501 Flashcards by Simon Evans

A 3-year-old is brought to the community pharmacy with their parent for advice about a sticky discharge from the child’s right eye, and difficulty keeping their right eye open due to eyelashes sticking together. The parent tells you the child’s right eye is red and there is a watery discharge throughout the day. Symptoms have been present for 2 days and you have checked that there are no red flag symptoms.
Which of the following products would be the most suitable first line treatment for this child?
A. Brimonidine 0.2% eye drops
B. Chloramphenicol 0.5% eye drops
C. Gentamicin 0.3% eye drops
D. Hypromellose 0.3% eye drops
E. Sodium hyaluronate 0.2% eye drops

Chloramphenicol .5%

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A 50-year-old man has been admitted to hospital with sudden shortness of breath, coughing up blood, and pain on one side of his chest. It has been confirmed that he has a pulmonary embolism. He is a smoker, currently taking metformin 1000mg twice a day for type 2 diabetes, has no renal impairment and has NKDA. The doctor would like to start the patient on rivaroxaban to treat the pulmonary embolism.
Which of the following is the most suitable dosage regimen for rivaroxaban for treating his pulmonary embolism?
A. 10mg twice a day for 21 days then 15mg once a day thereafter
B. 10mg twice a day for 21 days then 20mg once a day thereafter
C. 15mg twice a day for 21 days then 15mg once a day thereafter
D. 15mg twice a day for 21 days then 20mg once a day thereafter
E. 20mg twice a day for 21 days then 20mg once a day thereafter

15mg BD for 21 days then 20mg OD thereafter

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The mother of a 6-year-old girl calls the pharmacy to ask about her daughter’s mouth ulcers and raised lesions on her daughter’s hands and feet. She tells you that her daughter has been feeling unwell for the past two days and did not feel like eating. Her fever has reduced today, and the sore throat symptoms are improving, but the mother is very concerned as she cannot get an appointment with her GP.
Which of the following pieces of advice would be LEAST appropriate for the pharmacist to give the mother regarding the condition in this scenario?
A. Dehydration is a common complication
B. It is caused by a highly contagious virus
C. Paracetamol can be used as an analgesic
D. Soft diets should be advised
E. Urgent treatment with antibiotics is necessary

The least appropriate advice would be urgent antibiotics
This condition is hand, foot and mouth disease caused by the Coxsackie A16 virus – not to be confused with foot and mouth disease that can occur in animals which is caused by a different virus.
As the cause is viral, and it is a highly contagious disease and outbreaks can occur in groups such as nurseries and school settings. Spread amongst other household members is common, and children should be kept away from their usual childcare/school environment until they are feeling better – usually after about 5 days. Hygiene advice is also paramount and information about not sharing towels should also be given to families.
Lesions occur within the mouth, and raised spots occur on the sides of the hands and feet rather than the palms and soles of feet.
Although complications of hand, foot and mouth disease are rare as the condition is a mild and self-limiting one, complications such as dehydration can occur if oral intake is reduced as a result of mouth pain. Empirical treatment with antibiotics is not urgently indicated, unless severe secondary bacterial infection of lesions

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A 34-year-old woman with asthma has been in hospital for 10 days following a severe asthma attack. She was smoking 20 cigarettes a day, but has been working with a quit smoking advisor in hospital and has not had a single cigarette for 5 days now. She takes the following medication:
Salamol (100micrograms/dose) Easi-Breathe inhaler 1-2 puffs up to four times a day when required
Fostair NEXThaler 200/6 (beclometasone and formoterol) dry powder inhaler 2 inhalations twice a day
Montelukast 10mg tablets take one at night
Uniphyllin Continus (theophylline) tablets 400mg every 12 hours
The patient has started to deteriorate and is exhibiting signs of theophylline toxicity. The patient has NKDA.
Which of the following is the most likely sign of theophylline toxicity in this patient?
-Bradycardia
-Consticted pupils
- Hypoglycameia
-Severe hypokalaemia

Severe hypokalaemia
The most likely reason for toxicity in this patient is the fact that the patient had stopped smoking in hospital – smoking decreases plasma levels of theophylline, so smoking cessation would lead to a rise in theophylline plasma levels unless the dose of theophylline was adjusted.

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A 25-year-old woman has recently found out she is 4 weeks pregnant. She has been feeling overwhelmed with the advice she has been given and has forgotten what the midwife said about taking certain vitamins. She has come to the community pharmacy for advice on what vitamins she can take and ones she should avoid. The only medication she currently takes is levetiracetam 1000mg twice a day to control her epilepsy. She also has an allergy to nuts.
Which of the following is the most appropriate advice to give her regarding vitamin use in pregnancy?
A. Adding peanuts to her diet will maintain good levels of iron
B. Do not take healthy start vitamins as these are not suitable for pregnant women
C. Take 10 micrograms of vitamin D per day
D. Take folic acid 400 micrograms per day ×
E. Vitamin A supplementation is very important

Vitamin D is very important in general, but especially in pregnancy. It helps regulate calcium and phosphate levels in the body, as well as helping the immune system. It is recommended to take 10 micrograms or 400 units a day as a supplement, especially during the winter months but also all year round if you have dark skin or have limited exposure to sunlight.

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A pharmacist receives an out of hours telephone query regarding therapeutic drug monitoring. The call is from a neonatal registrar for a baby born 2 days ago at term weighing 3.4kg, with early onset neonatal sepsis. The dose of gentamicin is 5mg/kg as an initial dose with further extended interval dose regimens determined through therapeutic drug monitoring.
Which of the following statements is most appropriate regarding the use of gentamicin in the neonatal period for early onset sepsis in this scenario?
A. Gentamicin doses should always be withheld if there is a delay obtaining a trough concentration
B. Peak and trough gentamicin levels needed where there is a proven Gram- positive infection
C. Peak gentamicin levels are measured 6 hours after a dose is given
D. Serum creatinine and urine output needs to be monitored alongside
gentamicin levels
E. Trough gentamicin levels before the first dose need to be measured

Serum creatine and urine output needs to be monitored alongside gentamicin levels

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A 56-year-old man has been on metformin 500mg tablets, 2 tablets twice a day, for 6 months. He has come to the community pharmacy today for advice. For the past 2 weeks, he has been feeling a lot more tired than usual. He has also been complaining of a sore tongue and pins and needles. You decide to refer him to his GP for a blood test as you think he is deficient in a certain type of vitamin.
Which of the following is the most likely vitamin that the man is deficient in?
A. Vitamin B12
B. Vitamin C
C. Vitamin D
D. Vitamin E
E. Vitamin K

Extreme tiredness, pins and needles and pale/yellow skin can be signs of vitamin B12 deficiency. This patient has 2 of these symptoms. Vitamin B12 is commonly reduced in patients taking metformin, so it is important to refer them to their GP if they have symptoms of vitamin B12 deficiency for a blood test.

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A hospital pharmacist is reviewing an inpatient drug chart for a 5-year-old boy with cystic fibrosis. The ward would like a supply of his pancreatin ready for discharge home later in the day.
Which of the following statements is most appropriate regarding pancreatin used in the management of cystic fibrosis in children?
A. Capsules should be swallowed whole with milk or apple juice
B. Enteric coated preparations deliver a higher concentration in the stomach
C. Granules can be added to warm milk for administration to bottle fed infants
D. It is activated by gastric acid so doses are taken with all meals and snacks
E. Pancreatin is indicated due to an increase in exocrine lipase secretion

Pancreatin capsules can be swallowed whole with a glass of milk or slightly acidic juices such as apple, orange or pineapple juice. Gastro-resistant granules can also be mixed with milk or acidic juice too

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Concern Miss H, a 22-year-old woman suffering from menorrhagia.
A pharmacist is working in a community pharmacy and receives a call from an independent nurse prescriber wanting to prescribe tranexamic acid for Miss H, a 22- year-old woman suffering from menorrhagia. The nurse is not sure what the maximum dose is per day for tranexamic acid and would like your advice regarding this.
Which of the following would be the most likely maximum daily dose for tranexamic acid for Miss H?
A. 1 gram
B. 2 grams
C. 3 grams
D. 4 grams
E. 5 grams

BNF- 1g 3 times a day for up to 4 days with a maximum of 4g per day
Answer = 4g

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Miss H returns to the pharmacy 6 months later and explains she has been taking the tranexamic acid each month for up to 4 days, which has helped reduce the heaviness of her periods. She is slightly concerned, however, that the tablet is causing her to experience a certain side effect and would like your advice. Upon further questioning regarding the side effect, you advise Miss H to stop taking the tablet and speak to her GP straight away.
Which of the following is the most likely side effect Miss H is experiencing?
A. Allergic dermatitis
B. Colour vision change
C. Diarrhoea
D. Nausea
E. Vomiting

All answers are potential SE. BNF states any colour vision changes or visual impairments means that the patients should be withdrawn from treatment

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A Pharmacy Technician is explaining the term “half-life” to a trainee pharmacist.
If a drug has a plasma elimination half-life of 20 hours, how long will it take for the plasma concentration to drop to 12.5% of its peak level?
A. 5 hours
B. 10 hours
C. 20 hours
D. 40 hours
E. 60 hours

60 hrs

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Mr. B, aged 22-years-old, has been diagnosed with an open complex fracture of his tibia following a fall from a roof. He is being admitted to hospital via ambulance with severe pain. Mr. B uses a salbutamol inhaler when required for exercise induced asthma. He is allergic to ibuprofen, which causes bronchoconstriction.
Which of the following is the most appropriate drug treatment to manage Mr. B’s pain?
A. Aspirin
B. Codeine
C. Morphine
D. Naproxen
E. Paracetamol

Morphine - major trauma

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An acutely ill 80-year-old man has been admitted to the medical ward. The pharmacist is reviewing his medications and decides he requires pharmacological venous thromboembolism (VTE) prophylaxis. He has NKDA.
Which of the following would be most appropriate for VTE thromboprophylaxis in this patient?
A. Aspirin
B. Clopidogrel
C. Dabigatran
D. Enoxaparin
E. Warfarin

LMWH is first line. Offer for 7 days to acutely ill medical patients whose risk of VTE outweighs risk of bleeding. If LMWH is CI then use fondaparinux sodium

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A woman who takes Ambelina tablets (ethinylestradiol 30mcg, levonorgestrel 150mcg) contacts the pharmacy for advice about missed pills. She explains that she went to Paris for the weekend and forgot to take her Ambelina tablets. She has therefore missed days 10 and day 11 of her tablets.
Which of the following is the most appropriate advice to give?
A. Instruct her to skip the next seven day pill-free interval and start her next pack as soon as she finishes this one
B. Instruct her to omit the missed doses, and resume taking her pills as normal
C. Instruct her to take one pill and to use additional contraception for the next seven days
D. Instruct her to take two pills, and to use extra contraception for seven days
E. Provide a supply of emergency hormonal contraception and tell her to take it as soon as possible

This patient has missed more than one pill but they are not from the first or last seven in the packet, so the pill-free interval has not been extended.
A is incorrect because skipping the pill-free interval is only necessary if she has missed 2 or more pills from the last seven days.
B is incorrect as this would cause the patient to not have contraceptive protection.
D is incorrect as the BNF states that patients should only take the most recently missed active pill, not two, in this situation.
E is incorrect as EHC is only indicated if 2 or more combined oral contraceptive tablets are missed from the first 7 tablets in a packet and unprotected intercourse has occurred since finishing the last packet.

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A 15-year-old boy is worried about their end of year school exams in the summer because of his debilitating symptoms of nasal itching and continual sneezing due to grass pollen allergy. He would like some advice on over-the-counter treatment options.
Which of the following drugs is an example of a non-sedating antihistamine used for managing seasonal allergic rhinitis?
A. Acrivastine
B. Alimemazine
C. Chlorphenamine
D. Hydroxyzine
E. Ketotifen

Acrivastine

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A man has recently had a common cold, persisting beyond 10 days which seems to have gotten worse. He report nasal congestion, reduced sense of smell, and facial pain which is worse on the left side. The patient has a temperature of 38.6oC. A diagnosis of acute bacterial sinusitis is made.
Which of the following antibiotics is LEAST likely to be used as a first-line option for treating acute bacterial sinusitis?
A. Clarithromycin
B. Co-amoxiclav
C. Doxycycline
D. Nitrofurantoin
E. Phenoxymethylpenicillin

Nitrofurantoin is only indicated for UTI

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A patient has been diagnosed with hypertension after a consultation with the GP practice-based pharmacist. The patient now requires treatment with an antihypertensive. The patient has NKDA and takes metformin and gliclazide for type 2 diabetes. The patient is Caucasian and 70 years old.
Which of the following is the most appropriate medication to start for this patient’s hypertension?
A. Amlodipine
B. Bendroflumethiazide
C. Diltiazem
D. Indapamide
E. Ramipril

Ramipril
Offer an ACE inhibitor or an ARB, also known as an angiotensin-II receptor antagonist first line for people who:
Are aged under 55 years and who are not of black African or African- Caribbean family origin.
Have type 2 diabetes (irrespective of age or family origin. As above, use an ARB in preference to an ACE for people of black African or African- Caribbean family origin.)

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A man would like to purchase Viagra Connect (sildenafil 50mg tablets) OTC for erectile dysfunction.
For which of the following patients would it be LEAST appropriate to supply Viagra Connect?
A. A 19-year-old man suffering from erectile dysfunction with no other medical conditions
B. A 33-year-old man who suffers from depression and takes 50mg sertraline OD
C. A 55-year-old man who is currently prescribed 100mg sildenafil for erectile dysfunction but has run out and is unable to get a prescription from the GP until next week
D. A 60-year-old man who takes 40mg simvastatin ON
E. A 76-year-old man with COPD which is under control using a Fostair × 100/6 (beclometasone dipropionate and formoterol fumarate) inhaler and
a salbutamol inhaler PRN

Option C is correct due to the fact that Viagra Connect cannot be sold to anyone who takes a different dose of sildenafil prescribed, or who take another medication for the treatment of ED, and so if this patient presented to you in the pharmacy you would have to refer him to his GP

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A GP practice-based pharmacist is reviewing patients with AF who are currently prescribed warfarin. Where appropriate, warfarin should be switched to a DOAC in line with latest clinical guidelines, however, DOACs are not appropriate for all patients.
Which of the following patient groups would be LEAST appropriate to switch to a DOAC?
A. Patients with a history of pulmonary embolism
B. Patients with a mechanical heart valve
C. Patients with moderate renal impairment
D. Patients with paroxysmal atrial fibrillation
E. Patients with permanent atrial fibrillation

Mechanical heart valve

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child is prescribed an oral dose of 250micrograms of furosemide 10mg/mL oral solution. Following the hospital policy, the pharmacist dilutes 1mL of the oral solution to 20mL with water.
What volume of the resulting liquid should be given to the child for each dose?
A. 0.025mL
B. 0.05mL
C. 0.25mL
D. 0.5mL
E. 5mL

0.5ml

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A man who recently started carbimazole has come to the pharmacy for advice. He has started experiencing side effects which he is concerned about.
Which of the following is LEAST likely to be a sign of agranulocytosis or neutropenia, in relation to carbimazole therapy?
A. Bruising
B. Diarrhoea
C. Fever
D. Malaise
E. Sore throat

Diarrhoea

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Mrs G requires has Parkinsons Disease and requires an anti-emetic.
Which of the following anti-emetics would be most appropriate for Mrs G?
A. Cyclizine
B. Dexamethasone
C. Domperidone
D. Metoclopramide
E. Prochlorperazine

Dompeirdone

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Miss D is due to start taking clozapine for resistant schizophrenia. Her GP practice- based pharmacist is checking which patient parameters should be monitored and checking any other important safety information which they must be aware of.
What of the following statements regarding the monitoring of clozapine is INCORRECT?
A. Blood concentration should be monitored if a patient taking clozapine stops smoking or switches to an e-cigarette
B. Clozapine has been associated with varying degrees of impairment of intestinal peristalsis. Patient should be advised to seek immediate medical advice before taking the next dose of clozapine if constipation develops
C. Clozapine requires differential white blood cell monitoring fortnightly for 12 weeks, then monthly for up to one year, and then 6-monthly as part of the clozapine patient monitoring service
D. On planned withdrawal of clozapine, reduce dose over 1–2 weeks to avoid risk of rebound psychosis
E. Patients taking clozapine should have fasting blood glucose tested at baseline, after one months’ treatment, then every 4-6 months

C is incorrect

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Mr S has been prescribed amitriptyline 25mg tablets. The instructions from the prescriber are:
150mg ON for 7 days then reduce by 25mg every 5 days then stop.
If each box has 28 tablets inside, what is the minimum number of whole boxes which need to be dispensed to ensure Mr S can complete the reducing regimen?
A. 1box
B. 2 boxes
C. 3 boxes
D. 4 boxes
E. 5 boxes

110 tabs required -> 4 boxes (112 tabs)

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A 6-year-old child has been prescribed clotrimazole 1% cream for a fungal skin infection. The pharmacist is handing out the cream to the child’s parents with appropriate counselling. Which of the following is the most appropriate advice for the pharmacist to give? A. Apply daily until lesions have healed B. Apply daily continuing for 10 days after lesions have healed C. Apply twice daily until lesions have healed D. Apply twice daily and continue for at least 4 weeks E. Apply twice daily continuing for 14 days after lesions have healed

Apply BD and continue for at least 4 weeks

A 48-year-old woman has been experiencing constipation for the last few days. She broke her wrist three days ago and has been taking codeine 60mg every 4 hours as prescribed by her GP. She has no other health conditions and does not take any other regular medication. She has not tried any laxatives. Which of the following is the LEAST suitable drug treatment for her constipation? A. Bisacodyl B. Fybogel (3.5g ispaghula husk) C. Glycerol suppositories D. Macrogol and senna E. Naloxegol

Bulk-forming laxatives should be avoided. These laxatives increase the bulk of the stools, distend the colon, and augment peristalsis. Opioids prevent peristalsis of the increased bulk which worsens abdominal pain and can contribute to bowel obstruction.

Dosages of corticosteroids vary widely in different diseases and in different patients. When long-term corticosteroid therapy is used in some chronic diseases, the adverse effects of treatment may become greater than the disabilities caused by the disease. To minimise side-effects the maintenance dose should be kept as low as possible. Side effects can be caused by both mineralocorticoid and glucocorticoid activity. Which of the following side effects of hydrocortisone is caused by its mineralocorticoid activity? A. Depression B. Diabetes C. Hypertension D. Muscle wasting E. Osteoporosis

Mineralocorticoids can cause hypertension, sodium retention, water retention, potassium loss and calcium loss. Glucocorticoids can cause diabetes, osteoporosis, avascular necrosis of the femoral head, muscle wasting, peptic ulceration/perforation, and psychiatric reactions.

Diabetes is one of the most common chronic diseases in the UK, and its prevalence is increasing. About 90% of adults currently diagnosed have type 2 diabetes. It is therefore important for pharmacists to be aware of the signs and symptoms of type 2 diabetes. Which of the following is NOT a sign or symptom of type 2 diabetes? A. Anuria B. Blurred vision C. Fatigue D. Hyperglycaemia E. Increased thirst

Anuria is when the kidneys do not produce urine. In diabetes you get polyuria which is increased urinary frequency

A patient is attending the outpatient chemotherapy department to collect her capecitabine tablets as part of the management of breast cancer. Capecitabine is dosed based on BSA and the dose is rounded to the nearest 150mg tablet, for ease of administration. The patient has a BSA of 1.6m2 and according to her chemotherapy regimen, capecitabine should be doses at 1000mg/m2. Which of the following capecitabine doses would be most appropriate for the patient? A. 1200mg B. 1350mg C. 1600mg D. 1650mg E. 1800mg

Dose = 1000mg/m2 x 1.6m2 = 1600mg Rounded to nearest 150mg = 1650mg We can calculate this by noticing that 10 tabs x 150mg = 1500mg, so one more 150mg tablet would be 1650mg Note: 1600mg, divided by 150mg tablets, would give 10.66667 tabs, which is not practical, and so we round to the nearest 150mg which is 1650mg

In October 2023, a drug safety update was issued regarding the introduction of new safety measures concerning the use of Roaccutane (isotretinoin). Which of the following is the least appropriate statement regarding the use of isotretinoin? A. All patients must be counselled about the benefits and risks of treatment before isotretinoin is prescribed, including possible mental health and sexual function side effects B. Isotretinoin is teratogenic, all patients of childbearing potential must be entered into the Pregnancy Prevention Programme C. Isotretinoin should only be prescribed for severe acne that is resistant to adequate courses of standard therapy D. Prescribers should assess patients’ mental health before prescribing isotretinoin E. Two independent prescribers need to agree the initiation of isotretinoin in patients under 18 years

E All the other options are true

A father brings their 7-year-old child to the pharmacy. The child sprained their ankle yesterday and today they are still reporting pain and swelling. The pharmacist examines the injury and rules out a fracture, tendon rupture or any other serious complications. Which of the following is the most appropriate advice for the child at this stage? A. Advise a same day GP appointment is necessary to check for any damage to nerves or circulation B. Advise patient on the 'PRICE' self-management strategy for the first 48– ✓ 72 hours after injury C. Advise to continue walking on the injured ankle to prevent a DVT from developing D. Arrange referral to A&E due to persistent swelling E. Supply OTC paracetamol and codeine for pain relief

PRICE

A pharmacist working in the children’s ward of a district general hospital is completing a prescription review. The patient is a 13-year-old child admitted with a 6- day history of abdominal cramps and not opening bowels. The paediatric registrar has diagnosed idiopathic constipation after eliminating red/amber flags and asks the pharmacist for advice on prescribing a trial of osmotic laxatives. Which of the following would most likely be recommended to the paediatric registrar? A. Docusate Sodium Paediatric 12.5mg/5mL oral solution B. Glycerol 2g suppositories C. Movicol sachets D. Sennosides 7.5mg tablets E. Sodium picosulfate 5mg/5mL liquid

Movicol sachets are the osmotic laxative of choice from the above, and paediatric preparations are available for younger children under 12-years-old containing half of the adult dose of active ingredients. These macrogol 3350 containing preparations increase stool volume triggering gut motility.

A 22-year-old woman who takes sodium valproate for epilepsy has come to pick her repeat prescription. She explains to the pharmacist that she has recently found out she is pregnant. She wants to know if it is safe to carry on taking sodium valproate. She is not on any other medication. Which of the following is the most appropriate course of action? A. Tell her to carry on taking sodium valproate as normal and remind her to take 400mcg of folic acid daily B. Tell her to carry on taking sodium valproate and provide information on the pregnancy prevention programme C. Tell her to carry on taking sodium valproate as normal and book an urgent appointment with her specialist D. Tell her to stop taking sodium valproate immediately and book a review with her specialist E. Tell her to stop taking sodium valproate immediately and contact one of the patient support networks

Tell her to carry on taking SV as normal and book an urgent appt with her specialist

A new mother has brought her 28-week-old baby to the pharmacy. She would like to purchase OTC paracetamol suspension for her daughter, who has a fever. Which of the following is the most appropriate dose of paracetamol for the baby? A. 60mg every 4-6 hours, maximum BD B. 120mg every 4-6 hours, maximum QDS C. 180mg every 4-6 hours, maximum QDS D. 240mg every 4-6 hours, maximum QDS E. 360mg every 4-6 hours, maximum TDS

28 weeks = 7 months 120mg every 4-6 hrs max QDS

A patient on the ward has been diagnosed with tuberculosis. The standard treatment of active tuberculosis is completed in two phases—an initial phase using four drugs and a continuation phase using two drugs, in fully sensitive cases. Which of the following is LEAST likely to be included when treating tuberculosis in the initial phase? A. Rifampicin B. Isoniazid C. Ethambutol D. Rifaximin E. Pyrazinamide

Rifaximin

A man has brought his 7-year-old son into the pharmacy for advice on OTC treatment for threadworms. He explains that his son is constantly scratching his anal area and they are concerned about the risk of spreading any infection. The man explains that he lives with his wife, their 7-year-old son and 2.5-year-old daughter. His wife is expecting their third child in 8 weeks. What is the minimum number of mebendazole 100mg tablets you would advise the man to purchase for treating the household today? A. 1 tablet B. 2 tablets C. 3 tablets D. 4 tablets E. 8 tablets

minimum 3 (should be 6 as rpt dose after 14) man, 7 year old and 2 year old to have pregnant mother hygiene measures only

A pharmacist on an acute inpatient psychiatric ward has been asked for advice regarding switching a patient’s antidepressant. The patient requires a switch from fluoxetine to phenelzine. How long after stopping fluoxetine must the patient wait before starting phenelzine? A. 1 week B. 2 weeks C. 3 weeks D. 4 weeks E. 5 weeks

Other antidepressants should not be started for 2 weeks after treatment with MAOIs has been stopped (3 weeks if starting clomipramine or imipramine). Conversely, an MAOI should not be started until: at least 2 weeks after a previous MAOI has been stopped (then started at a reduced dose) at least 7–14 days after a tricyclic or related antidepressant (3 weeks in the case of clomipramine or imipramine) has been stopped at least a week after an SSRI or related antidepressant (at least 5 weeks in the case of fluoxetine) has been stopped”

A man is attending an out-patient appointment to assess his foot infection. The vascular consultant has prescribed potassium permanganate 400mg tablets, for cleansing and deodorising the wound. The patient has been advised to prepare a 0.01% solution (1 in 10,000) at home. Which of the following instructions would be most appropriate to give the patient when preparing the solution? A. Dissolve 1 tablet in 1 litre of water B. Dissolve 1 tablet in 4 litres of water C. Dissolve 1 tablet in 10 litres of water D. Dissolve 1 tablet in 40 litres of water E. Dissolve 4 tablets in 1 litre of water

Mr L was recently started on gentamicin and has a creatinine level which has risen from 60μmol/L to 294μmol/L. His urea has also risen from 2.4mmol/L to 7.9mmol/L, indicating an AKI. The pharmacist has noticed another new medication which they think may be contributing to the AKI. Which of the following is most likely to be contributing to Mr L’s AKI? A. Cyclizine B. Domperidone C. Naproxen D. Paracetamol E. Tinzaparin

SADMAN naproxen can cause nephrotoxicity

A 62-year-old woman presents to A&E with sudden onset shortness of breath, chest pain, and haemoptysis. The patient has a past medical history of epilepsy, depression, hypertension, and osteoporosis. She takes the following medications: phenytoin 300mg ON fluoxetine 20mg OD amlodipine 5mg OD alendronic acid 70mg weekly on a Monday calcium carbonate and colecalciferol, one tablet BD The patient underwent surgery 5 days ago for a fractured neck of femur. A CT pulmonary angiogram confirms a diagnosis of a pulmonary embolism. The junior doctor has asked for your opinion on anticoagulation. Which of the following is the most appropriate treatment for a pulmonary embolism for this patient? A. Apixaban 5mg BD B. Dabigatran 110mg BD C. Rivaroxaban 15mg BD for 7 days then 20mg OD D. Rivaroxaban 20mg OD E. Warfarin with bridging tinzaparin until INR in range

Phenytoin has interaction with DOACs leading to decreased anticoagulation effect. Therefore warfarin is most appropriate option. Tinzaparin will need to be continued until therapeutic INR is reached.

A nurse is preparing a test dose before administering an iron infusion. The nurse prepares the infusion in 500mL sodium chloride 0.9%. The first 15mg of this infusion bag is then given as a test dose over a period of 15 minutes. The patient is observed closely during this period and, if no reaction, the remaining dose can be given over 4- 6 hours. If a patient was to receive a total dose of 1,500mg, which of the following infusion volumes should be given as the test dose? A. 5mL B. 8mL C. 10mL D. 25mL E. 50mL

5ml

A pharmacist is preparing to run an alcohol awareness campaign to deliver in the local community. According to NHS guidance, which of the following patients would it be most appropriate to target to discuss reducing alcohol related health risks? A. A 76-year-old man, who drinks a total of 7 units at the weekend B. A 24-year-old man who drinks a total of 12 units over 4 days C. A 52-year-old woman, who drinks 3 units on a Friday night D. A 46-year-old woman, who drinks 3 units a night, 4 days a week E. A 66-year-old woman who drinks 4 units a day, every day

A 54-year-old woman is on the medical admissions ward with an exacerbation of asthma. She has been prescribed 40mg prednisolone and salbutamol nebulised. The woman tells you this is her 5th admission in 3 months, and every time she has received a course of prednisolone. Which of the following is the most appropriate advice for the management of her current course of steroids? A. A 5-day course of prednisolone 40mg then stop B. A 5-day course of prednisolone 40mg then wean gradually C. A 7-day course of prednisolone 40mg then stop D. A 7-day course of prednisolone 40mg then wean gradually E. This patient does not need steroids and they should be stopped now

a 5 DAY course of prep 40mg then wean gradually

A patient has brought in a prescription for Priadel 200mg MR tabs (lithium carbonate). The patient has been told by the prescriber that he will require frequent monitoring whilst he is taking this medicine. Which of the following tests is LEAST likely to be conducted for a patient whilst taking Priadel? A. BMI B. eGFR C. LFT D. U&E E. TFT

LFT is inccorect BNF recommends BMI/ body weight, serum electrolytes, eGFR and thyroid function every 6 months

Agranulocytosis is a rare condition in which bone marrow doesn't make enough of a certain type of white cell, most often neutrophils. Which of the following drugs should NOT be used in combination with methotrexate due to the increased risk of agranulocytosis? A. Aspirin B. Clomipramine C. Olanzapine D. Pioglitazone E. Tramadol

Olanzapine Both drugs have a high risk of agranulocytosis

A pharmacist is providing training on the responsible pharmacist (RP) legislation. A pharmacist must be in charge of a registered pharmacy as the RP, in order to lawfully conduct a retail pharmacy business. Which of the following statements relating to RP regulations is correct? A. An entry in the pharmacy record can only be made in person, not remotely B. An RP is required to display a notice that is clearly visible to the whole pharmacy team with the required information, for as long as she/he is the RP C. Legislation allows the responsible pharmacist to be absent for up to a maximum period of two hours during the pharmacy’s business hours between 8am and 10pm D. The pharmacy owner or superintendent pharmacist must keep the pharmacy record for a period of two years E. The pharmacy record must include the date and time at which the RP stopped being the RP

Vincristine, vinflunine and vinorelbine are all vinca alkaloid drugs used for a variety of cancers. Which of the following describes the most appropriate method of administration for the above drugs? A. IM B. Intrathecal C. IV D. PR E. SC

The GPhC standards for pharmacy professionals describe how safe and effective care is delivered. Which of the following statements regarding the standards for pharmacy professionals is INCORRECT? A. One of the standards includes the ‘duty of candour’, which means pharmacy professionals must declare any personal or professional interests and manage these professionally B. One of the standards is that pharmacy professionals must demonstrate leadership, which includes taking responsibility for their actions and leading by example C. Pharmacy professionals are personally accountable for meeting the standards and must be able to justify the decisions they make D. There are nine standards that every pharmacy professional is accountable for meeting E. The standards need to be met at all times, not only during working hours

An 8-month-old girl requires ibuprofen, 100 mg/5 mL, oral suspension for pyrexia. Which of the following doses would be most appropriate? A. 2.5mL TDS B. 5mL QDS C. 7.5mL BD D. 10mL OD E. 20mL PRN

A (50mg 3-4 times a day)

patient has come into the pharmacy requesting an emergency supply as she has run out of her repeat prescription medication. It is a Sunday afternoon and the GP practice is closed. Which of the following medicines is legally allowed to be supplied as an emergency supply at the request of a patient? A. Gabapentin B. Phenobarbital C. Pregabalin D. Temazepam E. Tramadol

Phenobarbital, for epilepsy. The other options are all schedule 3 CDs and emergency supplies are not allowed. It is illegal to supply schedule 1, 2 or 3 controlled drugs other than Phenobarbital to patients of UK-registered prescribers for the purpose of treating epilepsy only.

Mr G, age 24-years-old, has been suffering with toothache for the past 72 hours and does not have a dentist appointment until tomorrow. He contacts the pharmacist for advice on OTC analgesia. Mr G takes methotrexate 7.5mg once weekly and folic acid 5mg. Which of the following would be the most appropriate analgesic to recommend? A. Aspirin 300mg tablets B. Ibuprofen 400mg tablets C. Naproxen 250mg tablets D. Dihydrocodeine 30mg tablets E. Paracetamol 500mg tablets

Cannot use NSAIDS due to increased risk of toxicity as the excretion of MTX is reduced by NSAIDS when taken together. Is not a hard CI but paracetamol better option due to risk

Miss K, a 19-year-old woman, has come to collect her prescription for sodium valproate (Epilim Chrono) 300mg modified release tablets. She explains that she is not on the pregnancy prevention programme. The pharmacist supplies the medication and the patient guide, and explain she needs to see her consultant as soon as possible to discuss having highly effective contraception, as the contraception she is currently on does not come under the bracket of “highly effective”. Which of the following is considered a form of highly effective contraception for this purpose? A. Combined oral contraceptive tablet B. Levonorgestrel intrauterine system C. Parenteral progestogen-only contraceptives D. Progestogen-only implant E. Vaginal ring

Highly Effective forms of contraception - Male and female sterilisation - Copper IUD - Levonorgesteral intrauterine system - Progestogen only implant

man is visiting the UK with his family and brings in a prescription for metronidazole 200mg tablets from his dentist in The Netherlands. Some of the information is in another language, however there is enough information to safely provide the medication. Which of the following details is NOT legally required on the prescription in this situation? A. Date of issue B. Patients address C. Patients date of birth D. Prescribers professional qualifications E. Prescribers work address

All of the details except the patient’s address are legally required on a prescription from the EEA and Switzerland.

A 76-year-old man has come to the pharmacy for advice on an irritating rash on his abdomen. He reports abnormal skin sensations over the last 48 hours, and now the area feels like it’s burning and itchy. The pharmacist notices the rash is in one area, on one side of the man’s body. A. Contact dermatitis B. Measles C. Shingles D. Tinea versicolor E. Urticaria

Shingles

A patient with a history of myocardial infarction and heart failure with mid-range ejection fraction has attended for their annual review, and blood tests show their HbA1c is 52 mmol/mol. Three months later, a follow-up HbA1c test confirms the diagnosis of type 2 diabetes. They are prescribed metformin, but cannot tolerate this. Metformin is stopped and an alternative medication is prescribed to control blood glucose levels. Which of the following medicines would be most appropriate for this patient as monotherapy? A. Empagliflozin B. Gliclazide C. Insulin D. Linagliptin E. Pioglitazone

Empaglifozin as heart failure hx and CVD hx

On routine blood tests, a patient is found to have abnormal thyroid function markers and they are diagnosed with hyperthyroidism. The patient has had a number of symptoms, which developed slowly over time. Which of the following symptoms is LEAST commonly associated with hyperthyroidism? A. Agitation B. Increased appetite C. Insomnia D. Palpitations E. Sensitive to cold

Sensitive to the cold- this is more of an underactive thyroid symptom. Hyperthyroidism would have sensitivity to HEAT

A woman with asthma has had an exacerbation recently and the pharmacist has been asked to review her inhaler technique for both devices: - Easyhaler Salbutamol 100mcg dry powder inhaler, one or two inhalations four times a day, PRN. - Trimbow (beclometasone, formoterol, glycopyrronium) 87/5/9 pressurised inhaler, two inhalations BD Which of the following describes the most appropriate inhaler technique for each device? A. Inhale quickly and deeply with Trimbow and slowly and deeply with Easyhaler salbutamol B. Inhale quickly with Trimbow and slowly and deeply with Easyhaler Salbutamol C. Inhale sharply and fast with both devices D. Inhale slowly and deeply with both devices E. Inhale slowly and deeply with Trimbow and strongly and deeply with Easyhaler salbutamol

Inhale slowly and deeply with trimbow (pMDI)and strongly and deeply with easyhaler salbutamol (DPI)

A patient with type 1 diabetes HAS been admitted to the acute admissions ward due to dehydration and a rise in blood glucose. After a blood gas, the patient’s ketones suggested they are in diabetic ketoacidosis. Which of the following treatments would be most appropriate for the medical team to start? A. Rapid acting insulin such as Humalog (insulin lispro) given intravenously B. Rapid acting insulin such as Novorapid (insulin aspart) given intravenously C. Rapid acting insulin such as Novorapid (insulin aspart) given subcutaneously D. Soluble insulin such as Actrapid (insulin soluble human) given intravenously E. Soluble insulin such as Actrapid (insulin soluble human) given subcutaneously

Soluble insulin such as actarapid (insulin soluble human) given IV

Menopausal symptoms can be managed with HRT, however treatment benefits must be weighed against potential risks, as HRT can increase the risk of several conditions. Which of the following conditions is HRT LEAST likely to increase the risk of developing? A. Coronary heart disease B. Endometrial cancer C. Osteoporosis D. Stroke E. Ovarian cancer

Osteoporosis - Risk of fragility is decreased while taking HRT. This is beneficial reducing the risk of osteoporosis and fracture

A 61-year-old man was admitted to hospital with leg pain and difficulty walking. He was also experiencing numbness in the groin area and in his legs. After undergoing an X-Ray and MRI, the medical team diagnosed cauda equina syndrome and the patient was transferred for emergency lumbar spine surgery. Which of the following is also a symptom of cauda equina syndrome? A. Blurred vision B. GORD C. Loss of bladder control D. Polyuria E. Unexplained weight loss

Loss of bladder control Symptoms of cauda equina syndrome: Severe low back pain. Motor weakness, sensory loss, or pain in one or commonly both legs. Saddle anaesthesia (unable to feel anything in the body areas that sit on a saddle) Bladder dysfunction (such as urinary retention or incontinence) Bowel incontinence.

A man, aged 83-years-old, is speaking with the GP practice pharmacist. The man explains that he has felt unwell with muscle pain for the past 24 hours. The pharmacist notices that he appears to have a fever, be breathing rapidly and is slurring his speech. The man had a knee operation 4 weeks ago and he reports not passing urine for the last 18 hours. Which of the following is the most appropriate advice to give? A. Advise the patient that he may be having a heart attack and requires a GTN spray B. Advise the patient that he may have sepsis and an ambulance will be called for him C. Advise the patient to have several large glasses of water to enable him to pass urine D. Advise the patient to have paracetamol to treat the fever and call back tomorrow with an update E. Advise the patient to have paracetamol and ibuprofen together, and call back in 4 hours with an update

B Think SEPSIS: Slurred speech or confusion Extreme shivering or muscle pain Passing no urine (in a day) Severe breathlessness It feels like you’re going to die Skin mottled or discoloured

A woman has been diagnosed with osteoporosis and the GP practice based pharmacist has prescribed alendronic acid 70mg tablets to be taken once weekly. The woman comes to the pharmacy requesting guidance on how to take her new tablets correctly as she has forgotten some of the information previously given. Which of the following is the most appropriate advice to give? A. She must not lie down for 15 minutes after taking the tablet B. She must protect her skin from sunlight while taking this medication C. Take the alendronic acid first thing in the morning before getting up D. The tablets can be chewed or dispersed in water if she has difficulty swallowing E. The tablet must be taken at least 30 minutes before food, other medicinal product, or any drink other than water

A 68-year-old woman has been admitted to hospital with severe, persistent diarrhoea and dehydration. The patient suffers from GORD, for which she takes pantoprazole 20mg OD. She has also had a recent course of antibiotics for a lower respiratory-tract infection. The medical team suspect the woman has a Clostridium difficile infection, which is likely due to the recent antibiotic she has been taking. Which of the following is the most likely antibiotic that caused her Clostridium difficile infection? A. Amoxicillin B. Clarithromycin C. Clindamycin D. Doxycycline E. Metronidazole

Clindamycin

A 92-year-old woman has been diagnosed with mild to moderate dementia with Lewy bodies and is now starting treatment. She has NKDA and takes levothyroxine and regular paracetamol. Which of the following would be the most appropriate to start for this patient? A. Clozapine B. Donepezil C. Galantamine D. Memantine E. Risperidone

Donepezil or rivastigmine are recommended first line. - Galantamine is as option if donepezil and rivastigmine are not tolerated. - Other options are not indicated for dementia with lewy bodies. Lewy body dementia is a disease associated with abnormal deposits of a protein called alpha-synuclein in the brain. These deposits, called Lewy bodies, affect chemicals in the brain whose changes, in turn, can lead to problems with thinking, movement, behaviour, and mood. Lewy body dementia is one of the most common causes of dementia.

Mr P was diagnosed with acute coronary syndrome two weeks ago and started on the following secondary prevention medication: aspirin atorvastatin bisoprolol ramipril ticagrelor Mr P has returned to A&E today with shortness of breath and heart palpitations. He is found to have a potassium level of 6.2. Which of the following medications that the patient has started is most likely to have caused this rise in potassium? A. Aspirin B. Atorvastatin C. Bisoprolol D. Ramipril E. Ticagrelor

Ramipril

A woman is taking warfarin for AF and today attends an INR monitoring clinic. She has a target INR range of 2.0-3.0 and at her last appointment 4 weeks ago, her INR was 2.3. She was advised to continue taking her normal dose of 3mg daily. Today in clinic, her INR today was 6.4. The woman explains that she has not missed any doses, has had no changes to her diet, and does not drink any alcohol. She has however recently started some new medications. Which of the following medications is most likely to have caused the increased INR? Bisoprolol Carbamazepine Fluconazole Lithium St John wort

Fluconazole increases the anticoagulant effect of Warfarin. Manufacturer advises monitor INR and adjust dose. Carbamazepine and St John’s wort can decrease the INR

A 59-year-old man who is a regular patient in the pharmacy asks for advice. Over the last few months, he has noticed a change in his bowel habits and for the last week or so, he has also noticed some blood in his stools. He also appears to have lost weight. He has no past medical history and does not take any medication. Which of the following is the most appropriate action to take? A. Explain to him that that this is a normal part of aging and our bowel habits do change B. Provide lifestyle advice to help with his constipation and ask him to return in one week if no improvement C. Refer to GP immediately as he is displaying several red-flag symptoms D. Sell an osmotic laxative OTC to soften the stool and make it easier for him to pass to reduce his need for straining E. Sell him a bulk-forming laxative such as ispaghula as this is the first-line for the treatment of constipation

A patient has been brought in to A&E with suspected paracetamol poisoning. They ingested the overdose more than 24 hours ago and appear jaundiced, with abnormal alanine transaminase (ALT) levels. Which of the following should be used to reverse the effects of the paracetamol overdose for this patient? A. Acetylcysteine B. Activated charcoal C. Flumazenil D. Glucagon E. Naloxone

Acetylcysteine

Clinical audit is vital for patient care and safety, as well as for the development and improvement of professional practice. Which of the following statements regarding clinical audit is INCORRECT? A. Part of the process of clinical audit is to compare your service to existing standards or criteria B. Patient consent will not be required if you are collecting data which you already provide as part of your care to the patient, and which does not identify the patient C. The aim of a clinical audit is to determine whether a current service or procedure reaches a specified standard, to use that information to inform improvements in care, and then evaluate those changes by re-auditing D. The re-audit phase of the audit cycle involve collecting a second set of data and analysing the results to determine whether the changes made in the initial audit have been effective E. You must receive ethical approval before conducting a clinical audit

You do not need ethics approval to conduct a clinical audit

Some medicines are suspected or known to cause congenital malformations when taken by pregnant women. Which of the following medicines is LEAST likely to be associated with harm during pregnancy? A. Folic acid B. Misoprostol C. Modafinil D. Ramipril E. Sodium valproate

Folic acid is indicated before and during pregnancy for prevention of neural tube Misoprostol – used in the termination of pregnancy. Induces uterine contractions, and associated with abortion and birth defects; teratogenic in first trimester. Modafanil – BNF advises avoid in pregnancy. Suspected to cause congenital malformations when administered during pregnancy. Women of child bearing potential have to use effective contraception. As modafinil may reduce the effectiveness of oral contraception, alternative additional methods of contraception are required Ramipril – ACE inhibitors should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported. Sodium valproate – pregnancy should be excluded before treatment initiation and highly effective contraception must be used during treatment. Risk of serious developmental disorders (up to 30–40% risk) and congenital malformations (approx. 10% risk).

Miss A, a 26-year-old woman, comes into the pharmacy asking to buy ibuprofen 400mg tablets. Upon questioning, she crouches down in agony saying her right lower stomach and tip of her shoulder has been hurting her for the past week. She thinks it is period pain as she has been expecting her period for the last week but had only been spotting. She mentions she has been sexually active and had missed her appointment to get her regular contraceptive injection. Which of the following would be the most appropriate course of action for Miss A? A. Advise her to contact her GP for stronger painkillers as ibuprofen alone probably won't help B. Advise her to do a pregnancy test as she may be pregnant C. Make an appointment with a sexual health clinic D. Refer her to A&E E. Sell her ibuprofen 400mg tablets and advise her to take paracetamol 500mg tablets as well to give better pain relief

Possible ectopic pregnancy. Pain is on the lower abdomen and is one sided. Red flag is the pain on her shoulder and must seek immediate medical attention

A mother brings her 7-year-old child to the pharmacy with red spots all over her stomach. Some of the spots are filled with fluid. The child finds the spots very itchy and has a slightly raised temperature. The pharmacist identifies this as chickenpox. Which of the following is the most appropriate advice to give? A. Advise the child stay to away from school until all the spots have crusted over. Recommend ibuprofen suspension for the fever and chlorphenamine suspension for the itching B. Advise the child to stay away from school until all the spots have crusted over. Recommend paracetamol suspension for the fever and chlorphenamine suspension for the itching C. Advise the child to go to school so the rest of her classmates can catch chickenpox at the same time, to build immunity. Recommend Eurax (crotamiton) cream to apply on the spots D. Reassure the mother and recommend ibuprofen suspension for the fever and chlorphenamine suspension for the itching E. Recommend hydrocortisone cream to be applied to all the spots to reduce inflammation and itching

Mrs K has been taking azathioprine for the last 4 months. She has come to the pharmacy for advice as she has a bruise on her right leg which seems to be taking a while to go down. The bruise first appeared around 3 weeks ago and has started spreading up her leg. Which of the following would be the most appropriate advice to give Mrs K? A. Advise that the symptoms she is describing are unlikely to be due to her medication B. Mrs K should contact her GP straight away and explain that she has unexplained bruising C. Mrs K should buy arnica cream and see if that resolves the bruising D. Mrs K should call 999 as she requires an ambulance immediately E. Mrs K should stop taking the azathioprine straight away and call her consultant for an appointment in the next 2 weeks

Unexplained bruising needs to be reported to their GP immediately. Bruising could be a sign of bone marrow suppression related to the azathioprine. Inexplicable bleeding is also a sign, as is an infection.

NICE advises that the ORBIT bleeding risk score should be used to assess bleeding risk as it has higher accuracy in predicting absolute bleeding risk than other bleeding risk tools. However, it acknowledges that while it is the best tool, other bleeding risk tools (for example HAS-BLED) may need to be used until it is embedded in clinical pathways and electronic systems. Which of the following statements regarding the use of the ORBIT scoring tool is INCORRECT? A. Scores range from 0 to 7 based on the presence or absence of specific characteristics B. There is a score of 1 point for people with an eGFR of less than 60mL/min/1.73m2 C. There is a score of 1 point for people who are being treated with antiplatelets D. There is a score of 2 points for people aged over 55 years E. There is a score of 2 points for people with a history of bleeding, for example GI bleeding, or haemorrhagic stroke

D is incorrect

A 40-year-old woman has been taking phenelzine 15mg three times daily for one month. Today she goes to a dinner party and eats a lot of blue-aged cheese, smoked and cured meat and drinks a lot of red wine. A. Bleeding risk increased B. Bradycardia C. Diarrhoea D. Hyperkalaemia E. Hypertensive crisis F. Myopathy G. Reduced eGFR H. Thrombosi

Phenelzine is a monoamine oxidise inhibitor (MOAIs) antidepressant. MOAIs can interact with tyramine rich foods raising blood pressure. This can lead to hypertensive crisis. Blue-aged cheese smoked and cured meat and red wine are all examples of tyramine-rich foods. Patients are advised to avoid tyramine-rich food with MAOIs.

A 72-year-old woman has been taking sertraline 100mg for one year. She wishes to purchase aspirin 300mg for a headache over the counter. A. Bleeding risk increased B. Bradycardia C. Diarrhoea D. Hyperkalaemia E. Hypertensive crisis F. Myopathy G. Reduced eGFR H. Thrombosis

Both SSRI and aspirin have anti platelet effects and therefore combined are more likely to cause bleeding

Miss F is an 11-year-old girl who presented with symptoms of moderate depression at her GP practice. She was referred to a child and adolescent psychiatrist, who offered three months of psychological therapy (cognitive behavioural therapy). It has now been decided that Miss F might benefit from an antidepressant, and she has agreed to start the first-line treatment. A. Aripiprazole B. Citalopram C. Clozapine D. Fluoxetine E. Haloperidol F. Lamotrigine G. Primidone H. Risperidone

Fluoxetine is the preferred antidepressant for treating moderate and severe depression in children (5–11 years) and young people (12–18 years). It is the only antidepressant where the benefits outweigh the risks. Citalopram and sertraline can be used but they are unlicensed in children and can only be used as an alternative under specialist supervision.

A community pharmacist is dispensing a repeat prescription for an antiepileptic drug. They notice a discrepancy between the brand stated on the prescription and the brand usually given on the patient’s medication record. It is known that for this particular antiepileptic drug, the patient must be maintained on a specific manufacturer’s product. A. Aripiprazole B. Citalopram C. Clozapine D. Fluoxetine E. Haloperidol F. Lamotrigine G. Primidone H. Risperidone

Primidone

Mr C, aged 71-years, is in hospital receiving treatment for infective endocarditis. On the recommendation of a microbiologist, vancomycin has been selected for treatment. A doctor on the ward has asked for assistance calculating the vancomycin maintenance dose. The patient weighs 81kg and has a CrCl of 73mL/min. A. Increase the dose by 50% B. Maintain the present dosage regimen C. Stop, repeat level until <20 mg/L and seek advice regarding dose reduction D. 1.25g every 12 hours administered over 150 minutes E. 2g administered over 240 minutes F. 500mg every 24 hours, administered over 60 minutes G. 750mg every 12 hours, administered over 90 minutes H. 750mg every 24 hours, administered over 120 minutes

750MG every 12hrs administered over 90 mins

A patient with osteomyelitis has been prescribed vancomycin, with a plan for trough levels, pre-dose, to be taken to ensure safe dosing. The patient has a CrCl of 71mL/min and an actual body weight of 95kg. A pharmacist is calculating an appropriate loading dose. A. Increase the dose by 50% B. Maintain the present dosage regimen C. Stop, repeat level until <20 mg/L and seek advice regarding dose reduction D. 1.25g every 12 hours administered over 150 minutes E. 2g administered over 240 minutes F. 500mg every 24 hours, administered over 60 minutes G. 750mg every 12 hours, administered over 90 minutes H. 750mg every 24 hours, administered over 120 minutes

2g administered over 240 mins

Mrs Y is being treated with vancomycin for a Staphylococcus aureus infection and is responding well. As part of routine monitoring, a trough sample was taken just before the next dose was administered. The concentration has come back as 13mg/L. A pharmacist is advising the medical team on the most appropriate action to take. A. Increase the dose by 50% B. Maintain the present dosage regimen C. Stop, repeat level until <20 mg/L and seek advice regarding dose reduction D. 1.25g every 12 hours administered over 150 minutes E. 2g administered over 240 minutes F. 500mg every 24 hours, administered over 60 minutes G. 750mg every 12 hours, administered over 90 minutes H. 750mg every 24 hours, administered over 120 minutes

Maintain the present dosage regimen

Mr H is has type 2 diabetes and a history of heart failure. He attends a pharmacist led endocrinology clinic for his 6-month review and for the continued management of his diabetes. The pharmacist identifies an antidiabetic drug which would be least suitable for Mr H, given his medical history. A. Dapagliflozin B. Exenatide C. Glibenclamide D. Gliclazide E. Linagliptin F. Metformin G. Pioglitazone H. Saxagliptin

Pioglitazone is CI in HF or HF hx

Miss J is an 11-year-old girl with type 2 diabetes. Her HbA1c results have not improved despite making significant changes to her diet. The paediatric diabetes team now believe medication is required. A. Dapagliflozin B. Exenatide C. Glibenclamide D. Gliclazide E. Linagliptin F. Metformin G. Pioglitazone H. Saxagliptin

Metformin is the only oral anti diabetic drug licensed in patients under 12

Mrs E, a 66-year-old woman with type 2 diabetes, has visited the practice pharmacist. Mrs E explains that she has been feeling dizzy recently, and has experienced cystitis and vaginal thrush in the last two months. The practice pharmacist believes one of her antidiabetic drugs could be causing these issues. A. Dapagliflozin B. Exenatide C. Glibenclamide D. Gliclazide E. Linagliptin F. Metformin G. Pioglitazone H. Saxagliptin

SGLT2 cause glucose excretion in the urine which increases the risk of vaginal thrush and hypoglycaemia

A 23-year-old woman has returned from a beach holiday in Greece, presenting with a widespread, painful rash. She explains that she had been taking antibiotics for sinusitis throughout her trip. A. Amoxicillin B. Benzylpenicillin C. Clindamycin D. Co-amoxiclav E. Doxycycline F. Metronidazole G. Nitrofurantoin H. Trimethoprim

Doxy- Patient should be advised to protect themselves from sunlight when taking doxy due to photosensitivity

A 64-year-old man being treated for a staphylococcal bone infection presents with severe diarrhoea. A. Amoxicillin B. Benzylpenicillin C. Clindamycin D. Co-amoxiclav E. Doxycycline F. Metronidazole G. Nitrofurantoin H. Trimethoprim

Clindamycin can cause c. diff which is usually presented as diarrhoea. Patients and their carers should be advised to discontinue and contact a doctor immediately if severe, prolonged or bloody diarrhoea develops

A pharmacist is advising a patient to avoid alcohol whilst taking this antibiotic and for 48 hours after stopping. A. Amoxicillin B. Benzylpenicillin C. Clindamycin D. Co-amoxiclav E. Doxycycline F. Metronidazole G. Nitrofurantoin H. Trimethoprim

Metronidazole, an effective agent against anaerobic infections, has been reported to have aversive properties when ingested with ethanol. This is thought to be due to the blocking of hepatic aldehyde dehydrogenase (ALDH) enzyme followed by the accumulation of acetaldehyde in the blood

A 30-year-old woman who is 25 weeks pregnant with gestational hypertension has a sustained blood pressure of 150/95 mmHg. The specialist wants to prescribe an antihypertensive which is first-line in pregnant women. A. Amlodipine B. Bisoprolol C. Candesartan D. Furosemide E. Labetalol F. Moxonidine G. Ramipril H. Spironolactone

Labetalol is recommended first-line in pregnant women with pre-eclampsia, gestational or chronic hypertension presenting with a sustained blood pressure of 140/90 mmHg or higher. Nifedipine can be considered (unlicensed) if labetalol is unsuitable. Methyldopa can be considered (unlicensed) if both labetalol and nifedipine are unsuitable.

A 60-year-old man with stage 1 hypertension currently takes perindopril 4mg tablets (one tablet daily) and metformin 500mg tablets (two tablets twice daily) for type 2 diabetes. His blood pressure is still high and his GP wants to step-up treatment by adding another antihypertensive. He has no known allergies. A. Amlodipine B. Bisoprolol C. Candesartan D. Furosemide E. Labetalol F. Moxonidine G. Ramipril H. Spironolactone

The question asks about step 2 in the management of hypertension. According to the NICE guidelines, step 2 involves adding either a calcium channel blocker or thiazide-like diuretic. There is no thiazide-like diuretic in the possible answers (an example would be indapamide), meaning amlodipine is the only other option.

52-year-old woman of white British ethnicity is currently taking enalapril for hypertension. Four weeks after starting, the woman explains she has had a dry, irritating cough which she is struggling to tolerate. The community pharmacist contacts the GP practice pharmacist recommending a switch to this drug. A. Amlodipine B. Bisoprolol C. Candesartan D. Furosemide E. Labetalol F. Moxonidine G. Ramipril H. Spironolactone

A dry, irritating cough is a common side effect of ACE inhibitors. Sometimes patients can tolerate the dry cough and improves over time, but in this scenario the patient is struggling to tolerate the dry cough. According to the NICE guidelines, the best option is to switch the ACE inhibitor with an ARB, such as candesartan.

A parent presents to the pharmacy with their 6-year-old child who is complaining of dry, itchy, cracked skin on the backs of their knees and on their hands which they have had for two weeks now. The child has asthma and the only medication they take is a Clenil Modulite (beclometasone dipropionate) 50 microgram inhaler and a salbutamol 100 microgram inhaler. They have NKDA. A. Suggest booking an urgent appointment with their GP B. Suggest calamine lotion and chlorphenamine liquid C. Suggest clotrimazole 1% cream D. Suggest clotrimazole 2% cream E. Suggest going to A&E F. Suggest hydrocortisone 1% cream G. Suggest paracetamol oral suspension H. Suggest using an emollient

It is likely that the child is suffering from atopic eczema, especially when looking at their medical history of asthma (asthma and atopic eczema commonly goes hand-in- hand). Using an emollient liberally for mild eczema would be appropriate.

A parent presents to the pharmacy with their 5-year-old child. They are concerned about a red blanching rash that has recently developed on the child’s chest and tummy. They explain that initially, a couple of days ago, they had a high temperature (39 degrees centigrade) and a sore throat. A white coating has started to develop on the child’s tongue this morning which the parent describes as “looking like a strawberry”. The rash has now spread to the rest of the body and has a rough texture. They are not on any medication and have NKDA. A. Suggest booking an urgent appointment with their GP B. Suggest calamine lotion and chlorphenamine liquid C. Suggest clotrimazole 1% cream D. Suggest clotrimazole 2% cream E. Suggest going to A&E F. Suggest hydrocortisone 1% cream G. Suggest paracetamol oral suspension H. Suggest using an emollient

It is likely this child has scarlet fever, characterised by a blanching rash (as opposed to a non-blanching rash which could suggest meningitis) that starts on the trunk and spreads to the rest of the body 48 hours later. Initial features also include a fever greater than 38.3 degrees centigrade and a sore throat. The strawberry tongue further suggests scarlet fever. Prompt treatment with antibiotics is the reason they should be referred to their GP as soon as possible. There is no need to refer to A&E unless symptoms are severe or maybe meningitis is suspected.

A parent presents to the pharmacy with their 7-year-old child who has a ring- shaped rash on their left arm. The pharmacist notices it looks dry, scaly and raised on the outside but almost skin colour in the middle. The parent explains that it has been there for about a week now and has grown slightly. The child complains of it being quite itchy. They have tried an antiseptic cream but this has not made any difference. They are not taking any medication and have NKDA. A. Suggest booking an urgent appointment with their GP B. Suggest calamine lotion and chlorphenamine liquid C. Suggest clotrimazole 1% cream D. Suggest clotrimazole 2% cream E. Suggest going to A&E F. Suggest hydrocortisone 1% cream G. Suggest paracetamol oral suspension H. Suggest using an emollient

It is likely this child has ringworm, which is a common and contagious fungal infection of the skin. It has a classic ring shape. The outside tends to be red, dry, raised and scaly, while the inside tends to be more skin colour. Be careful not to confuse with Lyme’s disease which has a classic bullseye type rash! Clotrimazole 1% cream is the most appropriate product out of the above options, although other anti-fungal could be used such as miconazole 2% cream.

A 45-year old patient who is needing anti-rejection therapy following a kidney transplant. A. Gentamicin B. Carbamazepine C. Digoxin D. Lithium E. Tacrolimus F. Theophylline G. Vancomycin H. Warfarin

Tacrolimus

A 39-year-old patient needing rapid digitalisation for AF. A. Gentamicin B. Carbamazepine C. Digoxin D. Lithium E. Tacrolimus F. Theophylline G. Vancomycin H. Warfarin

Digoxin

A 28-year-old woman who has been taking quetiapine for the last two years has been given a course of clarithromycin to treat acute otitis media. A. Hyperkalaemia B. Hypernatremia C. Hyperprolactinaemia D. Hypoglycaemia E. Hypokalaemia F. Hypomagnesemia G. Hyponatremia H. QT interval prolongation

Clarithromycin is predicted to increase the exposure to quetiapine. Manufacturer advises avoid. Both clarithromycin and quetiapine have QT interval prolongation listed as side effects.

A 52-year-old man has been using more salbutamol than normal for the last few days due to feeling breathless. A. Hyperkalaemia B. Hypernatremia C. Hyperprolactinaemia D. Hypoglycaemia E. Hypokalaemia F. Hypomagnesemia G. Hyponatremia H. QT interval prolongation

Hypokalaemia

A patient with newly diagnosed diabetes has administered too much insulin. They now feel hungry, tired and are finding it difficult to concentrate. A. Hyperkalaemia B. Hypernatremia C. Hyperprolactinaemia D. Hypoglycaemia E. Hypokalaemia F. Hypomagnesemia G. Hyponatremia H. QT interval prolongation

Hypoglycaemia