Extended Q Flashcards
A dentist that you have a good working relationship with is on the phone to get your recommendation for treating a 40-year-old man who has attended the dentist practice complaining of moderate dental pain. The man also suffers from angina pectoris and takes atenolol 100mg and glyceryl trinitrate 400mcg spray?
Drug indications for non-steroidal anti-inflammatory drugs (NSAIDs)
A: Celecoxib B: Diclofenac C: Etodolac D: Ibuprofen E: Indometacin F: Ketoprofen G: Mefenamic acid H: Naproxen
According to the BNF guidelines, aspirin, ibuprofen and diclofenac can be used for dental pain. The man suffers from ischaemic heart disease (angina) so diclofenac is contraindicated. Now look at the options and see if aspirin or ibuprofen feature on the answer options. Select ibuprofen as the best option. D
A 70-year-old man is taking citalopram and ibuprofen long term? Drug interactions
A: increased risk of bleeding B: increased risk of gastric irritation C: increased risk of hyperkalaemia D: increased risk of hypomagnesaemia E: increased risk of nephrotoxicity F: increased risk of renal failure G: increased risk of seizures H: no significant drug interaction.
A. Ibuprofen (an NSAID) co-administered with citalopram (an SSRI) increases risk of bleeding.
Safe custody requirements apply, prescription handwriting requirements apply, the pharmacist does NOT need to confirm the identity of the patient collecting?
Legal requirements for controlled drugs
A: Buprenorphine B: Clenbuterol C: Diazepam D: Fentanyl E: Flunitrazepam F: Midazolam G: Pentazocine H: Phenobarbitone
Safe custody requirements apply means that the drug is in either schedule 2 or 3 (unless exempt). Identity of the patient collecting DOES NOT need to be confirmed means it is likely to be a schedule 3. Prescription writing requirements apply imply that it is most likely to be a schedule 2 or 3. Applying all the criteria should lead you to a drug in schedule 3. Be careful to consider some exemptions for schedule 3 controlled drugs! You then need to know which drug on the list is a schedule 3 and select your answer. Final answer A: buprenorphine.
A 26-year-old 4-month pregnant woman presents at the GP practice with a 2-day history of a sore throat. She has a CENTOR score of 4 and a positive throat swab result for Streptococcus pyogenes. The PMR shows that she developed wheeze, breathlessness, swollen tongue and lips after taking flucloxacillin 2 years ago?
Management of sore throats
A: Amoxicillin B: Call an ambulance C: Clarithromycin D: Co-amoxiclav E: Doxycycline F: Erythromycin G: Pain relief only e.g. paracetamol and reassurance H: Phenoxymethylpenicillin
The first line treatment according to NICE and Public Health England guidelines is phenoxymethylpenicillin. However, the woman’s history suggest penicillin allergy as demonstrated by wheeze, swollen tongue and lips after taking flucloxacillin (a penicillin) 2 years ago. The next drug option in patients with penicillin allergy is clarithromycin, but this too is not preferred for pregnant woman. That leaves us with erythromycin as the best option. A pen allergy B no red flag symptoms C 2nd line but unsuitable for pregnancy D pen allergy E not rec in preg F correct G bacterial infection H pen allergy
A 26-year-old 4-month pregnant woman presents at the GP practice with a 2-day history of a sore throat. She has a CENTOR score of 4 and a positive throat swab result for Streptococcus pyogenes. The PMR shows that she developed wheeze, breathlessness, swollen tongue and lips after taking flucloxacillin 2 years ago?
Management of sore throats
A: Amoxicillin B: Call an ambulance C: Clarithromycin D: Co-amoxiclav E: Doxycycline F: Erythromycin G: Pain relief only e.g. paracetamol and reassurance H: Phenoxymethylpenicillin
The first line treatment according to NICE and Public Health England guidelines is phenoxymethylpenicillin. However, the woman’s history suggest penicillin allergy as demonstrated by wheeze, swollen tongue and lips after taking flucloxacillin (a penicillin) 2 years ago. The next drug option in patients with penicillin allergy is clarithromycin, but this too is not preferred for pregnant woman. That leaves us with erythromycin as the best option. A pen allergy B no red flag symptoms C 2nd line but unsuitable for pregnancy D pen allergy E not rec in preg F correct G bacterial infection H pen allergy
A 68yo woman at GPs with a 5-day history of constipation. Stools are hard and lumpy. Medications:
-amlodipine 10mg 1OD,
-atorvastatin 20mg 1OD,
-beclometasone 100mcg CFC inhaler, 2puffs BD,
-buprenorphine patch 10mcg/h, 1 patch once weekly,
-morphine sulphate oral soln 10mg/5mL, 2.5mL QDS prn,
-salbutamol 100mcg, 1-2puffs QDS.
She has tried lifestyle measures which have not helped?
Drug(s) for managing constipation
A: Bisacodyl B: Docusate C: Ispaghula husk D: Lactulose + Senna E: Macrogol F: Methylcellulose + sodium picosulfate G: Methylnaltrexone bromide H: Naloxegol
A stimulant forming B stool softener C bulk forming xx avoid in opioid induced D osmotic+ stimulant forming - 1st line E osmotic - 1st line F bulk forming xx avoid in opioid induced G opioid rec antagonist - 2nd line H opioid rec antagonist - 2nd line
Usually bulk => osmotic => stimulant
bulk-forming (ispaghula, sterculia, methylcellulose), stimulant (bisacodyl, senna, sodium picosulfate) and osmotic (lactulose, macrogol).
Most likely opiate induced constipation. NICE (2020) rec osmotic laxative (or docusate sodium to soften the stools) and a stimulant laxative as 1st line and to AVOID bulk forming laxatives. Naloxegol and methylnaltrexone bromide can be used for opiated-induced constipation if other laxatives fail.
D; lactulose = osmotic + senna = stimulant.
A woman has a rupture in her achilles tendon, which drug is this likely to be down to:
Ramipril Ciclsporin Flupentixol Ciprofloxacin Bezafibrate
Ciprofloxacin
Quinolone antibiotics (Ciprofloxacine, Levofloxacin) have been associated with TENDONITIS
A patient takes the following medication:
Diazepam
Atenolol
Erythromycin
Captopril
They have developed Angioedema, swelling of the skin due to fluid build up with a hives like rash. Which medication is this likely to have been caused by?
Captopril
ACE inhibitors can cause angioedema, thought to be caused by the build up of bradykinin. Afro-carribean and black american patients are up to 4x more likely to get this.
Which anti epileptic from the following should be used in a patient with Antiepileptic Hypersensitivity syndrome (AHS):
A. Carbamazepine B. Phenytoin C. Sodium Valproate D. Lamotrigine E. Oxcarbazepine
Sodium Valproate! Safest in AHS
AHS is rare but potentially fatal, and can occur with carbamazepine, lamotrigine, oxcarbazepine, phenytoin, phenobarbital and primidone.
Sodium Valproate and gabapentin and Benzo’s are considered safe.
If a patient has an allergy, whether it be to a drug or to nuts or a food, what coloured wristband should they have in hospital?
A. Red B. Blue C. Green D. Yellow E. Purple
A red
Drug monitoring requirements
A patient was initiated on amiodarone several months ago for heart failure. The patient has since experienced unintended weight loss, palpitations and hyperactivity. A. Haemoglobin B. HbA1c C. Liver function tests D. Platelet count E. Potassium levels F. Renal function G. Sodium levels H. Thyroid function tests
H (Thyroid function tests) – amiodarone has a well document adverse effect on the thyroids and the symptoms are indicative of hyperthyroidism
Drug monitoring requirements
An 85-year-old male has atrial fibrillation with a CHADVASc-2 score of 4. Due to previous gastrointestinal issues, warfarin was selected as the most appropriate anticoagulation therapy. The patient has been admitted to hospital with dizziness and dark stools.
A. Haemoglobin B. HbA1c C. Liver function tests D. Platelet count E. Potassium levels F. Renal function G. Sodium levels H. Thyroid function tests
A (Haemoglobin) – the patient symptoms and drug history indicate a gastrointestinal bleed thus haemoglobin should be reviewed to help confirm diagnosis.
Drug monitoring requirements
A 34-year-old female who is taking lithium for bipolar disorder has been experiencing dizziness and confusion.
A. Haemoglobin B. HbA1c C. Liver function tests D. Platelet count E. Potassium levels F. Renal function G. Sodium levels H. Thyroid function tests
G (sodium). Lithium can cause hyponatraemia, which these symptoms may be due to
Medical Emergencies A. Adrenaline 300 mcg intramuscularly B. Adrenaline 150 mcg intramuscularly C. Chlorphenamine 5 mg orally D. Glucose 10–20 g orally E. Glucagon 1 mg intramuscularly F. Salbutamol 100 mcg inhaler 2- 10 puffs G. Salbutamol 5 mg nebules inhaled H. Oxygen
A seven year old child comes in to your pharmacy struggling to breathe, his mother tells you that he was wheezy and it has progressively got worse.
F (salbutamol 100 mcg inhaler, 2-10 puffs) the patient symptoms are indicative of an asthma attack which in the community can be managed using a salbutamol inhaler.
Medical Emergencies A. Adrenaline 300 mcg intramuscularly B. Adrenaline 150 mcg intramuscularly C. Chlorphenamine 5 mg orally D. Glucose 10–20 g orally E. Glucagon 1 mg intramuscularly F. Salbutamol 100 mcg inhaler 2- 10 puffs G. Salbutamol 5 mg nebules inhaled H. Oxygen
An adult male comes in to the pharmacy holding his throat and struggling to breath. He is clammy, pale and his tongue is swollen. You notice half a prawn sandwich in his bag.
A (adrenaline 300 mcg IM) – The symptoms are indicative of anaphylaxis which as an adult should be treated with 300mcg intramuscularly.
Medical Emergencies A. Adrenaline 300 mcg intramuscularly B. Adrenaline 150 mcg intramuscularly C. Chlorphenamine 5 mg orally D. Glucose 10–20 g orally E. Glucagon 1 mg intramuscularly F. Salbutamol 100 mcg inhaler 2- 10 puffs G. Salbutamol 5 mg nebules inhaled H. Oxygen
A 9-year-old girl is brought to the pharmacy as her mum has noticed she has become drowsy, dizzy and clammy. She states the child has not eaten this morning.
D (glucose 10-20g orally) – the symptoms are indicative of hypoglycaemia which may be treated with glucose.
A 65-year-old female patient has been taking siltuximab▼ every three weeks for treatment of their multicentric Castleman’s disease (MCD). The patient has been getting a headache after each infusion.
Yellow Card Scheme
A. Congenital abnormality – report
B. Delayed drug effect – report
C. Established ADR – no need to report
D. Herbal/homeopathic medicine – report
E. Limited experience of the use of this product – report
F. Reaction to a vaccination – report
G. Serious/life threatening reaction – report
H. This is not an ADR – no need to report
E (limited experience of the use of this product – report) – The medicine has a black triangle meaning limited experience with the medication. In this case, all ADRs should be reported.
A 72-year-old male patient has been on ciprofloxacin for the past three weeks for treatment of a diabetic foot infection. They went to A&E with severe muscle and joint pain and were subsequently diagnosed with tendonitis and admitted for 48 hours for monitoring.
Yellow Card Scheme
A. Congenital abnormality – report
B. Delayed drug effect – report
C. Established ADR – no need to report
D. Herbal/homeopathic medicine – report
E. Limited experience of the use of this product – report
F. Reaction to a vaccination – report
G. Serious/life threatening reaction – report
H. This is not an ADR – no need to report
G (serious/life threatening reaction – report) This is an established ADR of fluoroquinolones however as a serious reaction which involved hospitalisation, it should be reported
A patient who is taking a 4-week course of fluconazole for a candida infection is started on domperidone for sickness.
Drug interactions
A. Bleeding risk increased B. CNS depressant effects C. Hyponatraemia D. No interaction E. QT interval prolongation F. Risk of serotonin syndrome G. Renal toxicity H. Thrombosis
E (QT interval prolongation) – Domperidone increases the risk of QT-prolongation when given with fluconazole.
Manufacturer advises avoid. Severe reaction listed in BNF 80, p1519.
A patient who is taking clopidogrel for peripheral arterial disease has been initiated on escitalopram for depression.
Drug interactions
A. Bleeding risk increased B. CNS depressant effects C. Hyponatraemia D. No interaction E. QT interval prolongation F. Risk of serotonin syndrome G. Renal toxicity H. Thrombosis
A (Bleeding risk increased) – SSRIs and antiplatelets both increase risk of bleeding
Spironolactone has been initiated for a heart failure patient as an adjunct to furosemide.
Drug interactions
A. Bleeding risk increased B. CNS depressant effects C. Hyponatraemia D. No interaction E. QT interval prolongation F. Risk of serotonin syndrome G. Renal toxicity H. Thrombosis
C (Hyponatraemia) - Both spironolactone and furosemide reduce sodium and this can be potentiated together.
This recommended dose for this medicine is two dosage units, three times a day until symptoms are alleviated.
Pharmacy Only Medicines A. Amorolfine nail lacquer B. Atovaquone/proguanil 250 mg/100 mg tablets C. Omeprazole 20 mg tablets D. Orlistat 60 mg capsules E. Sildenafil 50 mg tablets F. Sumatriptan 50 mg tablets G. Tranexamic acid 500 mg tablets H. Ulipristal acetate 30 mg tablets
Answer: G - Tranexamic acid 500 mg tablets (it says dosage units to avoid saying tablets, which would be a clue!)
