Incorrect Mock Questions Flashcards
1
Q
Pregnant lady with a UTI (12/40 weeks gestation), which is most appropriate?
Amoxicillin Cefalexin Clindamycin Erythromycin Flucloxacillin Isoniazid Rifampicin
A
Cefalexin is ok for UTI in pregnancy.
2
Q
Which one of the following has been associated with convulsions in cases of overdosage?
Morphine Pethidine Methadone Fentanyl Codeine
A
Pethidine
3
Q
Mrs T normally takes carbamazepine, which of the following should she urgently report?
Diarrhoea Drowsiness Hirsutism Hyponatraemia Nausea Neonatal Haemorrhage Neural tube defects Unexplained bruising or bleeding
A
Carbamazepine:
Blood, liver, or skin disorders, fever, rash, mouth ulcers, bruising, bleeding.
4
Q
What for CCB overdose?
A
CCB
5
Q
Mr D, who is 52 years old, has been diagnosed with type 2 diabetes. His GP has noted that he has failed to respond to diet modification and increase in physical activity and wishes to commence him on oral antidiabetic medication. He is not overweight and does not have any relevant contraindications to this condition:
Acarbose Pioglitazone Gliclazide Metformin Insulin
A
Metformin which is usually used in patients who are overweight, but can
also be “considered” in patients who are not overweight if appropriate. In practice in this case –
Gliclazide would be first line.
Acarbose - sucrose + starch = flatulence, CI in abdominal surgery.
Pioglitazone: increase peripheral insulin use by reducing resistance, heart faliure CI due to fluid retention, associated with bladder cancer and hepatic disturbances.
Gliclazide, short-acting (6hour) sulfonyl, can cause hypos.
6
Q
Dose of paracetamol for immunisations?
A
2.5ml qds (2.5ml = 60mg)
7
Q
Can methotrexate cause a miscarriage?
A
May harm unborn baby but unlikely to cause a miscarriage.
8
Q
Which of these are/is ACh inhibitor(s):
Galantamine
Memantine
Rivastigmine
Donepezil
A
Memantine: NMDA antagonists with a neuroprotective effect.
Donepezil: ACh inhibitor
Galantamine: ACh inhibitor
Rivastigmine: Licensed as a twice daily dose for mild to moderate dementia associated with Parkinsons disease.
9
Q
Which of the following should be added to existing treatment of amlodipine in a 56 year old African patient?
Atenolol Bendroflumethiazide Indapamide Ramipril Valsartan
A
Valsartan:
ARBs are preffered second line after a CCB in treating a 56-year old, African patient.
10
Q
An antihistamine and serotonin antagonist indicated in the prophylaxis of migraines
A
Pizotfen
11
Q
Which of the following does NOT need to be excluded before starting treatment for osteoporosis?
Hyperparathyroidism
Hyperthyroidism
Hypothryroidism
Osteomalacia
A
Hypo does not cause osteoporosis
12
Q
scurvy is a deficiency of
A
Vit C
13
Q
Buccastem M is only licensed for what?
A
Nause and vomiting in previously diagnosed migraine, in adults aged 18 and over.
14
Q
Which of the following is LEAST appropriate in renal failure?
Chlorphenamine Fybogel Omeprazole Paracetamol Senna
A
Bulk-forming laxatives such as fybogel are best avoided in patients with renal impairment as they require high volumes of fluid intake to work.
There is also the risk of dehydration with laxatives.
Senna tablets/liquid are more suitable in patients with renal impairment.
15
Q
Failure to treat which of these may lead to heart failure?
Asthma COPD Anaemia Diabetes Epilepsy Hepatic disease Hypercholesterolamia Renal disease
A
When anaemia becomes severe, the heart has to pump harder and faster to compensate for the decreased oxygen levels in the body.
16
Q
When should sodium valproate be used in absence seizures?
A
When there is a high risk of GTC seizures.
17
Q
Itching down below, female, lot of discharge which is frothy-smelling and is yellow-green in colour:
Bacterial vaginosis Trichomoniasis Vaginalis Candida albicans Cervical polyps Toxic shock syndrome
A
BV: thin, white fishy-smelling discharge.
Cadida albicans: white, cottage-cheese like
TV: frothy, yellow-green smelly
18
Q
Can pregnant women use gaviscon or peptac?
A
Yh: following the lifestyle and dietary advices, an alginate preparation is advisable.
19
Q
Has both opiod agonist and antagonist properties. Sublingually, it is an effective analgesic for 6-8 hours. Its effects are only partially reversed by naloxone hydrochloride.
A
Buprenoprhine
20
Q
Patient with three-month history of feeling chronically tired, has been feeling sick for last week and pale in colour. These test results suggest what?
Haemoglobin: 110g/L (130-170g/L) MCV: 112fL (80-99fL) MCH: 36pg (27-32pg) Ferritin: 50ng/L (20-200ng/L) Folate: 4ng/L (8-13ng/L) B12: 97ng/L (200-800ng/L)
Haemoglobinopathy Methaemoglobinaemia Pernicious anaemia Sickle cell anaemia Thalassaemia
A
The results suggest pernicious anaemia which is characterised by low levels of vitamin B12.
Increased MCV + MCH: Megaloblastic anaemia due to low vitamin B12 and/or flic acid.
I think all the other options are shown with really low haemoglobin levels?
21
Q
Is loperamide ok in renal failure?
A
Yes
22
Q
Which of the following best describes a mandatory activity that must be completed by pharmacy contractors on an annual basis as part of clinical governance?
Clinical governance toolkit Clinical audits Unpublished patient survey Reaccreditation of services Registering of premises
A
Two clinical audits must be completed each year under clinical governance.
Survery results must be published.
Registering of pharmacy premises happens every year but does not form part of clinical governance.
23
Q
Carbamazepine and SSRs (and other antidepressants) can both cause what electrolyte imbalance?
A
Hyponatraemia.
24
Q
Piroxicam topical treatment should be reviewed after how long?
A
4 weeks
25
Has been associated with pulmonary, retroperitoneal and pericardial fibrotic reactions: Patients should be monitored for dyspnoea, persistent cough and chest pain.
```
Rizaptriptan
Amantadine
Ergotamine Tartate
Pramipexole
Cabergoline
Benserazide
```
Amantadine: glutamate antagonist drug.
Ergotamine Tartrate: migraine
Pramipexole: Dopamine receptor agonsit, also restlesslegs (ropinirole)
Benserazide: dopa-decarboxylase inhibitor, which reduces the peripheral conversion of levodopa to dopamine, thereby limiting side-effects such as nausea, vomiting and CVD effects.
Carbegoline: pulmonary, retroperitoneal and pericardial fibrotic reactions:
An ergot-derived dopamine-receptor agonist (bromocriptine, cabergoline or pergolide) should only be considered as an adjunct to levodopa if symptoms are not adequately controlled with a non-ergot-derived dopamine-receptor agonist.
26
Gliclazide has a black dot interaction due to enhanced hypoglycaemic effect when taken with what drug?
Warfarin
27
Which of the following does NOT cause hyponatraemia?
Glimepiride
Gliclazide
Glipizide
Gliclazide does not cause hyponatraemia.
Glimepiride and glipizide do.
28
Allopurinol is associated with what syndrome?
Steven-Johnsons-Syndrome
29
Noriday (norhisterone) is defined as being late when?
more than 3 hours late, all progestogen only are the same except for desogestrel which is 12 hours.
30
Recently prepared means
within 4 weeks
31
Lithium works by:
Modulation of inward and outward current of gutamate receptors
Modulation of monovalent and divalant anions in neurons
Inhibition of a transaminase responsible for degrading gamma-aminobutyric acid
Modulation of sodium channels on neuronal cells, thus reducing hyperexcitability.
Modulation of sodium channels on neuronal cells, thus reducing hyperexcitability
Stimulation of a synaptic vesicle protein which leads to inhibition of neurotransmitter
Lithium works by:
Modulating glutaminergic receptor currents
Modulating monovalent and divalent CATIONS in neuronal cells.
Inhibition of a transaminase responsible for degrading gamma-aminobutyric acid: VALPROIC ACID potentially.
32
Analgesic with both an opiod effect and enhances the serotonergic and adrenergic pathways
Tramadol
33
What is used to treat patent ductus arteriosus other tha surgery?
Prostaglandin inhibitors --> NSAIDs --> Indomethacin or ibuprofen
34
Which of the following is the single most possible consequence of the following drug interaction:
Co-beneldopa for PD + prochlorperazine 5mg tds for nausea
```
Bleeding risk increased
Bradycardia
Bradykinesia
Cardiac arrhythmias
Confusion
Postural hypotension
Reduced eGFR
Thrombosis
```
Bradykinesia
35
Do pharmacists have read/write access to SCR?
Not write.
36
AED and can be given once daily due to long-half life:
Topiramate
Carbamazepine
Phenobarbital
Levetirecatam
Phenobabr
37
Patient started on this drug needs to take extra precautions and to protect their skin from sunlight:
```
Indapamide
Lithium carbonate
Pizotifen
Promazine
Ramipril
```
Promazine makes the skin more susceptible to the UV rays from the sun.
As such, a patient on Promazine therapy is more susceptible to burning/sun burn and must take precautions in sunlight.
38
Should statins be discontinued if there is an increase in the blood-glucose concentration or HbA1c?
BNF 2.12 states that statins should not be discontinued if there is an increase in the blood-glucose concentration.
NICE guidance following an MI states to use a high propensity statin (such as atorvastatin) initially with a view to switching over to a more cost-effective alternative such as simvastatin after a set period of time.
39
Insulin glargine:
| Insulin glulisine:
Glarg: long
Glu: fast
40
Phenoxymethylpenicillin, with or without food?
Take phenoxymethylpenicillin when stomach is empty, this means an hour before or two hours after food.
```
Also empty stomach:
Pen V
Flucloxacillin
Ampicillin (not amoxicillin tho)
Tera + oxytetra
Rifampcicin
```
Bisphosphonates
41
Why would metformin need to be stopped in a patient undergoing examination using an iodine-containg contrast agent?
Due to the risk of renal failure.
42
Mr C, who is 62 years old, has been seen by the GP as he is currently suffering from persistent breathlessness due to his COPD. His is already prescribed a salbutamol inhaler which is not controlling his symptoms. He has a FEV 1 60%. Which of the following is the ONE most appropriate treatment option?
```
SAMA
LAMA
LABA+ICS combo
LAMA + LABA + ICS
Domicilliary oxygen
```
At this stage the options are either LABA or LAMA alone, as LAMA alone is only option presented this is the correct choice.
43
Chloramphenicol can cause gray baby syndrome if excessive doses are used in neonates with immature hepatic metabolism. How does this present?
```
Abdominal distension
Pallid cyanosis (grey)
Circulatory collapse
```
44
Amiodarone, azola antifungals and macrolides have what effect on simvastatin?
increase its levels
45
What are the long-term PPI use risks? (4)
1. C.diff
2. Fractures (osteoporosis)
3. Hypomagnesia
4. CAP
46
Cetrizine is only licensed for use in what ages?
>2 for liquid.
47
Which of the following statements about live vaccines is the best advice?
Two live vaccines should not be given together.
Giving parenteral or intranasal vaccines is thought to affect the immune response to subsequently administered oral live vaccines
Live vaccine and inactivated vaccine may be given at any time in relation to each other
Paracetamol should not be given routinely prior to immunisation with live vaccines.
Live vaccines can routinely be given to immunocompromised patients
If more than one non-oral live vaccine (e.g., live attenuated influenza vaccine [LAIV],
varicella, mumps) needs to be administered, it is recommended that the vaccines be given
on the same day. However, if this is not possible, doses of the live vaccines should be separated by at least four weeks. The four-week interval reduces the interference of
immune response to the first vaccine by the second vaccine. This rule for separation does
not apply to the administration of oral live vaccines not given on the same day: typhoid and
rotavirus. These vaccines can be given less than four weeks apart. However, this scenario
isn’t likely to occur because the age groups for which these vaccines are recommended do
not overlap.
Live vaccine and inactivated vaccine may be given at any time in relation to each other
(should either be given at same time or else 4 weeks apart)
In addition, parenteral or intranasal administration of a live vaccine is not thought to affect
the immune response of a subsequently administered oral live vaccine.
A live vaccine and an inactivated vaccine can be administered without regard to the timing
of the other. Antipyretics/analgesics such as acetaminophen or ibuprofen should not
routinely be given prior to immunization.
They might reduce a patient’s immune response. However, if needed, these meds can be
used for treatment of fever and pain as needed following vaccination.
48
A patient is prescribed sodium bicarbonate 4.8g orally daily for a chronic condition:
```
Iron overload
GP6D deficieny
Prevention of neural tube defects
Uraemic acidosis
Neutropenia
Pernicious anaemia
Iron deficieny anaemia
Sickle-cell disease
```
Prevention of neural tube defects - Folic acid 400microgram low risk, 5mg high risk.
Pernicious anaemia - hydroxocobalamin.
Iron deficieny anaemia- Cosmofer after test dose.
Filgrastim - neutropenia
Sodium bicarboante - uraemic acidosis.
49
MOAi are cautioned for use in cardiovascular disease.
| True or False?
True.
50
Terbinafine is associated with what skin disorder?
Toxic epidermal necrosis/SJS
51
Can aspirin be used for prevention of cardiovascular events in someone with COPD who has previously had a CV event?
Yes
52
The following are symptoms of what?
Rash,
Blood in stools,
Itchy skin,
Jaundice
```
Hepatotoxicity:
Amiodatone
Alpha-methyldopa
Isoniazid
Methotrexate
Vitamin A
Nitrofurantoin
Minocycline
Paracetamol
Amoxicillin
Niacin
Valproic acid
Phenytoin
```
53
What topical NSAID is associated with more frequent serious skin reactions?
Piroxicam
54
Patient on levothyroxine 50mcg for six months newly initiated onto citalopram for depression have these test results:
Free T4: 110g/L (130-170g/L)
Free T3: (80-99fL)
TSH: 36pg (27-32pg)
What should be done?
If TSH level is high and the free T4 is low, this suggests an under-active thyroid.
If TSH level is low and the free T4 is high, this suggests an over-active thyroid.
A low TSH with low free T4 may be the result of failure of the pituitary gland.
The results therefore indicate undertreatment (TSH level is high but the Free T4 is low) and so the dose needs to be increased.
No interaction of note between citalopram and levothyroxine.
Levothyroxine should not normally be stopped before surgery.
55
Calcium polystyrene resin treats
Hyperkalaemia.
56
Long-term use of which one of the following laxatives can lead to a weakened bowel?
Senna
Lactulose
Docusate
Ispaghula husk
Senna is a stimulant laxative that can cause weakening of the bowel if used for prolonged periods.
57
Clinical outcomes include what?
Length of hospital stay.
Adverse drug reactions.
Hospital readmission
Death
58
Infants have what pH gastric contents?
High pH
59
Patient with AKI, LEAST appropriate advice RE pain relief is:
The patient should only be given oral paracetamol up to three times a day
The patient should be monitored for signs indicative of coma.
Codeine must be avoided due to an increased risk of serious adverse reactions
The patient may have increased sensitivity to central nervous system side effects
Dihydrocodeine is the drug of choice and may be used at normal dosing irrespective of renal function
The advice regarding dihydrocodeine is the least appropriate as it is not the opioid of choice and care must be taken in renally impaired patients who require opioids.
60
Which heparins have a lower risk of heparin induced thrombocytopenia?
LMWH lower than ufh
61
What impact does severe renal impairment have on the plasma serum concentrations of highly protein bound drugs?
Severe renal impairment: protein leaks out of the kidneys and leaves the body in the urine, as a result there are less circulating proteins in the serum for these highly protein bound drugs to bind to and thus their active levels increase
62
15 yr old type 1 diabetic using insulin glargine once daily and novorapid prn. Has a script for Co-amoxiclav. Which of the following is most appropriate advice?
Do not make any adjustments to your regular blood glucose monitoring.
Increase your blood glucose monitoing as well as your insulin dosing.
As you are not eating, you will not require you regulr insulin doses.
Inject your insulin intravenously whilst ill as this will give a rapid response
Monitor yourself for hypoglycaemia and reduce your regular insulin dosing.
During periods of illness, diabetics are more likely to encounter diabetic acidosis therefore increased monitoring is required and insulin requirement may be increased.
63
How is hand foot and mouth treated?
PLenty of fluids to avoid dehydration
Soft foods
Paracetamol or ibuprofen
64
Perindopril should be taken with or without food?
Perindopril should be taken on an empty stomach, preferabbly 60mins before eating.
65
Target INR for DVT prophylaxis
3.5
66
A newborn baby at 8 weeks is given a vaccine via the oral route. Which ONE of the following vaccines did the child receive?
```
Bacillus Calmette-Guerin (BCG)
Diptheria, Tetanus, and Pertusis (DTaP)
Hep B vaccine
Human papillomavirus (HPV)
Rotavirus vaccine
```
The rotavirus protects against rotavirus infection, a common cause of childhod diarrhoea and sickness. It is given at 8 and 12 weeks of age.
Rotavirus liquid vaccines are given by mouth (orally) to young infants.
67
A 49 year old man is brought into A & E with nausea, vomiting, muscle twitching and
tremor. He is very unsteady on his feet and seems unable to co-ordinate his
movements. He appears to be dehydrated and says that he has managed to keep
taking all of his medications even though he has not been eating and drinking
```
Ciclosporin
Digoxin
Gentamicin
Lithium
Methotrexate
Phenytoin
Sodium valproate
Theophylline
```
Lithium toxicity - acute poisoning - nausea, vomiting, cramping and sometimes diarrhoea.
Progession of acute toxicity can involve neuromuscualr signs such as tremulousness, dystonia hyperreflexia, ataxia and cardiac dysrhythmias.
68
Which of the following best describes the mechanism of action of amlodipine in reducing blood pressure?
It exerts a positive inotropic effect which decreases myocardial stress and reduces blood pressure.
It inhibits the movement of potassium ions into vascular and myocardial smooth muscle cells.
It reduces myocardial contractility thus reducing electrical contractility and blood pressure.
It exerts a negative inotropic effect by inhibiting calcium in myocardial tissue which leads to vasodilation.
It blocks myocardial beta-adrenoceptors having a potent vasodilator effect which reduces blood pressure.
CCBs work by exerting a negative inotropic effect as well as inhibiting calcium in myocardial tissue, which leads to vasodilation and reduced blood pressure.
69
Indicated for the short-term relief (two to four weeks only) of anxiety that is severe, disabling, or causing the patient unacceptable distress:
Lorazepam
Temazapem
Lorazepam
70
Why should chlorphenamine be used with caution or not at all in patients with decreased liver function?
Increased risk of drowsiness as chlorphenamine hepatic metab, risk of coma
71
Out of the following which is the least emetogenic treatment:
```
Cisplatin
Doxorubicin
Mitoxantione (anthracycline derivative)
Vincristine
Cyclophosphamide
```
Vincristine least emetogenic out of those
72
p.c. means
After food
73
Drug use at all is not recommended during what stage of pregnancy?
First trimester
74
What is an alternative to flucloxacillin for cellulitis in pen-allergic?
Clarithromycin
75
Which of the following conditions is associated with a rash which is not itchy?
```
Ringworm
Impetigo
Dermatitis herpetiformis
Nappy Rash
Lyme disease
```
Lyme disease is caused by a bacterial infection from tick bites. An early symptom of this condition is a characteristic "bulls eye" rash at the site of the bite.
Not itchy.
76
Mrs Q goes to her doctor reporting that she has been feeling sick, lethargic and quite
confused. At night, she says that she has been seeing strange halos around the lights
at home.
```
Ciclosporin
Digoxin
Gentamicin
Lithium
Methotrexate
Phenytoin
Sodium valproate
Theophylline
```
```
Digoxin:
Confusion
irregular pulse
Loss of appetite
Nausea
Vomiting
Diarrhea
Fast heartbeat
Vision changes (unusual): blind spots, blurred vision, changes in how colours look or seeing spots.
```
77
What is the interaction between co-amoxiclav and simvastatin?
Clavulanic acid and simvastatin can increase the risk of hepatotoxicty.
78
There are three domains of public heath:
Health improvement
Health protection
Health service delivery and quality
What do they cover?
Health improvement including people's lifestyles as well as inequalities in health and the wider social influences of health.
Health protection including infectious diseases and environmental hazards and emergency preparedness
Health service delivery and quality (also known as healthcare public health)
79
The price of certain drugs which may be available as a branded product or a generic product is calculatec based on the manufacturers' price for branded products and the generic product price. If not generic product is available the pharmacist will be paid for the cost of the branded product if they endorse on the rx.
Which of the following best describes the category of payment for basic prices of drugs described above?
```
Category A
Category B
Category C
Category E
Category M
```
Category A: Drugs which are readily available.
The Secretary of State determines the prices for Category A drugs to be the weighted average of the prices listed by the following four manufacturers and suppliers; AAH, Alliance Healthcare (Distribution) Ltd, Teva UK and Actavis on or before the 8th of the month being reimbursed. In the weighted formula, AAH and Alliance Healthcare (Distribution) Ltd prices have a weighting of 2, the prices from the other suppliers have a weighting of one.
Category B: Drugs whose usage has declined over time.
Category C: Drugs which are not readily available as generic and price is determined by Secretary of State based on that listed by supplier.
Category E: ???
Category M: Drugs which are readly available and price determined on information supplied by manufacturers - not an average.
80
Amiodarone has a black dot interaction with which (if any) of the following:
Grapefruit juice
Amitriptyline
Simvastatin
Amiodarone interacts with grapefruit juice but just avoid the juice.
Amiodarone interacts with amitriptyline in a black dot interaction as increased risk of ventricular arrhythmias.
Amiodarone and simvastatin (max 20mg) both increase each others plasma concentration and both can cause myopathy.
(NB: amiodarone and amitriptyline react with parenteral erythromycin only)
81
Which of the following causes HYPOcalcaemia
Bendro
Furosemide
Bendro causes:
Hyper - glycaemia, natraemia, kalaemia, calcaemia.
Hypomagnesia
Loops cause hypocalcaemia
82
What is the target INR for recurrent thromboembolism?
3.5
83
Already taking clopidogrel, is pen-allergic, needing H.pylori eradication:
esomeprazole 20mg twice a day, clarithromycin 250mg twice a day,
metronidazole 400mg twice a day
lansoprazole 30mg twice a day, clarithromycin 250mg twice a day, metronidazole
400mg twice a day
omeprazole 20mg twice a day, clarithromycin 250mg twice a day, metronidazole
400mg twice a day
pantoprazole 40mg twice a day, amoxicillin 1 gram twice a day, clarithromycin
500mg twice a day
rabeprazole 20mg twice a day, amoxicillin 1 gram twice a day, clarithromycin
500mg twice a day
Esomeprazole and omeprazole both reduce the efficacy of clopidogrel.
Omeprazole, a moderate CYP2C19 inhibitor, has been shown to reduce the pharmacological
activity of Plavix if given concomitantly or if given 12 hours apart. Consider using another
acid-reducing agent with less CYP2C19 inhibitory activity. Patient is allergic to penicillin, so
can’t have amoxicillin
84
Which of the folllowing is LEAST appropriate in renal failure?
```
Panadol
Gaviscon Liquid
Gaviscon Tablets
Remegel Tablets
Gaviscon Advance
```
Paracetamol (Hedex ®, Panadol ® ) is safe and suitable to treat headaches.
For occasional treatment of indigestion a product such as Gaviscon ® Liquid or tablets can be taken. Gaviscon ®Advance should not be used as it contains potassium which may be restricted in renal disease.
Remegel ® tablets which contain calcium carbonate can also be taken occasionally provided levels of calcium in the blood are not raised above normal.
85
When can pertusis immunity be transferred to the child from a pregnanct mum?
If she is immunised between 28-32 weeks of pregnancy.
86
Which of the following medicines may affect a patients regular warfarin?
```
Ethambutol
Isoniazid
Omeprazole
Pyrazinamide
Rifampicin
```
Rifampicin is a potent enzyme inducer and therefore will increase the metabolism of particular drugs.
In this case it is rifampacin with warfin.
87
Unilateral pain within and above the eye in the temporal region which lasts for two hours and occurs three times a day is:
```
Chronic daily headache
Cluster headache
Medication-overuse headache
Migraine
Tension-type headache
```
Cluster headache.
88
Which of the following carries the lowest risk of cardiovascular side-effects when used in standard doses?
```
Diclofenac
Ibuprofen
Indomethacin
Naproxen
Piroxicam
```
High-dose naproxen is associated with less vascular risk than other NSAIDs.
High-dose diclofenac and possibly ibuprogen, are comparable to coxibs, whereas high-dose naproxen is associated with less vascular risk than other NSAIDs.
89
Which of the following is NOT correct?
Chloroquine is unsuitable for malaria prophylaxis in individuals with a history of epilepsy.
Travel to malarious areas should be avoided during pregnancy; if travel is unavoidable, then only use personal protection (such as mosquito nets), as proguanil is contraindicated in pregnancy
Prophylaxis is not absolute and therefore infection can occur with any of the drugs recommended.
Prophylaxis should be continued for 4 weeks after leaving with the exception of Malarone.®
Chloroquine has an increased risk of ventricular arrhythmias when used with amiodarone.
Proguanil can be given in the usual doses during pregnancy as benefit of prophylaxis in malaria outweighs risk.
90
Which of the following is the most appropriate treatment for pernicious anaemia?
```
Cyanacobalamin
Epoetin alfa
Ferrous sulfate
Folic acid
Hydroxocobalamin
```
The drug of choice is hydroxocobalamin, as cyanocobalamin is poorly absorbed.
91
Which one of the following medicines carries the lowest risk of gastro-intestinal side-effects when used in standard doses?
```
Diclofenac
Ibuprofen
Indomethacin
Naproxen
Piroxicam
```
Ibuprofen
92
What does R.U.L.E stand for?
Resist
Understand
Listen
Empower
93
Which of the following is least likely to occur in Reye's syndrome?
```
Vomiting
Seizures
Muscle aches
Raised white cell count
Raised transaminases
```
```
Initial symptoms can include:
•persistent, effortless vomiting
•listlessness (a lack of interest or enthusiasm) and a loss of energy
•drowsiness
•rapid breathing
•seizures (fits)
```
As the condition progresses, the symptoms may become more severe and wide ranging, and
can include:
•personality changes, such as extreme irritability, agitation or aggressive behaviour
•delirium (a severe state of mental confusion and anxiety sometimes associated with
hallucinations)
•coma (loss of consciousness)
Blood tests: lft’s, wcc
94
Are madopar dispersible equivalent to madopar capsules of same strength?
Yes
95
What are the more water soluble beta blockers?
```
Least likely to cross BBB:
Atenolol
Celiprolol
Nadilol
Sotalol
```
96
Phenytoin + fluconazole =
Toxicity
Visual disturbances, purple glove, slurred speech, confusion
elevated LFT
97
Which of the following has the broadest spectrum of activity?
```
Amoxicillin
Ciprofloxacin
Clarithromycin
Co-amoxiclav
Doxycyline
```
Co-amoxiclav consists of amoxicillin and clav acid which is a beta-lactamase inhibitor.
98
Can people with high Blood pressure use guaifenesin?
Yes
99
Which of the following is associated with the greatest risk of gastro-intestinal side effects?
Aspirin
Naproxen
Diclofenac
Ketoprofen
out of those: Ketoprofen is associated with the greatest risk of gastro-intestinal side effects
100
What painkiller should be used in those who cannot tolerate opioids?
Oxycodone
| Initial dose of oxycodone IV is 2mg/hr
101
How should cradle cap be managed?
Brushing, soaking etc.
102
The use or oral prednisolone and ciprofloxacin increases the risk of what?
Tendon rupture
103
Man taking darunavir 800mg, ritonavir 100mg and Truvada (emtricitabine and tenofovir) all 1 od, wants an OTC product for hay fever (runny nose). Which of the following is the most appropriate?
```
Fluticasone nasal spray
Beclometasone nasal spray
Nasacort nasal spray
Otrivine nasal drops
Sterimar nasal spray
```
Fluticasone interacts with:
Ritonavir
Darunavir
Nasacort (triamcinolone) interacts with:
Ritonavir
Darunavir
Otrivine must interact then?
Beclometase interacts with none of the meds.
104
Seretide is what?
LABA (Salmeterol) + Fluticasone (ICS)
105
Freshly prepared means
within 24 hours
106
Which of the following is recommended for patients visiting Mecca?
```
BCG vaccine
Hepatitis B vaccine
Influenza vaccine
Meningococcal B vaccine
Meningococcal quadrivalent ACWY
Pneumococcal conjugate vaccine
Rotavirus
Tetanus
```
Meningitis ACWY immunisation is recomended for patients visiting Mecca.
107
Otomize ear spray is usually given as what dosing?
Three times daily
108
Which of the following symptoms is most likely to be associated with acute sinusitis?
Dull, diffuse bilateral pain that often eases on bending down
Dull, diffuse bilateral pain that is often worse on bending down
Dull, localised unilateral pain that often eases on bending down
Dull, localised unilateral pain the is often worse on bending down
Sharp, localised bilateral pain that often eases on bending down
Dull, localised unilateral pain the is often worse on bending down
109
Mr LK, 54 years old is suffering from congestion for the past 4 days, he tells you his nose is blocked. He currently takes a nasal spray recommended by his GP for hay fever.
He also stopped taking phenelzine one week ago.
He finally mentions he has tried steam inhalation.
What type of OTC product would be most unsuitable?
Pseudoephedrine would not be appropriate - there is a risk of hypotensive crisis when pseudoephedrine is given with MAOIs - avoid psuedoephedrine for at least two weeks after stopping MAOI.
110
SL GTN typically provides relief for:
2-5mins
10-15mins
20-30mins
60-80mins
20-30mins
111
Which one of the following is indicated in phenytoin toxicity?
Nystagmus is a late complication
Alopecia is a complication
Agranulocytosis
Vitamin D metabolism abnormalities can occur
Increase in deep tendon reflexes are a manifestation of phenytoin toxicity.
Vit D metab abnormalities in phenytoin.
Nystagmus happens early on.
112
Which of these is most likely to have caused gout?
```
Allopurinol
Atorvastatin
Clopidogrel
Indapamide
Lisinopril
```
Indapamide
113
What is the best monitoring parament for smoking cessation progress?
Carbon monoxide monitoring is useful in following up smoking cessation treatment compliance. It is worth noting that the lungs will contain some residual carbon monoxide from road pollution.
114
Which of the following is most likely to have worsened a patients diabetic control?
```
Amlodipine
Atorvastatin
Citalopram
Olanzapine
Zopiclone
```
Olanzapine
115
Daptomycin is a lipopeptide antibacterial that only treats what type of infection?
Gram Positive, skin and skin structure infections, only via IV, works by disrupting cell membrane function.
116
Why do black patients respond better to diuretics?
Increased salt sensitivity and therefore renal vascualr resistance.
117
If amiodarone is found to be causing hyperthyroidism, what should happen?
It should be withdrawn, at least temporarily to help achieve control.
118
Best antidepressant in a patient with unstable angina, or a recent heart attack is
Sertraline
119
Which of the following cannot be prescribed in instalments?
```
Buprenorphine
Buprenorphine/naloxone
Chlordiazepoxide
Diazepam
Methadone
```
All Sch 2 plus diazepam can be prescribed by instalments.
120
Which of the following is NOT eligible for the free flu vaccination?
The main carer for an elderly or vulnerable person whose welfare may be at risk if the carer falls ill.
Pregnant women, in the second or third trimester.
Those who are 65 and over.
Those living in a long-stay residential care home or other long-stay care facility
A diabetic man of any age
Pregnant women of ANY stage of pregnancy are eligible.
```
Certain medical conditions:
Chronic respiratory conditions
CHD
CKD
C liver D
Chronic neurological disease
Diabetes
Immunosuppression
Asplenia or splenic dysfunction
Morbid obesity
```
121
The use of the SCR in the pharmacy setting is linked to what payment scheme?
The quality payment scheme in the community setting.
122
A patient brings in a rx for isosorbide mononitrate 20mg tablets, one to be taken three times each day.
Which of the following is the most appropriate advice to give?
He will need to return to his GP as isosorbide mononitrate is given twice daily.
Development of tolerance is not associated with tablet formulations of isosorbide mononitrate
He needs to ensure he takes it regularly at 6 hourly intervals
He is unlikely to experience any headache or flushing with this drug.
He can chew on the tablets if a heart attack is suspected whilst somone calls an ambulance.
Needs to be taken so that there is at least an 8 hour nitrate free interval
123
In stoma care, how should iron be supplemented?
Parenteral if oral not working, NOT MR forms.
124
Which of the following can be used IV and acts by inhibiting sodium and potassium activated myocardial adenosine triphosphate?
```
Adenosine
Amiodarone
Amphotericin
Ciclosporin
Infliximab
Insulin
Phenytoin
Tacrolimus
```
Amiodarone works by inhibiting myocardial ATPase activity via sodium and potassium channel inactivation.
125
Licensed as a twice daily dose for mild to moderate dementia associated with Parkinsons disease:
Galantamine
Memantine
Rivastigmine
Donepezil
Answer: Rivastigmine
Memantine: NMDA antagonists with a neuroprotective effect.
Donepezil: ACh inhibitor
Galantamine: ACh inhibitor
126
When should someone seek advice if the symptoms of slapped cheek have not improved?
Within 7-10 days.
127
Which LTRA can cause liver disorder?
Zarfirkulast
128
A patient with chronic kidney disease (not on dialysis) who has developed a high phosphate level (1.8 mmol /L), would be prescribed:
```
Phytomenadione
Pabrinex
Sevelamer
Colecalciferol
Menadiol sodium phosphate
Calcium polystyrene
```
High phosphate: sevelamer.
Warfarin overdose: Phytomenadione.
Alcohol abuse -> Wernicke's encephalopathy -> Pabrinex
Vit K deficieny in fat malabsorption syndromes like biliary obstruction: Menadiol sodium
Primary hyperparathyroidism when parathyroidectomy not possibe: Cincacalcet - impacted by smoking.
129
Which of the following is the LEAST appropriate in renal failure?
```
Zantac (ranitidine)
Pepcid (famotidine)
Gaviscon Liquid
Tagamet (cimetidine)
Remegel tablets
```
Ranitidine (Zantac ®), famotidine (Pepcid ®, Boots Excess Acid Control ®) and nizatidine can also be purchased for short term relief of heartburn, particularly when the symptoms are related to consumption of food and drink. Cimetidine (Tagamet ®) is also available to buy but can lead to a rise in the blood test for Creatinine, which will make it seem as if kidney function has got worse – so best avoided if there is an alternative.
130
What electrolyte imbalances can lead to digoxin toxicity?
Hypokalaemia and hypomagnesaemia.
131
Is the AED which carries with it an increased risk of cleft palate if taken in the first trimester
Topiramte.
| Also something to do with glaucoma risk.
132
Trastuzumab (herceptin) has what side effects?
1. Asthenia: abnormal physical weakness, lack of energy
| 2. Peripheral neuropathy
133
Which of the following is not a risk factor for GORD?
```
Smoking
Verapamil
Stress
Travelling abroad
Obesity
```
```
Risk factors for triggering GORD are:
Drugs which lower oesophageal sphincter relaxation (e.g. calcium channel blockers).
Smoking
Alcohol
Obesity
Stress
```
134
A dopamine receptor antagonist which acts centrally by blocking the chemoreceptor trigger zone:
Promethazine
Prochlorperazine
Prochloperazine.
135
Which of the following regarding indapamide is correct?
A common side-effect is hypernatraemia
It can be taken by breast feeding mothers
It is taken in the morning.
The usual dose is 5mg daily
There is no risk of cardiac toxicity if taken together with digoxin
A common side-effect of indapamide is HYPOnatraemia not HYPER.
It should not be used by breast feeding mothers.
It is taken first thing in the morning.
The usual dose is 2.5mg daily .
There is a risk of cardiac toxicity if taken with digoxin due to hypokalaemia.
136
Which of the following is most appropriate for endoscopy pre-med in extremely anxious person?
Temazepam 10mg orally night before
Diazepam 10mg orally 2 hours pre-op
Midazolam 2.5mg SC, 5-10 mins pre-op
Lorazepam 3mg oral the night before the procedure
Midazolam is best option as need a short-acting agent with rapid onset of action
137
The patient has been prescribed penicillin V for tonsillitis. She asks whether she will be okay to continue breastfeeding her 5 month old baby. What is the best advice for the patient?
She should avoid feeding the baby for 45 minutes after taking the medicine when it is at peak concentration
She should stop breastfeeding until after the course is complete
Pen V is considered compatible for breastfeeding but the infant should be monitored.
The patient should be referred to her health visitor
The treatment is not compatible with breastfeeding and the patient should be referred back to her GP
Pen V is considered safe but baby should be monitored.
Ceph too.
138
Using an enema to deliver a medicine gives acces to the haemorrhoidal veins, what is the benefit of this?
Bypass first pass metabolism
139
If a patient is taking phenytoin for epilepsy and develops blood or skin disorders, how should this be managed?
Withdraw the phenytoin.
140
Which of the following is considered an active failure leading to a medication administration error?
```
Clinical negligence
Communication
Errors in execution
Safety culture
Team structure
```
Errors in execution such as slips and lapses are considered active failures in the medication error model.
All other options are latent failures.
141
All suspected adverse reactions in children should be reported to the MHRA even if the black triangle status has been removed.
True or False?
False.
In September 2014 the advice on which suspected adverse drug reactions (ADRs) to report in children was changed to be the same as adults. Originally, the MHRA requested yellow card reporting of all suspected ADRs in children but this is no longer necessary.
142
Which of the following is LEAST appropriate for use in renal failure?
Zantac (ranitidine)
Pepcid (famotidine)
Oral Rehydration Sachets
Loperamide
Diarrhoea can result in fluid loss and upset fluid balance. Oral rehydration powder is sold for use in diarrhoea but since it contains both sodium and potassium it should be avoided in people with severe kidney disease except with medical advice. If the symptoms are mild, loperamide (Imodium ®) can be used to control them.
143
Black patients have what level of circulating renin?
High
144
Liver failure can be caused by:
Metformin
Acarbose
Insulin
Pioglitazone
The thiazolidinediones, like pioglitazone, have occasionally been associated with liver failure
(Acarbose not after abdominal surgery)
145
OTC tamsulosin should not be supplied and referral should be considered for symptoms of BPH of less than what length of time?
Symptoms <3 months.
Referral if any leaking of urine (incontinence) in the last 3 months as this may indicate chronic urinary retention.
146
Which of the following describes the morbidity rate?
The number of deaths per thousand population per year, scaled to population size.
Refers to the incidence rate of disease within a population.
The presence of two concomitant disease states, or conditions, in a patient at the same time.
The ratio of the risk of disease, or death, among people who are exposed to the risk factor, to the risk among people who are unexposed.
The number of deaths per hundred thousand people per year, scaled to population size.
Morbidity: incidence rate of disease within a person, so morbidity rate: incidence rate of disease within a population.
147
Which of the following is it most appropriate to counsel to be taken with or just after food?
Amiodarone
Metronidazole
Co-beneldopa
Metro and co-beneldopa
NB: neither co-beneldopa or co-careldopa have warning labels regarding drowsiness....
148
Simvastatin max dose of 20mg when with: (4)
Diltiazem
Amiodarone
Verapamil
Amlodipine
149
The usual flixonase dosing for nasal polyps is
6 drops in each nostril daily.
Flixonase nasaluse contain 12 drops per pouch.
150
What is procyclidine used for?
The EPS of parkinsons and antipsychotics
151
What type of vaccine is the varicella-zoster vaccine?
Live
152
Ramiprial can cause which of the following?
Bradycardia
Tachycardia
Tachycardia can be caused by ramipril.
153
Which of the following is NOT a clinically significant interaction?
```
Amiodarone + Grapefruit juice
Codeine phosphate + Grapefruit juice
Colchicine + grapefruit juice
Fexofenadine + grapefruit juice
Pravastatin + grapefuit juice
```
Rosuvastatin, fluvastatin and pravastatin can be safely taken with grapefruit juice.
154
Hair falling out can be caused by what anticoagulant?
Warfarin
155
Written consent is needed for the SCR, true or false?
There is a written form but consent can be verbal.
156
Low sodium has what effect on lithium?
Toxicity
157
Which of the following are stimulant laxatives?
```
Senna
Lactulose
Docusate
Arachic oil
Glycerol
```
Senna is a stimulant laxative which stimulates contractions of the gut.
Docusate sodium stimulates the gut and softens the stool.
Lactulose draws fluid from the blood and the fluid it is drunk with.
Arachis oil softens impacted stools
Glycerol causes peristalsis by irritating the area
Bulk-forming laxatives cause stimulation by increaseing faecal mass
158
Which of the following is incorrect refarding midwife supply orders?
It must contain the occupation of the midwife
It must contain the patient for which the controlled drug is being obtained
It must contain the total quantity of drug to be obtained
It must contain the signature of an appropriate medical officer
It must contain both the name and address of the midwife
It is not a pre-requisite for a midwife to state their address on a midwife supply order.
159
Mrs G, who is 55 years old, had been diagnosed with type 2 diabetes 6 months ago. She was prescribed metformin but suffered with chronic diarrhoea as a result of her treatment. Her GP decided to change Mrs G to dapagliflozin 10mg daily as monotherapy. What is the drug action of dapaglifozin?
Binds to, and activates the glucagon-like peptide-1 receptor to increase insulin secretion.
Inhibits dipeptidylpeptidase-4 to increase secretion and lower glucagon secretion
Decreases gluconeogenesis and increases peripheral utilisation of glucose
An inhibitor of intestinal alpha glucosidases and delays the absorption of starch and sucrose
Reversibly inhibits sodium-glucose co-transporter 2 in the renal proximal convoluted
tubule to reduce glucose reabsorption and increase urinary glucose excretion
GLP-1: Binds to, and activates the glucagon-like peptide-1 receptor to increase insulin secretion.
Gliptins: Inhibits dipeptidylpeptidase-4 to increase secretion and lower glucagon secretion
Metformin: Decreases gluconeogenesis and increases peripheral utilisation of glucose
Acarbose: An inhibitor of intestinal alpha glucosidases and delays the absorption of starch and sucrose
Glifozins: Reversibly inhibits sodium-glucose co-transporter 2 in the renal proximal convoluted
tubule to reduce glucose reabsorption and increase urinary glucose excretion
160
What is the best treatment option for theophylline overdose?
Activated charcoal
161
Children with stoma are at particular risk of what electrolyte imbalance?
Hypokalaemia
162
Can Pharmacy technicians access a patients SCR?
Yes
163
When should the following be stopped prior to surgery?
```
Warfarin
Aspirin
Clopidogrel
Dabigatran
Apixaban/rivaroxaban/edoxaban
```
```
Warfarin: one week.
Aspirin: one week.
Clopidogrel: one week (irreversible platelet binding, platelets lives ~7days)
Dabigatran:
Major and ok renal: 48h
Minor and ok renal: 24h
```
Apixaban/rivaroxaban/edoxaban:
Major and any renal: 48h
Minor and ok renal: 24h
164
Which of the following may cause hyperuricaemia?
```
Allopurinol
Febuxostat
Colchicine
Indapamide
Sulfinpyrazone
```
Indapamide can cause hyperuricaemia
165
Indicated for conscious sedation for dental procedures 30-60 minutes before procedure:
Lorazepam
Temazepam
Temazepam
166
What disturbances of calcium metabolism need to be corrected before starting zoledronic acid treatment?
Vitamin D deficiency
| Hypocalcaemia
167
Which one of the following drugs should be omitted in order to have the greatest reduction in risk of complications associated with the insertion of an epidural catheter?
```
Candersartan
Levothyroxine
Dabigatran
Gliclazide
Dalteparin
```
NOACs carry a risk of causing epidural haematoma (collection of blood in between skull and dura mater); no evidence of risk with LMWH.
168
Which of the following is not a side effect of procyclidine?
```
Blurred vision
Constipation
Bradycardia
Dry mouth
Urinary retention
```
Procyclidine is an anticholinergic which can cause tachycardia not bradycardia
169
What is the correct order of the following with regards to audit cycle?
```
Select criteria to review
Make improvements
Prepare for audit
Measure performance
Sustain improvements
```
1. Prepare for audit
2. Select criteria to review
3. Measure performance level
4. Make improvements
5. Sustain improvements
170
How should the normal H.pylori treatment be modified in a patient who is penicillin allergic, takes ciclosporin and clopidogrel?
Omeprazole and esomeprazole = NO with clopidogrel.
Lansoprazole ok!
Penicillin allergic so NO amoxicillin: left with clarithromycin or metronidazole.
Ciclosporin and Clarithyromycin: NO! so has to be metronidazole.
Would probably need to add in tetracycline plus tripotassium whatever it is.
171
Which of the following is the most likely cause of acute COPD exacerbation?
```
Chlamydia psittaci
E. coli
Legionella pnuemophillia
Moraxella Catarrhalis
Pseudomonas aeruginosa
```
Common bacterial pathogens of acute exacerbations include Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis.
172
Which of the following medications would be suitable for a 24 year old male with an acute psychotic episode?
```
Paloperidone decanoate 50mg monthly
Olanzapine 10mg daily
Haloperidol 10mg qds
Clozapine 100mg tds
Flupenthixol decanoate 200mg every two weeks
```
Olanzapine: 2nd gen
173
Can a child taking carbamazepine for epilepsy be treated with Ovex?
Yes, Ovex (mebendazole) is fine, it only interacts with cimetidine, increased mebendazole.
174
Failure to respond to betamethasone valerate 0.025% cream. Which is the best next treatment to try?
```
Clobetasone butyrate 0.05% cream
Hydrocortisone acetate 1% cream
Clobetasol propionate 0.05% cream
Hydrocortisone butyrate 0.1% cream
Aclometasone dipropionate 0.05% cream
```
Mild potency:
Hydrocortisone 0.1%, 0.5%, 1.0%, 2,5%.
```
Moderate potency:
Alclometasone 0.05%
Betamathosone valerate 0.025%
Clobetasone butyrate 0.05%
Fluocinolone acetonide 0.001%
```
```
Potent potency:
Betamethasone dipropionate 0.05%
Betamethasone valerate 0.1%
Hydrocortisone butyrate 0.1%
Mometasone furoate 0.1%
```
Very potent:
Clobetasol propionate 0.1%
Diflucortolone valrate 0.3%
So failure to respond to a moderate potency cream, so wouldnt use a low potency hydrocortisone acetate 0.1% or another moderate potency cream so wouldnt use clobetasone butyrate 0.05% or aclometasone dipropionate 0.05% .
So the option would be hydrocortisone butyrate as a potent steroid because clobetasol propionate 0.1% is a VERY potent steroid so wouldnt go to that without trying a potent one first.
175
Which is stronger:
| Clobetasol butyrate vs Clobetasol propionate
Mild potency:
Hydrocortisone 0.1%, 0.5%, 1.0%, 2,5%.
```
Moderate potency:
Alclometasone 0.05%
Betamathosone valerate 0.025%
Clobetasone butyrate 0.05%
Fluocinolone acetonide 0.001%
```
```
Potent potency:
Betamethasone dipropionate 0.05%
Betamethasone valerate 0.1%
Hydrocortisone butyrate 0.1%
Mometasone furoate 0.1%
```
Very potent:
Clobetasol propionate 0.1%
Diflucortolone valrate 0.3%
176
Which is stronger?
Betamethasone valerate 0.025%
Betamethasone valerate 0.1%
Betamethasone dipropionate 0.05%
Mild potency:
Hydrocortisone 0.1%, 0.5%, 1.0%, 2,5%.
```
Moderate potency:
Alclometasone 0.05%
Betamathosone valerate 0.025%
Clobetasone butyrate 0.05%
Fluocinolone acetonide 0.001%
```
```
Potent potency:
Betamethasone dipropionate 0.05%
Betamethasone valerate 0.1%
Hydrocortisone butyrate 0.1%
Mometasone furoate 0.1%
```
Very potent:
Clobetasol propionate 0.1%
Diflucortolone valrate 0.3%
177
Which is stronger, Clobetasol vs clobetasone?
Clobetasone butyrate 0.05% = moderate.
Clobetasol propionate = very potent
Mild potency:
Hydrocortisone 0.1%, 0.5%, 1.0%, 2,5%.
```
Moderate potency:
Alclometasone 0.05%
Betamathosone valerate 0.025%
Clobetasone butyrate 0.05%
Fluocinolone acetonide 0.001%
```
```
Potent potency:
Betamethasone dipropionate 0.05%
Betamethasone valerate 0.1%
Hydrocortisone butyrate 0.1%
Mometasone furoate 0.1%
```
Very potent:
Clobetasol propionate 0.1%
Diflucortolone valrate 0.3%
178
How long does it take for myelosuppresion to occur?
If you’re in chemotherapy, your blood cell counts will begin to decrease between 7 to 10 days after starting treatment. In mild cases of myelosuppression, treatment is not necessary. Blood count production will return to normal in a matter of weeks.
179
How to calculate IBW?
Men: 50kg + (2.3kg * [height in In - 60])
Women: 45.5kg + (2.3 * [helgiht in In - 60])
180
IS the interaction between doxycycline and phenytoin clinically relevant?
No
181
Patient on lymecycline, an acne cream and dermol is added, what is wrong with this?
Dont think dermol is indicated?
182
Drugs for respiratory depression in elderly care
Breathlessness at rest may be relieved by regular oral morphine in carefully titrated doses. Diazepam may be helpful for dyspnoea associated with anxiety. A corticosteroid, such as dexamethasone, may also be helpful if there is bronchospasm or partial obstruction.
183
Why is glucose suitable as a diluent in IV therapy?
DONT KNOW
184
What is the Green book used for?
Immunisations, vaccines.
185
What is the Orange Guide for?
Manfucaturing
186
Apixaban dose for stroke prevention in AF
5mg BD or reduced to 2.5mg BD if over 80, <60kg or Creatine >133
187
What does CHA2DSVASc stand for?
```
Coronary Heart Disease
Hypertension
Age >65 = 1
Diabetes
Stroke or TIA =2
Vascular disease
Age >75 = 2
Sex category, women = 1 point
```
188
Apixaban dose for VTE prophylaxis following knee surgery
2.5mg BD 10-14 days
189
What are the cardioselective beta blockers (NAMB)
Atenolol
Bisoprolol
Metoprolol
Nebivolol
190
What does HASBLED stand for?
```
Hypertension
Abnormal liver or renal
Stroke
Bleeding already lol or predisposed
Labile INR (up then down then up then down etc)
Elderly
Drugs alcohol etc
```
191
Which beta blockers are worse in breastfeeding?
Water soluble beta blockers are present in breast milk in greater amounts that other BB
192
Apixaban dose for the treatment of DVT/PE
10mg BD 7 days then 5mg BD
193
When should SSRI's be taken?
What about TCA's?
What about Mirtazepine?
SSRI's- take in the morning as they are mildly stimulating
TCA's- take at night as can cause drowsiness
Mirtazepine (tetracyclic)- take at night as can cause drowsiness
194
Which of the following medications is most likely to cause hypernatremia?
```
Beclometasone inhaler
Bisoprolol
Felodipine
Prednisolone
Salbutamol inhaler
```
Corticosteroids may cause:
Sodium retention, potassium, calcium loss, most pronoucned with oral steroids. so prednisolone.
Salbutamol could cause hypokalemia
195
Isosorbide mononitrate, 10mg twice a day counselling:
Headache occurrence tends to decrease with continued therapy
Tablets should be discarded 8 weeks after opening the packet
Tablets should be stored in a glass container
Doses should be spread evenly throughtout the day
Tablets may be dissolved under the tongue for faster relief of chest pain
Headache occurence will decrease, other stuff is for GTN tablets i think.
196
Which of the following statements is false?
phytomenadione is a lipid-soluble analogue of vitamin k
phytomenadione prevents the hepatic synthesis of active prothrombin
phytomenadione is indicated in babies at birth in order to prevent vitamin
k deficiency bleeding
vitamin k deficiency bleeding may manifest in intracranial bleeding
vitamin k deficiency may occur in neonates due to medications taken by
the mother during pregnancy, for example: carbamazepine
Phytomenadione Promotes the hepatic synthesis of active prothrombin, so encourages clotting preventing haemorrhage
197
Pain in the eye, red and watery, photophobia, difficulty reading small print, no trauma:
bacterial conjunctivitis
Iritis
Allergic conjuctivits
Sub-conjunctival haemorrage
viral conjunctivitis
Iritis
198
Can you use fentanyl with moclobemide?
not advicsed best avoid
199
Why is less phenytoin (on a mg/kg basis) needed to treat seizures in neonates compared to babies older than 3 months old?
the plasma concentration of phenytoin is higher in neonates than in
children
bilirubin is displacing phenytoin from albumin more readily in neonates
neonates have lower albumin levels leading to increased “free” phenytoin
phenytoin in equivalent doses is less toxic in neonates than in children
phenytoin is being excreted more slowly in neonates
Neonates have decreased plasma concentrations of albumin and alpha1-acid glycoprotein, resulting in increased plasma concentrations of unbound (active) drug.
