Multiple choice questions Flashcards
In a patient having a life-threatening asthma attack, why can inhaled salbutamol not be effective?
Due to the restrictions of the airways, the drug cannot reach the receptors.
You are called to Mike, a 26 year old male. On arrival he is very agitated, sweaty, tachycardic, tachypnoeic, non compliant and is very manic and not engaging.
His friends explain that he has been out with them all night and consumed lots of alcohol and 6 ‘lines’ of cocaine.
What best describes one of the main actions of cocaine on the central nervous system:
It increases dopamine concentrations in the synapses
After administering chlorphenamine, what should you advise your patient to do?
Avoid skilled tasks such as cycling, driving or operating machinery and avoid alcohol
You are called to Margaret, a 56 year old female who has been complaining of acid reflux. She has a history of post-menopausal osteoporosis and takes Alendronic Acid 10mg daily. After discussions with her GP, you both agree that Gaviscon (Sodium bicarbonate & Calcium carbonate) is the best course of treatment for Margaret. Which of the following pieces of advice must she be given prior to commencing this treatment?
Alendronic acid should be taken 30min before Calcium carbonate
Warfarin impacts the normal clotting cascade by which of the following?
Inhibits Vit K oxidase-reductase reaction
Effective digoxin therapy is associated with which of the following?
Increased Left Ventricular Ejection Fraction
Ted has been taking clopidogrel for some time and recently went to the pharmacist as he had some heart burn. He was given a pack of omeprazole which helped with his symptoms. Reading the patient information leaflet (although he is asymptomatic) he is now worried as it says he shouldn’t be taking omeprazole if he is already on clopidogrel. What is the most likely result of the interaction?
Omeprazole inhibits the cytochrome P450 enzymes that metabolise clopidogrel resulting in decreased plasma levels of the active metabolite of clopidogrel with the potential of clinical effects.
A histamine antagonist has which of the following properties?
Anti-emetic
You intend to give your patient a hydrocortisone injection for severe asthma. You check the medicine with someone and then pass the syringe to your ambulance technician colleague to administer. Is this legally allowed? Select the correct statement regarding the legality of the action.
Yes, it is listed under the Human Medicines Regulations 2012 schedule 19 and therefore they are allowed to administer it in an emergency
In palliative care why is the subcutaneous route often used to administer medicines?
It maintains a steady plasma concentration, avoiding the peaks and troughs of other routes
You are called to Angelica who is 6 and complaining of pain to her left ear for one day. The tympanic membrane is moderately inflamed, the ear canal appears normal and there are no signs of mastoiditis. Which of the following is recommended by NICE Clinical Knowledge Summaries (CKS) at this stage?
Regular paracetamol or ibuprofen.
You have administered haloperidol to a patient presenting with Acute Behavioural Disturbance. Considering the pharmacokinetics of haloperidol, which medicine is most likely to result in an adverse event when both medicines are in the systemic circulation at the same time?
Itraconazole - a CYP3A4 inhibitor
Paracetamol can be given by the IV route but must be given slowly. Which of the following statements is correct regarding this?
It is believed that the excipient, mannitol, causes hypotension.
Which of the following groups is at greatest risk of a type A reaction?
South East Asians
Which of the following is not a feature of an aspirin overdose?
Hypoventilation
Which of the following statements is true of Gram positive organisms?
Lower likelihood of developing antibiotic resistance
Vicarious liability is when
The employer accepts liability for the employees actions
In a patient with a mild asthma attack, why is it considered best practice to use a salbutamol inhaler rather than a nebuliser?
Sufficient drug will reach the target receptors without much systemic absorption.
Olivia has been given a prescription for clarithromycin. What is the advice regarding clarithromycin administration in a patient with hepatic impairment?
Avoid in severe hepatic impairment if renal impairment is also present.
You get called to Sara who is 22. 4 days ago she was supplied a course of amoxicillin for a productive cough with green sputum with fever. Sara now has signs of severe systemic illness. She says she took a few of the tablets but kept forgetting. What is the most likely reason for the progression of the illness?
The lack of adherence has led to an insufficient time above the minimum inhibitory concentration to have had an effect on the bacteria
When are benzodiazepines most effective in a tonic clonic seizure and why?
In the first 30 minutes as there is a significant decrease in the number of inhibitory GABAa receptor subunits after this time.
Jason is 19 yrs old, who has injected opioid and is unresponsive. On clinical assessment, he was also bradypnoeic. As a result of the presenting symptoms, he was given IM injection of naloxone which improved his respiratory function and consciousness levels but after a short time he becomes bradypnoeic and unresponsive again. What is the most likely reason for this?
Naloxone has a short half life relative to the opioid and the naloxone is therefore eliminated quicker.
Rivaroxaban impacts the normal clotting cascade by which of the following?
Inhibits factor Xa action.
Solomon has been given codeine by his doctor but explains that the pain is not improving and the medicine doesn’t seem to be working. He also takes Ramipril. What is the most likely reason that his pain is not improving?
Solomon has a deficiency in the CYP2D6 enzyme resulting in him not achieving therapeutic levels of the active metabolite.
Aspirin impacts the normal clotting cascade by which of the following?
Inhibits COX-1 action
Which of the following instructions is appropriate to write on an FP10?
Maximum 8 tablets in 24 hours
Which of the following is not a responsibility of a nurse prescriber?
Ensuring the product is correctly labelled
What is the advice regarding chloramphenicol administration in pregnancy?
There is a risk of neonatal grey baby syndrome if used in third trimester so it should be avoided.
In palliative care why is the subcutaneous route often used to administer medicines?
It maintains a steady plasma concentration, avoiding the peaks and troughs of other routes
You intend to give your patient an injection of morphine. You check the medicine with someone else and then pass the syringe to your ambulance technician colleague to administer. Is this legally allowed? Select the correct statement regarding the legality of the action.
No, it is listed under the Human Medicines Regulations 2012 schedule 17 which means that only Paramedics can administer it.
If lorazepam and buccal diazepam are shown to have less adverse effects after the termination of the seizure, why to ambulance trusts not routinely give these instead of diazepam?
Diazepam is more stable under the likely storage conditions
Clozapine can cause….
Agranulocytosis
Concordance is an informed partnership agreement negotiated between
Patient and prescriber
Which route of administration is the fastest to achieve therapeutic plasma levels?
Which route of administration is the fastest to achieve therapeutic plasma levels?
Where a drug works by saturating an enzyme e.g. NSAIDs exceeding the recommended dose will
Not increase the effectiveness of the drug
Correct
A client has been prescribed a lipid soluble drug - what effect would a low serum albumin have?
There would be no difference in the drug response
Most drugs and their metabolites are excreted via?
The kidneys
What is the effect on absorption of an oral drug if gut motility is increased?
Drug absorption is decreased
Which of the following conditions would be a contra-indication to prescribing an ACE inhibitor
Pregnancy
Half life is the time taken for?
The plasma concentration of a drug to fall by 50%
If a drug has a relatively short half life the route for administration is likely to be:
Oral 3 - 4 times a day
Which drugs are considered the first line treatment for Hyperlipidaemia?
Statins
Which organisation is responsible for regulating the injectable cosmetics industry?
None of the above
Cocaine inhibits the re-uptake of:-
Dopamine
Which of the following conditions is a contra-indication to prescribing a Tricyclic antidepressant
Recent myocardial infarction
Which of the following statements is correct
Which of the following statements is correct
Which of the following terms is defined as: - “The physiological state of neuro-adaptation produced by repeated administration of a drug, necessitating continued administration to prevent the appearance of the withdrawal syndrome”?
Dependence
When should a dry cough in response to a drug be reported using the yellow card scheme?
When the drug is marked by a black triangle in the BNF
Generic prescribing is prescribing using the
Approved name
What does the acronym WWHAM stand for?
W -Who is it for? W -What are the symptoms? H - How long have the symptoms been present? A - any Action taken so far? M - any other Medication?
How is an individual’s prescribing practice evaluated and monitored?
Audit and PACT data
Which section in the BNF identifies drugs affecting the musculo-skeletal system?
Section 10
Which of the following is not a common side effect of a β² adrenoreceptor agonist?
Bradycardia
Which type of receptor is responsible for the bronchodilator effects of Salbutamol?
Beta2 receptors (β2)
Most drugs are metabolised by the
Liver
Under which circumstances would drugs transported by plasma proteins be more likely to produce a type A adverse reaction?
Liver Disease
A “type A” adverse drug reaction
Is pharmacologically predictable
Which drugs are considered the first line treatment for uncomplicated hypertension in a young Caucasian diabetic
Angiotensin Converting Enzyme Inhibitor (ACEi)
With which type of drug does Chamomile interact?
Benzodiazepines
What advice would you give a client on the safe disposal of medicines?
Return to the pharmacy that supplied them
What advice would you give a client for whom iron has been prescribed?
May colour stools
Which of the following drug groups is most associated with avoidable drug-related admissions to hospital?
NSAIDs
Diazepam is contra-indicated in
Severe hepatic impairment
Under which circumstances is it acceptable to prescribe for a family member?
In a life threatening emergency
As an independant and supplementary prescriber when would a Clinical Management Plan (CMP) be legally required to prescribe a medication?
When prescribing for a client outside your normal scope of practice
“Off label” prescribing refers to prescribing
A drug for use outside the indications of the UK product licence
Who authorises payments to contractors for the dispensing of NHS prescriptions?
Prescription Pricing Authority
As a general principle the term “child” in the BNF refers to persons
aged 12 years and under
Appendix 4 in the BNF deals with
Wound management
The terms child or children are used generically to describe age ranges from
aged 1 month -17 years
Breastfeeding is generally accepted to be safe in women taking
Warfarin
Generic prescribing is prescribing using the
Approved name
How should the prescriber endorse a prescription for a drug that is for contraceptive purposes to ensure it is dispensed free of charge?
♀
If a patient has received an overdose of a benzodiazepine two hours ago which drug would be given?
Flumazenil
PACT data….
Summarizes drug and appliance prescribing patterns for an individual prescriber
The active ingredients in Marvelon are
Desogestrel and Ethinylestradiol
Under what circumstances must the quantity of the drug to be dispensed be included on a FP 10?
When the medicine is to be taken as required (p.r.n.) but the frequency and number of days treatment is not specified.
What is the cold chain?
The audit of storage mechanisms to ensure the viability of a vaccine
When assessing the efficacy of a drug, what information is required?
Numbers needed to treat and numbers needed to harm
When should mildly elevated liver enzymes in response to a drug be reported via the yellow card scheme?
When the drug is marked with a black triangle in the BNF
Which of the following antibiotics inhibits cell wall synthesis?
Penecillins
Which of the following is good advice for a prescriber relating to pharmaceutical representatives?
Decide if the information is evidence or marketing
Which of the following is not a feature of an aspirin overdose?
Hypoventilation
Which of the following statements is true of Gram positive organisms?
Lower likelihood of developing antibiotic resistance
A “type B” adverse drug reaction
Should be reported via the yellow card scheme
All non-steroidal anti inflammatory drugs (NSAIDs) work by
Inhibiting the action of cyclo-oxygenases
As a general principal oral paediatric drug dosages are calulated on
The child’s weight
Drug allergies occur
When the body identifies the drug as an antigen
How many steps are there in the prescribing pyramid?
seven
Section 5 in the BNF considers drugs related to
Infections
What advice would you give a client on the safe storage of medicines?
Store out of the reach of children
What is the effect on absorption of a drug delivered via a transdermal patch if the client is hypothermic?
Drug absorption is decreased
Which of the following antibiotics inhibits DNA synthesis?
Ciprofloxacin
Which of the following antibiotics is nephrotoxic?
Streptomycin
Which of these antibacterial agents is an Antifolate?
Trimethoprim
Which of these would you advise a patient for whom you have prescribed amoxicillin?
Take at regular intervals. Complete the course unless otherwise directed.
A patient who has an predictable adverse reaction to a drug is said to experience which type of reaction?
Type A
An antagonist is a drug that
Blocks a receptor site
For how long is a prescription for a Schedule 2 drug valid?
28 days
In the BNF Drug interactions are listed
Twice - Alphabetically by drug name and by drug group interactions
SSRI is an abbreviation for
Selective serotonin re-uptake inhibitor
The first line treatment for anaphylaxis is
Intramuscular adrenaline
The first pass effect refers to
The removal of some or all of the drug by the liver before it has had a therapeutic effect
The removal of some or all of the drug by the liver before it has had a therapeutic effect
Drug absorption is increased
What monitoring should be instigated for a client commencing on an ACEi
Renal Function tests
When assessing the efficacy of a drug, what information is required?
Numbers needed to treat and numbers needed to harm
When should a dry cough in response to a drug be reported using the yellow card scheme?
When the drug is marked by a black triangle in the BNF
Which of the following groups are not exempt from prescription charges?
Diet controlled diabetics
Which of the following is a common side effect of beta blockers?
Bronchospasm
Which of these diuretic groups is known to be ototoxic?
Loop diurectics
Which receptors do barbiturates work on?
Which Section in the BNF identifies drugs affecting the Respiratory System?
An agonist is a drug that
Triggers a response in a receptor
Clozapine can cause
Agranulocytosis
Pharmacodynamics considers
The way in which the drug affects the body
The side effects of a drug are listed in the BNF by order of
Frequency i.e. the most common first
Which of the following antibiotics is nephrotoxic?
Which of the following antibiotics is nephrotoxic?
Which of the following is a typical antipsychotic?
Flupenthixol
Which of the following terms is defined as: - “when after repeated administration, a given dose of a drug produces a decreased effect, or conversely, when increasingly larger doses must be administered to obtain the effects observed with the original use”?
Tolerance
Which Section in the BNF identifies drugs affecting the Cardio-vascular System?
Section 2
Which type of receptor is responsible for the analgesic properties of Morphine?
Mu (µ)
