BP1 Flashcards
a 58 year old male patient has been newly prescribed amiodarone for F, WHICH the pharmacist had to counsel him on prior to discharge which of the following is the most essential counselling point for this patient?
Avoid consumption of cranberry juice
Avoid travel to hot countries
Interactions with other medication is unlikely after one week of stopping treatment
Report any changes in vision
Take in a standing or sitting position
Amiodarone is associated with optic neuropathy and corneal microdeposits, which can lead to visual disturbances, including halos and blurred vision. In rare cases, it can cause serious eye conditions like optic neuritis, potentially leading to vision loss. Patients must be advised to report any changes in vision immediately and have regular eye check-ups.
A customer presents in community asking for chloramphenicol 0.5% eye drops for their 12 year old child. You learn the patient has bilateral symptoms consistent with bacterial conjunctivitis and is experiencing blurred vision. You observer that their eyes look cloudy. They have been bathing the eyes with boiled and cooled water. Their child wears glasses for reading and is allergic to penicillin. The pharmacist explains that the supply of chloramphenicol eye drops is not appropriate due to which of the follwing
The drops are not licensed for bacterial conjunctivitis
The patient is allergic to penicillin
The patient is experiencing blurred vision
The patient is too young
The patient wears glasses
In this case, the most concerning issue is that the patient has blurred vision, which can indicate a potential complication of the eye condition, such as corneal involvement or severe infection. Chloramphenicol eye drops are generally safe for bacterial conjunctivitis, but they should be avoided in cases where there is any concern about corneal involvement or other serious complications affecting vision. The cloudiness in the eyes observed by the pharmacist also suggests that the infection may be more severe and may require a more appropriate referral or treatment (e.g., oral antibiotics or referral to an eye specialist)
A 46 year old man with hypertension and diabetes states that his gums are swollen and bleed easily when he is eating and when he brushes his teeth. Which of the following may be the cuase
Amlodipine
Aspirin
Bendroflumethazide
Bisoprolol
Metformin
Amlodipine, a calcium channel blocker, can cause gingival hyperplasia, which is characterized by swollen gums that bleed easily, especially when brushing. This is a known side effect of amlodipine, and it can occur in some patients. It’s essential to maintain good oral hygiene to manage the condition, and in some cases, a dose adjustment or alternative medication might be considered if the gum issues are severe.
A 31 year old male presents in the pharmacy seeking advice for his right elbow. He firsts noticed the symptoms 6 weeks ago. He reports itching in addition to silvery white scales, he has no medication or medical history. Which of the following is most likely the cause
Atopic eczema
Non bullous Impetigo
Psoraris
Shingles
Vitiligo
The patient’s description of itching, silvery white scales, and the duration of the symptoms (6 weeks) are consistent with psoriasis, a chronic inflammatory skin condition. Psoriasis commonly presents with well-demarcated, red patches covered with silvery scales. It can appear anywhere on the body, including the elbows, and is often itchy.
A 67 year old patient is taking felodipine as prescribed for hypertension. Their blood pressure readings have remained elevated and the prescriber books them in for appropriate testing prior to initiating an ACE inhibitor. Which test would be the most appropriate to undertake prior to initiation?
Creatinine clearance
HbA1c
Liver function test
Thyroid function test
total cholesterol
Before starting an ACE inhibitor, it is important to assess renal function, as ACE inhibitors can potentially affect kidney function, especially in patients with pre-existing renal impairment. Creatinine clearance (or estimated glomerular filtration rate, eGFR) is commonly used to assess kidney function and ensure that the patient can tolerate the ACE inhibitor without risking further kidney damage
An 18 year old man has recently been diagnosed with asthma. Intermittent use of a salbutamol metered dose inhaler has failed to control his symptoms and the decision is made to step up his treatment to a low dose corticosteroid. Which of the following is the most appropriate treatment to initate?
Alvenco (ciclesonide) pressurised metered dose inhaler 160mcg, 1 puff OD
Clenil (beclometasone diproprionate) pressurised metered dose inhaler 200mcg, 1 puff BD
Flixotide accuhaler (fluticasone propionate) dry powder inhaler 500mcg, 1 puff BD
Pulmicort turbohaler (budesonide) dry powder inhaler 400mcg, 1 puff BD
QVAR (beclometasone dipropionate) pressurised metered dose inhaler 100mcg, 4 puff BD
The patient is transitioning to a low-dose inhaled corticosteroid (ICS), which is commonly recommended as a step-up therapy for asthma once a short-acting beta-agonist like salbutamol is no longer sufficient for symptom control. The recommended low-dose ICS for asthma management is typically in the range of 200–400mcg daily. Clenil (beclometasone) at 200mcg twice daily is an appropriate low-dose ICS option for this patient.
A 55 year old man has been diagnosed with respiratory depression, which is suspected to be an adverse medicine reaction. He is prescribed the following 1) Fluoxetine 60mg capsules once a day, Gabapentin 600mg TDS, Co-Codamol 30/500 2 QDS, mitrazapine 30mg OD, Bendroflumethazide 2.55mg OD.
Which of the following is the likely cause of the adverse reaction
A) Bendroflumethazide
B) Combination of Bendroflumethazide and fluoxetine
C) Combination of co-codamol and gabapentin
D) Combination of mirtazapine and fluoxetine
E) Mirtazapine
The combination of co-codamol (which contains codeine, an opioid) and gabapentin (a gabapentinoid) is a significant concern for respiratory depression. Both of these medications have central nervous system (CNS) depressant effects, and when taken together, they can potentiate each other’s sedative effects, leading to respiratory depression.
Co-codamol (codeine) is an opioid that can cause respiratory depression, especially at higher doses or when used with other CNS depressants.
Gabapentin is known to have CNS depressant effects, and while it does not directly cause respiratory depression, its sedative properties can exacerbate the respiratory depressant effects of opioids.
A woman visits the pharmacy the day before her 2 month old child is due to receive their first set of routine vaccinations at the local GP practice. Recently her friend’s child suffered a febrile convulsion following a first set of vaccination and the woman is worried that this may occur and asks for advice. Which of the following is the most appropriate course of action to recommend?
A) Advise the mother to not go ahead until she has discussed her concerns with a GP
B) Advise the mother that convulsions are rare and to avoid antipyretic medication
C) Recommend paracetamol suspension 120mg/5ml and advise the mother to administer a dose after the vaccinations and a further 2 doses four to six hours apart
D) Recommend paracetamol suspension 120mg/5ml and advise the mother to administer a dose before the vaccinations and a further 2 doses four to six Hours apart
E) Recommend ibuprofen suspension 100mg/5ml and advise the mother to administer a dose before the vaccinations and a further 2 doses six to eight hours apart
t is important to address the mother’s concerns properly and ensure that she has all the information she needs before proceeding with her child’s vaccinations. Although febrile convulsions following vaccinations are rare, it is essential to reassure the mother and provide her with the opportunity to discuss any concerns she may have with a GP. The GP can provide specific advice on the risks, benefits, and safety of vaccinations for her child, especially if there is a family history of febrile convulsions or any other concerns
A 62 year old caucasian man with a BMI of 34 is being treated for heart failure with type 2 diabetes. His current medication is : Ramipril 5mg one BD, Bisoprolol 5mg OD, Metformin 500mg 1 TDS, Atorvastatin 20mg OD.
His HbA1c is measured at 58 mmol/mol and its decided to intensify his diabetes treatment. Which of the following is the most appropriate adjunctive therapy.
Dapglifozin
Exenatide
Glicaziide
Pioglitazone
Sitagliptin
Dapagliflozin is an SGLT-2 inhibitor, which is not only effective in lowering blood glucose but also has additional benefits in heart failure. Specifically, SGLT-2 inhibitors like dapagliflozin have been shown to reduce the risk of hospitalization for heart failure and improve overall cardiovascular outcomes in patients with heart failure and diabetes. Additionally, they are weight-neutral or can promote modest weight loss, which is beneficial given the patient’s BMI of 34 (overweight/obese). The class also helps reduce blood pressure, which can be advantageous in heart failure management.
A 78 year old man presents in the surgery with loss of appetite, weight loss, nausea and abdominal pain. The symptoms have been getting worse over the past week. During the consultation, his answers seem confused and he has difficulty reading materials provided to him, as he explains everything looks blurred with a yellow tint
Which of the following is most likely the cause
Bisoprolol
Digoxin
Furosemide
Glicazide
Sitagliptin
Digoxin is a cardiac glycoside used in the treatment of heart failure and atrial fibrillation. It has a well-known side effect profile, with toxicity being a significant concern, particularly in elderly patients or those with renal impairment. Symptoms of digoxin toxicity can include:
Loss of appetite
Nausea
Abdominal pain
Weight loss
Confusion
Visual disturbances, such as seeing a yellow or green tint to vision, which is a hallmark of digoxin toxicity
A 6 year old is present in the community pharmacy with a rash on their arm. The parent noticed it a few days ago and described it as itchy but not sore. The child has no other medical conditions and has not tried anything so far. The rash is localised to the child arm only. Which is the best option
Acyclovir 5% cream
benzoyl Peroxide 2.5% gel
Clotrimazole 1% cream
Clotrimazole 2% cream
Diprobase cream
Hydrocortisone cream 1%
Ibuprofen 5% gel
Movelat cream
Clotrimazole 1% - Ringworm
In the community pharmacy a parent asks for advice about a 2 year old who has eczema in infancy and has developed eczema on the inside of their knees and elbows after a recent cold. The affected skin is dry, not red and there is NO signs of infection. The patient describes that the child is scratching only occasionally and is otherwise well.
Acyclovir 5% cream
benzoyl Peroxide 2.5% gel
Clotrimazole 1% cream
Clotrimazole 2% cream
Diprobase cream
Hydrocortisone cream 1%
Ibuprofen 5% gel
Movelat cream
The child has a history of eczema and is experiencing dry skin without redness or signs of infection.
Diprobase cream is an emollient that helps restore the skin barrier, reducing dryness and itching.
Regular emollient use is the mainstay of eczema management, especially when there is no active inflammation
2 weeks after starting a new therapy, a 48 year old man of afro-carribean descent develops swelling of his lower lip and painful muscles in his legs. He has been advised to increase his activity level to support cardiac rehab but it’s affecting his ability to do so. He has no other symptoms and feels well in himself Which of the following has caused the adverse effect
Bisoprolol
Clarithromycin
Lansoprazole
Lisinopril
Methotrexate
Pioglitazone
Risedronate
Sertraline
Swelling of the lower lip suggests angioedema, a known adverse effect of ACE inhibitors (like Lisinopril), particularly in Afro-Caribbean patients who are at higher risk.
Painful muscles in the legs could indicate myalgia, which can also occur with ACE inhibitors.
Timeline fits – angioedema with ACE inhibitors can develop days to weeks after starting therapy.
4 months after commencing an additional therapy, a 52 year old woman reports a weight gain of just under 3kg, her ankles are swollen and she is feeling increasingly short of breath. She is cautious about driving lately as her vision has also been slightly blurry. Which of the following has caused these effects?
Bisoprolol
Clarithromycin
Lansoprazole
Lisinopril
Methotrexate
Pioglitazone
Risedronate
Sertraline
The most likely cause of these adverse effects is Pioglitazone.
Reasoning:
Weight gain & ankle swelling → Pioglitazone can cause fluid retention and peripheral oedema.
Shortness of breath → Fluid retention can lead to heart failure or worsening of existing heart failure.
Blurry vision → Pioglitazone can cause macular oedema, leading to vision disturbances.
Timeline fits → These adverse effects often develop over months after starting therapy.
6 weeks after starting a new therapy a woman develops a sore throat, fever, ulcer, bruising and a skin rash. Which of the following has caused this ?
Bisoprolol
Clarithromycin
Lansoprazole
Lisinopril
Methotrexate
Pioglitazone
Risedronate
Sertraline
Methotrexate
A 75 year old man prescribed rivaroxaban 20mg daily for recurrent DVT. Which is the most likely counselling point ?
Caution, may impair your ability to drive
Chew tablets before swallowing
For external use only
May cause drowsiness or dizziness
Should be taken with plenty of water
Space the doses evenly throughout the day, complete the course
Take on empty stomach
Take with food
Rivaroxaban 20mg should be taken with food to improve absorption and bioavailability.
This is particularly important for the 15mg and 20mg doses, as taking them without food can reduce their effectiveness.
Lower doses (e.g., 2.5mg or 10mg) can be taken without food.
A 6 year old child is taking co-amoxiclav 250/62 suspension, 5ml three times a day for otitis media. Which is the most likely counselling point from the list below?
Caution, may impair your ability to drive
Chew tablets before swallowing
For external use only
May cause drowsiness or dizziness
Should be taken with plenty of water
Space the doses evenly throughout the day, complete the course
Take on empty stomach
Take with food
✅ “Space the doses evenly throughout the day, complete the course.”
Reasoning:
Antibiotics must be taken regularly → Spacing doses evenly (e.g., morning, afternoon, evening) ensures consistent drug levels.
Complete the full course → Prevents antibiotic resistance and ensures the infection is fully treated
A 27 year old man who is undergoing treatment for schizophrenia, but is having significant difficulty adhering to his medication regime. He has previously taken and tolerated oral risperidone. He suffers from extra pyramidal side effects if he takes first generation antipsychotics. Which is the most appropriate drug to prescribe?
Abilify (Aripiprazole) injection
Buspirone tablets
Clozapine tablets
Diazepam tablets
Lithium tablets
Quetiapine Tablets
Risperidone long acting injection
Zuclopenthixol decanoate injection
✅ Risperidone long-acting injection
Reasoning:
Poor adherence to oral medication → A long-acting injection (LAI) ensures consistent drug levels and improves adherence.
Previously tolerated oral risperidone → Since he has taken and tolerated oral risperidone before, using the long-acting injection (LAI) is a logical next step.
Extra-pyramidal side effects (EPS) with first-generation antipsychotics → Zuclopenthixol decanoate is a first-generation (typical) antipsychotic, which has a higher risk of EPS, making it unsuitable.
Risperidone LAI (Risperdal Consta®) is a second-generation (atypical) antipsychotic, which has a lower risk of EPS compared to first-generation options.
A 32 year old woman who has generalised anxiety disorder with currently uncontrolled symptoms, having previously tried sertraline and venlafaxine.
Which is the most appropriate drug to prescribe?
Abilify (Aripiprazole) injection
Buspirone tablets
Clozapine tablets
Diazepam tablets
Lithium tablets
Quetiapine Tablets
Risperidone long acting injection
Zuclopenthixol decanoate injection
✅ Buspirone tablets
Reasoning:
Generalised Anxiety Disorder (GAD) → Buspirone is an approved treatment for GAD and is a good option for patients who have not responded to SSRIs (e.g., sertraline) or SNRIs (e.g., venlafaxine).
Non-sedating and non-addictive → Unlike benzodiazepines (e.g., diazepam), buspirone does not cause dependence, making it a safer long-term option.
Alternative to SSRIs/SNRIs → Since the patient has already tried sertraline (SSRI) and venlafaxine (SNRI), buspirone can be considered before other medication classes.
A 59 year old man with Parkinson’s disease requires treatment for frequent hallucinations. it is not appropriate for the patient to reduce or discontinue their antiparkinsonism drugs, due to recurrence of severe motor symptoms
Which is the most appropriate drug to prescribe?
Abilify (Aripiprazole) injection
Buspirone tablets
Clozapine tablets
Diazepam tablets
Lithium tablets
Quetiapine Tablets
Risperidone long acting injection
Zuclopenthixol decanoate injection
✅ Quetiapine Tablets
Reasoning:
Parkinson’s disease with hallucinations → Quetiapine is an atypical antipsychotic that is commonly used to manage psychotic symptoms (e.g., hallucinations) in Parkinson’s disease.
Lower risk of worsening motor symptoms → Unlike first-generation antipsychotics (e.g., Zuclopenthixol), quetiapine has a lower risk of exacerbating motor symptoms in Parkinson’s disease compared to other antipsychotics.
It is often preferred over other antipsychotics because it has a lower risk of extrapyramidal side effects (EPS) and tardive dyskinesia compared to typical antipsychotics.
