On Track Flashcards
1
Q
A patient comes into your pharmacy and is concerned about a change in the colour of their urine.
Which is the LEAST likely to have caused this?
- Co-beneldopa
- Co-careldopa
- Co-danthramer
- Co-danthrusate
- Co-fluampicil
A
Co-fluampicil
The other drugs listed can all cause a discolouration of the urine.
Co-beneldopa = darkish red Co-careldopa = dark red Co-danthramer = red Co-danthrusate = orange
2
Q
Which of the following medicines may cause hyperuricaemia?
- Allopurinol
- Febuxostat
- Cochicine
- Indapamide
- Sulfinpyrazone
A
Indapamide
Thiazide diuretic
3
Q
Which of the following is not likely to cause bradycardia?
Bisoprolol Adizem® SR Ivabradine Amiodarone Ramipril
A
Ramipril
4
Q
Which one of the following is most likely to cause ketoacidosis?
Intravenous salbutamol Salmeterol Ipratropium Tiotropium Inhaled salbutamol
A
IV salbutamol
5
Q
Which of the following terms describes ‘asbestos-like’ scales on the scalp?
- Pityriasis alba
- Pityriasis amiantacea
- Pityriasis rosea
- Pityriasis versicolor
- Psoriasis
A
Pityriasis amiantacea
6
Q
Which ONE of the following drugs is NOT suitable for both supraventricular and ventricular arrhythmias?
- Verapamil
- Sotalol
- Amiodarone
- Flecainide
- Propafenone
A
Verapamil
usually effective for supraventricular tachycardias only
7
Q
Which of the following is NOT a recognised side effect of long term corticosteroid usage?
- Weight gain
- Glaucoma
- Osteoporosis
- Nystagmus
- Diabetes
A
Nystagmus
8
Q
Is a faxed CD drug requisition acceptable?
A
No
9
Q
Which of the following risks are NOT associated with the use of anti-psychotics in elderly patients?
- Hypothermia
- Hyperthermia
- Hypogylcaemia
- Postural hypotension
- Stroke
A
Hypoglycaemia
Can cause hyperglycaemia
10
Q
Which of the following is NOT a cause of bleeding gums?
- Asthma
- Diabetes
- Poor oral hygiene
- Pregnancy
- Smoking
A
Asthma
11
Q
With respect to the ingredients used in the preparation of an unlicensed medicine, which of the following is NOT a requirement for the record keeping process?
- Batch number
- Certificate of analysis
- Certificate of conformity
- Ingredient manufacture date
- Manufacturer, brand and wholesaler/distributor
A
Ingredient manufacture date
12
Q
Miss K is a 21 year old female who presents with a round bloated, moon-like face, facial acne and stretch marks on her abdomen.
These signs are associated with high doses of which one of the following drugs?
Clindamycin Folic acid Aspirin Methylprednisolone Magnesium trisilicate
A
Methylpred
Cushings syndrome risk
13
Q
How many NHS prescription charges do compression hosiery 2 pairs levy (assuming the patient is not exempt from NHS charges) for an NHS prescription written in England?
0 1 2 3 4
A
4
14
Q
Which one of the following medicines does NOT affect the monoamine oxidase enzyme family?
Selegiline Linezolid Moclobemide Phenelzine Clonidine
A
Clonidine
15
Q
Mrs Smith has been taking 800 units of ergocalciferol for 2 weeks now because she has a lack of vitamin D.
She develops nausea and has now vomited. What is the likely reason for this?
- The vitamin D may have led to an increase in serum calcium causing the symptoms
- The vitamin D therapy may have decreased serum calcium causing the symptoms
- The preparations of ergocalciferol are generally not well tolerated
- If ergocalciferol is given without calcium, it may cause this symptom
- These symptoms are unrelated to Mrs Smith’s therapy
A
The vitamin D may have led to an increase in serum calcium causing the symptoms
16
Q
Which of the following is NOT a requirement for pregabalin?
- Dose on prescription
- Drug formulation on prescription
- Drug strength on prescription
- Safe custody
- Total quantity in words and figures on prescription
A
Safe custody
17
Q
Which of the following will facilitate the absorption of calcium?
- Ascorbic acid
- Colecalciferol
- Hydroxycobalamin
- Pyridoxine
- Phytomenadione
A
Colecalciferol
18
Q
Which of the following requires a dose reduction with concomitant use of verapamil?
Warfarin Rivaroxaban Dabigatran Apixaban Phenindione
A
Dabigatran
19
Q
Which of the following non-prescription topical preparations is to be used with caution in patients taking phenytoin?
HC45® hydrocortisone 1% cream Clotrimazole 2% cream Daktarin® oral gel Zovirax® 5% cream Benzoyl peroxide 4% cream
A
Daktarin gel
Miconazole enhances anticonvulsant effect of phenytoin (plasma concentration enhanced) although with topical use, the risk is lower.
20
Q
Which of the following medications are listed in the BNF as suitable for treatment of pruritus?
Carbamazepine
Cinnarizine
Hydroxyzine hydrochloride Ketotifen
Loratadine
A
Hydroxyzine hydrochloride
21
Q
Which one of the following medicines does NOT stimulate the pancreas to release insulin?
Gliclazide Exenatide Canagliflozin Vildagliptin Repaglinide
A
Canagliflozin - reversibly inhibits SGLT2 in the kidney to reduce glucose reabsorption and increase urinary glucose excretion.
22
Q
Which one of the following risk factors is NOT a trigger factor for GORD?
Smoking Verapamil Stress Travelling abroad Obesity
A
Travelling abroad
Trigger factors for GORD include: drugs which cause lower oesophageal sphincter relaxation (e.g. calcium channel blockers), smoking, alcohol, obesity and stress.
23
Q
Miss M is a 29 year old pregnant women with suprapubic pain over the past 4 days and a “burning” sensation on urination.
Given that Miss M is in her first trimester of pregnancy and is not on any other medication, which one of the following antibiotics is the most appropriate for her condition?
Ciprofloxacin 250 mg twice daily
Doxycycline 200 mg once daily Nitrofurantoin 50 mg four times a day
Ofloxacin 200 mg daily Trimethoprim 200 mg twice daily
A
Nitrofurantoin 50 mg four times a day
Trimethoprim should not be given in the first trimester
Quinolone antibiotics should be avoided
Doxycycline affects the skeletal development so should be avoided
24
Q
Which ONE of the following can cause urine to be coloured pink or orange?
Warfarin Rivaroxaban Dabigatran Apixaban Phenindione
A
Phenindione
25
A mother requests a product OTC for her 7 yo son who is suffering from a cold. She wants to purchase a nasal decongestant containing xylometazoline. What is the maximum length of time the child should use it for?
```
Two days
Three days
Five days
Seven days
A child this age must not use it
```
5 days
Otrivine child nasal drops can be used for 6-12 years
26
Your dispenser is measuring out the daily methadone liquid prescriptions. As she returns the bottle to the cupboard she drops it and it smashes on the floor.
What is the most appropriate way to clear up the spillage?
- Clear up with tissue and denature
- Clear up with tissue and store in a bag in the CD cupboard
- Clear up with tissue and throw in the bin
- Mop up the floor and pour waste water down the drain
- Mop up the floor and pour waste water into denaturing kit
Clear up with tissue and store in a bag in the CD cupboard
Destruction of stock of a CD should be witnessed by an authorised person. This includes spillages. Therefore, the spillage should be cleaned up and kept in the CD cupboard until destruction can be witnessed.
27
Mrs R is a patient who has AIDS. She has been diagnosed with mild pneumocystis pneumonia. She is unable to tolerate trimethoprim.
Which single medication is the most likely treatment option for her pneumonia?
- Atovaquone
- Co-trimoxazole
- Pentamidine
- Hydrocortisone
- Prednisolone
Atovaquone
| Co-trimoxazole is made up of sulfamethoxazole and trimethoprim - Note that Mrs R can not tolerate trimethoprim
28
Which of the following Benzodiazepine drugs belongs to Schedule 3 of the Controlled Drugs list?
```
Alprazolam
Diazepam
Nitrazepam
Oxazepam
Temazepam
```
Temazepam
29
Treatment pack of chloramphenicol must not exceed what volume pack size?
10mL
30
Dermatophytic onychomycosis is a fungal infection of:
```
Nails
Scalp
Oral cavity
Genitals
Soles of the feet
```
Nails
31
Mrs G is a 27 year old student who presents with red scaly patches on her cheeks, eyebrows and hairline. She has had these patches for 2 years now.
Which one of the following conditions is Mrs G most ikely to have?
Atopic eczema Candidiasis
Psoriasis
Seborrhoeic dermatitis
Tinea faciei
Seborrhoeic dermatitis
32
Which of the following laxative agents can cause interference of fat soluble vitamins?
```
Lactulose
Liquid paraffin
Co-danthramer
Sodium docusate
Movicol®
```
Liquid paraffin
33
Coughs that last longer than how many weeks prompt a referral?
Longer than 3 weeks
34
Which ONE of the following is NOT a reason to STOP the combined oral contraceptive pill?
Sudden breathlessness
Severe stomach pains Hypertension - 150/90 mmHg Jaundice
Unexplained swelling of the calf of one leg
Hypertension - 150/90 mmHg
Only blood pressure above systolic 160mmHg or diastolic 95mm Hg is a reason to stop the combined oral contraceptive pill.
35
Mr N is worried about the abdominal pain, nausea and vomiting he has recently been suffering from. You know he is usually prescribed sodium valproate for the management of his epilepsy.
What advice should you give?
- There is no connection between his medication and the symptoms he's describing, you could suggest over the counter symptomatic relief
- These are normal side effects of the medication, nothing to worry about
- Seek immediate medical attention
- Advise Mr N to go to his GP, as the dose of sodium valproate might need to be increased
- Advice Mr N to go to his GP, as the dose of sodium valproate might need to be decreased
Mr N should seek immediate medical attention, as the symptoms he describes may be indicative of sodium valproate-induced pancreatitis.
36
A patient presents in your pharmacy and asks you for advice.
When he was cleaning his teeth this morning, he noticed bleeding from his gums. He is taking no medicines and is otherwise healthy. What is the best course of action?
- Advise the patient to stop brushing his teeth for 48 hours
- Recommend the patient brush his teeth four times daily
- Recommend the patient floss between his teeth
- Tell the patient he needs to see a dentist urgently
- Tell the patient he needs to see his GP
Flossing between teeth to clean this area is advised to help with bleeding gums.
37
What does the latin abbreviation p.c. mean on prescriptions?
After food
38
For which of the following antiepileptic drugs should you ensure the same brand is dispensed each time?
```
Carbamazepine
Ethosuximide
Gabapentin
Levetiracetam
Pregabalin
```
Carbamazepine
Category 1: Carbamazepine, Phenobarbital, Phenytoin, Primidone
Need to prescribe these by brand
39
Which option, when stopped suddenly, is the most likely to cause withdrawal symptoms?
- 40 mg prednisolone for 5 days
- 25 mg prednisolone for 14 days
- 10 mg prednisolone for 21 days
- 20 mg prednisolone for 10 days
- 40 mg prednisolone for 10 days
40 mg prednisolone for 10 days
Gradual withdrawal should be considered for patients receiving more than 40 mg prednisolone (or equivalent) daily for more than 1 week.
40
Mrs T comes into the hospital with a potassium level of 7 mmol/L (range 3.5-5.3) so she is diagnosed with hyperkalaemia.
Which drug is most likely to have caused the hyperkalaemia?
- Citalopram
- Enoxaparin
- Furosemide
- Naproxen
- Salbutamol
Enoxaparin
41
Which one of the following is NOT a legal requirement for a CD requisition?
- Address if recipient
- Date of requisition
- Occupation of recipient
- Purpose of requisition
- Signature of recipient
Date of requisition
- The legal requirements for a controlled requisition are: signature of the recipient, name of recipient, address of recipient, profession/occupation, total quantity of drug and purpose of requisition.
42
Mrs X, is a 55 year old patient. She has recently been suffering from acute migraine attacks which have not responded to paracetamol. She has a history of ischaemic heart disease.
Which of the following medications is the most suitable to treat her migraine?
- Metoclopramide and aspirin
- Almotriptan
- Naratriptan
- Rizatriptan
- Sumatriptan
Metoclopramide and aspirin
Triptans are contraindicated in those with ischaemic heart disease
43
A doctor calls you to ask what dose of atorvastatin her patient should be transferred to. The patient was previously on simvastatin 40 mg daily. What is a suitable dose?
- 10mg
- 20mg
- 30mg
- 40mg
- 80mg
10mg
44
Which of the following antisecretory and mucosal protectant drugs may cause severe diarrhoea which may require withdrawal of this drug?
```
Cimetidine
Misoprostol
Paracetamol
Ranitidine
Tripotassium dicitratobismuthate
```
Misoprostol
45
Mrs H comes to collect her prescription for candesartan regularly from your pharmacy. She has recently been prescribed lithium for the treatment of depression. She comes into your pharmacy disorientated and complains of diarrhoea and vomiting.
What do you suspect may be the most likely cause of Mrs H's presentation?
- Gastro-intestinal disturbances are a side effect of candesartan
- Candesartan could cause hypernatraemia which is causing lithium toxicity
- Lithium toxicity secondary to Mrs H taking extra doses of lithium
- Taking candesartan could lead to lithium toxicity
- She has an infection
Taking candesartan could lead to lithium toxicity - most likely as a result of natriuresis leading to hyponatremia. Lithium is primarily excreted via the kidneys, so changes in the estimated glomerular filtration rate will affect lithium levels accordingly.
46
A pregnant woman comes in to your pharmacy. She tells you that her friend has told her that 'she should check if she has had a rubella vaccination and if she is immune to Rubella'.
What can a rubella infection cause in pregnant patients who DON'T have immunity to rubella?
- Develop flu-like symptoms, such as sore throat and swollen glands
- Future infertility in the woman
- Lead to premature labour
- Nothing
- Organ damage to the foetus during the early stages of the pregnancy
Organ damage to the foetus during the early stages of the pregnancy
47
You are dispensing a prescription for sodium valproate for Mrs DS who is 26 years old.
When dispensing the prescription, you ask if she has signed a risk acknowledgement form, but she says that she hasn't. What should you do?
- Dispense the prescription, but advise the patient to see her GP as soon as possible
- Dispense the prescription without taking any further steps
- Do not dispense the prescription and advise the patient to see her GP as soon as possible
- Do not dispense the prescription and alert the GP that you have not dispensed it
- Do not dispense the prescription as this form should be signed before the prescription can be dispensed
Dispense the prescription, but advise the patient to see her GP as soon as possible
As per government advice:
Check whether women are enrolled in the Pregnancy Prevention Programme and have signed a Risk Acknowledgement Form (updated March 2019) – if not, dispense the prescription and advise the patient to speak to her GP as soon as possible (including by contacting the GP directly if necessary) for a specialist referral
48
Which of the following is NOT true regarding entries into the controlled drug register?
- A separate register is used for each class of drugs
- Entries must be in chronological order
- Entries must be in indelible ink
- Entries must be made on day of the transaction or within the following five days
- The register must not be removed from the premises at any time during use
Entries must be made on day of the transaction or within the following five days
Entries into the CD register must be made either on the day of transaction or the FOLLOWING day.
49
Mrs N explains that her 5 year-old niece has sores around her mouth and nose that quickly burst to leave a yellow-brown crust.
Which bacterium do you suspect could have caused this infection?
Helicobacter pylori Streptococcus pyogenes Escherichia coli
Sarcoptes scabiei
Streptococcus pneumoniae
The description the patient has given is that of impetigo secondary to infection with bacteria, usually Staphylococcus aureus or Streptococcus pyogenes.
50
Mrs L brings her 6 yo child into your pharmacy. The child has scabies. The mother would like to purchase a cream, which might stop the child from itching and causing a secondary infection.
Which of the following creams could you recommend for non-prescription supply?
- Crotamiton cream 10% (Eurax®)
- Titanium dioxide cream (Metanium®)
- Cod liver oil and zinc oxide cream (Morhulin®)
- Hydrocortisone cream 1%
- Clotrimazole 1% cream
Crotamiton cream is recommended for itching post scabies infection, other creams are not.
51
For CPR, what is the ratio of chest compressions to breaths needed?
30 chest compressions
| 2 breaths
52
If unopened, the shelf life of GTN tablets is what?
24 months
53
Which of the following prescribers CANNOT request an emergency supply of a prescription-only medicine?
```
Supplementary nurse prescriber
Swiss doctor
Vet
Dentist
Community nurse prescriber
```
Vet
54
How much longer after MMF treatment can a male and a female conceive?
For a woman- 6 weeks after stopping (until then, need adequate contraception)
For a man - 90 days after (Females who's male partner has been taking mycophenolate should use contraception for 90 days after their partner discontinues using the medicine.)
55
True or false:
Oxytocin is used for the induction of labour
True
56
A Doctor requests an emergency supply of a drug for a patient, when must the doctor present the prescription to the pharmacy?
```
Within 24 hours
Within 48 hours
Within 72 hours
Within 84 hours
Within 96 hours
```
Within 72 hours
57
A woman is breastfeeding her four week old baby and the baby has oral thrush. Her and her baby are being treated for the condition. She asks you about expressing milk. What is the best advice to give the lady?
- Advise her that expressing milk is not advised when treating oral thrush
- Advise her to freeze the expressed milk before using it
- Advise her to refrigerate the expressed milk before using it
- Advise her to use the expressed milk only while she and the baby are undergoing treatment
- Refer her to her health visitor
Advise her to use the expressed milk only while she and the baby are undergoing treatment
58
Which of the following drugs may antagonise analgesic effects of other opioids?
```
Buprenorphine
Codeine
Ibuprofen
Morphine
Paracetamol
```
Buprenorphine is a partial agonist/partial antagonist and will block, or antagonise, the effects of other opioids.
59
A patient newly started on tuberculosis treatment comes into your pharmacy with a bowel complaint.
What is the most likely cause of flatulence?
- Ethambutol
- Rifampicin
- Isoniazid
- Streptomycin
- Pyrazinamide
Ethambutol
60
Which of the following medications can cause QT prolongation?
- Bendroflumethiazide
- Chlorphenamine
- Ciprofloxacin
- Paracetamol
- Sodium valproate
Ciprofloxacin
61
What is the maximum duration of treatment which can be given via over the counter chloramphenicol?
- 2 days
- 3 days
- 5 days
- 7 days
- 10 days
5 days
62
The responsible pharmacist is allowed to be away from the Pharmacy for up to 2 hours, and that they are the only pharmacist working at the pharmacy, which one of the following activities could you do in their absence?
- Hand over medications to a patient, which had been dispensed and checked earlier in the day
- Provide insulin, as an emergency supply, to a diabetic patient
- Supply Beconase® 0.05% Hayfever Nasal Spray 100 dose pack to a patient with hayfever
- Supply chloramphenicol eye drops to a patient with conjunctivitis
- Supply 2 packs of 32 tablets of paracetamol to a patient with osteoarthritis
Supply Beconase as it is a GSL medicine
63
Which of the following laxative agents is first line for faecal impaction in a patient with hard stools?
- Lactulose
- Liquid paraffin
- Co-danthramer
- Sodium docusate
- Macrogols
Macrogols
64
What does a.u mean on a prescription?
Both ears
65
Which of the following beta blockers is not a once daily regimen for angina?
- Atenolol
- Bisoprolol
- Nadolol
- Celiprolol
- Propranolol
Propranolol
66
A patient is breastfeeding her four week old baby and the baby has oral thrush. She has been prescribed miconzaole cream for herself but she is unsure what to do with it. What is the best advice to give to the lady?
- Advise her that this is not the correct treatment for her
- Advise her to apply it to her nipples after feeding the baby
- Advise her to apply it to her nipples before feeding the baby
- Advise her to stop breastfeeding while undergoing treatment
- Refer her to her health visitor
Advise her to apply it to her nipples after feeding the baby
67
Which of the following creams/ointments could stain clothing?
- Betamethasone valerate/clioquinol cream
- Daktacort® ointment
- Fucibet® cream
- Locoid® ointment
- Synalar N® cream
Betamethasone valerate/clioquinol cream
68
Co-careldopa can turn urine what colour?
Dark red
69
What does the latin abbreviation a.c. mean on prescriptions?
Before food
70
How long should the pharmacy record be kept for?
5 years
71
For which of the following antiepileptic drugs should you consult the prescriber to establish if the same brand is to be dispensed each time?
- Carbamazepine
- Gabapentin
- Lamotrigine
- Levetiracetam
- Vigabatrin
Lamotrigine
In Category 2
72
Of the following controlled drugs, which is allowed to be issued via a repeat prescription? For example the prescriber may write on the prescription 'Repeat x 3'?
- Lorazepam
- Pethidine
- Methadone
- Morphine
- Temazepam
Lorazepam
CD4 drugs are allowed on repeats
73
Omeprazole is said to 'reduce the antiplatelet activity' of this drug if given concurrently.
What drug interacts with omeprazole in this way?
- Apixaban
- Aspirin
- Dalteparin
- Clopidogrel
- Dipryidamole
Clopidrogrel
74
Folic acid is what vitamin?
B9
75
Which of the following can lower seizure threshold?
- Aspirin
- Bisoprolol
- Sertraline
- Ramipril
- Isosorbide mononitrate MR
Sertraline
76
Which one of the following is the most suitable counselling advice you should offer with bromocriptine?
A. Report a skin rash on your chest immediately to your doctor
B. Report any signs of tremor immediately to your doctor
C. Take this at least 2 hrs after other medications
D. Take this medication in the morning
E. You may experience low blood pressure initially with this medication so take extra care to avoid falls
You may experience low BP initially with this medication so take extra care to avoid falls.
Hypotensive rxns can occur with D-receptor agonists; problematic during the first few days and care should be exercised when driving or operating machinery. Excessive daytime sleepiness and sudden onset of sleep can occur. Take at night.
77
What is the hierarchy of evidence?
1. Systematic reviews/meta-analysis
2. RCTs
3. Non RCTs
4. Observational studies
5. Case reports
78
Are systematic reviews or randomised controlled trials a more robust form of evidence?
Systematic review (same as meta-analysis)
79
common excipients and their properties
```
Mannitol
Benzyl alcohol
Cetostearyl alcohol
Aspartame
Propylene glycol
Aspartamine
Xylitol
Sorbitol
```
polysorbate 80 = solubilising agent; hypersensitivity
benzoic acid = preservative; neonates jaundice
Mannitol = sweetener
Benzyl alcohol = preservative; 'gasping' syndrome neonates
Cetostearyl alcohol = preservative
Aspartame = artificial sweetener
Propylene glycol = solvent; ADR CNS effects esp <4yrs
Aspartamine = non essential amino acid
Xylitol = sweetener
Sorbitol = sweetener; osmotic diarrhoea and GI discomfort
80
You are the Responsible Pharmacist in a community pharmacy and you receive a written requisition for morphine tablets.
Which of the following is a legal requirement for this requisition?
Date of birth of recipient
Purpose of the requisition
Quantity of the drug in words and figures
Strength of the drug in words and figures
Your signature
The correct answer was Purpose of the requisition
The six legal requirements for a CD requisition include:
```
Recipients signature
Name of recipient
Address of recipient
Profession/occupation
Total quantity of drug
Purpose of requisition
```
81
```
Miss O is a 24-year-old patient who tells you that she has weight loss accompanied by insomnia, diarrhoea and palpitations.
Anorexia nervosa
Bulimia nervosa
Cancer
Coeliac disease
Crohn's disease
Diabetes mellitus
Thyrotoxicosis
Tuberculosis
```
Her symptoms are those of thyrotoxicosis. This includes: weight loss, palpitations (associated with atrial fibrillation), insomnia, and diarrhoea.
References: https://www.nhs.uk/conditions/overactive-thyroid-hyperthyroidism/
x10 times more common women > men, and typically happens between 20 and 40 years of age
82
You are providing a training session on food interactions with medicines.
Which of the following is the LEAST likely to interact with grapefruit juice?
Budesonide
Lercanidipine
Simvastatin
Tacrolimus
Warfarin
Warfarin is not noted in the BNF as interacting with grapefruit juice. This gives an indication of the severity of the interaction. As warfarin isn't listed here, it indicates that it is least likely to interact because there isn't as much documented evidence.
83
```
The use of higher dosages of this drug may cause photosensitisation, and as such, sunlight should be avoided.
Amoxicillin
Baclofen
Chloramphenicol
Chlorpromazine
Ciprofloxacin
Fludrocortisone
Sodium risedronate
Tamsulosin hydrochloride
```
Chlorpromazine may cause photosensitisation.
Although ciprofloxacin can cause photosensitivity, this is not in a dose-related manner.
Chlorpromazine causes photosensitivity at higher doses, which is what the question asks about so that is the appropriate answer to this question.
Chloramphenicol is not associated with photosensitivity.
* antipsychotic of phenothiazine class
84
You are running a clinic for patients with diabetes.
You need to be vigilant for signs of diabetic ketoacidosis when withdrawing insulin on patients also taking which medicine?
Dipeptidylpeptidase-4 inhibitor
Glucagon-like peptide-1 receptor agonist
Metformin
Sodium glucose co-transporter 2 inhibitor
Sulfonylurea
The correct answer was Glucagon-like peptide-1 receptor agonist
Diabetic ketoacidosis has been reported in patients with type 2 diabetes on a combination of a GLP-1 receptor agonist and insulin who had doses of concomitant insulin rapidly reduced or discontinued.
SGCT 2 also cause DKA but independent of insulin
MHRA/CHM advice (updated April 2016): Risk of diabetic ketoacidosis with sodium-glucose co-transporter 2 (SGLT2) inhibitors (canagliflozin, dapagliflozin or empagliflozin)
85
Miss J is the new pharmacy summer student at your pharmacy. You are teaching her about the common dosages of various drugs. For the drugs and indications listed, select the most commonly prescribed doses from the list below. Each option may be used once, more than once, or not at all.
```
Tamoxifen for breast cancer.
A 400 micrograms once daily
B 5 mg once in the morning
C 10 mg once a week
D 7.5 mg once daily
E 20 mg once daily
F 70 mg once a week
G 500 mg twice a day
H 1 g three times a day
```
Answer: 20mg once daily
86
A 67-year-old male who has been prescribed co-careldopa for Parkinson's disease.
A. Take this medication on an empty stomach
B. Take this medication after food
C. You may experience sudden onset of sleep. Please exercise caution when preforming skilled tasks
D. Report any signs of visual impairment immediately to your prescriber
E. Your medication may colour your urine blue. This is harmless
F. Do not take this medication at the same time as antacids
G. Immediately report any signs or symptoms of anaemia, bruising or infection to your doctor
E. Take this medication at night
The correct answer was You may experience sudden onset of sleep. Please exercise caution when preforming skilled tasks
87
```
She calls the pharmacy to state she is stopping her methotrexate treatment to try for a baby. She would like to know how long she needs to continue to use contraception for.
1 week
4 weeks
30 days
6 weeks
3 months
90 days
26 weeks
One year
```
The correct answer was 26 weeks -
Women must not get pregnant during MTX therapy, and effective contraception must be used during tx with methotrexate and at least 6 months thereafter
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.
88
You are providing training for a trainee pharmacy technician on controlled drugs.
Which of the following is true with regards to cannabis-based products for medicinal use (CBPMS) not specifically listed by brand name in legislation?
CBPMs supplies can not be held for future use by licensed wholesalers
CBPMs need to be recorded in the controlled drugs register
Patients should be advised that the medicine they have been prescribed is licensed
Private prescriptions do not need to be on a standardised form
Take one as required is an unacceptable dose instruction for a prescription for CBPMS
The correct answer was CBPMs need to be recorded in the controlled drugs register
CBPMs should be treated as controlled drugs and therefore all prescription writing and control requirements apply.
Schedule 2
sativex is sched 4b
89
Mrs S is a 26-year-old female who comes into your pharmacy to ask for your advice. Her doctor has asked her to book an appointment to receive MMR vaccination. She tells you that she is planning to become pregnant and is worried about having this vaccination.
Which one of the following is the most suitable response you can give Mrs S?
Rubella should be given to individuals who do not have immunity to the condition, including woman of child-bearing age. Avoid pregnancy for at least 1 month after vaccination
Don't take the vaccination it is not necessary
Delay taking the vaccine until after you become pregnant and have given birth
No vaccine affects pregnancy
Ask your doctor for an alternative vaccination
The correct answer was Rubella should be given to individuals who do not have immunity to the condition, including woman of child-bearing age. Avoid pregnancy for at least 1 month after vaccination
This patient is not pregnant yet so can be given the MMR vaccine with advice regarding when it would be suitable to start trying for a baby (leave 1 month after injection).
90
```
Trihexyphenidyl
Procyclidine hydrochloride
Orphenadrine hydrochloride
Tolcapone
Amantadine hydrochloride
Selegiline hydrochloride
Entacapone
Rasagiline
```
1. This drug may colour the urine reddish-brown.
2. Early treatment with this drug can delay the need for levodopa therapy in Parkinson's disease.
3. This drug may exacerbate oedema and because of this is cautioned for use in congestive heart failure.
4. This drug may cause hair loss as a side effect.
1. This drug may colour the urine reddish-brown. entacapone
2. Early treatment with this drug can delay the need for levodopa therapy in Parkinson's disease. selegiline hcl.
3. This drug may exacerbate oedema and because of this is cautioned for use in congestive heart failure. amantadine.
4. This drug may cause hair loss as a side effect. selegiline
91
Mr K is a 19-year-old student who presents with a lesion on his lower abdomen. He has been using hydrocortisone 1% cream but says that it hasn't helped and the lesion is getting bigger.
Given that Mr K has tinea corporis, which one of the following treatments is the most suitable to treat his lesion?
Betamethasone valerate 0.1% cream
Flucloxacillin 250 mg capsules
Ketoconazole shampoo
Prednisolone 10 mg tablets
Terbinafine 250 mg tablets
Dermatophyte infections such as tinea corporis may be exacerbated by prolonged use of topical steroids such as hydrocortisone as these exhibit immunosuppressive properties. Terbinafine is indicated in the treatment of tinea corporis.
skin ringworm - ketoconazole also used but terbinafine first line
92
```
Ciclosporin
Diclofenac
Gold
Hydroxychloroquine
Methotrexate
Penicillamine
Prednisolone
Sulfasalazine
1. Mr A has swollen gums.
2. Mrs U tells you that she has been suffering from blurred vision after taking this medicine orally.
```
1. swollen gums = ciclosporin gingival hyperplasia
| 2. blurred vision = hydroxychloroquine
93
```
Cluster headache
Medication-overuse headache
Meningitis
Migraine
Sinusitis
Sub-arachnoid haemorrhage
Temporal arteritis
Tension-type headache
```
1. Is the most prevalent headache condition.
2. Is associated with nasal congestion and excruciating attacks of pain one side of the head.
3. Pain is occipital.
1. Most prevalent = Tension type headache. Most listed conditions are uncommon or rarely seen in primary care. Only migraine and tension-type headache are regularly encountered. Of the two, tension-type headache is the most prevalent.
2. Nasal congestion/pain one side of head = Cluster
- Accompanying symptoms with headache are useful in helping with a differential diagnosis. Nasal congestion associated with headache is not common and the only conditions listed where this would be seen is in sinusitis and cluster headache. As the pain is described as severe, => cluster headache most likely.
3. 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.
94
Most likely drug from the list below which may have caused the stated side-effect.
Akathisia in a 17-year-old girl.
```
Ciclesonide
Ranitidine
Sucralfate
Docusate sodium
Prochlorperazine
Felodipine
Glyceryl trinitrate
Carbocisteine
```
The correct answer was Prochlorperazine
Akathisia (restlessness) is an extrapyramidal side-effect which is commonly associated with high initial doses of piperazine phenothiazines like prochlorperazine
95
```
A small increase in the dose can produce a dramatic change in the plasma levels of this drug.
Amiodarone
Clozapine
Digoxin
Gentamicin
Lithium
Phenytoin
Theophylline
Warfarin
```
Phenytoin is approximately 90% bound to plasma proteins, and metabolised in the liver. At low concentrations, elimination is proportional to the concentration. However, as the concentration rises to therapeutic levels, the enzyme system in the liver can become saturated and elimination occurs at a constant rate despite the dose (zero order kinetics). The effect is that a small increase in the dose sometimes causes a large change in the level of free phenytoin in the blood.
```
Therapeutic doses:
Amiodarone:1.5 and 2.5 µg/ml
Clozapine: 250 to 350 ng/mL
Digoxin: 0.8-2.0 ng/mL
Gentamicin: 5 - 10 mg/L
Lithium: 0.4 - 1 mmol/L
Phenytoin: 10-20 mg/L
Theophylline: 10-20 mg/L
Warfarin: INR 2 - 3
```
96
Which of the following is not a risk factor for pre-eclampsia?
A. pregnancy intervals of more than 10 yrs
B. age 35 years and over
C. nulliparity
D. BMI 30kg/m2 or above
B. age 35 years and over
97
```
A requisition for a controlled drug which has been requested as an emergency by a doctor should be furnished within this many hours.
A. 2 hours
B. 12 hours
C. 24 hours
D. 72 hours
E. 92 hours
```
C. 24 hrs
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.
