Gold Flashcards by Simon Evans

Miss V has been started on an ultra-rapid-acting insulin. How long before a meal should an ultra-rapid-acting insulin be given?
At the time of, or immediately after, eating
15 minutes before
30 minutes before
40 minutes before
60 minutes before

At the time of, or immediately after eating

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Mr Jenkinson has visited his diabetes specialist nurse and has been started on a rapid-acting insulin. Which of the following insulin preparations is rapid-acting?
Insulatard®
Lyumjev®
Toujeo®
Tresiba®
Actrapid®

Lyumjev

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Miss Washington has been started on a new insulin and has noticed it is cloudy in appearance. Which of the following insulin preparations is cloudy in appearance?
Insulatard®
Lantus®
Novorapid®
Fiasp®
Humalog®

Insulatard

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Mr Khan has been started on doxycycline for the treatment of cellulitis. Which of the following foods can likely reduce the absorption of doxycycline?
Apple
Pomelo
Milk
Beef
Grapefruit

Doxycycline is a tetracycline antibiotic, and its absorption can be significantly reduced by calcium-containing foods and drinks, such as milk and dairy products. Calcium binds to doxycycline in the gut, forming insoluble complexes that reduce its bioavailability.

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Mr Smith has started a new medication and has noticed a blue-greyish discolouration of his skin. Which of his following medications is likely to be responsible for this side effect?
Diazepam
Amiodarone
Bendroflumethiazide
Bisoprolol
Ramipril

Amiodarone

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Which of the following is an example of a long acting benzodiazepine?
Nitrazepam
Loprazolam
Temazepam
Lormetazepam
Midazolam

Nitrazepam

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Mr James is complaining of severe pain from his heel after starting a new antibiotic, which of the following antibiotics is likely to be responsible for his symptoms?
Dalbavancin
Vancomycin
Linezolid
Ciprofloxacin
Ceftazidime

Cipro

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Which of the following is not a side effect of prednisolone?
Diabetes mellitus
Adrenal suppression
Osteoporosis
Psychotic disorder
Weight loss

Weight loss

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Which of the following foods can increase the blood concentration of tacrolimus?
Milk
Oats
Pomelo
Banana
Orange

Pomelo, like grapefruit, contains furanocoumarins, which can inhibit the CYP3A4 enzyme and P-glycoprotein in the liver and intestines. Since tacrolimus is metabolised by CYP3A4, this inhibition can lead to increased blood levels, raising the risk of toxicity.

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Prednisolone 40mg daily for 5 days then reduce the dose by one tablet every other day until all tablets are taken. How many prednisolone 5mg tablets would you supply?
28
56
84
96
112

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You receive a prescription for prednisolone tablets, what time of the day would you recommend the patient to take the tablet?
In the morning
At lunchtime
Mid afternoon
With dinner
At night

Morning

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What dose of temazepam is approximately equivalent to 5mg of diazepam?
1mg
2mg
5mg
10mg
20mg

10mg

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Which of the following can be used as treatment for benzodiazepine poisoning?
Ondansetron
Potassium chloride
Dicobalt edetate
Activated charcoal
Sodium thiosulfate

Activated charcoal

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Which of the following antibiotics demonstrates activity against chlamydia pneumoniae?
Doxycycline
Dalbavancin
Gentamicin
Piperacillin/Tazobactam
Amoxicillin

Doxy

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Which of the following antibiotics demonstrates activity against mycoplasma pneumoniae?
Co-amoxiclav
Dalbavancin
Ciprofloxacin
Piperacillin/Tazobactam
Amoxicillin

Cipro

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Which of the following is an example of a long-acting corticosteroid?
Prednisolone
Prednisone
Fludrocortisone
Hydrocortisone
Dexamethasone

Dexamethasone

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Which of the following antibiotics demonstrates activity against legionella pneumophila?
Co-amoxiclav
Vancomycin
Clarithromycin
Amoxicillin
Temocillin

Clarithomycin

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A patient is diagnosed with an animal bite and requires an antibiotic with activity against bacteroides fragilis. Which of the following antibiotics demonstrates activity against bacteroides fragilis?
Co-amoxiclav
Benzylpenicillin
Temocillin
Flucloxacillin
Gentamicin

Co-amox

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Which of the following antibiotics demonstrates activity against pseudomonas aeruginosa?
Co-amoxiclav
Benzylpenicillin
Trimethoprim
Cefalexin
Piperacillin/Tazobactam

Piperacillin/Tazobactam

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A patient walks into your community pharmacy with a prescription for Zopiclone. Which controlled drug schedule does zopiclone belong to?
Schedule 1
Schedule 2
Schedule 3
Schedule 4
Schedule 5

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A patient is commenced on vancomycin for the treatment of a infective endocarditis. Which of the following side effects is not a side effect of vancomycin?
Ototoxicity
Red man syndrome
Phototoxicity
Phlebitis
Nephrotoxicity

Phototoxicity

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Which of the following cephalosporins is an example of a fifth generation cephalosporin?
Cefalexin
Cefaclor
Ceftazidime
Ceftaroline
Cefuroxime

Ceftraoline

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Which of the following diseases is not an example of a notifiable disease?
Rubella
Scarlet fever
Endocarditis
Meningitis
COVID-19

Endocarditis

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What is the recommended treatment of severe acute ulcerative colitis if corticosteroids are contraindicated?
Intravenous hydrocortisone
Intravenous infliximab
Surgery
Intravenous ciclosporin
Oral methotrexate

IV ciclosporin

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What is the first-line treatment of severe acute ulcerative colitis? Intravenous hydrocortisone Topical hydrocortisone Surgery Intravenous ciclosporin Oral methotrexate

IV Hydrocortisone

Miss London has been diagnosed with moderate proctitis. What is the first-line treatment of mild to moderate proctitis? Oral aminosalicylate Topical aminosalicylate Oral corticosteroid Topical corticosteroid Oral methotrexate

Topical aminosalicylate

Which of the following medications is an example of an aldosterone antagonist? Digoxin Ranolazine Eplerenone Sacubitril/valsartan Sotalol

Eplerenone

Mr Smith has been prescribed a cardiac glycoside for atrial fibrillation. Which of the following medications is an example of a cardiac glycoside? Ranolazine Eplerenone Digoxin Bisoprolol Sotalol

Digoxin

Mr Andews is diagnosed with heart failure and is due to be prescribed medication. Which of the following medications is not licensed for heart failure? Bisoprolol Losartan Eplerenone Ramipril Ranolazine

Ranolazine – An anti-anginal medication, primarily used for stable angina. It is not licensed for heart failure treatment.

A patient, Mr Jones, is diagnosed with invasive aspergillosis. Which of the following antifungals is the first-line for aspergillosis? Amphotericin B Fluconazole Voriconazole Caspofungin Clotrimazole

Voriconazole

Mrs Smith has been commenced on an antifungal and is counselled on the risk of phototoxicity. Which of the following antifungals is associated with phototoxicity? Amphotericin B Clotrimazole Voriconazole Caspofungin Ketoconazole

Voriconazole: A triazole antifungal used for invasive fungal infections. It is known to cause photosensitivity reactions, which can lead to severe sunburn, photodermatitis, and even an increased risk of squamous cell carcinoma with long-term use. Patients should be advised to avoid excessive sun exposure and use high-SPF sunscreen.

Mr Daud is diagnosed with a severe diabetic foot infection and is due to be prescribed a glycopeptide antibiotic. Which of the following antibiotics is an example of a glycopeptide? Gentamicin Neomycin Dalbavancin Tobramycin Streptomycin

Dalbavancin

Mr Smith is experiencing constipation and you review his medication. Which of the following medications is most likely to be associated with constipation? Clindamycin Ferrous sulphate Piperacillin/tazobactam Metformin Empagliflozin

Ferrous sulphate – An iron supplement commonly used for iron-deficiency anaemia. It frequently causes gastrointestinal side effects, including constipation, nausea, and dark stools. Patients are often advised to increase fluid and fibre intake or consider a different iron formulation if constipation is problematic.

Mr Joshua is started on a short-acting corticosteroid. Which of the following is an example of a short-acting corticosteroid? Prednisolone Prednisone Fludrocortisone Hydrocortisone Dexamethasone

Hydrocortisone

Mr Alexander, a 57-old-patient, is started on a new medication for type 2 diabetes mellitus. He was informed by his general practitioner to discontinue treatment and seek immediate medical assistance if he experiences persistent and severe abdominal pain as this may indicate pancreatitis. Which of the following medications has Mr Alexander likely been prescribed? Gliclazide Metformin Sitagliptin Canagliflozin Acarbose

Sitagliptin – A DPP-4 inhibitor used for type 2 diabetes. It has been linked to acute pancreatitis, and patients should be advised to discontinue use and seek medical attention if they experience persistent, severe abdominal pain.

Miss Smith, a 23-year-old patient, walks in with a prescription of Paroxetine 20mg daily for the treatment of major depression. What time of the day would you recommend Miss Smith to take the medication? In the morning At lunchtime Mid afternoon Early evening At night

Paroxetine is a selective serotonin reuptake inhibitor (SSRI) used for major depression and anxiety disorders. It is known to cause insomnia, restlessness, and agitation in some patients. Taking it in the morning helps minimise sleep disturbances.

Mr Andews, a 57-year-old gentleman, has been prescribed atorvastatin for the treatment of primary hypercholesterolaemia in patients who have not responded adequately to diet and other appropriate measures. What is the usual dose a patient would be initiated on? 5mg 10mg 20mg 40mg 80mg

10mg

Mr Callum, a 63-year-old gentleman, is diagnosed with an acute exacerbation of chronic obstructive pulmonary disease (COPD) and is due to be prescribed antibiotics, he has myasthenia gravis and no drug allergies. Which of the following is the most suitable antibiotic to prescribe for Mr Callum? Doxycycline Erythromycin Clarithromycin Amoxicillin Co-amoxiclav

Amoxicillin is first-line for most COPD exacerbations, unless there's a penicillin allergy or suspected resistance. It covers common respiratory pathogens like Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. It is safe in myasthenia gravis, unlike macrolides (erythromycin, clarithromycin), which can worsen neuromuscular symptoms.

Mr London has been prescribed ciprofloxacin for a moderate diabetic foot infection, he is informed that ciprofloxacin may induce convulsions by the endocrinology consultant, he is also advised that certain medication classes alongside ciprofloxacin may also induce convulsions. Which medication class is the consultant likely referring to? Thiazide diuretics Loop diuretics Non-steroid anti-inflammatory drugs (NSAIDS) ACE inhibitors Beta blockers

Ciprofloxacin, a fluoroquinolone antibiotic, lowers the seizure threshold by blocking GABA-A receptors in the central nervous system. NSAIDs (e.g., ibuprofen, naproxen, diclofenac) can further inhibit GABA, increasing the risk of convulsions when taken alongside ciprofloxacin. This risk is particularly higher in elderly patients, those with epilepsy, or those with renal impairment.

Mrs Neez tells you she has been experiencing some ear pain and noticed some discharge too this morning. Which of Mrs Neez’s regular medicines is a cause for concern and warrants a referral due to the presenting symptoms? Lisonopril Simvastin Alendronic acid Bisoprolol Paracetamol

Alendronic acid is a bisphosphonate, used for osteoporosis, which is linked to osteonecrosis of the jaw (ONJ) and, more rarely, osteonecrosis of the external auditory canal. Symptoms such as ear pain, discharge, and infection can be early signs of bisphosphonate-related osteonecrosis. The MHRA has issued a warning about this risk, particularly in patients with long-term bisphosphonate use or concurrent steroid therapy.

Crohn's disease is a chronic, relapsing-remitting, non-infectious inflammatory disease of the gastrointestinal tract. Specialist drug treatments for Crohn's disease are generally given for induction of remission and maintenance of remission. Which of the following drugs / class of drugs should not be used to maintain clinical remission? Corticosteroids Azathioprine Mercaptopurine Methotrexate Infliximab

Corticosteroids (e.g., prednisolone) are commonly used in acute flare-ups of Crohn's disease to induce remission due to their powerful anti-inflammatory effects. However, they are not suitable for maintenance therapy because of their long-term side effects, including osteoporosis, hypertension, diabetes, and increased risk of infections. For maintenance of remission, other medications with fewer long-term side effects are preferred, such as azathioprine, mercaptopurine, methotrexate, and infliximab.

Which of the following corticosteroids express the highest mineralocorticoid activity? Prednisolone Hydrocortisone Betamethasone Dexamethasone Deflazacort

Hydrocortisone

Steroid Emergency Cards should be issued to patients with adrenal insufficiency and steroid dependence for whom missed doses, illness, or surgery puts them at risk of adrenal crisis. The Royal College of Physicians and the Society for Endocrinology advise that all of the following patients are considered at risk of adrenal insufficiency and should be given a Steroid Emergency Card except: Those taking corticosteroids at doses equivalent to, or exceeding, prednisolone 10 mg daily for less than 1 week Those taking a course of oral corticosteroids within 1 year of stopping long-term therapy. Those taking corticosteroids at doses equivalent to, or exceeding, prednisolone 5 mg daily for 4 weeks or longer across all routes of administration Those with primary adrenal insufficiency Those taking repeated short oral corticosteroid courses

Those taking corticosteroids at doses equivalent to, or exceeding, prednisolone 10 mg daily for less than 1 week

For the initial detection of H. pylori infection, a carbon-13 urea breath tests or stool antigen tests should be arranged. It should be ensured that the person has not taken a PPI in the past ______. 1 week 2 weeks 3 weeks 4 weeks 6 weeks

2 weeks

Loperamide is licensed for the symptomatic treatment of acute diarrhoea in irritable bowel syndrome (IBS). The recommended dose is: Initially 8 mg, followed by 2 mg for up to three days, dose to be taken after each loose stool; usual dose 8–10 mg daily; maximum 16 mg per day. Initially 2 mg, followed by 4 mg for up to five days, dose to be taken after each loose stool; usual dose 6 mg daily; maximum 10 mg per day. Initially 2 mg, followed by 2 mg for up to five days, dose to be taken after each loose stool; usual dose 4 mg daily; maximum 10 mg per day. Initially 6 mg, followed by 4 mg for up to five days, dose to be taken after each loose stool; usual dose 8-10 mg daily; maximum 20 mg per day. Initially 4 mg, followed by 2 mg for up to five days, dose to be taken after each loose stool; usual dose 6–8 mg daily; maximum 16 mg per day.

Initially 4 mg, followed by 2 mg for up to five days, dose to be taken after each loose stool; usual dose 6–8 mg daily; maximum 16 mg per day.

For the initial detection of H. pylori infection, a carbon-13 urea breath tests or stool antigen tests should be arranged. It should be ensured that the person has not taken antibiotics in the past ______. 1 week 2 weeks 3 weeks 4 weeks 6 weeks

4 weeks

Which of the following regimens would be most appropriate for an adult patient who has tested positive for H. pylori infection? (No allergies or PMH) Lansoprazole 30mg twice daily, Amoxicillin 1g twice daily and Clarithromycin 500mg twice daily for 7 days Lansoprazole 30mg once daily, Amoxicillin 1g once daily and Clarithromycin 500mg once daily for 14 days Lansoprazole 30mg once daily, Amoxicillin 1g once daily and Clarithromycin 500mg once daily for 7 days Lansoprazole 15mg twice daily, Amoxicillin 500mg twice daily and Clarithromycin 250mg twice daily for 14 days Lansoprazole 15mg twice daily, Amoxicillin 500mg twice daily and Clarithromycin 250mg twice daily for 7 days

Lansoprazole 30mg twice daily, Amoxicillin 1g twice daily and Clarithromycin 500mg twice daily for 7 days

Which of the following options correctly identifies the target serum lithium concentration in a non-elderly patient? 0.4–1 mmol/litre 1–4 mmol/litre 4–8 mmol/litre 0.2–0.4 mmol/litre 0.4–14 mmol/litre

0.4-1.0

Which of the following regimens would be most appropriate for an adult patient who has tested positive for H. pylori infection, is penicillin allergic and has had previous exposure to clarithromycin? Lansoprazole 15mg twice daily, Amoxicillin 500mg twice daily and Clarithromycin 250mg twice daily for 7 days Lansoprazole 30mg twice daily, Co-amoxiclav 500mg twice daily and Metronidazole 400mg twice daily for 7 days Lansoprazole 30mg twice daily, Metronidazole 400mg twice daily and Levofloxacin 250mg twice daily for 7 days Lansoprazole 30mg twice daily, Erythromycin 500mg twice daily and Metronidazole 400mg twice daily for 7 days Lansoprazole 15mg once daily, Metronidazole 400mg twice daily and Levofloxacin 250mg twice daily for 7 days

Lansoprazole 30mg twice daily, Metronidazole 400mg twice daily and Levofloxacin 250mg twice daily for 7 days

All of the following options are pieces of appropriate lifestyle advice that may help patients improve dyspepsia symptoms EXCEPT? Lose weight if they are overweight or obese Avoid any trigger foods, such as coffee, chocolate, tomatoes, fatty or spicy foods. Eat smaller meals Eat their evening meal just before going to bed Reduce alcohol consumption to recommended limits

Eat their evening meal just before bed

Loratadine 10mg tablets should not be sold over the counter (OTC) to persons below the age of? 12 15 16 18 21

Tamsulosin is indicated for the treatment of functional symptoms (i.e. urinary retention) of benign prostatic hyperplasia (prostate enlargement). Supply criteria of Tamsulosin over the counter is for male patients aged between ________. 35-45 years 35-75 years 45-75 years 50-65 years 25-65 years

45-75

Tamsulosin is indicated for the treatment of functional symptoms (i.e. urinary retention) of benign prostatic hyperplasia (prostate enlargement). For Tamsulosin to be supplied over the counter, symptoms of benign prostatic hyperplasia must have been present for a minimum of how many month(s)? 1 month 2 months 3 months 4 months 6 months

3 months

For adults aged 80 years and over, the aim is to reduce blood pressure and maintain at: 135/85 mmHg 140/90 mmHg 150/90 mmHg 155/95 mmHg 155/90 mmHg

150/90mmHg

Mrs Haigh Preshure (62) was recently diagnosed with stage 1 hypertension. After failed attempts to reduce her blood pressure with lifestyle changes, the GP decided to initiate her on an antihypertensive. Which of the following antihypertensives is most likely to have been prescribed assuming Mrs Preshure has no other medical history? Ramipril Losartan Amlodipine Spironolactone Bisoprolol

Amlodipine

Several months later, Mrs Preshure visits your pharmacy again with a prescription for a new antihypertensive. She tells you that her blood pressure has remained consistently high despite good adherence, and the GP has decided to initiate her on this new medicine. Which of the following antihypertensives is most likely to have been prescribed next? - was started on amlodipine first Furosemide Bisoprolol Spironolactone Ramipril Doxazosin

Ramipril

One week after being prescribed the 2nd antihypertensive, Mrs Preshure pops into the pharmacy on her way to work. She tells you that she has been having a particularly troublesome dry cough at night from the ramipril and hopes you would be able to sell her something which would help. Sell Mrs Preshure Pholcodine Linctus BP – 5-10mg to be taken 3-4 times a day PRN Sells Mrs Preshure Benylin Chesty Cough – 5ml to be taken 3 times a day PRN Sell Mrs Preshure Lemsip dry cough – 2.5ml to be taken 4 times a day PRN Refer Mrs Preshure to the GP Refer Mrs Preshure to A&E

refer to gp

If a patient is on Spironolactone and their blood potassium levels remain elevated above the recommended limit, the recommended alternative treatment option to a low dose Spironolactone is? Alpha blocker or beta blocker Beta blocker Furosemide Hydralazine Finasteride

alpha or beta

Mr John Ray (52) was recently diagnosed with stage 1 hypertension. He was persistent with attempting to control his blood pressure with lifestyle changes before commencing on drug treatment. Which of the following lifestyle changes would you not have expected Mr Ray to make? Healthy diet and regular exercise Increased caffeine consumption Reduced dietary sodium intake Reduced intake of alcohol Reduced smoking

Increased caffeine consumption

After failed attempts of Mr ray (diabetic) reducing his blood pressure with lifestyle changes, the GP decided to initiate him on an antihypertensive. Which of the following antihypertensives is most likely to have been prescribed assuming Mr Ray has type 2 diabetes? Rampiril Bisoprolol Doxazosin Amlodipine Spironolactone

ACE inhibitors (e.g., Ramipril) are the first-line treatment for hypertension in patients with type 2 diabetes due to their renal-protective effects. They help slow the progression of diabetic nephropathy by reducing proteinuria and preserving kidney function

Which of the following antihypertensives would most likely to have been prescribed if Mr Ray had no past medical history but was of black African or African-Caribbean family origin? Ramipril Losartan Amlodipine Furosemide Spironolactone

Amlodipine

Patients should abstain from alcohol for at least 48 hours following discontinuation of therapy with which of the following antibiotics due to the possibility of a disulfiram-like reaction occurring? Amoxicillin Tinidazole Doxycycline Flucloxacillin Azithromycin

Tinidazole, like metronidazole, can cause a disulfiram-like reaction when combined with alcohol. This reaction leads to symptoms such as flushing, nausea, vomiting, tachycardia, and hypotension due to the inhibition of aldehyde dehydrogenase, which results in acetaldehyde accumulation. Patients should avoid alcohol during treatment and for at least 48 hours after stopping tinidazole to prevent this reaction.

Statins should be avoided in pregnancy as congenital anomalies have been reported and the decreased synthesis of cholesterol possibly affects fetal development. They should ideally be discontinued ______ before attempting to conceive. 2 weeks 1 month 6 weeks 2 months 3 months

Statins should be discontinued at least 3 months before attempting to conceive due to the potential risk of congenital anomalies and the essential role of cholesterol in fetal development. Cholesterol is critical for fetal cell membrane formation and hormone synthesis, so statins, which inhibit cholesterol production, may impact normal embryonic development.

What are the contraception requirements in patients receiving statin therapy? During treatment only During treatment and 1 week after During treatment and 1 month after During treatment and 2 months after During treatment and 3 months after

Statins are contraindicated in pregnancy due to the risk of congenital anomalies and their potential to interfere with fetal development by inhibiting cholesterol synthesis. Women of childbearing potential should use effective contraception during statin treatment and for at least 1 month after discontinuation to ensure the drug is fully cleared from the body. This is based on the pharmacokinetics of statins, as most statins have an elimination half-life that would allow them to clear within a few days, but a 1-month precaution is recommended for safety.

All of the following antipsychotics have the capability to cause hyperglycaemia as a side effect except? Clozapine Quetiapine Risperidone Olanzapine Haloperidol

Haloperidol (first-generation/typical antipsychotic) has a much lower risk of metabolic side effects, making it the exception in this list.

Parkinson's disease is a chronic, progressive neurodegenerative condition resulting from the loss of the dopamine-containing cells of the substantia nigra. Which of the following anti-emetics would be least suitable to use in patients with Parkinson’s disease? Cyclizine Domperidone Ondansetron Metoclopramide Motillum

Metoclopramide is a dopamine antagonist that works by blocking dopamine receptors (D2) in the chemoreceptor trigger zone (CTZ) to prevent nausea and vomiting. However, in Parkinson’s disease, where dopamine levels are already deficient, further blocking dopamine can worsen motor symptoms, leading to: Extrapyramidal side effects (EPSEs) such as dystonia and tardive dyskinesia Worsening of Parkinsonian symptoms (rigidity, tremors, bradykinesia)

The benefits and risks of metoclopramide have been reviewed by the European Medicines Agency’s Committee on Medicinal Products for Human Use, which concluded that the risk of neurological effects such as extrapyramidal disorders and tardive dyskinesia outweigh the benefits in long-term or high-dose treatment. To help minimise the risk of potentially serious neurological adverse effects, Metoclopramide should only be prescribed for short-term use – up to a maximum of how many days? 2 days 3 days 5 days 7 days 14 days

5 days

Which of the following antibiotics would be least appropriate to take with food? Amoxicillin Metronidazole Nitrofurantoin Doxycycline Gentamicin

Doxycycline is best taken on an empty stomach because food, especially dairy products, can reduce its absorption by forming chelation complexes with calcium, leading to decreased effectiveness. However, if gastric irritation occurs, it may be taken with food, but this could slightly reduce its absorption.

Mrs Hart Prolem (42) was recently diagnosed with stable angina. The GP has decided to initiate Mrs Prolem on a beta blocker (severe contraindication to calcium channel blocker) and would like your advice on selecting a Cardioselective beta blocker as Mrs Prolem also has asthma. Which of the following Beta blockers is Cardioselective and would be most appropriate? Propanolol Timolol Bisoprolol Carvedilol Nadolol

Bisoprolol

Which of the following options is NOT a contraindication beta blocker use? Phaeochromocytoma Frequent episodes of hypoglycaemia Hypothyroidism Symptomatic bradycardia History of bronchospasm

Hypothyroidism

_______ class of antibiotics should not be given to pregnant women; effects on skeletal development have been documented in the first trimester in animal studies. Administration during the second or third trimester may cause discoloration of the child’s teeth, and maternal hepatotoxicity has been reported with large parenteral doses. Macrolides Penicillin's Carbapenems Cephalosporins Tetracylines

Tetracylines

Which of the following drugs is most likely to cause weight gain as a side effect? Metformin Orlistat Paroxetine Liraglutide Acarbose

Paroxetine is a Selective Serotonin Reuptake Inhibitor (SSRI) used for depression and anxiety disorders. Among SSRIs, paroxetine is the most associated with weight gain, likely due to its effects on appetite, metabolism, and serotonin regulation.

If headaches or visual disturbances occur during treatment with this antibiotic, treatment should be discontinued as these symptoms are indicative of benign intracranial hypertension. Erythromycin Ceftriaxone Tetracyline Phenoxymethylpenicillin Gentamicin

Tetracycline and its derivatives (e.g., doxycycline) are known to potentially cause benign intracranial hypertension (pseudotumor cerebri), which can lead to symptoms such as headaches and visual disturbances. If these symptoms occur during treatment, it is important to discontinue the antibiotic as they may indicate increased pressure within the skull.

Bisphosphonates should be considered for osteoporosis prophylaxis if a patient is on long term therapy for which of the following drugs/drug classes? ACEi Beta blockers Corticosteroids Vitamin D Diuretics

Corticosteroids (e.g., prednisolone, hydrocortisone) are associated with increased risk of osteoporosis due to their impact on bone metabolism. Long-term use can lead to bone loss and increase the risk of fractures. For patients on long-term corticosteroid therapy, bisphosphonates are often considered as part of osteoporosis prophylaxis to help prevent bone loss and reduce fracture risk.

Which of the following drugs is capable of causing pink urine discolouration? Nefopam Senna Nitrofurantoin Amitryptyline Doxorubicin

Nefopam

Which of the following drugs belongs to the “lincosamide” class of antibiotics? Clindamycin Doxycycline Vancomycin Erythromycin Lymecycline

Clindamycin

Mr Butin one of your regular customers called up the pharmacy this morning sounding very concerned. He tells you that as of this morning he noticed his urine had turned a bright red colour. After checking his patient medication records (PMR), you provided Mr Butin with plenty of reassurance that this was a harmless side effect of one of his medications. PMR system: Triamterene 150mg daily for 1 week, Nitrofurantoin 100mg BD for 3 days, Lisinopril 20mg OD, Bisoprolol 10mg OD, Doxorubicin by intravenous infusion, Amitriptyline 25mg OD. Which of the medications was most likely responsible for causing this side effect? Triamterene Nitrofurantoin Lisinopril Doxorubicin Amitryptyline

Doxorubicin, an anthracycline chemotherapy agent, is known to cause red urine as a harmless side effect. This is due to the red colour of the drug itself, which can be excreted in the urine. The bright red urine typically appears within a few hours of administration and may last for a few days after the infusion, which fits Mr Butin’s situation.

A patient is due to start a statin and has been prescribed simvastatin. What would be the most appropriate counselling advice to provide the patient? Take the statin in the morning Take the statin one hour before breakfast Crush the tablet before taking it Take the statin at night Take the statin with a glass of orange ju

Take at night

A lady comes into the pharmacy explaining she is thinking about starting a family. However, she has some concerns because of her current medications. What would be the most appropriate advice to provide? Below are her current repeat medication list: Rosuvastatin 5mg, Ramipril 10mg, Amlodipine 5mg. Advise the patient to arrange an appointment with her GP because she would need to stop taking her rosuvastatin three months before planning to conceive. She can continue to take her medication as normal Refer to A&E Advise her to stop all her medication and see the GP as soon as possible Advise the patient to stop taking her Ramipril three months before planning to conceive

Rosuvastatin (and other statins) are contraindicated during pregnancy due to the potential risk of congenital anomalies and interference with fetal cholesterol production. It is recommended that statins be discontinued at least 3 months before attempting to conceive.

Which blood pressure target would be most appropriate for an 84-year-old Caucasian lady? <140/90mmHg <150/90mmHg <130/80mmHg <135/85mmHg <160/90mmHg

<150/90 mmHg

A patient has recently started taking Ramipril 5mg for high blood pressure. However, for the past few weeks he has noticed a cough which has been keeping him up at night. What would be the most appropriate action? Explain that it is a common side effect and should disappear Switch his medication to a diuretic Refer him to the urgent care centre Refer him to his GP as a switch in his medication to Losartan would need to be considered Sell him an over the counter cough syrup

Refer to switch to lorsartan

What dose of Atorvastatin would be expected to be prescribed for secondary prevention of heart disease? 20mg 80mg 10mg 7.5mg 5mg

80mg

A patient has newly been prescribed Amiodarone for the treatment of arrhythmias. He is to initially take 200mg three times a day for 1 week. Which of the following side effects would require discontinuation of Amiodarone? Weight loss Impaired vision Nausea Skin reactions Confusion

Impaired vision, such as blurred vision or halos around lights, can be a serious side effect of Amiodarone due to its potential to cause corneal deposits or even optic neuropathy. This can be a sign of toxicity, and if a patient experiences this, discontinuation of the drug should be considered. Immediate medical evaluation is needed to assess the severity of the issue.

Mr X visits the pharmacy to collect his repeat medication. Whilst there, he asks for some advice about one of his medications; Amiodarone which he has been taking for about three months which was started in hospital. He is going on holiday to Spain next week and he remembers the doctor telling him lots of new information about his medication. He asks if there are any precautions he should take whilst on holiday. What would be the most appropriate advice? No further advice needed. He should take his medication as normal Advise him to cancel his holiday as it is not appropriate to travel whilst on this medication Advise Mr X that he should use a wide spectrum sun cream to protect his skin from the light whilst on holiday and you show him the range of sun creams available Whilst on holiday, he should keep his medication in the fridge Advise him to make sure he has enough medication whilst travelling

Amiodarone is known to increase sensitivity to sunlight, leading to photosensitivity. This can make the skin more prone to sunburn, even with brief sun exposure. Therefore, using a high SPF sunscreen and wearing protective clothing is crucial for patients on amiodarone, especially in sunny destinations like Spain.

Patients who have low potassium and magnesium should ensure these are within range before starting which of the following medications? Digoxin Rampiril Simvastin Flecainide Sotalol

Digoxin, a medication used to treat heart failure and arrhythmias, can have toxic effects if potassium and magnesium levels are low. Low levels of these electrolytes can increase the risk of digoxin toxicity, leading to arrhythmias and other serious side effects. Therefore, it is crucial to ensure that potassium and magnesium levels are within the normal range before starting digoxin therapy.

How many hours after a dose of digoxin should a blood sample be taken? 2 hours 1 hour 6 hours 24 hours 12 hours

A patient has been admitted to hospital due to a possible overdose of digoxin. Which of the following is an overdose sign? Yellow vision Diarrhoea Dizziness Vomiting Depression

Yellow vision (also known as xanthopsia) is a classic symptom of digoxin toxicity. Patients may see a yellowish tint in their vision, which can be a sign of overdose.

Tranexamic acid can be used in the treatment of menorrhagia. What is the maximum duration that it can be used for? 2 days 3 days 14 days 4 days 7 days

4 days

A woman comes into the pharmacy explaining she has been experiencing heavy bleeding and would like something for it. Having had a consultation with her, there are no red flags and find it appropriate to make the sale of Tranexamic acid to her. Which age group can tranexamic acid be sold to? 18-45 16-80 25-50 18-40 18-50

18-45

A risk assessment for venous thromboembolism has been carried out on Mrs Y who has been admitted into hospital due to falling down the stairs. Within how many hours should prophylaxis for Mrs Y begin? 10 hours 5 hours 1 hour 14 hours 24 hours

Prophylaxis for venous thromboembolism (VTE) should begin within 14 hours of hospital admission, as per NICE guidelines

A patient is being treated for deep vein thrombosis with warfarin. What would be the most appropriate INR target? 2.5 3.5 1.5 6 5

The most appropriate INR target for a patient being treated for deep vein thrombosis (DVT) with warfarin is 2.5 (with a typical therapeutic range of 2.0–3.0).

Rivaroxaban is a direct inhibitor of factor X which can be used for the treatment of venous thromboembolism. Mr Z has been newly prescribed rivaroxaban at a dose of 20mg daily for a while now where he is due for a medicine use review at the pharmacy. When he comes in to collect his medication you have a review with him in the consultation room about all his medications. Which of the following is an appropriate reminder for Mr Z about rivaroxaban? He should take rivaroxaban with food He should take it on an empty stomach He should take it before bed He should take it 1 hour before breakfast He should take rivaroxaban while standing up only

Take with food

Dipyridamole can be used as secondary prevention of ischaemic stroke not associated with atrial fibrillation. It is given by mouth using modified release medicines at a dose of 200mg twice daily. Which of the following is the most appropriate advice regarding the storage of modified release dipyridamole? The original pack can be split to make up a prescription It can be stored up until the expiry date No special advice is needed regarding storage It should be dispensed in the original container and any remaining capsules should be appropriately discarded 6 weeks after opening It should be dispensed in the original container and any remaining capsules should be appropriately discarded 8 weeks after opening

It should be dispensed in the original container and any remaining capsules should be appropriately discarded 6 weeks after opening

Me Z explains, he has recently been finding it hard to swallow his rivaroxaban tablets and if there is something he could do about it. Which of the following would be appropriate to give advice? There is nothing he can do, and he should not miss his medications so should take it whole Refer him to his GP for an alternative medicinal form Advise him that he can crush his tablets and mix it with either apple puree or water just before he is due to take his medication and should immediately eat food after taking Rivaroxaban. Advise him that he can crush his tablets and mix it with either apple puree or water just before he is due to take his medication. Advise him he can crush the tablets and mix it with orange juice

Advise him that he can crush his tablets and mix it with either apple puree or water just before he is due to take his medication and should immediately eat food after taking Rivaroxaban.

A few weeks later, Mr Z is admitted to hospital due to falling. His creatinine clearance is measured whilst in hospital. Which of the following creatinine clearance levels would require Mr Z stopping his rivaroxaban temporarily? <15ml/min <45ml/min <30ml/min <25ml/min <50ml/min

<15ml/min

Which of the following is an appropriate antidote for rivaroxaban? Idarucizumab Andexanet alfa Vitamin K Digifab Penicillamine

Andexant alfa

Mrs S has been treated for high blood pressure for the past few months. However, her blood pressure still remains high despite stepping up her anti-hypertensive medications. The doctor has decided to initiate her on Spironolactone, but would need to take a potassium level first to check if this is appropriate. Which of the following levels of potassium would be appropriate to initiate spironolactone? <4.5mmol/L <10mmol/L <7mmol/L <5mmol/L <8mmol/L

<4.5mmol/l

Following potassium levels being checked, it is appropriate to initiate Spironolactone to Mrs S. The doctor has asked her to come back within a month. Which of the following would be most appropriate to monitor in one month? Renal function, magnesium levels and liver function Renal function, potassium and sodium levels Renal function, potassium and magnesium levels Liver function, potassium and sodium levels Liver function, potassium and calcium levels

Renal function, potassium and sodium levels

Why should beta blockers not be stopped suddenly in patients being treated for ischaemic heart disease? It can cause electrolyte disturbances It can cause bronchospasms It can cause rebound worsening of myocardial ischaemia It can cause liver function to deteriorate It can cause myasthenia gravis

Beta-blockers should not be stopped suddenly in patients being treated for ischaemic heart disease because it can cause rebound worsening of myocardial ischaemia, potentially leading to angina, myocardial infarction, or even sudden death.

As a PCN pharmacist, you are working today on telephoning patients for medication reviews. Whilst on the phone to Mr E he explains how he has been getting a lot of nightmares recently which means he wakes up during the night. Which of the following medications would be better for him to help with this? Atenolol Propanolol Acebutalol Nebivolol Labetalol

Atenolol is the best choice because it is a hydrophilic beta-blocker, meaning it has less penetration into the central nervous system (CNS), reducing the risk of nightmares compared to more lipophilic beta-blockers like propranolol.

Mr S has had asthma since he was 10 years old. He has been using inhalers since then and has well controlled asthma. He also has type 2 diabetes in which he takes metformin 500mg twice a day. He suffers from angina and is newly prescribed a beta blocker to treat it. Which of the following would be the most appropriate to prescribe? Celiprolol Carvedilol Bisoprolol Nadolol Pindolol

Bisoprolol is the correct answer because it is a cardioselective beta-1 blocker, meaning it has a lower risk of causing bronchospasm in patients with asthma compared to non-selective beta-blockers. While beta-blockers should generally be used with caution in asthma, bisoprolol is often preferred when a beta-blocker is necessary for conditions like angina or heart failure.

Hydrochlorothiazide is an example of a thiazide like diuretic which is available as a combination product. Which of the following is the most appropriate MHRA advice? Increase risk of osteoporosis Risk of non-melanoma skin cancer Hypokalaemia risk Arrythmia risk Risk of severe diarrohea

The MHRA has warned that prolonged use of hydrochlorothiazide is associated with an increased risk of non-melanoma skin cancer (NMSC), particularly squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). This is thought to be due to photosensitising effects of the drug. Patients should be advised to limit sun exposure, use sunscreen, and regularly check their skin for changes.

A patient's eGFR is measured whilst admitted in hospital. At what eGFR should thiazide diuretics be avoided? <45ml/min/1.73m2 <30ml/min/1.73m2 <20ml/min/1.73m2 <35ml/min/1.73m2 <25ml/min/1.73m2

Below 30

You have a pre-registration pharmacist working with you. You are teaching them all about ACE inhibitors. Which of the following ACE inhibitors would be most appropriate to take 30-60 mins before food? Ramipril Captopril Perindopril Lisinopril Enalapril

Perindopril should be taken before food because food can reduce its absorption, making it less effective. While captopril is also affected by food, perindopril is the key ACE inhibitor with specific MHRA guidance to be taken on an empty stomach.

Which electrolyte disturbance is most likely to occur with ACE inhibitors Hyperkalaemia Hypokalaemia Hyponatraemia Hypermagnesemia Hypercalcaemia

Hyperkalemia

You are a locum pharmacist working at a regular store. You are checking a prescription with the following medications and decide to contact the GP. What would be the most appropriate reason for contacting the GP? Amlodipine 10mg- One to be taken daily, Losartan 50mg - One to be taken daily, Simvastatin 40mg - One to be taken at night, Cyanocobalamin 50mcg - One to be taken three times a day Interaction between Amlodipine and Losartan Query the Losartan dose as it is an inappropriate dose Query the Simvastatin dose may be too high as the patient is also on Amlodipine Patient has been inappropriately prescribed Cyanocobalamin The directions for simvastatin are incorrect on the prescription

Query the Simvastatin dose may be too high as the patient is also on Amlodipine

Nicorandil can be used in the treatment of angina as it works as a vasodilator. Which of the following side effects would require stopping nicorandil? Mouth ulcers Dizziness Headache Heamorrhage Angioedema

The side effect that would require stopping nicorandil is mouth ulcers. Nicorandil, a vasodilator used in the treatment of angina, can cause mouth ulcers as a known and potentially serious side effect. If a patient develops mouth ulcers, it is important to stop the medication and assess the situation.

Which of the following anti-epileptic medications does not need to be brand prescribed? Carbamazepine Lamotrigine Phenobarbital Phenytoin Primidone

Lamotrigine

Patient Y has had epilepsy since he was 11 years old and since has been on anti- epileptic medication thus has well controlled epilepsy. He has passed his driving test and is going to be driving a car from next week which was gifted to him. Which of the following is the most appropriate DVLA recommendation regarding driving with epilepsy? Patients should not drive during medication changes or withdrawal of anti-epileptic drugs, and for 6 months after their last dose Patients do not need to take extra precautions when driving Patients who have had a first unprovoked epileptic seizure or a single isolated seizure must not drive for 6 months. If a driver has a seizure they must stop driving and immediately notify DVLA Patients are able to drive 30 minutes after a seizure

If a driver has a seizure they must stop driving and immediately notify DVLA

Carbamazepine is an anti-epileptic which has many indications, one being for the treatment of generalised tonic clonic seizures. Which of the following is the most appropriate target level for carbamazepine? 10-20mg/L 1.5-3mcg/L 4-12mcg/L 3-10mcg/L 5-7m

4-12

A patient has been initiated on Carbamazepine, as you are handing out the prescription you provide some advice regarding his medication. Which of the following is the most appropriate advice to provide? Take it on an empty stomach 2 hours before food Advise him to see a GP in 4 months for a review Advise him to seek immediate medical attention if he gets any visual disturbances Advise him to seek immediate medical attention if a fever, rash, mouth ulcers, bruising or bleeding develops Advise him to stop taking his medication if he starts vomiting

Advise him to seek immediate medical attention if a fever, rash, mouth ulcers, bruising or bleeding develops

You are providing a lunchtime teaching session at the hospital regarding anti-epileptic medication as there have been numerous prescribing and administration errors being reported on the hospital reporting system. Which of the following is the most appropriate advice regarding phenytoin? Phenytoin should not be given intramuscularly due to the absorption being slow and erratic Patients who are being enteral fed, feeding should be interrupted 1 hour before and after a phenytoin dose Injection solutions which are acidic are irritant to tissues The total plasma phenytoin concentrations should be between 15-20mg/L for adults. Patients can be prescribed different brands of phenytoin

Phenytoin should not be given intramuscularly due to the absorption being slow and erratic

Miss E, has been prescribed Sodium Valproate. Which of the following indications would be most appropriate to prescribe Sodium Valproate to Miss E? Migraine prophylaxis Bipolar prophylaxis Epilepsy Depression Schizophrenia

Epilepsy

A prescription from the hospital for Concerta XL has been received by the pharmacy for a 12 year old boy. The patient is a regular patient and you recognise his mum very well when she comes in to collect the prescription. The prescription states “Concerta XL 18mg once daily in the morning, supply 56 days”. Which of the following would be the most appropriate reason for not dispensing this medication and querying the prescription? Dosage is incorrect Prescription has exceeded maximum supply The medication is not suitable for the patient Direction are incomplete Modified release preparations of methylphenidate do not need to be brand prescribed and you do not have this brand in stock as there is a current stock issue so would require another prescription

Rx has exceeded the max supply For Concerta XL (a modified-release formulation of methylphenidate), the usual maximum supply is 30 days per prescription, as per NHS guidance and many prescribing regulations. The prescription for 56 days exceeds the recommended duration, which is an issue that should be addressed with the prescriber.

Mr F is 60years old and has been on lithium for 4 years now for the treatment of bipolar disorder. He has been having no problems with his medication and has no other medical conditions. Which of the following would be the most appropriate monitoring requirements? Monitoring of BMI, eGFR, electrolytes, and thyroid function every 6 months Monitor BMI, renal, cardiac and electrolytes every 6 months Monitor BMI, thyroid, cardiac and electrolytes every 6 months Monitor BMI, eGFR, electrolytes, and thyroid function every year Monitor BMI, renal, ECG, and electrolytes every 6 months

Monitoring of BMI, eGFR, electrolytes, and thyroid function every 6 months

Which of the following would be a contraindication for lithium carbonate? Concomitant diuretic treatment Untreated hypothyroidism Elderly Epilepsy Myasthenia gravis

Lithium can interfere with thyroid function and may exacerbate or precipitate hypothyroidism. Therefore, untreated hypothyroidism is a contraindication for initiating lithium therapy. Other conditions listed (such as diuretic use, elderly, epilepsy, and myasthenia gravis) are not absolute contraindications but require careful monitoring and dose adjustments when prescribing lithium.