Incorrect Mock Questions Flashcards
Pregnant lady with a UTI (12/40 weeks gestation), which is most appropriate?
Amoxicillin Cefalexin Clindamycin Erythromycin Flucloxacillin Isoniazid Rifampicin
Cefalexin is ok for UTI in pregnancy.
Which one of the following has been associated with convulsions in cases of overdosage?
Morphine Pethidine Methadone Fentanyl Codeine
Pethidine
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
Carbamazepine:
Blood, liver, or skin disorders, fever, rash, mouth ulcers, bruising, bleeding.
What for CCB overdose?
CCB
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
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.
Dose of paracetamol for immunisations?
2.5ml qds (2.5ml = 60mg)
Can methotrexate cause a miscarriage?
May harm unborn baby but unlikely to cause a miscarriage.
Which of these are/is ACh inhibitor(s):
Galantamine
Memantine
Rivastigmine
Donepezil
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.
Which of the following should be added to existing treatment of amlodipine in a 56 year old African patient?
Atenolol Bendroflumethiazide Indapamide Ramipril Valsartan
Valsartan:
ARBs are preffered second line after a CCB in treating a 56-year old, African patient.
An antihistamine and serotonin antagonist indicated in the prophylaxis of migraines
Pizotfen
Which of the following does NOT need to be excluded before starting treatment for osteoporosis?
Hyperparathyroidism
Hyperthyroidism
Hypothryroidism
Osteomalacia
Hypo does not cause osteoporosis
scurvy is a deficiency of
Vit C
Buccastem M is only licensed for what?
Nause and vomiting in previously diagnosed migraine, in adults aged 18 and over.
Which of the following is LEAST appropriate in renal failure?
Chlorphenamine Fybogel Omeprazole Paracetamol Senna
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.
Failure to treat which of these may lead to heart failure?
Asthma COPD Anaemia Diabetes Epilepsy Hepatic disease Hypercholesterolamia Renal disease
When anaemia becomes severe, the heart has to pump harder and faster to compensate for the decreased oxygen levels in the body.
When should sodium valproate be used in absence seizures?
When there is a high risk of GTC seizures.
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
BV: thin, white fishy-smelling discharge.
Cadida albicans: white, cottage-cheese like
TV: frothy, yellow-green smelly
Can pregnant women use gaviscon or peptac?
Yh: following the lifestyle and dietary advices, an alginate preparation is advisable.
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.
Buprenoprhine
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
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?
Is loperamide ok in renal failure?
Yes
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
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.
Carbamazepine and SSRs (and other antidepressants) can both cause what electrolyte imbalance?
Hyponatraemia.
Piroxicam topical treatment should be reviewed after how long?
4 weeks
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.
Gliclazide has a black dot interaction due to enhanced hypoglycaemic effect when taken with what drug?
Warfarin
Which of the following does NOT cause hyponatraemia?
Glimepiride
Gliclazide
Glipizide
Gliclazide does not cause hyponatraemia.
Glimepiride and glipizide do.
Allopurinol is associated with what syndrome?
Steven-Johnsons-Syndrome
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.
Recently prepared means
within 4 weeks
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.
Analgesic with both an opiod effect and enhances the serotonergic and adrenergic pathways
Tramadol
What is used to treat patent ductus arteriosus other tha surgery?
Prostaglandin inhibitors –> NSAIDs –> Indomethacin or ibuprofen
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
Do pharmacists have read/write access to SCR?
Not write.
AED and can be given once daily due to long-half life:
Topiramate
Carbamazepine
Phenobarbital
Levetirecatam
Phenobabr
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.
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.
Insulin glargine:
Insulin glulisine:
Glarg: long
Glu: fast
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
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.
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.
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
Amiodarone, azola antifungals and macrolides have what effect on simvastatin?
increase its levels
What are the long-term PPI use risks? (4)
- C.diff
- Fractures (osteoporosis)
- Hypomagnesia
- CAP
Cetrizine is only licensed for use in what ages?
> 2 for liquid.
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.
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.
MOAi are cautioned for use in cardiovascular disease.
True or False?
True.
Terbinafine is associated with what skin disorder?
Toxic epidermal necrosis/SJS
Can aspirin be used for prevention of cardiovascular events in someone with COPD who has previously had a CV event?
Yes
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
What topical NSAID is associated with more frequent serious skin reactions?
Piroxicam
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.
Calcium polystyrene resin treats
Hyperkalaemia.
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.
Clinical outcomes include what?
Length of hospital stay.
Adverse drug reactions.
Hospital readmission
Death
Infants have what pH gastric contents?
High pH
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.
Which heparins have a lower risk of heparin induced thrombocytopenia?
LMWH lower than ufh
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
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.
How is hand foot and mouth treated?
PLenty of fluids to avoid dehydration
Soft foods
Paracetamol or ibuprofen
Perindopril should be taken with or without food?
Perindopril should be taken on an empty stomach, preferabbly 60mins before eating.
Target INR for DVT prophylaxis
3.5
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.
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.
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.
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
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
Out of the following which is the least emetogenic treatment:
Cisplatin Doxorubicin Mitoxantione (anthracycline derivative) Vincristine Cyclophosphamide
Vincristine least emetogenic out of those
p.c. means
After food
Drug use at all is not recommended during what stage of pregnancy?
First trimester
What is an alternative to flucloxacillin for cellulitis in pen-allergic?
Clarithromycin
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.
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.
What is the interaction between co-amoxiclav and simvastatin?
Clavulanic acid and simvastatin can increase the risk of hepatotoxicty.
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)
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.
