BNF Misc

Question 1

What is a biological medicine? Give two examples

Answer 1

They are made by or derived from a biological source using biotechnology such as recombinant DNA technology. Size, complexity as well as the way they are produced by result in a degree of variability - this is acceptable within strict limits. E.g. Insulins & Monoclonal antibodies

Question 2

TRUE OR FALSE Biological medicines must be prescribed by brand name. Brand must be specified on Rx. Can they be substituted at the point of dispensing? Applicable to biosimilar meds too

Answer 2

TRUE Brand name specific on Rx and no substitutions at the point of dispensing. Applicable to biosimilar meds too

Question 3

What is a biosimilar medicine?

Answer 3

It’s a biological medicine which is highly similar and clinically equivalent to an existing biological medicine which has already been authorised by the EU. Active substance is similar but not identical. Once the patent runs out on the biological version - the biosimilar can be authorised by EMA. European Medicines Agency

Question 4

Is a biosimilar the same thing as a generic medicine?

Answer 4

No because a biosimilar is similar not identical to the original. Whereas the generic is identical to original.

Question 5

When biosimilar med has been given initial authorisation - what is it subject to? What should be recorded when reporting side effects?

Answer 5

Black triangle status Important to report suspected reactions using Yellow card scheme. Clearly include brand name and batch number.

Question 6

Give some examples of biosimilar meds?

Answer 6

1. Enoxaparin sodium 2. Epoetin alfa /zeta 3. Filgrastim 4. Infliximab 5. Insulin glargine/lispro

Question 7

When should oral syringes be supplied? When should the 5ml spoon be used?

Answer 7

Supplied when oral liquid medicines are prescribed in doses OTHER THAN MULTIPLES OF 5ML. 5ml spoon us used for doses of 5ml/multiples of

Question 8

Branded oral liquid preparations that do not contain 1. 2. 3. are described as ‘sugar-free’ in the BNF.

Preparations containing 4. 5. 6. 7. 8. are described as “sugar free” as evidence shows they do not cause ______.

Answer 8

1. Fructose 2. Glucose 3. Sucrose
2. Hydrogenated glucose syrup 5. Mannitol 6. Maltitol 7. Sorbitol 8. Xylitol Don’t cause dental caries.

Sugar free should be used whenever possible.

Question 9

Benzyl alcohol present in some injections as a preservative has been associated with what?

Answer 9

Fatal toxic syndrome in preterm neonates. Should not be used.

Question 10

Polyoxyl castor oil present in some injections as a vehicles is associated with ___?

Answer 10

Severe anaphylactoid reactions

Question 11

Propylene glycol can cause adverse effects if its elimination is impaired. In which patients should be cautious? Which two medicines can it react with?

Answer 11

1. Renal impairment 2. Neonates and Young children 3. Slow metabolism 1. Disulfiram 2. Metronidazole

Question 12

Is lactulose in medicines an issue for lactulose intolerant patients?

Answer 12

Usually amount too small to cause problems. But if severe intolerance - amount of lactulose should be determined before prescribing.

Question 13

Extemporaneous preparation - should be freshly made…what does this mean?

Answer 13

Must not be made more than 24 hours before it is issued.

Question 14

If something has been recently prepared - what is the likely timeframe for deterioration ?

Answer 14

Deterioration is likely if stored for longer than about 4 weeks at 15-25 degrees.

Question 15

What does water mean when it is used without qualification? When should it be used

Answer 15

Potable water freshly drawn direct from public supply and suitable for drinking OR Freshly boiled and cooled purified water. Latter should be used if the public supply is from storage tank or if potable water is unsuitable for a particular preparation.

Question 16

The Misuse of Drugs Act 1971 has 3 classes of CDs which on the harmfulness attributable to a drug when misused.. Give examples of Class A drugs (13) When are class B substances classed as Class A?

Answer 16

1. Alfentanil 2. Cocaine 3. Diamorphine hydrochloride (heroin) 4. 3,4 - methylenedioxymethamfetamine MDMA/Ecstasy 5. Fentanyl 6. Lysergide (LSD) 7. Morphine 8. Opium 9. Oxycodone hydrochloride 10. Pethidine hydrochloride 11. Phencyclidine 12. Remifentanil 13. Methadone hydrochloride class B when prepared for injection become class A

Question 17

Give examples of Class B drugs (9)

Answer 17

1. Oral amphetamines 2. Barbiturates 3. Cannabis 4. Sativex (cannabis) 5. Codeine phosphate 6. Dihydrocodeine tartrate 7. Ketamine 8. Nabilone 9. Pholcodine

Question 18

Give examples of Class C drugs (11)

Answer 18

1. Drugs related to ampehtamines such as benzfetamine and chlorphentermine 2. Buprenorphine 3. Most benzadiazepines 4. Tramadol hydrochlordie 5. Zopiclone 6. Zopidem 7. Androgenic and anabolic steroids 8. HCG & non-human - Human chorionic gonadotrophin 9. Somatotropin, Somatropin 10. Gabapentin 11. Pregabalin

Question 19

What does the black triangle on medicines mean?

Answer 19

Identifies newly licensed medicines that require additional monitoring by the European Medicines Agency.

Question 20

How long should black triangle usually stay on a product and what do you report according to MHRA?

Answer 20

Usually 5 years Report any adverse effects including those that are not considered to be serious Also even if not sure the drug caused it or if reaction is well recognised or if may have been caused by another drug Report through the Yellow Card Scheme

Question 21

When should adverse effects of well established vaccines and medicines (inc. OTC/herbal/unlicensed/off-label) be reported?

Answer 21

Serious, medically significant or result in harm Examples - anaphylaxis, blood disorders, endocrine disturbances, fertility etc Prolonged hospitalisation, life threatening, fatal, incapacitating

Question 22

What are some examples of drugs/classes hat can cause oral ulcers? (7)

Answer 22

1. Cytotoxic drugs - methotrexate 2. ACE inhibitors 3. Gold 4. Nicorandil (used in angina) 5. NSAIDs 6. Penicillamine 7. Protease inhibitors

Question 23

What drugs can stain the teeth and what colour?

Answer 23

1. Chlorhexidine (brown) 2. Iron salts in liquid form (black) 3. Tetracyclines (intrinsic staining - permanent yellow-grey) AVOID in pregnancy/children under 12 4. Fluoride - excessive ingestion leads to mottling of enamel- white patches

Question 24

Gingival overgrowth is a side effect of which 3 medicines?

Answer 24

1. Phenytoin Sometimes… 2. Ciclosporin 3. Nifedipine

Question 25

Examples of drugs that cause xerostomia (dry mouth/reduce saliva flow)? (10)

Answer 25

1. Antimuscarinics 2. Antidepressants - tricyclic and SSRIs 3. Alpha-blockers 4. Antihistamines 5. Antipsychotics 6. Baclofen 7. Bupropion hydrochloride 8. Clonidine hydrochloride 9. Opioids 10. 5HT1 agonists

Question 26

Examples of drugs that cause taste disturbance? (14)

Answer 26

1. Amiodarone
2. ACE inhibitors
3. Calcitonin
4. Carbimazole
5. Clarithromycin
6. Gold 7
7. Griseofluvin
8. Lithium salts
9. Metformin
10. Metronidazole
11. Penicillamine
12. Phenindione
13. Terbinafine
14. Zopiclone

Question 27

Why are Penicillins and cephalosporins not usually given by continuous infusion? Which method instead?

Answer 27

Due to stability problems and because adequate plasma and tissue concentrations are best obtained by intermittent infusion

Question 28

What is the New Medicines Service? and what are the 3 stages?

Answer 28

Provides education and support to patients who are newly prescribed a medicine to manage a long term condition 1. Patient engagement 2. Intervention 3. Follow up

Question 29

Which patients are eligible for New Medicines Service?

Answer 29

Prescribed a new medicine for one of the following: 1. Asthma 2. COPD 3. Type 2 diabetes 4. Hypertension 5. New antiplatelet or anticoagulant

Question 30

What is the Medicines Use Review?

Answer 30

Structured adherence-centered reviews with pts on multiple medicines esp for long term conditions. Periodically but no more than once a year

Question 31

What must the pharmacist providing the MUR service ensure of?

Answer 31

At least 70% pts are within the two groups: 1. Pts on high risk meds - NSAIDs, anticoagulants (inc. low molecular weight heparin), antiplatelets, diuretics 2. Pts recently discharged from the hospital who have had changes made to their meds whilst in hospital

Question 32

What’s the age range for a neonate and child?

Answer 32

0- 28 days neonate/new born infant 1 month - 17 years child

Question 33

Hypoalbuminaemia in severe liver disease is associated with reduced protein binding and increased toxicity of some highly protein bound drugs such as ____ & _____?

Answer 33

Phenytoin Prednisolone

Question 34

manufacturers advise caution with warfarin in mild to moderate hepatic impairment; avoid in severe impairment. Why?

Answer 34

Reduced clotting Reduced hepatic synthesis of blood-clotting factors indicated by prolonged prothrombin time, increases sensitivity to oral anticoagulants such as warfarin sodium and phenindione

Question 35

Which drug types can precipitate hepatic encephalopathy (decline in brain function that occurs as a result of severe liver disease)? (4)

Answer 35

1. All sedative drugs 2. Opioids 3. Drugs that cause constipation 4. Diuretics that produce hyPOkalaemia

Question 36

Which two drug groups can cause exacerbate fluid overload (oedema & ascites) in chronic liver disease?

Answer 36

1. NSAIDs 2. Corticosteroids

Question 37

When is the use of eGFR not recommended for dosing? What should be used instead?

Answer 37

1. Toxic drugs 2. Elderly 3. Pts at extremes of body mass Creatinine clearance

Question 38

What is the cockcroft gault equation?

Answer 38

Question 39

What are the CKD stages based on GFR?

Answer 39

Question 40

What can phenobarbital affect in infants who breastfeed?

Answer 40

Inhibit infant’s sucking reflex

Question 41

What can bromocriptine affect in breastfeeding women?

Answer 41

Can affect lactation - inhibits the release of prolactin so decreases milk production

Question 42

What are the 3 broad classes of analgesics in palliative care?

Answer 42

1. Non-opioids - paracetamol, NSAIDs
2. Opioids - codiene, weak morphine
3. Adjuvants - antidepressants, antiepileptics