Chapter 8, 9, 10 (medium weighted) Flashcards

Question 1

Q

ANAEMIA

Answer

A

> A condition in which there is a deficiency of red cells or haemoglobin in the blood.
There are about six types of anaemia.
You should know about 4: sickle cell anaemia, iron deficiency anaemia, haemolytic, vitamin deficient anaemia i.e megaloblastic anaemia (lack of B12, B9)
SICKLE CELL ANAEMIA – hereditary (two parent carriers)=>suffer from a crisis that causes a lot of pain as new red blood cells are being produced as they have irregular shape
Occurs due to a structural abnormality of haemoglobin. Can lead to increase in folic acid requirement.
*Phenoxymethylpenicillin (antibiotic) is used in prophylaxis of infection. (6+: 250 BD prevent/treatment QDS, under 6: 125mg)
folic acid, B9
**Hydroxycarbamide is used to reduce frequency of crisis and need for blood transfusion.

Question 2

Q

HAEMOLYTIC ANAEMIA

Answer

A

*Epoetins (synthetic of erythropoietin) are used to treat the anaemia associated with
erythropoetin deficiency in chronic kidney failure
 (erythropoetin stimulates the bone-marrow to produce more red blood cells)
*MHRA warns about severe reactions in patients being treated with erythropoetins. Some cases were fatal
*It can also affect blood pressure and lead to hypertensive crisis.

Question 3

Q

Which drug is used in the prophylaxis of minor infections in patients with sickle cell anaemia?
A. Hydroxycloroquine
B. Amoxicillin
C. Ciprofloxacin
D. Phenoxymethylpenicllin E. Methotrexate

Answer

A

D. Phenoxymethylpenicllin

Question 4

Q

IRON DEFICIENCY ANAEMIA

Answer

A

> blood test to find out type of anaemia
 Give iron supplementation only if there is demonstrable iron-deficiency state. This is to avoid iron overdose=>toxic.
Antidote: desferoxamine
 Take extra care if patient is pregnant (do not dispense OTC, unless prescribed and check SCR) and severe asthma
 100mg to 200mg of elemental iron usual daily dose for treatment of iron -deficient anaemia.
 ***Familiarize yourself with ferrous table
 Iron can discolour stools, altered taste (metallic), abdominal discomfort, after last iron injection must wait 5 days to take oral iron
 Iron can cause constipation as a side-effect. Give with vitamin C (glass of orange juice) to increase absorption=>less constipation issues; ferrogotC
 Iron can cause GI side-effects. Consider taking after food if this occurs
 See interactions such as iron and tetracyclines, chloramphenicol etc=>min of 2 hrs with other meds (levo, quinolones)

Question 5

Q

MEGALOBLASTIC ANAEMIA (vitamin deficiency: B12, B9)

Answer

A

*Occurs due to lack of vitamin B12 or (B9) folic acid.
*Hydroxocobalamin (injection) has completely replaced cyanocobalamin as the vit B12 form of choice for therapy in the UK
*Hydroxocobalamin is retained in the body alotl onger and can be given
 Every 12 weeks/3 months

Question 6

Q

VI TAMINS

Answer

A

 ADEK – Fat soluble
 Which drugs can lead to loss of fat soluble vitamin? Orlistat
>celiac disease=>can cause low levels of ADEK
 CB – water soluble; metformin causes low B12
 VITAMIN A
 Found in liver pate, liver sausage, fish liver, palm oil, carrots.
 Can improve vision.
 High doses can lead to toxicity: excess of vitamin A or D are more likely to lead to toxicity
 VERY IMPORTANT – vitamin A may be teratogenic in pregnancy (amount not known to consume that would cause this). Advice pregnant women to avoid Vitamin A except on doctor’s advice.
 Note- ISOTRETINOIN (a drug used to treat acne) is a vitamin A analogue. Pregnancy prevention programme (PPP) applies: (sodium valproate, vitamin A analogues, mycophenalate motil, thalidomide), rule out pregnancy/pregnancy test (ideally 2 tests, min 1), rx needs date as cannot be more than 7 days old with negative test result (day rx prescribed is day 1), 30 day quantity, patient becomes pregnant: if taking SV, keep taking but refer urgent to gp, stop taking other drugs and refer urgent, contraception.

Question 7

Q

VITAMIN C

Answer

A

 Ascorbic acid
 Found in fruits etc (oranges, lemon, lime)
 Deficiency can lead to scurvy – swollen gums and bleeding margins.
 Vitamin C increases iron absorption.
 There is no evidence to show that vitamin C (anti-oxidant) ameliorate cold and flu symptoms.
 Vitamin C is contraindicated in cardiac dysfunction: HF

 VITAMIN D
 Sun vital in production of vitmin D
 Many people in the UK are vit D deficient. Lack of vit D can cause rickets (low metabolism and low vitamin D)
 Supplements are readily available: maintenance dose 1000units in regular vitamin D levels
 High doses can lead to toxicity!
 High vit D levels can lead to hypercalcaemia: drugs affected by high levels of calcium=>digoxin

Question 8

Q

WHAT ADVICE WOULD YOU GIVE TO DARKER SKIN PATIENTS IN THE UK REGARDING VITAMIN D INTAKE REQUIREMENT ?

Answer

A

Asian/Olive-tone:
Black: risk of low levels vitamin D bc more melanin, more melanin the less likely vitamin D is absorbed into the skin, more melanin less likely to get burned=>advice regarding vitamin D; take all year long
White: needs to cover her skin from sun to avoid burn, wear sunscreen

**all races must use sunscreen

Question 9

Q

MANAGEMENT OF VITAMIN D DEFICIENCY OR INSUFFICIENCY FOR CHILDREN

Answer

A

Link/NICE Management

Question 10

Q

VITAMIN D AND SKIN TONE

Answer

A

 Darker skin patients are at higher risk of vitamin D deficiency in the UK.
Light skin can produce up to five times the amount of vitamin D compared to dark skin tones. However, light-skinned individuals have less melanin and are at a higher risk of sunburn and skin cancer.

Question 11

Q

A mother wants to know which vitamins are safe for her 4-year-old son. Which vitamins are safest in young children?
A. A, B, C, D
B. A, B, E
C. A, C, D
D. A, B, E
E. B, D, K

Answer

A

**can’t give E and K
**vitamin D doses in young children table: allowance for 1.5-yr old?

C. A, C, D=>6 months-5yrs

Question 12

Q

VITAMIN K

Answer

A

> Vit K is necessary for the production of blood clotting factors.
Oral anticoagulants antagonise the effects of vitamin K (warfarin)
Vitamin K is given to newborn infants after birth via injection for example if the mother is on antiepileptic medication: risk of bleeding, haemoraggic newborn disease.
Green leafy vegetables (kale, spinach, Brussel sprouts, broccoli, collard greens) contain vitamin K. Caution patients whilst taking which drug ????
Vitamin E is essential for skin care

> VITAMIN B
Thiamine (B1) – is most common vitamin B lacked by alcoholics. Rx in Wernicke ebcephalopathy
Mothers who are severely deficient in thiamine should avoid breast feeding due toxic methyl-glyoxal present in their breast milk. >Pyridoxine (B6)– doses over 200mg daily can lead to neuropathy.
Folic Acid (B9)
Hydroxycalabin (B12)
B2, riboflavin
B3, niacin
Isoniazide (TB treatment) can reduce pyridoxine levels and lead to neuropathy=>B6 given as a supplement
Cyanocobalamin / B12 –
Deficiency of B12 can lead to megaloblastic anaemia.

Question 13

Q

FOLIC ACID

Answer

A

 For conception(planning to conceive) and pregnancy
 Dose for conception and up to 3 months of pregnancy is 400mcg.

 Folic acid 5mg and higher required for –
 Patients taking antiepileptic medication
 Patient who are diabetic
 Patients who have sickle cell anaemia
 It Prevents methotrexate induced side-effects. (take folic acid on a different day than when you take the methotrexate)
>smoking/obese
>neural tube defects

Question 14

Q

FOLIC ACID DOSES

Answer

A

 Folic acid Dose is from 5mg
 How should folic acid be taken in methotrexate rx
case? different day to methotrexate, if methotrexate taken on Monday, take folic acid any other day
 Lack of folic acid can lead to megaloblastic anaemia
 Prevention of neural tube defects
Neural tube defects tend to occur within 28 days of pregnancy.

Question 15

Q

***ELECTROLYTES (will come on exam, drug, symptoms, solution)

Answer

A

 Electrolytes Ranges
 Sodium: 135 –145mmol/L
 Potassium: 3.5 –5.0mmol/L – over 5.5 is usually considered hyperkalaemia
 Calcium: 2.1 –2.6mmol/L
 Magnesium: 0.7 –1.0mmol/L
 Urea: 2.5 –6.4mmol/L
 Creatinine clearance (CCL) Men: 97 –140ml/min, Women: 85 – 125ml/min

Question 16

Q

DIRECTED STUDY QUESTION

Answer

A

 Which drugs can cause hypokalaemia?
Which drugs can cause hyperkalaemia?
Which drugs can cause hyponatraemia? what can cause the problem: SSRI, diuertics, carbamazepine, desmopressin; drug that will be affected by low levels od sodium is lithium, symptoms: dizzy, drowsy, low BP, confusion, seizure, solution: withhold medication, give supplements like slow sodium chloride tablets
Which drug can cause hypomagnesaemia?
Which drug can cause hypercalcaemia?

Question 17

Q

Which drug does not carry a risk of haemolysis (bleeding) in G6PD deficient patients.
 A. Gliclazide
 B. Dapsone
 C. Ciprofloxacin
 D. Phenoxymethylpenicllin
 E. Aspirin

Answer

A

 D. Phenoxymethylpenicllin

Question 18

Q

G6PD DEFICIENCY

Answer

A

> Glucose 6-phosphate dehydrogenase deficiency
 glucose 6-phosphate dehydrogenase deficiency can lead to acute haemolytic anaemia which can occur from taking certain drugs. Ingestion of fava beans (especially raw) and broad beans can also cause the deficiency.
 DRUGS: 3Q SANDIP=>quinine (leg cramps, 4 weeks), quinolones, quinidine (malaria), sulphonyureas/sulfasalzin, aspirin, nitrofurantoin, dapsone, isoniazid, primaquine
 ACUTE POPHYRIAS: susceptible to increase risk of bleeding=>Anti-depressants, amiodarone, nitrofurantoin, carbamazepine , erythromycin

Question 19

Q

GOUT - INTRO

Answer

A

 Gout is a type of arthritis in which small crystals form inside and around the joints. It causes sudden attacks of severe pain and swelling.
>patients with certain type of diet/medication, rich man’s disease: only rich people could afford foods that increase the risk ie red meat, alcohol, high in sugar, processed foods
>lifestyle changes can reduce the incedence of gout
 It’s estimated that between one and two in every 100 people in the UK are affected by gout.
 The condition mainly affects men over 30 and women after
the menopause. Overall, gout is more common in men than women.
 Gout can be extremely painful and debilitating, but treatments are available to help relieve the symptoms and prevent further attacks.

Question 20

Q

SIGNS AND SYMPTOMS

Answer

A

severe pain in one or more joints
the joint feeling hot and very tender
swelling in and around the affected joint
red, shiny skin over the affected joint

Question 21

Q

GOUT CAUSES

Answer

A

 Genetics
 DIET – Red meat=>protein=>amino acids=>purines and pyridamines=>purines turn into uric acid=>accumulation of uric acid=>gout, sea food, alcohol, certain sugary drinks
may also increase risk of gout.
 AMINO ACIDS
 PURINES
 URIC ACID
 SOME Drugs can exacerbate gout: loop/thiazide diuretics,

Question 22

Q

T YPES

Answer

A

> Acute Gout Attack: NSAIDs (gi irritation/ulcers/increase risk of bleeding/interacts with wrafarin/anticoagulants, HF: increase fluid overload, uncontrolled BP, asthma)(naproxen, diclofenac, NOT ibuprofen too weak), colchicine (can interact with statins, stop statin while on colchicine as it is used for 3-7 days), canakinumab (always screen for TB before prescribed, rx by specialist), experiences once in a while
Chronic long-term gout: allopurinol (1st line, prevents build-up of uric acid, drink plenty of water, interacts with azothiaprin=>reduce axothiaprin to 25%, rashes developed=>stop and refer to GP, can be a sign of toxicity), febuxostat (1st line, history of CVD avoid this med), sulphinepirazone, 2 or more acute attacks in a year or presence of tophi
acute gout attack treatment to chronic/long-term gout=>need to wait 1-2 weeks before start second medication
if patient is taking allopurinol and develop an acute gout attack=>take both allopurinol and colchicine

Question 23

Q

PRESENCE OF TOPHI

Answer

A

nubby of toe, start treating patient for long-term management of gout

Question 24

Q

THERAPY

Answer

A

ACUTE GOUT
 NSAIDs
 COLCHICINE avoid in Egfr less than 10ml/min and adjust if between 10 to 50 ml/ min
 CANAKINUMAB

Question 25

Q

Therapy

Answer

A

CHRONIC GOUT
 ALLOPURINOL – rashes,water intake
 FEBUXOSTAT – mhra: monitor for st. johns syndrome (severe skin rash) and CVD
 SULFINPYRAZONE – acute porphyria

Question 26

Q

Drugs to Avoid

Answer

A

 If a patient is being treated for acute how long before starting long-term treatment ?
 AVOID DEHYDRATION
 Diuretics
 ASPIRIN
 CICLOSPORIN interact with colchicine
 NIACIN – VIT B3

Question 27

Q

WHICH DRUG DOES NOT REQUIRE PREGNANCY PREVENTION PROGRAMME
 A. MYCOPHENOLATE MOPHETIL
 B. THALIDOMIDE
 C. ISOTRETINOIN
 D. SODIUM VALPROATE
 E. AZATHIOPRINE

Answer

A

 E. AZATHIOPRINE

Question 28

Q

METHOTREXATE

Answer

A

 DIHYDROFOLATE REDUCTASE (folate antagonist)
 TAKE WEEKLY (once weekly)
 2.5MG STRENGTH VS 10MG STRENGTH: increased risk of dispensing errors, so keep in separate places
 HOW TO TAKE FOLIC ACID ?? take on a different day to methotrexate
 do not Handle with bare hands: cytotoxic, use gloves, separate tweezer and counting tray
 COUNSEL PATIENTS ON HOW TO TAKE

Question 29

Q

METHOTREXATE ADVERSE EFFECTS

Answer

A

 BLOOD DISORDER: carbimazole, sulfasalizin, trimethoprim, phenytoin, mirtazipine, carbamazepine, methotrexate
 LIVER TOXICITY: dark urine, jaundice, increase in bilirubin levels and AST/ALT, nausea, vomitting, fatigue
 RESPIRATORY EFFECTS: SOB, wheezing, difficulty breathing
 PHOTOSENSITIVITY
 DEHYDRATION: drink plenty of water
 ASCITES: type of liver disease, should not initiate treatment until ascites is managed
 CONTRACEPTION AND CONCEPTION: both men and woman, wait 6 months after stopping methotrexate in order to start trying to concieve
 OTHER SIDE-EFFECTS: G.I IRRITATION, TOXICITY withdraw if stomatitis, ANAEMIA, taste disturbance,
dyspnoea
 GIVE CALCIUM FOLINATE (folinic acid) IN ACUTE TOXICITY

Question 30

Q

Methotrexate Caution

Answer

A

Blood count: factors which increase bone marrow suppression (age, renal impairment, trimethoprim (antifolate)

GI toxicity: withdraw treatment if stomatitis

Liver toxicity: do not start treatment or discontinue if abnormal liver function test results

Pulmonary toxicity: special problem in rheumatoid arthritis. Seek medical attention if (dyspnoea, cough or fever. Monitor symptoms at each visit and discontinue if pneumonitis suspected=>refer!

Which drug to avoid with methotrexate:
Colchicine
Naproxen: reduces eGFR
Trimethoprim: can never take 2 antifolate drugs at same time=>increase risk of mylosuppresion
Amlodipine
Co-Codamol

Question 31

Q

Methtrexate Monitoring

Answer

A

> FBC, Renal, and Liver test every 1-2 weeks until stabilised (then every 2-3 months)
Advice to patients to report all signs of infection especially sore throat, bleeding, unexplained bruising, stomatitis and pneumotitis=>STOP and REFER
Treatment with folinic acid may be require in acute toxicity
folinic acid helps to prevent methotrexate induced mucositis and myelosuppresion

Question 32

Q

DRUG INTERACTIONS

Answer

A

 NSAIDS NOT OTC if taking methotrexate
 ASPIRIN NOT OTC
 PENICILLINS
 TRIMETHOPRIM
CO-TRIMOXAZOLE: contains trimethoprim
 PPIs: omeprazole interacts With MECCI
 QUINOLONES

Question 33

Q

VINKA ALKALOIDS

Answer

A

 Examples- vindensine, vincristine , vinblastine
 Used for treating various cancers
 IV USE*** AVOID INTRATHECAL
 Vinorelbine semi- synthetic vinka-alkaloid
 Intrathecal route is contraindicated=>leads to neurotoxity=>fatal
 50ml bag sizes for adults
 5ml to 10ml for children and young adolescence
===>bag sizes to reduce the risk of effects in case an error has been made, prevent overdose
 Neurotoxicity!!!!!
 Note – neurotoxicity, ototoxicity and nephrotoxicity caused by cisplatin

Question 34

Q

MYCOPHENOLATE MOFETIL

Answer

A

 Immunosuppressant
 Renal transplantation and hepatic transplantation
 Cautions – cough and dyspnoea, recurrent infections
 PPP – MHRA
 Side-effects alopecia, anaemia, drowsiness, increased risk of infections, red cell aplasia
 Pregnancy page 896
 How long should male/ female patients wait before conception? women: 6 weeks, male: 90 days

***BNF: pregnancy/contraception

Question 35

Q

C YCLOSPORIN (GPhC loves)

Answer

A

 POTENT IMMUNOSUPRESSANT
 PRESCRIBE BY BRAND (theophylline/aminophylline, lithium, carbamazepine/phenytoin/phenobarbitol for epilepsy, insulin, enoxaparin, clexin, cyclosporin, clenil/qvar, tacrolimus
 PHOTOSENSITIVE- UV LIGHT, SUNLIGHT, SUN BEDS, SUN LAMPS
 AVOID GRAPE-FRUIT JUICE (inhibitor) (statins, amlodipine, amiodarone)
 INTERACT WITH MACROLIDES (CLARITHROMYCIN, ERYTHROMYCIN=>increase conc. of cyclosporin), CARBAMAZEPINE, ST JOHNS WORT, COLCHICINE

=>clopidogrel and ciclosporin: avoid omeprazole (interacts with clopidogrel) and clarithromycin (interacts with ciclosporin)

Question 36

Q

MONITORING

Answer

A

 BLOOD CONCENTRATIONS
 blood pressure twice before starting
 blood lipids
 LIVER FUNCTION
 POTASSIUM AND MAGNESIUM LEVELS- risk of high K (ACE, heparins, trimethoprim, ciclosporin, spironolactone, potassium supplements)
 KIDNEY FUNCTIONS

Question 37

Q

AZ ATHIOPRINE

Answer

A

 Azathioprine is metabolised to mercaptopurine (comes on its own but if pt is allergic to merca then will be allergic to aza).
 Side-effects- bone marrow suppression/blood suppression (similar symptoms), increased risk of infection
 Pre-treatment screening – TPMT
 Seek advise for those with reduced or absent TPMT activity
 PREGNANCY: should not take while pregnant, do not need PPP, just use effective contraceptives
 Nausea, neutropenia and hypersensitivity
 ALLOPURINOL interaction: reduce aza to 25%
 MONITORING REQ toxicity , full blood count, myelosuppression signs

**digoxin and quinine/amiodarone/darnadarone interaction: half digoxin

Question 38

Q

CHAPTER 8/10

Mr G is admitted into hospital and present with hyperventilation, tinnitus, deafness, vasodilatation, and sweating. He took an overdose of a certain drug and so was given sodium bicarbonate as antidote. Which of the following drugs is associated with the signs and symptoms presented by Mr. G?

A. Aspirin
B. Iron
C. Paracetamol
D. Diazepam
E. Heparin

Question 39

Q

Cytotoxic drugs may be categorised according to their emetogenic potential. Which of the following is the least emetogenic treatment?

A. Fluorouracil
B. Doxorubicin
C. Cisplatin
D. Cyclophosphamide E. Dacarbazine

Question 40

Q

Miss Phoebe regularly suffers from three migraine attacks a month; she is complaining that the recurrent episodes are having an increased impact on her quality of life. You have recommended that she sees the GP. In light of the information provided, which of the following would be the most appropriate and licensed choice the GP should prescribe for migraine prophylaxis?
A. Sumatriptan
B. Rizatriptan
C. Zolmitriptan
D. Propranolol
E. Gabapentin

Question 41

Q

A mother attends the pharmacy for advice for her 24-month-old child who has chicken pox and is suffering from itching, discomfort and fever. Which treatment options would you recommend?

A. Ibuprofen 50mg 3-4 times daily and chlorpheniramine 1mg twice daily.
B. Ibuprofen 50mg 3-4 times daily and topical calamine lotion.
C. Paracetamol 120mg every 4-6 hours, maximum of four times daily
and chlorpheniramine 5ml twice daily.
D. Paracetamol 120mg every 4-6 hours, maximum of four times daily and chlorpheniramine 2.5ml twice daily.
E. Paracetamol 120mg every 4-6 hours, maximum of three times daily and topical calamine lotion.

Question 42

Q

The MHRA advice to exclude pregnancy in females of child-bearing potential before treatment of mycophenolate, which of the following is false?
A Pregnancy tests 8–10 days apart are recommended.
B Effective contraception during and for at least 6 months after treatment in men and women.
C. Women should use at least 1 method of effective contraception before and during treatment.
D Male patients or their female partner should use effective contraception for 90 days after discontinuation.
E. Women should use effective contraception for 6 weeks after discontinuation.

Question 43

Q

Miss K is 20 years old, and she comes into the pharmacy with a prescription for isotretinoin capsules. Which one of the following statements is false regarding the treatment?
A. Quantity prescribed should be for a maximum of 7 days.
B. Prescription is valid for 7 days from the date on prescription. C. Patient should use sunscreen and avoid sunlight exposure.
D. She should be advised not to use waxing during treatment for at least 6 months.
E. Patient should have her pregnancy status established as negative within preceding 7 days.

Question 44

Q

A 45-year-old woman walked into the pharmacy and complained about an acute left sided shooting jaw pain (which feels like an electric shock). She also mentioned that it gets worse when she brushes her teeth. You then referred her to the GP. A week later, she comes back to the pharmacy with a prescription. Which of the following would she most likely have been prescribed?
A Carbamazepine
B Morphine
C Tramadol
D Diclofenac
E Amitriptyline

Question 45

Q

Mr. W has been diagnosed with advanced osteoarthritis. The orthopaedic registrar wants to prescribe Mr. W on NSAIDs but the history of his medical conditions make NSAIDs an unsuitable choice to be prescribed for his current condition. Which of the following conditions are NSAIDs contraindicated in?
A. Mild to severe heart failure
B. Hypertension
C. Crohn’s disease
D. Acute porphyrias
E. Cerebrovascular disease

Question 46

Q

A mother attends the pharmacy for advice for her 24 month old child who has chicken pox and is suffering from itching, discomfort and fever. Which treatment options would you recommend?
A. Ibuprofen 50mg 3-4 times daily and chlorpheniramine 1mg twice daily.
B. Ibuprofen 50mg 3-4 times daily and topical calamine lotion.
C. Paracetamol 120mg every 4-6 hours, maximum of four times daily and chlorpheniramine 5ml twice daily.
D. Paracetamol 120mg every 4-6 hours, maximum of four times daily and
chlorpheniramine 2.5ml twice daily.
E. Paracetamol 120mg every 4-6 hours, maximum of three times daily and topical calamine lotion.

Question 47

Q

Which of the following is not regarded as a routine reason to stop taking methotrexate immediately?
A. photosensitive reactions
B. Pneumonitis
C. Stomatitis
D. Renal impairment
E. Hepatic disorder

Question 48

Q

Which of the following drugs does not require BRAND prescribing and dispensing?
A. Methotrexate
B. Ciclosporin
C. Lithium
D. Enoxaparin
E. Clenil Inhaler

Question 49

Q

Mr. Q presents a prescription for pethidine 50mg tablets to be taken every 4 hours for acute pain. What is the recommended maximum duration of supply on a single prescription for this medicine?
A. 5 days
B. 28 days
C. 7 days
D. 30 days
E. 6 months

Question 50

Q

Mrs. D. is currently taking allopurinol 300mg daily for gout. She developed an acute gout attack recently. Her symptoms include severe pain in one joint, the joint feels hot and very tender. She takes regular medicines. Which of her regular medicines might have exacerbated her condition?
A. Naproxen 500mg tablets
B. Lisinopril 10mg tablets
C. Amlodipine mg tablets
D. Bendroflumethiazide 5mg tablets
E. Simvastatin 20mg tablets

Question 51

Q

Which of the following medication is most likely to cause mood swings?
A. Isotretinoin
B. Baclofen
C. Azathioprine
D. Ramipril
E. Methocarbamol.

Question 52

Q

Which of the following statements is not true about ciclosporin?
A. Female patients on ciclosporin do not need to be put on the Pregnancy Prevention Programme (PPP).
B. Ciclosporin should be prescribed by brand only and dispensed as such.
C. Ciclosporin can increase a patient’s blood pressure.
D. Patients on ciclosporin should be advised to avoid direct sunlight as ciclosporin is photosensitive.
E. Ciclosporin should never be taken with orange or apple juice as it is very dangerous to do so.

Question 53

Q

Mr. and Mrs. Ramsey present in your pharmacy and tell you that they would like to try for a baby soon. They mention that Mr. Ramsey currently takes a certain DMARD for arthritis. They show you a box of the drug. You inform them that effective contraception should be used during treatment and for at least 6 months after treatment is discontinued. Which DMARD does this refer to?
* A. AZATHIOPRINE
* B. TACROLIMUS
* C. METHOTREXATE
* D. MYCOPHENOLATE MOFETIL
* E. BICALUTAMIDE
* F. DEXAMETHASONE
* G. PYRIDOXINE
* H. FOLIC ACID 5MG
* I. VINBLASTINE

Question 54

Q

You work as a community pharmacist. Mr. P. a regular male patient presents in your pharmacy with a prescription. He mentions that his doctor insists that he must have the same BRAND prescribed. Which of the drugs listed is it inappropriate to switch brands?
* A. AZATHIOPRINE
* B. TACROLIMUS
* C. METHOTREXATE
* D. MYCOPHENOLATE MOFETIL
* E. BICALUTAMIDE
* F. DEXAMETHASONE
* G. PYRIDOXINE
* H. FOLIC ACID 5MG
* I. VINBLASTINE

Question 55

Q

A 70-year-old male patient is diagnosed with prostate cancer. Which of the drugs above can be used to treat locally advanced prostate cancer in male patients?
* A. AZATHIOPRINE
* B. TACROLIMUS
* C. METHOTREXATE
* D. MYCOPHENOLATE MOFETIL
* E. BICALUTAMIDE
* F. DEXAMETHASONE
* G. PYRIDOXINE
* H. FOLIC ACID 5MG
* I. VINBLASTINE

Question 56

Q

A university student asks you about DMARDs. Which drug listed above requires measurement of TPMT activity within a patient’s body as part of its monitoring requirements?
* A. AZATHIOPRINE
* B. TACROLIMUS
* C. METHOTREXATE
* D. MYCOPHENOLATE MOFETIL
* E. BICALUTAMIDE
* F. DEXAMETHASONE
* G. PYRIDOXINE
* H. FOLIC ACID 5MG
* I. VINBLASTINE

Question 57

Q

Deficiency of which of the above can cause peripheral neuropathy?
* A. AZATHIOPRINE
* B. TACROLIMUS
* C. METHOTREXATE
* D. MYCOPHENOLATE MOFETIL
* E. BICALUTAMIDE
* F. DEXAMETHASONE
* G. PYRIDOXINE
* H. FOLIC ACID 5MG
* I. VINBLASTINE

Question 58

Q

CHAPTER 9
Why is vitamin K given to newborns in certain circumstances?
a. To prevent thyroid disease in newborns
b. To prevent haemoptysis disease of newborns
c. To treat tuberculosis in newborns
d. To prevent scurvy
e. To prevent haemorrhagic newborn disease

Question 59

Q

Isoniazide is usually used to treat tuberculosis as a result isoniazide can lead to deficiency of which vitamin?
a. Vitamin B1
b. Vitamin D
c. Vitamin B9
d. Vitamin B6
e. Vitamin B2

Question 60

Q

Mr. Drake’s potassium level is 7.5mmol/L (normal range is 3.5 – 5.1mmol/L). He wants you to tell him if you think one of his medication may be the cause of this . choose from options below.
a. Theophylline
b. Salbutamol
c. Eplerenone
d. Beclomethasone
e. Amiodarone

Question 61

Q

Mr. Ahmed wants to buy Sudafed tablets and ibuprofen tablets. He has been stabilized on levothyroxine and also takes folic acid, simvastatin, metformin, tamsulosin, Phenelzine and Hydralazine. Can you make a sale? Choose most appropriate answer.
a. Yes. But short-term use only
b. No. Due to his Tamsulosin
c. No. Due to his thyroid medicationd.
d. No. Due to drug interaction with ibuprofen
e. No. Due to risk of significant hypertension

Question 62

Q

Mr. W. complains of orange stains on his new contact lenses. You check his PMR to see if any of his medication may be responsible. Which of these can stain soft contact lenses?
a. Theophylline
b. Aminophylline
c. ciprofloxacin
d. Sulfasalazine
e. Tamsulosin

Question 63

Q

Bonjela junior for ulcers and teething in children was re-classified a few years ago in the UK from GSL to P. Which ingredient contained in Bonjela is responsible for this change?
a. Cetalkonium chloride
b. Salicylic acid
c. Choline Salicylate
d. Lidocaine
e. Benzalkonium chloride

Question 64

Q

Choose the most appropriate option. What would be your concern if indapamide 2.5mg tablets is taken concomitantly with ciclosporin long term.
a. increase risk of Bradycardia
b. increase risk of Hyponatraemia
c. increase risk of Hypokalaemia
d. increase risk of Hypernatremia
e. increase risk of Hyperkalaemia