EXAM QS: ONTRACK Flashcards
For each of the following patients, select the most relevant safety concern associated with the patient’s medication. Each option may be used once, more than once or not at all.
A 64-year-old woman prescribed empagliflozin 10 mg once daily.
Atypical femoral fractures
Benign idiopathic osteonecrosis
Fatal diabetic ketoacidosis
Increased incidence of heart failure
Risk of severe harm and death
Subacute cutaneous lupus erythematosus
Suicidal ideation
Uterine perforation
FATAL DIABETIC KETOACIDOSIS:
For each of the following products sold over the counter, select the minimum age that they can be used from. Each option may be used once, more than once, or not at all.
Nurofen® for Children 100 mg/5 mL.
2 months
3 months
6 months
12 years
16 years
18 years
45 years
65 years
3 months
For each of the following products sold over the counter, select the minimum age that they can be used from. Each option may be used once, more than once, or not at all.
Alli® 60 mg hard capsules.
2 months
3 months
6 months
12 years
16 years
18 years
45 years
65 years
18 yrs
For each of the following scenarios, choose the appropriate treatment for the patient. Each option may be used once, more than once, or not at all.
[You should refer to NICE guidance on COPD (NG 115): https://www.nice.org.uk/guidance/ng115/resources/chronic-obstructive-pulmonary-disease-in-over-16s-diagnosis-and-management-pdf-66141600098245]
A non-smoking patient who has spirometrically confirmed COPD and asthmatic features, but remains breathless despite optimised SABA treatment.
ICS
LABA
LABA + ICS
LABA + LAMA
LAMA
LAMA + LABA + ICS
SABA or SAMA
SAMA only
LABA + ICS
For each of the following scenarios, choose the appropriate treatment for the patient. Each option may be used once, more than once, or not at all.
You should refer to NICE guidance on COPD (NG 115): https://www.nice.org.uk/guidance/ng115/resources/chronic-obstructive-pulmonary-disease-in-over-16s-diagnosis-and-management-pdf-66141600098245
A non-smoking patient with spirometrically confirmed COPD who does not have asthmatic features but remains breathless despite use of a SABA.
ICS
LABA
LABA + ICS
LABA + LAMA
LAMA
LAMA + LABA + ICS
SABA or SAMA
SAMA only
LABA + LAMA
A patient newly diagnosed with COPD who needs treatment to relieve breathlessness and exercise limitation.
ICS
LABA
LABA + ICS
LABA + LAMA
LAMA
LAMA + LABA + ICS
SABA or SAMA
SAMA only
SABA or SAMA
A patient with spirometrically confirmed COPD who has features suggesting steroid responsiveness and remains breathless despite taking LABA + ICS.
ICS
LABA
LABA + ICS
LABA + LAMA
LAMA
LAMA + LABA + ICS
SABA or SAMA
SAMA only
LAMA + LABA + ICS
Which of the listed conditions are cautioned with the following products?
Pseudoephedrine tablets.
Asthma
Diabetes and hypertension
Epilepsy
Hay fever
Hypertension and asthma
Migraine
Ulcer
Ulcer and asthma
Diabetes and hypertension [ DIABETES: Due to activation of SNS it increases the blood glucose and in hypertension increases TPR/cardiac work=increasing BP]
Paracetamol 500 mg and pseudoephedrine 30 mg.
Asthma
Diabetes and hypertension
Epilepsy
Hay fever
Hypertension and asthma
Migraine
Ulcer
Ulcer and asthma
Diabetes and hypertension
A 38-year-old male who presents with excruciating pain in his right ankle at night. He described the ankle as being ‘red, inflamed and feels warm’.
Anaphylaxis
Asthma attack
Ectopic pregnancy
Gout
Hernia
Irritable bowel syndrome
Osteoporosis
Rheumatoid arthritis
GOUT [https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions/gout]
What are the signs and symptoms of gout.
Gout commonly affects the large toe but may also affect the ankles, heels, knees, wrists, fingers and elbows. It commonly occurs at night and may last 3-10 days.
A 17-year-old female who experiences lower abdominal pain 8 weeks after having unprotected sex.
Anaphylaxis
Asthma attack
Ectopic pregnancy
Gout
Hernia
Irritable bowel syndrome
Osteoporosis
Rheumatoid arthritis
Ectopic pregnancy
For each of the following patients described, select the most likely possible consequence of the drug interaction from the list above. Each option may be used once, more than once or not at all.
An 80-year-old man is on the following medication:
isosorbide mononitrate 50 mg m/r daily
aspirin 75 mg daily
amlodipine 10 mg daily
He has been newly prescribed lisinopril 10 mg daily.
Bleeding risk increased
Bradycardia
Constipation
First dose hypotension
Hypertensive crisis
QT interval prolongation
Reduced eGFR
Serotonin syndrome
First dose hypotension
A 77-year-old woman is on the following medication:
atorvastatin 10 mg daily
aspirin 75 mg daily
digoxin 62.5 mcg daily.
She has been newly prescribed atenolol 10 mg daily.
Bleeding risk increased
Bradycardia
Constipation
First dose hypotension
Hypertensive crisis
QT interval prolongation
Reduced eGFR
Serotonin syndrome
Bradycardia
A patient who takes warfarin for atrial fibrillation and has an INR of >8 is admitted onto your ward. What should be given by slow intravenous injection?
Ascorbic acid
Calcium
Folic acid
Iron
Retinol
Vitamin D
Vitamin K
Zinc
Vitamin K
This requires hydroxylation by the kidneys to its active form, therefore, in patients with a severe reduction in renal function, alfacalcidol should be prescribed instead of this.
Ascorbic acid
Calcium
Folic acid
Iron
Retinol
Vitamin D
Vitamin K
Zinc
Vitamin D, colecalciferol, is the non-activated form of vitamin D. It is activated in the kidneys, so if a patient has reduced renal function then the activated form (alfacalcidol) should be given instead.
This helps the absorption of calcium in the gut.
Ascorbic acid
Calcium
Folic acid
Iron
Retinol
Vitamin D
Vitamin K
Zinc
Vitamin D
Used in the prevention of a methotrexate side effect.
Ascorbic acid
Calcium
Folic acid
Iron
Retinol
Vitamin D
Vitamin K
Zinc
Folic acid
Which of the following has a side effect that can cause stools to be darkened?
Ascorbic acid
Calcium
Folic acid
Iron
Retinol
Vitamin D
Vitamin K
Zinc
Iron
You should advise pregnant patients to avoid liver and oil products due to the fact they contain this.
Calcium
Folic acid
Iron
Retinol
Vitamin D
Vitamin K
Zinc
Retinol (Vitamin A)
When a patient has an overload of this substance, deferasirox should be administered to the patient.
Calcium
Folic acid
Iron
Retinol
Vitamin D
Vitamin K
Zinc
Iron Indicated for the treatment of chronic iron overload when desferrioxamine is contraindicated or inadequate (with non-transfusion-dependent thalassaemia syndromes).
A drug has an indication for deep vein thrombosis and is described as a direct thrombin inhibitor with a rapid onset of action.
Apixaban
Aspirin
Clopidogrel
Dabigatran etexilate
Dalteparin sodium
Danaparoid sodium
Dipyridamole
Unfractionated heparin
Dabigatran etexilate is direct thrombin inhibitor with a rapid onset of action.
A patient is being treated for deep vein thrombosis and is only aware of the dose of the medication they are taking. They inform you they were told to take ‘10 mg twice daily for 7 days, then a maintenance dose of 5 mg twice daily’. Which medication is this likely to be?
Apixaban
Aspirin
Clopidogrel
Dabigatran etexilate
Dalteparin sodium
Danaparoid sodium
Dipyridamole
Unfractionated heparin
Apixaban is licensed for use in the treatment of DVT at a dosage regime of ‘10 mg twice daily for 7 days, then a maintenance of 5 mg twice daily’.
A patient aged 7 years has contracted Kawasaki disease and a doctor asks which drug is most useful to help treat the condition.
Apixaban
Aspirin
Clopidogrel
Dabigatran etexilate
Dalteparin sodium
Danaparoid sodium
Dipyridamole
Unfractionated heparin
Aspirin; Kawasaki is thrombotic disease involving the arterial making aspirin the most appropriate agent to deal with the disease pathogenesis.
Which of the drugs below requires the following counselling points according to the BNF? Each option may be used once, more than once, or not at all.
Brush teeth for one minute before spitting out. Avoid drinking or rinsing mouth for 30 minutes after use.
A. Alendronic acid
B. Amiodarone
C. Chlorhexidine
D. Colgate Duraphat®
E. Felodipine
F. Olsalazine sodium
G. Pancreatin
H. Rotigotine
D
Which of the drugs below requires the following counselling points according to the BNF? Each option may be used once, more than once, or not at all.
It is important to ensure adequate hydration at all times in patients receiving higher-strength preparations of this drug.
A. Alendronic acid
B. Amiodarone
C. Chlorhexidine
D. Colgate Duraphat®
E. Felodipine
F. Olsalazine sodium
G. Pancreatin
H. Rotigotine
G
Patients should be advised to report any unexplained bleeding, bruising and sore throat.
A. Alendronic acid
B. Amiodarone
C. Chlorhexidine
D. Colgate Duraphat®
E. Felodipine
F. Olsalazine sodium
G. Pancreatin
H. Rotigotine
f.
olsalazine: interference in the metabolism of arachidonic acid to prostaglandins and leukotrienes, scavenging,of reactive oxygen species, effects on leucocyte function and production of cytokines. Analogue of 5-ASA
For the patients described, select the most likely contraindication or caution from the list below. Each option may be used once, more than once, or not at all.
Ganciclovir.
A. 18-year-old male
B. 21-year-old male with type 1 diabetes mellitus
C. 29-year-old male with an abnormally low neutrophil count
D. 35-year-old male with unstable myasthenia gravis
E. 38-year-old female with a haematoma on her upper arm
F. 45-year-old female with blood pressure of 187/112 mmHg
G. 58-year-old female who regularly drinks ginger tea
H. 72-year-old male with erectile dysfunction
C
You are training a summer student on the use of medicines.
Which of the following non-prescription topical preparations should be used once at night?
A. Canesten® soft gel pessary
B. Clotrimazole 2% cream
C. Daktarin® oral gel
D. HC45® hydrocortisone 1% cream
E, Zovirax® 5% cream
A
The local community nurse phones you to say her patient has run out of medicines. The nurse would like to know which of the patient’s medicines she can prescribe for the patient. She is not an independent or supplementary prescriber.
Which of the patient’s medicines could the nurse prescribe?
Atenolol
Bendroflumethiazide
E45 cream
Morphine sulphate 20 mg tablets
Timodine cream®
E45 cream
Which symptom is LEAST likely experienced with thrush?
A thin, white discharge
Discharge associated with a strong odour
Dysuria
Superficial dyspareunia
Vaginal itching and soreness
Discharge associated with a strong odour
Which of the following is NOT a recommended check point for avoiding prescribing errors?
A. Right dose
B. Right medicine
C. Right patient
D. Right quantity
Right route
D
It is mid-March and a patient presents to you in the pharmacy displaying cold-like symptoms. On questioning she says she remembers having a really bad cold last year at the same time.
On questioning the patient, you suspect she might have an allergy rather than a cold. What is the likely cause of her allergy?
A. Dust mites
B. Grass pollen
C. Mould
D. Pet allergy
E. Tree pollen
E
You are working a Sunday morning shift in a high street pharmacy in England.
A mother approaches you and asks for a spacer for her five year old son because his has broken. What would be the most appropriate course of action?
Advise the mother to ask her GP for a prescription on the Monday
Demonstrate how to use an inhaler without a spacer
Make an emergency supply
Sell the mother a spacer
Send the mother to an out of hours service for a prescription
Sell mother a spacer
For each of the following questions or statements, select the illness which is correct. Each option may be used once, more than once or not at all.
Vaccination against this disease is usually given within the first year of life in a combination vaccine with diphtheria, tetanus, haemophilus influenza type b and polio.
Atopic eczema
Chicken pox (varicella)
German measles (rubella)
Impetigo
Measles (morbilli)
Mumps (epidemic parotitis)
Slap cheek syndrome (parvovirus)
Whooping cough (pertussis)
Whooping cough (pertussis)