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1
Q

What May cause staining on clothes?

A

Betamethasone valerate/clioquinol cream

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2
Q

Name 3 drugs Known as Xanthines?

A

Caffeine
Theobromine
Theophylline

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3
Q

What are symptoms of Hypercalcaemia?

A

Muscle weakness
Constipation
Anorexia and nausea
Fatigue
Polyuria and polydipsia
Dyspepsia - due to calcium-regulated release of gastrin
Depression
Mild cognitive impairment
Vomiting
Dehydration
Lethargy
Cardiac arrhythmias, shortened QT interval
Coma
Pancreatitis

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4
Q

What is Phenindione?

A

Vitamin K antagonist (Anticoagulant)

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5
Q

What is the chemical name for Vitamin K?

A

PHYTOMENADIONE

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6
Q

What is Lyme disease and the cause?

A

Caused by tick bite and looks like bullseye on skin

*Bacterial infection

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7
Q

What is Primary Dysmenorrhoea?

A

Period cramps that occur in lower abdomen, either before, during OR both

Can be dull and continuous AND can often cause back pain

*HOWEVER Secondary Dysmenorrhoea is due to another cause

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8
Q

What is the difference between Sinusitis and Common Cold?

A

BOTH = Nasal Congestion, Sore Throat

BUT Sinusitis Significant sbx = Loss of Smell

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9
Q

Signs of UNCONTROLLED diabetes?

A

Nocturnal Enuresis (toilet more esp at night)

Feeling Thirsty

Fatigue

Weight loss

Thrush

Blurred Vision

Slowed Healing

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10
Q

What Preparations are not useful for Non-productive viral Coughs?

A

Cough suppressants and Antihistamines

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11
Q

What Diuretic causes Hyperuricaemia?

A

Thiazide Diuretics (e.g. Indapamide)

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12
Q

What is a red flag sbx when after taking EHC?

A

Lower abdominal pain (possible sign of ectopic)

*Seek medical attention

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13
Q

What is baclofen used for?

A

Muscle Spasm pain in Palliative care

Pain in MS

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14
Q

What advice should be provided to pt using emollients?

A

Fire risk still possible even with non-paraffin containing emollients

*percentage of paraffin doesn’t make difference still risk

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15
Q

When should hypurin porcine neutral be administered?

A

30 mins before meal (as onset of action = 30 - 60 mins)

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16
Q

Name some drugs that can cause dyspepsia?

A

Calcium antagonists (CCBs e.g. Nifidipine)

Nitrates

Theophyllines

Bisphosphonates

Corticosteroids

NSAIDs

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17
Q

What protocols should be used for handling of cytotoxic?

A

BNF states Local procedures

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18
Q

How should Rivaroxaban be taken?

A

With food due to lack of efficacy on an empty stomach

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19
Q

What are the symptoms of a stye?

A

Slight swelling + red eyelid + soreness

*Chalzion less common in children and doesn’t present with pain

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20
Q

What are the symptoms of glandular fever?

A

High temp/hot + shivery

Severe sore throat

Swollen Glands

Fatigue

Tonsillitis that not getting better

*Affects mostly teens and young adults AND normally only get once

**Caused by Epstein-Barr Virus

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21
Q

Which drug when withdrawing pts on insulin should signs of diabetic ketoacidosis be monitored?

A

Glucagon-like peptide-1 receptor agonist

*suffix-ide (semaglutide, delaglutide etc), administered via SC in fatty tissue (thigh, abdo, upper arm + rotate sites)

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22
Q

What Antimalarial medication can be bought OTC?

A

Maloff Protect 250mg/100mg tabs (Atovaquone with proguanil HCl)

Rarely Used (resistance) = Avloclor (chloroquine 250mg), Paludrine (Proguanil HCl 100mg), Paludrine/Avloclor Anti-malarial travel pack (proguanil HCl 100mg/Chloroquine 250mg)

*18 years +, weighing > 40kg travelling to at risk areas

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23
Q

What are some key points for Maloff Protect Supply?

A
  • 18 + for up to 12 weeks
  • Dose = OD starting 1-2/7 prior to entering area then during and for 7/7 after leaving
  • Don’t use in HI or RI or < 18 years
  • Caution/interaction = Etoposide / Rifampicin or Rifabutin / Metoclopramide / All oral anticoags / Tetracycline / Indinavir, Efavirenz, Zidovudine or boosted protease inhibitors (REFER)
  • Other referral = History of depression or seizures, with TB, pregnant/planning to/breastfeeding/ <40kg/ > 12 weeks travel
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24
Q

What are some counselling points for Maloff Protect?

A
  • Take at same time every day, with food or milky drink (increased absorption), don’t crush
  • Important that don’t miss dose (if missed take ASAP then continue as normal (Don’t take 2 at once))
  • If vomit w/i hour of taking repeat dose
  • Dizziness sometimes reported therefore assess driving ability
  • If have diarrhoea = normal dosing
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25
Q

Examples of medications that cause dry mouth?

A

Antimuscarinics (Ipratropium, Trospium, Oxybutinin, Tolterodine, Solifenacin, Flavoxate), TCAs, Antihistamines and Some diuretics

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26
Q

What type of information should a pt have written when taking oral cytotoxic medication?

A

Intended Drug Regimen

Monitoring Arrangement

Specialist Contact Details

Treatment Plan

*Should be taken from the protocol initiated from hospital

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27
Q

What are the monitoring requirements for Clozapine?

A

Leucocyte + differential blood counts

Differential WBC = Every 1/52 for 18 weeks then every 2/52 for up to 1 year then every 1/12

Lipids + Weight (every 3 months for the first year then yearly)

Fasting blood glucose at base line, after one month then every 4-6 months

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28
Q

Common symptoms in of otitis medica in young children?

A

Irritability, crying, fever and pain

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29
Q

What type of pain are experienced in Appendicitis, Diverticulitis, Gastric Ulcer, Irritable bowel Syndrome and Renal Colic?

A

Appendicitis = Central/Lower Right area

Diverticulitis + Irritable bowel Syndrome = Left Lower area

Gastric Ulcer = Epigastric Pain

Renal Colic = Loin Area

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30
Q

What headache symptoms require urgent referral?

A

Unilateral Headache with Malaise (Suggests temporal arteritis)

*********************************************

Unilateral + Nausea = Migraine

Bilateral Generalised Headache or Bilateral headache with progressively worse during day = Tension-Type Headache

Unilateral Frontal Headache Which worsens on bending down = Sinusitis

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31
Q

What Pollen affects during the year?

A

Tree Pollen = March - May

Grass Pollen = May - Sep

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32
Q

Which Antisecretory + Mucosal Protectant Drugs are potent uterine Stimulant?

A

Misoprostol (labour induction or used in termination of pregnancy)

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33
Q

What symptoms requires urgent stopping of HRT?

A

Severe Stomach Pain

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34
Q

What is the adrenaline (1 in 1000 or 1 mg/ml) doses for the different age groups?

A

< 6 months = 100-150 mcg

6 months - 5 years = 150 mcg

6 - 11 years = 300 mcg

12 - 17 years = 500 mcg (300 if small or prepubescent)

Adult = 500 mcg

*to be repeated after 5 mins if no response in thigh (in adults to be repeated every 5 mins until specialist care is available)

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35
Q

What foods interact with Warfarin and their effect on INR?

A

Pomegranate Juice = Increases INR

Green Veg/Tea (high in Vit K) = Decrease INR

Alcohol = Decrease INR

Cranberry = Increases INR

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36
Q

When should pts be referred to dentist for Mouth Ulcer?

A

>2 weeks to exclude oral cancer

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37
Q

What BP warrants same day referral?

A
  • Clinical BP of >/= 180/120mmhg + either Signs of retinal haemorrhage and/or papilloedema OR Life threatening symptoms (new onset confusion/chest pain, sign of heart failure or acute kidney injury)
  • Suspected phaechromocytoma (labile/postural hypotension, headache, palpitations, pallor, abdo pain or diaphoresis)
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38
Q

Which Abx can cause cholestatic jaundice up to 2 months after treatment?

A

Flucloxacillin

*MHRA alert so should be adequately counselled to report any sbx

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39
Q

Which Statins are noted as high intensity (> 40%)?

A

Atorvastatin 20/40/80mg

Simvastatin 80mg

Rosuvastatin 10/20/40mg

*% = intensity of LDL-C reduction

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40
Q

Which statins are noted as medium intensity (31 - 40%)?

A

Atorvastatin 10mg

Simvastatin 20/40mg

Fluvastatin 80mg

Rosuvastatin 5mg

*% = intensity of LDL-C reduction

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41
Q

Which statins are noted as low intensity (20 - 30%)?

A

Simvastatin 10mg

Pravastatin 10/20/40mg

Fluvastatin 20/40mg

*% = intensity of LDL-C reduction

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42
Q

If a medical device can be sold should emergency supply be done?

A

NO as available to purchase not emergency

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43
Q

Differences between Otitis Media, Externa, Meniere’s Disease and Perichondritis?

A

Perichondritis = Outer ear structure swelling

Otitis Media = Pain but no itching

Otitis Externa = Pain and Itching

Meniere’s Disease = Dizziness

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44
Q

Signs of nipple thrush in both mother and baby?

A

Nipple pain in mother

Baby = oral thrush, nappy rash that won’t go, unsettled

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45
Q

Common side effect of ACE inhibitors?

A

Dry cough (can also cause hyperkalaemia)

*Ramipril, Enalapril, Lisinopril, Catopril

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46
Q

What vaccine is indicated for splenectomy pts?

A

Pneumococcal Vaccine (due to increased risk of infection)

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47
Q

Should Bisphosphonates be used in renal impairment?

A

Should be used with caution as when CrCl is decreased need to avoid

Alendronic acid < 35

Sodium Risedronate < 30

48
Q

Signs and Symptoms of Glandular Fever?

A

It’s caused by the Epstein-Barr virus caused by severe bout of tonsillitis

May experience a rash when given amoxicillin

*A&E for signs of Abscess (Quinsy as needs to be drained and XS enlarged)

49
Q

Can Miconazole gel for oral thrush be given to pts on Warfarin?

A

NO (interaction thus need Nystatin sol)

50
Q

When is there an increased risk of Rhabdomyolysis?

A

All statins

*Simvastatin + Bezafibrate = MHRA alert

51
Q

Examples of Drugs that interact with Grapefruit juice (AVOID)?

A

Amiodarone, CCBs, Statins, Budesonide, Buspirone, Dronedarone, Clopidogrel (monitor), Ivabradine, Quetiapine, Ranolazine, Sertraline, Sildenafil, Tacromilus/Sirolimus, Verapamil, Ulipristal

52
Q

Hypertension BP for each stage (diagnosis)?

A

Stage 1 = 140/90 to 150/99 mmHg

Stage 2 = 160/100 to 180/120 mmHg

53
Q

Target BP for hypertension?

A

Adults < 80yrs = 140/90 mmHg

Adults > 80yrs = 150/90 mmHg

*If pt > 80 yrs and has postural hypotension (BP measured while sat and stood) = systolic drops by 20 mmHg or more review treatment

54
Q

Hypertension treatment pathway Step ¼ (4 steps)?

A

Aged < 55 (not black African/Afro-Caribbean) = ACE inhibitor / ARB (not both at same time)

Aged > 55 OR (black African/Afro-Caribbean) = CCB (if not tolerated = thiazide like diuretic e.g. indapamide)

Evidence of HF = Thiazide-like diuretic e.g. indapamide

If starting or changing diuretic treatment for hypertension = Thiazide-like diuretic OR if already on thiazide (bendroflumethiazide/hydrochlorothiazide) maintain

55
Q

Hypertension treatment pathway Step 2/4 (4 steps)?

A

If not controlled with ACE inhibitor or ARB offer the following in addition = CCB or A thiazide-like diuretic

If step 1 on CCB and not controlled then in addition = ACE inhibitor or ARB (dependent on contraindications) OR thiazide-like diuretics

*Before changing ensure compliance isn’t reason for continue high BP

56
Q

Hypertension treatment pathway Step ¾ (4 steps)?

A

If not controlled well offer combination = ACE Inhibitor or ARB (consider contraindications) AND CCB AND Thiazide like diuretic

*Talk about compliance as can be reason for treatment failure

57
Q

Hypertension treatment pathway Step 4/4 (4 steps)?

A

If not controlled by optimal doses of previous medications then = Resistant hypertension BUT before more treatment = Confirm elevated clinic BP + asses for postural hypotension

Options = Seek specialist OR add 4th antihypertensive drug

  • If Blood K+ = 4.5mmol/l with low-dose Spironolactone (Caution in reduced eGFR as increased risk of hyperkalaemia) (Monitor blood Na + K + renal function within 1 month of starting and rpt as needed)
  • If blood K+ >/= 4.5mmol/l consider Alpha blocker (doxazosin/Terazosin) or Beta blocker

If 4 drugs doesn’t work then need speak to specialist

58
Q

What BB are used in resistant hypertension?

A

HF = Bisoprolol/Carvedilol/Nebivolol

Angina = Atenolol/Bisoprolol/Metoprolol

Previous MI = Metoprolol (standard release)/ Propranolol (standard release)/Timolol/Atenolol

59
Q

When children have hearing issues what’s the best action to take?

A

Refer to GP as it’s difficult to tell the cause so take all concerns seriously

Might need referral to audiometry

60
Q

Signs of threadworm in young children?

A

Causes them to wake at night and occasionally wet the bed

Present in poo

Extreme itching around anus or vagina specifically at night

*Comes out at night so may see on child’s bottom

61
Q

Reasons to STOP COC pill?

A

Hypertension > 160/100 mmHg

Jaundice

Loss of motor or sensory function

Sudden breathlessness

Unexplained swelling of the calf of one leg

62
Q

What is Clotrimazole 2% licensed for?

A

External treatment of Vaginal Thrush

*1% is licensed for use in athletes foot

63
Q

Which appliances in NHSBSA can be supplied against the FP10 form?

A

Appliances in Section IX A/B/C of the drug tarrif

64
Q

Red Flag sbx for Diarrhoea?

A

Blood in stool, unexplained weight loss, Persistent diarrhoea, recently travelled abroad and systemic illness

65
Q

Symptoms of Cystitis?

A

Painful to urinate (burning/stinging)

Feels to urinate frequently but only small amounts of urine

Dark urine and smells strong

66
Q

First line Treatment for Uncomplicated Chlamydia?

A

1g STAT Azithromycin

67
Q

Indicative Sign of Tension Headache?

A

Tight band headache

68
Q

Antidepressant Switching time frame?

A

Others = Immediately taper (No washout)

BUT

MOAI = 2 week washout then titrate next drug

69
Q

Max use time for Xylometazoline Nasal drops?

A

5 days in children 6 - 12yrs

*Not to be used if < 6 yrs

70
Q

Can Penicillin V be used in Breastfeeding?

A

YES but should be used with caution and infant monitored

71
Q

What Laxatives Colour urine and what colour?

A

Co-Dranthramer = Red

Senna = Yellow or Red-Brown

72
Q

Onset of Action for Senna Vs Bisacodyl?

A

Senna = 8 - 12 hrs

Bisacodyl = 10 - 12 hrs

73
Q

Counselling Points for Zonisamide?

A

Avoid factors which cause overheating or dehydration like exercise

74
Q

Counselling Point for Baclofen?

A

Drowsiness may affect your driving, which can be enhanced with alcohol consumption

75
Q

If an FP10 prescription is written and the quantity is missing what should be done?

A

Contact the prescriber for guidance and add a PC endorsement to the prescription

*If prescriber not available 5 days worth should be dispensed (not legal requirement)

76
Q

What is the difference between german measles (Rubella) and Measles?

A

Measles manifests with WHITE spots in mouth

77
Q

What Vaccines are given to babies under 1?

A

8 weeks = 6 in 1 vaccine (⅓)/Rotavirus vaccine (1st)/Men B

12 weeks = 6 in 1 vaccine (⅔)/Pneumoccocal (PVC) vaccine/Rotavirus vaccine (2nd)

16 weeks = 6 in 1 vaccine (3/3)/Men B (2nd)

78
Q

What is included in the 6 in 1 vaccine?

A

Diptheria, Hepatitis B, Hib, Polio, Tetanus, Whooping Cough (pertussis)

*4 in 1 = D, T, WC, P

*3 in 1 = T, D, P

79
Q

What vaccines are given between ages of 1 - 15?

A

1 yr = Hib/Men C (1st), MMR (1st), PVC (2nd), MenB (3rd)

2 - 10 yrs = Flu Vaccine (pa)

3 yrs and 4 months = MMR (2nd), 4 in 1 pre-school booster

5 - 15 yrs = Covid-19 vaccine (1st + 2nd)

12 - 13 yrs = HPV vaccine

14 yrs = 3 in 1 teenage booster, MenACWY

80
Q

What Vaccines are given between 16 - 70 yrs?

A

16 yrs + = Covid-19 vaccine (all 3 or indicated)

50 yrs (pa after) = Flu vaccine

65 yrs = PPV vaccine

70 yrs = Shingles Vaccine

81
Q

What Vaccines are recommended during pregnancy?

A

Flu Vaccine (during season)

16 weeks + = Whooping cough vaccine

82
Q

What is a bone related side effect of bisphosphonates?

A

Osteonecrosis of the jaw

83
Q

When the word rpt is on a private script how many times can it be dispensed?

A

ONCE if the number isn’t listed

*Max rpts on private = 6

*BUT if for COC then can be rptd 5 times

84
Q

Recommended number of yrs to retain Savitex (Sch 4 p1)?

A

No requirement BUT NICE = 6 years for HM tax & Customs purposes

85
Q

Prior to starting Amiodarone pt should have C-XRAY (T/F)?

A

TRUE (Due to lung toxicity = fatal)

86
Q

Signs of lithium Toxicity?

A

Blurred Vision, Resting Tremor, Muscular Weakness, Light-headedness, drowsiness

87
Q

What is vitamin B9 known as?

A

AKA Folic Acid

*taken during pregnancy = decreases risk of Spina Bifida

88
Q

Which Medications/Factors increase the risk of spina bifida?

A

Lack of folic acid

FH

Medications e.g. Valproate and Carbamazepine

89
Q

What does au mean as latin Rx abbreviation?

A

Both ears

90
Q

Which OPIOD pain killer has increased risk of OD in an infant when breastfeeding due to maternal variation in capacity to metabolise?

A

Codeine

91
Q

Counselling points for MTX?

A

ONCE weekly

May cause Respiratory effects

May Cause Liver problems

May cause blood problems

92
Q

Max days of issue on Rx for CD 2-4 drug?

A

30 Days

93
Q

What are some Glucocorticosteroid SEs?

A

incl Diabetes, osteoporosis and Muscle Wasting

94
Q

What SEs are associated to Mineralocorticosteroids?

A

Calcium Loss

Hypertension

Potassium Loss

Water retention

95
Q

What age should a pt with a migraine be referred for first time?

A

60 + Refer to GP

96
Q

What is the MAX dose for Ibuprofen OTC?

A

1.2g in 24hrs

*Adult = 200 - 400 mg every 4hrs

**POM = up to 2.4g daily in divided doses MR form

97
Q

List of some drugs that discolour urine?

A

Co-beneldopa + Co-careldopa = Dark reddish

Co-danthramer = Red

Co-danthrusate = Orange tint

Senna = Red/Yellow

Sulfasalazine = Yellow-Orange

Phenindione = Pink/Orange

Triameterene preperations (Co-triametrixide) + Frusene = Blue

Entacapone = Reddish-Brown

Nefopam = Pink

Clofazimine = Red

Nitrofurantoin = Yellow/Brown

Rifampicin/Rifambutin = Orange-Red

Deferiprone = Reddish-Brown

98
Q

Examples of Antiepileptics where if the brand is needed should be checked with prescriber?

A

Clobazam, Clonazepam, Eslicarbazepine, Lamotrigine, Oxcarbazepine, Perampanel, Retigabine, Rufinamide, Topiramate, Valproate, Zonisamide

99
Q

BNF Safety information for MTX to ensure safe prescribing?

A

Advise Pt of dose and frequency and reason for MTX + other Rx medication

Only ONE strength of MTX to be Rx (usually 2.5mg) and dispensed

The Rx and dispensing label clearly show the dose + frequency of MTX

Advise the pt to report immediately the onset of any features of blood disorders (sore throat, bruising, mouth ulcers), Liver toxicity (nausea, N&V, abdominal discomfort and dark urine) and Respiratory effects (SOB)

100
Q

What is the difference between Apnoea, Dysphagia, Dysplasia, Dyspraxia and Orthopnea?

A

Apnoea = Cessation of breathing during sleep

Dysphagia = Difficulty swallowing

Dysplasia = Abnormal cell growth

Dyspraxia = Developmental disorder

Orthopnea = SOB (Dyspnoea) on lying down flat

101
Q

Examples of long term SEs of Steroid cream USE?

A

Adrenal Suppression, Skin atrophy, Skin Depigmentation, Telangiectasia (Spider veins), Hypertrichosis (overgrowth of hair)

102
Q

SEs of long term use of corticosteroids use?

A

Weight gain, Diabetes, Glaucoma, Osteoporosis, Hypertension, Muscle Wasting, Fluid Imbalance

103
Q

Abx to be AVOIDED in BF?

A

Tetracyclines, Macrolide (Except Erythromycin), Quinolones (-floxacin)

104
Q

What is the ONSET of action for DMARDs?

A

2-3 Months

105
Q

Hydrocortisone MIN age OTC?

A

10 +

106
Q

What is a pt meant to do if vomit after taking POP?

A

If w/i 2hrs of taking POP then take another pill ASAP

IF > 3 hrs late (12 for DESOGESTREL) then missed pill rules for POP should be followed (OR if continued severe watery diarrhoea or vomit)

107
Q

What is an appropriate action to take with a pt on high strength insulin?

A

Check that they can read the strength on the medicine of the pen

108
Q

What is the difference between ac vs pc when prescribing?

A

ac = ante cibium = before food

pc = post cibium = after food

109
Q

What is the dosage regimen for Choroquine 310mg?

A

WEEKLY

Shouldn’t be administered any more frequently as can increase risk of toxicity (Occular toxicity risk if >/= 4mg/kg)

**Can be seen as daily if 155mg for RA or Systemic/Discoid Lupus Erythematosus

110
Q

What are the six LEGAL requirements for a CD requisition?

A
  • Recipients signature
  • Name of recipient
  • Address of recipient
  • Profession/occupation
  • Total quantity of drug
  • Purpose of requisition
111
Q

What are the handling conditions associated with Valganciclovir?

A

Potential Teratogen and carcinogen. Therefore when handing any formulation, if it comes into contact with the skin/mucosa wash off immediately with water/ avoiding inhalation

112
Q

What conditions should Pseudoephedrine be used with caution in?

A

Diabetes; heart disease; hypertension; hyperthyroidism; ischaemic heart disease (in adults); prostatic hypertrophy (in adults); raised intra-ocular pressure (in children); susceptibility to angle-closure glaucoma (in adults)

112
Q

What conditions should Pseudoephedrine be used with caution in?

A

Diabetes; heart disease; hypertension; hyperthyroidism; ischaemic heart disease (in adults); prostatic hypertrophy (in adults); raised intra-ocular pressure (in children); susceptibility to angle-closure glaucoma (in adults)

113
Q

What are the sbx of PCOS + Recommended dose of Metformin?

A

Irregular Periods (or absent)

Difficulty getting pregnant

Weight gain

Thinning of hair or loss

Oily skin or Acne prone

Dose = Initially 500mg IR OD for 1/52 then BD for 1/52 then can be increased to 1.5-1.7g daily in BD-TDS

114
Q

Minimum age for Vaginal thrush OTC treatment?

A

16 - 60 if falls outside range = GP for further treatment or investigations

115
Q

Important Counselling point with Indapamide?

A

Dose to be taken in the morning

Based on Revision Qs (2 decks)

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