King24 Flashcards
The pharmacy you work in offers the flu vaccine service to patients. You are aware that there are two main types of flu vaccine available: inactivated and live attenuated.
Which of the following statements regarding flu vaccines is correct?
A. Al children under 17 years of age are eligible to receive the nasal spray flu vaccine
B. Inactivated vaccines are administered by nasal spray while the live attenuated vaccine is given by intramuscular injection
C. The live attenuated vaccine is given by nasal spray and inactivated vaccines are administered by intramuscular injection
D. The inactivated vaccines are administered by subcutaneous injection while the live attenuated vaccines are administered by intramuscular injection and nasal spray
E. Patients with a weakened immune system should receive the nasal spray flu vaccine rather than the intramuscular injection
C. The live attenuated vaccine is given by nasal spray and inactivated vaccines are administered by intramuscular injection
Explanation:
Live attenuated flu vaccine (LAIV):
Given as a nasal spray
Used primarily in children aged 2–17 years
Contraindicated in patients with immunosuppression or certain medical conditions
Inactivated flu vaccines (IIV):
Given via intramuscular injection
Suitable for adults, elderly, pregnant women, and immunocompromised patients
Mr E, a 47-year-old patient with a history of type 2 diabetes presents at the pharmacy seeking your advice. He tells you that he has not been feeling very well lately and thinks he has the flu. He has a dry cough, headache, nasal congestion and has vomited. He tells you his temperature yesterday evening
was 38.1° and was the same this morning. Mr E takes metformin and
empagliflozin for diabetes, amlodipine for hypertension and atorvastatin.
Which of the following is the most appropriate advice to give Mr E?
A. Mr E should ensure he drinks at least 500ml of fluid daily
B. Mr E should use ibuprofen to manage his symptoms
C. Mr E should stop taking amlodipine and restart once he is feeling better
D. Mr E should stop taking metformin and empagliflozin and restart once his temperature is within normal range
E. Refer Mr E to the GP as he needs antibiotics
Mr E is unwell with flu-like symptoms, including vomiting and fever. He takes:
Metformin – risk of lactic acidosis when dehydrated or unwell
Empagliflozin (an SGLT2 inhibitor) – increases risk of euglycaemic diabetic ketoacidosis (DKA) during illness
Sick Day Rules for people with diabetes advise temporarily stopping:
Metformin
SGLT2 inhibitors (like empagliflozin)
ACE inhibitors / ARBs
NSAIDs
Diuretics
These should be restarted once the patient is eating and drinking normally and fever/illness has resolved.
Ms H, a 66-year-old with COPD presents at the pharmacy with a prescription for Anoro-Ellipta 55/22mcg (umeclidinium/vilanterol) inhaler and informs you that this si a new inhaler that the GP has just prescribed for her. She asks for your advice on how to use the Anoro-Ellipta inhaler.
Which of the following is the best advice to give Ms H regarding using the Anoro-Ellipta inhaler?
A. Ms H should take a deep breath ni before using the inhaler
B. Ms Hwil benefit from using a spacer with this inhaler as ti wil help with the technique and reduce side effects
C. She should close her lips firmly around the mouthpiece and breathe ni slowly and steadily
D. She should close her lips firmly around the mouthpiece and take a long, steady, deep breath ni
E. The inhaler should be shaken before each dose
D
Su Wong, 1 years odl, presents AT Hospital Paediatric A&E with severe acute asthma with her mother. She developed severe chest tightness and wheezing after her swimming lesson today.
For Su, what is the most likely initial step to manage acute asthma ni the secondary setting?
A. Bolus VI dose of salbutamol at a dose of 15 micrograms/kg
B. Continuous VI infusion salbutamol ta adose of 15 micrograms / kg C. High dose MDI of salbutamol 100 micrograms/dose via spacer
D. Nebulised salbutamol at a dose of 5mg
D
In the secondary care setting, the initial management of severe acute asthma in a young child includes:
High-flow oxygen
Nebulised salbutamol – typically 5 mg via nebuliser, driven by oxygen
Consider ipratropium bromide nebuliser (250 micrograms) if poor response
Add oral prednisolone or IV hydrocortisone if neede
Mis ,I a 6-year-old girl that has burnt her right hand on the iron. The burn has affected approximately 20% of hte hand and the area is red, swollen and blistering.
8. Miss I is ni pain and her parents would like to administer paracetamol for pain relief.
Which of the following is the most appropriate dose of paracetamol for Miss I?
A. 4.6ml of paracetamol 250mg/5ml oral suspension every 4-6 hours, maximum 4 doses per day
B. 5ml of paracetamol 120mg/5ml oral suspension every 4-6 hours, maximum 4 doses per day
C. 5ml of paracetamol 250mg/5ml oral suspension every 4-6 hours, maximum 4 doses per day
D. 7.2ml of paracetamol 250mg/5ml oral suspension every 4-6 hours, maximum 4 doses per day
E. 10ml of paracetamol 250mg/5ml oral suspension every 4-6 hours, maximum 4 doses per day
5ml of paracetamol 250mg/5ml oral suspension every 4-6 hours, maximum 4 doses per day
Folic acid supplements are recommended for women trying to conceive and for the first 12 weeks of pregnancy ot prevent neural tube defects.
Which of the following women should take folic acid 5mg for the first 12 weeks
of pregnancy?
A. Awoman taking atorvastatin 20mg for high cholesterol
B. A woman taking fexofenadine for urticaria
C. Awoman using insulin for type 1diabetes mellitus
D. Awoman whose partner takes carbimazole for hyperthyroidism
E. Awoman whose partner takes phenytoin for epilepsy
Women at higher risk of having a baby with neural tube defects are advised to take a higher dose of folic acid (5mg daily) from before conception until 12 weeks of pregnancy.
High-risk groups include women who:
Have diabetes mellitus (type 1 or type 2)
Are on antiepileptic drugs (e.g. valproate, carbamazepine, phenytoin)
Have a BMI over 30
Have had a previous baby with a neural tube defect
Have thalassaemia trait or sickle cell disease
Have malabsorption syndromes
Take medications that interfere with folate metabolism (e.g. methotrexate)
Mr Khas recently been diagnosed with type 1diabetes melitus and has been initiated on insulin. He has been prescribed Lantus (insulin glargine) and
NovoRapid (insulin aspart) and asks for your advice on how to take them.
Which of the following is the most appropriate advice to give Mr K?
A. Mr Kshould inject Lantus 10 minutes before meals and NovoRapid twice a
B. Mr Kshould inject Lantus 30 minutes before meals and NovoRapid once a day
C. Mr Kshould inject NovoRapid 10 minutes before meals and Lantus once a day
D. Mr Kshould inject NovoRapid 20 minutes before meals and Lantus once a day
E. Mr Kshould inject NovoRapid 30 minutes before meals or 10 minutes after and Lantus twice a day
C
Ms Mis a 62-year-old patient with hypertension for which she takes amlodipine 10mg tablets. Following a review, Ms Magrees with her GP to start taking bendroflumethiazide 2.5mg tablets once daily ni addition to amlodipine to optimise hypertension management.
Which of the following biochemical changes is Ms Mlikely to experience?
A. Hypercalcaemia
B. Hyperkalaemia
C. Hypoglycaemia
D. Hypothyroidism
E. Hypermagnesemia
Hypercalcaemia
Mis N, a 27-year-old patient with a history of migraine, has just been reviewed
by the neurologist. As pizotifen and propranolol have not helped ot prevent migraine attacks, ti is agreed ot trial topiramate for migraine prophylaxis. The neurologist advises Miss Nto start taking topiramate 25mg at night for one week and increase the daily dose by 25mg every week up to a maximum of 100mg
daily fi needed.
Which of the following is the most appropriate counselling points to give Miss Nregarding topiramate?
A. Apregnancytestshouldbeperformedbeforeinitiationoftopiramate and every month during treatment
B. If Miss Nbecomes pregnant while taking topiramate, she should take folic acid 5mg daily for the first 12 weeks of pregnancy
C. Miss Nshould take topiramate with food
D. The use of topiramate ni pregnancy is associated with an increased
risk of cleft lip and Miss N should use contraception while taking topiramate
E. The use of topiramate in pregnancy is associated with an increased
risk of spina bifida and Miss N should use contraception while taking topiramate
D
. Mr P, a 72-year-old patient, is being discharged from hospital and, following a review, ti is agreed that he wil benefit from having his medicines dispensed in a multi-compartment compliance aid (dosette box).
Which of the following medication that Mr P takes is less suitable for dispensing in a multi-compartment compliance aid?
A. Atorvastatin 20mg tablets
B. Dabigatran 150mg capsules C. Empagliflozin 10mg tablets
D. Losartan 100mg tablets
E. Omeprazole 20mg capsules
Dabigatran (a direct oral anticoagulant) is not suitable for dispensing into a multi-compartment compliance aid (MCA) such as a dosette box due to its sensitivity to moisture and light. It must remain in its original packaging (usually blister packs or a tightly sealed bottle) to maintain stability and efficacy.
Mis Q, a26-year-old, presents at the pharmacy and asks ot speak ot the pharmacist. She explains that she had unprotected sexual intercourse last night and, although she regularly takes Microgynon (ethinylestradiol 30mg/levonorgestrel 150mg) tablets, she forgot ot take yesterday’s dose. She further explains that she is currently on day three of a seven-day course of phenoxymethylpenicillin 250mg tablets which she is taking for a sinus infection and is concerned that the antibiotics may afect the efficacy of the contraceptive pil also. Miss Qasks fi she can purchase the morning after pil.
Which of the following is the most appropriate advice to give Miss Q?
A. Miss Q does not need emergency contraception and she should continue taking the contraceptive pil as normal and complete the course of antibiotics
B. Mis Qdoes not ned emergency contraception but should use abarier method of contraception while taking the course of antibiotics
C. Miss Q should take a Levonelle (levonorgestrel 150mg) tablet as soon as possible and use abarrier method of contraception for the next 4days D. Miss Q should take an EllaOne (Ulipristal acetate 30mg) tablet as soon as possible and use a barrier method of contraception for the next 7 days ni addition ot the contraceptive pil
E. Miss Q should visit the local family planning clinic to have an IUD fitted as that si the most effective form of emergency contraception
A
Antibiotic interaction:
Penicillin-type antibiotics (like phenoxymethylpenicillin) do not reduce the effectiveness of the combined oral contraceptive pill.
The only antibiotics known to interact are rifampicin and rifabutin (enzyme inducers).
Missed pill guidance (combined pill):
Missing one pill (even with a recent missed dose) does not typically compromise protection, especially if taken within 24 hours.
As she takes Microgynon regularly and has only missed one pill, no emergency contraception is needed.
Emergency contraception is only recommended if:
Two or more pills are missed (particularly in week 1),
Or if she vomits within 3 hours of taking a pill (not the case here),
Or if she’s on enzyme-inducing medications (not the case here).
Following a recent blood test and urine sample, Mr U a 67-year-old patient with type 2 diabetes mellitus is found to have an HbA1c of 69mmol/mol and an eGFR of 32ml/minute/1.73m?. He si currently taking metformin 500mg twice a daily and linagliptin 5mg once a day to manage type 2 diabetes. A decision is made to intensify diabetes management. Mr Uhas BMI of 35.3kg/m?.
Which of the following is the most appropriate action to take?
A. Add canagliflozin 100mg daily
B. Add exenatide 2mg once weekly
C. Add gliclazide 80mg ni the morning
D. Add insulin glargine 100units/ml
.E Increase the metformin dose ot 1000mg twice a day
GLP-1 receptor agonists like exenatide are effective for reducing HbA1c and support weight loss.
They are suitable add-on therapy when dual therapy (metformin + DPP-4 inhibitor) is not enough.
Exenatide (especially the weekly formulation) can be considered in patients with eGFR >30, making it suitable here.
Obese patients benefit significantly from GLP-1 agonists due to their weight-loss properties.
Why other options are less appropriate:
A. Canagliflozin – SGLT2 inhibitors are generally not recommended when eGFR is <30, and with caution between 30–45. Risk of volume depletion, genitourinary infections, and ketoacidosis.
C. Gliclazide – A sulfonylurea; risk of hypoglycaemia especially with reduced renal function. Not ideal given his renal profile.
D. Insulin glargine – While effective, it’s not the next step unless oral options are unsuitable or patient is symptomatic. GLP-1 agonists are preferred before insulin in obese patients.
E. Increasing metformin – Not appropriate when eGFR <45. Most guidelines recommend reducing or stopping metformin below that threshold due to risk of lactic acidosis.
Ms Vhas been experiencing abdominal pain, nausea, bloating and belching for the last two weeks. Astool sample tests positive for helicobacter pylori infection and the GP asks you to advise on a suitable treatment regimen. Ms Vtakes has citalopram 20mg tablets for the management of anxiety and depression and
no known drug allergies.
Which of the following is the most appropriate helicobacter eradication regimen for Ms V?
A. Omeprazole 20mg twice a day, amoxicilin 1g twice a day and clarithromycin 500mg twice a day for 7 days
B. Omeprazole 20mg twice a day, amoxicillin 1g twice a day and metronidazole 400mg twice aday for 7days
C. Omeprazole 20mg twice a day, amoxicilin g1 twice a day and tetracycline 500mg twice a day for 7 days
D. Omeprazole 20mg twice a day, clarithromycin 500mg twice a day and metronidazole 400mg twice a day for 7 days
.E Omeprazole 20mg twice aday, metronidazole 500mg twice aday and tetracycline 500mg twice a day for 7 days
B
can’t use macrolide due to increased risk of prolonging QT due to taking citalopram
a 63-year-old man visits the GP with a three-day history of a productive cough, fever and shortness of breath. Following a physical examination, the GP diagnosis community acquired pneumonia and calculates a CRB-65 score of 0 (low severity). Mr Wtakes no other regular medication and has adocumented penicillin allergy.
Which of the following is the most appropriate treatment for Mr W?
A. Amoxicillin 500mg three times a day for 5 days
B. Amoxicillin 500mg three times a day and clarithromycin 500mg twice a day for 5 days
C. Clarithromycin 500mg three times a day for 5 days
D. Doxycycline 100mg daily and erythromycin 500mg four times a day for 5 days
.E Doxycycline 200mg on the first day and then 100mg once daily for 4 days
E
One of your regular patients comes into the pharmacy for their daily instalment of methadone (non-supervised). He has been taking methadone for the last 5 months. He has missed the last 2 days and tells you he has got a new job for which he had to stay late. He apologises and asks for today’s dose.
Which of the following is the most appropriate response you should give him?
A. Give them half of today’s dose to the patient to re-titrate them
B. He should go to the doctor as he has missed 2 consecutive doses
C. Make a note to inform the drug team of the situation and give today’s dose D. Refuse to dispense the medication and tell him he has broken the agreement
in the written care plan
E. Take him into the consulting room to discuss his failure to attend the last 2
days
C
A47-year-old man si atending an out-patient appointment ot assess his foot infection. The vascular consultant has seen the patient ni clinic and prescribed potassium permanganate 400 mg tablets. These are for external use only and
are used for cleansing and deodorising wounds. The patient has been advised ot make a 0.01% solution 1( ni 10000).
Which of the following instructions would be most appropriate to give the patient to prepare the solution?
A. Dissolve 1 tablet in 1 litre of water
B. Dissolve1tabletin4litresofwater
C. Dissolve 1tablet in 10 litres of water
D. Dissolve 1 tablet in 40 litres of water
E. Dissolve 4 tablets in 1 litre of water
b
A 56-year-old woman attends a warfarin INR monitoring clinic. She takes warfarin for atrial fibrillation and has a target range of 2.0-3.0. On her last appointment 4 weeks ago, she had an INR of 2.3 and was told to continue taking her normal dose of 3 mg daily. She has been stable on this dose for the past 6 months.
The patients’ INR today was 5.2. On questioning, she reports that she has not missed any doses, has had no changes to her diet, and does not drink any alcohol. She has however recently started some new medications.
Which of the following medications is most likely to have caused the increased INR?
A. Bisoprolol
B. Carbamazepine C. Doxycycline
D. Lithium
E. Theophylline
C. Doxycycline ✅
A broad-spectrum antibiotic.
Can increase INR by:
Inhibiting gut flora that produce vitamin K.
Possibly displacing warfarin from protein-binding sites.
⚠️ Known to interact with warfarin and increase its anticoagulant effect.
Mr E, a78-year-old man, presents ot A&E
with symptoms of vomiting, dizziness, agitation and confusion. He si accompanied by his daughter who explains that, 30 minutes ago, Mr Eaccidentaly took four tablets of his verapamil hydrochloride 120 mg.
Which of hte folowing would be hte most appropriate drug ot manage hte patient’s symptoms and associated poisoning?
A. Acetylcysteine
B. Adrenaline
C. Activated charcoal
D. Dicobalt edetate
E. Naloxone hydrochloride
Activated charcoal
Ayesha is a 55-year-old woman who has been on Vagifem® (estradiol hemihydrate) vaginal tablets for 21 months and found ti works wel to control her symptoms of vaginal atrophy. She has requested a supply of Gnia® over-the- counter (OTC) as she has seen this ni the pharmacy and finds ti easier to come in than to see her GP.
Which of the following is the most appropriate advice regarding the supply of Gina® to Ayesha?
A. Gina® can be purchased over the counter and she needs to use one vaginal
tablet twice a week for 3 months as her initial OTC supply is from the pharmacy
B. Gina® can be purchased over the counter for use as one tablet daily for the first 2 weeks and then one tablet twice a week thereafter, and she should return for her next supply after 7weeks
C. Gina® should not be supplied to women over 54 years of age due to the
increased risk of breast cancer
D. Gina® wil help with al symptoms of menopause and can be purchased as long as she switches immediately from Vagifem® with no breaks
E. she must go back to see the GP for approval before she can purchase Gina® to replace Vagifem®
A
. Mis Lcomes ot the pharmacy ot discuss her iron tablets she recently has been prescribed. One wek ago, she started no ferous sulphate 20mg tablets od yb her GP ofr anaemia. Msis Ltels you that she has stopped taking hte ferous sulphate tablets because she has developed nausea and constipation.
Which of the folowing si the most appropriate advice for this patient?
A. Advise her ot take vitamin C alongside the ferous sulphate tablets
B. Advise her ot try a modified-release iron preparation
C. Advise her ot try an alternate oral iron salt
D. Advise she reduces the dose frequency ot alternate days
E. She should continue with the ferous sulphate tablets as the symptoms wil
subside
d
Which of the following laxatives is the preferred first line treatment to be given to a pregnant lady who already tried lifestyle changes?
A. Docusate
B. Lactulose
C. Ispaghula husk
D. Macrogol
E. Senna
A bulk-forming laxative (fibre supplement).
Increases stool mass and promotes natural bowel movement.
First-line in pregnancy if lifestyle changes are insufficient.
💡 Encourage adequate fluid intake to prevent obstruction.
Hsut benefia mtusebhearne against ehposaba snmenopausal sympotms,
Which condition is least likely ot result from HRT use?”
A. Breast cancer
B. Blood clots
C. Heart disease
D. Osteoporosis
E. Stroke
op
Apre-menopausal woman who has completed chemotherapy for estrogen- receptor-positive breast cancer si prescribed extended adjuvant endocrine
therapy ot lower hte risk of recurrence. She has not previously received adjuvant endocrine therapy.
Which medication is most suitable for her?
A. Anastrozole
B. Exemestane
C. Letrozole
D. Tamoxifen
E. Tibolone
First-line for premenopausal women
Can be used alone without ovarian suppression
Usually given for 5–10 years, depending on risk profile
✅ Most suitable choice here
Mrs W, a 64-year-old woman who suffers from resistant hypertension and is compliant with medication. She is currently taking Ramipril 10mg once daily,
Amlodipine 10mg once daily, Indapamide 2.5mg once daily. Her blood potassium level is 4.2 mmol/L.
Given that Mrs W has resistant hypertension—defined as uncontrolled blood pressure despite adherence to optimal doses of three antihypertensive agents of different classes, one ideally being a diuretic—the next line of treatment would typically involve adding a fourth agent.
Since her potassium is within the normal range (4.2 mmol/L), and she is already on an ACE inhibitor, calcium channel blocker, and thiazide-like diuretic, adding spironolactone 25 mg once daily is a common next step. Spironolactone is a mineralocorticoid receptor antagonist (MRA) and has shown good efficacy in resistant hypertension.
