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Prescribing > Multiple choice questions > Flashcards

Multiple choice questions Flashcards

1
Q

In a patient having a life-threatening asthma attack, why can inhaled salbutamol not be effective?

A

Due to the restrictions of the airways, the drug cannot reach the receptors.

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2
Q

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:

A

It increases dopamine concentrations in the synapses

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3
Q

After administering chlorphenamine, what should you advise your patient to do?

A

Avoid skilled tasks such as cycling, driving or operating machinery and avoid alcohol

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4
Q

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?

A

Alendronic acid should be taken 30min before Calcium carbonate

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5
Q

Warfarin impacts the normal clotting cascade by which of the following?

A

Inhibits Vit K oxidase-reductase reaction

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6
Q

Effective digoxin therapy is associated with which of the following?

A

Increased Left Ventricular Ejection Fraction

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7
Q

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?

A

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.

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8
Q

A histamine antagonist has which of the following properties?

A

Anti-emetic

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9
Q

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.

A

Yes, it is listed under the Human Medicines Regulations 2012 schedule 19 and therefore they are allowed to administer it in an emergency

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10
Q

In palliative care why is the subcutaneous route often used to administer medicines?

A

It maintains a steady plasma concentration, avoiding the peaks and troughs of other routes

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11
Q

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?

A

Regular paracetamol or ibuprofen.

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12
Q

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?

A

Itraconazole - a CYP3A4 inhibitor

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13
Q

Paracetamol can be given by the IV route but must be given slowly. Which of the following statements is correct regarding this?

A

It is believed that the excipient, mannitol, causes hypotension.

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14
Q

Which of the following groups is at greatest risk of a type A reaction?

A

South East Asians

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15
Q

Which of the following is not a feature of an aspirin overdose?

A

Hypoventilation

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16
Q

Which of the following statements is true of Gram positive organisms?

A

Lower likelihood of developing antibiotic resistance

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17
Q

Vicarious liability is when

A

The employer accepts liability for the employees actions

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18
Q

In a patient with a mild asthma attack, why is it considered best practice to use a salbutamol inhaler rather than a nebuliser?

A

Sufficient drug will reach the target receptors without much systemic absorption.

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19
Q

Olivia has been given a prescription for clarithromycin. What is the advice regarding clarithromycin administration in a patient with hepatic impairment?

A

Avoid in severe hepatic impairment if renal impairment is also present.

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20
Q

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?

A

The lack of adherence has led to an insufficient time above the minimum inhibitory concentration to have had an effect on the bacteria

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21
Q

When are benzodiazepines most effective in a tonic clonic seizure and why?

A

In the first 30 minutes as there is a significant decrease in the number of inhibitory GABAa receptor subunits after this time.

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22
Q

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?

A

Naloxone has a short half life relative to the opioid and the naloxone is therefore eliminated quicker.

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23
Q

Rivaroxaban impacts the normal clotting cascade by which of the following?

A

Inhibits factor Xa action.

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24
Q

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?

A

Solomon has a deficiency in the CYP2D6 enzyme resulting in him not achieving therapeutic levels of the active metabolite.

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25
Q

Aspirin impacts the normal clotting cascade by which of the following?

A

Inhibits COX-1 action

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26
Q

Which of the following instructions is appropriate to write on an FP10?

A

Maximum 8 tablets in 24 hours

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27
Q

Which of the following is not a responsibility of a nurse prescriber?

A

Ensuring the product is correctly labelled

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28
Q

What is the advice regarding chloramphenicol administration in pregnancy?

A

There is a risk of neonatal grey baby syndrome if used in third trimester so it should be avoided.

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29
Q

In palliative care why is the subcutaneous route often used to administer medicines?

A

It maintains a steady plasma concentration, avoiding the peaks and troughs of other routes

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30
Q

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.

A

No, it is listed under the Human Medicines Regulations 2012 schedule 17 which means that only Paramedics can administer it.

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31
Q

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?

A

Diazepam is more stable under the likely storage conditions

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32
Q

Clozapine can cause….

A

Agranulocytosis

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33
Q

Concordance is an informed partnership agreement negotiated between

A

Patient and prescriber

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34
Q

Which route of administration is the fastest to achieve therapeutic plasma levels?

A

Which route of administration is the fastest to achieve therapeutic plasma levels?

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35
Q

Where a drug works by saturating an enzyme e.g. NSAIDs exceeding the recommended dose will

A

Not increase the effectiveness of the drug

Correct

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36
Q

A client has been prescribed a lipid soluble drug - what effect would a low serum albumin have?

A

There would be no difference in the drug response

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37
Q

Most drugs and their metabolites are excreted via?

A

The kidneys

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38
Q

What is the effect on absorption of an oral drug if gut motility is increased?

A

Drug absorption is decreased

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39
Q

Which of the following conditions would be a contra-indication to prescribing an ACE inhibitor

A

Pregnancy

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40
Q

Half life is the time taken for?

A

The plasma concentration of a drug to fall by 50%

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41
Q

If a drug has a relatively short half life the route for administration is likely to be:

A

Oral 3 - 4 times a day

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42
Q

Which drugs are considered the first line treatment for Hyperlipidaemia?

A

Statins

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43
Q

Which organisation is responsible for regulating the injectable cosmetics industry?

A

None of the above

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44
Q

Cocaine inhibits the re-uptake of:-

A

Dopamine

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45
Q

Which of the following conditions is a contra-indication to prescribing a Tricyclic antidepressant

A

Recent myocardial infarction

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46
Q

Which of the following statements is correct

A

Which of the following statements is correct

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47
Q

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”?

A

Dependence

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48
Q

When should a dry cough in response to a drug be reported using the yellow card scheme?

A

When the drug is marked by a black triangle in the BNF

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49
Q

Generic prescribing is prescribing using the

A

Approved name

50
Q

What does the acronym WWHAM stand for?

A

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?

51
Q

How is an individual’s prescribing practice evaluated and monitored?

A

Audit and PACT data

52
Q

Which section in the BNF identifies drugs affecting the musculo-skeletal system?

A

Section 10

53
Q

Which of the following is not a common side effect of a β² adrenoreceptor agonist?

A

Bradycardia

54
Q

Which type of receptor is responsible for the bronchodilator effects of Salbutamol?

A

Beta2 receptors (β2)

55
Q

Most drugs are metabolised by the

A

Liver

56
Q

Under which circumstances would drugs transported by plasma proteins be more likely to produce a type A adverse reaction?

A

Liver Disease

57
Q

A “type A” adverse drug reaction

A

Is pharmacologically predictable

58
Q

Which drugs are considered the first line treatment for uncomplicated hypertension in a young Caucasian diabetic

A

Angiotensin Converting Enzyme Inhibitor (ACEi)

59
Q

With which type of drug does Chamomile interact?

A

Benzodiazepines

60
Q

What advice would you give a client on the safe disposal of medicines?

A

Return to the pharmacy that supplied them

61
Q

What advice would you give a client for whom iron has been prescribed?

A

May colour stools

62
Q

Which of the following drug groups is most associated with avoidable drug-related admissions to hospital?

A

NSAIDs

63
Q

Diazepam is contra-indicated in

A

Severe hepatic impairment

64
Q

Under which circumstances is it acceptable to prescribe for a family member?

A

In a life threatening emergency

65
Q

As an independant and supplementary prescriber when would a Clinical Management Plan (CMP) be legally required to prescribe a medication?

A

When prescribing for a client outside your normal scope of practice

66
Q

“Off label” prescribing refers to prescribing

A

A drug for use outside the indications of the UK product licence

67
Q

Who authorises payments to contractors for the dispensing of NHS prescriptions?

A

Prescription Pricing Authority

68
Q

As a general principle the term “child” in the BNF refers to persons

A

aged 12 years and under

69
Q

Appendix 4 in the BNF deals with

A

Wound management

70
Q

The terms child or children are used generically to describe age ranges from

A

aged 1 month -17 years

71
Q

Breastfeeding is generally accepted to be safe in women taking

A

Warfarin

72
Q

Generic prescribing is prescribing using the

A

Approved name

73
Q

How should the prescriber endorse a prescription for a drug that is for contraceptive purposes to ensure it is dispensed free of charge?

A

♀

74
Q

If a patient has received an overdose of a benzodiazepine two hours ago which drug would be given?

A

Flumazenil

75
Q

PACT data….

A

Summarizes drug and appliance prescribing patterns for an individual prescriber

76
Q

The active ingredients in Marvelon are

A

Desogestrel and Ethinylestradiol

77
Q

Under what circumstances must the quantity of the drug to be dispensed be included on a FP 10?

A

When the medicine is to be taken as required (p.r.n.) but the frequency and number of days treatment is not specified.

78
Q

What is the cold chain?

A

The audit of storage mechanisms to ensure the viability of a vaccine

79
Q

When assessing the efficacy of a drug, what information is required?

A

Numbers needed to treat and numbers needed to harm

80
Q

When should mildly elevated liver enzymes in response to a drug be reported via the yellow card scheme?

A

When the drug is marked with a black triangle in the BNF

81
Q

Which of the following antibiotics inhibits cell wall synthesis?

A

Penecillins

82
Q

Which of the following is good advice for a prescriber relating to pharmaceutical representatives?

A

Decide if the information is evidence or marketing

83
Q

Which of the following is not a feature of an aspirin overdose?

A

Hypoventilation

84
Q

Which of the following statements is true of Gram positive organisms?

A

Lower likelihood of developing antibiotic resistance

85
Q

A “type B” adverse drug reaction

A

Should be reported via the yellow card scheme

86
Q

All non-steroidal anti inflammatory drugs (NSAIDs) work by

A

Inhibiting the action of cyclo-oxygenases

87
Q

As a general principal oral paediatric drug dosages are calulated on

A

The child’s weight

88
Q

Drug allergies occur

A

When the body identifies the drug as an antigen

89
Q

How many steps are there in the prescribing pyramid?

A

seven

90
Q

Section 5 in the BNF considers drugs related to

A

Infections

91
Q

What advice would you give a client on the safe storage of medicines?

A

Store out of the reach of children

92
Q

What is the effect on absorption of a drug delivered via a transdermal patch if the client is hypothermic?

A

Drug absorption is decreased

93
Q

Which of the following antibiotics inhibits DNA synthesis?

A

Ciprofloxacin

94
Q

Which of the following antibiotics is nephrotoxic?

A

Streptomycin

95
Q

Which of these antibacterial agents is an Antifolate?

A

Trimethoprim

96
Q

Which of these would you advise a patient for whom you have prescribed amoxicillin?

A

Take at regular intervals. Complete the course unless otherwise directed.

97
Q

A patient who has an predictable adverse reaction to a drug is said to experience which type of reaction?

A

Type A

98
Q

An antagonist is a drug that

A

Blocks a receptor site

99
Q

For how long is a prescription for a Schedule 2 drug valid?

A

28 days

100
Q

In the BNF Drug interactions are listed

A

Twice - Alphabetically by drug name and by drug group interactions

101
Q

SSRI is an abbreviation for

A

Selective serotonin re-uptake inhibitor

102
Q

The first line treatment for anaphylaxis is

A

Intramuscular adrenaline

103
Q

The first pass effect refers to

A

The removal of some or all of the drug by the liver before it has had a therapeutic effect

104
Q

The removal of some or all of the drug by the liver before it has had a therapeutic effect

A

Drug absorption is increased

105
Q

What monitoring should be instigated for a client commencing on an ACEi

A

Renal Function tests

106
Q

When assessing the efficacy of a drug, what information is required?

A

Numbers needed to treat and numbers needed to harm

107
Q

When should a dry cough in response to a drug be reported using the yellow card scheme?

A

When the drug is marked by a black triangle in the BNF

108
Q

Which of the following groups are not exempt from prescription charges?

A

Diet controlled diabetics

109
Q

Which of the following is a common side effect of beta blockers?

A

Bronchospasm

110
Q

Which of these diuretic groups is known to be ototoxic?

A

Loop diurectics

111
Q

Which receptors do barbiturates work on?

A

Which Section in the BNF identifies drugs affecting the Respiratory System?

112
Q

An agonist is a drug that

A

Triggers a response in a receptor

113
Q

Clozapine can cause

A

Agranulocytosis

114
Q

Pharmacodynamics considers

A

The way in which the drug affects the body

115
Q

The side effects of a drug are listed in the BNF by order of

A

Frequency i.e. the most common first

116
Q

Which of the following antibiotics is nephrotoxic?

A

Which of the following antibiotics is nephrotoxic?

117
Q

Which of the following is a typical antipsychotic?

A

Flupenthixol

118
Q

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”?

A

Tolerance

119
Q

Which Section in the BNF identifies drugs affecting the Cardio-vascular System?

A

Section 2

120
Q

Which type of receptor is responsible for the analgesic properties of Morphine?

A

Mu (µ)

Prescribing (1 decks)

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