Low Flashcards
Which of the following medications is a selective cyclooxygenase-2 (COX-2) inhibitor used in the treatment of musculoskeletal pain?
Celecoxib
Diclofenac
Gabapentin
Naproxen
Pregabalin
RATIONALE: CELECOXIB IS THE ONLY COX-2 INHIBITOR ON
THIS LIST. DICLOFENAC AND NAPROXEN ARE BOTH NSAIDS
AND ARE NON-SELECTIVE IN THEIR MECHANISM OF ACTION.
PREGABALIN AND GABAPENTIN ARE BOTH GABAPENTINOIDS
AND TARGET THE GABA RECEPTOR.
Following a neck of femur fracture, a patient is started on alendronic acid 70mg to be taken orally once weekly. What is the maximum duration of treatment with bisphosphonates for osteoporosis, after which there is little evidence for their use?
1 month
3 months
1 year
3 years
5 years
E
RATIONALE: IT IS ADVISED THAT FOLLOWING FIVE YEARS
ORAL TREATMENT WITH BISPHOSPHONATES (IE
ALENDRONATE, RISEDRONATE AND IBANDRONATE), THE
NEED FOR CONTINUED TREATMENT SHOULD BE RE-
EVALUATED. DISCONTINUATION OF A BISPHOSPHONATE
AFTER 5 YEARS DOES NOT GENERALLY INCREASE THE RISK
OF FRACTURES.
Which of the following medications is a synthetic disease-modifying antirheumatic drug (DMARD) used in the treatment of rheumatoid arthritis?
Adalimumab
Infliximab
Etanercept
Mesalazine
Vedolizumab
RATIONALE: ETANERCEPT IS THE ONLY DMARD OR
MONOCLONAL ANTIBODY THAT IS LICENSED FOR USE IN
RHEUMATOID ARTHRITIS IN THIS LIST. INFLIXIMAB AND
VEDOLIZUMAB ARE MONOCLONAL ANTIBODIES FOR
GASTROENTEROLOGY INDICATIONS. MESALAZINE IS LICENSED
FOR ULCERATIVE COLITIS OR CROHN’S. OMALIZUMAB IS
LICENSED FOR USE IN SEVERE ASTHMA.
A 65-year-old gentleman presents to your general practice with symptoms you determine to be an acute flare up of gout. This gentleman normally takes Ramipril, Warfarin, Atorvastatin, and Lansoprazole. He also has a history of chronic kidney disease. What would be the most appropriate choice of treatment given his medication history and medical history?
Allopurinol
Colchicine
Naproxen
Prednisolone
Topical diclofenac
RATIONALE: ALLOPURINOL IS INAPPROPRIATE IN THE ACUTE
TREATMENT OF GOUT AS IT IS PROPHYLAXIS. NAPROXEN
WOULD NOT BE APPROPRIATE EITHER GIVEN HIS HISTORY OF
CKD AND CONCOMITTANT RAMIPRIL. COLCHICINE IS
GENERALLY AVOIDED IN THE ELDERLY - PREDNISOLONE
WOULD BE THE MOST SUITABLE CHOICE.
A 55-year-old woman who has been diagnosed with rheumatoid arthritis has suffered an acute flare up. You decide to start her on prednisolone, and she asks the mechanism of action of the drug. What is the primary mechanism of action of prednisolone in the management of inflammatory joint diseases such as rheumatoid arthritis?
Glucocorticoid receptor agonism
Histamine H1 receptor antagonism
Prostaglandin inhibition
Serotonin receptor agonism
TNF-alpha inhibition
A
RATIONALE: PREDNISOLONE TARGETS GLUCOCORTICOID
RECEPTORS.
Which medication is used for the treatment of herpes simplex keratitis?
Acyclovir eye ointment
Gentamicin eye drops
Moxifloxacin eye drops
Prednisolone eye drops
Tetracycline eye ointment
A
RATIONALE: ALL OTHER OPTIONS ARE EITHER ANTIBIOTIC IN
NATURE OR STEROIDAL. HERPES SIMPLEX IS A VIRUS, AND
THEREFORE AN ANTIVIRAL WOULD BE THE MOST
APPROPRIATE CHOICE FOR TREATMENT
A young man presents to your community pharmacy explaining that he has scratched his eye. His eye looks red and is irritable. He explains this happened roughly 3 hours ago. He requests chloramphenicol eye drops as he is concerned that it will become infected. He has no previous medical history and works in an office. What is the most appropriate course of action in this case?
Do not supply the chloramphenicol 0.5% eye drops and explain that there is no infection, so there is no indication for chloramphenicol now. Suggest some eye drops for dry eye and safety net the patient.
Refer the patient to A&E
Refer the patient to the GP
Supply the patient chloramphenicol 0.5% eye drops and explain that he is to use 1 drop every 2 hours for the first 24 hours, and then reduce to 1 drop every 4 to 6 hours for the remaining 6 days
Supply the patient chloramphenicol 0.5% eye drops and explain that he is to use 1 drop every 4 to 6 hours for 7 days
A
RATIONALE: THIS IS IMPORTANT FOR ANTIMICROBIAL
STEWARDSHIP.IF THERE IS NO INDICATION OF INFECTION,
THEN THERE IS NO REASON TO SUPPLY THE PATIENT WITH
CHLORAMPHENICOL. A REFERRAL TO A&E OR GP WOULD BE
INAPPROPRIATE.
Which of the following drugs is used for the management of glaucoma?
Atenolol
Bisoprolol
Labetalol
Pindolol
Timolol
Timolol only topical answer
A patient who is receiving treatment for mycobacterium tuberculosis is on a myriad of medication. He has just been started on treatment. He presents to your community pharmacy complaining that ever since starting them, his contact lenses always end up being stained red. Which of the following medications is most likely culpable to changing the eye colour of the patient’s lenses?
Ethambutol
Isoniazid
Rifampicin
Pyrazinamide
Pyridoxine
C
RATIONALE: RIFAMPICIN AND SULFASALZINE ARE BOTH
EXAMPLES OF MEDICATIONS THAT CAN STAIN CONTACT
LENSES WITH DIFFERENT COLOURS.
A patient presents to your pharmacy complaining about irritating itchy eyes. Upon examination, you notice that his eyes are watering, there is diffuse redness, but no purulent discharge. He explains that this always happens at certain points of the year. He has an allergy to cats. He takes no regular medications. He has a history of childhood eczema. What is the most appropriate recommendation for this patient?
Carbomer eye drops
Chloramphenicol 0.5% eyedrops
Referral to an ophthalmologist is needed as the symptoms are too vague for a working diagnosis to be made reliably
Self-care, no medication supply is needed
Sodium cromoglicate eyedrops
RATIONALE: THE PATIENT’S SYMPTOMS INDICATE THAT THIS
PATIENT IS LIKELY SUFFERING FROM ALLERGIC
CONJUNCTIVITIS. SODIUM CROMOGLICATE WOULD BE THE
MOST APPROPRIATE CHOICE
Which of the following steroids is commonly used for allergic rhinitis?
Betamethasone
Clobetasone
Clobetasol
Mometasone
Prednisolone
D
RATIONALE: MOMETASONE IS THE ONLY STEROID HERE THAT
IS COMMONLY FOUND IN FORMULATIONS FOR ALLERGIC
RHINITIS. PREDNISOLONE TENDS TO BE FOR ORAL USE,
WHEREAS BETAMETHASONE, CLOBETASONE AND CLOBETASOL
ARE ALL TOPICAL FORMULATIONS.
A young woman presents to your community pharmacy under the Pharmacy First service. She explains that she’s been having some ear trouble and would like some help identifying what it is. She explains that she’s had some trouble hearing out of her left ear; she also explains that she normally gets blocked ears and that she’ll use olive oil or sodium bicarbonate for this, but neither has helped. Upon further questioning, you can gather that this started around a week ago at a boxercise class. You use an otoscope to examine her ear. She reports no temperature, there is no obvious trauma to the outside of the ear, and you are able to rule out mastoiditis. What is the most likely working diagnosis?
A perforated ear drum
A viral infection
Otitis externa
Otitis media
Severe wax impaction that would require suction
RATIONALE: A PERFORATED EAR DRUM IS THE MOST LIKELY
DIAGNOSIS. PERFORATED EAR DRUMS ARE ASSOCIATED WITH
HEARING LOSS, PARTICULARLY ON THE BACKGROUND OF WHAT
SOUNDS LIKE BLUNT FORCE TRAUMA. INFECTION IS UNLIKELY IN THE
ABSENCE OF A TEMPERATURE.
A patient presents to your clinic in a general practice surgery with what you diagnose to be oral thrush. He explains that he would need something for it. Upon looking at his medical history, you see that he is on carbamazepine for trigeminal neuralgia, gabapentin, regular paracetamol and E45 cream. He has no allergies. What would be the most appropriate treatment for this patient?
Clotrimazole 1% cream – To be applied to the affected areas three times a day for 14 days
Fluconazole 50mg capsules – 50mg to be taken once a day for 7 days
Fluconazole 100mg capsules – 100mg to be taken once a day for 7 days
Fluconazole 100mg capsules – 400mg to be taken once a day for 7 days
Nystatin 100,000 units/mL – 1mL to be swirled around the mouth four times a day, and then for 48 hours after lesions heal
E- Nystatin 100,000 units/mL – 1mL to be swirled around the mouth four times a day, and then for 48 hours after lesions heal
RATIONALE: CLOTRIMAZOLE CREAM WOULD BE USEFUL FOR
TOPICAL CANDIDA INFECTIONS. FLUCONAZOLE CAN BE USED,
BUT WOULD LIKELY INTERACT WITH HIS CARBAMAZEPINE
WHICH COULD PRECIPITATE CARBAMAZEPINE TOXICITY.
NYSTATIN WOULD BE THE MOST PRAGMATIC CHOICE.
You are a pharmacist working in A&E. Whilst on a ward round, you meet a patient whom you diagnose to have a case of otitis externa. This patient has a penicillin allergy, and you have swabbed the wound which returns traces of the very resistant pathogen, pseudomonas aeruginosa. Which of the following antimicrobials would be the most appropriate choice to treat this patient’s otitis externa?
Azithromycin 250mg tablets
Ciprofloxacin eye drops
Clarithromycin 500mg tablets
Doxycycline 100mg capsules
Erythromycin 250mg gastro-resistant tablets
B
RATIONALE: FLUOROQUINOLONES ARE CONSIDERED A
HALLMARK IN TERMS OF TREATING PSEUDOMONAS
INFECTIONS. OTITIS EXTERNA SELDOM REQUIRES SYSTEMIC
TREATMENT, AND SO LOCAL TREATMENT WOULD BE
PREFERRED. ALSO, NOTE THAT CIPROFLOXACIN EYE DROPS
CAN BE USED FOR THE EAR ALSO (THIS WAS
INTENTIONALLY ADDED AS A RED HERRING!)
What is the primary side effect associated with prolonged use of nasal decongestants?
Hypertension
Insomnia
Nausea and Vomiting
Osteoporosis
Tachycardia
RATIONALE: INSOMNIA IS A PROLONGED USE OF NASAL
DECONGESTANTS, AS MOST CONTAIN STIMULANTS SUCH AS
PSUEDOEPHEDRINE.
Which of the following medications is commonly used for the treatment of scabies?
Acyclovir 5% gel
Clotrimazole 2% cream
Miconazole 2% cream
Permethrin 5% cream
Tretinoin cream
D
RATIONALE: PERMETHRIN 5% CREAM IS USED TO TREAT SCABIES.
APPLY ONCE WEEKLY FOR 2 DOSES, APPLY 5% PREPARATION
OVER WHOLE BODY INCLUDING FACE, NECK, SCALP AND EARS
THEN WASH OFF AFTER 8–12 HOURS. IF HANDS ARE WASHED
WITH SOAP WITHIN 8 HOURS OF APPLICATION, THEY SHOULD BE
TREATED AGAIN WITH CREAM.
Which of the following medications is commonly used for the treatment of acne vulgaris?
Benzoyl peroxide 5% gel
Clindamycin location
Fluocinolone cream
Ketoconazole cream
Retin-A cream
A
RATIONALE: BENZOYL PEROXIDE 5% GEL IS THE MOST
COMMONLY USED FOR ACNE.
Which of the following medications is commonly used for the treatment of nappy rash in infants that can also be sold over the counter?
Calamine lotion
Clotrimazole 1% cream
Clobetasone 1% cream
Coal tar ointment
Mupirocin ointment
B
RATIONALE: CLOTRIMAZOLE 1% CREAM OR A BARRIER CREAM
SUCH AS SUDOCREM CAN BE USED IN THE TREATMENT OF
NAPPY RASH. CALAMINE IS USED FOR CHICKEN BOX, COAL
TAR IS USED IN PSORIASIS, MUPIROCIN IN MRSA
ERADICATION. CLOBETASONE IS A MODERATE STEROID.
A young lady is started on isotretinoin for acne vulgaris. You are counselling her on contraception as there are strict regulations of isotretinoin under the pregnancy prevention programme. Which choice of contraceptives would be unsuitable for the safe supply of isotretinoin under the pregnancy prevention programme?
Cerazette (Desogestrel tablets)
Copper IUD
Depo Provera (medroxyprogesterone injection)
Microgynon tablets and barrier protection
Mirena IUD
A
RATIONALE: PROGESTERONE ONLY PILLS ARE NOT CONSIDERED
SUITABLE AS MONOTHERAPY AS A CONTRACEPTIVE METHOD WHEN ON
ISOTRETINOIN FOR TREATMENT OF ACNE. GUIDANCE STIPULATES ONE
USER INDEPENDENT FORM OF CONTRACEPTIVE (IUD, A DEPO
INJECTION), OR TWO USER DEPENDENT FORMS (ORAL CONTRACEPTIVE
AND BARRIER PROTECTION)
Which of the following side effects would not warrant an urgent medical referral when on isotretinoin?
Abdominal pain
Constipation
Depression
Nausea and vomiting
Suicidal ideation
B
RATIONALE: ALL OTHER SIDE EFFECTS INDICATE PSYCHIATRIC
SIDE EFFECTS OR POSSIBLE PANCREATITIS. CONSTIPATION
DOES NOT.
Out of the following patient examples, which patient is safe to receive a live vaccine?
A pregnant woman
A patient who is HIV positive
A patient who has received a kidney transplant years ago and is on tacrolimus
A patient who regularly takes lenalidomide
A 1 year old child
E
RATIONALE: OPTIONS A THROUGH TO D ARE NOT SUITABLE
FOR LIVE VACCINES. PREGNANT WOMEN ARE NOT
RECOMMENDED TO HAVE LIVE VACCINES DUE TO RISK TO THE
FOETUS. PATIENTS WHO ARE IMMUNOCOMPROMISED (HIV
POSITIVE, TRANSPLANT PATIENTS OR PATIENTS WITH
MULTIPLE MYELOMA - LENALIDOMIDE), SHOULD NOT
ROUTINELY HAVE LIVE VACCINES EITHER
Which of the following medications can be used in the management of post-immunisation pyrexia in children?
Aspirin
Celecoxib
Diclofenac
Ibuprofen
Naproxen
RATIONALE: IBUPROFEN IS THE ONLY LICENSED CHOICE IN
THIS LIST. BOTH PARACETAMOL AND IBUPROFEN CAN BE
USED IN THE MANAGEMENT OF POST-IMMUNISATION PYREXIA
IN CHILDREN.
Which of the following symptoms is not an indicator of systemic toxicity of local anaesthesia?
Blurred visions
Constipation
Convulsions
Drowsiness
Oropharyngeal numbness
B
RATIONALE: ALL OTHER OPTIONS ARE INDICATORS OF
SYSTEMIC TOXICITY IN LOCAL ANAESTHESIA.
Many vaccines are subject to articles which are not medically accurate. Which of the following complications is falsely related to the MMR vaccine?
Anaphylaxis
Aseptic Meningitis
Autism Spectrum Disorder
Diabetes
Idiopathic Thrombocytopenic Purpura
Autism
