Cardio v2

Question 1

A 33-year old patient is due to undergo surgery, the
patient requires venous thromboembolism prophylaxis
and is renally impaired.
Which of the following pharmacological options is the
preferred option for patients that are renally impaired?

A. Aspirin
B. Edoxaban
C. Heparin (unfractionated)
D. Rivaroxaban
E. Warfarin

Answer 1

Unfractionated Heparin (UFH) is preferred in patients with renal impairment because it does not rely on renal clearance, unlike low molecular weight heparins (LMWH) or direct oral anticoagulants (DOACs). UFH is metabolised by the liver and has a shorter half-life, making it safer and more manageable in patients with renal dysfunction.

Question 2

A 47-year-old patient has recently started on a low
molecular weight heparin (LMWH) and starts to develop
bruising of the skin.
What is the likely cause of the bruising?

A. Hyperkalaemia
B. Hypokalaemia
C. Hypersensitivity
D. Thrombocytopenia
E. Lymphocytopenia

Answer 2

Thrombocytopenia

Question 3

Miss Linda Mycin has come into the pharmacy with a prescription for amiodarone 200mg tablets. Though they have been taking this for a while, they would like to be refreshed on some of the counselling points. Which of the following counselling points would be inappropriate?

Choose only ONE best answer.

A
Amiodarone has a long half-life so side-effects will be present for up to months after treatment ends
B
Avoid exposing your skin to sunlight
C
This medication may colour your urine darker, this is normal
D
You may have blurred vision, affecting your driving skills
E
You must report any shortness of breath

Answer 3

C

Question 4

Mr Ed Oxaban has been initiated on warfarin recently which requires monitoring even once the patient has stabilised on the medication. Once they have been stabilised, assuming they have no other co-morbidities, what is the maximum amount of time between further INR tests that should be allowed?

Choose only ONE best answer.

A
4 weeks
B
8 weeks
C
12 weeks
D
6 months
E
12 months

Answer 4

12 weeks

Question 5

A patient has been rushed into hospital after having an overdose from digoxin. They need to be administered an antidote to clear out the digoxin immediately. Which of the following should be administered to the patient?

Choose only ONE best answer.

A
Activated charcoal
B
Digoxin-specific antibody
C
Digoxin-specific peptide
D
Flumazenil
E
Naloxone

Answer 5

B

Question 6

Mr Ben Dro has been initiated on bendroflumethiazide for the treatment of oedema. They have never taken this before and would like to be counselled on how to take it. How should the patient take this medication?

Choose only ONE best answer.

A
Take this medication at bed-time
B
Take this medication in the evening
C
Take this medication in the morning
D
Take this medication on an empty stomach
E
Take this medication with food

Answer 6

Bendroflumethiazide is a thiazide diuretic, commonly used for oedema and hypertension. It works by increasing urine output, especially soon after taking it.

👉 To avoid nocturia (frequent urination at night) and disturbed sleep, it should be taken

Question 7

A patient has been admitted to hospital for an emergency operation after having a road traffic collision, and the surgery cannot be delayed. On checking the patient’s medication history, you can see that they take amlodipine, simvastatin and warfarin. Which of the following precautions should be taken?

Choose only ONE best answer.

A
Administer intravenous dried prothrombin complex
B
Administer intravenous vitamin K
C
Administer intravenous vitamin K and dried prothrombin complex
D
Administer oral vitamin K
E
No precautions are needed

Answer 7

Usually an emergency surgery should be delayed by 6-12 hours and the patient should be given IV vitamin K, but in this scenario, the surgery could not be delayed, requiring the concomitant administration of IV vitamin K and dried prothrombin factor.

Question 8

Mr Blee Ding has come into the pharmacy as they have had a nose bleed which won’t stop, even though pressure has been applied for 30 minutes. On checking, they have an INR of 6.7. Which of the following would be the most appropriate steps to take?

Choose only ONE best answer.

A
Stop warfarin, give IV vitamin K, restart warfarin when INR < 5
B
Stop warfarin, give oral vitamin K, restart warfarin when INR < 5
C
Stop warfarin, give IV vitamin K, restart warfarin when INR < 6
D
Stop warfarin, give oral vitamin K, restart warfarin when INR < 6
E
Stop warfarin, restart warfarin when INR < 6

Answer 8

A – As there is a minor bleed, warfarin should be stopped, the vitamin K should be given intravenously and restarted when the INR is under 5

Question 9

A patient has been living with heart failure for the last 12 years and has been slowly deteriorating. They have got to the point where specialists have started prescribing alternative medications. Which of the following medications would not be seen being prescribed by specialists in patients with heart failure?

Choose only ONE best answer.

A
Amiodarone
B
Canagliflozin
C
Digoxin
D
Ivabradine
E
Sacubitril with valsartan

Answer 9

Canagliflozin is a SGLT2 inhibitor primarily used for type 2 diabetes mellitus. While some SGLT2 inhibitors, such as dapagliflozin and empagliflozin, are licensed and recommended for the treatment of heart failure, canagliflozin is not typically used for this indication in the UK.

Question 10

A patient with asthma has been initiated on a beta-blocker, but the doctor would like to prescribe a cardio selective beta-blocker to avoid increased side-effects in asthmatic patients. Which of the following beta-blockers would be recommended?

Choose only ONE best answer.

A
Carvedilol
B
Metoprolol
C
Nadolol
D
Pindolol
E
Sotalol

Answer 10

B – Cardio selective beta-blockers include Bisoprolol, ATenolol, Metoprolol, Acebutolol, and Nebivolol (BATMAN

Question 11

Miss Angi Na has been treated by the cardiologist for her recurring onset of stable angina. They have been put on long-term prevention of angina, but the doctor would like to also initiate them on more medications to prevent any further cardiovascular events. Which of the following medications could be initiated at this point?

Choose only ONE best answer.

A
Aspirin 75mg
B
Atorvastatin 80mg
C
Clopidogrel 75mg
D
Rivaroxaban 20mg
E
Warfarin 5mg

Answer 11

aSPIRIN

Question 12

Mr Dia Retic has been initiated on triamterene for the treatment of oedema. This medication has been known to dye urine a specific colour which is harmless. Which colour does triamterene dye urine?

Choose only ONE best answer.

A
Blue
B
Brown
C
Pink
D
Red
E
Yellow

Answer 12

bLUE

Question 13

Mr Chris Keemic has recently had a stroke due to a blood clot and as well as treating the blood clot, the doctor would like to manage their hypertension. Which of the following medications should not be used to manage the hypertension?

Choose only ONE best answer.

A
Amlodipine
B
Bisoprolol
C
Doxazosin
D
Indapamide
E
Ramipril

Answer 13

Bisoprolol

Question 14

Mr Winnie Pooh has come into the pharmacy complaining that ever since they started taking a beta-blocker, their dreams have become a lot more vivid and scary. Which of the following medications should the patient be converted over to alleviate these side-effects?

Choose only ONE best answer.

A
Acebutolol
B
Bisoprolol
C
Celiprolol
D
Nebivolol
E
Oxprenolol

Answer 14

Beta-blockers may cause nightmares due to crossing the blood-brain barrier. Water soluble beta-blockers are less likely to cross the blood brain barrier and cause nightmares. Water soluble beta-blockers include Celiprolol Atenolol Nadolol Sotalol (Water CANS).

Question 15

Mr Tim O’Lol has come to the doctor for their regular review after having a heart attack 12 months ago. The doctor has decided to discontinue one of their medications. Given that the patient has a reduced LVEF, which medication is most likely to be discontinued?

Choose only ONE best answer.

A
Aspirin 75mg
B
Atorvastatin 80mg
C
Bisoprolol 5mg
D
Clopidogrel 75mg
E
Ramipril 5mg

Answer 15

D – Patients who have had an acute coronary syndrome would only be on dual anti-platelet therapy for 12 months. After that, they would continue aspirin on its own, discontinuing the second anti-platelet which is a choice of clopidogrel, ticagrelor or prasugrel. The beta-blocker may be discontinued if there isn’t a reduced LVEF. Statin and ACE-Inhibitor will be continued long-term too.

Question 16

A patient with atrial fibrillation is currently being assessed on whether they need to be initiated on an anticoagulant and has just received an ORBIT score of 6, giving him a high risk of bleeds. Which of the following factors would not have been a contributing factor to his ORBIT score of 6?

Choose only ONE best answer.

A
Already being treated with an oral antiplatelet
B
Being aged 82 years old
C
Having a history of bleeds
D
Having a reduced haemoglobin of 9 mg/dL
E
Having an eGFR of 75 mg/dl/1.73m2

Answer 16

The ORBIT score is based on age (over 75), a reduced haemoglobin (< 13 mg/dL in men, < 12 mg/dL in women, a history of bleed, an eGFR under 60 mg/dl/1.73m2, as well as treatment with an anti-platelet.

Question 17

Mrs River Oxaban has been to the doctors for having a blood clotting disorder, and has been prescribed some tranexamic acid to help with menorrhagia. Which of the following doses would be most appropriate for treatment with tranexamic acid?

Choose only ONE best answer.

A
1 g two times daily for up to four days
B
1 g three times daily for up to four days
C
1 g two times daily for up to a week
D
1 g three times daily for up to a week
E
1 g four times daily for up to a week

Answer 17

b

Question 18

A patient has collapsed after having a stroke and has been transferred to a hospital, where they will be administered alteplase as a thrombolytic. How quickly after the onset of the stroke should they receive the alteplase?

Choose only ONE best answer.

A
1 hour
B
2.5 hours
C
3 hours
D
4.5 hours
E
6 hours

Answer 18

4.5

Question 19

A patient with a swollen left calf has come into the pharmacy asking for some ibuprofen. They have explained that they leg is painful and hot to touch despite not looking bitten or infected. The pharmacist has referred them to the clinic to be tested for a venous thromboembolism. Which of the following tests would be most likely performed for the patient?

Choose only ONE best answer.

A
13C urea breath test
B
CHADsVASc test
C
D-dimer test
D
INR test
E
Stool antigen test

Answer 19

d dimer

Question 20

being treated for an ischaemic stroke. The doctors are going to remove them from initial treatment and start them on long-term management. Which of the following anti-platelet options would be most appropriate for this patient?

Choose only ONE best answer.

A
Aspirin 75mg
B
Clopidogrel 75mg
C
Dipyridamole 200mg
D
Dual therapy of aspirin 75mg + clopidogrel 75mg
E
Dual therapy of aspirin 75mg + prasugrel 5mg

Answer 20

Once initial management with aspirin 300mg has been used for 14 days, life-long management with clopidogrel 75mg should be used. If clopidogrel is contra-indicated, then aspirin 75mg can be used instead.

Question 21

Mr Apu Xiban has been using swapped over from warfarin to rivaroxaban for the prevention of blood clots secondary to atrial fibrillation. The patient accidentally forgot they had swapped to rivaroxaban, and where they used to take 6 warfarin tablets, they have now taken 6 rivaroxaban tablets causing an overdose. Which of the following medications should be administered to the patient as an antidote?

Choose only ONE best answer.

A
Activated charcoal
B
Andexanet alfa
C
Flumazenil
D
Protamine
E
Vitamin K

Answer 21

B- Antidote for apixiban and rivaroxaban

Question 22

A patient has been admitted to hospital for an emergency hip operation and has been initiated on unfractionated heparin. The heparin has not been cleared out of the patient’s system quick enough and has led to toxic side-effects. Which of the following medications would be the antidote for this overdose?

Choose only ONE best answer.

A
Activated charcoal
B
Andexanet alfa
C
Flumazenil
D
Protamine
E
Vitamin K

Answer 22

D – Protamine would be the antidote for unfractionated and low molecular weight heparin

Question 23

Mrs Amy Triptalline has been to the emergency clinic after their ankles have swollen to the extent that they cannot stand up. The doctor has put this down to oedema, and would like to prescribe bendroflumethiazide but is aware that it can interact with the patient’s regular treatment, lithium. Which of the following interactions would occur between lithium and bendroflumethiazide?

Choose only ONE best answer.

A
Bendroflumethiazide would cause a decrease in lithium levels
B
Bendroflumethiazide would cause an increase in lithium levels
C
Bendroflumethiazide would cause hyperkalaemia when given with lithium
D
Bendroflumethiazide would cause hypokalaemia when given with lithium
E
Bendroflumethiazide would cause nephrotoxicity when given with lithium

Answer 23

B – Bendroflumethiazide would cause an increase in lithium levels resulting in an increased risk of lithium toxicity.

Question 24

Mr Lee Thium, who has a prolonged history of cardiovascular disease has been scheduled for a heart valve replacement with a mechanical prosthetic. They would need to measure their international normalised ratio (INR) more regularly again, at a different target. Which INR target would be most appropriate for this patient?

Choose only ONE best answer.

A
An INR of 0.5 (+/- 0.5)
B
An INR of 1.0 (+/- 0.5)
C
An INR of 2.5 (+/- 0.5)
D
An INR of 3.5 (+/- 0.5)
E
An INR of 4.5 (+/- 0.5)

Answer 24

D – Patients with mechanical prosthetic heart valves, as well as patients with recurring DVTs or PEs should have an INR aim of 3.5 with a leniency of 0.5.

Question 25

A patient has been admitted to the cardiology ward after having an irregular heart beat which was then later diagnosed to be atrial fibrillation. The doctor would like to start them on a rate control medication. Which of the following medications would be inappropriate to give the patient as a rate limiting therapy? Choose only ONE best answer. A Atenolol B Bisoprolol C Metoprolol D Sotalol E Verapamil

Answer 25

First line therapy for rate control would be either a standard beta-blocker (not sotalol), or a rate-limiting calcium channel blocker such as verapamil or diltiazem. Digoxin may be used in non-paroxysmal atrial fibrillation who are predominantly sedentary.

Question 26

The trainee pharmacist is currently working on the cardiology ward and is doing a ward round with the doctors to ensure no one is at risk of an embolism. The trainee would like to understand more about mechanical prophylaxis. Which of the following statements would be incorrect regarding mechanical prophylaxis, such as compression stockings? Choose only ONE best answer. A Compression stockings are not needed if the patient is already on pharmacological prophylaxis B Compression stockings can be worn for short periods of times such as being on an aeroplane C Compression stockings should be measured against the patient’s size D Compression stockings should not be given to patients with acute strokes E Compression stockings should be worn till the patient is mobile

Answer 26

A – Patients can be put on both compression stockings as a mechanical prophylaxis as well as a blood thinner. This would reduce the risk of blood clots.

Question 27

A patient has been initiated on warfarin for the prevention of stroke due to being at a high risk. They have never had this medication before, and would like to have some counselling. Which of the following points would be inappropriate to give to the patient? Choose only ONE best answer. A Calciphylaxis is a rare side-effect which is a build-up of calcium and phosphate within small arteries B The patient should look out for signs of bleeding C The patient should start eating a lot of leafy greens D Warfarin should be avoided in the first trimester of pregnancy E Warfarin should be avoided in the third trimester of pregnancy

Answer 27

c

Question 28

Mr Dappy Gloflozin, a patient with type 1 diabetes mellitus has come into the general practice for their annual medication review. The doctor has decided to initiate them on a statin to prevent cardiovascular events. Which of the following points would not be a reason to start them on a statin? Choose only ONE best answer. A Being over the age of 40 B Having diabetes for over 10 years C Having established hepatotoxicity D Having established nephropathy E Having other CVD risk factors

Answer 28

C – Patients with type 1 diabetes should be offered a statin if they are over the age of 40, have had diabetes for over 10 years, have established nephropathy or have other CVD risk factors.

Question 29

A patient has suddenly felt a tight crushing sensation on their chest which has caused them to fall unconscious. After being assessed, the emergency room found that they were having a STEMI, which was evident through and ECG and troponin blood tests. Which of the following test results would most likely be displayed by the patient with the STEMI? Choose only ONE best answer. A ST zone elevated; high troponin levels B ST zone elevated; low troponin levels C ST zone not elevated; high troponin levels D ST zone not elevated; low troponin levels

Answer 29

A – In a STEMI, the ST zone would be shown to be elevated in an ECG. As well as this, the blood troponin levels would be high due to the troponin being released into the blood stream when heart muscle is damaged

Question 30

been admitted to hospital after coughing up blood and having shortness of breath. The doctor has diagnosed this to be a pulmonary embolism and would like to initiate them on apixaban. Which of the following dosing regimens would be most appropriate for this patient? Choose only ONE best answer. A 5 mg twice a day for 7 days, then 10mg daily as maintenance B 5 mg twice a day for 7 days, then 10mg twice a day as maintenance C 10mg once a day for 7 days, then 5mg daily as maintenance D 10mg twice a day for 7 days, then 5mg daily as maintenance E 10mg twice a day for 7 days, then 5mg twice a day as maintenance

Answer 30

PE would be 10mg twice a day for 7 days, and then a maintenance dose of 5mg twice daily.

Question 31

een initiated on digoxin for the treatment of atrial fibrillation. The patient would need to have some blood tests to ensure that they are not at risk of having toxic side-effects. Which of the following points regarding the blood tests would be true? Choose only ONE best answer. A Blood samples should be taken within 3 hours of the last dose B Different formulations can affect the blood levels of digoxin C Digoxin toxicity is seen more commonly seen in blood concentration of over 1ng/ml D Renal function tests are not needed in patients taking digoxin E Serum electrolytes would not be affected by digoxin

Answer 31

Different formulations have different bioavailability. Blood samples should be taken around 6 hours after a dose, and toxic side-effects can be seen more commonly in blood concentrations above 2ng/ml. Serum electrolytes and renal function should be monitored due to the potential risk of disturbance.

Question 32

Mrs Tammy Sulosin has been to the GP to get a prescription for a chest infection, where they prescribed clarithromycin 500mg twice a day for five days. The patient currently takes omeprazole, simvastatin and also has a penicillin allergy. Which of the following steps would you take? Choose only ONE best answer. A Dispense the clarithromycin, no issues raised B Dispense the clarithromycin, stop taking statin during treatment with clarithromycin C Refer patient back to doctor to get a prescription for amoxicillin 500mg three times a day for 5 days D Take double the amount of the simvastatin E Take double the amount of the clarithromycin

Answer 32

Hold the statin

Question 33

A patient has been to see their doctor for their annual health check and they have decided to initiate them on a statin. The patient is annoyed that the statin may need to be taken at night as they tend to take all their medications in the morning and they feel like they will forget to take their statin. Which of the following statins can be administered in the morning to align with the patient’s routine? Choose only ONE best answer. A Fluvastatin 5mg B Pravastatin 10mg C Pravastatin 40mg D Rosuvastatin 5mg E Simvastatin 10mg

Answer 33

Rosuva

Question 34

admitted to the hospital a few weeks ago after having a myocardial infarction and is being prepared to be released back home. The pharmacist needs to supply two weeks’ worth of medications for the patient to take home with him. Which of the following medications would least likely be dispensed? Choose only ONE best answer. A Amlodipine 10mg B Atorvastatin 80mg C Bisoprolol 2.5mg D Prasugrel 5mg E Ramipril 5mg

Answer 34

The five medications for secondary prevention of ACS would be dual antiplatelet therapy, usually aspirin for lifelong use as well as either of clopidogrel, ticagrelor or prasugrel, a high intensity statin, a beta-blocker and an ACE-inhibitor.

Question 35

has been having very erratic atrial fibrillation has been initiated on amiodarone even though they are already on digoxin. The concomitant use of the two may lead to an interaction. Which of the following dose adjustments, if any should be made? Choose only ONE best answer. A Amiodarone dose needs to be doubled B Amiodarone dose needs to be halved C Digoxin dose needs to be doubled D Digoxin dose needs to be halved E No dose adjustments necessary

Answer 35

D – Administration of amiodarone to a patient already receiving digoxin will bring about an increase in the plasma digoxin concentration and thus precipitate symptoms and signs associated with high digoxin levels. Clinical, ECG and biological monitoring is recommended and digoxin dosage should be halved

Question 36

A patient who is 28 weeks pregnant needs to be initiated on antiplatelet therapy as they have suddenly become a lot less mobile which has increased their risk of thromboembolic events. Which of the following medications would not be appropriate to give the patient? Choose only ONE best answer. A Bemiparin B Dalteparin C Enoxaparin D Heparin (unfractionated) E Parnaparin

Answer 36

D – Low molecular weight heparins are preferred in pregnancy over unfractionated heparin as LMWH carries a lower risk of heparin-induced thrombocytopenia (HIT).

Question 37

A patient has been initiated on spironolactone for the treatment of fluid retention and would like some counselling on the side-effects. Which of the following side-effects would be inappropriate to advise when taking spironolactone? Choose only ONE best answer. A Spironolactone may cause a change in libido B Spironolactone may cause breast pain C Spironolactone may cause confusion D Spironolactone may cause hypokalaemia E Spironolactone may cause nausea

Answer 37

Causes hyperkalemaia

Question 38

as been to the pharmacogenomic test centre which has diagnosed him with heterozygous familial hypercholesterolaemia. They have not yet had any cardiac events that warrants secondary prevention. What would be the first line treatment for this patient? Choose only ONE best answer. A Atorvastatin 10mg once daily B Atorvastatin 80mg once daily C Ezetimibe 10mg once daily D Pravastatin 40mg once daily E Simvastatin 40mg once daily

Answer 38

B – All patients with familial hypercholesterolaemia are at a high risk of coronary heart disease and therefore should be started on a high intensity statin, such as atorvastatin 20mg or above. Ezetimibe would be second line treatment.

Question 39

patient has been on long term maintenance therapy for atrial fibrillation with bisoprolol. This has not managed the patient’s symptoms and is being stepped up to dual therapy. Which of the following would not be an appropriate combination to give? Choose only ONE best answer. A Bisoprolol + digoxin B Bisoprolol + diltiazem C Bisoprolol + verapamil D Digoxin + diltiazem E Digoxin + atenolol

Answer 39

C – The use of verapamil in combination with a beta-blocker is not allowed due to the risk of cardiac side-effects. Only diltiazem can be used in dual therapy.

Question 40

has been started on heparin-based anticoagulation and would like to know some of the side-effects associated with it. Which of the following statements would be correct regarding heparins. Choose only ONE best answer. A Heparins do not have a risk of haemorrhage B Heparins may cause hyperkalaemia C Heparins may cause hyponatraemia D Unfractionated heparin should not be used if a quick reversal is needed E Unfractionated heparin has a lower risk of heparin induced thrombocytopenia

Answer 40

B – All anticoagulants have a risk of bleed. Heparins do not have an effect on sodium levels. Though unfractionated heparin can be reversed quicker, it has a higher risk of heparin induced thrombocytopenia.

Question 41

58-year-old female patient weighing 56kg has been admitted to hospital after having a pulmonary embolism. They have been given enoxaparin during their stay, and the doctors will now prescribe them edoxaban. Which of the following dosing regimens would be most appropriate? Choose only ONE best answer. A 30mg once daily after at least 5 days of parenteral anticoagulation B 30mg twice daily after at least 5 days of parenteral anticoagulation C 30mg once daily after at least 7 days of parenteral anticoagulation D 60mg once daily after at least 5 days of parenteral anticoagulation E 60mg once daily after at least 7 days of parenteral anticoagulation

Answer 41

A – Edoxaban should be given after an initial use of parenteral anticoagulation for 5 days if used for the treatment of a thrombosis. As the patient weighs under 61kg, they should receive a dose of 30mg once daily. If they weighed 61kg or more, they would be taking 60mg once daily.

Question 42

A patient has come into the doctor’s surgery for their INR test and has given a result of 9.4. The patient does not show any signs of bleeding. Which of the following actions should be taken? Choose only ONE best answer. A No action needed – INR is within range B Stop warfarin, give IV vitamin K, restart warfarin when INR < 5 C Stop warfarin, give oral vitamin K, restart warfarin when INR < 5 D Stop warfarin, restart warfarin when INR < 5 E Withhold 1-2 doses before starting warfarin again

Answer 42

C – As the patient’s INR is over 5, warfarin must be stopped and vitamin K must be given. However, as there are no signs of bleeding, it can be administered orally. Warfarin can be restarted when the INR is below 5.

Question 43

Enable fullscreen QUESTION 7 OF 10 A patient has come into the hospital with fluid build-up in their ankles, as well as having shortness of breath. They have been diagnosed with heart failure with reduced ejection fraction and need to be started on medication. Which of the following medications should be started? Choose only ONE best answer. A Bisoprolol + Furosemide + Ramipril B Bisoprolol + Ramipril C Furosemide + Bisoprolol D Furosemide + Ramipril E Furosemide + Propranolol + Ramipril

Answer 43

A – Patients with reduced ejection fraction heart failure should be started on a beta-blocker licensed in heart failure (bisoprolol, carvedilol and nebivolol), and an ACE-inhibitor as first line treatment. All patients experiencing fluid retention should also be started on a diuretic such as furosemide.

Question 44

A patient has been living with atrial fibrillation for the past 3 years and would like to have a sinus rhythm restoration with cardioversion. Which of the following points is true regarding cardioversion? Choose only ONE best answer. A Amiodarone and flecainide should not be used for pharmacological cardioversion B Amiodarone should not be used in patients who have already had electrical cardioversion C If atrial fibrillation has been present for more than 48 hours, electrical cardioversion is preferred D Patient should be anticoagulated for 1 week before electrical cardioversion E Patient should be anticoagulated for 2 weeks after electrical cardioversion

Answer 44

C – Electrical cardioversion is preferred in patients who have atrial fibrillation present for more than 48 hours. Patients undergoing electric cardioversion should be anticoagulated for 3 weeks before and 4 weeks after. Amiodarone can be used to maintain sinus rhythm, started 4 weeks before electric cardioversion, and 12 months after. Pharmacological cardioversion is done with amiodarone and flecainide.

Question 45

A patient has been initiated on amiodarone tablets but prior to starting them off, they would need to have some baseline monitoring. Which of the following tests would not be appropriate for a patient being started on amiodarone? Choose only ONE best answer. A Chest x-ray B Liver function test C Renal function test D Serum potassium levels E Thyroid function test

Answer 45

C – Before initiation, patients monitoring includes a chest x-ray, liver function test, serum potassium test, and a thyroid function test. An annual eye examination is also required once they have started. ECG monitoring is required in those using IV amiodarone, whilst monitoring liver transaminases closely.

Question 46

has using amiodarone as a pharmacological cardioversion and would like to know if there is anything that would interact with their medication, and what would be safe to take. Which of the following items can be taken as usual in patients taking amiodarone? Choose only ONE best answer. A Alcohol B Fluconazole C Grapefruit juice D Ibuprofen E Mefloquine

Answer 46

D – Alcohol can increase the risk of hepatotoxicity. Fluconazole and mefloquine will increase the risk of QT interval prolongation. Grapefruit will act on the CYP450 pathway to increase the risk of amiodarone toxicity. Ibuprofen does not interact.

Question 47

A patient has come into the pharmacy after accidentally consuming 10 times the amount of digoxin that they were meant to. The doctor has asked the nurse to look out for signs of toxicity. Which of the following would not be a sign of toxicity? Choose only ONE best answer. A Blurred vision B Confusion C Diarrhoea D Tachycardia E Vomiting

Answer 47

D-would be bad in OD

Question 48

A patient has been admitted to hospital to undergo an operation and has been put on a nil-by-mouth regimen. This means that they need to be given thromboembolism prophylaxis parenterally. Given that the patient also has mild kidney impairment, which of the following anticoagulants should be used? Choose only ONE best answer. A Bemiparin B Dalteparin C Enoxaparin D Heparin (unfractionated) E Tinzaparin

Answer 48

D

Question 49

an 82-year-old patient has just had a deep vein thrombosis in their left calf and needs to be treated with dabigatran. Which of the following doses would be most appropriate for this patient? Choose only ONE best answer. A 110 mg twice a day following 5 days of parenteral anticoagulation B 110 mg twice a day following 7 days of parenteral anticoagulation C 150 mg once a day following 7 days of parenteral anticoagulation D 150 mg twice a day following 5 days of parenteral anticoagulation E 150 mg twice a day following 7 days of parenteral anticoagulation

Answer 49

A

Question 50

QUESTION 4 OF 10 A patient who is pregnant has come into the general practice for their pregnancy screening. The nurse would like to check to see if they are at risk of pre-eclampsia. Which of the following factors would make the patient more at risk of having pre-eclampsia? Choose only ONE best answer. A Being aged under 25 years B Being pregnant with twins C Having a birth less than 2 years ago D Having a BMI of 29 kg/m2 E Having a thyroid disorder

Answer 50

TWINS

Question 51

A patient has been diagnosed with pre-eclampsia. As well as managing their hypertension, the doctor would like to offer them an anti-platelet to prevent the risk of blood clots. Which of the following recommendations should be made? Choose only ONE best answer. A Aspirin 75mg from week 12 of pregnancy till birth B Aspirin 75mg till week 12 of the pregnancy C Aspirin 300mg till week 12 of the pregnancy D Clopidogrel 75mg from week 12 of pregnancy till birth E Clopidogrel 75mg till week 12 of the pregnancy

Answer 51

A – In patients in risk of pre-eclampsia, it is advised to take 75 mg to 150 mg of aspirin daily from 12 weeks until the birth of the baby.

Question 52

A patient has been admitted to hospital for a severe chest infection. Their current medication history consists of furosemide, atorvastatin, and amlodipine. The pharmacist is concerned regarding interactions between furosemide and some of the antibiotics. Which of the following antibiotics could cause an interaction? Choose only ONE best answer. A Amoxicillin B Doxycycline C Gentamicin D Linezolid E Phenoxymethylpenicillin

Answer 52

C – Furosemide and gentamicin would interact causing an increased risk of nephrotoxicity. Furosemide should be given in caution with other nephrotoxic drugs.