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PRE-REG own > Miscellaneous/incorrect q's > Flashcards

Miscellaneous/incorrect q's Flashcards

1
Q

For a moderate severity diabetic foot infection in pen allergic patient - what is used?

A

Co-trimoxazole 960mg BD oral (good absorption so route is fine)

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2
Q

What is an example of GPHC standard using professional judgement?

A

Having the information needed to provide appropriate care

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3
Q

What is some advice for skin conditions e.g. eczema

A

Keeping room cool
using cotton fabrics
emollients can be used as often as needed, even up to every 2hrs if very dry
avoid synthetic fibres

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4
Q

What would be a referral for suspected pancreatic cancer

A

62 y/o with new onset type 2 diabetes with unexplained. weight loss

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5
Q

Do you get pneumococcal vaccine at 8 weeks?

A

NO - only at 3 months

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6
Q

What is croup/symptoms?

A

Childhood viral condition - shortly after mild fever/cold symptoms get sudden onset barking cough
worse at night
severe=treat with steroids
only give analgesia if child is in distress

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7
Q

What is the advice for sprains/strains

A 
Sprains usually tender around joint, swelling, bruising, pain when weight bare
PRICE
can take 24hours for bruising to occur
para and topical NSAIDS
seek advice if worsens after 5-7 days
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8
Q

How many weeks after last depo-medrone injection would you give contraception if unrpotected sex occurred yesterday

A

15 weeks

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9
Q

What are the symptoms of prostate cancer

A 
Haematuria
urinary symptoms, dribbling, urge 
unexplained back pain
ED
lethargy
weight loss
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10
Q

What is pain on ejactulation a symptom of

A

prostatitis

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11
Q

What monitoring is required in the first 6 months of use of Concerta XL?
(methylphenidate)

A

BP due to risk of hypertension

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12
Q

What is monitored every week for the first month of olanzapine?

A

Weight due to risk of obesity

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13
Q

For an 11 year old boy who weighs 40kg diagnosed with type 1 diabetes, what dietary advice is most appropriate?

A

Limit fruit juice to one small glass a day - it can cause blood glucose to rise quickly -better eating whole fruit. Sugar free drinks. water, tea coffee more suitable

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14
Q

You conduct a literature search to identify evidence to critically appraise to add weight to your recommendations - what resource evidence would you prioritise if you want to choose a high level of evidence to review?

A

Systematic reviews

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15
Q

A 67 y/o man has acute gout and presents Rx for Diclofenac 75mg BD. He is also on: bisoprolol 10mg OD, furosemide 40mg BD, methotrexate 7.5mg week, paracetamol, ramipril 5mg BD. What is the most appropriate reason for contacting the prescriber in this case?

A

Diclofenac is C/I in heart failure –> given his drugs he likely has HF.

It does reduce elimination of MTX but it is not contraindicated in mtx use so wouldnt be to do with mtx in this case

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16
Q

A 45 y/o woman has alcoholic liver disease and cirrhosis, she has back pain and Dr asks what analgesic to initiate out of these:

  • co-codamol 30-500 2 QDS
  • codeine 60mg QDS
  • ibuprofen 400mg TDS
  • paracetamol 1g QDS
  • tramadol 100mg QDS
A

In this case would be paracetamol 1g QDS
- NSAIDS increase bleeding and fluid retention in liver cirrhosis
Opioids cause constipation and sedation, risking coma

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17
Q

A 54-year old woman, would like some advice, she has recently finished a course of antibiotics and has started with symptoms of vaginal thrush. She has had similar symptoms before, the last time she had symptoms was 6 months ago and she was treated by her GP. She describes the symptoms as itchy with a thick creamy coloured discharge. She would like to try the ‘capsule you swallow’ that she has seen on TV. She currently takes the following medication:
Warfarin 3 mg tablets, Salbutamol 100 mcg inhaler, Beclometasone 250 mcg inhaler
What is the most appropriate recommendation?

A

500mg clotrimazole pessary to be inserted at night before bed

  • wouldn’t give oral capsule as fluconazole enzyme inhibitor, increases INR and bleeding with warfarin
  • not an STI so wouldn’t refer to gum clinic
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18
Q

A 65-year-old woman is prescribed vancomycin 1g twice daily intravenously for the treatment of staphylococcal cellulitis. A trough level is taken before the 3rd dose and is reported by the biochemistry lab as 10mg/L (reference range is 10-15mg/ml). The junior doctor on duty asks for your advice for ongoing dosing.

What is the most appropriate course of action?

A

1g twice daily is a suitable dose for this patient, recheck levels after another 3 or four doses

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19
Q

A 50-year-old patient presents with a prescription for fentanyl 25 mcg/h transdermal patches
Which one of the following directions would be legally correct for this prescription?

A

One as directed

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20
Q

What is the most appropriate cautionary and advisory label that is recommended to be added on the label of one or more of the medications:
lansoprazole 30mg
propranolol 40mg

A

Do not stop taking this medication unless the doctor tells you to stop - for propranolol - if stop suddenly can cause rebound tachycardia

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21
Q

What medication causes urine to turn pink?

A

Nefopam

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22
Q

What drugs cause orange urine?

A

Rifampicin
Phenazopyridine

Doxorubicin is red urine

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23
Q

What drugs cause blue urine?

A

Amitryptylline
cimetidine
indometacin

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24
Q

What drug causes yellow urine

A

sulfasalazine

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25
Q

what drugs cause brown urine

A 
Metronidazole
nitrofurantoin
senna
chloroquine
acetomenaphen OD
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26
Q

What drug causes red urine

A

Dantron preps

Doxorubicin

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27
Q

What drugs cause DARK red urine

A

levodopa

entacapone

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28
Q

What drug causes black urine

A

ferrous (iron) salts

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29
Q

Dose of piperacillin 4g/ tazobactam 0.5g IV every 6 hours for 10 days is treating which infection?

A

Severe pneumonia

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30
Q

What calcium channel blocker is used for treating subarachnoid haemorrhage (thunderclap headache, stiff neck, blurred vision, nausea)

A

Nimodipine

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31
Q

Symptoms and Treatment of diabetic ketoacidosis?

A

Unconscious, SOB, severe thirst, tiredness, vomiting, hyperventilation, confusion

Replacement of fluid and electrolytes and administer insulin

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32
Q

What is the dose of paracetamol for 8 year old child? (8-9 years old)

A

360-375 mg every 4-6hrs

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33
Q

Is “one as directed” a legally acceptable dose for CD?

A

yes

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34
Q

If a patient is returning 56 morphine sulfate m/r tablets to your pharmacy because they are no longer needed - how should this be handled?

A

Denature it in presence of another member of staff and record in a register dedicated to controlled drugs returns

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35
Q

If a patient is returning medicine - what is important to ensure?

A

Any information identifying the patient must be destroyed/obscured

36
Q

A 9 year old asthma patient has a prescription for:

  • symbicort turbohaler (budesonide + formoterol) 100/6 2 puffs BD
  • salbutamol 100mcg/dose - 2 puffs QDS PRN

When handing out you check her control and technique which are perfect and her asthma is well controlled/ You recommend she visit the asthma nurse for a review to step down. What is the most appropriate change?

A

Reduce symbicort to one puff BD

37
Q

Which class of drugs are elderly patients NOT commonly more sensitive to the effects of?

A

Statins

they are more sensitive to effects of BZs, opioids, antipsychotics, antiparkinsons

38
Q

if a patients eGFR declines >25% AFTER initiation of ACEi, what should be done?

A

Stop ACE, consider suitable alternative antihypertensive and monitor eGFR (change in baseline >25% needs to stop)

39
Q

How long is a yellow fever vaccination certificate valid for?

A

Valid for duration of life of the person after vaccinated

40
Q

A patient comes in with Rx for rheumatoid arthritis- methotrexate, folic acid and naproxen. You notice an interaction between mtx and naproxen that may increase mtx levels. What is the most appt course of action in this situation?

A

Advise the pt of the interaction. but that they are safe ass long as they are both taken regularly and that regular blood tests are carried out. Counsel the patient to report any signs of mtx toxicity immediately

41
Q

What bloods need to be checked for methotrexate before giving out? how often?

A

FBC
Liver function
renal function
- repeat every 1-2 weeks until stable then every 2-3M

42
Q

It is a saturday afternoon and you receive a telephone call from a veterinary surgeon - he would like to authorise an emergency supply of diazepam for a dog under his care.He explains that usually keeps stock but has run out over weekend/ What is the most appt course of action?

A

Explain you are unable to make supply ass vet surgeons are not considered relevant prescribers for ES requests

43
Q

What are appropriate counselling points for orlistat?

A

recommend realistic weight loss - slow and steady 0.5-1kg/week
Flatulence S/E
take immediately before or up to 1 hour after a meal

44
Q

A 59 year old woman has been taking pioglitazone for the past 2 weeks as her usual medicines were not controlling blood sugar. She has been feeeling nausea, fatigue and dark urine for the past 10 days and wonders if they have caused it. What is the best advice to give?

A

Whilst it is rare, the symptoms she is experiencing could be caused by the pioglitazone and should book an appt with GP for exploratory blood tests

45
Q

10 year old girl has just started taking nitrofurantoin for UTI. She has had 4 doses and has a headache that is bad. What is appt advice?

A

Stop tablets immediately and go to A&E

Other key s/e to be worried about: their skin starts to turn red and then blisters or peels
• they experience bad headaches
• they are more sleepy than normal or have blurry or
double vision.
• persistent fever, chills or cough that does not settle

46
Q

What is appropriate dosing of omeprazole for h pylori eradication?

A

20-40mg BD

47
Q

What is the MHRA guidance regarding repeated/prolonged calcium gluconate injection packaged in 10ml glass containers in children <18?

A

Contraindicated to use glass containers for <18 and renal impairment due to risk of aluminium accumulation - need to package in plastic containers

48
Q

a 78 year old man has severe pain from metastatic bone cancer, he is prescribed morphine but unable to tolerate nausea and vomiting. What is the most appt alternative analgesic?

A

oxycodone- can be used in pts who need opioid but cannot tolerate morphine
if already receiving opioid- can start at a dose equivalent to the current morphine dose

49
Q

what is the most appt anti-epileptic for a 23 year old woman newly diagnosed with generalised tonic clonic seizures?

A

Lamotrigine - usually sodium valproate is 1st line for newly diagnosed gen tonic clonic but not for childbearing age unless others tried/failed. Lamotrigine safe alternative.

50
Q

A patient was on this medicine for psoriatic arthritis which has now been stopped but needs to continue effective contraception for up to 2 years after stopping - which medicine is this?

A

Leflunomide

51
Q

what is the most appt CCB for a 62 year old woman who needs a long acting OD preparation for angina, with a PMH of Heart failure

A 
amlodipine
All CCBs (except amlodipine) should be avoided in HF as they can further depress cardiac function and exacerbate symptoms
52
Q

A 35 year old female requires oral hormonal contraception. She has hypertension, CVD associated with type 1 diabetes and heavy smoker. What is most appt option?

A

norethisterone 350mcg tabs (the 5mg dose is not effective for contraception)
- progesterone only offer suitable when oestrogens are C/I (including venous thrombus,hypeertension, cvd)

53
Q

Which drugs are affected by smoking so when someone abruptly stops it can cause high drug levels?

A 
Theophylline
cincacalcet
ropinerole
clozapine/ olanzapine / chlorpromazine / haloperidol
warfarin
54
Q

What drugs can cause photosensitivity?

A 
Amiodarone
chlorpromazine
NSAIDS
diuretics-loop,thiazide
tetracyclines
quinolones
sulfonamides (co-trimoxazole)
55
Q

what is medication of choice in a patient suffering an acute gout attack who is on anticoagulation?

A

Colchicine

NOT diclofenac due to bleeds risk

56
Q

It is a Sunday morning and a nurse practitioner requests emergency supply of 100 ml morphine sulfate solution 10 mg / 5ml for palliative patient and forgot rx pad. What is the most appt course of action

A

Supply the medicine and enter into register - schedule 5 so can supply

57
Q

A patient has just been diagnosedwith parkinsons disease and has mild motor symptoms that do not affect his quality of life. He has a history of binge eating 15 years ago and was treated with CBT. What is the most appt therapy?

A

Rasagiline because he has a history of impulse control disorders which rules out dopaminergic therapy- MAOB.

58
Q

What is the treatment for dry mouth

A

Pilocarpine

59
Q

What medictations can cause dry mouth

A 
Antimuscarinics 
Antispasmodics(mebeverine)
TCAs 
diuretics
antihistamines
60
Q

A patient has been preescribed carbamazepine 200mg tablets TDS for trigeminal neuralgia. The rx for generic carbmazepine but on PMR they were previously given Tegretol. Whatis the most appropriate course of action?

A

Dispense the generic as per Rx - MHRA advice maintain on same brand or same generic as category 1 does NOT apply to other indications (ONLY epilepsy) so appt to do generic

61
Q

What ingredients have a firehazard risk?What is this warning?

A

Containing paraffin ee.g. coal tar and zinc oxide

MHRA warning regarding risk of fire and awareness, not smoking etc

62
Q

What route of administration is used for patient controlled analgesia

A

IV

63
Q

A woman is prescribed a new bronchodilator therapy on top of her regular nebulised salbutamol for asthma. You recommend the patients potassium levels are monitored as they can cause hypokalaemia - which drug is most likely to have been prescribed?

A

Theophylline

64
Q

If a patient was previously taking Norimin (ethinylestradiol and norethisterone) for contraception but reported headaches frequently - what are appropriate alternatives?

A

Femodene - ethinylestradiol with gestodene

OR drospirenone, or desogestel

65
Q

A patient has been diagnosed with unstable angina, which CV medication is contraindicated in unstable angina?

A

Amlodipine

66
Q

a 42 year old patient of afro caribbean origin has ben diagnosed with hypertension and needs an anti hypertensive, they also have diabetes. Which drug is most appropriate?

A

Losartan - ARBs better in black/afro, and needs one of these because of the diabetes

67
Q

A patient has tried ramipril and amlodipine together and still not controlled, what is most appropriate antihypertensive to add onto current medicines?

A

Thiazide like diuretic - indapamide

68
Q

Which diuretic needs to be taken with food?

A

Spironolactone

69
Q

Which anticoagulant is licensed (at low doses) for the prevention of atherothrombotic events in combination with aspirin following STEMI?

A

Rivaroxaban

70
Q

What is a high risk of taking hydroxyzine?

A

QT prolongation and TDP - MHRA alert

Max dose daily 100mg (50mg in elderly)

71
Q

What is a counselling point for nicorandil?

A

Take one with breakfast and evening meal

72
Q

What is the most appropriate counselling point for orlistat?

A

realistic weight loss target of 0.5-1kg a week
Take immediately before/up to 1hr before food
low fat diet due to 25% of dietary fat absorption blocked

73
Q

What is an MHRA warning regarding latanoprost

A

Reports of increased eye irritation / watering eyes severe enough to make them consider stopping treatment -report to hcp

74
Q

If a patient has heart failure what colour sputum are they likely to have

A

pink frothy

75
Q

If a patient has suspected PE (SOB, chest pain) and is on HRT, overweight, smoker (ie all risk factors) what colour sputum is it likely to be?

A

rust coloured mucus

76
Q

If an elderly patient is unable to manage opening tiotropium capsules into the handihaler due to dexterity, but not suffering any S/E of the medicine, what is the other option?

A

Spiriva respimat - tiotropium inhaler, diff device

77
Q

A 76 year old man is admittted with STEMI and is due to undergo. PCI. What drug should be administered/initiated?

A

Prasugrel

78
Q

a 59 year old lady complaining of chest pain on exertion, she has HTN and angina which she is on amlodipine, bisoprolol, aspirin OD and GTN PRN which she finds effective. What is the most appt medication to initiate?

A

Nicorandil - prevention of angina

79
Q

Which anaesthetic/muscle relaxant causes malignant hyperthermia and what is this

A

MH: rare but lethal when temp suddenly increases, muscle rigidity, tachycardia, acidosis
Volatile anaesthetics such as suxamethonium

80
Q

A woman is in labour with her first child and is about to undergo C section, what anaesthetic is recommended

A

Isoflurane

81
Q

if needing an opioid in syringe driver but renal function has deteriorated over last 24hrs, what drug can be used

A

alfentanil
oxycodone

Alternative opioids (when morphine is not tolerated or in patients with severe renal failure e.g. GFR<
30mL /min) include oxycodone or alfentanil.
82
Q

If a doctor wants to prescribe an opioid with mixed agonist and antagonist activity at opioid receptors due to chronic resp disease, what is an option

A

meptazinol

83
Q

A patient has been complaining of pins and needles since starting chemotherapy, experiencing peripheral paraesthesia, loss of tendon rerdlex. abdo pain and constipation - which drug/class is responsible?

A

Vinca alkaloids

84
Q

A patient has creps on both lungs and diagnosed with dose related progressive pulmonary fibrosis due to chemotherapy, which drug is responsible?

A

Bleomycin

85
Q

What is classed as high intensity statins?

A

Atorvastatin 20mg or more
Rosuvastatin 10mg or more
Simva 80mg

86
Q

when is renal function measured with mesalazine?

A

initiation
3 months
annually

87
Q

when do you stop warfarin prior to surgery

A

5 days

PRE-REG own (35 decks)

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