extra flashcards

Question 1

Pregnant woman comes in and says she has heart burn and upper abdominal pain lately esp after meals. Would like to buy something OTC. What would you recommend?

Answer 1

1. lifestyle advice (e.g. raise head of bed, avoid trigger foods, have small frequent meals etc)
2. antacids/alginates e.g. gaviscon
3. omeprazole - can sell OTC as pyrocalm in pregnant ladies

Question 2

what would you recommend re adminsitration of the following meds

Calcium carbonate 1.25g chewable tablets sugar free – two tablets daily

Sulfasalazine EC 500mg tablets – one tablet twice a day

Answer 2

separate admin by 2 hours. Cautionary and advisory label for enteric coated preparations. Antacids affect the absorption of many drugs and may damage enteric coatings, so ideally should not be taken at the same time.

Question 3

A 32-year-old patient presents to the pharmacy requiring some advice. She says she has been experiencing some tummy discomfort, bloating and acid reflux in the past week or so. She has tried Rennies tablets, which helped with symptoms but did not completely. She denies experiencing any other symptoms and reports going through a stressful period lately, which she believes is contributing to the symptoms. What would be the treatment of choice in this patient?

omeprazole 20mg daily for 4 weeks then review
gaviscon 10ml QDs 4 weeks then review
continue with Rennies (peppermint) as can take 2 weeks for full effect
famotidine 20mg BD 4 weeks then review

Answer 3

Initial management of uninvestigated dyspepsia consists of a PPI taken for 4 weeks or testing and treating for H. Pylori. H2 receptor antagonist would not be first choice and antacids like Gaviscon would not be continued for 4 weeks.

Question 4

Diverticulitis happens when the small pouch protruding from the walls of the …… intestine become inflamed and infected. This can present with symptoms like: fever, bleeding, mucus, tenderness in lower quadrant and palpable abdominal mass.

Answer 4

large

Question 5

Ispaghula husk should not be taken before bedtime. Patients should be advised to take it at least ….. before going to bed to avoid the risk of intestinal obstruction.

Answer 5

1hour

Question 6

True or false - codeine and loperamide is CI in IBD like Crohns and UC

Answer 6

False
CI in UC due to risk toxic megacolon
Can be used Crohns

Question 7

Which of the following drugs below is associated with causing diarrhoea?
codeine
colchicine
verapamil
amitriptyline
clozapine

Answer 7

colchicine

rest cause constipation

Question 8

Which of the following is not a treatment option for diarrhoea associated with short bowel syndrome after a significant surgical resection?
codeine, loperamide, cholestyramine, co-phenotrope, hyoscine butylbromide

Answer 8

hyoscine

Question 9

A patient presents in pharmacy for advice as he reports experiencing some occasional rectal bleeding for the past 7 weeks. He can see the blood on toilet paper and a burning sensation followed by cramping when passing stools.

Two weeks ago, he went to another pharmacy in town, which suggested a numbing agent, but he says the cream is only able to relieve pain for a short period of time. He has finished the cream now. He has made some changes in his diet and is passing stools normally as well as taking paracetamol, but the pain has not resolved. What would be the next treatment option?

Answer 9

GTN ointment is the next treatment option as symptoms have now lasted for more than 6 weeks and he has already tried lifestyle changes, lidocaine (which he has overused). It would be inappropriate to offer ibuprofen as it can cause further bleeding, whilst codeine could cause constipation aggravating his symptoms.

Question 10

Which antacids can cause acid rebound secretion?

Answer 10

calcium containing antacids
Calcium carbonate is used as an antacid, it neutralizes stomach acid, which can lead to increased acid production once its effects diminish.

Question 11

magnesium containing preps can cause

Answer 11

diarhorrea
magnesium is laxative - LM in alphabet

Question 12

aluminium containing preps can cause…

Answer 12

constipation

AC alphabet

Question 13

It is essential to maintain …… at all times in patients taking higher strength pancreatin preparations.

Answer 13

adequate hydration

Question 14

Patient has been on this medication long term for peptic ulcers and he reports experiencing some muscle weakness, nausea, and seizures. What medication and what electrolyte imbalance?

Answer 14

PPI
HypoMg

more common after 1 yr treatment but can occur after 3m

Question 15

Name a preparation OTC suitable for pregnant women with haemorrhoids

Answer 15

Treatment of haemorrhoids in pregnancy is done with bulk forming laxatives. A simple soothing preparation can be used if needed and preparation H is safe for use. Avoid other products with CC and LA etc

Question 16

What is first-line treatment for people with a mild to moderate first presentation or inflammatory exacerbation of proctosigmoiditis or left-sided ulcerative colitis.

Answer 16

topical aminosalicylate e.g. enema or suppository

Question 17

Which of the following is not a side effect of H2 receptor antagonists?

diarrhoea, dizziness, headache, masks gastric cancer, osteoporosis

Answer 17

osteoporosis - a SE of PPI not H2RA

Question 18

A customer presents to the pharmacy on a Friday afternoon seeking advice regarding her 4-year-old son which has been unable to pass stools recently. He has been treated with laxative by the GP in the past however she was unable to secure an appointment with them this time as they were fully booked for today and she is worries she cannot wait for them to open on Monday.

When you access summary care record you see that the last supply was for Paediatric Laxido (macrogol) 2 years ago. What would be the most appropriate course of action in this instance?

• refer back to GP
• sell laxido and ask her to book appt with GP on monday
• sell glycerin suppositories until she can see GP on monday
• offer bisacodyl (dulcolax) until she can see GP on monday

Answer 18

sell glycerin suppositories until she can see GP on monday

Option A does not help the patient. Option B is incorrect as the NHS website recommends to only give macrogol paediatric sachets to children under 12 if a doctor has prescribed it, not otc. On the other hand, option D is incorrect as Dulcolax liquid is only licensed for 12+.

Question 19

Patient has HTN and needs a product for indigestion and acid reflux. What would you suggest

Answer 19

Maalox Suspension contains co-magaldrox and has a low sodium content. This is required as patient suffers from hypertension and more sodium could affect his blood pressure control.

Question 20

Patient needs something for constipation. This is their medication list. Which laxative would you not sell and why?
Amlodipine 5mg tablets
Aspirin 75mg tablets
Atorvastatin 20mg tablets
Mesalamine 500mg MR tablets
Paracetamol 500mg tablets

Answer 20

lactulose
they are on mesalazine and lactulose lowers stool pH which can interfere with release of mesalazine MR or GR

Question 21

A 7-year-old child has come into the pharmacy with a prescription for a laxative after not being able to poo for around 4 days. Which laxative was most likely prescribed for the patient?

Answer 21

Macrogol

1st line in children is osmotic, macrogol

if inadequate use stimulant or softener

Question 22

Pt who is 28 weeks pregnant has come into the pharmacy for some lifestyle advice to handle their pregnancy. After changing their diet to incorporate more fibre and water, they have returned to the pharmacy as this has not helped. Which laxative should now be recommended?

Answer 22

ispaghula husk

Question 23

this laxative may cause a red-brown discolouration of skin and bodily fluids. This is harmless.

Answer 23

senna

Question 24

co danthramer can colour urine..

Answer 24

red

Question 25

Pt has been admitted to hospital after having a flare-up of ulcerative colitis. This is their first time they have had this and has been initiated on maintenance treatment for it. Which of the following medications would be most appropriate to prescribe the patient for long-term management?

A. Adalimumab
B. Azathioprine
C. Budesonide
D. Golimumab
E. Infliximab
F. Methotrexate
G. Prednisolone
H. Sulfasalazine

Answer 25

H – An oral aminosalicylate such as sulfasalazine or mesalazine is usually recommended for the maintenance treatment of ulcerative colitis. Corticosteroids are not usually suitable due to high risk of side-effects.

Question 26

A patient has come into the hospital after having an acute flare-up of Crohn’s disease. This was the first one that they have had in the last 12 months. Which of the following medications would be best to prescribe for the management of the acute flare-up?
A. Adalimumab
B. Azathioprine
C. Budesonide
D. Golimumab
E. Infliximab
F. Methotrexate
G. Prednisolone
H. Sulfasalazine

Answer 26

G – Monotherapy with prednisolone, methylprednisolone of IV hydrocortisone can be given to a patient with their first flare-up of Crohn’s disease.

Question 27

Mr Alan Dronic has been admitted to the hospital for the third acute flare-up of Crohn’s disease this year. The doctor would like to prescribe an additional medication on top of the IV methylprednisolone that they are already on. Which of the following medications should be prescribed?
A. Adalimumab
B. Azathioprine
C. Budesonide
D. Golimumab
E. Infliximab
F. Methotrexate
G. Prednisolone
H. Sulfasalazine

Answer 27

B – If a patient has had two or more acute flare-ups with Crohn’s disease in a 12-month period, either azathioprine or mercaptopurine should be added onto the treatment as well as corticosteroid treatment.

Question 28

After the treatment with the azathioprine and IV hydrocortisone, Alan Dronic’s has had an allergic reaction to the azathioprine. Which of the following medications should the azathioprine be swapped for?
A. Adalimumab
B. Azathioprine
C. Budesonide
D. Golimumab
E. Infliximab
F. Methotrexate
G. Prednisolone

Answer 28

F – Methotrexate can be used in addition to corticosteroids if azathioprine or mercaptopurine is contraindicated when patients have had 2 or more flare-ups in 12 months.

Question 29

Mrs Amy O’Darone has been initiated on senna for the treatment of constipation. Looking at their drug history, the patient also takes warfarin and haloperidol. Which of the following interactions, if any, is most likely to occur?

A. Decreases the efficiency of the new drug
B. Increases the risk of bleeding
C. Increases the risk of confusion
D. Increases the risk of hepatotoxicity
E. Increases the risk of QT interval prolongation
F. Increases the risk of serotonin syndrome
G. Increases the risk of toxicity of the new drug
H. No known interaction

Answer 29

E – Both senna and haloperidol can cause QT interval prolongation. Concomitant use of both will increase the risk of this. this is bc prolonged or excessive use of senna can cause hypokalaemia.