MEGA1 Flashcards by Simon Evans

Ms. O a 36-year-old woman with no known medical conditions visits her GP complaining of shoulder pain. She explains to the GP that the pain started two nights ago following a strength training session using dumb bells. She has tried taking paracetamol to help with the pain, which has helped but only slightly. Following examination, the GP informs Ms. O that she would benefit from taking an NSAID.

As Ms. O. has experienced severe GI side effects with previous NSAID treatment, she wants to use an NSAID with the least risks of GI side effects.

Which of the following NSAIDs is the GP most likely to prescribe?

A- Naproxen 500 mg BD

B- Ibuprofen 400mg QDS

C- Piroxicam 20mg OD

D- Indomethacin 50mg OD

E- Diclofenac 25mg TDS

The correct answer is A - Naproxen 500 mg BD because:

Lower GI Risk Compared to Other NSAIDs
While all NSAIDs carry a risk of gastrointestinal (GI) side effects, some have a higher risk than others.
Piroxicam and Indomethacin have the highest risk of GI side effects and are generally avoided in patients with a history of severe GI reactions.
Diclofenac also has a relatively higher GI risk compared to ibuprofen and naproxen.
Balancing GI Safety and Efficacy
Ibuprofen (B) has the lowest GI risk overall but is less effective for musculoskeletal pain at standard doses (400 mg QDS).
Naproxen (A) has a better balance between pain relief and GI safety, making it a preferred option when GI side effects are a concern.
When needed, a proton pump inhibitor (PPI) such as omeprazole can be co-prescribed to reduce the risk of GI complications.
Thus, Naproxen 500 mg BD is likely to be prescribed as it provides effective pain relief with a lower GI risk compared to the other options.

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You are the GP practice pharmacist, and you are conducting a review with 53-year-old Mrs. Z who is taking Co-careldopa 25/100mg, one tablet three times daily. She explains to you that she has been feeling nauseous recently and would like a treatment for it.

Which of the following antiemetics would you recommend to Mrs Z’s doctor to prescribe?

A- Metoclopramide

B- Domperidone

C- Chlorpromazine

D- Prochlorperazine

E- Trifluoperazine

B - Domperidone

Explanation:
Mrs. Z is taking Co-careldopa (levodopa/carbidopa), which is used in Parkinson’s disease. When selecting an antiemetic, it is crucial to avoid dopamine antagonists that cross the blood-brain barrier, as they can worsen Parkinson’s symptoms by blocking dopamine receptors in the central nervous system.

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You are reviewing the ambulatory blood pressure for a 50-year-old male patient who was referred from his local pharmacy due to a high blood pressure reading. The 24-hour average blood pressure was recorded to be 151/105 mmHg.

He is also currently taking the following medication:

Paracetamol 1g FOUR times DAILY

Metformin 1g TWICE DAILY

Gliclazide 40mg TWICE DAILY

What is the most appropriate treatment to provide?

A- No action should be taken as the average blood pressure reading is within normal range for the patient’s age

B- The patient should be counselled on adopting healthier behaviours into their lifestyle such as increasing their intake of fruits and vegetables and increasing their exercise.

C- Prescribe the patient amlodipine 5mg ONCE DAILY and review the patient’s blood pressure after 4-8 weeks, continue to recommend health eating advice and increasing exercise.

D- Prescribe the patient ramipril 1.25mg ONCE DAILY and review the patient’s blood pressure after 4-8 weeks, continue to recommend healthy eating advice and increasing exercise.

E- Advise that the patient is provided an emergency referral to secondary care.

The correct answer is D - Ramipril 1.25mg OD.

The patient has Stage 2 hypertension (151/105 mmHg), requiring treatment.
ACE inhibitors (e.g., Ramipril) are first-line for patients <55 years old.
Amlodipine is first-line for patients >55 or Black African/Caribbean.
Lifestyle changes (option B) alone are insufficient.
No emergency referral (option E) as BP is not in crisis range (>180/120 mmHg).

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Mr. R, a 68-year-old man admitted to the hospital with a clostridium difficile infection.

While taking a medication history, Mr. R hands you a bag of the following medication which he is currently taking:

Metformin 500mg THREE times DAILY

Metronidazole 400mg THREE times daily for 7 days

Amlodipine 5mg ONCE DAILY

Omeprazole 20mg ONCE DAILY

Bendroflumethiazide 2.5mg ONCE DAILY

Which of the medications that Mr. R is taking is most likely to have contributed to him developing a clostridium difficile infection?

A- Metformin

B- Metronidazole

C- Amlodipine

D- Omeprazole

E- Bendroflumethiazide

The correct answer is D - Omeprazole.

Proton pump inhibitors (PPIs) like Omeprazole increase the risk of Clostridium difficile infection (CDI) by reducing stomach acid, allowing C. difficile spores to survive and colonise the gut.
Antibiotics (e.g., Metronidazole) can also disrupt gut flora, but Metronidazole is actually used to treat CDI, making it unlikely to be the cause.
Other medications (Metformin, Amlodipine, Bendroflumethiazide) do not significantly increase CDI risk.

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Mr. R is then given a 10-day course of vancomycin to treat the clostridium difficile infection. On completion of the course of vancomycin, Mr. R is still symptomatic and further treatment is sought.

In accordance with NICE guidance, which of the following treatment options would be the most suitable for Mr. R to take?

A- Amoxicillin

B- Faecal microbiota transplantation

C- Fidaxomicin

D- Metronidazole

E- Teicoplanin

The correct answer is C - Fidaxomicin.

NICE guidelines recommend Fidaxomicin as the next step if vancomycin fails to resolve Clostridium difficile infection (CDI).
Fidaxomicin is more selective for C. difficile, has a lower recurrence rate, and is preferred over Metronidazole, which is no longer first-line.
Faecal microbiota transplantation (B) is reserved for multiple recurrent infections, not after just one failed course.

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A worried mother comes into the pharmacy with her 3-year-old son. The mother informs you that her son feels warmer than usual, and you record a temperature of 38°C. The child appears distressed and has been pulling at and rubbing his left ear. The mother tells you he developed a cold a few days ago. You suspect an ear infection and suggest she takes him to the GP for a review. You recommend she gives him paracetamol 120mg/5ml for the fever and any pain in the meantime.

Which of the following is the most appropriate dose of paracetamol to be administered every four to six hours?

A- 60mg

B- 120mg

C- 180mg

D- 240mg

E- 360mg

According to the BNF for Children, the appropriate dose of paracetamol for a 3-year-old is 180 mg (7.5 mL of 120 mg/5 mL suspension) every 4-6 hours, up to four doses in 24 hours.
120 mg (B) is the correct dose for 2-3 months old, but at age 3 years, the dose increases to 180 mg.

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Mr H, a 45-year-old man comes into your pharmacy seeking advice about his face. He tells you that about a month ago, he began to experience episodes of flushing during which his face turned red for a while. However, recently the flushing has increased, and some redness remains. It is also accompanied by burning and stinging sensations. He tells you the symptoms seem to become worse when he goes for a walk in the park, and he has noticed that the blood vessels are becoming increasingly visible on his face. He has no medical conditions and is not taking any regular medication.

The most likely diagnosis is rosacea.

Key symptoms:
Flushing that worsens over time with persistent redness.
Burning/stinging sensations.
Worsened by triggers (e.g., sun exposure during walks in the park).
Visible blood vessels (telangiectasia).

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Mrs W, a 52-year-old patient weighing 62kg, was initiated on phenytoin, the doctor orders a serum phenytoin concentration.

Which of the following is the target therapeutic range of serum-phenytoin concentration that should be achieved?

A- 0.5-1mg/L

B- 10-20 mg/L

C- 4-12 mg/L

D- 6-12 mg/L

E- 8-15mg/L

The correct answer is B - 10-20 mg/L.

The therapeutic range for serum phenytoin concentration is typically 10-20 mg/L for most adults.
Concentrations outside this range can lead to either suboptimal therapeutic effects or toxicity.

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Mr. L is a 70-year-old male, with metastatic small cell lung cancer (SCLC). His current analgesic regimen includes MST Continus tablets 60mg to be taken twice daily, as well as Oramorph 10mg/5ml solution for breakthrough pain. Recently, his MST Continus tablets have been increased to 90mg twice daily.

Given this new regime, what is the minimum volume of oramorph solution that Mr L can take per dose to manage breakthrough pain?

A- 4mL

B- 5mL

C- 8mL

D- 9mL

E- 10mL

MST Continus 90 mg twice daily = 180 mg of morphine per day.
For breakthrough pain, the general guideline is to provide 10-20% of the total daily dose as rescue medication with a short-acting opioid like Oramorph.
10% of 180 mg = 18 mg for each breakthrough dose.
Now, to convert this into Oramorph solution:

Oramorph 10 mg/5 mL means 2 mg/mL.
To deliver 18 mg, the volume required would be:
18

mg
2

mg/mL
=
9

mL
2mg/mL
18mg

=9mL
Therefore, the correct dose for breakthrough pain management is 9 mL, which corresponds to answer D.

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Mrs D has visited the TB (tuberculosis) clinic at her local hospital for a check-up. She presents with a prescription for rifampicin, isoniazid, and pyridoxine. She has no known allergies and takes metformin 500 mg twice daily for type 2 diabetes mellitus. Mrs D asks you for more information regarding the medication.

Which of the following is the most appropriate advice to give Mrs D regarding pyridoxine?

A- Pyridoxine is given to prevent peripheral neuropathy caused by isoniazid

B- Pyridoxine is given to patients as the third medication in the continuation phase of TB treatment

C- Pyridoxine is given to prevent pancreatitis caused by rifampicin

D- Mrs D must take pyridoxine as part of TB treatment as she is diabetic

E- Pyridoxine is given to prevent the interaction between metformin and rifampicin

The correct answer is A - Pyridoxine is given to prevent peripheral neuropathy caused by isoniazid.

Isoniazid, one of the key drugs in TB treatment, can cause peripheral neuropathy as a side effect, especially in patients with certain risk factors such as diabetes.
Pyridoxine (vitamin B6) is given alongside isoniazid to prevent this neuropathy.
The other options do not relate to pyridoxine’s role in TB treatment.

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You are working as a GP practice pharmacist. The Physician’s Associate asks you for advice regarding. Mr N, a 64-year-old male with atrial fibrillation, takes daily warfarin for stroke prevention. The Physician’s Associate has measured his INR today as 6.0 and informs you that he is not experiencing any bleeding.

Given that Mr N is not experiencing any bleeding, which of the following is most appropriate advice to give him?

A- Mr N should stop warfarin and be administered phytometadione (Vitamin K1) by slow intravenous injection. He can restart warfarin when his INR <5.0

B- Mr N should withhold the next 1 or 2 doses of warfarin and the subsequent maintenance dose should be reduced

C- Mr N should stop warfarin and take phytometadione (Vitamin K1) orally using the intravenous preparation. The dose of phytometadione should be repeated if INR is still high after 24 hours and restart warfarin when INR<5.0

D- Mr N should stop warfarin and be administered phytometadione by slow intravenous injection. The dose of phytometadione should be repeated if INR still high after 24 hours and restart warfarin when INR<5.0

E- Stop taking warfarin and refer to A&E for further assessment

The correct answer is B - Mr N should withhold the next 1 or 2 doses of warfarin and the subsequent maintenance dose should be reduced.

INR of 6.0 is high but does not require urgent reversal unless there are signs of bleeding.
Withholding the next 1 or 2 doses of warfarin will help lower the INR. After that, the maintenance dose of warfarin should be reduced to prevent further increases in INR.
Phytomenadione (Vitamin K) is generally only needed for higher INR levels (typically >8.0 or with signs of bleeding).

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You are a pharmacist at a mental health clinic. You receive a prescription for haloperidol depot injection for Mr A. You notice from his patient medication record that he was previously taking haloperidol tablets.

Which of the following is the most likely reason that the haloperidol has been changed from tablets to a depot injection?

A- To improve efficacy

B- To improve adherence

C- To provide a more rapid response

D- To reduce the risk of neuroleptic malignant syndrome

E- To reduce the risk of extra-pyramidal side effects

Improve adherence

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A 70-year-old patient with meningitis has been admitted to your ward and is going to be treated with meropenem. He is currently living with hypertension and stage 4 chronic kidney disease, his current eGFR is 20mL/min.

What is the most appropriate dose of meropenem to provide to the patient?

A- 1g every 8 hours

B- 1g every 12 hours

C- 2g every 8 hours

D- 2g every 12 hours

E- 2g every 24 hours

1g every 12 hrs

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Mr E, a 57-year-old man, asks for your advice regarding abnormal blood test results. He tells you that he was started on Bendroflumethiazide 2.5mg two months ago. He recently had a blood test and was told that the abnormal results may be attributed to the Bendroflumethiazide.

Which of the following abnormal blood test results is least likely to be caused by Bendroflumethiazide?

A- Hyponatraemia

B- Hypomagnesaemia

C- Hypocalcaemia

D- Hypokalaemia

E- Hyperglycaemia

The correct answer is C - Hypocalcaemia.

Bendroflumethiazide is a thiazide diuretic, and thiazide diuretics typically cause hypokalemia, hyponatremia, hypomagnesaemia, and hyperglycaemia as common side effects.
However, thiazide diuretics like Bendroflumethiazide tend to increase calcium levels (hypercalcaemia), not decrease them, so hypocalcaemia is least likely to be caused by Bendroflumethiazide.

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Mrs. B is receiving treatment for tuberculosis (TB). She has been prescribed rifampicin, isoniazid, ethambutol, and pyrazinamide. She has no known allergies and takes metformin 500 mg twice daily for type 2 diabetes mellitus. Mrs. B has reported severe blurred vision after starting the anti-TB therapy.

Assuming Mrs. B’s blood glucose has been well-controlled throughout this period, which of the following medication has most likely contributed to the visual effects?

A- Rifampicin

B- Isoniazid

C- Ethambutol

D- Pyrazinamide

E – Metformin

The correct answer is C - Ethambutol.

Ethambutol is known to cause optic neuropathy, which can lead to symptoms like blurred vision. This is a well-documented side effect of the medication.
The other options (rifampicin, isoniazid, pyrazinamide, and metformin) are not typically associated with visual disturbances like ethambutol.

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You are conducting a training session for your pharmacy staff for the new cholesterol assessment service that has been commissioned to run from your pharmacy. This service would involve identifying patients with a level of total cholesterol and/LDL cholesterol that is above the reference range and referring them to their GP for further assessment.

What is the normal range for total cholesterol and LDL-cholesterol?

A- Total cholesterol <5 mmol/L and LDL- Cholesterol <1 mmol/L

B-Total cholesterol <5 mmol/L and LDL- Cholesterol <2 mmol/L

C- Total cholesterol <5 mmol/L and LDL- Cholesterol <3 mmol/L

D- Total cholesterol <4 mmol/L and LDL- Cholesterol <3 mmol/L

E -Total cholesterol <3 mmol/L and LDL- Cholesterol <3 mmol/L

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Master S, a 4-month-old baby is brought into your pharmacy on Monday morning by his mother Mrs T, who is worried about him having a fever of 38℃ and cough which started the night before. She says he was unusually irritable throughout the night and refused to feed. He also felt floppy in her arms. He also had cold hands and feet. Upon examining Master S, you notice a small, red pin prick rash on his neck spreading down to his torso. Mrs T is not aware of the rash and does not believe it was present when she left the house this morning. Master S has no known drug allergies.

What is the most appropriate course of action?

A- Give Paracetamol 60mg every 4-6 hours for the fever and inform Mrs T to take Master S to the GP if there is no improvement within 3 days.

B- Refer Master S to the closest Accident and Emergency department.

C- Ring 999 for an ambulance to transfer Master S to the hospital.

D-Give Ibuprofen 50mg every 8 hours for the fever, and Chlorphenamine 1mg twice a day for the rash which is likely to be an allergic reaction.

E -Reassure Mrs T and inform her that if the fever remains for 24 hours to call NHS 111.

The correct answer is C - Ring 999 for an ambulance to transfer Master S to the hospital.

The baby is showing severe symptoms, including high fever, irritability, floppiness, and a rash that suggests the possibility of meningococcal infection, which can progress quickly and is potentially life-threatening. The rash that doesn’t fade when pressed is a key sign of meningococcal septicaemia.
Given the urgency and the risk of severe complications, immediate transfer to the hospital via ambulance is necessary for urgent treatment and assessment.

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Mr T is a 65-year-old man who is a regular patient at your pharmacy. He visits the pharmacy today and explains that he has not been feeling well recently. He asks you to advise him on the best medication to help manage his cold, particularly his sore throat, which is especially troublesome. You refer to his PMR and note he is taking the following medications:

Simvastatin 40mg tablets

Paracetamol 500mg tablets

Priadel (Lithium Carbonate) 200mg tablets

Carbimazole 5mg tablets

Senna tablets

Which of the following would be the most appropriate action to take?

A- Recommend Benylin dry cough mixture to Mr T and advise him to see the GP at the next available appointment

B- Advise Mr T to stop taking carbimazole immediately and to visit the GP or the nearest A&E

C- Advise the patient to stop taking simvastatin and to visit the GP immediately

D- Advise the patient to continue taking all his medication as prescribed and to visit the GP immediately

E - Advise the patient to stop taking Priadel and visit the GP immediatel

B- Advise Mr T to stop taking carbimazole immediately and to visit the GP or the nearest A&E

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Mr R, a 24-year-old student is asking for your advice regarding antimalarial treatment as he is planning on going abroad on a tour of Southeast Asia in two weeks’ time. He shows you the following itinerary that he has booked:

Destination Duration

Madhya Pradesh, India 2 weeks

Lam Dong, Vietnam 1 week

Irian Jaya, Indonesia 2 weeks

Incheon city, South Korea 2 weeks

Sha Tin, Hong Kong 1 week

Mr R states that he is not taking any medication except sertraline 100mg ONCE DAILY for depression and has no known drug allergies.

Which of the following anti-malarial treatments would you recommend to Mr R for use during the entire duration of his trip?

A- Proguanil and chloroquine

B- Only chloroquine

C- Atovaquone with proguanil

D- mefloquine

E - Only proguanil

The correct answer is C - Atovaquone with proguanil.

Atovaquone with proguanil (Malarone) is a commonly recommended antimalarial treatment for travelers visiting regions like India, Vietnam, and Indonesia (including areas with chloroquine-resistant malaria). It is also suitable for long-term use and does not interact with sertraline.
The other options (proguanil and chloroquine, only chloroquine, mefloquine, and only proguanil) either have limitations or are not suitable for the destinations Mr. R is visiting.

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a 76-year-old man, who was admitted to hospital for an infection.

Mr C was started on intravenous gentamicin at a dose of 3mg/kg daily in three divided doses. On the second day, his trough serum gentamicin level was found to be 0.5mg/L and his peak serum gentamicin level was 7mg/L (target trough level <1mg/L, target peak level 3-5mg/L).

Which of the following is the most appropriate method of dose rationalisation?

A- Increase the dose and increase the dosing interval

B- Decrease the dose and maintain the dosing interval

C- Maintain the same dose and increase the dosing interval

D- Decrease the dose and increase the dosing interval

E - Maintain the same dose and decrease the dosing interval

B - Decrease the dose and maintain the dosing interval.

The peak level is higher than the target (7 mg/L, with a target of 3-5 mg/L), indicating that the dose is too high for the current dosing schedule.
To bring the peak level within the target range while keeping the trough level within the desired range, the best approach is to decrease the dose but maintain the dosing interval. This would help in managing the peak levels while avoiding toxicity

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Which of the following parameters should be monitored while treating Mr C with gentamicin?

A-Neutrophils

B- Thyroid function

C- Respiratory rate

D- Serum creatinine

E - Blood pressure

The correct answer is D - Serum creatinine.

While treating with gentamicin, monitoring serum creatinine is crucial because gentamicin can cause nephrotoxicity, and monitoring kidney function helps detect any early signs of kidney impairment. Serum creatinine is a key indicator of kidney function, and any increase in its levels may suggest that the patient is developing kidney problems due to the drug.

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You are the lead medicines optimisation pharmacist, and you are giving an insight to your role in prescribing to a new cohort of junior doctors that are scheduled to start at the Trust next week. You explain that medicines optimisation is a tool that is incorporated into the everyday prescribing within the Trust and offers a range of benefits to the prescriber, patients, and the public.

Which one of the following is the best definition of ‘medicines optimisation’?

A- A system which looks at how people use medicines and acknowledges that the way people use medicines over time may change, it can help encourage people to take ownership of their treatment.

B- The clinical, cost-effective, and safe use of medicines to ensure patients get the maximum benefit from the medicines they need, while at the same time minimising potential harm.

C- A formalised and standardised process that involves obtaining a patient’s comprehensive current medication list and comparing it to any medication they request or are being given at any healthcare setting, in order to identify and resolve any discrepancies.

D- A cyclic process that aims to improve the development of medication guidelines through incorporating the views of many different healthcare professions.

E - A service that would secure better communication of changes to a patient’s medication when they leave hospital and to reduce incidences of avoidable harm caused by medicines.

A- A system which looks at how people use medicines and acknowledges that the way people use medicines over time may change, it can help encourage people to take ownership of their treatment.

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Mr D, a 25-year-old has asked to speak to you regarding how to accommodate exercise around his busy work/school schedule and wants your advice on how much exercise he should be completing every week.

Which of the following choices is the minimum recommendation duration of exercise that Mr D should perform each week?

A- At least 30 minutes of moderate activity

B- At least 90 minutes of moderate activity

C- At least 120 minutes of moderate activity

D- At least 150 minutes of moderate activity

E -At least 180 minutes of moderate activity

At least 150 minutes of moderate activity

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An anxious patient comes into the pharmacy on a Sunday afternoon. She informs you that she is visiting friends here for the week and has forgotten her medication at home. She shows you a box of Co-codamol 30mg/500mg tablets labelled with her details and instructions to take two tablets four times a day when required. She explains that she only has one tablet left and requires a further supply urgently as she is in extreme pain. You confirm the patient’s medication with their permission using their summary care record. You agree to issue an emergency supply.

What is the maximum number of Co-codamol 30mg/500mg tablets that can be legally supplied?

A- 5

B- 8

C- 40

D- 56

E- 100

40 (5 day supply)

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25. Mrs A, a 49-year-old patient, presents at your pharmacy with a prescription for simvastatin 40mg tablets, one to be taken at night. Whilst dispensing this medication, you check her patient medication record (PMR) and notice she is also taking the following medications: Glyceryl trinitrate sublingual spray 400mcg, when required. Ranolazine tablets 500mg, twice daily Ramipril 5mg capsules, once daily What of the following is the most appropriate course of action to take when dispensing this medication for Mrs A? A- Contact the prescriber as the dose of simvastatin should be reduced to 10mg daily with concurrent use of ramipril capsules B- Contact the prescriber as the dose of simvastatin should be reduced to 10mg daily with concurrent use of ranolazine tablets C- Contact the prescriber as the dose of simvastatin should be reduced to 20mg daily with concurrent use of ramipril capsules D- Contact the prescriber as the dose of simvastatin should be reduced to 20mg daily with concurrent use of ranolazine tablets E -Ensure Mrs A has a patient alert card as she is taking ranolazine tablets

D - Contact the prescriber as the dose of simvastatin should be reduced to 20mg daily with concurrent use of ranolazine tablets. Ranolazine can increase the blood levels of simvastatin due to inhibition of the CYP3A4 enzyme, which is responsible for metabolizing simvastatin. This can increase the risk of simvastatin-related side effects, such as muscle toxicity. To reduce the risk of these adverse effects, the dose of simvastatin should be lowered to 20mg daily when used in combination with ranolazine. Therefore, contacting the prescriber to discuss a dose adjustment is the most appropriate course of action.

26. You are a hospital pharmacist and receive a call from the oncology ward seeking advice. They explain that a patient on the ward is experiencing pain and inflammation and is blistering in what appears to be an extravasation injury following administration of a cytotoxic drug. Which of the following is the most appropriate advice to give? A- Stop the infusion immediately, administer hydrocortisone and analgesia B- Stop the infusion immediately, administer dexamethasone and antibiotics C-Stop the infusion and remove the cannula before aspirating the area D- Stop the infusion, remove the cannula before aspirating the area and administer hyaluronidase E -Stop the infusion, remove the cannula before aspirating the area and administer dexrazoxane

In the case of extravasation with a cytotoxic drug, the most appropriate immediate action is indeed A - Stop the infusion immediately, administer hydrocortisone and analgesia. Extravasation of chemotherapy drugs, particularly those that are vesicants (e.g., anthracyclines or vinca alkaloids), requires stopping the infusion right away. The administration of hydrocortisone may help to reduce inflammation, and analgesia is important to manage the pain associated with the injury.

27. You are the Responsible Pharmacist on duty in a community pharmacy. You are the only pharmacist working on the premises, but you need to be absent for an hour to attend a meeting at the CCG. You have made all the appropriate arrangements to ensure you are contactable. Which of the following tasks could be undertaken by the pharmacy staff during your absence? A- Receive a prescription for atorvastatin 20mg tablets and dispense it in the presence of an Accredited Checking Technician (ACT) B-Give out previously checked and prepared prescriptions to the relevant patients C- Make a sale of a pack of 7 esomeprazole 20mg tablets D- Make a sale of a tube of hydrocortisone 1% cream for a 25-year-old with eczema on the wrist E - Wholesale of medicines

B: Pharmacy staff can give out previously checked and prepared prescriptions to the relevant patients. This task is permissible as long as the prescriptions have been properly checked and are ready for collection. This is a task that doesn't require professional judgment, so it is allowed when the RP is absent temporarily.??????

Mrs B is a 52-year-old patient weighing 58kg and requires treatment for deep vein thrombosis. You have been asked to provide advice on an appropriate dose of Edoxaban to administer to Mrs B. Which of the following is the most appropriate dose to be administered to Mr B? A- Edoxaban 30mg once daily B- Edoxaban 30mg twice daily C- Edoxaban 30mg three times daily D- Edoxaban 60mg once daily E -Edoxaban 60mg twice daily

Edoxaban 30mg once daily

30. Mr P is a 55-year-old patient who has been diagnosed with moderate rheumatoid arthritis. He has been started on prednisolone at an initial dose of 60mg daily which will be tapered to 7.5mg daily over 6 weeks and reviewed. Which of the following is the most appropriate statement? A- Mr P’s prednisolone should be gradually withdrawn as he has received more than 5 days’ treatment B- Mr P’s prednisolone should be gradually withdrawn as his disease is likely to relapse and has been given repeat doses in the morning C- If Mr P has not had chickenpox, he should avoid close contact with people with chickenpox but will not be affected by contact with people with shingles D-Mr P should stop taking prednisolone immediately if he develops symptoms of confusion, irritability, or delusions E -Mr P is at risk of developing a fever and conjunctivitis if prednisolone is abruptly withdrawn

29. Mr F who is 24 years old is admitted to A&E by emergency services. He was found unconscious surrounded by empty boxes of loperamide hydrochloride in his flat by paramedics, and a loperamide overdose is suspected. Which of the following symptoms is characteristic of loperamide toxicity? A- Prolongation of the QT interval B- Toxic megacolon C- Cervical lymphadenopathy D- Acute kidney injury E -Polymorphic VT arrhythmia

The correct answer is A: Prolongation of the QT interval. Loperamide is an over-the-counter anti-diarrheal medication that, when taken in high doses (as in overdose), can have serious effects, including: Prolongation of the QT interval: This is a well-documented effect of loperamide toxicity, and it can lead to torsades de pointes, a potentially fatal arrhythmia.

31. You are working in a local community pharmacy and receive a phone call from one of the patients who collects her insulin from you every month. She states that she collected her insulin from the pharmacy last week and has forgotten to place it in the fridge and is worried that it won’t be fit for use. She states that over the last week, following collection, she had kept the insulin in her bedroom cupboard where the temperature is controlled to be between 15C-20C. Which of the following is the best advice to give the patient? A- The insulin has been kept out of the fridge for too long and is no longer fit for use. The patient should return the insulin to the pharmacy to be discarded B- The patient should return the insulin to the fridge, and it will be fit for use for a further 30 months C- The insulin can be used for a further 3 weeks D- The insulin can be used for a further 6 weeks E - The insulin is safe for use for a further 30 months

C: The insulin can be used for a further 3 weeks. Here's why: Insulin storage guidelines generally recommend that unopened insulin should be stored in the fridge at 2°C to 8°C. However, once opened, insulin can be kept at room temperature (between 15°C and 25°C) for up to 4 weeks without compromising its effectiveness. In this case, the insulin has been stored between 15°C and 20°C for a week, which is within the acceptable range for storage. As long as it has not been exposed to extreme temperatures, the insulin is still safe to use. Therefore, the insulin is still fit for use, and the best advice would be to reassure the patient that it can be used for a further 3 weeks.

32. Miss T presents at your pharmacy after being bitten on her hand by a dog and asks for your advice. Her hand is rather warm and tender, and she is worried that it may be infected. You suggest Miss T visits her GP as she may need antibiotics. She has no known drug allergies Which of the following antibiotics would be the most appropriate for the GP to prescribe? A- Co-amoxiclav B- Doxycycline C- Clarithromycin D- Amoxicillin E - Flucloxacillin

Co-amoxiclav

33. You are conducting a medication review for Mr R, a 68-year-old man who has a history of COPD, hypothyroidism, and depression. During the review, you note that Mr R is also taking omeprazole 20mg daily which he tells you was prescribed for gastro-oesophageal reflux disease (GORD) 6 months ago. Mr R further informs you that he has been using the omeprazole regularly and that he is no longer experiencing any symptoms. As Mr R has been taking the omeprazole for longer than 2 months, you recommend that the GP reviews the need for it with the possibility of deprescribing to avoid the risk of complications associated with the long-term use of proton pump inhibitors. Which of the following is not a risk factor of long-term use of proton pump inhibitors? A- Clostridium difficile infection B- Fractures C- Hypomagnesaemia D-Constipation E - Community acquired pneumonia

Constipation Clostridium difficile infection (A): Long-term PPIs can alter the stomach’s acidity, which may increase the risk of infections such as Clostridium difficile, particularly in vulnerable patients. Fractures (B): Long-term use of PPIs has been associated with an increased risk of bone fractures due to impaired calcium absorption, especially in older adults. Hypomagnesaemia (C): PPIs have been linked to low magnesium levels, which can lead to serious complications like muscle spasms, arrhythmias, and seizures. Community-acquired pneumonia (E): PPI use can reduce gastric acid, which is a barrier to pathogens. This can increase the risk of community-acquired pneumonia, especially in patients with other risk factors.

Mr. T who is a regular at your community pharmacy is and has been taking methotrexate at a consistent dose for the last year. Today, Mr. T phones the pharmacy in a panic and explains that he usually takes methotrexate on a Tuesday but has forgotten to take it this week. It is Thursday today, and Mr T asks for your advice on what he should do. Which of the following is the most appropriate advice to give Mr. T? A- Advise Mr. T to omit this week’s dose and take his next dose on the correct day B-Advise Mr. T to reduce his dose proportionally by 2 days for this week and take his normal dose next Tuesday C-State that Mr. T can take the methotrexate dose today D- Explain that as he has missed his dose of methotrexate, it is likely that his condition will deteriorate quickly and that he should visit his local hospital. E - Advise Mr. T to make an urgent appointment for a review with the GP

Take the methotrexate dose today

35. The following month Mr. T comes into the pharmacy seeking your advice. He informs you that following a review with the rheumatologist last week, he has now stopped taking methotrexate. Mr. T and his wife are hoping to start a family and he would like advice regarding this. Which of the following is the most appropriate advice to give Mr T? A- Methotrexate will have no effect on Mr T’s ability to father a child B- Mr T should take folic acid 5mg to prevent any risks to the foetus C- Methotrexate is excreted in the semen and Mr F should wait at least three months before trying to conceive D- Mr T should wait at least six months before trying to conceive E - Advise Mr T that his wife should start taking folic acid 5mg from now until 12 weeks of pregnancy

6 months

37. An elderly man comes into your pharmacy requesting pain killers. You question him further and he mentions that since his diagnosis with depression, he has increased his alcohol intake and would like advice on his alcohol intake. Which one of the following statements is correct in accordance with the current alcohol guidelines? A- Sudden reduction in alcohol intake increases your risk of developing cancer B- To keep health risks from alcohol to a low level, it is safest not to drink more than 3 units a day on a regular basis C- If you regularly drink as much as 14 units per week, it is best to spread your drinking evenly over three or more days D-If you have one or two heavy drinking episodes a week, your risk of long-term illness and injury is low E - If you wish to cut down the amount you drink, a good way to help achieve this is to have no more than two drink-free days a week

C- If you regularly drink as much as 14 units per week, it is best to spread your drinking evenly over three or more days

39. Mr B, a 28-year-old man, was stopped this morning on his way to work by police for speeding and careless driving. Mr B informs the police he takes regular medication prescribed by his doctor that sometimes make him drowsy. The police use a roadside drug-screening device to test his saliva and Mr B tests positive for the presence of a drug. Which of the following drugs can be detected using a roadside screening device? A- zopiclone B-Flunitrazepam C- Alprazolam D- Fluvoxamine E – Aripiprazole

xFlunitrazepam, commonly known as Rohypnol, is a potent benzodiazepine that can cause drowsiness, impaired motor coordination, and cognitive dysfunction, making it a substance that can be detected by roadside drug-screening devices, as these tests often detect substances that impair driving.

40. Mrs I is a 67-year-old woman who has hypertension, osteoporosis, and asthma for which she takes the following medication: Lisinopril 30mg od Amlodipine 10mg od Alendronic acid 70mg weekly Calcichew D3 two tablets daily Seretide 125 evohaler two puffs bd Mrs I presents at the pharmacy requesting medication for diarrhoea. She informs you that this is the second day that she has had diarrhoea and vomiting and that she vomited three times yesterday and has been to the toilet regularly with very loose stools. Which one of Mrs I’s medication should be temporarily withheld until she recovers from the diarrhoea and vomiting? A- Lisinopril B- Amlodipine C- Alendronic acid D- Calcichew D3 E - Seretide 125 evohaler40. Mrs I is a 67-year-old woman who has hypertension, osteoporosis, and asthma for which she takes the following medication: Lisinopril 30mg od Amlodipine 10mg od Alendronic acid 70mg weekly Calcichew D3 two tablets daily Seretide 125 evohaler two puffs bd Mrs I presents at the pharmacy requesting medication for diarrhoea. She informs you that this is the second day that she has had diarrhoea and vomiting and that she vomited three times yesterday and has been to the toilet regularly with very loose stools. Which one of Mrs I’s medication should be temporarily withheld until she recovers from the diarrhoea and vomiting? A- Lisinopril B- Amlodipine C- Alendronic acid D- Calcichew D3 E - Seretide 125 evohaler

Lisinopril (ACE inhibitor): Diarrhoea and vomiting can lead to dehydration, which increases the risk of hypotension and kidney damage, especially in patients taking ACE inhibitors like lisinopril. ACE inhibitors can also cause hyperkalemia, and dehydration can exacerbate this risk. Withholding lisinopril temporarily during diarrhoea and vomiting, when the patient is at risk of dehydration, is a prudent decision.

41. Miss G comes into the pharmacy seeking head lice treatment for her 2 children. She mentions that one is 3 years old and the other is 6 years old. She tells you that she would like a preparation that can be left in overnight as she feels that would be most effective. Which of the following products is the most appropriate to give to Miss G? A- Dimeticone 4% lotion B- Dimeticone 4% Once gel C- Mineral oil and dimeticone spray D-isopropyl myristate and cyclomethicone solution E -Olive oil with a nit comb

Dimeticone 4% lotion

42. Mrs X asks for your advice about how best she can manage her osteoarthritic pain. Which of the following is the most appropriate advice to give Mrs X regarding management of osteoarthritis? A- Mrs X should use a rubefacient cream in addition to oral paracetamol B-Acupuncture may help provide her with pain relief C- Mrs X should not use an NSAID but should use co-codamol instead D- Mrs X may benefit from trying a topical NSAID in combination with exercise E - Mrs X should refrain from exercising and should try taking ibuprofen tablets

Mrs x may benefit from trying topical NSAID in combination with exercise

43. One of the measures introduced to help community pharmacies manage medicines shortages in practice was the development of serious shortage protocols (SSP); which provided an exemption to substitute a prescribed item with another specified item that was deemed clinically suitable without the need for prescriber approval. Which one of the following choices are not true with respect to SSP’s? A- For a SSP to be issued the shortage of a particular medicine needs to be recognised by the Chief Pharmaceutical Officer of England. B-SSP’s are only valid for a limited time. C-SSP’s are developed in collaboration with clinicians. D- SSP’s must only be issued in exceptional circumstances. E - SSP’s are more likely to only allow for an alternative quantity, strength, or pharmaceutical form to be provided to a patient who has been prescribed a medication that is in serious shortage.

A- For a SSP to be issued the shortage of a particular medicine needs to be recognised by the Chief Pharmaceutical Officer of England.

44. You are working in a Hyper-acute stroke unit (HASU) as the lead pharmacist and Mr PY who is 34 years old is admitted with a suspected ischaemic stroke. The paramedics state that Mr PY was provided a 300mg STAT dose of aspirin at the scene prior to transfer to hospital. Mr PY is accompanied by his wife who reports she noticed her husband’s face start to ‘slope to one side’ around an hour ago and provides you with his regular medication as follows: Paracetamol 1g when required up to four times a day. Atorvastatin 20mg daily Ramipril 10mg daily Chlortalidone 25mg daily On admittance, Mr PY’s blood pressure is measured at 140/90mmHg, and his wife reports a recent body weight of 80kg. Which of the following treatment would be most appropriate as initial management for Mr PY? A- Administer 72mg of alteplase through intravenous infusion B- Administer 900mcg of alteplase through intravenous injection C- Administer 90mg of alteplase through intravenous infusion D- Administer 300mcg of alteplase through intravenous injection E - Administer 30mg of alteplase through intravenous infusion

Alteplase is typically given as an intravenous infusion over a period of time for the treatment of ischaemic stroke. The standard dose of alteplase for acute ischaemic stroke is 0.9mg/kg, with 10% of the total dose given as an initial bolus, and the remaining 90% infused over the next hour. The maximum dose of alteplase is 90mg, which is given in total for a patient weighing over 90kg. In this case, Mr PY weighs 80kg, so the total dose would be 72mg (0.9mg/kg x 80kg = 72mg). Thus, the correct answer is: A- Administer 72mg of alteplase through intravenous infusion.

45. A 24-year-old male patient had recently developed fatigue, weight gain, increased appetite and disrupted bowel habit. His thyroid test results were requested and are displayed below: Hormone Measured Reference range Triiodothyronine (T3) 2pmol/L 3.1 - 6.8 pmol/L Thyroxine (T4) 5pmol/L 10 - 24.5 pmol/L Thyroid Stimulating Hormone (TSH) 7.2miU/L 0.2 - 5.5 miU/L Which of the following would be the most appropriate treatment? A- Carbimazole B- Propylthiouracil C- Radioactive iodine D- Triiodothyronine E – levothyroxine

Levothyroxine

46. Miss M, a 14-year-old girl is at a party where she gets drunk and has unprotected intercourse with a 16-year-old boy from school who she knows. Miss M cannot tell her parents what happened and, the next day she visits the pharmacy for emergency hormonal contraception. According to the Fraser guidelines, which of the following actions should the pharmacist take prior to supplying EHC to Miss M? A- Contact Miss M’s parents to obtain their consent B-Interview the 16-year-old boy Miss M had intercourse with C-Try to encourage Miss M to inform her parents that she is seeking contraceptive advice D- Establish whether Miss M has used contraceptives previously E - Inform Miss M that she is below the legal age of consent

Try to encourage Miss M to inform her parents that she is seeking contraceptive advice

47. Miss C, a 36-year-old patient comes to the pharmacy with a prescription for Norgeston 30mcg, one to be taken daily. You notice from her PMR she is also taking phenobarbital 30mg. Which of the following is the best advice regarding Miss C’s medication? A- Phenobarbital may reduce the effect of Norgeston and Miss C should take any combined oral contraceptive with standard dosing instead B- Contact the prescriber and advise them that a contraceptive patch will be more suitable for Miss C C- Inform Miss C that there is no suitable contraception while she is taking phenobarbital other than barrier methods, but she can use emergency hormonal contraception at the standard dose if she needs to D-Contact the prescriber and suggest that Depo-Provera 150mg/ml injection could be a more suitable contraception for Miss C E - If Miss C needs to use emergency hormonal contraception, she should ulipristal rather than levonorgestrel as it does not interact with phenobarbital

D-Contact the prescriber and suggest that Depo-Provera 150mg/ml injection could be a more suitable contraception for Miss C

48. You are reviewing the pharmacovigilance procedures with your trainee pharmacist and discussing which adverse effects would require a report to the MHRA via the Yellow Card Scheme. Which of the following adverse drug reactions would need to be reported to the MHRA? A- Stomach ulcer that occurred during ibuprofen use B- Development of skin irritation with doxycycline C- Development of white plaques in mouth and throat after use of Clenil Modulite inhaler (Beclomethasone) D-Death from blood disorders following patient error with methotrexate use E - Excessive sleepiness following administration of chlorphenamine

Death from blood disorder following patient error with methotrexate use

49. Mrs. V a 28-year-old pregnant female attends the pharmacy and asks for your advice on the types of vitamins that should be used during pregnancy. She explains that she is currently 3 months pregnant and that she is keen to support her baby’s development with the correct vitamins and supplements Which of the following supplements should Mrs V avoid during pregnancy? A- Folic acid B- Vitamin B12 C- Vitamin D D- Cod liver oil E – Selenium

Cod liver oil is high in vitamin A, and excessive intake of vitamin A during pregnancy, especially in the form of preformed vitamin A (retinol), can be harmful to the developing fetus, increasing the risk of birth defects. Therefore, Mrs. V should avoid cod liver oil and other sources of high-dose vitamin A during pregnancy.

50. Mrs. D, a 49-year-old patient has attended the GP clinic for a medicines’ review following a myocardial infarction that happened 3 months ago. You see that she was started on several medications at the time of the event including Atorvastatin 80mg once a day. What is the target minimum percentage reduction in non-HDL cholesterol expected after 3 months of statin therapy? A- 10% B- 20% C- 40% D- 60% E - 80%

40%

51. Mr A, a 54-year-old, comes into the pharmacy to speak to a pharmacist in private. He informs you that he has heard from a friend that you can purchase Viagra (sildenafil) over the counter. He informs you that recently he has recently started to experience erectile dysfunction which is proving to be an issue in his relationship with his girlfriend. You obtain his consent to access his Summary Care Record and can see he is on the following medication: Tamsulosin 400mcg capsules Metformin 500mg tablets Paracetamol 500mg tablets What is the most appropriate advice to give Mr A? A- Give Mr A non-pharmacological advice to try first. Inform Mr A that if he still requires the Viagra, he can return and purchase it B- Sell Viagra to Mr A and keep a note of this on his records C- Sell Viagra to Mr A but ask him to come back to see you before his next purchase D-Sell Viagra to Mr A but ask him to see his GP for future purchase’s E - Refer Mr A to his GP

Refer- tamsulosin and viagra interact causing hypotension

52. Mrs X is a 45-year-old woman who was initiated on warfarin a year ago. She tells you that she has just seen her GP regarding an acute attack of gout and asks you to check whether the prescription she has been given will help to manage her pain. She also informs you that she has no known allergies. Which of the following medication would be the most suitable treatment for Mrs X’s acute attack of gout? A- Allopurinol B- Febuxostat C- Aspirin D- Colchicine E – Paracetamol

Colchicine

53. Mrs E, a 54-year-old female patient, presents at the pharmacy and explains that she is experiencing chest pain. Upon questioning, she informs you that the pain occurred suddenly, and she does not remember doing anything strenuous. She has no history of heart conditions and does sometimes have mild heartburn especially after she eats a heavy meal for which she takes 10ml Gaviscon, which helps. She tells you that the pain is in the mid chest and is not radiating anywhere else. Mrs E’s PMR: Paracetamol 500mg caplets, one-two caplets when required up to four times a day Elleste Duet 1mg tablets (estradiol/norethisterone), use as directed Levothyroxine 100mcg tablets daily Which of the following is the best course of action? A- Sell omeprazole 10mg capsules to Mrs E and advise her to take 2 capsules daily until symptoms subside B- Advise Mrs E that she should see her GP as her levothyroxine dose may require adjusting C- Provide Mrs E with aspirin 300mg dispersible tablets and GTN spray; call 999 D- Provide Mrs E with aspirin 75mg dispersible tablets and GTN spray; call 999 E -Advise Mrs E to stop taking Elleste Duet 1mg tablets

54. Mr U’s PMR includes the following medication: Gliclazide 80mg tablets - 1 OM Metformin 500mg tablets - 1 TDS with food Nitrolingual 400mcg/dose pump sublingual spray - PRN as directed. Atenolol 100mg tablets - 1 OD He tells you that he has been taking medication for angina for about 3 years, but only started taking medication for type 2 diabetes 6 months ago. Whilst discussing his diabetes management, you deem it necessary to advise him of the symptoms of hypoglycaemia and their management. Which of the following symptoms is Mr U most likely to experience if he develops hypoglycaemia? A- Tremor B- Sweating C- Extreme thirst D-Polyuria E -Palpitations

Sweating

. You have been sent a query from the local community pharmacy regarding one of your patients that has been stabilized on citalopram 20mg. The pharmacist explains that there has been a shortage of all strengths of the medicine, and they need an alternative prescribed. Using the resource provided, which of the following antidepressant treatments could be directly switched to replace citalopram? A- Amitriptyline B- Trazodone C- Fluoxetine D- Mirtazapine E – Moclobemide

Fluoxetine

57. Mr V is a 27-year-old male weighing 65Kg, who recently had an anaphylactic shock after eating a takeaway, which he later discovered contained peanut oil. Consequently, his GP recommended that he always carries intramuscular adrenaline injection with him. Which of the following is the most appropriate dose of adrenaline that should be administered to Mr V in case of anaphylaxis? A- 100 mcg B- 150 mcg C- 200 mcg D- 300 mcg E - 500 mcg

500MCG

58. Miss F, a 56-year-old has been admitted to the Accident and Emergency department by paramedics after being found collapsed. She is complaining of severe pain in her right leg. Upon examination, the patient appears to have a cellulitis infection on the anterolateral portion of her right thigh and calf. The doctors diagnose class I cellulitis and decide to discharge Miss F on oral antibiotics. Miss F is of no fixed abode and has no known allergies. Which of the following oral treatments would be most appropriate to provide to Miss F? A- Flucloxacillin 1g FOUR TIMES DAILY for 5-7 days B- Erythromycin 500mg FOUR TIMES DAILY for 5-7 days C- Flucloxacillin 250mg FOUR TIMES DAILY for 5-7 days D- Clarithromycin 1g TWICE DAILY for 5-7 days E - Amoxicillin 500mg THREE times DAILY for 5-7 days

Flucoxacillin 1g QDS for 5-7 days

59. You are required to find out the requirements for the short-term storage of refrigerated medicinal products for a wholesale dealer’s license. Which of the following is the most important reference source to consult for this information? A- Orange guide B- British national formulary C- Martindale D- NICE guidelines E - British Pharmacopoeia

The Orange Guide (Official Medicines Control Agency Guide to Good Distribution Practice) provides detailed guidance on the storage, distribution, and handling of medicinal products. It specifically addresses the regulatory requirements for wholesalers, including temperature-controlled storage, which is crucial when dealing with refrigerated medicinal products.

61. Miss R is a 24-year-old university student who has been using sodium valproate to manage her epilepsy for the last 10 years. She comes to the pharmacy to purchase folic acid 400 micrograms tablets as she is now pregnant and has read that she should take folic acid for the first 12 weeks of pregnancy. Which of the following is the is the most appropriate advice for Miss R? A- Advise Miss R that she should take a multi-vitamin that is recommended for pregnant females as this will contain a range of nutrients that would support foetal development. B-Advise Miss R to stop taking sodium valproate immediately and seek advice from her prescriber. C- Sell Miss R the folic acid tablets and state that she should see her prescriber as soon as possible. D- Refuse the sale of the folic acid tablets and advise her to see her prescriber as soon as possible. E - Sell the folic acid tablets to Miss R and advise that she should have consulted her prescriber prior to becoming pregnant but, this is not necessary now as she is already pregnant.

Refuse the sale of the folic acid tablets and advise her to see her prescriber as soon as possible.

Mr C has been admitted to A&E following an overdose of digoxin. His serum digoxin concentration on admission is 5.0 micrograms/L. Given that digoxin has a half-life of 60 hours, and assuming that his renal function is stable and absorption is complete, how long will it take for the digoxin plasma level to reach 1.25 micrograms/L? A- 30 hours B- 60 hours C- 90 hours D- 120 hours E - 150 hours

120 hrs

You are the clinical pharmacist in a local GP practice, and you receive a query from a doctor who wants to prescribe an anti-diabetic medication for the treatment of type 2 diabetes mellitus of an elderly patient. The GP has made it clear that he wants to prescribe a medicine which presents the lowest risk of hypoglycaemia as the patient has suffered from severe hypoglycaemic episodes in the past. Which one of the following is least suitable for the patient? A- Metformin B - Exemestane C- Gliclazide D- Dapagliflozin E -Acarbose

Gliclazide is a sulfonylurea, which works by stimulating the pancreas to release more insulin. One of the main risks of sulfonylureas is hypoglycaemia, especially in elderly patients or those with renal impairment. Therefore, it poses the greatest risk of hypoglycaemia among the options provided.

Question 64 and 65 relate to Mr O, a 58-year-old Caucasian male who is 180cm tall and weighs 100kg, visits your pharmacy for a cardiovascular health check. You check Mr O’s blood pressure, cholesterol and calculate his BMI. According to Mr O’s BMI, which of the following categories would he be classified as? A- underweight B - Healthy weight C- Overweight D- Obese E - Morbidly obese

Obese

Which of the following is most important to highlight to Mr O as a risk factor for developing coronary heart disease? A- BMI of 21.9kg/m2 B - Low serum triglycerides C- Low serum HDL cholesterol D- Low waist/hip ratio E - Low blood glucose levels

Low serum HDL cholesterol

You are preparing a training session for your team about patient confidentiality and decide to use some scenarios to support their learning. In which of the following situations would it be acceptable for you to provide the information requested? A- A GPhC representative asking for medication records of a pharmacist who is currently under investigation by the court of law B - A woman asks you to explain what the medication she found in her 16-year-old daughter’s room are used for C- A policeman asking for medication records of one of your patients D- During a visit to your parent’s home, your mother asks you why one of her neighbour’s had an appointment at the GP surgery where you work E - Your pharmacy can access Electronic Patient Records. You can access your family’s patient records at the request of your mother

A- A GPhC representative asking for medication records of a pharmacist who is currently under investigation by the court of law

68. A junior doctor states that his patient has told him that she has researched the nausea/vomiting associated with certain chemotherapy treatments and is very anxious about this. Which of the following options has the greatest risk of chemotherapy-induced nausea and vomiting? A- Vinorelbine B - Cisplatin C- Bleomycin D- Vincristine E – Ariprepant

Cisplatin is a platinum-based chemotherapy drug that is well known for causing severe chemotherapy-induced nausea and vomiting (CINV). It is considered one of the most emetogenic (vomit-inducing) chemotherapy agents.

69. A 67-year-old patient with severe, chronic pain associated with advanced rheumatoid arthritis was taking the following analgesic regime to help manage his pain. Morphine MST 30mg – ONE to be taken TWICE DAILY Oramorph 10mg/5mL solution – 7.5mL to be taken WHEN REQUIRED Paracetamol 500mg – 2 tablets taken FOUR times DAILY Over the last two weeks, the patient has been taking oramorph four times a day for breakthrough pain. The patient has become nil by mouth and, the consultant advises he is switched to a transdermal analgesic instead. Which of the following strengths of fentanyl patch would be most appropriate for the patient to be initiated on? A- Fentanyl ‘12’ patch B - Fentanyl ‘25’ patch C-Fentanyl ‘50’ patch D- Fentanyl ‘75’ patch E - Fentanyl ‘100’ patch

50 patch

70. Mr S visits the pharmacy seeking advice. He explains he has recently felt lethargic, with low mood and regularly experiences a sensation of pins and needles in his feet. He further informs you that he is a strict vegetarian. You advise him to visit his GP for a blood test as you suspect a vitamin deficiency. Which of the following vitamins is Mr S most likely to be deficient in? A- Vitamin A B - Vitamin B12 C- Vitamin C D- Vitamin E E - Vitamin D

Vitamin B12

71. You are teaching your trainee pharmacist the importance of maintaining contemporaneous records of controlled drugs within your community pharmacy. They ask which law dictates the need to keep specific controlled drugs within a lockable cabinet. Which of law determines which drugs are required to be kept in a lockable cabinet within the pharmacy? A- Misuse of drugs act 1971 B - Misuse of drug regulations 2001 C- Safe custody regulations 1973 D- Human medicines regulations 2012 E - Psychoactive Substances Act 2016

Safe custody regulations 1973

72. Master D, an 8-year-old patient has recently been diagnosed with attention deficit hyperactivity disorder (ADHD) and has been commenced on methylphenidate 5mg ONCE DAILY. Master D’s mother tells you that the nurse at the hospital said that her child will need to attend the hospital every 6 months for a check-up where they would test different ‘things’. Which of the following parameters are not routinely assessed on a 6 monthly basis in patients taking methylphenidate? A- Pulse B - Blood pressure C- Appetite D- Weight E - Sight and hearing changes

Sight and hearing changes

73. Mr N, a 67-year-old man who has type 2 diabetes, comes in to collect his repeat prescription for metformin tablets. He informs you that the doctor wants to see him for a medication review in a few weeks’ time, but he may have to postpone it as he is due to go to hospital next week for knee surgery, which will be performed under general anaesthetic. Which of the following is the most appropriate advice to give Mr N? A- Mr N should ensure he continues taking his regular dose of metformin when he is in hospital and make sure it is added to his drug chart so that it is not forgotten B - Mr N should request his doctor conducts his medication review prior to him having surgery C- Mr N should discontinue metformin at the time of surgery and continue with a low-fat diet instead. He can restart metformin the day after surgery if all his blood tests are found to be normal D- Mr N should discontinue metformin at the time of surgery, and re-start it no earlier than 48 hours post-surgery if normal renal function has been established E - Mr N should stop taking metformin only if his blood sugars are well controlled

Discontinue metformin at the time of surgery, restart it no earlier than 48hrs post surgery if normal renal function has been established

74. You are completing an audit on Controlled Drugs (CDs) and notice that you have a number of expired CDs that require disposal. For which of the following would it be most important to arrange for an authorized witness to be present whilst you denature the CDs? A- expired pharmacy stock of dipipanone hydrochloride 10 mg / cyclizine hydrochloride 30 mg tablets B - expired pharmacy stock of suboxone 2 mg/500 mg tablets C- expired pharmacy stock of morphine sulphate 10 mg/5 mL oral solution D- five buprenorphine 400 mcg tablets returned by a patient who no longer requires them; the tablets have not yet expired E - five expired diamorphine hydrochloride 10 mg tablets returned by a patient

A- Expired pharmacy stock of dipipanone hydrochloride 10 mg / cyclizine hydrochloride 30 mg tablets Explanation: An authorized witness is required for the disposal of Schedule 2 Controlled Drugs (CDs) that are part of pharmacy stock. Dipipanone (combined with cyclizine) is a Schedule 2 CD, meaning its destruction must be witnessed by an authorized person (e.g., an inspector from the NHS, Home Office, or a Controlled Drugs Accountable Officer).

75. Mr. D, a 30-year-old man has been admitted to your ward with cholestatic jaundice. The medical team are unsure of what factors could have triggered this presentation. Mr. D has no previous history of liver dysfunction. Mr. D has a past medical history of asthma, type 2 diabetes and hypercholesteremia. Recent medication history: Medication Dose Indication Date prescribed Salbutamol 100mcg inhaler 2 puffs when required Long-term asthma treatment 1 month ago Clenil modulate 100mcg inhaler 2 puffs twice daily Long-term asthma treatment 1 month ago Metformin 500mg tablet 1 tablet twice daily Long-term treatment of T2DM 6 weeks ago Flucloxacillin 500mg tablet 1 tablet four times daily for 3 weeks Bacterial chest infection 5 weeks ago Doxycycline 100mg capsules 2 immediately and then one daily thereafter Animal bite 7 weeks ago Which of the recently prescribed medications is most likely to be responsible for the patient’s admission? A- Salbutamol 100mcg inhaler B - Clenil modulate 100mcg inhaler C- Metformin 500mg tablet D- Flucloxacillin 500mg tablet E - Doxycycline 100mg capsules

Flucloxacillin is a well-known cause of cholestatic jaundice and hepatic dysfunction, particularly in older patients or those who take it for longer than two weeks. The onset of symptoms is often delayed, appearing 1 to 2 months after completing the course.

76. Mr G is a 42-year-old man that experiences neuropathic pain. His doctor has advised that he would benefit from switching from pregabalin 75mg capsules to gabapentin 300mg capsules. Which of the following is the most suitable advice that Mr G should be given regarding the change in his medication? A- Pregabalin should normally be tapered down, but not when switching to gabapentin B - Pregabalin should not be abruptly withdrawn but should be tapered down over at least 2 weeks C- Pregabalin should not be abruptly withdrawn but should be tapered down over at least a week D- Mr G should stop taking pregabalin and start the gabapentin immediately E - Pregabalin has a long half-life, so Mr G should wait at least 48 hours after stopping the pregabalin before starting gabapentin

A - Pregabalin should normally be tapered down, but not when switching to gabapentin suggests that when switching between pregabalin and gabapentin, direct substitution is considered safe without needing a gradual taper.

80. Mr AJ is 25 years old and regularly uses your pharmacy’s needle exchange service. He asks to speak to you and tells you that he recently lost his friend due to a heroin overdose and would like advice about where he can get some help to stop using heroin. Which of the following would best describe the stage in the cycle of change Mr AJ is currently at? A- action B - contemplation C- maintenance D- relapse E - pre-contemplation

Contemplation

81. Mr T, a 35-year-old male patient, presents at the pharmacy with a prescription for vildagliptin. He informs you that this is a new medication that his GP has added to his treatment for type 2 diabetes. Which of the following would be appropriate advice to give Mr T when dispensing his prescription for vildagliptin? A- Mr T should avoid exposure to sunlight whilst taking vildagliptin B - Mr T should seek immediate medical attention if he experiences nausea, vomiting, abdominal pain, fatigue, or dark urine C- Mr T should take vildagliptin on an empty stomach, at least one hour before food D- Mr T should monitor his blood pressure whilst taking vildagliptin E - Mr T should temporarily stop taking vildagliptin if he has vomiting, diarrhoea or fever

Vildagliptin is a DPP-4 inhibitor (gliptin) used for the treatment of type 2 diabetes mellitus. A key safety concern with vildagliptin is its risk of hepatotoxicity, which can lead to liver injury.

82. Mrs. Y, a 49-year-old woman has been diagnosed with a malignant tumor. She is to commence chemotherapy following surgical removal of the tumor. Mrs. Y has read about chemotherapy related side effects and is worried about the associated blood-related side effects. Which chemotherapy agent is not associated with bone marrow suppression? A- Carboplatin B - Epirubicin C- Mitoxantrone D- Vincristine E – Cyclophosphamide

Epirubicin

86. Mr AT a 67-year-old man has recently been diagnosed with atrial fibrillation Following a review, the doctor has decided to initiate amiodarone. Mr A is a non-smoker and drinks an average of 2 units of alcohol per day. Which of the following clinical tests is required prior to the initiation of amiodarone? A- ECG B - Serum magnesium C- Ocular examination D- Chest x-ray E - Renal function test

Chest x ray

87. You are a medicines information pharmacist. You receive a call regarding a particular medicine that requires you to look into the current literature available to you for evidence-based information. Which of the following is the most robust form of evidence? A- Case-control B - Randomised controlled trial C- Case reports D- Cohort studies E -Cross-sectional studies

RCT

88. You are shopping on your lunch break and notice a man collapse in the street., You approach the man to see if you can help and confirm that he is not breathing. As you are first aid trained, you begin to administer Cardio-pulmonary resuscitation. What is the recommended ratio of chest compressions: rescue breaths that should be administered to adults who have stopped breathing? A- 30:2 B - 2:30 C- 32:2 D- 15:2 E - 30:4

30:2

89. Your GP practice is conducting a meeting to review the prescribing of antiepileptic medication to help consider if any cost-reducing measures can be introduced to improve the efficiency of the care being provided. One proposal that was suggested is that all antiepileptic medication are prescribed as generic products as this would reduce prescribing costs and improve accessibility of medication from the pharmacy. Which of the following medications must be prescribed by brand-name? A- Phenytoin B - Perampanel C- Ethosuximide D- Sodium valproate E – Lamotrigine

The MHRA (Medicines and Healthcare products Regulatory Agency) categorizes antiepileptic drugs (AEDs) into three groups based on the need for consistency in brand prescribing. Phenytoin falls under Category 1, meaning it must be prescribed by brand-name due to: ✅ Narrow therapeutic index – Small changes in drug levels can lead to toxicity or loss of seizure control. ✅ Differences in bioavailability between brands. ✅ Enzyme-inducing properties – Interactions can affect metabolism.

90. A 65-year-old male attends your pharmacy with nasal congestion due to a cold that he developed 2 days ago and requests to purchase some Sudafed (pseudoephedrine) tablets to help manage his symptoms. As he is planning on going on holiday tomorrow, he asks to purchase 3 packets of Sudafed to ensure he has sufficient supply for his trip. He states that he is using the following medications: Amlodipine 10mg ONCE DAILY Bendroflumethiazide 2.5mg ONCE DAILY Ramipril 10mg ONCE DAILY Which of the following is the most appropriate action? A- Sell the patient one packet of Sudafed tablets and advise him to use 1 tablet THREE times DAILY. B - Advise that the Sudafed congestion relief nasal spray would be more suitable for the patient’s condition as it would provide a more local effect and reduce the risk of systemic adverse effects. C- Explain to the patient that you can only sell him a maximum of two packets of Sudafed tablets D- Recommend the patient uses Sudafed Sinus capsules (paracetamol, caffeine & phenylephrine) instead as this will provide them with more relief. E - Recommend the use of a saline nasal drop solution or spray instead and advise the patient not to use pseudoephedrine products without the supervision of a prescriber.

Recommend the use of a saline nasal drop solution or spray instead and advise the patient not to use pseudoephedrine products without the supervision of a prescriber.

91. Mr G visits his GP after experiencing several episodes of chest pain during physical activity. He informs the GP that the pain starts in the front of chest and radiates to his arms and neck and is relieved when he rests. A diagnosis of stable angina is made, and Mr G is commenced on medication to take regularly to reduce the symptoms. A- Bisoprolol B - Ramipril C- Glyceryl trinitrate spray D- Losartan E - Indapamide F - Labetalol G - Amiodarone H - Flecainide

Bisoprolol

Mr I is due to undergo electrical cardioversion for atrial fibrillation. He has been advised to start pharmacological therapy four weeks before the procedure and has been advised that he may need to continue it for 12 months after in order to maintain sinus rhythm. A- Bisoprolol B - Ramipril C- Glyceryl trinitrate spray D- Losartan E - Indapamide F - Labetalol G - Amiodarone H - Flecainide

Amiodarone

Ms M is a 28-year-old woman who is 15 weeks pregnant and has been diagnosed with gestational hypertension. She has no other medical conditions. A- Bisoprolol B - Ramipril C- Glyceryl trinitrate spray D- Losartan E - Indapamide F - Labetalol G - Amiodarone H - Flecainide

Labetalol

Mr N is a 52-year-old Afro-Caribbean male who visits his GP for a hypertension review. Despite taking amlodipine 10mg daily, he continues to have an average blood pressure of 152/94 mmHg. The GP Decides to step up his treatment. Mr N also has a medical history of gout and takes allopurinol once a day. A- Bisoprolol B - Ramipril C- Glyceryl trinitrate spray D- Losartan E - Indapamide F - Labetalol G - Amiodarone H - Flecainide

Lorsartan

x95. Mrs. F presents at the pharmacy with her 4-year-old daughter. She explains that her daughter has been experiencing symptoms of a cold and a cough for the last 2 weeks. The cough was becoming progressively worse, and she recently started to have coughing fits. She also informs you that her daughter became short of breath on occasions and had episodes of choking and vomiting. Her daughter appeared to be weak and exhausted. A- Chickenpox B - Measles C- Mumps D- Rubella E - Whooping cough F - Hand Foot and Mouth Disease G - Croup H - Scarlet Fever

Whooping cough

. Mrs Y, a 52-year-old woman who has a chronic health condition, is admitted to hospital with severe intractable vomiting and a rapid pulse. Her blood results indicate low potassium levels. She informs the medical team that she has recently been on a diet as she is trying to lose weight and has stopped smoking so as to improve her health condition

Theophylline is a medication used to treat respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD). It has a narrow therapeutic window, meaning that the difference between an effective dose and a toxic dose is small. Vomiting and Rapid Pulse: Theophylline toxicity can cause symptoms like intractable vomiting, tachycardia (rapid pulse), and low potassium levels (hypokalemia), among other side effects. The toxicity can be exacerbated by factors like dehydration (common in vomiting), and changes in diet can affect its clearance or plasma levels, especially with recent dietary changes. Potassium levels: Theophylline toxicity can lead to disturbances in electrolyte balance, including hypokalemia.

. Mr B, who is 8 years old, is admitted into hospital with nystagmus, confusion and slurred speech. His records show he recently started treatment to help manage a newly diagnosed condition. A- Phenobarbitone B -Lithium C- Digoxin D- Phenytoin E - Gentamicin F - Carbamazepine G - Theophylline H - Vancomycin

Phenytoin

102. Mr R has been admitted with severe infective endocarditis. An intravenous dose of 20mg/Kg of the medication was administered a rate of 20mg/min over 20 minutes. The nurse alerted the doctor that the patient’s blood pressure was decreasing rapidly, and it appeared that he was reacting to the infusion because he developed an erythematous, maculopapular rash. The doctor advised to stop the infusion immediately. A- Phenobarbitone B -Lithium C- Digoxin D- Phenytoin E - Gentamicin F - Carbamazepine G - Theophylline H - Vancomycin

Vancomycin is known to cause Red Man Syndrome, which is a histamine-mediated reaction. This can result in symptoms such as: Erythematous, maculopapular rash (typically on the upper body and face) Hypotension (a rapid decrease in blood pressure) Flushing These reactions are more common when the drug is infused too quickly. The recommended infusion rate for vancomycin is typically 1g per hour, and exceeding this can trigger these symptoms. The key clue here is the erythematous maculopapular rash and hypotension occurring during the infusion, which are hallmark signs of Red Man Syndrome