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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

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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

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3
Q

What is the interaction between amoxicillin and methotrexate

A

amoxicillin can increase risk of toxicity of mtx

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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

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5
Q

When would you measure LFTs with statins

A

3 months then 12 months

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6
Q

Upon initiation of olanzapine, what parameter must be reviewed and recorded prior

A

fasting BG - susceptible to hyperglycaemia

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7
Q

What is a common s/e of trimethoprim

A

Fungal overgrowth

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8
Q

What is a s/e of GTN apart from headache/hypotension/flushing etc

A

tachycardia (and brady)

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9
Q

What is a common adverse reaction for clindamycin

A

colitis

abdominal pain

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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

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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

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12
Q

What is max senna pack size as P med under supervision of a pharmacist

A

100

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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

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14
Q

If using other eye drops alongside latanoprost eye drops-when should they be used

A

leave 5 min gap

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15
Q

How often do diabetics need to test their blood glucose on long journeys

A

every 2hrs

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16
Q

what is age licensing OTC for
cetirizine
loratadine

A

cetirizine 6+

Loratadine 2+

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17
Q

if a patient presents with dyspepsia what is an urgent referral

A

dysphagia

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18
Q

What is a common s/e of sildenafil

A

hot flushing

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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;

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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

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21
Q

are prasugrel and ticagrelor indicated for stroke

A

no

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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

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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
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24
Q

Patient has suffered overdose of ferinject - what is appt action to investigate this?

A

RCA

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25
Q

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?

A

STOP digoxin straight away and see GP asa soon as possible

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26
Q

What is a missed pill for desogestrel? what isthe advice?

A

12hours

If within 12hours-take it and take next as normal, no need for precautions

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27
Q

What is the most appt option for a patient on parkinsons who is experiencing nausea and vomiting ass a result of apomorphine?

A

Domperidone
- NOT meto, halo, prochlorperazine
Ondanseton is Contraindicated with apomorphine due to increased QTc

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28
Q

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?

A

Methotrexate is 6 months after

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29
Q

How long after stopping mycophenolate is protection contraception needed

A

90 days

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30
Q

How long after stopping tacrolimus is contraception needed

A

3months

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31
Q

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?

A

Sell paracetamol and advise to rest joint

  • no need for referral, weight bearing
  • cant have NSAIDS duet to asthma
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32
Q

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?

A

sell pack of 12 hyoscine hydrobromide 300 microgram tablets

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33
Q

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?

A

Anal fissure

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34
Q

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 (3.5􏰙5.3mmol/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

A

Patiromer calcium

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35
Q

which antidiabetic drug causes weight loss?

A

SGLT2

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36
Q

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?

A

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

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37
Q

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?

A

Ibuprofen - NSAIDS and quinolones SEVERE interaciton-avoid-reduced seizure threshold

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38
Q

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

A

STOP lithium
STOP enalapril/hydrochlorothiazide
seizure suggests severe Li toxicity, Li excretion reduced by ACEi and thiazide plus poor renal function contributing further

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39
Q

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)
A

Levemir insulin detemir-OD admin

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40
Q

when do you re-start COC post surgery?

A

2 weeks after full mobilisation

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41
Q

What is the interaction between sildenafil and macrolides?

A

both prolong the QT interval

Macrolides enzyme inhibitors

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42
Q

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.

A

Reefer to foot protection service

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43
Q

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

A

As per BTS- addition of LABA - Replace QVAR with Fostair

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44
Q

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?

A

zonisamide-can lead to fatal heat stroke

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45
Q

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?

A

Montelukast-warning causing abnormal behaviour and obsessive compulsive symptoms

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46
Q

What is long term effect of PPIs

A

hypomagnesaemia

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47
Q

What is MHRA warning regarding PPIs

A

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

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48
Q

what are some interactions of Orlistat

A

reduced levothyroxine-reduced control

reduced oral contraceptive efficacy

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49
Q

which antidiabetic drug increases the risk of fractures esp in women?

A

pioglitazone

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50
Q

which antihistamine is available GSL that is 12+?

A

Fexofenadine (120mg allevia)

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51
Q

what is first line for mixed bladder incontinence and 2nd line?

A

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

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52
Q

what is better in extremes of body wight e.g. ?120kg (BMI >40) - doac or warfarin?

A

Warfarin

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53
Q

Which drug carries the MHRA warning of a cleft lip when used in pregnancy?

A

Ondansetron

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54
Q

What is the minimum period of use of antidepressants before deeming ineffective in general population and elderly?

A

general: 4 weeks
Elderly: 6 weeeks

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55
Q

Which ACEi causes insomnia?

A

Captopril

56
Q

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?

A

Apomorphine

57
Q

Which CD is licensed for conscious sdation30-60mins before a procedure?

A

Temazpem 15-30mg

58
Q

If a patient has been diagnosed with moderate dementia associated with parkinsons disease - which medicine can be used?

A

RIvastigmine- only licensed acetylcholinesterase inhibitor for moderate dementia associated with parkinsons

59
Q

what is the interaction between amiodarone and propranolol?

A

risk of CV effects and bradycardia-avoid

60
Q

What is first line drug treatment for focal seizures

A

Lamotrigine

Carbamazepine

61
Q

If a patient is taking fludrocortisone and is prescribed methadone -what is the risk?

A

Avoid-interaction- increased risk of torsade de pointes

62
Q

what is max dose of ramipril if egfr 30-60?

A

5mg OD

63
Q

what CV drug causes facial flushing

A

amlodipine

64
Q

what dosing of risedronate is appropriate for a male patient for treatment of osteoporosis?

A 
35mg OW
(5mg daily dose not licensed in men only women)
65
Q

what are common symptoms of sepsis

A 
High HR
Low BP
fever, shiver, cold
confusion,
SOB
pain
clammy/sweaty
66
Q

what is 1st line for generalised tonic clonic. seizures

A

sodium valproate

2nd: lamotrigine (choice in women)

67
Q

is sleep disorders a s/e of montelukast

A

yes-uncommon

68
Q

which thiazide diuretic is appropriate for poor renal function

A

metolazone

69
Q

what options are for a patient who has gestational diabetes and metformin not controlling?

A

Insulin - Lispro, aspart, detemir

70
Q

how often are bloods monitored for carbimazole

A

6weekly then 3 monthly

71
Q

what is adrenaline anaphylaxis dose for and when to repeat?
child 6M-5 years
Child 6-11 years
Child 12 or over/adult

A

6 months - 5 years = 150mcg
6-11 years= 300mcg
12+ = 500mcg

72
Q

which type of juice affects warfarin

A

CRANBERRY ONLY and pomegranate

73
Q

what is the treatment for children <3 months for bacterial meningitis?

A

IV cefotaxime

74
Q

if a patient has increased risk of CVD / circulatory disease - what type of combined contraception is used

A

low dose oestrogen e.g. 20mcg

75
Q

if a patient has high BP and smokes, what contraception is used

A

desogestrel - preferred if smoke/high BP

76
Q

if a patient has high BP and smokes, what contraception is used

A

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
Q

When would you report an ADR to MHRA

A

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
Q

what DONT you report for ADRs to MHRA

A

a well known relatively minor S/E e.g. dry mouth with TCAs or contipation and opioids

79
Q

what is C/I to supply of sildenafil

A

Stroke in last 6 months
taking strong CYP inhibitors long term
severe CKD

80
Q

what is NOT a legal requirement on a dispensing label

A

external use only

out of sight and reach of children

81
Q

what NSAIDS have low risk of GI effects

A

Ibuprofen <1.2g

Naproxen <1g

82
Q

what vitamins are avoided in pregnancy

A

Cod liver oil

vit A

83
Q

are type 1 diabetics eligible for NMS

A

No

84
Q

what is counselling for metronidazole

A

space doses evenly, takewith food

no alcohol during or 48hrs after

85
Q

how long is VTE treatment for provoked DVT in active cancer

A

3-6 months

86
Q

what are some interactions of isonazid

A

tyramine rich foods or histamine rich

87
Q

which cytotoxic drugs do NOT cause BM suppression

A

vincristine

bleomycin

88
Q

if miss a dose of mtx in
- within 2 days
- 3days or more
what is done

A

within2. days: take forgotten dose
3 days or more: contact dr/specialist nurse for advice, likely skip
never double up

89
Q

what is a CI of GLP1 agonist

A

severe GI diseases

90
Q

what is the egfr cut off for thiazide diuretics

A

30ml/min

91
Q

what is max dose of ramipril for egfr
30-60
<30

A 
30-60= 5mg OD
<30= 1.25mg OD
92
Q

which CCB is contraindicated with beta blocker use and which is cautioned? what is the risk?

A

C/I: verapamil
Caution: diltiazem
risk of cardiodepression, bradycardia, reduced CO etc = monitor pulse and BP

93
Q

what would you do if have amiodarone and digoxin?

A

half the digoxin dose

94
Q

in DAPT, if high risk of bleeding what antiplatelet is used and in favour of?

A

clopdiogrel over tigacrelor

95
Q

how many days missed of opioid substitution therapy should be referred back prescriber

A

3 or more missed days

96
Q

what is the interaction between macrolides and hydroxychloroquine/chloroquine?

A

Avoided due to risk of cadiovascular effects

and psychiatric

97
Q

What is the interaction between beta blockers and verapamil?

A

Never use BB and verapamil together - risk of heart block and bradycardia

98
Q

the issuing of how many salbutamol inhalers within a year would determine a r/v or change is needed?
How many a month?

A

12 or more a year

99
Q

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?

A

refer to GP - hypertensive crisis - can be dealt with in GP

100
Q

which IV anaeesthetic is appropriate in chidlren to give quick recovery and minimal hangover?

A

propofol

101
Q

what is the interaction between SSRIs and sodium valproate?

A

Hyponatraemia

risks seizures

102
Q

How would you describe digoxin toxicity

A

Sick and slow

103
Q

What are antibiotics for infective exacerbation of COPD

A

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
Q

Patient has mild cellulitis with pencillin allergy where they develop a rash. What is an option for abx?

A

clarithromycin, Doxycycline

105
Q

Which antibiotic doesnt demonstrate activity against Pseudomonas?

A

Cefuroxime

106
Q

Which antibiotics demonstrate activity against pseudomonas?

A

Ciprofloxacin
gentamicin
meropenem
ceftazidime

107
Q

What is an example of a short acting glucocorticoid?

A

Hydrocortisone - licensed for treatment of adrenal crisis

similar to bodys natural glucocorticoid (cortisol)

108
Q

What is a lacosamide abx?

A

clindamycin

109
Q 
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
A

Chlorphenamine- antimuscarinic effects can cause urinary retention, which may result in overflow incontinence urine production
(duloxetine is used to treat)

110
Q

Which drugs cause increased urine production

A

Diuretics
alcohol
caffeine

111
Q

which drugs can cause urinary retention

A

TCA, antimuscarinic drugs sedative antihistamines, some antipsychotics, oioids
Reduced awareness of need to urinate: Z drugs, BZs

112
Q

Advice to give someone purchasing amorolfine nail laquer?

A 
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
Q

What are baseline bloods to check when initiated on TB medication

A

Liver
renal
FBC

If no evidence of liver disease then no further checks necessary

114
Q

When would you advise pt to take isosorbide mononitrate tablets 1 BD?

A

Morning and lunch to allow for free period

115
Q

which drugs are avoided in breastfeeding

A 
Tetracyclines
metronidazole: bitter metallic taste
aspirin: reye
Lithium:toxicity
bromocriptine: suppresses lactation
combined contraception: prefer POP as oestrogens adverse effects on lactation
116
Q

Can ISMN be bought OTC

A

yes

117
Q

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?

A

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
Q

When do insulin requirements. increase

A

stress, trauma, illness etc

pregnancy

119
Q

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.

A

Need home BP target <135/85, his home BP is higher than this so would suggest increasing ramipril dose

120
Q

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

A

Any BP between 140.90 and 180/120 do ambulatory BP monitoring to confirm the diagnosis

121
Q

Which antiepileptic drugs can reduce clearance of methotrexate?

A

levetiracetam

122
Q

What are interactions of methotrexate

A

nsaids
trimethiprim
ciprofloxacin
penicillins

123
Q

what antidepressants are used if patient is on wafarin

A

mitrazepine
trazodone
reboxetine
mianserin

124
Q

which anti depressant causes blood dygrasias

A

mirtazepine

125
Q

what is a s/e of metoclopramide and what are restrictions to its use (MHRA)

A 
oculogyric crisis - repetitive eye movements 
5 days use
RISK EPSE
18+ 
10mg TDS
126
Q

what is MHRA advice for domperidone

A

Cardiac S/e and QT
7 days use
10mg TDS
NOT in <12 or <35kg

127
Q

in metoclopramide if <60kg what is dosing

A

500mcg/kg

max 30mg a day

128
Q

What is a s/e of ondansetron

A

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
Q

What is treatment for mastitis and advice

A

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
Q

What are the 3 main interactions of amoxicillin

A

mtx
warfarin
allopurinol
WAM

131
Q

Which beta blockers are used in heart failure

A

Any grade:
bisoprolol
carvedilol

Nebivolol: stable mild to moderate in >70

Treatment initiation by specialist

132
Q

What type of anaemia does pyridoxine treat?

A

Sideroblastic anaemia

haemolytic anaemias

133
Q

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?

A

Osmotic

e.g. lactulose

134
Q

If a patient is taking desmopressin complaining of a prolonged headache and nausea, what is appropiate recommndation

A

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
Q

most common first anti-emetics in pregnancy

A 
lifestyle failed
cyclizine 
promethazine
prochlorperazine
reassess 24hrs then if response good continue for week

2nd line are metoclopramide or ondansetron5. days

136
Q

side effects of ccb

A 
flushing
erectile dysfunction with amlodipine 10mg 
oedema
headaches
gingival hyperplasia
muscle cramps

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