GPhC Qs Flashcards
How long do you retain signed orders for?
2 years from date of supply
EMERGENCY SUPPLY
PATIENT REQUEST?
immediate need
previously prescribed
appropriate dose
5 days- phenobarbital/schedule 4/5
EMERGENCY SUPPLY
EEA ES
NOT ALLOWED?
SCHEDULE 1/2/3
EMERGENCY SUPPLY PATIENT
ENTRY?
DATE
NAME/QUANTITY/FORM/SRENGTH
NAME+ADDY OF PATIENT
NATURE
EMERGENCY SUPPLY
PATIENT LABELLING?
DATE NAME/QUANTITY/FORM/STRENGTH ANME OF PATIENT NAME+ADDY OF PHARMACY 'EMERGENCY SUPPLY'
VET
‘KEEP OUT OF REACH OF CHILDREN’ ‘must’ lol
EMERGENCY SUPPLY PRESCRIBER
REQUIREMENTS
PROVIDE SCRIPT IN 72HOURS
NO CDS 1/2/3 (except pheno)
EMERGENCY SUPPLY PRESCRIBER REQUEST
ENTRY?
DATE NAME/QUANTITY/FORM/STRENGTH NAME+ADDY OF PRACTITIONER NAME+ADDY OF PATIENT DATE PRESCRIPTION AMEND ENTRY, INCLUDE DATE PRESCRIPTION RECEIVED
WHAT CDs REQUIRE DENATURING?
RETURNED/EXPIRED/OBSOLTE
SCHEDULE 2/3/4 (part 1)
SCH 2/3/4 RETURNED
AUTHORISED WITNESS NEEDED?
NO,
just witness to see is preferred, myna
EXPIERD CD
AUTHORISED WITNESS REQUIRED?
YES, ONLY IF SCHEDULE 2!
3? Good practice, etc…
patient returned cd entry?
NO, KEEP it separate, but record destruction yes
EXPIRED STOCK ENTRY?
RECORD FOR SCHEDULE 2 CDs
CDs, bank holiday coming up, prescription wording wag1?
Instalments due on days when the pharmacy is closed should be dispensed on the day immediately
prior to closure
Methadone+contraceptive pill?
Should be calm
Fluclo, breastfeeding?
Ery preferred
Warfarin+miconazole?
Inhibitor, INR increases, bleed
Theophylline, patient stopped smoking?
Reduce dose
Ibuprofen dose 3 year?
100mg TDS
Paracetamol dose 7 year old?
240-250mg QDS
Vaginal thrush treatment?
Fluconazole/itraconazole/clotrimazole/minconazole
Etc
Bacterial vaginosis treatment?
Metronidazole
Fungal nail infection?
2 nails max, tips/sides only
1-2 times a week amorofline, 18+
yellow/distored, crumblish
Fever+chicken pox?
Give paracetamol, not ibuprofen
infection risk L
dabigatran labelling?
read additional info!
swallow whole, do not chew or crush!
topiramate labelling?
sleepy, don’t drive/use tools/machines
do not stop taking this med!!!! (anti-epileptic)
+kidney stones? cool
alendronic acid dosing?
10mg OD or 70MG WEEKLY
70MG OD is an L
risk, osteonecrosis, fractures, auditory canal
metformin+next intensification
bladder L, takes trimethoprim UTI, needs to lose weight?
Pioglitazone L bladder
Flozin L urine
Sulphonylurea L weight gain
GLP-1? HMMM
Child
Clenil+SABA+next up?
LTRA
Under 16, UPSI 2 days, best contraceptive, doesn’t wnna see anyone?
Ulipristal, any child bearing age (but IUD probs best)
Trimethoprim+Methotrexate?
bone marrow suppression L, anti-folate, blood counts
teratogenic btw, avoid in pregnancy, UTI no!
How often do you clean spacers?
Once a month
mild detergent
air dry, no rinse
DO NOT USE A CLOTH INSIDE!
Wipe detergent off mouthpiece obvs
How often do you replace spacers?
6-12 months
END OF LIFE
Diamorphine, preferred, route?
Syringe driver
Meds contraindicated syringe route?
Chlorpromazine
Prochlorperazine
Diazepam
Cyclizine
Levomepromazine
skin reactions L
Animal bite?
Co-amoxiclav
OR
Doxy+metro (allergy)
Animal scratch?
Flucloxacillin
Cyclophosphamide/alkylating agents
BIG BOY RISK?
Neutropenia
contraception during+3 months after
Cisplatin- during+6 months after
Sespsis in children symptoms?
dry nappies
Crying
clinging
mute :|
profound bradycardia?
bisoprolol? really?
stage 1 hypertension, <55, >10% cvd risk?
ACE/arb gogo
Vincristine route?
IV, neurotoxicity risk otherwise
VET prescription years?
5 years
Ring worm, yute arm, treatment?
Clotrimazole
What drugs cause hypercalcaemia?
Hydrochlorthiazide
Thiazide-like
Lithium
Excess vitamin A/d/calcium
palpitations+feeling faint, sign of?
HYPOKALAEMIA
SALBUTAMOL+CORTICOSTEROIDS
ABCDE
SSRI, hypo?
hyponatraemia
signs of hyponataraemia?
nausea
headache
irritability
seizures
HIGH TSH, LOW T3/T4, WHAT IS THAT? TREATMENT?
hypothyroidism
levothyroxine
C diff. treatment order?
Relapse in 12 weeks of resolution?
Relapse after 12 weeks?
Life threatening?
Oral vanc
Oral fidaxo
Relapse in 12 weeks of resolution?
fidaxomicin
Relapse after 12 weeks?
vancomycin/fidaxomicin
Life threatening?
vanc+ IV metro
PYELONEPHRITIS, AVOID?
RENALLY CLEARED DRUGS PROBS
COPD exacerbation, penicillin allergy? purulent sputum
Doxy 200mg first day, 100mg OD +4 days
+ prednisolone 30mg 5 days
Animal scratch?
Fluclo apparently
Apixaban
DVT/PE general treatment?
10mg BD 7 days, 5mg BD maintain
Apixaban
VTE prophylaxis after knee surgery?
2.5mg BD 10-14 days
APIXABAN
VTE prophylaxis after hip surgery?
2.5mg BD 32-38 days
APIXABAN 2.5MG BD DOSING CRITERIA?
> /= 133 creatinine
> /= 80 years
= 60kg
Boostrix, pertussis, protects you from?
WHOOOOOOOOOOOOOPING
COUGH
CHLAMYDIA TREATMENT?
AZITHROMYCIN 1G STAT OR DOXYCYCLINE 7 DAYS OR ERYTHROMYCIN 14 DAYS
antibiotic myna penicillin allergy, thrush?
fluclo, might as well give it :|
be a MAN! (or woman)
SICK DAY RULES?
SADMAN
SGLT ACE DIURETICS METFORMIN ARBS NSAIDS
SICK DAY RULES diabetes
SICK?
SUGAR- increase bgm, (some anti-diab drugs dose increase)
INSULIN- NEVER STOP! (bar SADMAN) (possible dose increase)
CARBS- adequate hydration+carbs
KETONES- type 1, check every 2-4hrs, EXTRA rapid acting insulin dose! wow
gap between 2 different eye drops?
5mins
CARER, ONCE DAILY INSULIN?
Determir (OD/BD)
Degludec
Glargine
isophane?
insulin the mixes?
Biphasic, multiple, with meals, duh!
swollen ankles?
CCBs!
CLOZAPINE MONITORING?
leukocytes, blood counts
weekly first 18 weeks, then fortnighly till year, then monthly
look out for intestinal obstruction/constipation!
MUSCLE ACHE STATINS?
creatine kinase?
STATINS HEPATIC L?
ALT levels
STROKE PREVENTION
CHA2-DS2-VAS SCORE?
WHEN DO YOU TREAT?
C congestive HF Hypertension Age 75+ (2) Diabetic Stroke/TIA (2) Vascular disease- dvt, aneurysm, etc Age 65-74 Sex- female
When is thromboprophylaxis NOT needed?
Men= 0
Women= 1
TREAT?
>/= 2,
men 1? consider…
MHRA
only report the serious, adverse effects?
is codeine constipation established? yes
DKA, FLOZIN, REPORT TO MHRA
DKA, SLGT, REPORT?
YEAH PROBS :z
Lithium+antidepressants risk?
Serotonin syndrome
C
A
N
ikykyk
breakthrough pain?
1/10th to 1/6th
MORPHINE dose increase?
1/3 to 1/2
QUNINE INDICATION
NOCTURNAL LEG CRAMPS 200-300 mg ON
MALARIA
Not the best, side-effects, tinnitus, QT prolongation
Can take 4 weeks to work, review every 3 months
amiodarone+digoxin interaction?
bradycardia risk
what is duty of candour?
being honest when things go wrong
How long do you retain private scripts?
2 years, date of supply!
BISOPROLOL CAUTIONARY LABEL?
Do not stop taking this medicine unless your doctor tells you to stop
RIVAROXABAN CAUTIONARY LABEL?
Take with or just after food, or a meal
Warning: Read the additional information given with this medicine
digoxin yellow vision, toxicity, mangement?
withdraw. specalist, a&E?
digoxin specific antibody
K+ sparing diuretic also helps, as hypokalaemia potentiates toxicity :(
Hypoglycaemia treatment?
15-20g sucrose/glose
3-4 heaped spoons sugar (in water?)
150-200ml juice
NOT diet coke lol
HYPOGLYCAEMIA- SYMPTOMS?
SWEATING LETHARGIC DIZZINESS HUNGER TREMOR TINGLING LIPS PALPITATIONS EXTREME MOODS PALE
MASTITIS TREATMENT?
Flucloxacillin 10-14 days
Erythromycin 10-14 days
EVIDENCE HIERARCHY ORDER?
SYSTEMATIC REVIEW/META-ANALYSIS RCT COHORT CASE-CONTROL CASE SERIES/REPORTS
Methotrexate, what drug to avoid?
Trimethoprim, bone marrow L
METHOTREXATE+NSAIDs?
reduces mtx clearance, but just monitor more, calm
methotrexate contraception monitoring?
during+ 6 months
What is the 6-in-1 vaccine?
DTPHPHs
DIPTHERIA TETANUS PERTUSSIS HEPATITIS B POLIO HAEMOPHILIUS INFLUENZA B
emergency supply insulin, brand not in stock, action?
other pharmacies?
any brand? :O
Some are by brand, eg. glargine, careful
insulin prescribing?
UNITS PLEASE TY
PRIVATE CDs?
Use standardised form (vet excluded)
Send to NHS
Prescribe POMs separately (so you can retain 2 years)
needs ‘prescriber ID number’ not reg hmm
pom REGISTER?
2 YEARS FROM LAST ENTRY
private prescriptions?
repeatable, not NHS
repeat, repeat once, dispense total twice
private prescription, oral contraceptive?
can repeat 5 times, dispense total 6 tiems
private script, dispense within?
6 months, rest repeats doesn’t matter
private script schedule 4, dispense within?de
28 days, rest repeats no limit
desogesterl depression?
side-effect
desogestrel+phenytoin?
L
SCHIZO
HALOPERIDOL+RISPERIDONE TRIED, L, WHAT’S NEXT?
CLOZAPINE!
WARFARIN+CLARITHROMYCIN INTERACTION?
Increases INR, adjust dose, monitor
MACROLIDE BRUH
ibuprofen 3 year old?
100mg TDS
PARACETAMOL DOSE 10 YEAR OLD?
480-500MG QDS
WHAT IS THIS?
VERRUCA
Pressure areas, sole of feet, painful, black spos
WHAT IS THIS?
Warts
smooth, raised, hands
refer if wart on face/genitalia
WARTS/VERRUCA TREATMENT?
SALICYLIC ACID
GLUTARALDEHYDE
LACTIC ACID
CRYOTHERAPY
FILE W/ EMERY BOARD
WATERPROOF PLASTER+SOCKS TO STOP SPREAD
symptoms of candidiasis?
white patches easily wiped off
bleeding, red area
loss of taste
cracks
oral thrush treatment?
miconazole
after food, hold in mouth, swirl,
continue 7 days after lesions healed
breastfeeding/nipples calm but wash remove? same with permethrin
phenelzine+pseudoephedrine interaction?
hypertensive crisis
avoid+for 14 days after stopping MAOI, phenelzine
Longtec OD, shortec PRN, CDs
flucloxacillin counselling?
Take this medicine when your stomach is empty. This means an hour before food or 2 hours after food
space doses evenly, complete course
enoxaparin+rivaroxaban?
risk of bleed :(
enoxaparin thrombocytopenia MHRA?
risedronate dosing
treatment osteoporosis
female?
male?
female?
5MG OD
35MG ONCE A WEEK
male?
35MG ONCE A WEEK
prevent females 5mg od btw
patient, candidiasis, steroid, advice?
spacer
stage 1 hypertension, cvd risk>10%, diabetic?
ACE/ARB?
ACTIVITIES NOT REALLY NEEDING RP PRESENCE? STILL NEED TO SIGN IN!
ASSEMBLY ACCURACY CHECKING DISPENSING GSL MEDS? WASTE STOCK PROCESS? ORDERING RECEIVING (excluding CDs)
NAPPY RASH TREATMENT?
BARRIER PREPS
CLOTRMIAZOLE/MICONAZOLE (+7 days after rash has gone)
HYDROCORTISONE 1% CREAM POM
FLUCLO/ERY IF BACTERIAL INFECTION
ALLERGIC DERMATITIS TREATMENT?
EMOLLIENTS
STEROIDS
CALAM ITCHINESS RELIEF
URTICARIA TREATMENT?
cetirizine (non-sedating)
oral L?
IV/IM chlorphenamine
Morphine MR instead of IR issue?
delayed pain relief
Patient w/
low HB+folate
treatment?????
Hydroxycobalamin injections (probs)
birth prevent bleeding?
vitamin k antagonist!
TB INITIAL?
RIPE rifampicin isoniazide (+pyridoxine b6) pyrazinamide ethambutol
2 months
TB CONTINUOUS?
RIFAMPICIN
ISONIAZID
4 months
SSRI+sodium valproate interaction, electrolyte?
hyponatraemia
spironolactone electrolyte?
hyperkalaemia, SPARES POTASSIUM!
AKI, drugs to stop?
renally cleared drugs, ace/arb/nsaids,
metformin, lactic acidosis!!!!
VET label requirements?
expiry (when human, under cascade) name+addy of owner name+addy of pharmacy name of VET id+species of animal for animal treatment only
VET PRESCRIPTION LEGAL REQUIREMENTS?
NAME/ADDY/TELEPHONE NUMBER/QUALI/SIG OF PRESCRIBER (schedule 2/3, need RCVS registration number as well)
NAME+ADDRESS OF OWNER
ID/SPECIES/ADDY OF ANIMAL
DATE- 6 MONTHS VALIDITY | SCH 2/3/4- 28 DAYS
NAME/QUANTITIY/DOSE/ADMINISTRATION- ‘as directed’ is poor
ANY WARNINGS/WITHDRAWAL PERIODS?
SIGNED ORDER REQUIREMENTS?
NAME OF SCHOOL PRODUCT DETAILS (+ spacer) STRENGTH (if relevant) PURPOSE OF PRODUCT TOTAL QUANTITY SIGNATURE OF PRINCIPAL/HEAD TEACHER headed paper not a legal requirement
patient, thorn, cellulitis? staph?
treatment?
add in IV
vancomycin
teicoplanin
linezolid
eye drop+eye ointment gap?
5 minutes, same same
CURB65 SCORE INDICATORS?
CONFUSIONt
UREA NITROGEN>7mmol/L
RAISED RESP. RATE>/= 30breaths/min
low bp systolic <90, dyastolic /=65 years
1 point each
diabetes uti medication?
flozins, proximal tubule, excretes glucose in urine
meds falls?
risepirdone….
amiodarone warning label?
Protect your skin from sunlight—even on a bright but cloudy day. Do not use sunbeds
GLARGINE HAS TO BE BY BRAND!!!
Ciclosporin patient has H pylori?
PPI+AMOXI+
METRO, not clari, interaction
stool softener?
docusate
EMERGENCY SUPPLY, RX, PRESCRIBER?
72 HOURS
COELIAC DISEASE, AVOID?
GLUTEN
WHEAT
BARLEY
RYE
REASON FOR CHEMOTHERAPY BREAK?
LET BLOOD CELL LEVELS RECOVER, WE GO AGAIN
PATIENT 60+
AMLODIPINE+RAMIPRIL, what’s next step?
INDAPAMIDE!
Child
fever, cold-like symptoms, white spots?
Measles
alufozin+sildenafil?
big hypotension risk!
stabilse on alfuzosin first, THEN add sildenafil lowest dose
Orange book?
aseptic stuff
manufacture and distribution of human medicines
good manufacturing practice
Green book?
broader distribution of human medicines
DSITRIBUTE!
good dstributing practice!
Memantine maximum daily dose, dementia?
20mg OD
GOUT
Patient on diuretic+antihypertensive, treatment?
COLCHICINE
Avoid NSAID cos hyperkalaemia/renal impairment L
resuscitation adult
ompression:breath ratio?
30:2
babies resuscitate?
5 rescue breaths before starting chest compression :(
Fluoxetine+St John’s wart interaction?
serotonin syndrome
Methylphenidate PR advice?
Do not crush/chew
equasym/medikinet- can sprinkle on apple sauce/yoghurt, then swallow
6+, CD2 BTW
PATIENT UTI
METHOTREXATE, PEN ALLERGY?
Nitro calm
Private prescription, HRT, menopause symptoms, record in POM register?
Prescriptions for oral contraceptives are exempt
from record keeping
:/
EMERGENCY SUPPLY FUN FACTS TREATMENT LENGTHS!
CDs 4/5?
POM?
If the emergency supply is for a CD (i.e.
phenobarbital or Schedule 4 or 5 CD), the maximum
quantity that can be supplied is for five days’
treatment. For any other POM, no more than 30
days can be supplied except in the following
circumstances:
• If the POM is insulin, an ointment, a cream,
or an inhaler for asthma (i.e. the packs cannot
be broken), the smallest pack available in the
pharmacy should be supplied
• If the POM is an oral contraceptive,
a full treatment cycle should be supplied
validity
schedule
4 part 1/2?
5?
4 part 1/2? 28 days
5? 6 months
Atorvastain muscle pain, monitor?
creatine kinase >x5 upper limit L :(
ATORVASTATIN LFT MONITORING?
BEFORE
AT 3 MONTHS
AT 12 MONTHS
Patient using OTC co-codamol, 3 days, still in pain, next step?
co-codamol POM? but 3 days
tramadol? step up?
even up morphine? :o
Co-codamol 8/500 max OTC pack size?
32 units, but 3 days use only max
co-codamol label?
Do not take more than 2 at any one time. Do not take more than 8 in 24 hours
Contains paracetamol. Do not take anything else containing paracetamol while taking this medicine. Talk to a doctor at once if you take too much of this medicine, even if you feel well
OTC pain arthritis, tried co-codamol, what’s next?
Capsaicin, topical? Idk
CITALOPRAM/ESCITALOPRAM/DOMPERIDONE/ERYTHROMYCIN/FLUCONAZOLE/QUININE
BIG BOY RISK?
QT prolongation
SPECIFIC EXAMPLES BTW
ETANERCEPT PRESCRIBING?
BRAND PLEASE TY
biological drugs!!
brand prescribing?
CP3 qvar/clenil inhalers potency ciclosporin tacrolimus etanercept glargine
NOT fentanyl? hmm
WHAT IS THIS?
STYE excessively watery swelling eyelish lid/follicle small yellow-pus
STYE advice?
1month+
self-limiting
warm compress 2-4x a day 5-10mins till stye drains
avoid makeup, contact lenses
DABIGATRAN REVERSAL AGENT?
IDARUCIZUMAB
peak expiratory flow?
blow out hard+fast
cellulitis minor allergy?
jus give the fluclo
numb, cramp?
treat hypocalcaemia
Potentially life-threatening hypertensive crisis can develop in those taking MAOIs who eat tyramine-rich food (such as mature cheese, salami, pickled herring, Bovril®, Oxo®, Marmite® or any similar meat or yeast extract or fermented soya bean extract, and some beers, lagers or wines) or foods containing dopa (such as broad bean pods). Avoid tyramine-rich or dopa-rich food or drinks with, or for 2 to 3 weeks after stopping, the MAOI.
hba1c 46?
diet advice
VET LABEL REQUIREMENTS
Name of the prescribing veterinary surgeon
• Name and address of the animal owner
• Name and address of the pharmacy
• Identification and species of the animal
• Date of supply
• Expiry date of the product
• The name or description of the product
or its active ingredients and content quantity
• Dosage and administration instructions
• If appropriate, special storage instructions
• Any necessary warnings for the user (e.g.
relating to administration, disposal, target
species, etc)
• Any applicable withdrawal period (i.e. the time
between when an animal receives a medicine
and when it can safely be used for food)
• The words: ‘For animal treatment only’
• The words: ‘Keep out of reach of children
SATIVEX VALIDITY?
28 DAYS
SERETIDE?
fluticasone w/ salmeterol
kid,
Seretide+ICS, next step up?
increase ICS dose or change to SABA
lady on seretide, next step?
increase ICS dose or add LTRA
COPD, had, green sputum, prescribe?
AMOXI,DOXY,CLARI
DRUGS THAT CAUSE HYPONATRAEMIA?
CERTAIN DRUGS DITCH SALT Carbamazepine Diuretics Desmopressin/Vasporessin SSRIs
DRUGS THAT CAUSE HYPERNATRAEMIA?
SALTY CEO Sodium Bicarbonate/Chloride Corticosteroids Effervescent Formulations Oestrogens/Androgens
what patch is 7 days?
BUPRENORPHINE
BUTRANS
Manufacturer advises apply patch to dry, non-irritated, non-hairy skin on upper torso, removing after 7 days and siting replacement patch on a different area (avoid same area for at least 3 weeks).
STYE FIRST LINE?
HOT COMPRESS
chickenpox
no ibu
WHAT’S THIS?
IMPETIGO
HYDROGEN peroxide fusidic acid mupirocin fluclo clari/ery
WHAT IS THIS?
molluscum contagiosum
s&S molluscum?
all over the body
small/raised/smooth/pink/papules, sometimes black dots
how do u manage molluscum?
self-limiting
don't share towels don't scratch can go school wear waterproof bandages lesions r contagious :(
paracetamol calm!
ENZYME INDUCING ANTI EPILEPTICS?
CP3T
Carbamazepine. Eslicarbazepine acetate. Oxcarbazepine. Perampanel (at a dose of 12 mg daily or more). Phenobarbital. Phenytoin. Primidone. Rufinamide. Topiramate (at a dose of 200 mg daily or more).
valproate, non-enzyme inducer, cu iud still?
chest pain?
nitroglycerin/GTN
SUBCONJUNC, NO PAIN ,ETC?
CALM, REASSURE
POSSIBLE SIGNS OF STROKE?
CALL 999
Patient
slurred speech, can’t raise arm
Call 999
can’t give aspirin 300 cos it might be haemorrhagic, bp+statins ;)
HYPOGLYCAEMIA- SYMPTOMS?
SWEATING LETHARGIC DIZZINESS HUNGER TREMOR TINGLING LIPS PALPITATIONS EXTREME MOODS PALE
travel sickness, 4 year old?
kwells
hyoscine hydrobromide
joy ride 3+
‘CASCADE’ IS FOR?
THE VET PRESCRIPTION, NOT THE LABEL
‘FOR ANIMAL TREATMENT ONLY’
THAT’S FOR THE LABEL BRUH
VET PRX MEETS CASCADE YEAH BUT ALWAYS
GO FOR SPECIES LICENSE FIRST
CASCADE ORDER?
EXPIRY 10/21?
31/10/21!
mr ISNTEAD OF IR?
DELAYED PAIN RELEIEF
ES NOT ALLOWED?
SCHEDULE 3, TRAMADOL, L
TAMSULOSIN OTC?
45 and 75 years
Symptoms of BPH present for a minimum of three months
A two week supply of tamsulosin can be supplied initially
If there has been an improvement in urinary symptoms within the initial two weeks, a further supply of four weeks can be made
After six weeks, a further supply can be made only where the patient confirms that the doctor has carried out a clinical assessment and agreed further supplies are appropriate.
MTX+FOLIC ACID SEPARATE DAYS?
Give folic acid to reduce side-effects. Folic acid decreases mucosal and gastrointestinal side-effects of methotrexate and may prevent hepatotoxicity; there is no evidence of a reduction in haematological side-effects.
Withdraw treatment if ulcerative stomatitis develops—may be first sign of gastro-intestinal toxicity.
Treatment with folinic acid (as calcium folinate) may be required in acute toxicity.
UPPER UTI?
Oral first line (upper UTI symptoms):
Cefalexin, ciprofloxacin, co-amoxiclav (if culture susceptible), or trimethoprim (if
trimethoprim uti dose?
Manufacturer advises dose reduction to half normal dose after 3 days if eGFR 15–30 mL/minute/1.73 m2.
TRI UTI DOSE?
Adult
200 mg twice daily for 3 days (7 days in males).
short-term prednisolone side-effect?
increased appetite, mood changes and difficulty sleeping
metallic taste abx/dabetic?
metronidazole
metformin
methadone and driving?
as long as it’s not impaired
zolpidem elderly?
risk of falls
zolpidem schedule?
4
elderly PK?
decreased renal function?
LITHIUM+
ANTIPSYHCO
SSRI
MAOI
ANTIPSYCHOTICS- QT prolongation
SSRI/MAOI- serotonin syndrome
L
MAYBE just clozapine?
chemotherapy break?
recover from myelosuppression?
trimethoprim duration uti?
females 3, men 7
TEETHING MANAGEMENT ORDER?
GUM RUBBING RING CUDDLING WIPE AWAY SALIVA PARACETAMOL/IBUPROFEN (3MONTHS+ and/or really?) LIDOCAINE, 5MONTHS+
15 year old UPSI? dlow
ULI
13 year old lithium, period pain?
Can’t do NSAIDS, age, interaction!
Give dihydrocodeine w/ parcetamol
paramol
pharmacy record?
5 years
cd register from date of entry?
2 years
You need minimum 75 people in each arm. You have 3 arms at a ratio of 1:2:2
STATIN MONITORING?
Before starting treatment with statins, at least one full lipid profile (non-fasting) should be measured, including total cholesterol, HDL-cholesterol, non-HDL-cholesterol (calculated as total cholesterol minus HDL-cholesterol), and triglyceride concentrations, thyroid-stimulating hormone, and renal function should also be assessed.
Liver function
There is little information available on a rational approach to liver-function monitoring; however, NICE suggests that liver enzymes should be measured before treatment, and repeated within 3 months and at 12 months of starting treatment, unless indicated at other times by signs or symptoms suggestive of hepatotoxicity (NICE clinical guideline 181 (July 2014). Lipid Modification—Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease).
Those with serum transaminases that are raised, but less than 3 times the upper limit of the reference range, should not be routinely excluded from statin therapy. Those with serum transaminases of more than 3 times the upper limit of the reference range should discontinue statin therapy.
Creatine kinase
Before initiation of statin treatment, creatine kinase concentration should be measured in patients who have had persistent, generalised, unexplained muscle pain (whether associated or not with previous lipid-regulating drugs); if the concentration is more than 5 times the upper limit of normal, a repeat measurement should be taken after 7 days. If the repeat concentration remains above 5 times the upper limit, statin treatment should not be started; if concentrations are still raised but less than 5 times the upper limit, the statin should be started at a lower dose.
Diabetes
Patients at high risk of diabetes mellitus should have fasting blood-glucose concentration or HbA1C checked before starting statin treatment, and then repeated after 3 months.
H PYLORI
MACROLIDES OR AMOXI L?
A proton pump inhibitor, plus bismuth subsalicylate [unlicensed], plus metronidazole, and tetracycline [unlicensed].
HYPERTENSION
57 YEAR OLD+BLACK
CAN’T TAKE CCB?
ARB!!!
SARTANNNNN
lansoprazole GR label directions?
Do not take indigestion remedies 2 hours before or after you take this medicine
Take 30 to 60 minutes before food
Swallow this medicine whole. Do not chew or crush
OMEPRAZOLE long-term side-effect?in
may reduce absorption of vitamin B12 with long-term treatment
C diff risk btw
key aspect of audit?
investigating and comparing to gold standard
ciclosporin, cyp induce/inhibit interaction?
doxy calm?
rivaroxaban dosing?
15mg BD 21 days, then 20mg OD
2.5mg BD too low
15-49mL/min? 15mg OD
RIVAROXABAN DOSE ADJUSTMENTS?
When used for Treatment of deep-vein thrombosis or pulmonary embolism:
Following the first 21 days of treatment for deep-vein thrombosis or pulmonary embolism, the usual dose of 20 mg once daily can be given, but consider reducing to 15 mg once daily if creatinine clearance 15–49 mL/minute and the risk of bleeding outweighs the risk of recurrent deep-vein thrombosis or pulmonary embolism.
When used for Prophylaxis of recurrent deep-vein thrombosis or pulmonary embolism:
When the recommended dose is 20 mg once daily, consider reducing to 15 mg once daily if creatinine clearance 15–49 mL/minute and the risk of bleeding outweighs the risk of recurrent deep-vein thrombosis or pulmonary embolism.
When used for Prophylaxis of stroke and systemic embolism in patients with non-valvular atrial fibrillation:
Reduce dose to 15 mg once daily if creatinine clearance 15–49 mL/minute.
mebendazole advice?
wear underwear, don’t scratch, silly
DRUG BREAST PAIN/CHANGES
spironolactone
Levofloxacin seizures?
lowers threshold
statin, 3 months, 12 months?
LFTs
tamsulosin+sildenafil?
hypotension risk
Tamsulosin causes significant hypotensive effects when given with Sildenafil – patient should be stabilised on first drug then second drug at lowest recommended dose
tamsulosin+amlodipine?
hypotension again
Adults should eat no more than 6g of salt a day (2.4g sodium) – that’s around 1 teaspoon. Children aged: 1 to 3 years should eat no more than 2g salt a day (0.8g sodium) 4 to 6 years should eat no more than 3g salt a day (1.2g sodium)
Ulcer 5 weeks?
Refer, cancerous
Meropenem+valproate?
Concentration decreased
Valp
EEA CDs?
Not buprenorphine
methadone, citalopram, QT avoid
fluclo, breastfeeding, calm mastitis
miconazole, warfarin, inhibitor, conc berzerk
recurrent UTIs, trimethoprim, now diabetes, first drug????
under 16, UPSI, dlow?
ulipristal 30mg
(levo 1.5mg)
5mg is fibroids!!
trimethoprim, methotrexate?
anti folate, renal L, nephrotoxicity risk
Route in palliative care?
End of life adding hyoscine + diamorphine hydrobromide always give it
SYRINGE DRIVER
NEUTROPENIC SEPSIS TREATMENT?
beta lactam (fluclo etc) monotherapy with piperacillin with tazobactam
X aminoglycoside or glycopeptides
Lady was shopping and fell and has profound bradycardia
Bisoprolol, B for bradycardia!
stage 1 hypertension, CVD>10%, FIRST LINE?
TREAT WITH GUIDELINE
Pharmacist signed in, not present, what can HCA do?
Dispense+Accuracy check
ARM, ringworm, OTC?
miconazole, clotrimazole, etc
hypercalcaemia, POM vitamin supplement treatment?
but if malignancy?
dehydration iv sodium chloride
pamidronate sodium
but if malignancy? calcitonin, pamid best still
high tsh, low t3 t4, is? treatment?
HYPOTHYROIDISM
GIVE LEVOTHYROXINE
Prescribed medication 50mcg/kg and the drug was 250mg per 5ml. (4) doses of tinzaparin.
Patient had surgery and are on amlodipine and have a respiratory rate of 18 and BP was
100/58 and it was 70 beats per minute. What drug modification do you recommend?
Hypotensive, stop the CCB? Hmmm
Mania, first-line antipsychotic, no regular testing?
LORAZEPAM?
ROQ?
Etc
pertussis, whooping cough calm
citalopram+valproica cid?
hyponatraemia!
LITHIUM+ANTIDEPRESSANTS?
SERTRALINE- SEROTONIN SYNDROME
CITALOPRAM- QT PROLONGATION
MED, MOST LIKELY TO CAUSE FALLS?
INDAPAMIDE/METFORMIN/FERROUS/VALSARTAN/CHOLECALCIFEROL?
Valsartan
hyperkalaemia, persistent postural hypotension- falls
Where a product states ‘Use by’ or ‘Use before’,
this means that the product should be used before
the end of the previous month. For example,
‘Use by 06/2022’ means that the product should
not be used after 31 May 2022.
STATIN+MACROLIDE?
exposure statin, myopathy
cough for someone who wants to snooze?
pholcodiene linctus, 12+ generally
children 6-12 5 days only ok
diphenhydrdamine?
sildenafil+tamsulosin?
hypotension
INSULIN ONCE DAILY?
isophane
or
DDG? Hmmm
malaria, pregnancy?
Chloroquine and Proguanil can both be used at normal doses in pregnancy as benefit of malaria prophylaxis outweighs any risk
BUT recommend FOLIC ACID 5mg to be taken with proguanil
short-term contraception, wants to get pregnant later?
pill- 2 weeks calm
desogrestel- 2months (smoking)
long-acting, doesn’t want kids anymore
SURGERY
ETONORGESTREL- 5 YEARS
IUD PRO DEVICE, MIRENA 5 YEARS^
ALWAYS DOUBLE CHECK INPUTTED ANSWER! FUMING :D
q19 september 2019 alternative
What is it? What you doing?
Chickenpox, paracetamol, calm
1st line- NSAID
2nd line- Codeine with/without paracetamol
3rd line- spasm, short course benzo, diazepam
QT PROLONGATION DRUGS
Long hearts make vets cut animals - lithium /Haloperidol /Macrolides /Venlafaxine /Citalopram /Amiadorone
BACK PAIN?
NSAID, lowest dose
codeine with/without paracetamol
Drug, dry cough, help sleeping?
vancomycin, c diff, oral,?
licensed
Olanzapine issue, diabetes?
weight gain
hyperglycaemia
osteoporosis+prednisolone L
BABY NO URINATION refer?
baby, paracetamol post-immunisation dose?
up to 6months
60mg right after vaccination
60mg 4-6hrs after first dose
60mg 4-6hrs after second dose
vaccine that sets offever?
menb
MALARIA MEDS WHILST ON CONTRACEPTION?
NO INTERACTION!
med to stop diarrhoea, sick?
SADMAN!
burnt hand,HIL
run water don't use ice cover burns with cling film, X wet dressings, topical creams elevate, avoid oedema pain relief
REFER KIDS UNDER 5!
BURNS REFERRAL?
CHILDREN UNDER 10
SECRETIONS IN PALLIATIVE CARE?
hyoscine hydrobromide/butylbromide
glycopyrroinum bromide
LAXATIVE+CONSTIPATION? Hmmm
Subconjunctival haemorrhage?
self-limiting, dw, calm
slapped cheek maangement?
paracetamol
nsaid
etc
formoterol, next stepup?
Add LTRA, if not already MART?
spacer technique?
Breathe in through your mouth, slowly and steadily over 4 to 5 seconds or, breathe in and out through your mouth, slowly and steadily
UTI, women, penicillin allergy, sensitive to trim and ntiro?
EHC, uli, childbearing age
TEMAZEPAM?
Temazepam is schedule 3 but subject to safe custody and special Rx requirements – same with Butec
fentanyl patch return?
Remove the backing and fold the patch over on itself. Place into a waste disposal
bin or a CD denaturing kit.
denature, witness good practice, boss doesn’t care
VET CD?
ANIMAL UNDER MY CARE
P<0.05
megaloblastic anaemia?
vitamin b12
Megaloblastic anaemia
– one cause is pernicious anaemia which is down to vitamin b12 deficiency. Can give oral hydroxocobalamin or if it is due malabsorption IM hydroxocobalamin
If folate deficiency – Folic Acid OD for 4 months. Never give alone if undiagnosed = neuropathy of spinal cord
folic acid dosing?
5mg, 400mcg certain, sickle?
VET label needed?
animal treatment only
out of reach of children
ACEI+ccs?
HYPERKALAEMIA :/
afro carib?a
ARB»> candesartan
levothyroxine hair loss?
can contribute :/
methotrexate adr?
mucositis
myelosuppression
patient adr, wrong med, wat do u do?
NRLS report? yellow card? manager? idk
insulin before/after meal?
before usually
metallic taste?
metformin
metronidazole
b2 agonist+prednisolone?
hypokalaemia
REVALIDATION SUBMIT?
4 CPDs
1 peer discussion
1 reflective
sore throat, can’t have amoxicillin?
order
phenoxy
clary/ery
FLOZINS, dry cough?
dry mouth yes, but cough?
UPPER respiratory tract infection, really?
plans to stop smoking?
preparation
stopped smoking, came, what can i take?
action?
alcohol units Q
answer 15 units
ABV x
ml of alcohol/ 1000
gaviscon feeds, not in the same line?
CD cupboard?
morhpine 13mg/ml mad strength
ampoules? cocain?
For liquid containing ampoules, open the ampoule and empty the contents into
a CD denaturing kit, or dispose of in the same manner as liquid dose formulations above. Dispose
of the ampoule as sharps pharmaceutical waste
cocain?e big boys
bets evidence?
systematic
then meta
then etc
osteoporosis vitamin needed?
vitamin d- calciferol etc
folic acid methotrexate dose?
5mg weekly g
‘animal use only’?
not needed on prescription
“animal under my care”?
not needed on label lol
private POM years?
2
es REQUEST prescriber?
72 hrs
insulin hypoglycaemia risk?
long acting glibenc prosb
stimulates insulin secretion?
sulphonylureas
meglitis?
once weekly insulin?
GLP-1s, dulaglulatides, etc
RI, maintenance, 4 months
valproate in pregnancy?
lowest effective dose etc
anticoagulant in blister pack?
apixaban/rivaroxaban/edoxaban
NOT dabigatran
annual flu vac?
immunocompurosemise
migraine, contraceptive?
COC calm
nasal congestion, CVD, avoid ephed?
give inhalation
what is clinical governance?
Clinical Audit, Risk Management, Education + CPD, Evidence based care and effectiveness, patient + carer experience and involvement, staffing arrangement
clinical governancea system through which NHS organisations are accountable for continuously improving the quality of their services
tramadol advice?
Warning: This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol
Dissolve or mix with water before taking
shingles treatment?
aciclo, refer, etc
treatment of diabetes, pt has renal and heart failure, egfr is 25, can’t take SGLT-2, their BMI is
overweight?
linagltiptin FTW
cyclophosphamide?
neutropenia
oxycodone?
less s-e, better in renal
rivaroxaban stroke?
20mg od with food
aripiprazole s-e?
hyperglycaemia hyperprolactinaemia weight gain qt ED Fatigue
CD LEGAL REQUIREMENTS?
Patient name and address
Drug name
Dose (‘as directed’ on its own is not permitted)
Formulation
Strength (where appropriate)
Total quantity/dosage units of the preparation in both words and figures (for liquids, total volume in ml)
Prescriber signature and address
Date of issue
For instalment prescriptions, specify the instalment amount AND instalment interval
The words “for dental treatment only” written on it if issued by a dentist
dystonia, procyclidine?
It is used to treat symptomatic Parkinsonism and extrapyramidal dysfunction caused by antipsychotic agents. The mechanism of action is unknown. It is thought that Procyclidine acts by blocking central cholinergic receptors, and thus balancing cholinergic and dopaminergic activity in the basal ganglia.
56 year old omeprazole, heart burn?
refer, 55+!
but constipation 50+ refer
parenteral guidance, paediactric drug administration?
medusa? green book?
azathioprine?
inhibits purine synthesis
girl on COC and had missed one pill what to do ?
Missed pill = >24 hours for COC
Take one pill ASAP and next dose normal time even if it means taking 2 together. No extra precautions
Whereas – if it was POP, missed pill = >3 hours (Desogestrel >12 hours). Take ASAP and use condom for 2 days
someone was on levo and baclofen and was suffering hypothyroid symtoms - is it DDI or is it just baclofen causing them
Baclofen: drowsy, dizzy, weak, tired, nausea, constipatedVet surgery details, N & A, Qualification – RCVS no. for CD2 or CD3
Animal: Name + Species (inc. address if different from owner)
Medication: Name, strength, form, dosage
Admin instructions, NOT “as directed”
Warnings e.g. withdrawal period
If repeat, state no.
If human/unlicensed = “FOR ADMINISTRATION UNDER THE VETINARY CASCADE”
If CD2/CD3 = “THIS ITEM HAS BEEN PRESCRIBED FOR AN ANIMAL OR HERD UNDER CARE OF VET”
Vet signature
Date: 6-month expiry and 28 day expiry for CD2,3,4
VET RX?
Vet surgery details, N & A, Qualification – RCVS no. for CD2 or CD3
Animal: Name + Species (inc. address if different from owner)
Medication: Name, strength, form, dosage
Admin instructions, NOT “as directed”
Warnings e.g. withdrawal period
If repeat, state no.
If human/unlicensed = “FOR ADMINISTRATION UNDER THE VETINARY CASCADE”
If CD2/CD3 = “THIS ITEM HAS BEEN PRESCRIBED FOR AN ANIMAL OR HERD UNDER CARE OF VET”
Vet signature
Date: 6-month expiry and 28 day expiry for CD2,3,4
vet label
Name of prescribing veterinary surgeon Name + Address of owner Medication: Name, Strength, Dosage and administration Any special storage instructions “FOR ANIMAL TREATMENT ONLY” Name and Species of animal Pharmacy Name and Address Expiry and Date of Supply KOROC
buprenorphine?
cd3 no reg
but
safe custdoy
dose for allopruionol and colchicije and ibuprofen in GOUT
allo 100mg mild
300-600mg moderate severe
GOUT DOSING?
Gout: Acute
1st Line: NSAIDs e.g. Diclofenac, Naproxen
Ibuprofen: initially 300-400mg TDS-QDS
Diclofenac: 75-150mg OD in 2-3 divided doses
Alt: Colchicine: max 500mcg BD-QDS max 6mg per course and do not repeat course in 3 days
Gout: Prevention
1st Line: Allopurinol: Initially 100mg OD
2nd Line: Feboxust
Alt: Sulfinpyrazone (initiation may precipitate an acute attack)
CHLORAMPHENICOL DOSING?
Drops: Every 2 hours for the first 48 hours then every 4 hours during waking hours for 5 days
Ointment: Apply 3-4 times OD for 5 days
Refer if not improving >48 hours
C/I: FH of blood dyscrasias, history of myelosuppression
VERRUCA?
SALICY
MICONAZOLE AGE?
4MONTHs+
patients with COPD give oxygen at 88-92 % in acute asthma or COPD because of the risk of sending them into hypercapnic drive (normal patients it’s usually 98% o2 I think something quite high)
Exacerbations of COPD: Target = 88-92%
Acute asthma: Target = 94-98% (if not at risk of hypercapnic respiratory failure)Digoxin
Monitor: K+, Mg2+, Ca2+. Toxicity increased by hypokalaemia, hypomagnesaemia and hypercalcaemia, RF, plasma digoxin.
Cardiac arrhythmias, weakness, lethargy, dizzy, headache, confusion, nausea, anorexia, diarrhoea, blurred or yellow vision
Overdose: more likely 1.5-3 mcg/litre
DIGOXIN?
Digoxin
Monitor: K+, Mg2+, Ca2+. Toxicity increased by hypokalaemia, hypomagnesaemia and hypercalcaemia, RF, plasma digoxin.
Cardiac arrhythmias, weakness, lethargy, dizzy, headache, confusion, nausea, anorexia, diarrhoea, blurred or yellow vision
Overdose: more likely 1.5-3 mcg/litre
PD, LEVODOPA
“On” state = may feel energetic and able to move more easily
“Off” state = very stiff slow
Occurs as an end of dose, “weaning” off – worsening of motor function
Means shorter length of benefit
M/R preps may help of Levodopa or take at specific times of the day to avoid off periods
Advanced PD: can use Apomorphine for refractory motor fluctuations “OFF” episodes
BACK PAIN?
Offer NSAID if no C/I (otherwise codeine with or without paracetamol)
. Patient on b2 agonist, corticosteroids, and is currently on a 9 month relegeous fast. What
electyolyte disturbaces do you see. She breaks her fast daily to injest her meds. what electrolyte
disturbance are they at risk of ?
WHOOPING COUGH MANAGEMENT?
Prescribe clarithromycin for infants less than 1 month of age.
Prescribe azithromycin or clarithromycin for children aged 1 month or older, and non-pregnant adults.
Prescribe erythromycin for pregnant women.
From 36 weeks’ gestation, this is recommended to reduce the risk of transmission to the newborn baby.
Prior to this, it is likely to be of clinical benefit for the woman only if administered within the first 21 days of the illness, or may be advised if she is likely to come into close contact with a person from a vulnerable group.
Prescribe co-trimoxazole if macrolides are contraindicated or not tolerated (off-label indication). However, co-trimoxazole is contraindicated during pregnancy, and is not licensed for use in infants younger than six weeks of age.
For full information on dosing regimens, contraindications, and adverse effects of antibiotics, see the section on Prescribing information.
SATIVEX?
just records, not safe custody
Child 4 years old with cough which was chesty now its dry it’s been 10 days?
pholcodine linctus age?
16+
med increase neutrophils?
filgrastim
sativex nabilone epidyolex dronabinol ?
schedule 4 cd
pom
schedule 5 cd
schedule 2 d
GI surgery past 5 days?
metoclopramide contraindicated
mentronidazole inhibits, careful, clary ery
CO-BENELDOPA WHEN?
EMPTY STOMACH
1 HOUR BEFORE/2 HOURS AFTER
COLOURS URINE, HARMLESS
n&v in migraines?
bucclizien, buccastem
NAUSEA IN RADIOTHERAPY?
DEXAMETHASONE
SUBARROCHNOID HAEMORRHAGE TREATMENT?
NIMODIPINE
drug to avoid in gout?
bendroflumethiazide
caffeine+bp?
L
verapamil side-ef?
constipation
NSAIDS lowest CVD risk?
naproxen+ibu 1.2
pink sputum?
HF
osteomyelitis treatment?
fluclo (6 weeks)
w/
fusidic acid/rifampicin (2 weeks)
septicaemia?
tazobacta+piperacillin
isotretinoin+vitamin A, cod liver?
avoid in pregnant!
SET INTERACTION?
SILDENAFIL
ERYTHROMYCIN
TADALAFIL
DISULFIRAM, DRINK ALCOHOL?>
FULL BODY RASH!
IBANDRONIC ACID OSTEOPOROSIS?
150mg monthly
HBA1C TARGETS?
48 IF NO hypoyglycaemia drugs
53 IF HYPOYGLYCAEMIA DRUGS
RECURRENT VAGINAL THRUSH DOSE?
moetronidazole
150MG every third day for 3 doses+150mg ONCE weekly for 6 months
ulipristal BF?
1 WEEK GAP
BMI>30?
OBESE
ORAL VACCINE?
ROTAVIRUS
EXCRETE 1 UNIT OF ALCOHOL?
1HOUR
OT?
PATIENT DISABILITY LIFE
SPEECH AND LANGUAGE?
SWALLOWING DIFFICULTIES
ISOTRETINOIN BLOOD DONATION?
AVOID DURING+1 MONTH AFTER
BEST BOOK FOR VACCINE INFO?
GREEN BOOK, KO
VAC IN PREGN?
INFLUENXA? OK
oral thrush yeah but nystatin is POM REFER
Patient, ace, diabetic, HF?
indapamide!
over 65, hypertension, ccb, next?
increase dose
methotrexate common?
fever hm
chadvas 2 female?
start treatmetn
impulse drug?
levodopa, non-erogt prami the worst
mefanamic acid+naproxen?
both same class!
low hb/folate?
Give hydroxocobalamin (vitamin B12) at intervals of up to 3 months Frequent IM injections to replenish stores- then maintenance
HYDROXOCOBALAMIN DOSING?
Initially 1 mg 3 times a week for 2 weeks, then 1 mg every 2–3 months
statin lfts monitor?
before
3m
12m
COPD fev1<50
laba+ics, enxt?
lama
zopiclone shcedule?
4, no words fiugres
CIPROFLOXACIN?
Do not take milk, indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine
Space the doses evenly throughout the day. Keep taking this medicine until the course is finished, unless you are told to stop
Swallow this medicine whole. Do not chew or crush
clari+statin?
jus withold 7 days? contact?
hives, urticaria?
chlorphenamine gwarn
diabetic patient
low egfr
HF
?
glipti
letrozole+hrt?
avoid
denosumab risk?
hypocalcaemia
Pow ferritin?
Give ferrous sulphate
FOSTAIR LOWER DOSE THAN BECLO?
POTENCY!
METHOTREXATE, BREATHING, TOXIC
gentamicin bacteria?
MRSA
CICLOSPORIN- SIDE-EFFECTS?
bit longer start
HYPER- glycaemia/uricemia/kalaemia/lipidaemia/tension HYPO- magnesaemia Renal/Liver Impairment Skin Reactions Gingival Hyperplasia Hair changes (hirsutism) Eye inflammation/vision Ls (topical)
CICLOSPORIN- INTERACTIONS
Increases exposure? GPOM
Decreases exposure? PG
Can mix with?
GRAPEFRUIT+POMELO juice-> increased ciclosporin exposure
PURPLE GRAPE JUICE-> decreased ciclosporin exposure
BUT…
Can mix with orange/apple juice to improve taste
TACROLIMUS- SIDE-EFFECTS?
HYPER-glycaemia+uricaemia/kalaemia HYPO/HYPERtension RENAL/LIVER IMPAIRMENT SKIN REACTIONS VISUAL DISTURBANCES BLOOD DYSCRASIA CVD (QT prolongation/cardiomyopathy in children) Nervous system disorder/peripheral neuropathy
TACROLIMUS- INTERACTIONS? GP^2
Patient has hypersensitivity to macrolide?
GRAPEFRUIT/POMEGRANATE/POMELO juice- INCREASES tacrolimus levels
Patient has hypersensitivity to macrolide? DO NOT USE
drug pre-screen TB?
Etanercept
palliative care
bowel colic/secretions?
hyoscine
glyc
BITYL??
4 YEAR OLD NAUSEA?
HYOSCINE
JOY RIDE 3+
KWELLS KIDS 4+
hives?
iv chlorphenamine!
methotrexate likely?
fever
Know hypertension guidelines inside out. Pt was on ACE and diabetic, I chose thiazide as had heart failure too
Patient over 65 hyper tension on amlodipine 10mg, either add next step, I chose increase to max 20mg dose first??????????????????????????/
Where the CD prescription is written by
a dentist, the words ‘for dental treatment
only’ must be presen
RL for vet on label- what is not a LR I put ‘under cascade’ as this is LR under prescription only
zopiclone, sch 4, no need words n figures
Do not take letrozole with HRT as it may interfere with letrozole effectiveness?
HYPOCALCAEMIA- depressed, forgetful muscle cramp confusion
isotretinoin suicidal?
gp asap!
myelosuppression monitoring?
full blood count
Diabetic pt, what is first step. I chose gliptin, as had an eGFR of lower than 30 and had heart failure
Breastfeeding
Paroxetine – present but not known to be harmful
Advice if immunosuppressed and taking influenza vaccine – IM inactivated version
INJECTION
NOT NASAL!!!
Carbamazepine – increased risk of major congenital malformations
Labetolol doses – same as for HT 100mg BD initially
clozapine monitiring?
weekly, 18 weeks, 1 year, monthly
osmotic?
lactulose+macrogol
carbamazepine vitamin
d
neutropenia side-effect
Diarrhea. Vomiting. Burning or pain with urination. Unusual vaginal discharge or irritation
neutropenia side-effects
Chills, with or without a fever. Body aches. Extreme fatigue. Sore throat. Mouth sores. Runny nose. New or worsening cough
gums?
gingival
colchicine+azithromycin?
Azithromycin is predicted to increase the exposure to Colchicine. Manufacturer advises avoid P-glycoprotein inhibitors or adjust Colchicine dose.
Three pictures of prescriptions saying what’s wrong: one was epinephrine and
phenalizine interaction serious
3. Another was a duplication of same medicine of mst it was wrong dose coz longtec given
less frequently than shortec
LITHIUM, PERIOD, PAIN/
dihydro+parace
renal L?
calcium
MEASLES
CONTACT DERMATITIS
SHINGLES
MOLLUSCUM
NAPPY RASH?
CLOTRIMAZOLE 1%
headlice,med, doesn’t smell?
dimeticione 1% lotion?
dabigatran MOA?
direct thrombin (factor IIa) inhibitor
rivaroxaban stroke?
20mg od
butrans?
7 days
lithium+depression?
fluox and olanzapine, olanzapine, quetiapine or lamotrigine
methotr+trim?
anti folate, myelo
lady falls give?
vitamin d
neutropenia leads to?
sepsis
quetiapine, antibiotic chocie?
doxycycline!
rate control af?
beta blocker
low ferrtin+hb?
give ferrous sulp
fluclo
jaundice
mesalazin report or na blodo dyscrasia?
zolpidem sch 4 ES?
5 DAYS
grey circle inhaler?
handihaler?
kid, asthma, add?
ltra probs
h pylori amox allergy?
pcm
finasteridepc
moodbs
fludricort storage?
check spc
euresis kid ,water swallow?
hypernatraemia
Very common greater than 1 in 10 Common 1 in 100 to 1 in 10 Uncommon [formerly 'less commonly' in BNF publications] 1 in 1000 to 1 in 100 Rare 1 in 10 000 to 1 in 1000 Very rare less than 1 in 10 000
Very common greater than 1 in 10 Common 1 in 100 to 1 in 10 Uncommon [formerly 'less commonly' in BNF publications] 1 in 1000 to 1 in 100 Rare 1 in 10 000 to 1 in 1000 Very rare less than 1 in 10 000
naproxen age?
15-50
tranexamic acid age?
18-45
clari+statin?
omit statin 7 days?
statin, muscle pain, test?
creatinien kinase
CHADVASC
ORBIT
HASBLED
HPV VAC?
CERVICAL PREVENT
COC+AMOX
CALM
Seizure medicine for an 8 week year old oromucosal tabs put under tongue or yogurt -
buccual midazolam
co-codamol max?
240mg/day, 4-6hrs
isotretinoin 7 days
ssri valp?
hyponatraemia
amiodarone, weight, tired?
thyroid
yellow eyes, nausea?
fluclo
neutropenia symptoms?
sore throat
RINGWORM
RASH
WHITE SPOTS MOUTH
GREY EGG INHALER?
TRELEGY ELIPTA
heart failure, drug to stop?
amlodipine
BASAL-BOLUS REGIME!
apix dvt?
10mg bd 7 days, 5mg bd
MHRA REPORTING?
We are particularly interested in receiving Yellow Card reports of suspected ADRs:
in children
in patients that are over 65
to biological medicines and vaccines
associated with delayed drug effects and interactions
to complementary remedies such as homeopathic and herbal products
Permethrin once weekly for 2 doses – apply to whole body including face and wash off after 8-12 hours
Morphine patient and one some IV randomcaine – why do you contact the prescriber about the morphine? This is for spine surgery? HELP
signed order?
he reason for requesting inhalers was missing
Paracetamol kid dose for a 2 month baby
30–60 mg every 8 hours as required, maximum daily dose to be given in divided doses; maximum 60 mg/kg per day.
HAP+PEN ALLERGY?Usually give co-amoxiclav for 5 days but pen allergic so doxycycline + metronidazole
Non severe: usually Co-amoxiclav but pen allergic so alt: doxycycline
Severe HAP: IV Pip/Taz, cephalosporins, meropenem or levofloxacin
BITE+PEN ALELRGY?
Usually give co-amoxiclav for 5 days but pen allergic so doxycycline + metronidazole
EPILEPSY AFTER CARE?
Recovery position
HIGH TSH, LOW T3T4?
hypothyroidism
Woman’s arms and legs hurt she’s on simvastin what blood test does she need - serum creatinine
saba uncuntrolled ,40?
beclo, celnil
factor no dvt?
exercise
seizure, 8 week?
buccal midazolam
drugs, driving, methadone, driving?
it impairs
naproxen days max?
3 days, pack of 9
lansop?
Take 30 to 60 minutes before food
Do not take indigestion remedies 2 hours before or after you take this medicine
metro+statin?
calm
only chc, oestrogen stopped pre- srugery, not proges
emergency supply cd?
refer
out of hours
pom register?
POM Register (private rx):
Supply date, Rx date
Medicine details (name, qty, form, strength)
Rx’er details and Pt details
confidential?
20 days normally and has to be a written request
VET SCRIPT?
et surgery details, qualification (RCVS if CD 2/3)
Animal name and species
Owner
Med details
Admin instructions
Repeatable rx – write no.
If human med/unlicensed: for admin under vet cascade
If CD2/3: Item has been rx’d under care of vet etc
Vet signature
Date: 6 month expiry (inc. repeats) and 28 day expiry for CD2/3/4
Good practice: 28 days’ supply
SCHD 2, SAFE STORAGE, THEN DISPOSE?
Sch 2 e.g. diamorphine, methadone, oxycodone, ketamine
PHENYTOIN INTERACTION?
Sodium Valproate Isoniazid/Itraconazole Cimetidine Ketoconazole Fluconazole, Fluoxetine, Amiodarone, Diltiazem, Verapamil Alcohol Chloramphenicol Erythromycin/Clarithromycin Sulphonamide (sulfadiazine/co-trimoxazole) Ciprofloxacin Omeprazole Metronidazole/Miconazole
ASPIRIN+NAPRO?
BLEED
HEADACHE REFER?
LIGHTS+VOMIT
whooping cough) Pertussis, Infranix or Boosterix
OPIOID INDUCED?
STIMULANT+OSMOTIC
ALREADY TRIED BULK LAXATIVE?
Chronic constipation: bulk-forming, then osmotic and can try stimulant after (or after – prucalopride)
ASTHMA
Adult: (SABA as required)
Low-dose ICS Trial
Regular preventer: Low-dose ICS regular
Initial add-on: LABA 🡪 MART therapy
Additional: Medium-dose ICS OR LTRA
Child (SABA as required)
Very low-dose ICS trial e.g. Clenil modulate 50mcg TT BD
Regular preventer: Very low-dose ICS or 5 add LABA or LTRA and if <5 LTRA
Additional: Increase to low dose, >5 add LABA or LTRA and if no response to LABA, discontinue
patient was 4 had nocturnal asthma what inhaler should be prescribed
most likely add LTRA
patient was on salbutamol but badly controlled what is the next treatment
If adult, put on low dose ICS
patient was on salbutamol but badly controlled what is the next treatment
If adult, put on low dose ICS
BECLO
800BD AMXXX
Clinical Audit, Risk Management, Education + CPD, Evidence based care and effectiveness, patient + carer experience and involvement, staffing arrangement
OWNER-STANDARDS
lithium monitor?
weekly till stable
3 months
6 months
3months, 65+, elderly peak etc
citalopram?
taste disturbed
omeprazole L LONG-TERM?
VITAMIN B12 DOWN
hydrocortisone?
apply sparingly TWICE A DAY maximum for 7 days
post-herpetic neuralgia
paracetamol mild
amitripyline serious
breastfeeding?
Levonorgestrel – wait 8 hours and for Ulipristal wait one week
Person is smoking and would like quit sometime in the future but not now, at what stage is this in the change cycle
contemp
tests
Rhabdomyolysis CK
Agranulocytosis WBC
liver dysfunction LFTS
IMBALANCES SYMPTOMS
K+
, Na+
, Ca2+, Mg2+
HYPOKALAEMIA vs HYPERKALAEMIA?
HYPOKALAEMIA- muscle cramps, arrhythmias
HYPERKALAEMIA- numbness, nausea, SOB, chest pain
both palpitations- heart rate
HYPONATRAEMIA vs HYPERNATRAEMIA?
HYPONATRAEMIA- nausea, headache, irritability, seizures
HYPERNATRAEMIA- thirst, fatigue, confusion
HYPOCALCAEMIA vs HYPERCALCAEMIA?
HYPOCALCAEMIA- depressed, forgetful
HYPERCALCAEMIA- nausea, lethargy, arrhythmias
both muscle cramp/confusion
mouth ulcer order?
hydrocortisone lidocaine benzydamine chlorhexidine doxycycline ?
subconjuntival?
myna
subarrochnoid?
serious
phenytoin+doxy?
less doxy
paclitaxel class?
taxane
myelosupp?
7-10daysafter
SPC Qs?
There’s always a contradiction!
DIABETIC KETOACIDOSIS?
soluble insulin such as Actrapid (insulin soluble human) given intravenously
HYPO?
For adults with hypoglycaemia, give 15–20 g glucose, repeated after 15 minutes if necessary.
15–20 g is available from 60–80 mL oral glucose liquid, 4–5 glucose tablets, or 1.5–2 tubes of glucose 40% oral gel.
If oral glucose formulations are not available, the dose may be given using another fast-acting carbohydrate; 15–20 g is available from approximately 3–4 teaspoonfuls of sugar dissolved in an appropriate volume of water, or 150–200 mL of pure fruit juice.
READ THE Q, LEAST APPROPRIATE?!!! CHILD, RINGING BELLS
DOXYCYCLINE!
ALL HAVE QT RISK BAR CCB!!!
DOXY+WARFARIN?
INR ROCKET
Chlorthalidone is a diuretic
SICK DAY
Ranolazine is a treatment for angina. Dehydration is an uncommon side effect, however there are no sick day rules for it. It isn’t widely recognised as a medicine to be withheld during dehydrating illness.
DON’T STOP!
what drugs cause gord?
alpha-blockers, anticholinergics, benzodiazepines, beta-blockers, bisphosphonates, calcium-channel blockers, corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), nitrates, theophyllines, and tricyclic antidepressants should be reviewed
NOT INDAPAMIDE!!!!
what drugs cause gord?
Drugs that may cause or exacerbate the symptoms of GORD, such as alpha-blockers, anticholinergics, benzodiazepines, beta-blockers, bisphosphonates, calcium-channel blockers, corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), nitrates, theophyllines, and tricyclic antidepressants should be reviewed
Mirtazapine is a presynaptic alpha2-adrenoreceptor antagonist. It is given at bedtime due to its sedating effect.
Citalopram, fluoxetine, paroxetine and sertraline are all SSRI drugs. They are not usually associated with sedating effects.
Mrs R is taking the DMARD sulfasalazine, which acts as an immunosuppressant. Yellow fever is a live vaccine and should therefore be avoided in all patients taking DMARDS due to the increased risk of possibly life-threatening generalised infections. Specialist advice must always be sought in such situations.
- Hepatitis A, DTP, meningitis ACWY and rabies are all inactivated vaccines and are therefore safe for Mrs R
PPI LONG-TERM?
B12!
FUNGAL SKIN?
apply twice daily continuing for 10 days after lesions have healed
A 72-year-old patient who is required to start an intermediate acting insulin regimen which can be administered by her carers.i
INSULATARD INTERMEDIATE!!
A 45-year-old patient with type 2 diabetes who wants to change from his current basal-bolus insulin regimen to a biphasic insulin regimen to reduce his number of daily injections.
NovoMix 30 (insulin aspart) twice daily
MIX!!!
ISOPHANE IS?
INTERMEDIATE ACTING!!
Mrs L presents in the pharmacy with yellow skin. You explain this is likely the result of high bilirubin levels in her blood due to one of her medicines.
Patients should be told how to recognise signs of liver disorder and advised to seek prompt medical attention if symptoms such as anorexia, nausea, vomiting, fatigue, abdominal pain, jaundice, dark urine, or pruritus develop.
The correct answer is:
propylthiouracil
LIVER DISORDER, YELLOW SKIN, DIFERENT TO PANCREATITIS, ABDDOMINAL PAIN!
PD/ASTHMA exacerbations + ABX
Amoxicillin 500mg TDS for 5 days
200mg stat doxy and then 100mg OD for 7 days
200mg BD clarithromycin for 7 days
Prednisolone:
40mg OD for asthma for 5 days
30 OD for COPD for 7-14 days
If prophylaxis then Azithromycin Three times per week
VERAPAMIL CCB IN AF, NOT DILTIAZEM!
VERAPAMIL CCB IN AF, NOT DILTIAZEM!
warfarin
Isolated calf-vein DVT = 6 wks
Provoked VTE = 3 months
Unprovoked DVT or PE = at least 3 months (long-term possibly)
analgesia
pains/strains?
Paracetamol or topical NSAID
+ codeine adjuvant
48hrs post injury PO NSAID
PRICE – what to do
HARM – what to avoid
Seek medical advice 5-7 days or worsening Sx
analgesia
Effervescent preparations = high salt content. Avoid espec if HT
Routes:
INTRATHECALLY
= methotrexate, cytarabine and hydrocortisone
VINKA alkaloids
= INTRAVENOUSLY or orally
If IV for adults to be in 50ml mini-bag
If IV for paeds can be in 10 or 20ml syringe
toujeo high strength 300 units
Oral agents plus basal insulin
Type 2 only
Basal bolus Rapid acting with meals (bolus) Long acting once daily (basal) or Long-acting: or Twice daily mixture Mix of short and intermediate acting
number needed to treat (NNT) the number of patients that we would need to treat with ‘drug’ to prevent event.
1 / ARR => 1/ 0.02 = 50
i.e. 50 people have to be treated before 1 outcome is achieved.
Higher number = less efficacious
Systematic Review
collection of studies asking same Q & basing conclusions on the cumulated results
Meta-analysis is the statistical process of combining the results
Only as good as source
Retrospective
RCT
Participants (individuals or groups) randomly allocated to receive either the new intervention or a control treatment (usually the standard treatment or a placebo).
Prospective
Qualitative study
Examines the experiences and beliefs of people from their own perspective e.g. interviews
Cohort study
Follow-up or longitudinal study, is a type of observational study
At the end of the period of observation the incidence of disease or frequency of health outcome in the exposed group is compared to that in the unexposed group.
prospective as it looks forward from potential cause to consequence.
Case-Control study
Observational group of studies
Got disease = case. Not = controls
retrospective because it looks backwards in time to the earlier exposures of individuals.
DEPRESCRIBING
when to NOT use depot?
quick result needed
skin
allergy
VERAPAMIL CCB IN AF, NOT DILTIAZEM!