On Track Flashcards
1
Q
MHRA Pioglitazone
A
MHRA has issued a safety alert for increased risk of heart failure linked with pioglitazone.
2
Q
MHRA Empagliflozin
A
MHRA has issued a safety alert for increased risk of diabetic ketoacidosis linked with empagliflozin.
3
Q
MHRA Insulin
A
MHRA has issued a safety alert for increased risk of severe harm and death due to withdrawing insulin from pen devices.
4
Q
Generalised Anxiety Disorder
A
Generalised anxiety disorder is characterised by persistent excessive and inappropriate anxiety on most days for at least 6 months. The anxiety is not restricted to a specific situation.
5
Q
Agoraphobia
A
Agoraphobia is where a person becomes afraid of places or situations from which escape might be difficult.
6
Q
PTSD
A
Post-traumatic stress disorder usually occurs after exposure to a traumatic event which involved actual or threatened death, or serious injury or threats to the physical integrity of self or others. The person responds with intense fear, helplessness or horror. Sufferers can re-experience symptoms (flashbacks) and avoid situations associated with the trauma. This condition usually occurs within 6 months of the traumatic event.
7
Q
Crohn’s disease
A
The chronic history, loose stools, weight loss and raised inflammatory markers are suggestive of Crohn’s disease. Further specialist investigations are required for this patient.
8
Q
Coeliac disease
A
The recurrent abdominal pain, loose and pale stools, together with poor growth, are suggestive of coeliac disease. Further specialist investigations are required for this patient.
9
Q
Form written on prescription for nasal drops
A
Narist. is the latin term for nasal drops.
10
Q
Form written on prescription for ointment
A
Unguentum is the latin word for ointment.
11
Q
Digoxin and quinine
A
Plasma concentration of digoxin increased by quinine. Nausea and vomiting may be early signs of an excessive dose of digoxin.
12
Q
Pimozide and ketoconazole
A
This combination is very dangerous as pimozide is a CYP3A4 enzyme substrate and ketoconazole is a potent inhibitor of CYP3A4 leading to a marked increase in pimozide serum levels. This can cause ventricular arrhythmias.
13
Q
Sildenafil and isosorbide mononitrate
A
Sildenafil may markedly increase the hypotensive effect of isosorbide mononitrate.
14
Q
Epigastric pain
A
Gastric ulcer
15
Q
Central or right lower quadrant pain
A
Appendicitis
16
Q
Left lower quadrant pain
A
Diverticulitis and irritable bowel syndrome
17
Q
Loin area
A
Renal colic
18
Q
Why is lactulose used for hepatic encephalopathy?
A
Through its mechanism of action lactulose prevents the reabsorption of ammonia and other toxins from faecal matter in the gut which can cause hepatic encephalopathy.
19
Q
Phenytoin-miconazole (Daktarin oral gel)
A
Miconazole enhances anticonvulsant effect of phenytoin (plasma concentration enhanced) although with topical use, the risk is lower.
20
Q
Which drug can decrease the INR of a patient on warfarin?
A
Phytomenadione- vitamin K which antagonises the vitamin K antagonist warfarin.
21
Q
Symptoms of cystitis
A
Painful to urinate- burning, stinging type of pain.
Feels like she needs to urinate frequently but is only passing small amounts of urine.
Urine is quite dark and smells strongly.
22
Q
Trichomoniasis
A
Sexually transmitted infection (STI) caused by a tiny parasite called Trichomonas vaginalis (TV).
23
Q
Symptoms of trichomoniasis
A
Abnormal vaginal discharge that may be thick, thin or frothy and yellow-green in colour
Producing more discharge than normal, which may also have an unpleasant fishy smell
Soreness, swelling and itching around the vagina – sometimes the inner thighs also become itchy
pain or discomfort when passing urine or having sex
24
Q
Inward growth on the sole of the foot, with tiny black dots on its surface
A
Verruca
25
Recommended check points for avoiding prescribing errors
Right medicine, right patient, right dose, right route, right time
26
Enoxaparin
Enoxaparin can raise potassium levels due to it inhibiting aldosterone secretion. This is particularly in patients with diabetes mellitus, chronic renal failure, pre-existing metabolic acidosis, taking medicinal products known to increase potassium. Plasma potassium should be monitored regularly especially in patients at risk.
27
Supply order for midwife
It must contain the occupation of the midwife
It must contain name of the patient for which the controlled drug is being obtained
It must contain the total quantity of drug to be obtained
It must contain the signature of an appropriate medical officer
28
Which patients should avoid combined oral contraceptives due to arterial disease risk factors?
Under risk factors for arterial disease - only migraine as described is an avoid criteria.
Patients with migraine with aura are at an increased risk of stroke and should not take combined contraceptives because of the increased risk of stroke.
29
Symptoms of pyelonephritis
Dysuria, fever and flank pain
30
Threadworm in pregnancy
Anthelmintics are not recommended during pregnancy and so the patient should be given advice regarding hygiene measure only, which should be followed for six weeks.
Advise her to maintain hygiene measures for six weeks (e.g. cut finger nails and launder bedding and towels on a daily basis)
31
Symptoms of thyrotoxicosis
weight loss, palpitations (associated with atrial fibrillation), insomnia, and diarrhoea
32
Symptoms of coeliac disease
abdominal pain, foul smelling steatorrhoea (fatty stools due to malabsorption), weight loss and dermatitis herpetiformis (a type of skin rash that is itchy and has blisters that burst when scratched).
33
Maximum interval the responsible pharmacist should leave for reviewing the pharmacy procedures
Standard operating procedures (SOPs) should be reviewed at least every 2 years.
34
How long should the Responsible Pharmacist record be kept for from the date of the last entry?
The Responsible Pharmacist record should be kept for 5 years from the last day to which the record relates.
35
How long should the CD register should be kept for from the date of last entry?
CD registers should be kept for 2 years from the date of last entry.
36
Vitamin D in renal impairment
Vitamin D, colecalciferol, is the non-activated form of vitamin D. It is activated in the kidneys, so if a patient has reduced renal function then the activated form (alfacalcidol) should be given instead of colecalciferol.
37
Treatment of iron overload
Indicated for the treatment of chronic iron overload when desferrioxamine is contraindicated or inadequate (with non-transfusion-dependent thalassaemia syndromes).
38
Mycophenolate counselling
As a precautionary measure for male patients, it is now recommended that either the patient or their female partner use reliable contraception during treatment with mycophenolate medicines and for at least 90 days after stopping.
Female patients of childbearing age receiving mycophenolate should always use contraception - 2 methods of effective contraception are preferred.
39
Statins in pregnancy
Statins should be avoided in pregnancy (discontinue 3 months before attempting to conceive) as congenital anomalies have been reported and the decreased synthesis of cholesterol possibly affects fetal development.
40
Which drug used in hypertension can cause post-menopausal bleeding as a side effect?
Spironolactone
41
Which drug used in hypertension can cause insomnia as a side effect?
Captopril
42
Prescriber emergency supply
In an emergency, a doctor or dentist maybe supplied with a Sch 2 or 3 CD on the undertaking that a requisition will be furnished within 24 hours.
43
The invoice for Sativex® is recommended by NICE to be retained for this length of years for the purpose of HM Revenue and Custom.
Sativex is a Sch 4 part I, thus no requirement to retain invoice. However, NICE recommends to retain for 6 years for HM Tax and Custom purposes.
44
Repeats of private prescriptions
If a private prescription does not state the number of times the item maybe repeated, it can be repeated once, except if it is for contraception where it can be repeated five times.
45
Which antiplatelet has anti-pyretic properties?
Aspirin
46
Which drug can result in gingival hyperplasia (swollen gums)?
Ciclosporin
47
Hydroxychloroquine
Associated with retinopathy
48
Which class of drugs can mask the symptoms of hypoglycaemia?
Beta-blockers
| Be wary if patient taking sulphonylureas or insulin where there is greater risk of hypos
49
Beta blockers
Bradycardia
| Cold extremities
50
Statin for secondary prevention of CVD
Annual monitoring of cholesterol required
51
Disposing of paracetamol tablets
Paracetamol tablets should be disposed of in a medicines disposal bin, how they were purchased does not change the disposal process.
52
Emergency supply of Cilest®
21 days
53
Emergency supply of Zoely
Zoely is a 28-day preparation with 24 active tablets and 4 inactive tablets, rather than a seven day tablet free interval. Under emergency supply regulations, a full cycle of a contraceptive may be supplied so in this case 28 days would be classed as the full cycle even with the inactive tablets.
54
Rifaximin for travellers diarrhoea
200 mg every 8 hours for 3 days
55
Owings
Owings must be dispensed within the validity of a prescription, which is 6 months for NHS prescription.
56
CD owings
The appropriate date of a NHS CD prescription is either the signature date or the date indicated by the prescriber as a date before which the medicine should not be supplied, whichever is the later. The 28 day validity of a CD prescription runs from the appropriate date.
57
Private scripts owings
Owings must be dispensed within the validity of a prescription, which is 6 months for this prescription. The appropriate date of a private prescription is the signature date.
58
Carbamazepine and erythromycin
Plasma concentration of carbamazepine is increased by erythromycin thus increased risk of carbamazepine toxicity.
59
Amiodarone and simvastatin
There is an increased risk of myopathy when simvastatin is given with amiodarone.
60
Warfarin and fluconazole
Anticoagulant effect of warfarin increased with fluconazole.
61
Theophylline and disulfiram
Metabolism of theophylline is inhibited by disulfiram and therefore there is an increased risk of theophylline toxicity.
62
Type of headache frequently seen in elderly women
Temporal arteritis is the only condition listed which is strongly associated with advancing age and is also more common in women.
63
Which headache develops secondary to infection?
Sinusitis occurs as a result of a previous infection, whereas the headache associated with meningitis is one of the symptoms of an infection itself.
64
Which headache is most closely associated with children?
Meningitis is most closely associated with young children
65
Headache that is associated with nasal congestion and excruciating attacks of pain one side of the head.
Cluster headache
66
Headache where the pain is occipital
Sub-arachnoid haemorrhage
Sinusitis, cluster headache, migraine and temporal arteritis are associated with frontal headache; meningitis, tension-type headache and medication overuse headache are more generalised in nature.
67
A parenteral drug misuser is seen in the clinic.
| Which vaccine is indicated for this patient?
Hepatitis A vaccine
68
What renal function is alendronic acid contraindicated below?
35ml/min
69
Signs and symptoms of otitis media in children
Irritability, crying, fever and pain
70
Withdrawal of baclofen
Serious life-threatening side-effects such as hallucinations and fever result from sudden withdrawal of baclofen therapy. Patients must be warned not to suddenly stop taking this medication.
71
Max dose of ibuprofen
The maximum dose of Ibuprofen that can be prescribed as per BNF is 600 mg q.d.s. Which equates to a maximum daily dose of 2.4 grams.
72
Carbamazepine dosing
Carbamazepine is an enzyme autoinducer and thus a lower loading dose is required. Carbamazepine induces its own metabolism and so the maintenance dose is higher than the initial doses
73
Treating pneumocystis infection in patients who cannot tolerate co-trimoxazole
Atovaquone is licensed for the treatment of mild to moderate pneumocystis infection in patients who cannot tolerate co-trimoxazole.
If it is severe, then hydrocortisone, pentamidine isetionate or prednisolone could be given
74
Theophylline and smoking
Smoking may increase theophylline clearance and increased doses of theophylline are therefore required.
75
Clozapine and smoking
In cases of sudden cessation of smoking, the plasma clozapine concentration may be increased, thus leading to an increase in adverse effects.
76
Pirfenidine and smoking
Smoking has the potential to induce hepatic enzyme production and thus increase medicinal product clearance and decrease exposure.
77
Ropinirole and smoking
Smoking is known to induce CYP1A2 metabolism, therefore if patients stop or start smoking during treatment with ropinirole, dose adjustment may be required.
78
OTC age for chloramphenamine
Chlorphenamine is licensed for use in children aged 1 year and above but not for use in coughs and colds.
79
Fosavance®
Alendronic acid and colecalciferol
80
Teysuno®
Tegafur, gimeracil and oteracil
81
Triapin®
Ramipril and felodipine
82
Targinact®
Oxycodone and naloxone
83
Mycophenolate contraception
As a precautionary measure for male patients, it is now recommended that either the patient or their female partner use reliable contraception during treatment with mycophenolate medicines and for at least 90 days after stopping. Female patients of childbearing potential receiving mycophenolate should always use contraception and for up to 6 weeks after stopping treatment.
84
Private CD scripts
Private prescriptions for Schedule 2 CDs should be sent to the relevant NHS agency.
85
Vet CD scripts
Veterinary prescriptions for Schedule 2 CDs should be retained for 5 years, there is no requirement to submit them to the relevant NHS agency.
86
NHS CD scripts
NHS prescriptions for Schedule 2 CDs should be sent to the relevant NHS agency.
87
Requisition for a Schedule 2 CD from a registered doctor
Requisitions from doctors for Schedule 2 CDs should be sent to the relevant NHS agency.
88
Proguanil in pregnancy
Can be given in the usual doses during pregnancy as benefit of prophylaxis in malaria outweighs risk.
89
CAP in pregnancy
Amoxicillin is indicated in low-severity community acquired pneumonia. Amoxicillin is appropriate to use in breastfeeding according to the BNF. Although clarithromycin can be indicated in some instances for low-severity community acquired pneumonia, the BNF states that it should be avoided in breastfeeding.
90
Side effect of desmopressin
Hyponatraemia
91
Which items are not accepted by pharmacies as part of the disposal of medicinal waste scheme?
The pharmacy will, if required by NHS England or the waste contractor, sort them into solids (including ampoules and vials), liquids and aerosols, and the local NHS England team will make arrangements for a waste contractor to collect the medicines from pharmacies at regular intervals.
92
What is herpes labialis?
Oral herpes
93
Misoprostol
Diarrhoea may occasionally be severe and require withdrawal, reduced by giving single doses not exceeding 200 micrograms and by avoiding magnesium-containing antacids.
94
Legal requirements for a requisition of a controlled drug
Name of the recipient
Purpose of the requisition
Signature of the recipient
Total quantity of the drug
95
Above what strength of insulin is considered a high strength insulin?
100 units/mL
96
You have just finished using a stock bottle of methadone in the pharmacy. You are unable to pour anything out of the bottle, but you can see that there are still traces inside.
In what way should you deal with the disposal of the remaining liquid inside the bottle?
Rinse the bottle with water and pour into a denaturing kit
97
Contact sensitisation is a risk with this drug
Chlorpromazine
98
How do bisphosphonates work?
Bisphosphonates are adsorbed onto hydroxyapatite crystals in bone, slowing both their rate of growth and dissolution, and therefore reducing the rate of bone turnover. This in turn can help prevent osteoporosis.
99
6-in-1 vaccine
Given as a single injection (at 8 weeks, 12 weeks and 16 weeks) containing vaccines to protect against six separate diseases: diphtheria; tetanus; whooping cough (pertussis); polio; Haemophilus influenzae type b (Hib); and hepatitis B.
100
Rubella during pregnancy
Rubella usually only becomes a serious concern if a pregnant woman catches the infection during the first 20 weeks of her pregnancy. This is because the rubella virus can disrupt the development of the baby and cause a wide range of health problems.
101
This medication is used at a continuing dose of 1 mg daily in the management of Parkinson's disease.
Rasagiline
102
Early treatment with this drug can delay the need for levodopa therapy in Parkinson's disease.
Selegiline
(Note rasagiline is not indicated for delaying the need for levodopa therapy although it is a monoamine oxidase B inhibitor as well)
103
This drug may exacerbate oedema and because of this is cautioned for use in congestive heart failure.
Amantadine is cautioned in congestive heart failure as it may exacerbate oedema.
104
This Parkinsons drug may cause hair loss as a side effect.
Hair loss is a side effect of treatment with selegiline hydrochloride.
105
Gout
Commonly affects the large toe but may also affect the ankles, heels, knees, wrists, fingers and elbows. It commonly occurs at night and may last 3-10 days.
106
RP record
If the record is kept electronically it needs to be backed up, kept on the pharmacy premises, and available for GPhC inspection if required.
107
How long does the RP record need to be retained for?
5 years
108
How long should signed orders be retained for?
Signed orders should be kept for two years from the date of supply.
109
How long should private prescriptions be retained for?
Private prescription records should be kept for two years from the date of dispensing.
110
Intermediate steroids
Prednisolone and triamselone
111
Prednisolone 5mg=
Hydrocortisone 20mg
112
Causes of secondary diabetes
Steroid induced
| Pancreatic damage
113
Long acting insulin dosing
Twice daily determir (not as long acting)
| Once daily levemir
114
Rapid acting insulins
Just before meals
115
Long acting insulins
Lantus- glargine
Levemir- detemir
Tresiba- degludec (ultra long acting)
116
Glibenclamide
Long acting sulphonylurea
117
SGLT-2 inhibitor
Dapagliflozin
| Inhibits the reabsorption of glucose from the renal tubules
118
Acarbose
Alpha glucosidase
119
Humalog
Insulin lispro- rapid acting
120
Linezolid and MAOI
Linezolid is a reversible, non-selective inhibitor of monoamine oxidase; however, at the doses used for antibacterial therapy, it does not exert an anti-depressive effect.
121
Fentanyl '50' patch
equivalent to 120 mg daily of morphine salt
122
Treating migraines in patients with ischaemic heart disease
Aspirin and metoclopramide could be used to relieve the symptoms of a migraine: pain and vomiting, respectively. Serotonin 5HT1 agonists (i.e. the 'triptans') are contraindicated in patients with ischaemic heart disease.
123
Bromocriptine
Hypotension- especially during the first couple of days
124
Causes of bleeding gums
Diabetes, poor oral hygiene, pregnancy and smoking
125
Lower abdominal pain when taking the pill
Ectopic pregnancy
126
Buprenorphine
Schedule 3
127
First-line treatment option for uncomplicated chlamydia.
Azithromycin 1g STAT
128
Flucloxacillin
May cause cholestatic jaundice at any time during treatment and up to two months post treatment.
129
Yasmin
Can cause vaginal discharge
Contains drospirenone 3 mg and ethinylestradiol 30 mcg
It is a monophasic 21-day preparation
It may cause sexual dysfunction
130
SSRIs and epilepsy
SSRIs lower seizure threshold
131
Methadone
Schedule 2
132
Ergotamine
Used in cluster headaches
| Contraindicated in inadequately controlled hypertension
133
Benzodiazepines contraindications
```
Acute pulmonary insufficiency
Marked neuromuscular respiratory weakness
Phobic states
Sleep apnoea syndrome
Unstable myasthenia gravis
```
134
Monitoring of azathioprine
Consider measuring TPMT activity before starting azathioprine, mercaptopurine, or tioguanine therapy
Monitor full blood count weekly (more frequently with higher doses or if severe renal impairment) for first 4 weeks (manufacturer advises weekly monitoring for 8 weeks but evidence of practical value unsatisfactory), thereafter reduce frequency of monitoring to at least every 3 months.
Blood tests and monitoring for signs of myelosuppression are essential in long-term treatment.
135
Treating muscle cramps
Quinine
| Baclofen
136
Excessive drooling of saliva
Glycopyrronium bromide- good for patients with cognitive impairments due to fewer CNS effects
Can be referred for botulinum toxin A
137
Tetrabenazine
Control movement disorders in Huntington's chorea
| Can also be given for tardive dyskinesia if switching or withdrawing the antipsychotic drug
138
Diabetes and the DVLA- for those on insulin and on drugs that can cause hypos (e.g. sulphonylureas)
If you have more than one severe hypo while awake in 12 months you must stop driving and tell the DVLA.
If you have even one severe hypo while driving, you must stop driving and tell the DVLA straight away.
If you usually check your blood glucose, check them within two hours of driving – however short the trip. On longer journeys, you must check them every two hours.
139
Epilepsy and the DVLA
Epilepsy or multiple unprovoked seizures: Must not drive and must notify DVLA. Driving must cease for 12 months from the date of the most recent seizure
First unprovoked epileptic seizure/ isolated seizure: Must not drive and must notify DVLA. Driving must cease 6 months from the date of the seizure, or for 12 months if there is an underlying causative factor that may increase risk.
140
Tetracyclines in pregnancy
1st trimester- effects on skeletal development
2nd + 3rd trimesters- discolouration of the child’s teeth, and maternal hepatotoxicity has been reported with large parenteral doses.
141
Patients <50kg taking paracetamol
patients weighing <50 kg should be monitored for signs of toxicity if using paracetamol and the max daily dose may be reduced to 500 mg qds to help prevent toxicity.
142
Which drug must be used in caution in patients with sensitivity to sulphonamides?
Sumatriptan
143
Senna onset of action
8 to 12 hours
144
Bisacodyl onset of action
10 to 12 hours
145
Heparin toxicity antidote
Protamine sulfate
146
Methotrexate and pregnancy
Sexually active male patients or their female partners are recommended to use reliable contraception during treatment of the male patient and for at least 6 months after cessation of methotrexate. Men should not donate semen during therapy or for 6 months following discontinuation of methotrexate.
147
Which drug is a potent uterine stimulant and may be teratogenic?
Misoprostol
148
How long after treatment cessation can flucloxacillin cause cholestatic jaundice?
8 weeks
149
Which antiepileptic drug may cause visual field defects?
Vigabatrin
150
Which SSRIs are licensed for PTSD?
Sertraline and paroxetine
151
When to avoid SSRIs
In a manic phase of bipolar disorder.
Taking monoamine oxidase inhibitors (MAOIs), or who have recently discontinued a MAOI.
Taking pimozide.
With uncontrolled epilepsy or new onset seizures.
152
Treating impetigo
Topical antiseptic such as hydrogen peroxide 1% cream
Offer an oral antibiotic for patients with bullous impetigo, or with impetigo who are systemically unwell or at high risk of complications.
First choice topical antibiotic:
Fusidic acid 2%- Apply TDS for 5 to 7 days
First choice oral antibiotic:
Flucloxacillin- 500 mg QDS for 5 to 7 days
153
Contraindications of amiodarone
Avoid in severe conduction disturbances (unless pacemaker fitted); avoid in sinus node disease (unless pacemaker fitted); iodine sensitivity; sino-atrial heart block (except in cardiac arrest); sinus bradycardia (except in cardiac arrest); thyroid dysfunction
154
Which drug is contraindicated in a patient suffering with complete biliary obstruction?
Colestyramine is contraindicated in complete biliary obstruction as it NOT likely to be effective.
155
Which medication is contraindicated in acute inflammation of the gall bladder?
Ursodeoxycholic acid
156
Serious skin rashes when taking lamotrigine
Serious skin reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis have developed (especially in children); most rashes occur in the first 8 weeks.
157
Which drug is licensed for use in narcolepsy?
Dexamfetamine sulfate
158
Which drug is used for migraines (unlicensed)?
Valproic acid
159
Use of which drug is contraindicated in patients who suffer with, or have a history of postural hypotension?
Tamsulosin hydrochloride- may cause a reduction in blood pressure. As such, it is contraindicated in those who suffer with postural hypotension.
160
Use of higher dosages of which drug may cause photosensitisation, and as such, sunlight should be avoided
Chlorpromazine causes photosensitivity at higher doses
161
Cluster headaches
Brief headaches around an eye with possible associated symptoms of unilateral photophobia, redness, lid swelling and nasal stuffiness. These are recurrent and could last for a couple of weeks.
162
Sinus headaches
a dull, throbbing headache in the upper half of the face which is made worse on bending down. It can also be associated with halitosis and pain, swelling and tenderness around the eyes, cheeks and forehead.
163
Which antidiabetic drug would you give after metformin if CV targets are not being met?
SGLT2 inhibitors e.g. dapagliflozin
164
Which antidiabetic drug would you give after metformin if targets are not being met and the patient is obese?
SGLT2 inhibitors e.g. dapagliflozin
165
Pancreatin
It is important to ensure adequate hydration at all times in patients receiving higher-strength preparations of this drug.
166
Side effect of sucralfate
A bezoar is a solid mass of indigestible material that accumulates in the digestive tract, sometimes causing a blockage.
