501 21 Flashcards by Simon Evans

palliative care patient on your ward is being discharged after a short stay in hospital. The patient has received information on all of their new medicines except the Matrifen® (fentanyl)transdermal patches. Which of the following counselling points regarding the use of Matrifen® patches isINCORRECT?
A.The patient should avoid the use of prolonged hot baths and electric blankets due to the risk of possible overdose.
B.The patient should be advisedto monitor for increased side-effects if fever is present.
C.The patient should remove and replace the patch every 24 hours.
D.The patient should remove the patch immediately if they experience any breathing difficulties.
E.The patient should rotate the site of applicationat each application.

C. Fentanyl patchesmay be worn continuously for 72 hours, not 24 hour. Excessive heat can increase the risk of side-effects and if concern of overdose i.e. breathing difficulties, the patch should be removed immediately. Rotate the site of application to avoid skin irritation

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Mr O, a 47-year-old man,requests to buy OTC Pantoloc Control© (Pantoprazole)for the treatment of heartburn. He is not taking any other medicines and has no allergies. Which of the following signs/symptoms would make the supply unsuitable?
A.Acidic taste in mouth after meals
B.Burning sensation in middle of the chest
C.Family history of colon cancer D.Increased appetite E.Unintentional weight loss

E. Unintentional weight loss
❗ Red flag symptom. May indicate malignancy or other serious GI disease. Referral to a GP is required, and Pantoloc Control should not be supplied OTC.

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hich of the following doses of ibuprofen, 100 mg/5 mL, would be most appropriate for an 8-year-old girlto treat pyrexia? A.2.5 mL tds,maximum daily dose to be given in 3-4 divided doses
B.5 mL tds,maximum daily dose to be given in 3-4 divided doses
C.7.5 mL tds,maximum daily dose to be given in 3-4 divided doses
D.10 mL tds, maximum daily dose to be given in 3-4 divided doses

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Which of the following statement is INCORRECT? A.Alli©may potentially impair the absorption of fat-soluble vitamins
B.Alli©should be taken in conjunction with high fat, mildly hypocaloric diet
C.Alli©should only be sold to overweight adults with a BMI >28kg/m²
D.Maximum daily dose of 180mg in divided doses. E.Treatment with OTC Alli©should not exceed 6 months

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, a 27-year old woman,has come to the community pharmacy on Tuesday morning. She would like to speak to the pharmacist about emergency contraception. She currently takes no other medicines and has no known drug allergies. She tells you she is currently breastfeeding and has a 7-month-old baby. The unprotected sexual intercourse took place last Friday night around 11pm. She would like to take something immediatelyas emergency contraception. Which of the following isthe most appropriate response for Ms D?
A.No action required as she is currently breastfeeding so can use the lactational amenorrhoeamethod (LAM)
B.Recommend she gets anintrauterine device(IUD)fitted C.Recommend she takes EllaOne©immediately and avoid breastfeeding for at least 8 hours
D.Recommend she takes EllaOne©immediately and avoid breastfeeding for the next 7 days
E.Recommend she takes Levonelle One Step©immediately and avoid breastfeeding for at least 8 hours.

D -Recommend she takes EllaOne©immediately and avoid breastfeeding for the next 7 daysLevonelle One Step©is unsuitable as it can only be taken 72 hours post UPSI. EllaOne©can be taken up to 120 hours post UPSI so will be suitable until Wednesday morning. After intake of EllaOne©breastfeeding is not recommended for one week. Refer to EllaOne©SPC (https://www.medicines.org.uk/emc/product/6657/smpc#gref). She does not need to get IUD fitted as EllaOne© is suitable and she wants something immediately. LAM only works if your baby is under 6 months old-Ms D’s baby is 7 months old.

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aged 16-years, comes into the pharmacy asking to speak to the pharmacist privately. Miss J explains that she is experiencing very heavy periods and often bleeds through her bedding at night. She also needs to change her sanitary protection every two hours throughout the day which is preventing her from doing her normal everyday activities. She read online that there are medicines she can buy to help with this. She is currently not taking any other medicines and has no allergies.What would be the most appropriate response to Miss J?
A.No action required, condition is self-limiting
B.Refer to GP
C.Supply ibuprofen tablets
D.Supply paracetamol tablets
E.Supply tranexamic acid tablets

Refer - patient has symptoms of menorrhagia, this can be treated OTC with tranexamic acid however as patient is 16 years old, we cannot supply (women aged 18-45 years), therefore must refer patient to GP to get prescription. Paracetamol, ibuprofen would not be sufficient for treatment

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Mr. Pattendsyour pharmacy based travel clinic with his 9-year old son. Heasks for advice about malaria tablets for their upcoming trip to Ghana. Mr. P is currently taking citalopram 10mg and amlodipine 10mg. His son doesnot takeany regular medication. Neither Mr P nor his son have any known allergies. You check the appropriate website and confirm that there is a high risk of malaria in Ghana and the recommended anti-malarials are atovaquone with proguanil hydrochloride or doxycycline or mefloquine.Considering Mr P would prefer for both him and his son to take the same anti-malarialtablets, which of the following would be the mostappropriate?
A.Atovaquone alone
B.Atovaquonecombined with proguanil
C.Doxycycline
D.Mefloquine
E.Proguanil alone

B- Doxy not in under 12 and mefloquine unsuitable in depression

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Mr. K, a 65-year-old man, comes into the pharmacy asking to speak to the pharmacist regarding the purchase of Viagra Connect® (sildenafil 50mg tabs). You speak to Mr K in the consultation room and ask questions to determine whether you can make a supply. After questioning, you decide to refer Mr. K to his GP as you are unable to supply the medicine as a Pharmacy medicine.Which of the following is the most likely reason that the supply for Mr. K was NOTappropriate?
A.He drinks alcohol
B.He is 65 years old
C.He is currently taking doxazosin
D.He is currently taking lansoprazole
E.He is a smoker

Interaction between sildenafil and alpha blockers. Doxazosin causes significant hypotensive effects when given with sildenafi

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Master M, an 8-year-old child,has been diagnosed with scarlet fever. He is known to be allergic to penicillin. Which of the followingwould bethe most appropriate option for Master Mto treat his condition? A.Azithromycin 300 mg once daily for 5 days
B.Doxycycline 200 mg daily for 7 days
C.No treatment, the condition is self-limiting. D.Phenoxymethylpenicillin 250 mg qds for 10 days
E.Treatment with paracetamol alone

A, Azithromycin.
-B and D are not possible, due to child’s age and history of penicillin allergy
-C and E are incorrect. Paracetamol can be given alongside the antibiotics. Scarlet fever should be treated promptly with antibiotics to prevent complications,regardless of the severity of illness. Azithromycin is recommended for people with penicillin allergy. 1st line is phenoxymethylpenicillin qdsfor 10 days, however, this is unsuitable due to history of allergy. Doxycycline is unsuitable as it is not a recommended antibioticfor this condition,plus it should not be prescribed for children <12 years

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Miss V, a 10-year-old child, has beenexperiencingfever, runny nose, and a red rashfor the past 72 hours. Her mother took her to see the GP who recommended paracetamol and plenty of fluids and said the child does not need to stay off school. The GP found noother symptoms, including nosigns of photophobia, stiff neck or vomiting.Which of the following conditions is the mostlikely diagnosisforMiss V’s condition? A.Chickenpox
B.Impetigo
C.Meningitis
D.Scarlet fever
E.Slapped cheek syndrome

E, slapped cheek syndromeOnce diagnosed with slapped cheek syndrome, you do not need to keep your child off school because once therash appears, they are no longer infectious. It is usually a mild, self-limiting illness.For children andadults (who are not pregnant)with suspected parvovirus B19 infection, management includes advice on:Symptom relief, such as fluids, analgesia, and rest.The need for exclusion from school, nursery, or work (if appropriate). Note: this is not usually necessary as the person is no longerinfectiousone day after anyrash or symptoms develop.Scarlet fever, impetigo and meningitis would all require antibiotic treatment. If your child haschickenpox, they need to be kept off school until all the spots have crusted over

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A patient requires a dose of vancomycin 1g IV BD. The infusion bags available on the ward are 1.25g in 500mL sodium chloride 0.9%. An infusion rate of 10mg/min needs to be set on the syringe driver.What infusion rate, in mL/minute, should the nurse set the pump to?
A.2 mL/minute
B.4 mL/minute
C.8mL/minute
D.12mL/minute
E.16 mL/minute

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Mrs G, aged73years, has recently been discharged from hospital following a stroke. The hospital hasstarted Mrs G on clopidogrel, however the consultant is concerned about the risk of gastrointestinal bleeding and would like to co-prescribe gastrointestinal protection. Which of the following medicineswould be the least appropriate to co-prescribe?
A.Lansoprazole
B.Omeprazole
C.Pantoprazole
D.Rabeprazole
E.Ranitidine

interaction with omeprazole decreasing the efficacy of the antiplatlet

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GP practice based pharmacist is carrying out a medication review for Mrs L, aged 67 years. The pharmacist is considering the appropriateness of a statin for Mrs L, given her myocardial infarction 2 years ago. According to her current and past medication lists, Mrs L has never been prescribed a statin. You cannot see from her notes any clinical reason why a statin would not be appropriate and so decide toinitiate one. Which statin would be considered first line for Mrs L?
A.Atorvastatin 20mg o.d. B.Atorvastatin 80mg o.d.
C.Rosuvastatin 20mg o.d.
D.Simvastatin 20mg o.d.
E.Simvastatin 80mg o.d

Atorva 80mg

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Mr H, a 45-year old patient at your community pharmacy, brings in a new prescription for linagliptin 5 mg tablets once daily. You notice that he was previously prescribed sitagliptin 100 mg tablets once daily, which he had been taking for 2 years. Mr Hhas type 2 diabetes mellitus which is currently well controlled. Mr H’s only other regular medication is ibuprofen 400 mg tds for back pain. Which of the followingis the most likely reason for the switch to linagliptin?
A.Linagliptin has fewer side effects than sitagliptin
B.NICE recommends linagliptin over sitagliptin to reduce the risk of hypoglycaemia
C.The patient’s HbA1C is not controlled
D.The patient’s liver function has deteriorated and so linagliptin is more appropriate
E.The patient’s renal function has deteriorated and so linagliptin is more appropriate

Renal function has deteriorated and so lingaliptin is more appropriate

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You receive a prescription for sodium valproate for Miss R, a 35-year old woman. You see this as a good learning opportunity to quiz your pharmacy teamregarding the use of sodium valproate in women of childbearing age. Which of the following statements regarding the use of sodium valproate is INCORRECT?
A.Pharmacists must discuss the riskswith female patients each time sodium valproate is dispensed.
B.Sodium valproate can be used as a last line therapy in pregnancy to manage bipolar disorder.
C.Sodium valproate should be dispensed in whole packs where possible,with warning labels.
D.Thepatient’s full blood count and liver function must be monitored during treatment.
E.Women of child-bearing age taking sodium valproate must be on the pregnancy prevention programme

B - CI in bipolar with pregnancy

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Miss J comes into your pharmacy asking to speak to the pharmacist. She has been taking antibiotics for the past 3 days and has noticed that her urine has turned dark yellow,and occasionally brown.What of the following antibiotics is most likely to have caused this? A.Clindamycin 150mg caps
B.Co-amoxiclav 500/125 tabs C.Nitrofurantoin 100mg MR Caps
D.Rifampicin 150mg caps E.Trimethoprim 100mg tabs

Nitro

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Mr Nhas brought in a new prescription for Priadel©200mg MR tabs (lithium carbonate) for the management of bipolar disorder. Mr Nhas 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 whilst Mr Nis taking Priadel©?A.Body Mass Index
B.Liver function test
C.Renal function test
D.Serum electrolytes
E.Thyroid function test

LFT

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Mrs C, a 33-year old woman, comes into the pharmacy asking to buy something over the counter to help with nausea, vomitingand stomach-ache. Mrs C’s appetite has reduced over the past few weeks and she has been feeling more tired than usual. You notice that the whites of her eyes are slightly yellow. Upon further questioning, Mrs C tells you she is currently taking folic acidand methotrexate for the management of Crohn’s disease. Mrs C has not tried anything yet to relieve her symptoms.Which of the following would be the most appropriate advice for Mrs C? A.Advise Mrs Cto try Gaviscon©Advancefor 48 hours and see her GP if symptoms persist.
B.Advise Mrs C to purchase omeprazole over the counter.
C.Recommend a pregnancy test as a first priority.
D.Recommend whitening eye drops and a tonic to help boost Mrs C’s appetite. E.Refer Mrs C to her GP urgently

AnswerE, urgent GP referral: nausea, vomiting, stomach-ache, reduced appetite, fatigue, yellowing of the whites of the eye are all possible signs of liver toxicity due to methotrexate-would warrant urgent referral to GP. Interaction between methotrexate and omeprazole-omeprazole decreases the clearance of methotrexate, manufacturer advices use with caution or avoid.

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Miss T has been taking azathioprine for the last 4 months. She is in the pharmacy collecting her mother’s repeat medication and mentions that she has a bruiseon her left leg which seems to be taking a while to go down. The bruising has also startedspreading up her leg. The bruise first appeared around 3 weeks ago.Which of the following options would be the most appropriate advice to give MissT?
A.Advise Miss T that the symptoms she is describing are unlikely to be due to her medication.
B.Miss T should contact her GP straight away and explain that she has unexplained bruising.
C.Miss T should buy arnica cream and see if that resolves the bruising. D.Miss T should call 999 as she requires an ambulance immediately.
E.Miss T should stop taking the azathioprine straight away and call her consultant for an appointment in the next 2 weeks

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Miss V has recently found out she is 6 weeks pregnant. She would like to purchase multivitamins as she has read that this is important to ensure a healthy pregnancy. Miss V has a previous medical history of asthma and sickle cell disease.Which of the following wouldbe the most appropriate advice for Miss V?
A.Miss Vshould avoid taking medications in pregnancy and instead eat a balanced, healthy diet with ginger if required for nausea.
B.Miss Vshould purchase a multivitamin supplement over the counter which contains iron and folic acid.
C.Miss V should see her GP for a prescription for folic acid 5 mg.
D.Miss Vshould talk to her GP as she will need a blood test first to establish if she requires multivitamins.
E.Miss Vshould take folic acid 400 microgram each day to prevent neonatal defects.

Answer: C, see GP for folic acid 5 mgFolic acid 5 mg daily should be prescribed during pregnancy to reduce the risk of neural tube defect and to compensate for the increased demand for folate during pregnancy.This strength is not available for purchase OTC and therefore a Rx is required.

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A patient has had a blood test and is found to have elevated thyroid function markers. Which of the following medicines is least likely to cause hyperthyroidism?
A.Amiodarone
B.Calcium carbonate C.Levothyroxine
D.Liothyronine
E.Lithium

Answer: B –calcium carbonate. All others can cause hyperthyroidism except calcium carbonate.Calcium can reduce the absorption of levothyroxine, therefore this shouldn’t be taken at the same time as levothyroxine.Overtreatment with levothyroxine or liothyronine can cause hyperthyroidism.Amiodarone and lithium can cause thyroid disorders

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Pharmacists and pharmacy technicians must adhere to the nine GPhC Standards for Pharmacy Professionals. One of these standards relates to safeguarding people, particularly children and vulnerable adults.Which of the following is NOT one of the four principle categories of child abuse?A.Emotional abuse
B.Modern slavery
C.Neglect
D.Physical abuse
E.Sexual abuse

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Menopausal symptoms can be managed with hormone replacement therapy (HRT), however treatment benefits must be weighed against potential risks.Which of the followingconditions is least likely to develop as a result of using HRT?
A.Breast cancer
B.Osteoporosis
C.Stroke
D.Ovariancancer
E.Venous thromboembolism

Answer: B (osteoporosis)Risk of fragility fracture is DECREASED while taking HRT. This is beneficial, reducing risks of osteoporosis and fracture

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You screen a prescription for a patient with a leg ulcer infection. The patient is not severely unwelland it has been agreed that he can be treated at home. The patient is penicillin allergic.Using the information in the resource pack provided, what would be the most suitable antibiotic choice for this patient? A.Clarithromycin500 mg bd for 7 days
B.Co-amoxiclav500/125 mg tds for 7 days
C.Flucloxacillin500 mg qds for 7 days
D.Linezolid600 mg bd
E.Piperacillin with tazobactam4.5 g tds IV

First‑choice oral antibiotic –FlucloxacillinAlternative first‑choice oral antibiotics for penicillin allergy or if flucloxacillin unsuitable –Doxycycline, Clarithromycin, Erythromycin (in pregnancy)Second‑choice oral antibiotics (guided by microbiological results when available) -Co-amoxiclav, Co-trimoxazole(in penicillin allergy)Piperacillin with tazobactam is only indicated as a second‑choice antibiotic if severely unwell (guided by microbiological results when available or following specialist advice).Linezolid is only used if vancomycin or teicoplanin cannot be used; specialist advice only, to be added if MRSA infection is suspected or confirmed (combination therapy with antibiotics listed above)

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A pharmacist isexplaining inhaler technique to an adultpatient newly prescribed a salbutamol pressurised metered dose inhaler.Which of the following statements regarding inhaler technique in this situation is most accurate? A.Breathe in slowly and steadily through your mouth. Just after starting to breathe in, press the canister to release the dose. Continue to breathe in for 20 seconds, then hold your breath for a further 30 seconds, then breathe out gently away from your inhaler. B.Breathe in slowly and steadily through your mouth. Just after starting to breathe in, press the canister to release the dose. Continue to breathe in until your lungs feel full, then hold your breath for up to 10 seconds, or as long as is comfortable, then breathe out gently away from your inhaler. C.Press the canister to release the dose, then breathe in slowly and steadily until your lungs feel full, then hold your breath for up to 10 seconds, then breathe out gently away from your inhaler. D.Start breathingin quickly and deeply whilst simultaneously pressingthe canister to release the dose. Continue breathingin quickly and deeply until your lungs feel full, then hold your breath for up to 10 seconds, then breathe out gently away from your inhaler. E.Start breathingin quickly and deeply whilst simultaneously pressingthe canister to release the dose. Continue breathingin quickly and deeply until your lungs feel full, then hold your breath for up to 10 seconds, then breathe out gently away from your inhaler

Following admission to the cardiology ward, a patient has their HAS-BLED score calculated. This score is taken into account before initiating a new medicine. What purpose does the HAS-BLED tool serve? A.Calculatesthe likelihood of apatient having amajor cardiovascular event over the following ten years. B.Determinesa patient’s probability of having a deep vein thrombosis. C.Estimates the risk of bleeding in patients with atrial fibrillation who are being offered anticoagulation. D.Estimates the risk of bleeding in patients with heart failure who are taking immunosuppressants. E.Estimatesthe risk of stroke for a patient with non-valvular atrial fibrillation.

Which of the following risk factors does a HAS-BLED score NOT take into account as part of the calculation? A.Age B.Alcohol use C.Congestive heart failure D.Hypertension E.Liver disease

C, congestive heart failure, which is part of the CHADVASc stroke risk score.

An82-year-oldpatient has been newly diagnosed with type 2 diabetes mellitus. Their past medical history includes atrial fibrillation, previous bladder cancer and hypertension. Recent blood results show an eGFR of 25 mL/min.Which of the following would be the most appropriate initial drug therapy for this patient? A.Dapagliflozin B.Glibenclamide C.Metformin D.Pioglitazone E.Sitagliptin

Sitagliptin at reduced dose Pioglitazone is CI Glicazide not suitable due to age Metformin and dapa not suitable due to renal impairment

Neuroleptic malignant syndrome is a potentially life-threatening adverse effect related to the use of some antipsychotic and antiemetic drugs. It may affect up to 3% of patients taking antipsychotic agents and is characterized by distinctive clinical signsand symptoms. Which of the following symptoms is NOT part of the typical tetrad of symptoms associated with neuroleptic malignant syndrome? A Altered mental state B Hyperthermia C Muscle rigidity D Red or purple rash E Tachycardia

Red or purple rash is incorrect. That is seen in SJS which associated with certain AED

Award pharmacist is monitoringthe INR of patients prescribed warfarin. An INR which is within 0.5 units of the target value is considered to be satisfactory. For larger deviations, the pharmacist may make recommendations to medical staff on any necessary dosage adjustment.Which of the following is the usual INR target value for a patient prescribed warfarin for atrial fibrillation? A 1.0 B 2.0 C 2.5 D 3.5 E 3.75

2.5 is the target value for many conditions including atrial fibrillation, treatment of DVT and PE, and bioprosthetic heart values.-3.5 is used for recurrent DVT or PE in patients occurring in patients who were already on anticoagulation.-A higher range (3.0 –4.0 or 3.0 –4.5) might be used for higher risk patientssuch as those with mechanical heart valves.-1.0 is the reference INR value, which would be expected for a normal person who isn’t on an anticoagulant

A patient is admitted to hospital after developing slurred speech, a one-sided facial droop and confusion. They are diagnosed with an acute ischaemic stroke, and intracerebral haemorrhage is excludedby brain imaging. The patient has dysphagiaand they are in atrial fibrillation.What therapy should be initiated for this patient within 24 hours of presentation? A Apixaban 5 mg plus atorvastatin 80mg orally B Aspirin 300 mg orally C Aspirin 300mg plus atorvastatin 80mg orally D Aspirin 300 mg rectally or by enteral tube E Clopidogrel 300 mg rectally or by enteral tube

Answer: D -Aspirin 300mg rectally or by enteral tube-Aspirin 300 mg orally if they do not have dysphagia or aspirin 300 mg rectally or by enteral tube if they do have dysphagia.-Ensure that people with disabling ischaemic stroke who are in atrial fibrillation are treated withaspirin 300 mg for the first 2 weeks before anticoagulation treatment is considered.-Immediate initiation of statin treatment is not recommended in people with acute stroke-Clopidogrel 75 mgis used for patients with aspirin hypersensitivity, or those intolerant of aspirin despite the addition of a proton pump inhibitor. A 300mg loading dose is given for patients with STEMI or NSTEMI

There are a number of lifestyle changes which can be made by people in mid-life to reduce the risk of developing dementia as they grow older.Which of the following health promotion interventions is NOT related to dementia risk? A. Achieve and/or maintain a healthy weight B.Avoid air pollution C.Be more physically active D.Reduce alcohol consumption E.Stop smoking

You have a 1000 mLinfusion bag of glucose 5%w/v. You discard 200 mL of this infusion bag and replace it with 200mL glucose 50%. What volume and concentration of glucose do you now have? A.200 mL glucose 50% bag B.500 mL glucose 10% bag C.1000 mLglucose 14% bag D.1000 mL glucose 18% bag E.1200 mL glucose 25% bag

You are running a weight loss clinic and one of your clients explains to you that whilst she knows she needs to start exercising, she just doesn’t have the motivation to start yet. She recently thought about buying an exercise bike to use at home, but then lost her job and can no longer afford it.Which of the following stages of behaviour change is the client most likely at? A.action B.contemplation C.maintenance D.pre-contemplation stage E.preparation

A 60-year-old patient of black African family origin attends an annual health review at their GP surgery. They have type 2 diabetes treated with metformin, and osteoarthritis treated with co-codamol. At their health review, they have high blood pressure. This is confirmed with follow-up readings and it is decided they should start a new medicine to control their blood pressure.Which class of antihypertensive drugs is the first-line choice for this patient according to NICE guidance?A.Angiotensin II receptor antagonist B.Beta blocker C.Calcium channel blocker D.Thiazide diuretic E.Neprilysin inhibitor

ARB

A 65-year-old female was admitted to hospital for intense back and leg pain. Her right leg was weak and she reported a history of her legs buckling unexpectedly. She was also experiencing numbness in the groin area and in her 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.Fever B.Loss of bladder control C.Loss of consciousness D.Sharp pain at the back of the head E.Unexplained weight loss

Answer: B -Loss of bladder controlSymptoms of cauda equina syndrome: *Severelow back pain.*Motor weakness, sensory loss, or pain in oneor 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 patient visited theirGP with symptoms which prompted an urgent referral under the suspected cancer pathway for an appointment within 2 weeks.Which of the following is the most likely scenario which prompted the GPs decision? A.A 24-year-old malewith changes in their bowel habit for the last 7 days B.A 36-year-old femalewith constipation for the last 3 days C.A 48-year-old malecomplaining of diarrhoea and tiredness for the past 2 days D.A 54-year-old malewith unexplained rectal bleeding E.A 61-year-old female with symptoms of indigestionand flatulence

Answer:DCKS guidelines for suspected cancer pathway referral (for an appointment within 2 weeks)if:*they are aged 40 and over withunexplainedweight loss and abdominal painor*they are aged 50 and over with unexplained rectal bleedingor*they are aged 60 and over with either iron-deficiency anaemiaorchanges in their bowel habit,or*tests show occult blood in their faeces.*Consider a suspected cancer pathway referral for colorectal cancer in adults with a rectal or abdominal mass.*Consider a suspected cancer pathway referral for colorectal cancer in adults aged under 50 with rectal bleedingandany of the following unexplained symptoms or findings:-abdominal pain-change in bowel habit-weight loss-iron-deficiency anaemia.

You are reviewing new treatments for a condition and checking what the latest evidence base is for a particular drug. The drug you are interested in showed positive results in a cohort study and you are wondering whether or not this is a higher form of evidence compared that available for the other drugs.Which of the following gives the most accurate descriptionof a cohort study? A.astudy where a group ofpeople are identified and followed over a period of time to see how their exposures affect their outcomes B.a study where people are randomly allocated to receive (or not receive) a particular intervention C.a synthesis of themedical research on a subject, using thorough methods to search for and include all or as much as possible of the research on the topic. D.atrialwhere neither the researchers nor the patients know what they are getting E.anepidemiological studythat describes characteristics of a population

Vincristine, vinflunine andvinorelbineare all vinca alkaloiddrugs used for a variety of cancers. Which of the following describes the most appropriate method of administration for the above drugs? A.intradermal B.intramuscular C.intrathecal D.intravenous E.subcutaneousAnswer

IV ONLY

Which of the following doses of paracetamol, 120 mg/5 mL would be most appropriate for a 5-year-old boy? A.2.5 mL every 4–6 hours; maximum 4 doses per day B.5 mL every 4–6 hours; maximum 4 doses per day C.7.5 mL every 4–6 hours; maximum 4 doses per day D.10 mL every 4–6 hours; maximum 4 doses per day E.20 mL every 4–6 hours; maximum 4 doses per day

D- 10ml every 4-6 hours, max 4 doses per day

As part of information governance, pharmacy professionals must comply with the relevant data protection legislation. Which of the following statements regarding data protection is CORRECT? A.Dataprotection legislation applies to anonymised data as well as patient identifiable information B.Hand written records are exempt from data protection requirements C.Patient consent is required each time their data is accessed D.Patients can consent by default totheir data being collected, storedand processed E.The Data Protection Officer must ensure non-compliance with data protection legislation is reported to the Information Commissioner’s officer within 72 hour

A 5-year-old child has presented at the pharmacy with bullousimpetigo. They are not systemically unwell or at high risk of complications.You suggest the patient makes a GP appointment.Which of the followingwould be the most suitable initial treatment for thechild? A.A topical antibiotic such as fusidic acid2% cream for 3 days B.A topical antibiotic such as mupirocin 2% cream for 7 days C.An oral antibiotic such as flucloxacillin 250 mg for 5 days D.An oral antibiotic such as erythromycin 500 mg for 5 days E.Hydrogen peroxide 1% cream for 5 days

Answer: C -An oralantibiotic such as flucloxacillin 250 mg for 5 days. Erythromycin is the other possibility, however it is only used in pregnancy for this condition. Clarithromycin would be used if patient is penicillin-alergic.Impetigo is a highly contagious skin infection most commonly affecting young children. Sores (non-bullous impetigo) or blisters (bullous impetigo) usually develop on the face or hands.

You have been approached by a junior doctor who is reviewing a patient presenting with Clostridium difficile infection. The patient has recently finished a course of antibiotics but is unable to recall the name of them.Which of the following is least likely to cause Clostridiumdifficile infection?A.Aminoglycosides B.Cephalosporins C.Clindamycin D.Co-amoxiclav E.Quinolones

Aminoglycosides

A 38-year-oldwomanpresents at the pharmacy feeling sick and dizzy. You recognise her as a regular patient who recently brought in her new born baby. Upon further questioning, she explains that she feels confusedand has severe muscle pain.You take her into the consultation room and notice her speech is slurred and she has cold and pale skin. She tells you that she has not urinated in the last 24 hours.Which of the following conditions is she most likelysuffering from? A.diabetes B.malaria C.meningitis D.sepsis E.stroke

AnswerD Patients should seek medical helpurgently if they develop any of the following:Slurred speech or confusionExtreme shivering or muscle painPassing no urine (in a day)Severe breathlessnessIt feels like they’re going to dieSkin mottled, pale or discoloured She has recently given birth, and if by C-section (i.e. an invasive procedure), this puts her at increased risk of sepsis.

When preparing for surgery it is vital that the anaesthetist is aware of all medication that a patient is taking. The risk of losing disease control on stopping long-term medication before surgery is often greater than the risk posed by continuing it during surgery.Which of the following would be least appropriate to stop prior to surgery?A.Anticoagulants B.Antiepileptics C.Antiplatelets D.Combined oral contraceptives E.Hormone replacement therapy

AED Patients taking antiplatelet medication or an oral anticoagulant present an increased risk for surgery.-COCsand HRT have a VTE risk

Youare preparing to run an “alcohol awareness” campaign to deliver in the community pharmacy.According to NHS guidance, which of the following patients would it be most appropriatefor you target to discuss reducing alcohol related health risks? A.Mr E, a 76-year-old male, who drinks a totalof 7units at the weekend. B.Mr K, a 24-year-old malewho drinks a total of 12 units over 4 days. C.MissL, a 52-year-old female, who drinks 3units on a Friday night. D.MissM, a 46-year-old female, who drinks 3units a night, 4 days a week. E.Mrs T, a 66-year-old femalewho drinks 4units a day, every day

An83-year-old womanwith Parkinson’sdiseaseis experiencing post-operative nausea and vomiting. Which of the following antiemeticswould be LEASTappropriate to recommend for this patient?A.cyclizine IV B.cyclizine IM C.domperidone PO D.metoclopramide PO E.ondansetron IV

:D-Metoclopramide Metoclopramide can induce acute dystonic reactions involving facial and skeletal muscle spasms

You receive a prescription for cefalexin 125 mg/5 mL for an 8-year-oldgirl weighing 22 kg.The recommended dose is 12.5 mg/kg twice daily.Which of the following is the correct volume per dose? A.5 mL B.8 mL C.11 mL D.12.5 mL E.25 mL

You are preparing250 mLof a disinfectant solution for a patient. You explain to the patient that they must dilute the solution which you supply 1 in 10before using it. This will then produce a solution with a concentration of one part per 5000, which is ready to apply to the patient’s skin.What quantityof disinfectant, in grams, will becontained in the solutionwhich you supply to the patient?A.0.01gB.0.1gC.0.5gD.2.5gE.5g

Agranulocytosisis 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 NOTbe usedin combination with methotrexatedue to the increased risk of agranulocytosis? A.Aspirin B.Clomipramine C.Olanzapine D.Pioglitazone E.Tramadol

Olanzapine

Every time a pharmacy professional renews their registration with the GPhC, they mustsubmit records to show how they have carried out and recorded revalidation activities.Which of the following statements regarding revalidationis CORRECT? A.Each year, andby the time a pharmacy professionalrenews theirregistration, the GPhCwill expect them to carry out, record and submit nineCPD entries, at least twoof which must be planned learning activities. B.Each year, and by the time a pharmacy professionalrenews theirregistration, the GPhCwill expect them to carry out, record and submit twopeer discussions andtworeflective accounts. C.Planned learning is a learning and development activity that encouragesyou to engage with others in your reflection on learning and practice. D.The purpose of the reflective account is to encourage pharmacy professionals to think about how they meet the GPhC standards for pharmacy professionals in the work which they do. E.Unplanned learning is when you decide to develop your knowledge and/or skills in advance of carrying out the learning activity.

A 2-year-old childhas chicken poxand requires treatment over-the-counter for the itch. They have no other medical conditions and do not take any other medication.Which of the following would bethe most appropriateto recommend?A.cetirizine 5 mg twice daily B.chlorphenamine 1 mg every 4-6 hours C.hydroxyzine 50 mg twice daily D.loratadine 1mg once daily E.promethazine 25mg twice daily

B is correct A is the dose for aged 6+ C is a POM and an overdose D isan incorrect dose (should be 5 mg or 10 mg depending on the child’s weight ) E is an overdose

A patient presentswith symptoms of sneezing, nasal itching, rhinorrhoea and nasal congestion. You diagnose allergic rhinitis and explain to the patient which products are available over-the-counter.The patient decides to buy a Clarinaze®Allergy Control Nasal Spray, containing mometasone 0.05%.Which of the following statements regarding the use of the Clarinaze® Allergy Control Nasal Sprayis INCORRECT?A.Before first administration the spray should be primed, this is achieved by actuating the pump ten times until a fine mist is obtained; re-prime with two sprays if the pump has not been used for 14 days B.Clarinaze® Allergy Control NasalSpraymay be supplied to adults over 12years of age. C.Side effects include epistaxis, headache, nasal discomfort and irritated throat D.The active ingredient, mometasone, is a corticosteroid. E.The recommended dose is 100 mcginto each nostril once a day until symptoms are controlled, then 50 mcginto each nostril daily

B is incorrect - is licensed for 18+

Clinical audit is vital for patient care and safety, as well as for the development and improvement of professional practice.Whichof 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 ethicalapproval before conductinga clinical audit

Mr R has been prescribed colchicine for an acute attack of gout. Which of the following statements regarding gout and the use of colchicineis INCORRECT? A.Certain drugs can increase the risk of developing gout by raising plasma urate levels, such as ACE inhibitors, beta-blockers and diuretics. B.Colchicineshould be avoided in people with an eGFR less than 10, women who are pregnantor breastfeeding, or those with severe hepatic impairment. C.Mr Rshould have500micrograms of colchicine, two to four times a day, until pain relief is achieved, or diarrhoea or vomiting occurs. D.Mr Rshould be advised to not exceed a total dose of 6mg of colchicine and to not repeat treatment within three days. E.Purine-rich foods, such as green leafy vegetables,increase the risk of gout, as higher purine intake is associated with uric acid levelsabove 150 micromol/L

e IS INCORRECT

42-year-old woman asks for your advice on the management of rosacea.She tells you that she has read conflicting reports of the most common factors which may trigger or worsen her symptoms.Based on current evidence, which of the following factors is LEASTlikely to trigger or worsenrosacea symptoms?A.Emotional stress B.Exercise C.Ice-cold drinks D.Smoking E.Spicy foods

Hot drinks are a trigger not ice cold drinks

Topical corticosteroids are classified according to their potency, being either mild, moderate, potent or very potent.Which of the following topical corticosteroids is classified as moderate?A.Betnovate®(betamethasone valerate) B.Dermovate®(clobetasol propionate) C.Eumovate®(clobetasone butyrate) D.Hc45®(hydrocortisone) E.Nerisone Forte®(diflucortolone valerate)

C- Eumovate

Proton pump inhibitors inhibit gastric acid secretion by blocking the ‘proton pump’ of the gastric parietal cell. Whilst effective and commonly used medicines, they have several cautions and monitoring requirements associated with them.Which of the followingcautionsis NOT associated with proton pump inhibitors? A.Measurement of serum-magnesiumconcentrations should be considered before and during prolonged treatment with a proton pump inhibitor. B.Patients at risk of osteoporosis should maintain an adequate intake of calcium and vitamin D, due to the increased riskof fractureswith proton pump inhibitors. C.Particular care is required for patients presenting with any ‘alarm features’ of prostatecancer, due to the abilityof proton pump inhibitors to mask the symptoms of prostate cancer in adults. D.Proton pump inhibitors may increase the risk of gastro-intestinal infections, including Clostridioides difficileinfection. E.Proton pump inhibitorsshould always be prescribed for appropriate indications at the lowest effective dose for the shortest periodof time

C is incorrect. They can mask gastric cancer not prostate

It is normal practice when dispensing atenololto add which of the following cautionary labelsto the container? A.Dissolve or mix with water before taking B.This medicine may colour your urine. This is harmless C.Warning: Do not drink alcohol D.Warning: Do not stop taking this medicine unless your doctor tells you to stop E.Warning: May cause drowsiness. If affected do not drive or operate machinery

Answer: D-Sudden cessation of beta-blockers may cause a rebound worsening of myocardial ischaemia & may cause exacerbation of angina.

Healthcare professionals are expected to be competent in the use of adrenaline for the emergency treatment of anaphylaxis.Which of the following would be the most appropriate dose of adrenaline to administer for a 7-year-old child? A.100 micrograms B.250 micrograms C.0.15 mL of a 1:1000 injection D.0.3 mL of a 1:1000 injection E.0.5 mL of a 1:1000 injection

hen supplying inhaled corticosteroids, there are several important counselling points which should be discussed with the patient and/or carer.Which of the following statements regarding the use of inhaled corticosteroidsis CORRECT? A.A steroid card is only required to be supplied to patients taking oral corticosteroids and not those who are only on inhaled corticosteroids. B.If oral candidiasis develops, treatment should be stopped while an anti-fungal suspension or oral gel is being used as treatment. C.Qvar®and Clenil®Modulite are interchangeable, as both are beclometasone dipropionate CFC-free pMDIs. D.The height and weightof children receiving prolonged treatment with inhaled corticosteroids should be monitored annually. E.The risk of oral candidiasis is increased by using a spacer device with a corticosteroid inhaler

D- height and weight should be checked yearly. If stopping growth refer to paeds

A 13-year-old childhas been prescribed carbimazole. You have arranged to speak with the child’s parents regarding the use of the new medicine. Which of the following symptoms is LEASTlikely to be a sign of agranulocytosisor neutropenia? A.bruising B.diarrhoea C.fever D.malaise E.sore throat

Diarrhoea

Pharmacists must be first aid trained to ensurethey are able to manage medical emergencies in the community.In a community setting with a conscious adultpatient, which of the following would be the most appropriate first-lineemergency medical treatment for a patient with diabetessuffering from hypoglycaemia? A.A 500 mLglass of pure fruit juice B.Approximately2.5 g of glucose C.Approximately20g of sucrose D.Glucose 10% intravenous infusion E.Glucagon injection 1 mg

Answer:C A.150–200 mL pure fruit juice would be appropriate -500 mL too much B.Approximately2.5 g of glucose –approx. 15-20 g is recommended of glucose or sucrose C.Approximately20g of sucrose –CORRECT D.Not first lineand wouldn’t be available immediately -Glucose 10% intravenous infusion E.Glucagon injection 1 mg –only if hypoglycaemia unresponsive or if oral route cannot be used

Miss Yhas come to collect her repeat prescription for Ovranette® tablets (ethinylestradiol30micrograms and levonorgestrel 150 micrograms). When handing out her medication, Miss Y explains thatshe recently missed a pill and is not sure whether she still has contraceptive protection.What of the following statements regarding missed pills for combined hormonal contraceptivesis CORRECT? A.A missed pill is one that is 12or more hours late B.A missed pill is one that is 24 or more hours lateC.A missed pill is one that is 48 or more hours late D.A missed pill is one that is 72 or more hours late E.A missed pill is one that is 120 or more hours late

B A missedpill is one that is 24 or more hours late. If a woman misses only one pill, she should take an active pill as soon as she remembers and then resume normal pill-taking. No additional precautions are necessary

Baby S, aged 15monthsandweighing 11 kg, hasreflux oesophagitis. He has been prescribed ranitidine liquid 75 mg/5 mLat a dose of 4mg/kg twice daily. What volume of ranitidine liquid, in mL, will Baby Sreceive per day? A.2.9 mL B.5.9 mL C.8.8 mL D.11.7 mL E.14.6 mL

B 5.9ml

Mrs T has been admitted to A&E having vomited fresh blood. Her current medication list is shown below:-Atorvastatin 40 mg od-Metformin 500 mg tds-Naproxen 500 mg bd-Paracetamol 500 mg prn-Valsartan 160 mg odWhich of Mrs T’s current medicines is most likely to be causing her symptoms? A.Atorvastatin B.Metformin C.Naproxen D.Paracetamol E.Valsartan

Naproxen is a non-steroidal anti-inflammatory drug (NSAID), and NSAIDs are well-known for their potential to cause gastric irritation, gastritis, and peptic ulcers, which can lead to GI bleeding. Vomiting fresh blood (hematemesis) typically indicates bleeding in the upper GI tract (e.g., stomach or esophagus), and NSAID-induced ulcers are a common culprit.

A Pharmacy Technician asks for your advice regarding a recent increase in dispensing errors across the pharmacy team. She would like to know how she can train her colleagues to minimise the risk of making future errors.Which of the following statements would be the leastappropriate advice to give? A.Arrange a meeting with all staff to encourage reporting of errors to help identify any changes required in the dispensing process or layout of the dispensary. B.Create a near miss log which tracks all the errors made and then analyse the near misses to look for patterns which may suggest a reason for the increase in errors C.Create a short mental break once the medicines are assembled and before completing the accuracy check. D.Usethe medicine labels toselect products from the dispensary shelves, rather than dispensing from the prescription. E.When dispensing balances of prescription items which are owed, refer to the patient medication recordfor what was previously dispensed.

The Home Office has advised that all controlled drugs (CDs)in Schedules 2, 3 and 4 (part 1) should be denatured and, therefore, rendered irretrievable before disposal.Which of the following statements regarding the denaturing of CDs is INCORRECT? A.Aerosol formulations should be expelled into water and the resulting liquid disposed of in an appropriately-sized CD denaturing kit. B.An authorised witness is not required to denature a patient-returned Schedule 3 CD C.An authorised witness is notrequired to denature an expired Schedule 2 stockitem. D.It is advisable to grind or crush solid dose formulationsbefore adding them to aCD denaturing kit toensure that whole tablets or capsules are not retrievable. E.Patches can be destroyed by removing the backing and folding the patch over on itself.

C is incorrect

A patient has received their first prescription for glyceryl trinitrate 500 microgram tablets. Which of the following statements describingthe shelf life and storage requirementsis CORRECT? A.The glass container has cottonwool wadding inside to prevent the tablets from breaking. B.The tablets are flammable and must be keptaway from fire or flames. C.The tablets can be removed from their glass containerand placed in a dossette box if required. D.The tablets should be discarded 8 weeks after first opening. E.The tablets should be discarded 12 weeks after first opening

D- Tablets should be discarded 8 weeks after opening

Mrs Visexperiencing nightmares which are disturbing hersleep. Her GP contacts you to ask whether one of her medicines could be causing the nightmares.Which of the following is least likely to cause nightmares as a side effect?A.Labetalol B.Oxprenolol C.Propranolol D.Sotalol E.Timolol

sotalol is water soluble andless likely topermeate the blood brain barrierWater soluble–atenolol, sotalol, nadolol –less likely to enter the brain, therefore less likely to cause sleep disturbance and nightmares

An elderly patient is suffering with constipation and requires treatment with a suitable laxative. She is not drinking much liquid at the moment and would like something to take at night before bed.Which of the following laxatives would be least appropriate? A.Bisacodyl tablets B.Ispaghula husk granules C.Lactulose oral solution D.Senna tablets E.Sodium picosulphate oral solution

Answer: B–Fluid intake must bemaintained with bulk-forming laxatives to avoid intestinal obstruction. They should not be taken immediately before going to bed.

Mrs C is 54 years old and has been commenced on sulfasalazine1.5g four times a day by her GP two weeks ago, alongside prednisolone20mg daily for treatment of inflammatory bowel disease. She enters your pharmacy complaining of having a sore throat, feverand has a few nosebleedsin the last 24 hours. She wonders if her new tabletis to blame. Which is the most appropriate advice for this patient? A.The symptoms described are not known to be caused by sulfasalazine B.She should see her GP as the dose of sulfasalazine may need to be increased C.She should see her GP as the dose of sulfasalazine may need to be reduced D.She is experiencing a side-effect of sulfasalazine, and whilst safe to continue taking it, she may wish to see her GP for an alternative E.Stop taking sulfasalazine straight away and see her GP as soon as possible

Stop taking sulfasalazine and see GP - Blood dyscrasia symptoms

You are presented with a prescription for Baby W for dexamethasone 2mg/5mLoral suspension to treat croup. The dose prescribed is 150micrograms/kg as a single dose. Baby W is 18-months-old and weighs18 kg.Which of the following is the required volumeof dexamethasone for this stat dose? A.3.4 mL B.6.8 mL C.9.1 mL D.12.6 mL E.16mL

6.8ml

A palliative care patient is currently receiving a combination of MST®Continus (morphine sulphate m/r) tablets to provide a dose of 40mg every 12 hours. In addition he is taking Oramorph®(morphine sulphate 2mg/1mL) 12.5mL qds. His pain is being controlled adequately, however he is finding it increasingly difficult to swallow. You suggest to the consultant that he is changed to fentanyl patchesreplace the equivalent daily dose of morphine sulphate.Using the information in the resource pack provided, what would be the most appropriate dose of fentanyl transdermal patch? A.Fentanyl ‘12’ patch B.Fentanyl ‘25’ patch C.Fentanyl ‘50’ patch D.Fentanyl ‘75’ patch E.Fentanyl ‘100’ patch

Answer:D–Fentanyl ‘75’patchMST 40mg bd = 80mg daily, plus 50mL daily of Oramorph 2mg/1mL =100mg morphine/day + 80mg MST = 180 mg total morphine per day.

A 37-year-old woman presents at the pharmacy with a red eye. She explains that her eye has been red and irritated for the past day or so. She asks to buy some over-the-counter drops for it. Which of the following symptoms would require an urgent referralto the nearesteye hospital? A.Excessive watering of the eye. B.Photophobiawith painoriginating from inside the eye. C.Slightlyblurred visionfollowing a long period of computer working. D.Stiff neck and tense shouldersalongside red eyes. E.Yellow, sticky discharge and discomfort in the eye

B. Photophobia with pain originating from inside the eye. Here's why: Photophobia (light sensitivity) combined with pain inside the eye is a red flag symptom that could indicate a serious ocular condition, such as uveitis, keratitis, or acute angle-closure glaucoma. These conditions can threaten vision and require urgent referral to an eye hospital or ophthalmologist.

Which monitoring is required: A patient was initiated on amiodarone several months ago for heart failure. The patient has since experienced unintended weight loss, palpitations and hyperactivity

Thyroid markers: Amiodarone is known to effect the thyroid and these symptoms are in keeping of hyperthyroidism

What monitoring is required: An 85-year-old male has atrial fibrillation with a CHADVASc-2 score of 4. Due to previous gastrointestinal issues, warfarin was selected as the most appropriate anticoagulation therapy. The patient hasbeen admitted to hospital with dizziness and dark stools.

A (Haemoglobin)–the patient symptoms and drug history indicate a gastrointestinal bleed thus haemoglobin should be reviewed to help confirm diagnosis.

What monitoring is required: 34-year-old female who is takinglithium for bipolar disorder has been experiencing dizziness and confusion

Lithium can cause hyponatreamia - monitor sodium