is the first-line treatment for acute otitis media caused by Haemophilus influenzae and other common pathogens, such as Streptococcus pneumoniae.
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Question: Which of the following antibiotics is commonly used to treat Methicillin-resistant Staphylococcus aureus (MRSA) infections?
A) Amoxicillin
B) Vancomycin
C) Cephalexin
D) Gentamicin
Answer: B) Vancomycin
Explanation: Vancomycin is used to treat infections caused by MRSA, as the bacteria are resistant to beta-lactam antibiotics such as methicillin and amoxicillin.
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Question: A 35-year-old man presents with symptoms of community-acquired pneumonia (CAP). Which of the following antibiotics is most appropriate for the empirical treatment of CAP in a patient with no comorbidities?
A) Doxycycline
B) Ciprofloxacin
C) Amoxicillin
D) Azithromycin
Answer: C) Amoxicillin
Explanation: Amoxicillin is recommended as the first-line empirical treatment for community-acquired pneumonia in patients with no comorbidities, targeting common pathogens like Streptococcus pneumoniae.
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Question: Which of the following antibiotics is contraindicated in pregnancy due to the risk of fetal harm, particularly bone and teeth discoloration?
A) Amoxicillin
B) Doxycycline
C) Erythromycin
D) Nitrofurantoin
Answer: B) Doxycycline
Explanation: Doxycycline, a tetracycline antibiotic, is contraindicated during pregnancy as it can affect fetal bone growth and cause teeth discoloration.
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