Mock Questions Flashcards
What is the dose of Naproxen for Rheumatoid Arthritis?
0.5 - 1g in divided doses
What countries can have their prescriptions dispensed in the UK?
Austria
Belgium; Bulgaria
Croatia; Cyprus; Czech Republic
Denmark
Estonia
Finland; France
Germany; Greece
Hungary
Iceland; Republic of Ireland; Italy
Latvia; Liechtenstein; Lithuania; Luxembourg
Malta
The Netherlands
Norway
Poland; Portugal
Romania
Slovakia; Slovenia; Spain; Sweden
Switzerland
A 10-year-old comes in with a sprained ankle. There is mild swelling and he does not seem to be in discomfort. What is the most appropriate option for him?
Using an ice pack
A 12-year-old comes in with a sprained ankle. There is moderate swelling and he does seem to be in discomfort. What is the most appropriate option for him?
Ibuprofen
A patient has started Simvastatin 40mg
His drug history: Bezefibrate, Amlodipine, Ramipril. What adjustment needs to be made?
Reduce dose of Simvastatin to 10mg due to bezafibrate.
If bezafibrate wasn’t there, reduce simvastatin to 20mg
What dose adjustment do you need to make to simvastatin due to interactions? 6
Bezfibrate or Ciprofibrate = 10mg daily
Amlodipine, Amiodarone, Ranolazine = 20mg daily
CYP inhbitors = reduce dose ->
Verapamil/Diltiazem (inhibitors) =20mg daily
Bempedoic acid (with ezetimbe) = 20mg daily
Severe hypercholesterolaemia and at high risk of cardiovascular complications = 40mg daily
lomitapide or ticagrelor = 40mg daily
When taking Carbimazole what causes sore throat and mouth ulcers
Agranulocytosis - lowered white blood cell count
and Neutropenia - low conc of neutrophils
What are contributing factors of hypoglycaemia
Taking too much insulin or diabetes medication.
Not eating enough.
Postponing or skipping a meal or snack.
Increasing exercise or physical activity without eating more or adjusting your medications.
Drinking alcohol
What is the age limit of OTC Naproxen for period pains
15-50
A patient has been taking pseudoephedrine for the past 3 days for a cold and flu. They present at the hospital with a fast heart rate, bp of 170/90 and headache.
Drug history:
Amlodipine - started last week
Phenelzine - taken off last week
Bempedoic acid - dose increase last week
Which could have caused the hospital admission?
There is a SEVERE interaction between
MAOIs e.g. Phenelzine, Isocarboxazid or Tranylcypromine and Pseudoephedrine
It’s predicted to cause hypertensive crisis during and up to 14 days after stopping MAOIs
symptoms = hypertension, palpitation, headache, dizziness, visual disturbances, SOB and malaise
List of notifiable disease in the UK that start with A, B, C, D
Acute encephalitis
Acute infectious hepatitis
Acute meningitis
Acute poliomyelitis
Anthrax
Botulism
Brucellosis
Cholera
COVID-19
Diphtheria
List of notifiable dieases that start with E, F, H, I
Enteric fever (typhoid or paratyphoid fever)
Food poisoning
Haemolytic uraemic syndrome (HUS)
Infectious bloody diarrhoea
Invasive group A streptococcal disease
List of notifiable diseases that start with L, M, P
Legionnaires’ disease
Leprosy
Malaria
Measles
Meningococcal septicaemia
Monkeypox
Mumps
Plague
List of notifiable diseases that start with R, S, T, C W, Y
Rabies
Rubella
Severe Acute Respiratory Syndrome (SARS)
Scarlet fever
Smallpox
Tetanus
Tuberculosis
Typhus
Viral haemorrhagic fever (VHF)
Whooping cough
Yellow fever
A pt chart shows hypokalemia which antihypertensice medication would you avoid?
a) Irbesartan
b) Lisinopril
c) Ramipril
d) Spironolactone
e) Furosemide
THE ANSWER IS E
A-D causes HYPERkalemia which is ‘fine’
However, diuretics (loop and thiazide) cause hypokalemia so you wouldn’t want to add Furosemide
What malarial prophylaxis is suitable in epilepsy
Atovaquone with proguanil
or
Doxycycline
What malarial prophylaxis is suitable in pregnancy
Chloroquine and Proguanil (+folic acid)
consider Mefloquine in 2nd-3rd trimester
Antimalarial in someone taking warfarin rule
start 2-3 weeks before depatrure
INR must be stable. Measure 7 days before starting prophylaxis and after completing the course
Nish is taking Aripiprazole 15mg OD. what is the least suitable antimalarial?
a) Chloroquine
b) Chloroquine with Proguanil
c) Mefloquine
d) Proguanil
e) Atovaquone with Proguanil
THE ANSWER IS C
Mefloquine is contra-indicated in individuals with a history of psychiatric disorders (including depression) or conclusions
Aripiprazole is used in Schizophrenia and Mania
What to do if taking warfarin and experience a major bleed
Stop warfarin
give Phytomenadione (Vit K1) by slow IV
give dried prothrombin complex (fresh frozen if unavailable)
What to do if taking warfarin. INR >8.0 and minor bleed
Stop warfarin
give Phytomenadione (Vit K1) by slow IV
repeat vit K1 if INR is still high after 24hrs
restart warfarin when INR <5.0
What to do if on warfarin. INR >8.0 and no bleed
Stop warfarin
give Phytomenadione (Vit K1) ORALLY using IV preparation
repeat vit K1 if INR is still high after 24hrs
restart warfarin when INR <5.0
What to do if INR 5-8 with minor bleeding
Stop warfarin
give Phytomenadione (Vit K1) by slow IV
resart warfarin when INR <5.0
What to do if INR is 5-8 with no bleeding
withhold 1 or 2 doses and reduce maintenance dose
what to do if taking warfarin and there is unexpected bleeding at therapeutic levels
investigate the underlying cause
What level of renal function is an eGFR <15
Kidney failure
What level of renal function is an eGFR 15-29
Severe reduction
What level of renal function is an eGFR 30-44
Moderate - severe reduction
What level of renal function is an eGFR 45-49
Milde - moderate reduction
What level of renal function is an eGFR 60-89
Mild reduction… relative to normal range for a young adult
What level of renal function is an eGFR >90
Normal
A few months later, Mrs Aslam collects a prescription for Amiodarone, citalopram and atenolol tablets, and buys grapefruit juice. You contact her doctor to discuss possible interactions. Which of the following is false?
a) Citalopram and amiodarone can both prolong the QT interval
b) Amiodarone and atenolol can both cause bradycardia
c) Grapefruit juice increases exposure to amiodarone
d) Atenolol and amiodarone taken together increase the risk of cardiovascular
side effects
e) Amiodarone and citalopram can both cause hyponatraemia
The answer is E
Citalopram causes Hyponatraemia
Amiodarone affect Potassium
Mr Winks then tells you the medication he is currently taking. You suggest to Mr Winks that it may be one of his medicines causing his dry eyes and mouth. Which of the following medications is most likely to be causing his dry mouth?
a) Amlodipine
b) Olmesartan medoxomil
c) Oxybutynin
d) Piroxicam
e) Salbutamol
The answer is C as its an antimuscarinic
a) Amlodipine - CCB
b) Olmesartan medoxomil - ARB
c) Oxybutynin - ANTIMUSCARINIC
d) Piroxicam -NSAID
e) Salbutamol - B2 AGONIST
What reverses Digoxin toxicity
Digoxin-specific antibody fragments
A junior doctor wants to administer diazepam to one of his patients who is suffering from convulsive status epilepticus. However, there are not any intravenous injections available on the ward so she asks you for an alternative.
Based on your knowledge of drug absorption and the available formulations, which one of the following would you recommend to the junior doctor?
a) Diazepam buccal tablet
b) Diazepam patches
c) Diazepam intramuscular injection
d) Diazepam oral solution
e) Diazepam enema
The answer is E, enema
Cabergoline what is it? Other drugs in same class? and key side effects
is a stimulant of dopamine receptors (agonists) in the brain and inhibits the pituitary’s release of prolactin.
Other drugs in this call are
Amantadine hydrochloride; Apomorphine hydrochloride; Bromocriptine; Pramipexole; Quinagolide; Ropinirole; Rotigotine
Main side effects include
- IMPULSE CONTROL DISORDERS e.g gambling, hypersexuality, binge eating
- Monitored for dyspnoea, persistent cough, chest pain, cardiac failure, and abdominal pain or tenderness
What diuretic can cause gout
Furosemide
Key side effects of Phenytoin
Rash - discontinue
Bradycardia/hypotension (IV) - reduce administration rate
Plateletes decrease
Key points of Liothyronine
Liothyronine is more rapidly metabolised than levothyroxine
So is suitable when a rapid response is needed
Brands without a UK licence may not be bioequivalent and dose adjustment may be necessary.
What BMI range shows you’re underweight
<18.5
What BMI range shows you’re normal
18.5 - 24.9
What BMI range shows you’re overweight
25 - 29.9
What BMI range shows your obese
> 30
Dose for nystatin
100 000 units
4 times a day usually for 7 days,
and continued for 48 hours after lesions have resolved.
Rabies dose regime
The patient should receive one dose of rabies vaccine today,
one dose in 3 days’ time,
one dose in 7 days’ time,
one dose in 14 days’ time
and one dose in 30 days’ time
Terbinafine (used in athlete foot) main side effect
Liver toxicity e.g. Jaundice
Serious skin reaction e.g. rash like Stevens-Johnson syndrome and toxic epidermal necrolysis
Blood meningitis would be indicated by what blood parameter
C-reactive protein
What is the recommended dose of vitamin D
Recommend vitamin D 10 mcg tablets as this the advice given by Public Health England for all individuals in the UK during the winter months.
What advice would you give to someone with coeliac disease regarding vitamins
Go to the GP to review their vitamin levels via a blood test, as coeliac disease may mean that he needs additional supplementation
Key point about methotrexate and conception
Use effective contraceptives during and 6 months after stopping
Methotrex = sex = six
Jeremy has been prescribed an antibiotic in hospital for surgical prophylaxis. However, his surgery has now been delayed as he has reacted to the antibiotic. He has a red rash and appears flushed around his torso, face, and arms. This reaction occurred within 10 minutes of being administered the
antibiotic via IV infusion.
Which one of the following antibiotics is most associated with this side effect?
a) Vancomycin
b) Neomycin
c) Gentamicin
d) Clindamycin
e) Rifampicin
The answer is A
Tim has been taking Priadel® 400mg tablets at a dose of one tablet daily, for the last 2 months. He has recently started experiencing side effects of a skin rash, nausea and muscle weakness. He has come to the hospital for a blood
test.
Which of the following blood serum levels of lithium is Tim most likely
to have?
a) 0.4 to 0.8 mmol/L
b) 0.5 to 1.0 mmol/L
c) 0.8 to 1.0 mmol/L
d) 0.8 to 1.2 mmol/L
e) 1.2 to 1.6 mmol/L
The answer is E
if he is experiencing toxicity it is likely to be over the target range 0.4-0.8/0.8-1.2
Key SSRI interactions
NSAIDs e.g. aspirin, naproxen
Digoxin
Why would someone taking sotalol not be able to take domperidone
Domperidone is contra-indicated in conditions where cardiac conduction is, or could be, impaired and sotalol treats AF (rhythm)
Anti Nausea medicine to use in pregnancy (6)
Promethazine
Ondansetron
Prochlorperazine
Chlorpromazine
Cyclizine
Metoclopramide
hyperemesis gravidarum
regular antiemetic therapy, intravenous fluid and electrolyte replacement, and sometimes nutritional support
severe give antiemetic via parental or rectum
consider Thiamie suplemant
management of nausea and vomiting in patients receiving cytotoxics
ondansetron
granisetron,
and palonosetron,
management of nausea in chemotherapy
Dexamethasone
or Prochlorperazine
can add on Nabilone
preventing chemo-induce nausea
aprepitant and fosaprepitant
Nausea in palliative care
Levomepromazine
and Haloperidol
Prevention and treatment of opiod induced nausea
Cyclizine
Ménière’s disease
accute attack: cinnarizine, cyclizine, promethazine teoclate, prochlorperazine
severe acute attack: Buccal prochlorperazine or deep IM cyclizine or prochlorperazine
reccurent attacks: Betahistine
Motion sickness
prevent with
- Hyoscine Hydrobromide (Hy in the sky)
- less sedating cinnarizine or cyclizine
- more sedating promethazine
Methyldopa counselling
can cause drowsiness
Which CCB treat Raynauds syndrome
Nifedipine 5mg tds adjust acoording to response
This medication was prescribed to John to sedate him during a dental procedure.
Temazepam
Conscious sedation for dental procedures
by mouth
15-30mg 20-60mins before procedure
manual therapy to relieve pain is…
targeting the area e.g. deep tissue massage
Side effects for Chloramphenicol in chlidren
Circulatory collapse
grey baby syndrome e.g. pallid cyanosis
TB ethambutol drug can cause…
Visual disturbance - discontinue and there should be recovery of eye sight
montelukast side effect
Hyperkinesia - excessive movement and impaired concentration
Speech impairment
OCD
16 year old taking ferrous fumarate oral solution. s experiencing loose stools and soreness what is the best thing to do
Change formulation and take with or after food
An epileptic patient who is vegan taking Phenytoin should consider taking what supplement
Vitamin D
has an inadequate intake of calcium
elderly patient taking Isosorbide mononitrate immediate release keeps forgetting to take his medication what is an option that could help this situation
switching him to Modified Release
Nitrate Side effects
A Helicopter Falling Down Lost His Tail
Arrhythmias
Headache
Flushing
Drowsiness
Lightheaded/dizzy
Hypotension
Tolerance
Clozapine Important Safety Information (5)
1) Risk of intestinal obstruction, faecal impaction, and paralytic ileus
2) Monitor blood conc
3) Risk of agranulocytosis and Neutropenia
4) Myocarditis and cardiomyopathy common in first 2 months
5) monitor prolactin (look out for breast enlargement /galactorrhoea)
Methylphenidate side effects
o M/r needs t be prescribed by brand
o Weight loss
o Growth retardation (in children)
o Tourettes
o Psychiatric
o Hypertension
Cant swallow MR Methylphenidate. what can they do?
Advise patient to empty content onto a spoon of apple sauce or yoghurt and swallow content whole
Vancomycin IV most common side effect
Phlebitis - inflammation of a vein
other:
Thrombocytopenia
Drug fever/shivering
Tinnitus (discontinue) / Hearing loss
Vomiting
Agranulocytosis / Neutropenia (1 week after)
Nephrotoxicity/renal failure
Bradycardia
rapid infusion = cardiac arrest/cardiogenic shock
Which OTC medication is MOST LIKLEY to have an MHRA warning associated with abuse due to increased risk of cardiovascular events
a. Senna
b. Loperamide
c. Paracetamol
d. Dioralyte
e. Glycereine
the answer is B, loperaminde
safety information: reports of serious cardiac adverse reactions with high doses of loperamide associated with abuse or misuse give naloxone
methotrexate missed dose
if you remember AFTER two days - miss the dose and continue as normal
if you remember WITHIN two days - take the missed dose and continue as normal
NEVER double dose
treatment for HYPERthyroidism in pregnancy
treatment of HYPOthyroidism in pregnancy
Hyperthyroidism - Carbimazole (in 2nd trimester)
Carbimazole is associated with an increased risk of congenital malformations when used during pregnancy, especially in the first trimester and at high doses (daily dose of 15 mg or more).
Hypothyroidism - Levothyroxine (might need to increase dose)
Nicorandil ADR
Asthenia - weak/lack energy
Mouth ulcer (discontinue)
Dizziness/Headache
Nausea and vomiting
Haemorrhage
Vasodilation
Treatment for animal or human bite
Oral:
1st - Co-amoxiclac
pen allergy/alternative: Doxycycline and metronidazole
List of pregnant women the may require a higher dose of folic acid
previously had an infant with a neural tube defect
taking carbamazepine/antiepileptic
has type 1 diabetes
has sickle cell anaemia
5mg daily
before conception up to 12 weeks = 400mcg
tamsulosin OTC requirements
45 - 75
cant take drugs that cause hypotension
cant take viagra
tbc…
What reverses beta-blocker overdose
Activated charcoal within 1 hr of ingestion
Atropine IV for symptomatic bradycardia
Glucagon IV for severe hypotension
A vegan patient comes in for some blood tests what vitamin is she likely to have a deficient in?
Vitamin B12 because it commonly found in meat, fish, eggs, dairy products, yeast extract which a vegan wouldn’t eat
What is used to treat Acute Severe Ulcerative Colitis
IV Corticosteriods
alternative IV Ciclosporin or Ifliximab
Constipation in children treatment
1st = Macrogol 3350
still hard? Lactulose otr docusate
faecal impaction = add stimulant to macrogol
Most appropriate NSAID to use in a patient with a history of GI bleed and ulceration
Celecoxib
