Mocks Flashcards
1
Q
5 year old boy presenting with exanthema behind ears which spread to face and later to trunks and extemities, after 3 days begin to fade
A
rubella
2
Q
What is the condition: 18 months old with general malaise, loss apetite, small erythematous macules on stomach and arms with a few pustules
A
chickenpox - red spots look like blisters, on any part of body
3
Q
What is the interaction between amoxicillin and methotrexate
A
amoxicillin can increase risk of toxicity of mtx
4
Q
If a patient is on sodium valproate what parameter should b measured before initiation?
A
ALP/LFTs because it causes hepatotoxicity
also causes panceratitis and blood dysgrasias
5
Q
When would you measure LFTs with statins
A
3 months then 12 months
6
Q
Upon initiation of olanzapine, what parameter must be reviewed and recorded prior
A
fasting BG - susceptible to hyperglycaemia
7
Q
What is a common s/e of trimethoprim
A
Fungal overgrowth
8
Q
What is a s/e of GTN apart from headache/hypotension/flushing etc
A
tachycardia (and brady)
9
Q
What is a common adverse reaction for clindamycin
A
colitis
abdominal pain
10
Q
When are the trough levels taken for vancomycin
do you withhold dose whilst waiting for results?
What is max rate? and why?
A
after 3-4 doses (before next dose)
Withhold next dose whilst waiting
max rate 10mg/min due to risk of red man syndrome
11
Q
What is a counselling point for how to use a DPI (.e.g. symbicort turbohaler)
A
form tight seal around mouthpiece and breathe in quickly and forcefully
12
Q
What is max senna pack size as P med under supervision of a pharmacist
A
100
13
Q
Can pseudoephedrine be sold if RP isnt present
What is max amount to sell otc
A
NO - can only be sold when RP is present
max 720mg
14
Q
If using other eye drops alongside latanoprost eye drops-when should they be used
A
leave 5 min gap
15
Q
How often do diabetics need to test their blood glucose on long journeys
A
every 2hrs
16
Q
what is age licensing OTC for
cetirizine
loratadine
A
cetirizine 6+
Loratadine 2+
17
Q
if a patient presents with dyspepsia what is an urgent referral
A
dysphagia
18
Q
What is a common s/e of sildenafil
A
hot flushing
19
Q
What is appt counselling of placement of a GTN patch for angina (transiderm nitro)
When would they potentially leave the patch off?
A
Placed on side of chest and replace every 24 hours with a new patch - choose a different area of skin every time it is eplaced - dont need to remove to shower
If tolerance is suspected during the use of transdermal patches they should be left off for 8–12 hours (usually overnight) in each 24 hours;
20
Q
if a woman has heavy/irregular periods bleeding and has a history of antiphospholipid syndrome to which she is on wafarin for, what treatment option would be appropriate
A
levonorgestel releasing intrauterine system
doesnt increase thrombosis risk and can be used to reduce heavy bleeding
21
Q
are prasugrel and ticagrelor indicated for stroke
A
no
22
Q
A patieents hearing has suddenly deteriorated and has ringing in her ears, she has just started azithromycin, is this an issu
A
Yes - tinnitus s/e of azithro
23
Q
What is the most suitable adviceregarding smoking cesssation?
a) quite date agreed to help motivation
b) single intervention
c) Give bupropion first line
d) E-cigarettes are licensed in smoking cessation
e) pt can purchase varenicline otc
A
Quite date should be agreed to help motivation
- usually combination is better
- bupropion is NOT first line
- E cigs are NOT licensed
- varenicline is POM
24
Q
Patient has suffered overdose of ferinject - what is appt action to investigate this?
A
RCA
25
A 58-year-old woman is currently taking digoxin 125micrograms daily for the past two months. She has no known drug allergies. She has also been taking furosemide 40mg tablets twice a day for the past two weeks. The patient tells you that she has not been feeling very well and has been experiencing nausea, diarrhoea, palpitations and feeling faint.
Question
What is the most appropriate advice to give to this patient?
STOP digoxin straight away and see GP asa soon as possible
26
What is a missed pill for desogestrel? what isthe advice?
12hours
| If within 12hours-take it and take next as normal, no need for precautions
27
What is the most appt option for a patient on parkinsons who is experiencing nausea and vomiting ass a result of apomorphine?
Domperidone
- NOT meto, halo, prochlorperazine
Ondanseton is Contraindicated with apomorphine due to increased QTc
28
A 35-year-old woman has been prescribed a medication for the management of an autoimmune condition. She has been advised to use effective contraception during treatment and for at least 6 months after the treatment ends.
Question
Which of the following medication is likely to have been prescribed?
Methotrexate is 6 months after
29
How long after stopping mycophenolate is protection contraception needed
90 days
30
How long after stopping tacrolimus is contraception needed
3months
31
56-year-old man presents himself at the pharmacy you are working in. He would like some painkillers after hurting his ankle playing football. He is weight bearing although limping slightly. He has tried nothing so far for the pain in his ankle. You ask the patient if he is on any regular medication, he tells you he takes:
Multivitamins
Omeprazole 20mg once daily
Folic acid 5mg daily (four-month course)
Symbicort turbohaler two puffs twice a day and when required
Question
What would be the most appropriate action to take?
Sell paracetamol and advise to rest joint
- no need for referral, weight bearing
- cant have NSAIDS duet to asthma
32
A 40-year-old woman visits your community pharmacy and asks to purchase travel sickness tablets, as she is going on a long-haul flight next week. The counter assistant tells you that she has hypertension, type 2 diabetes and occasional back pain, which are all adequately managed by her regular medication.
Which of the following options are you most likely to take next?
sell pack of 12 hyoscine hydrobromide 300 microgram tablets
33
A 33-year-old woman visits your pharmacy and asks to speak to you privately about a sensitive issue. She explains that she is experiencing a sharp pain when going to the toilet.
She is finding it difficult to pass stools and on occasions has noticed blood in the toilet. She has been experiencing these symptoms for two weeks. She is otherwise well and does not take any other medication.
Which of the following conditions is the patient most likely to be suffering from?
Anal fissure
34
A patient is admitted into medical admissions following urgent referral by their GP, as they have stymptoms that suggest abnormal potassium= potassium level is taken and are found to be 6.2mmol/L (3.55.3mmol/L).
Which of the following medicines would be the most appropriate to administer to the patient?
- calcium acetate
- mag aspartate
- patiromer calcium
- potassium chloride
- sevelamer
Patiromer calcium
35
which antidiabetic drug causes weight loss?
SGLT2
36
A 66-year-old man started on dapagliflozin 10 mg once a day for two weeks. He has also been taking metformin 500 mg three times a day and gliclazide 40 mg twice a day for the past four years. When collecting his repeat prescription, he complains of having stomach pain, feeling sick and frequent urination in the last few days. His blood sugar level is normal. He believes that the new tablet may be the reason for his symptoms.
Question
Which of the following is the most appropriate advice to give to this patient?
STOP taking Dapa and attend A&E to seek medical treatment - pt experiencing euglycaemic DKA - MHRA warning that DKA atypical presentations even if BG normal but ketones raised
37
A patient has come into the pharmacy with a four-week prescription for ciprofloxacin for prostatitis. Thereis interaction between a pre-existing medication and their ciprofloxacin.
Question
Which of the following medicines is most likely to interact with ciprofloxacin?
Ibuprofen - NSAIDS and quinolones SEVERE interaciton-avoid-reduced seizure threshold
38
52-year-old woman with hypertension and bipolar disorder, is admitted into hospital due to a seizure which she experienced for the first time. According to the patient notes, no recent dose changes of lithium have been reported however, she was recently prescribed a combination preparation enalapril with hydrochlorothiazide. Her moods have been stable however, the patient complains of constant fatigue.
You request the following tests:
Lithium conc raised 2.2
Creatinine raised
STOP lithium
STOP enalapril/hydrochlorothiazide
seizure suggests severe Li toxicity, Li excretion reduced by ACEi and thiazide plus poor renal function contributing further
39
A 77-year-old woman with type 1 diabetes is getting forgetful. She has a carer who visits once a day to help her with her medication.
Question
Which of the following insulins is suitable for once daily administration?
Answer options
```
A
Humalog (insulin lispro)
B
Humalog mix 50
C
Levemir (insulin determir)
D
Novomix 30
E
Novorapid (aspart insulin)
```
Levemir insulin detemir-OD admin
40
when do you re-start COC post surgery?
2 weeks after full mobilisation
41
What is the interaction between sildenafil and macrolides?
both prolong the QT interval
| Macrolides enzyme inhibitors
42
A 38-year-old man with type 2 diabetes visits your community pharmacy to collect his repeat medication. You overhear him conversing with the counter assistant about ulceration on his left foot.
Reefer to foot protection service
43
You are a GP practice pharmacist conducting an asthma review. The adult patient you are currently reviewing is still symptomatic despite being on salbutamol 100microgram inhaler one to two puffs when required and a Qvar 100microgram inhaler two puffs twice a day. You have confirmed they have the appropriate inhaler technique, so it is decided to step up treatment.
Which of the following medicines would be the most appropriate to add on to this
A Inhaled fluticasone
B Oral montelukast
C Oral prednisolone
D Oral theophylline
E Replace Qvar inhaler with Fostair (beclomethasone/formoterol) E
As per BTS- addition of LABA - Replace QVAR with Fostair
44
A 15-year-old boy has been started on a new anti-epileptic medication. You make sure that the boy and his parents understand the risks associated with over-heating and dehydration while he is on this medication.
Which of the following medicines is this patient most likely to be taking?
zonisamide-can lead to fatal heat stroke
45
A 42-year-old man with a past medical history of asthma has been admitted to hospital with difficulty speaking, body weakness, and tremor. They are also repetitively cleaning and washing their hands.
what could be causing his symptoms?
Montelukast-warning causing abnormal behaviour and obsessive compulsive symptoms
46
What is long term effect of PPIs
hypomagnesaemia
47
What is MHRA warning regarding PPIs
very low risk of subacute cutaneous lupus erythematosus (SLE) - weeks/months/years after esp in sun exposed areas
most of time it resolves on wtihdrawal but steroids may be needed
48
what are some interactions of Orlistat
reduced levothyroxine-reduced control
| reduced oral contraceptive efficacy
49
which antidiabetic drug increases the risk of fractures esp in women?
pioglitazone
50
which antihistamine is available GSL that is 12+?
Fexofenadine (120mg allevia)
51
what is first line for mixed bladder incontinence and 2nd line?
1: lifestyle= bladder trtraining and supervised pelvic floor exercises (6 weks and 3months)
Addition of drug 2nd line .g. oxybutynin, tolterodin, darifenacin
ONLY add mirabegron if severe and. others are c/i not tolerated
52
what is better in extremes of body wight e.g. ?120kg (BMI >40) - doac or warfarin?
Warfarin
53
Which drug carries the MHRA warning of a cleft lip when used in pregnancy?
Ondansetron
54
What is the minimum period of use of antidepressants before deeming ineffective in general population and elderly?
general: 4 weeks
Elderly: 6 weeeks
55
Which ACEi causes insomnia?
Captopril
56
Which is a potent dopamine agonist indicated in advanced parkinsons for patients experiencing off-periods and is available as SC injection to be given at first sign of off episode?
Apomorphine
57
Which CD is licensed for conscious sdation30-60mins before a procedure?
Temazpem 15-30mg
58
If a patient has been diagnosed with moderate dementia associated with parkinsons disease - which medicine can be used?
RIvastigmine- only licensed acetylcholinesterase inhibitor for moderate dementia associated with parkinsons
59
what is the interaction between amiodarone and propranolol?
risk of CV effects and bradycardia-avoid
60
What is first line drug treatment for focal seizures
Lamotrigine
| Carbamazepine
61
If a patient is taking fludrocortisone and is prescribed methadone -what is the risk?
Avoid-interaction- increased risk of torsade de pointes
62
what is max dose of ramipril if egfr 30-60?
5mg OD
63
what CV drug causes facial flushing
amlodipine
64
what dosing of risedronate is appropriate for a male patient for treatment of osteoporosis?
```
35mg OW
(5mg daily dose not licensed in men only women)
```
65
what are common symptoms of sepsis
```
High HR
Low BP
fever, shiver, cold
confusion,
SOB
pain
clammy/sweaty
```
66
what is 1st line for generalised tonic clonic. seizures
sodium valproate
| 2nd: lamotrigine (choice in women)
67
is sleep disorders a s/e of montelukast
yes-uncommon
68
which thiazide diuretic is appropriate for poor renal function
metolazone
69
what options are for a patient who has gestational diabetes and metformin not controlling?
Insulin - Lispro, aspart, detemir
70
how often are bloods monitored for carbimazole
6weekly then 3 monthly
71
what is adrenaline anaphylaxis dose for and when to repeat?
child 6M-5 years
Child 6-11 years
Child 12 or over/adult
6 months - 5 years = 150mcg
6-11 years= 300mcg
12+ = 500mcg
72
which type of juice affects warfarin
CRANBERRY ONLY and pomegranate
73
what is the treatment for children <3 months for bacterial meningitis?
IV cefotaxime
74
if a patient has increased risk of CVD / circulatory disease - what type of combined contraception is used
low dose oestrogen e.g. 20mcg
75
if a patient has high BP and smokes, what contraception is used
desogestrel - preferred if smoke/high BP
76
if a patient has high BP and smokes, what contraception is used
progesterone only - desogestrel - preferred if smoke/high BP
or norethisterone 350microgram
- also used in pts at high risk of VTE, heavy smoker, HTN (160/95), migraine with aura
77
When would you report an ADR to MHRA
adverse rxn that is serious/medically significant/results in harm
e. g. life. threatening or results in prolonged hospitalisation or congenital abnormality
e. g. anaphylaxis, blood disorders, endocrine changes,fertility, jaundice, CNS, severe skin,
78
what DONT you report for ADRs to MHRA
a well known relatively minor S/E e.g. dry mouth with TCAs or contipation and opioids
79
what is C/I to supply of sildenafil
Stroke in last 6 months
taking strong CYP inhibitors long term
severe CKD
80
what is NOT a legal requirement on a dispensing label
external use only
| out of sight and reach of children
81
what NSAIDS have low risk of GI effects
Ibuprofen <1.2g
| Naproxen <1g
82
what vitamins are avoided in pregnancy
Cod liver oil
| vit A
83
are type 1 diabetics eligible for NMS
No
84
what is counselling for metronidazole
space doses evenly, takewith food
| no alcohol during or 48hrs after
85
how long is VTE treatment for provoked DVT in active cancer
3-6 months
86
what are some interactions of isonazid
tyramine rich foods or histamine rich
87
which cytotoxic drugs do NOT cause BM suppression
vincristine
| bleomycin
88
if miss a dose of mtx in
- within 2 days
- 3days or more
what is done
within2. days: take forgotten dose
3 days or more: contact dr/specialist nurse for advice, likely skip
never double up
89
what is a CI of GLP1 agonist
severe GI diseases
90
what is the egfr cut off for thiazide diuretics
30ml/min
91
what is max dose of ramipril for egfr
30-60
<30
```
30-60= 5mg OD
<30= 1.25mg OD
```
92
which CCB is contraindicated with beta blocker use and which is cautioned? what is the risk?
C/I: verapamil
Caution: diltiazem
risk of cardiodepression, bradycardia, reduced CO etc = monitor pulse and BP
93
what would you do if have amiodarone and digoxin?
half the digoxin dose
94
in DAPT, if high risk of bleeding what antiplatelet is used and in favour of?
clopdiogrel over tigacrelor
95
how many days missed of opioid substitution therapy should be referred back prescriber
3 or more missed days
96
what is the interaction between macrolides and hydroxychloroquine/chloroquine?
Avoided due to risk of cadiovascular effects
| and psychiatric
97
What is the interaction between beta blockers and verapamil?
Never use BB and verapamil together - risk of heart block and bradycardia
98
the issuing of how many salbutamol inhalers within a year would determine a r/v or change is needed?
How many a month?
12 or more a year
99
A patient has a cold and has blocked nose and pain in lower cheekbone area,he tried sudafed but it has not worked. He now has a throbbing headache, his current medicines are: gaviscon, selegiline, codeine. what is the most appropriate action?
refer to GP - hypertensive crisis - can be dealt with in GP
100
which IV anaeesthetic is appropriate in chidlren to give quick recovery and minimal hangover?
propofol
101
what is the interaction between SSRIs and sodium valproate?
Hyponatraemia
| risks seizures
102
How would you describe digoxin toxicity
Sick and slow
103
What are antibiotics for infective exacerbation of COPD
Amoxicillin 500 mg three times a day for 5 days.
Doxycycline 200 mg on first day, then 100mg once a day for 5-day course in total.
Clarithromycin 500 mg twice a day for 5 days.
104
Patient has mild cellulitis with pencillin allergy where they develop a rash. What is an option for abx?
clarithromycin, Doxycycline
105
Which antibiotic doesnt demonstrate activity against Pseudomonas?
Cefuroxime
106
Which antibiotics demonstrate activity against pseudomonas?
Ciprofloxacin
gentamicin
meropenem
ceftazidime
107
What is an example of a short acting glucocorticoid?
Hydrocortisone - licensed for treatment of adrenal crisis
| similar to bodys natural glucocorticoid (cortisol)
108
What is a lacosamide abx?
clindamycin
109
```
A woman is experiencing symptoms of stress incontinence as she has noticed involuntary leakage of urine when sneezing/laughing. Which medicine is most likely the cause ?
Duloxetine
chlorphenamine
diclofenac
lansoprazole
```
Chlorphenamine- antimuscarinic effects can cause urinary retention, which may result in overflow incontinence urine production
(duloxetine is used to treat)
110
Which drugs cause increased urine production
Diuretics
alcohol
caffeine
111
which drugs can cause urinary retention
TCA, antimuscarinic drugs sedative antihistamines, some antipsychotics, oioids
Reduced awareness of need to urinate: Z drugs, BZs
112
Advice to give someone purchasing amorolfine nail laquer?
```
Toes 9-12months
weekly
File down nail bed first then apply
Apply to entire nail
R/v with pharmacist every 3 months (if symptoms not improved/worsened then GP)
```
113
What are baseline bloods to check when initiated on TB medication
Liver
renal
FBC
If no evidence of liver disease then no further checks necessary
114
When would you advise pt to take isosorbide mononitrate tablets 1 BD?
Morning and lunch to allow for free period
115
which drugs are avoided in breastfeeding
```
Tetracyclines
metronidazole: bitter metallic taste
aspirin: reye
Lithium:toxicity
bromocriptine: suppresses lactation
combined contraception: prefer POP as oestrogens adverse effects on lactation
```
116
Can ISMN be bought OTC
yes
117
A 29-year-old pregnant woman has had sinusitis for 5 days, she complains of a mild fever. Her only other medication is 400mcg folic acid and she is allergic to penicillin.
What is the most appropriate treatment and advice for this patient?
Sinusitis generally self limiting esp after cold (likely viral)
As she hasnt had it for >10 days would reassure and give paracetamol for the pain
If need abx over 10 days then fluclox
118
When do insulin requirements. increase
stress, trauma, illness etc
| pregnancy
119
A 57-year-old man, who has been taking ramipril 2.5mg daily for his blood pressure for the last six months, visits you for an annual medication review. You decide to check his blood pressure and after 3 readings you record his clinic blood pressure as 145/95. The patient informs you that they have been monitoring their blood pressure at home for the last two weeks. From his readings you can see that his average home blood pressure reading is 139/92. The patient is a non-smoker, with a BMI of 26 and he is experiencing no side effects from his ramipril. He also takes simvastatin 40mg tablets.
What is the most appropriate action to take?
advise on diet and exercise and review him in clinic in 2 months
offer another blood pressure check in 1-2 weeks before advising a dose adjustment
recommend to the prescriber that amlodipine is added into his treatment
recommend to the prescriber that the ramipril dose is increased
take no action on this occasion.
Need home BP target <135/85, his home BP is higher than this so would suggest increasing ramipril dose
120
A 57-year-old man has attended his GP for a routine health check. The GP records a clinic blood pressure of 164/102mmHg after three readings in both arms. He is fit and well and has no worrying signs and symptoms. He has no previous medical conditions and is not taking any medication.
Which one of the following would be the most appropriate course of action to take?
arrange a follow up appointment for further blood pressure checks to confirm diagnosis
offer ambulatory blood pressure monitoring to confirm the diagnosis before
prescribing antihypertensive medication
offer ambulatory blood pressure monitoring and consider prescribing anti-hypertensive medication immediately
prescribe anti-hypertensive medication immediately
refer the patient to specialist care the same day
Any BP between 140.90 and 180/120 do ambulatory BP monitoring to confirm the diagnosis
121
Which antiepileptic drugs can reduce clearance of methotrexate?
levetiracetam
122
What are interactions of methotrexate
nsaids
trimethiprim
ciprofloxacin
penicillins
123
what antidepressants are used if patient is on wafarin
mitrazepine
trazodone
reboxetine
mianserin
124
which anti depressant causes blood dygrasias
mirtazepine
125
what is a s/e of metoclopramide and what are restrictions to its use (MHRA)
```
oculogyric crisis - repetitive eye movements
5 days use
RISK EPSE
18+
10mg TDS
```
126
what is MHRA advice for domperidone
Cardiac S/e and QT
7 days use
10mg TDS
NOT in <12 or <35kg
127
in metoclopramide if <60kg what is dosing
500mcg/kg
| max 30mg a day
128
What is a s/e of ondansetron
QT prolongstion and interacts with other QT proloning dugs or those causing hypokalaemia as causes TDP
serotonin syndrome with other serotongeric drugs
feeling hot
129
What is treatment for mastitis and advice
flucloxacillin 500 mg four times a day for 10–14 days.
If the woman is allergic to penicillin, prescribe either erythromycin 250–500 mg four times a day or clarithromycin 500 mg twice a day for 10–14 days.
simple analgesia
warm compress/bath
encourage continuation of breast feeding, or express until better
130
What are the 3 main interactions of amoxicillin
mtx
warfarin
allopurinol
WAM
131
Which beta blockers are used in heart failure
Any grade:
bisoprolol
carvedilol
Nebivolol: stable mild to moderate in >70
Treatment initiation by specialist
132
What type of anaemia does pyridoxine treat?
Sideroblastic anaemia
| haemolytic anaemias
133
If a patient has mild constipation, has tried diet/lifestyle and also a bulk forming and has not worked (stools remain hard and difficult to pass)- what is next step?
Osmotic
| e.g. lactulose
134
If a patient is taking desmopressin complaining of a prolonged headache and nausea, what is appropiate recommndation
stop immediately and se GP asap - diabetes inspidus - taking desmo or drinking too much fluid when on it can cause body to retain too much fluid- causes prolonged severe headache and nausea due to hyponatraemia
135
most common first anti-emetics in pregnancy
```
lifestyle failed
cyclizine
promethazine
prochlorperazine
reassess 24hrs then if response good continue for week
```
2nd line are metoclopramide or ondansetron5. days
136
side effects of ccb
```
flushing
erectile dysfunction with amlodipine 10mg
oedema
headaches
gingival hyperplasia
muscle cramps
```
