Buttercups Mock Revision Flashcards
What is the paracetamol dosing in a child 10-11 years old?
480-500mg every 4-6 hours, maximum 4 doses in a day (2g)
What is the paracetamol dosing in a child 6 months - 1 year old?
120mg every 4-6 hours; maximum 4 doses per day (480mg)
What is the paracetamol dosing in a child 2-3 years?
180mg every 4-6 hours; maximum 4 doses per day.
What is the ibuprofen dosing in a child 3 - 5 months old?
50mg tds,
what is the ibuprofen dosing in a child 6-11 months?
50mg tds-qds, maximum 30mg/kg per day.
What is the ibuprofen dosing in a child 1 - 3 years old?
100mg 3 times a day/
What is the ibuprofen dosing in a child 4-6 years old?
150mg tds
What is the ibuprofen dosing in a child 7-9 years?
200mg tds;
What is the ibuprofen dosing in a child 10-11 years old?
300mg tds
What is the ibuprofen dosing 12+?
300-400 tds-qds, increased to 600mg qds if needed (POM), OTC max = 1.2mg, POM max = 2.4mg.
Do pharmacies need to hold a CD disposal/denaturing license?
No
What does ‘Use by..’ refer to?
USe by 12.2018 means this item can be used until the end of 11.2018, hence use by the beginning of 12.2018
What does ‘Expiry Date..’ refer to?
Expiry date 12.2018 means the item can be used until the end of this month.
Expires January 2019 means
Discard 31/01/2019
Which of the following is NOT a contraindication using Maloff Protect OTC?
Recieving treatment for depression.
17-year old female.
Planning to concieve.
50 year old taking metformin.
Are using etoposide for cancer, metoclopramide for nausea.
Recently been switched from warfarin to rivaroxaban.
It is fine to use Maloff Protect if taking metformin for T2 diabetes.
Which of the following is NOT a contraindication to purchasing Viagra Connect OTC?
A patient who carries GTN spray for chest pain.
A recreational user of the party drug ‘poppers’ (amyl nitrite).
A patient recieving treatment for chonic thromboembolic pulmonary hypertension following surgery.
A 50 year-old man who occasionally takes cimetidine.
A 48 year-old man prescribed diffundox XL for BPH.
A 55 year-old man with Glaucoma.
A 25 year-old man with Sickle cell anaemia.
Sildenafil potentiates the hypotensive effects of nitrates, and its co-administration with nitric oxide donors, amyl nitrate (poppers), or nitrates in any form (GTN, isosorbide, nicorandil etc).
Riociguat is used for chonic thromboembolic pulmonary hypertension following surgery. It is a soluble guanylate cyclase stimulator and the co-administration of phosphodiesterase type 5 inhibitors such as sildenafil with guanylate cyclase stimulators, may lead to symptomatic hypotension.
Clearance of sildenafil has been reduced when used with CYP3A4 inhibitors such as ritonavir, ketoconazole, itraconazole, erthyromycin and cimetidine.
Postural hypotension can result from PDEv inhibitors and alpha blockers: alfuzosin, doxasozin or tamsulosin.
Patients who have conditions which may predispose them to priapism (such as sickle cell anaemia, multiple myeloma or leukaemia) should consult a doctor.
Nothing in SPC or questionnaire about Glaucoma.
Which of the following is NOT a contraindication to usage of Viagra Connect?
A man with Peyronie’s disease.
A man with retinitis pigmentosa.
A man with glucose-galactose malabsorption.
A man with multiple myeloma.
A man taking warfarin.
A man currently taking omeprazole 20mg once daily.
Peyronies disease = penis problem caused by scar tissue (bent penis) silfenafil CI in any physical penis deformities.
Vision problems: CI.
Galactose intolerance, Lapp lactase deficiency or glucose-galactose: the film coating of the tablet contains lactose.
Patients who have conditions which may predispose them to priapism (such as sickle cell anaemia, multiple myeloma or leukaemia), should consult a doctor before using agents for the treatment of erectile dysfunction, including sildenafil.
Warfain is fine.
The omeprazole could be to treat a gastric ulcer:
bleeding issues like haemophillia or active stomach ulcers are a contraindication.
Which of these IS a contraindication to usage of Viagra Connect?
Usage of Aspirin Usage of Warfarin Usage of Tolbutamide Usage of Diltiazem Usage of Amlodipine Usage of Ramipril
CI: CYP3A4 inhibitors such as saquinavir (HIV infection), Cimetidine (heartburn), Diltiazem (high blood pressure), eryhromycin or rifampacin, itra/ketoconazole.
What is the target range for fasting blood glucose?
4-7mmol/L
Which of the following can only be administered by someone with suitable training under the HMR 2012?
Adrenaline 1:1000 up to 1mg for intramuscular use in anaphylaxis. Atropine sulphate injection. Chlorphenamine injection. Glucagon injection Glucose injection Hydrocortisone injection Naloxone injection. Pralidoxime chloride injection Salbutamol injection
Schedule 19 of the HMR 2012 sets out what medicinal products can be parenterally administered in an emergency:
Adrenaline 1:1000 up to 1mg for intramuscular use in anaphylaxis
Atropine sulphate and obidoxime chloride injection
Atropine sulphate and pralidoxime chloride injection
Atropine sulphate injection
Atropine sulphate, pralidoxime mesilate and avizafone injection
Chlorphenamine injection
Dicobalt edetate injection
Glucagon injection
Glucose injection
Hydrocortisone injection
Naloxone hydrochloride
Pralidoxime chloride injection
Pralidoxime mesilate injection
Promethazine hydrochloride injection
Snake venom antiserum
Sodium nitrite injection
Sodium thiosulphate injection
Sterile pralidoxime
Salbutamol is not included.
What are the best sources of dietary iron?
Liver (not in preg) Meat Beans Nuts Dried fruit - dried apricots Wholegrains such as brown rice Fortified breakfast cereals Soybean flour Dark-green leafy vegetables - such as watercress and curly kale.
How much iron do men over 18 need each day?
8.7mg a day for men over 18
How much iron do women aged 19-50 years need a day?
14.8mg a day
How much iron do women over 50 need?
8.7mg a day, same as men over 18.
What are good sources of Vitamin A?
Cheese Eggs Oily fish Fortified low-fat spreads Milk and yoghurt Liver and liver products such as liver pate, avoid in preg.
Also beta-carotene is turned into vit A in body so:
yellow, red and green (leafy vegetables), such as spinach, carrots, sweet potatoes and red peppers.
Yellow fruit, such as mango, papaya and apricots.
How much vitamin A is recommended daily for adults aged 19-64 years old?
- 7mg for men
0. 6mg for women
What are the B vitamins? (the important ones on NHS.uk)
Thiamin (vitamin B1) Riboflavin (vitamin B2) Niacin (B3) Pantothenic acid Vitamin B6 Biotin B7 Folic acid Vitamin B12
What is the role of Thiamin (B1)?
Break down and release energy from food.
Keep the nervous system healthy.
What are good sources of Thiamin (B1)?
Peas Fresh and dried fruit Eggs Wholegrain breads Some fortified breakfast cereals Liver
How much thamin (B1) do adults (19-64 years) need?
1mg a day for men
0.8mg for women.
What is the role of riboflavin (vitamin B2)?
Keeps skin, eyes and the nervous system healthy.
Helps the body release energy from food.
What are some good sources of riboflavin?
Milk, eggs, fortified breakast cereals. Rice.
What antibiotics are associated with ototoxicity?
Aminoglycosides (gentamacin and tobramycin) - once-daily dosing may protect against this.
Macrolide antibiotics, including erythromycin, are associated with reversible ototoxic effects.
What diuretics are associated with ototoxicity?
Loop and thiazides.
Loop furosemide is particularly associated with ototoxicty when doses exceed 240mg per hour.
What OTC blood thinner can cause high-pitch tinnitus and hearing loss in both ears which is typically reversible upon stopping the drug?
Aspirin, (also quinine and other salicylates).
Chemotherapeutic agents containing what element are associated with ototoxicity?
Platinum-containing agents: cisplatin, carboplatin. Less frequently with oxaliplatin.
What other chemotherapy agents, apart from platinum containing ones, can cause ototoxicity?
Vinca alkaloids such as vincristine are associated with reversible ototoxicty.
Is methadone safe to use during pregnancy?
YES!
Is buprenorphine a licensed alternative to methadone in pregnancy?
NO
Which of the following is no appropriate counselling for methotrexate?
Moderate your caffeine intake.
May cause drowsiness.
Do not take medicines containing aspirin or ibuprofen (unless told to do so by GP).
Avoid getting pregnant or fathering a child whilst on this medicine and for three months after treatment has finished.
Folic acid should never be taken more than once weekly.
Inform GP if any of the following develop: sore throat, mouth ulcers, unusual bruising, severe abdominal pain, being sick, dark urine, high temp, skin rash.
The British Society for Rheumatology guidelines for disease modifying anti-rheumatic drug therapy recommends a typical folic acid dose of 5mg once weekly, preferably the day after the methotrexate. They state that folic acid can be given any day as long as it is not on the same day as methotrexate. Folic acid reduces toxic effects and improves continuation of therapy and compliance.
However, some GPs do prescribe folic acid to be taken everyday of the week apart from the day methotrexate is taken.
The BNF only lists the once weekly dosing regimen for the prophylaxis of methotrexate side-effects.
Is supervised consumption a legal requirement if the script says supervised consumption?
Nope, someone else can pick up on behalf if stipulated in writing by the patient.
Is it a legal requirement for someone to sign the back of a CD script?
No, they can legally refuse.
NICE NG80 recommends that if a SABA and Low dose ICS is ineffective what should be added to treatment?
LTRA trial.
BTS recommends that if a SABA and low dose ICS is ineffective what should be added to treatment?
LABA.
What are the first line treatment options for severe asthma in the community? (inhaled) [3]
Either:
Salbutamol 100mcg OR salbutamol nebulised solution (1mg/mL, 2mg/mL) OR Terbutaline sulfate nebuliser solution (2.5mg/mL).
Plus a steroid and high-flow oxygen if possible, monitor response 15-30 minutes after nebulisation; if any signs of acute asthma persist, arrange hospital admission. While awaiting ambulance, repeat nebulised beta2-agonist (as above) and give with ipratropium bromide nebuliser solution.
What are the first line treatment options for severe asthma attack in the community? (Not the inhaled ones)
Alongside one of the three inhlaed options (salmbutamol inhaler, salbutamol nebulised, terbutaline nebulised):
Either Prednisolone tablets (or soluble tabs) 5mg
OR
Hydrocortisone [preferably as sodium succinate].
What is the dosing of dexamethasone oral solution (2mg/5ml) for severe croup presenting in the pharmacy?
Child 1 month - 2 years 150 micrograms/kg as a single dose.
In the management of severe asthma attacks presenting in the community, what should be done once the decision to arrange hospital admission is made?
Repeat nebulised beta2 agonist as earlier in pathway and add ipratropium bromide nebuliser solution (250micrograms/mL)
What is the only licensed medication to treat trigeminal neuralgia?
carbamazepine
Amitriptylin is unlicensed
A class 4 recall from the MHRA is also known as what?
A caution in use notification.
A Class 1 recall presents
A life threatening or serious risk to health.
A class 2 recall is because the product may..
cause mistreatment or harm to the patient, but it is not life-threatening or serious.
A class 3 recall is unlikely
To cause harm to the patient, and the recall is carried out for other reasons, such as non-compliance with the marketing authorisation or specification.
A class 1 recall must be actioned
immediately including out of hours.
A class 2 recall must be actioned
Within 48 hours
A class 3 recall must be actioned
Within 5 days
A class 4 recall (caution in use) must be actioned
within 5 days
Why can domperidone not be used in heart failure patients?
domperidone is a dopamine antagonist with antiemetic properties.
QT prolongation = risk of cardiac arrythmias and death.
Should be used at lowest effective dose for shortest time possible.
Contraindicated now in: HF Other QT prolongation meds. Potent CYP3A4 inhibitors. Severe hepatic impairment.
Why is hyoscine hydrobromide cautioned in cardiac conditions?
It is an antimuscarininc medicine and for all antimuscarinics (systemic) the BNF states caution use in:
Acute myocardial infarction (in adults); arrhythmias (may be worsened); autonomic neuropathy; cardiac insufficiency (due to association with tachycardia); cardiac surgery (due to association with tachycardia); children (increased risk of side-effects) (in children); conditions characterised by tachycardia; congestive heart failure (may be worsened); coronary artery disease (may be worsened); diarrhoea; elderly (especially if frail) (in adults); gastro-oesophageal reflux disease; hiatus hernia with reflux oesophagitis; hypertension; hyperthyroidism (due to association with tachycardia); individuals susceptible to angle-closure glaucoma; prostatic hyperplasia (in adults); pyrexia; ulcerative colitis
Gradual withdrawal of systemic corticosteroids should considered in those whose disease is unlikely to relapse and have recieved more than __ prednisolone (or equivalent) daily for more than _ week.
Gradual withdrawal of systemic corticosteroids should be considered in those whose disease is unlikely to relapse and have:
received more than 40 mg prednisolone (or equivalent) daily for more than 1 week;
been given repeat doses in the evening;
received more than 3 weeks’ treatment;
recently received repeated courses (particularly if taken for longer than 3 weeks);
taken a short course within 1 year of stopping long-term therapy;
other possible causes of adrenal suppression.
Gradual withdrawal of systemic corticosteroids should considered in those whose disease is unlikely to relapse and have been given repeat doses in the ______.
Gradual withdrawal of systemic corticosteroids should be considered in those whose disease is unlikely to relapse and have:
received more than 40 mg prednisolone (or equivalent) daily for more than 1 week;
been given repeat doses in the evening;
received more than 3 weeks’ treatment;
recently received repeated courses (particularly if taken for longer than 3 weeks);
taken a short course within 1 year of stopping long-term therapy;
other possible causes of adrenal suppression.
Gradual withdrawal of systemic corticosteroids should considered in those whose disease is unlikely to relapse and have received more than _ weeks’ treatment.
received more than 40 mg prednisolone (or equivalent) daily for more than 1 week;
been given repeat doses in the evening;
received more than 3 weeks’ treatment;
recently received repeated courses (particularly if taken for longer than 3 weeks);
taken a short course within 1 year of stopping long-term therapy;
other possible causes of adrenal suppression
Gradual withdrawal of systemic corticosteroids should considered in those whose disease is unlikely to relapse and have taken a short course within __ year(_) of stopping long-term therapy.
taken a short course within 1 year of stopping long-term therapy;
other possible causes of adrenal suppression
Would an acidic mouthwash be recommended for mucositis?
No, so no listerine.
What is the treatment pathway for those of Afro-caribbean heritage with hypertension?
1st line: CCB
2nd line: CCB + ARB (in preference to an ACE inhibitor).
3rd line: Thiazide-like diuretic, such as chlortalidone (12.5mg-25mg once daily) or indapamide (1.5mg modified-release once daily or 2.5mg once daily).
4th line: Consider further diuretic therapy with low-dose spironolactone (25 mg once daily) if blood potassium level is 4.5mmol/L or lower.
What is the first line treatment of hypertension in anyone of afro/caribbean origin in whom CCBs are not tolerated?
Thiazide-like diuretic, such as chlortalidone (12.5mg-25mg once daily) or indapamide (1.5mg modified-release once daily or 2.5mg once daily). `
For step 4 treatment of resistant hypertension, why should higher-dose thiazide-like diuretic treatment be the treatment of choice (over low-dose spironolactone) if the blood potassium level is higher than 4.5mmol/l?
Spironolactone is a potassium-sparing diuretic and in cases where the blood potassium level is higher than 4.5mmol/l its use should be avoided due to the risk of hyperkalaemia.
What is milia?
Milia are small, bump-like cysts found under the skin. They are usually 1 to 2 milimeters in size.
They form when skin flakes or keratin, a protein, become trapped under the skin. Milia most often appear on the face, commonly around the eyelids and cheeks.
ellaOne is a better EHC in people of what weight?
70kg and above.
When would two levonelle tablets be taken as EHC?
When enzyme inducing medication is being taken or has been taken in the last 4 weeks.
If a patient needs EHC, having taken which of these drugs within the last 4 weeks (or currently) would NOT require them to take two levonelle 1500microgram tablets?
Carbamazepine for trigeminal neuralgia. St John's Wort for mild depression (OTC) A sulphonylurea for diabetes. Griseofulvin for tinea pedis. Rifampacin (alongside isoniazid for prevention of TB in susceptible close contacts). Ritonavir (as part of HAART).
Sulphonyureas for diabetes.
4.5 Interaction with other medicinal products and other forms of interaction
The metabolism of levonorgestrel is enhanced by concomitant use of liver enzyme inducers, mainly CYP3A4 enzyme inducers. Concomitant administration of efavirenz has been found to reduce plasma levels of levonorgestrel (AUC) by around 50%.
Drugs suspected of having similar capacity to reduce plasma levels of levonorgestrel include barbiturates (including primidone), phenytoin, carbamazepine, herbal medicines containing Hypericum perforatum (St. John’s Wort), rifampicin, ritonavir, rifabutin, griseofulvin.
For women who have used enzyme-inducing drugs in the past 4 weeks and need emergency contraception, the use of non-hormonal emergency contraception (i.e. a Cu-IUD) should be considered. Taking a double dose of levonorgestrel (i.e. 3000 mcg within 72 hours after the unprotected intercourse) is an option for women who are unable or unwilling to use a Cu-IUD, although this specific combination (a double dose of levonorgestrel during concomitant use of an enzyme inducer) has not been studied.
No mention of interactions between sulphonylureas and levonelle.
What does SICKFACES.COM stand for?
Enzyme inhibitors:
Sodium valproate Isoniazid Cimetidine Ketoconazole FLuconazole Alcohol chronic Chloramphenicol Erythyromycin Sulfonamides Ciprofloxacin Omeprazole Metronidazole
What does SCRAP GP stand for?
Enzyme inducers:
Sulphonylureas Carbamezapine Rifampin Alcohol Phenytoin Griseofulvin Phenobarbital
What can we use to treat oral thrush in someone taking warfarin?
Not daktarin oral gel (miconazole) as it interacts with warfarin.
Systemic miconazole can potentiate the anticoagulant effect of warfarin, because it is a strong inhibitor of the P450 isoenzyme CYP2C9, one of the main enzymes involved in warfarin metabolism.
Nystatin can also be used for candidal infections. It is not known to affect cytochrome P450, so it would not be expected to affect warfarin metabolism. (POM only)
What is the risk with the using chloramphenicol orally?
Aplastic anaemia, affecting 1 in 24,000-40,000 patients who take it orally.
What are the antibiotics of choice in pregnancy?
Penicillins and cephalosporins.
What antibiotics should be avoided entirely in pregnancy? (4)
Quinolones
Tetracyclines
Aminoglycosides unless severe of life threatening infection.
High dose metronidazole.
What antibiotics should only be used at certain times during pregnancy?
Trimethoprim should not be used in the first trimester as it is a folate antagonist.
Nitrofurantoin should not be used near term due to risk of neonatal haemolysis.
Why should streptomycin not be used in pregnancy?
It can cause foetal auditory nerve damage.
Can erythromycin be used in pregnancy?
Not known to be harmful but penicillins and cephalosporins should be used instead.
What dosing is usually seen with Apixaban?
Twice daily
What is the target fasting serum triglyceride level?
<1.7mmol/L
A triglyceride level of what is a reasonable level at which to prompt referral or seeking of specialist advice?
> or = 10mmol/L
A triglyceride level of what indicates the need for urgent referral (or urgent specialist advice)?
> 20 mmol/L
What are some of the secondary causes for high triglyceride levels?
High alcohol
Uncontrolled diabetes
Isotretinoin.
Do triglycerides contribute to athersclerosis?
Nope
What can cause blue wee?
Triamterene - used for oedema etc.
What electrolyte imbalances can SSRI’s cause?
Hyponatraemia.
Syndrome of inappropriate ADH secretion.
A rough feeling rash which blanches, with white spots on the tongue indicates what?
Scarlet fever.
What does a presentation of scarlet fever in the pharmacy need to end in?
Referral for antibiotics from the GP
Ocular prostaglandin use can cause
Thickening of eye lashes.
Darkening of pigments of iris and the skin around the eye.
Azole drugs cause what organ damage?
Hepatits not renal
What are the symptoms of DKA?
Abdominal pain Pear odour Metallic taste in mouth Exessive thirst Slow pulse
What is balantis?
Balanitis is a skin irritation on the head of the penis that can affect men and boys.
Symptoms include:
a sore, itchy and smelly penis
redness and swelling
build-up of thick fluid
pain when peeing
Canaglifozin is what type of drug?
SGLT-2 inhibitor associated with increased risk of lower limb amputation.
