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Pre-Reg November Exam '24 > Past Paper Learning Points > Flashcards

Past Paper Learning Points Flashcards

LEARN BITCH

1
Q

Treatment for bacterial meningitis in 2 month old boy

A

IV benzylpenicillin - 600mg

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2
Q

Treatment advice for pregnant woman using canestan pessaries

A

Insert without the applicator

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3
Q

Which vitamin can cause peripheral neuropathy when taken regularly, requiring hospital admission?

A

Vitamin B6

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4
Q

Which medications should be stopped as per ‘Sick Day Rules’

A
  • ACE inhibitors and ARBs (reduce risk of AKI)
  • Diuretics
  • NSAIDs
  • Metformin (risk of dehydration and lactic acidosis)
  • Sulfonylureas (hypoglycaemia risk)
  • SGLT-2 inhibitors
  • GLP-1 inhibitors
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5
Q

Risks associated with HRT

A
  • Endometrial cancer
  • Ovarian cancer
  • Breast cancer
  • Venous thromboembolism
  • Stroke
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6
Q

Which beta blocker is least likely to give patients sleep disturbances?

A

Atenolol (water soluble)- least likely to enter the brain

However, more likely to cause renal damage

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7
Q

RTS- over 50 presenting with reflux or dyspepsia to pharmacy

A

Sell calcium carbonate (rennie) and refer to GP as soon as possible for investigation

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8
Q

Common tell-tale side effect of nitrofurantoin

A

Dark brown/yellow urine

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9
Q

Which thiazide-like diuretic is still safe in renal impairment

A

Metolazone

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10
Q

Does ramipril affect potassium levels?

A

Yes- elderly, diabetics and the renally impaired can become HYPERkalaemic

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11
Q

First line treatment for Parkinson’s disease dementia

A

Acetylcholinesterase inhibitor- Rivastigmine 1.5mg daily initially

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12
Q

Which statin (+ dose) should be offered to patients in secondary prevention of CVD

A

High dose atorvastatin (80mg nocte)

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13
Q

When should patients with thrush be referred to GP?

A
  • Over 60
  • Pregnant
  • First experience
  • Recurring experience within 6 months of last bout
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14
Q

What indication can carbimazole be taken for, aside from hyperthyroidism?

A

Grave’s disease

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15
Q

Monitoring requirements for carbimazole

A

Bloods every 6 weeks initially

Every 3 months when stable

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16
Q

Does grapefruit juice interact with warfarin?

A

No- cranberry juice can affect warfarin though

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17
Q

Contraception options for woman taking enzyme-inducing drugs e.g. carbamazepine

A

Always advised to switch to methods unaffected by enzyme- inducing drugs e.g. copper IUD, depo-provera injection

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18
Q

NSAID most likely to induce adverse gastro effects on patients who have never had GI upset in the past?

A

Piroxicam

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19
Q

What is prescribed for ‘off-episodes’ in Parkinson’s disease, when patient is controlled by co-careldopa therapy, or other dopaminergics?

A

Apomorphine

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20
Q

Which class of antihypertensive most likely to cause facial flushing?

A

Calcium channel blockers e.g. amlodipine

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21
Q

Can Canesten pessaries be used by women during pregnancy?

A

Yes- but only on advice from GP or midwife

Do NOT sell OTC

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22
Q

Oral anticoagulant of choice for patient with mechanical heart valve replacement (post surgery)

A

Warfarin

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23
Q

What is the duration of time a prescription for Isotretinoin should be dispensed after being written under the Pregnancy Prevention Programme

A

Dispensed on the same day

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24
Q

Maximum duration of treatment permitted for a controlled drug Schedule 4 under an emergency supply

A

5 days

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25
Q

First line treatment for glaucoma

A

360 degrees selective trabeculoplasty

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26
Q

What class of CD are cannabinoids

A

Schedule 5

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27
Q

What is dermatophytic onychomycosis?

A

Fungal infection of the nail

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28
Q

In what scenario should HRT be stopped immediately

A
  • Severe stomach pain
  • Sudden severe chest pain
  • Sudden breathlessness
  • Serious neurological effects
  • Liver symptoms
  • High BP
  • Prolonged immobility after surgery
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29
Q

Reason why pseudoephedrine is used in caution in diabetes

A

Stimulates release of epinephrine and norepinephrine, cuasing blood glucose to rise as muscles are energised

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30
Q

A patient with bipolar disorder, treated with lithium, requires analgesia.

Which is the LEAST appropriate analgesic for this patient?

A

NSAIDs- serious interaction, leading to reduced excretion of lithium and subsequent toxicity

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31
Q

Can prescribers outside of the UK prescribe Sch 2 and 3 CDs?

A

No- patients hsould be advised to get a Rx from a local prescriber

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32
Q

Mrs A presents to the pharmacy complaining of dysuria, fever and flank pain.

Which condition is this symptom cluster most indicative of?

A

Pyelonephritis

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33
Q

Malaria prophylaxis options during pregnancy

A

Proguanil

Dose to be started 1 week before enterin endemic area and continued for 4 weeks

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34
Q

Classic symptoms of impetigo

A

Weeping golden pustules on the peri-oral and nasal region

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35
Q

Why should atenolol be avoided in asthmatic patients

A

It is a beta blocker and BBs can precipitate bronchospasm

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36
Q

What does MDRD mean in medical notes?

A

Modification of diet in renal disease

Used to calculate the eGFR of a patient

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37
Q

Can co-codamol eff tabs be sold to the public

A

yes- but only in a pack size of 32

Pack size of 100 is a POM

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38
Q

How often should SOPs be reviewed by the RP?

A

At least every 2 years

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39
Q

How long should the RP record be kept after the last entry?

A

5 years

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40
Q

Second line treatment for patient taking metformin with a high HbA1c

A

A sulphonylurea e.g. gliclazide

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41
Q

Which painkiller can antagonise the analgesic effect of opioid painkillers

A

Buprenorphine- is a partial agonist/partial antagonist and will block the effect of other opioids

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42
Q

What is the BCG vaccine indicated against?

A

Tuberculosis

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43
Q

What vaccines would be indicated for a patient travelling to an area of poor sanitation and poor food hygiene?

A
  • Typhoid
  • Cholera
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44
Q

Which laxative can be used for hepatic encephalopathy?

A

Lactulose- by its MoA, it prevents the reabsorption of ammonia and other toxins from faecal matter which cn cause hepatic encephalopathy

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45
Q

What is the chief underlying mechanism of encephalopathy?

A

Build up of ammonia in the blood

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46
Q

Which painkiller has a risk of overdose in infants if used in BF due to maternal variation in capacity to metabolise?

A

Codeine- metabolised in the liver to morphine, by enzyme CYP2D6. There are many genetic variations of this enzyme in the population, meaning overdose can be unexpected but common

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47
Q

Safe laxative for use in pregnancy?

A

Lactulose

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48
Q

When must the first dispensing of a script occur on an Rx stating “repeat x-times”

A

Within 6 months- after which there is no legal final dispensing date. This is left to clinical judgement

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49
Q

Are repeats permitted on a private/standard script for Sch 4/5 drugs?

A

Yes- as long as first dispensing was within 28 days of signing

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50
Q

How long after ceasing methotrexate therapy must women continue to use contraception and avoid pregnancy?

A

6 months

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51
Q

How long after ceasing methotrexate therapy must men continue to use contraception and avoid pregnancy?

A

3 months- it is not known if methotrexate is present in sperm, and there is limited data. This is a precautionary measure

Men should also not donate sperm during therapy or within 3 months of discontinuation

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52
Q

How to treat blepharitis on the community (OTC)

A
  • Warm compress to closed eyelids for 5-10 mins to help melt oils that may have built up. Carry out BD but the OD once symptoms calmed
  • If general hygiene doesn’t resolve issue- use propamidine isetionate (brolene 0.1% drops) BD
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53
Q

How many times can a private Rx be repeated if the number of repeats aren’t stated?

A

Can be repeated ONCE- so dispensed twice including the first initial dispensing

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54
Q

How many times can a private Rx for combined oral contraceptives be dispensed with “repeat” stated on them?

A

6 times

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55
Q

Incubation period for chickenpox

A

11-20 days

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56
Q

Incubation period for slapped cheek disease

A

13-18 days

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57
Q

Incubation period for whooping cough

A

7-10 days

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58
Q

Incubation period for mumps

A

15-24 days

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59
Q

What is the limit on number of months supply on CD scripts?

A

There is no legal limit on CD script duration, however it should be limited to 30 days

Any longer, and the patient’s prescriber should be contacted to enquire why more than a month has been prescribed

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60
Q

First line treatment for gout prophylaxis

A

Allopurinol or febuxostat

Both are first line but patient preference should be considered and co-morbidities. Allopurinol is recommended in those with major cardiovascular disease

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61
Q

Methadone patient drops their dose outside the pharmacy and requests another to replace it. Best course of action?

A

Advise patient that they must obtain another Rx from their prescriber (it is a Sch 2 drug)

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62
Q

Which hot drinks should a patient taking warfarin avoid?

A

Green tea- anything containing vitamin K

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63
Q

Most common organism causing vaginal thrush

A

Candida albicans

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64
Q

Which antipsychotic at high doses requires protection of the skin from UV light?

A

Promazine

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65
Q

Does ear discharge require referral to GP

A

Yes, potential infectioin requiring antibiotic ear drops

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66
Q

Recommended cream to prevent itching for 6 year old patient with scabies

A

Crotamiton cream 10% (Eurax)

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67
Q

Which direct-acting oral anticoagulant should be taken with food?

A

Rivaroxaban

Due to lack of efficacy on an empty stomach

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68
Q

Signs of digoxin toxicity

A
  • Nausea
  • Anorexia
  • Diarrhoea
  • Visual disturbances- yellow haze or blurred vision
  • Arrhythmias
  • General malaise
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69
Q

What age is hydrocortisone 1% licensed from?

A

10 years

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70
Q

What does the Latin p.c. mean on a script?

A

To be taken after food

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71
Q

Which Parkinson’s medication is associated with impulse control side effects e.g. gambling, binge eating, obsessive shopping etc)

A

Dopamine-receptor agonists e.g. ropinirole

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72
Q

Signs of theophylline toxicity

A
  • Vomiting
  • Agitation
  • Restlessness
  • Dilated pupils
  • Sinus tachycardia
  • Hyperglycaemia
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73
Q

Treatment for girl presenting with several red lumps and patches (1-5cm) on lower legs

A

The lumps are characteristic of erythema nodosum

Treatment: rest and ibuprofen

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74
Q

Treatment for scalp fungal infection (tinea capitis)

A

Griseofulvin

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75
Q

Treatment for uncomplicated hyperpigmented patches on trunk and back

A

Ketoconazole shampoo

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76
Q

Can digocin therapy cause hypokalaemia or hyperkalaemia?

A

HYPOkalaemia

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77
Q

Common treatment of hypertension during pregnancy

A

Methyldopa

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78
Q

MoA of metformin

A

Decreases gluconeogenesis by increasing peripheral utilisation of glucose

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79
Q

MoA of acarbose?

A

Delays the digestion and absorption of starch and sucrose

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80
Q

Drug class of saxagliptin

A

DDP-4 inhibitor

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81
Q

What Sch. controlled drug is temazepam?

A

Sch 3

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82
Q

Common neuro SE of baclofen

A

Hallucinations

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83
Q

What sch. controlled drug is buprenorphine

A

Sch 3

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84
Q

Which prescriber can not request emergency supply of a POM medicine?

A

Veterinarians

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85
Q

Mechanism of action of dabigatran etexilate

A

Dabigatran etexilate is direct thrombin inhibitor with a rapid onset of action

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86
Q

Treatment options of transient ischaemic attack when aspirin and dipyridamole are not tolerated

A

Clopidogrel

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87
Q

Counselling point for patient starting lamotrigine therapy

A

If patient develops severe skin reaction in the first 8 weeks, stop treatment immediately

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88
Q

Which drug is commonly prescribed at a dose of 1 gram STAT for uncomplicated genital chlamydial infections

A

Azithromycin

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89
Q

Medicine-induced colitis is a risk factor with use of this medication

A

Clindamycin

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90
Q

What is the MoA of cholestyramine

A

A bile acid sequestrant

Binds to bile acids, preventing their reabsorption. This promotes cholesterol conversion into bile acids, therefore increasing LDL-receptor activity in liver cells, lowering plasma LDL

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91
Q

Does grapefruit juice interact with warfarin?

A

No

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92
Q

On which diabetes medication class do you need to be vigilant re diabetic ketoacidosis when withdrawing insulin?

A

GLP-1 agonists e.g. dulaglitide, semaglutide

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93
Q

A mother comes into your pharmacy to ask for advice. Her 3-year-old daughter has been waking at night and has recently started wetting the bed.

Which parasitic infection is most likely to be causing these symptoms?

A

Threadworm

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94
Q

Is the warning: ‘Keep out of sight and reach of children’ a legal requirement on dispensing labels?

A

No, only advised by the RPS

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95
Q

An 18-year-old girl enters your pharmacy and asks for your advice regarding a sore throat, tiredness and swollen glands in her neck.

What do you suspect may be her condition and most likely cause?

A

Glandular fever caused by Epstein-Barr virus

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96
Q

A 12-year-old girl is taken to see her GP by her mother to discuss prevention of cervical cancer.

Which vaccine is indicated for this patient?

A

HPV- Human papiloma virus vaccine

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97
Q

Which laxative is indicated for constipation in terminally ill patients?

A

Co-danthramer

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98
Q

What monitoring is required for enoxaparin?

A

Plasma-potassium concentration for hyperkalaemia

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99
Q

Is the midwife’s name and address needed on a midwife supply order?

A

No

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100
Q

What is the interaction between MOAI and other antidepressants?

A

Increased risk of serotonin syndrome

Other antidepressants should not be started for 2 weeks after treatment with an MOAI

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101
Q

Common causes of migraine with aura

A
  • Hormonal changes
  • Emotional triggers
  • Fatigue
  • Dietary triggers e.g. cheese, chocolate or alcohol
  • Certain medications
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102
Q

Which cream would be suitable for treatment of a child over the age of 8 with infected eczema because it contains an antibacterial with the steroid?

A

Fucidin H

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103
Q

Mr King, a 44 year old, presents with symptoms of nasal congestion, slight sore throat, headache and general loss of smell. He has had these symptoms for 10 days and feels unwell. The patient has been tested to confirm they do not have coronavirus.

The pharmacist decides to make a referral to the doctor because the differential diagnosis suggests?

A

Sinusitis

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104
Q

Which tuberculosis treatment drugs can cause flatulence?

A

Ethambutol

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105
Q

In which conditions is pseudoephedrine cautioned

A

HTN and diabetes

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106
Q

How should private Rx for a sch 3 drug be processed?

A

Sent to the relevant NHS agency

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107
Q

How should a veterinary Rx/ requisition for Sch 3 CDs be processed

A

Retained for 5 years- no need to send to an NHS agency

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108
Q

How long should an invoice for Sch 3 CD be retained for, taking into account tax requirements

A

Retained for 6 years

Although the law relating to CDs requires 2 years, the law relating to tax requires they be retained for 6 years

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109
Q

Which illness is characterised by white spots surrounded by a red ring on the inner cheek and gums?

A

Measles (morbilli)

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110
Q

Pregnant women have to be extra cautious to ensure that they will not come into contact with this disease as there is an increased risk of congenital abnormalities

A

German measles (rubella)

Only a serious concern if caught during first 20 weeks of pregnancy. The virus can disrupt the development of the baby and cause a wide range of health problems

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111
Q

Considerations for use of bendro in patients with lowered eGFR

A

Not effective in patients with eGFR lower than 30ml/min/1.73m2

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112
Q

Which high risk drug for arrhythmias is contraindicated in patients with thyroid dysfunction due to its ability to accentuate thyroid problems

A

Amiodarone

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113
Q

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?

A

Atovaquone

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114
Q

What is the initial recommended daily dose for patients taking metformin for polycystic ovary syndrome?

Can this then be increased?

A

500mg OD for 1 week, then 500mg BD for 1 week

This can then be increased between 1.5g-1.7g daily in 2-3 divided doses

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115
Q

What is the maximum daily dose of etodolac?

A

600mg

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116
Q

Which OTC topical prep is to be used wit caution in patients taking phenytoin?

A

Daktarin oral gel

Miconazole enhances the anticonvulsant effect of phenytoin (plasma conc. enhanced

Although with topical use, the risk is lower

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117
Q

What is the maximum duration of treatment which can be given via over the counter chloramphenicol?

A

5 days

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118
Q

Which side effect of clozapine should patients report due to the risk of fatality?

A

Constipation- clozapine has been associated with varying degrees of intestinal peristalsis

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119
Q

What is the target INR for patients taking warfarin with a mechanical prosthetic heart valve?

A

This depends on the type and location of the valve etc

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120
Q

What colour does urine turn for up to 48 hours after doxorubicin is used?

A

Red

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121
Q

Special circumstances surrounding isotretinoin Rx

A
  • 7-day validity- should be dispensed on the same day
  • Pregnancy test taken on day of issue
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122
Q

Patient comes in with mouth ulcers which have been present for 5 days and medical history includes nicorandil, action?

A

Refer to GP- nicorandil can cause serious skin, mucosal and eye ulceration; including gastro ulcers

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123
Q

H. Pylori regimen for patient allergic to penicillin

A

metronidazole 400 mg bd, clarithromycin 500 mg bd, lansoprazole 30 mg bd for 7 days

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124
Q

Which diabetic drug is contraindicated in history of heart failure?

A

Pioglitazone

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125
Q

Is the copper IUD more effective at pregnancy prevention compared to EHC?

A

Yes

126
Q

Most appropriate treatment for malignant hypothermia as a result of anaesthesia

A

Dantrolene sodium

127
Q

How many and which types of CPD must pharmacists submit annually

A

4 CPDs (at least 2 planned) , 1 peer review and 1 reflective account

128
Q

Preferred 1st line antihypertensive in black African or African-Caribbean origin patients?

A

ARB rather than ACE e.g. candesartan

129
Q

Directions for admin of bisphosphonates

A
  • Take 30 mins before breakfast (or any other oral medication)
  • Plenty of water
  • Stand or sit upright for at least 30 mins after taking
130
Q

Most appropriate route of admin for vincritine

A

IV

131
Q

Diabetic drug to avoid in hisotry of hernia

A

Acarbose- inhibits carbohydrate digestion by competitively inhibiting alpha glucosidase enzyme in small intestine lumen, making hernias worse

132
Q

Patient presents with this eye, no pain, changes to vision and no trauma to head. BP is well controlled

Action?

A

Suggest doing nothing; the blood shot appearance should resolve in one to two weeks

133
Q

Which abnormal result could result in requiring a doxorubicin dose reduction?

A

Elevated bilirubin

134
Q

Mesalazine interacts with which laxative

A

Lactulose- it lowers stool pH, which could precipitate a flare or worsen the condition

135
Q

Which NSAIDs are associated with lower thrombotic and CVD risk?

A

Naproxen

136
Q

A father brings his 3-year-old child into the pharmacy. The child’s symptom of perianal night-time itching leads you to conclude that he has threadworm

Action taken?

A

Supply mebendazole to the whole family, followed by a repeat dose after 14 days

137
Q

Licenced age for sale of chloramphenicol eye drops

A

2+ years

138
Q

What are hyoscine butylbromide/ hydrobormide indicated for?

A

BUTYL- abdominal cramps/ spasms and IBS-like symptoms

HYDRO- travel sickness

139
Q

How long is a script for morphine sulfate soln valid for?

A

It is Sch 5, so 6 months

140
Q

A hospital inpatient experiences swallowing difficulties post-operatively and is fitted with a nasogastric tube to facilitate enteral feeding and medication administration. They normally take phenytoin capsules, however this has now been supplied as an oral suspension. His nurse asks you for advice on how to administer his next phenytoin dose

A

Interrupt feeding for 2 hours before and after dose- those receiving enteral feeding preps have lower than expected phenytoin levels, reducing seizure control

Closer monitoring also required

141
Q

High levels of which vitamin should be avoided in pregnancy?

A

Vitamin A- present in fish liver oil etc

142
Q

P value of what indicates statistic significance

A

Below 0.05

143
Q

A 62-year-old man informs you he has been prescribed a new medicine for his overactive bladder that requires close blood pressure monitoring

Which medication?

A

Mirabegron

144
Q

At which levels of HbA1c, fasting and random blood glucose is a diabetes diagnosis considered?

A
  • HbA1c of 48 mmol/L (6.5%) or more
  • Fasting blood glucose of 7.0 mmol/L or more
  • Random blood glucose of 11.1 mmol/L or more
145
Q

Is metformin effective in the absence of insulin?

A

No- only acts in the presence of endogenous insulin

146
Q

Most likely drug interaction consequence of metformin and empagliflozin?

A

Hypoglycaemia

147
Q

Which drug for urinary incontinence would be most suitable for patient with dementia and is frail i.e. lowest anticholinergic burden?

A

Mirabegron- acts on beta-3-adrenoceptors therefore minimal anticholinergic burden unlike antimuscarinics (high burden)

148
Q

Why shouldn’t doxy be used in children

A

Dental hypoplasia- deposits in teeth and bones

149
Q

Licenced age for Curanail 5% medicated lacquer?

A

18 years+

150
Q

Why should metoclopramide, haloperidol and prochlorperazine not be used in Parkinson’s?

A

They cross the BBB and can act as a dopamine blockade, resulting in worsening of the condition

151
Q

Recommended anti emetic used with apomorphine use

A

Domperidone- however QT prolongation still possible so assessment of cardiac risk factors and ECG monitoring still recommended

152
Q

You are dispensing a new prescription for glyceryl trinitrate patch Deponit® to be applied once a day, for a 65-year-old man for the management of his angina

What’s the most appropriate advice regarding administration of the patch

A

apply the patch to the side of the chest for 12-14 hours and then remove. The patch may also be applied to the upper arm, abdomen, or shoulder

153
Q

Which microorganism are UTIs usually caused by

A

Typically those found in the GI tract which have travelled to the urinary tract e.g. E. coli

154
Q

1st line treatment for UTI

A

Nitrofurantoin 50mg QDS for 3 days

100mg QDS for 7 days for chronic recurrent UTIs

155
Q

How long after initial dose should digoxin levels be checked for drug monitoring purposes

A

6-8 hours after dose

156
Q

Which type of medical condition are generally contraindicated in combined oral contraceptive use?

A

Cardiac e.g. HTN

157
Q

What is typical effective dosing for amitriptyline in severe depression

A

50mg OD or in divided doses

158
Q

A mother brings her 3-year-old son into your pharmacy and tells you she thinks he has an ear infection. He has been complaining of pain around the ear and scratching his ear. He has also recently had a temperature and has been congested following a cold, preventing him from sleeping properly

Appropriate action?

A

Most ear infections clear up on their own within 72 hours, do nothing

159
Q

A 27-year-old man is on high dose intravenous methotrexate for osteosarcoma. You are reviewing their medication list for any potential drug interactions.

Which of the following medications would most likely cause a negative interaction?

Question 85Answer

a.
ibuprofen 5% gel applied once daily only when required

b.
lansoprazole 30 mg gastro-resistant capsules once daily

c.
metformin hydrochloride 1000 mg tablets twice a day

d.
nitrofurantoin 50 mg tablets once daily

e.
ramipril 5 mg capsules once daily

A

Lansop 30mg OD- PPIs may increase likelihood of limited methotrexate clearance, increasing chances of toxicity

160
Q

Example of medium intensity statin

A

Fluvastatin

161
Q

Which treatment for oral thrush would interact wit warfarin

A

Miconazole- greatly increases anticoagulant effect of warfarin

162
Q

Adrenaline dose requirements for anaphylaxis of a 6 month-6 y/o child, 6-12 years and 12 years + child respectively

A

150mcg IM- 6 month-6 years

300mcg IM- 6-12 years

500mcg IM- 12 years+

163
Q

1st line antihypertensive for use in pregnancy

A

Labetalol- initially 100mg BD, increased to 200mg BD

164
Q

Vitamin D supplement strength recommended for 6 month old baby

A

8.5-10 mcg vitamin D

165
Q

Laxative licenced to treat opioid induced constipation

A

Naloxegol

166
Q

A 55-year-old male attends your clinic for a medication review and you note that he has been recently started on tamsulosin hydrochloride 400 mcg modified release capsules. He is currently taking citalopram 10 mg tablets and simvastatin 40 mg tablets.

Which one of the following options best describes the adverse effect the patient is likely to experience?

a.
constipation

b.
depression

c.
epistaxis

d.
hypertension

e.
nausea

f.
sexual dysfunction

g.
skin reaction

h.
vision disorders

A

Sexual dysfunction is a common SE of tamsulosin hydrochloride

167
Q

A 72-year-old patient with newly diagnosed atrial fibrillation requires anticoagulation therapy for prophylaxis against stroke and systemic embolism. They have a past medical history of hypertension for which they are prescribed amlodipine 5 mg once daily and atorvastatin 20 mg once daily

A

DOAC should be offered e.g. rivaroxaban

168
Q

A 28-year-old woman is admitted to hospital following a fall and has a suspected broken ankle. She has no past medical history but requires venous thromboembolism prophylaxis. She follows a vegan diet and avoids animal derived products

A

LMWH are used, enoxaparin however is derived from porcine intestinal mucosa (she is vegan)

Fondaparinux is used as an alternative

169
Q

Action to take when unable to dispense a medication from outside of the EEA

A

Refer to appropriate UK prescriber

Do not make emergency supply

170
Q

A 72-year-old man with a three-day history of diarrhoea develops acute kidney injury and hypokalaemia. He subsequently demonstrates symptoms of nausea, vomiting, confusion, and visual disturbances, including yellow vision

Which drug is likely to have caused this toxicity

A

Digoxin- visual disturbances and yellow visuals are tell-tale signs

171
Q

Which endocrine condition is a common SE of amiodarone

A

Hypothyroidism

172
Q

1st line treatment for impetigo

A

Topical fusidic acid 2% cream

173
Q

What term describes ‘asbetstos-like’ scales on the scalp?

A

Pityriasis amiantacea

174
Q

Which form of NRT would be most suitable for a pregnant mother suffering from pregnancy-related N&V

A

Nicotine patch

175
Q

What class of drug is Phenelzine

A

A monoamine-oxidase inhibitor (MOAI)

176
Q

Which corticosteroid is indicated for treatment of postural hypotension

A

Fludrocortisone

177
Q

Which antibiotic’s absorption is impacted by dairy and should not be consumed in large amounts concurrently

A

Ciprofloxacin

Dairy consumption should be restricted to 1-2 hours before tkaing this medication

178
Q

The use of higher doses in which antipsychotic drug can cause photosensitisation, and sunlight shoould be avoided in its high dose use

A

Chlorpromazine

179
Q

Symptoms suggestive of coeliac disease

A
  • Recurrant abdominal pain
  • Loose and pale stools
  • Poor growth
180
Q

What is hydroxyzine indicated for?

A

Pruritus- itch

181
Q

What are the active ingredients in Atripla, and what is it indicated for?

A

Efavirenz, emitricitabine & tenofovir disoproxil fumurate

Indicated as single tablet regimen of a triple therapy for HIV

182
Q

How long can the RP be absent from the pharmacy for a given 24 hour period?

A

2 hours

183
Q

Which skin condition classically affects lower extremeties

A

Discoid eczema

184
Q

The patient has been suffering from a mouth ulcer for the past three weeks. It is not causing him any pain. What is the best course of action?

A

Refer to dentist for ulcer lasting >2 weeks to rule out oral cancer

185
Q

Which type of fruit juice is most likely to interact with warfarin and induce a bleeding event

A

Cranberry juice

186
Q

Above which BP are oral contraceptive pills required to be stopped?

A

Systolic 160 mmHg

OR

Diastolic 100 mmHg

187
Q

A 36-year-old woman has been experiencing irregular periods, weight gain and hair loss in the past few months. Her GP has prescribed metformin 500 mg tablets which she has been taking for 2 weeks.

She returns to the pharmacy and explains that she is experiencing diarrhoea. What is the most appropriate advice to give to the patient?

A

This is a normal SE of metformin- slow increases in dose can improve tolerability

or a formulation change can be considered

188
Q

What is NOT required on a midwife supply order

A

Address of the midwife

189
Q

A patient who is HIV positive is deemed to be at risk of opportunistic infections and requires prophylactic treatment for Pneumocystis jirovecii pneumonia.

Which antibiotic is most appropriate to prescribe for this indication?

A

Co-trimaxazole

190
Q

What does the latin abbreviation a.c. mean on an Rx?

A

Before food

191
Q
A
192
Q

First line treatment for treatment of osteoporosis in mean at high risk of fractures?

A

Risedronate 35mg once weekly

193
Q

Which medications are known for interacting with sumatriptan?

A

Antidepressants and Tramadol

Increases the risk of Serotonin Syndrome

194
Q

Asthmatic patient with gout requires pain relief for a flare up. Most suitable option?

A

Paracetamol- NSAIDs are known to precipitate bronchospasm in asthmatics

195
Q

Which classes of drugs are known to cause dyspepsia?

A
  • CCBs
  • Nitrates
  • Theophylline
  • Bisphosphonates
  • Corticosteroids
  • NSAIDs
196
Q

Which Sch of CDs are growth hormones part of?

A

Sch 4 Part 2

197
Q

Miss O is a 24-year-old patient who tells you that she has weight loss accompanied by insomnia and palpitations. Which condition is likely responsible?

A

Thyrotoxicosis

198
Q

Mrs X is a 40-year-old patient who presents with abdominal pain, foul smelling steatorrhoea, weight loss and dermatitis herpetiformis on her elbows and buttocks. Most likely disease responsible?

A

Coeliac disease

Steatorrhoea (fat in stools) due to malabsorption of fats

199
Q

Which antibiotic is associated with severe optic neuropathy and should be monitored closely if using for more then 28 days?

A

Linezolid

200
Q

This antibiotic is cautioned when used by inhalation in those suffering with haemoptysis

A

Aztreonam

201
Q

With with other group of medications is sumatriptans similar to and should be avoided in their allergy

A

Sulfonamides- sumatriptan contains a sulfonamide group and should be avoided in intolerance to sulfonamides

202
Q

This medication is used to terminate pregnancy following mifepristone administration

A

Misoprostol

203
Q

A junior doctor calls you asking for advice. He has a medical emergency and wishes to induce labour in a patient for medical reasons and wishes to know what drug is most appropriate to induce labour in a women with a Bishop score of 7

A

Oxytocin

204
Q

Which oral side effect is common in ciclosporin use?

A

Gingival hyperplasia (swollen gums)

205
Q

Can private Rx be repeated when ‘repeat x3 etc’ is stated on the script?

A

Yes- private scripts can be repeated on any form

206
Q

Can standard NHS Rx with instructions to ‘repeat x2 etc’ be repeat dispensed?

A

No- Specific forms must be used in England AND Wales

207
Q

What Sch of CDs is clenbuterol in?

A

Sch 4 Part 2

208
Q

The patient has been prescribed penicillin V for tonsillitis. She asks whether she will be able to continue breastfeeding her 5-month-old baby whilst she is taking the antibiotic. What is the best advice for the patient?

A

Breastfeeding is safe when using Pen V

209
Q

Are faxed CD requisitions acceptable?

A

No

210
Q

What are the recommended check points to avoid errors in prescribing?

A
  • Right patient
  • Right medicine
  • Right dose
  • Right route
  • Right time
211
Q

Which laxative can cause urine to turn red

A

Co-danthramer

212
Q

Common SE of phenindione

A

Can colour urine pink/orange

213
Q

What Sch of CD is methadone

A

Sch 2

214
Q

How long must vet Rx be retained for

A

5 years

215
Q

The invoice for Sativex® is recommended by NICE to be retained for this length of years for the purpose of HM Revenue and Custom

A

6 years

216
Q

The number of times a private prescription for an oral contraceptive may be repeated

A

No mention of repeat usually means can be repeated once

Oral contraceptives can be repeated 5 times

217
Q

Which antibiotics can cause choleastatic jaundice, and may occur up to 8 weeks after treatment

A

Flucloxacillin

218
Q

During a ward round, a patient is found to be pregnant. Which drug should NOT be used in pregnant women due to concerns over ‘grey baby syndrome’?

A

Systemic chloramphenicol

Topical is safe to use in pregnancy

219
Q

Secondary complications of diabetes

A
  • CVD
  • Diabetic neuropathy
  • Neuropathy
220
Q

Appropriate treatment for daytime sleepiness in Parksinson’s patients

A

Modanifil

221
Q

What complication can beta 2 agonists cause in diabetic patients

A

Ketoacidosis- especially in IV salbutamol use

222
Q

What can chlorpromazine cause if handled inappropriately

A

Contact sensitisation

223
Q

Tendon damage, and even rupture, can occur within 48 hours of taking which medications

A

Quinolones e.g. ciprifloxacin

224
Q

For which medications should oral health be reviewed before initiating treatment

A

Bisphosphonates

Can cause osteonecrosis of the jaw

225
Q

Which medications can induce convulsions in patients with or without a history of convulsions

A

Quinolones e.g. ciprofloxacin

226
Q

With which medication does bee venom extract interact with which can cause a severe anaphylactoid reaction

A

ACE inhibitors

227
Q

A 35-year-old female suffered from a history of pernicious anaemia (in which a lack of gastric intrinsic factor results from an autoimmune gastritis). This caused the malabsorption of a vitamin and subsequently megaloblastic anaemia

Which vitamin?

A

Vitamin B6

228
Q

Wernicke’s encephalopathy secondary to chronic alcoholism is treated in the long term with the oral administration of this

A

Vitamin B1 (Thiamine)

229
Q

Mrs G, a 30-year-old female who is 4 months pregnant and lives alone, comes into your pharmacy complaining of persistent perianal pruritis that’s been keeping her up all night for the last couple of weeks. She is currently not taking any medicines or has any pre-existing medical conditions but does occasionally take lactulose for pregnancy-induced constipation. Also, one of her children was diagnosed with threadworm a month ago but this was treated successfully.

What is the most appropriate advice you should give Mrs G?

A

Maintain hygeine measures for SIX weeks e.g. cut finger nails and launder bedding and towels on daily basis

Anthelmintic treatment is NOT recommended in pregnancy and therefore only hygeine measures are recommended

230
Q

What is the result of the interaction between baclofen and ACE inhibitors/beta blockers

A

Increased hypotensive effect

231
Q
A
232
Q

What should patients watch for when first starting treatment with bromocriptine

What class of drug is this

A

Patients may experience low BP- talk extra care to avoid falls

It is a dopamine receptor agonist

233
Q

How long until a DMARD patient is likely to see results form treatment

A

Typically a slow onset of action and can take 2-3 months to take effect

234
Q

A patient presents in your pharmacy with a prescription.

She 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?

A

Advise to use expressed milk only while she and the baby are undergoing treatment to prevent re-infection

235
Q

Mr JB attends your pharmacy he is suffering from diarrhoea and thinks it is a side effect of his medication. Patients may experience side effects that warrant discontinuation of the medicine.

Which antibiotics must be discontinued immediately and the patient advised to contact their doctor if diarrhoea develops?

A
  • Ampicilin
  • Clindamycin
  • Fluoroquinolones e.g. ciprofloxacin
  • Cephalosporins
236
Q

Miss J is a 23-year-old female who has just been admitted into hospital following a car accident. She is recovering from a hip fracture. Her consultant prescribes her zoledronic acid

What is the issue with this?

A

Zolendronic acid has shown toxicity in animal studies and should be avoided in woman of child-bearing potential

237
Q

What are the side-effects of glucocorticoid use?

A

Glucocorticoid side-effects include diabetes, osteoporosis and muscle wasting

238
Q

What are the side-effects of mineralcorticoid use?

A
  • Calcium loss
  • Hypertension
  • Potassium loss
  • Water retention
239
Q

A doctor wants your advice on what to prescribe a patient with low severity community-acquired pneumonia who has a history of hypersensitivity to penicillin.

Which is the most suitable option for this patient?

A
  • Clarithromycin
  • Doxycycline
  • Aithromycin
  • Erythromycin
240
Q

A 34-year-old woman has come in with her prescription for carbamazepine 200 mg three times daily. She asks you what the likely reason is for her maintenance dose to be higher than the dose she was started on, as her symptoms have not worsened since the start of treatment.

What is the most appropriate explanation to give to this patient?

A

Carbamazepine itself increases how quickly the body processes it so the maintenance dose is higher than the initial dose

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

241
Q

Mrs Jones presents to the pharmacy complaining of headaches. She tells you that the pain has been present for the last 24 hours and is at the front left of her head, and she has felt a little sick.

Based on this information what would be the most likely diagnosis?

A

Unilateral headache associated with sickness in women is highly suggestive of migraine

242
Q

When should bisphosphonates be avoided

A
  • Abnormalities of oesophagus
  • Hypocalcaemia
  • Other factors delaying emptying
  • IF CrCl is below 35 ml/min
243
Q

What is the other common name for slapped cheek disease

A

Erythema infectiosum

244
Q

A patient has been prescribed a cream to treat their condition. You need to counsel them that this cream may stain their clothing.

Which of the following creams/ointments could stain clothing?

Betamethasone valerate/clioquinol cream
Daktacort® ointment
Fucibet® cream
Locoid®ointment
Synalar® cream

A

Betamethasone valerate/clioqionol cream

245
Q

Step 1 HTN treatment in patients over 55

A

Calcium channel blocker

246
Q

A person whose spleen was removed following a road traffic accident is seeing their general practitioner.

Which vaccine is indicated for this patient?

A

Pneumococcal vaccine

If they have had a splenectomy then they are at an increased risk of pneumococcal infection

247
Q

Which of the electrolytes is most likely to have an adverse effect on serum lithium levels?

A

Sodium- the sodium-lithium channels can’t differentiate between sodium and lithium, therefore, changes in the diet that reduce or increase sodium intake affect serum lithium levels resulting in sub-therapeutic or toxic levels. Raised calcium levels also need to be monitored but have less impact than sodium

248
Q

What drug class is penicillamine and what do patients need counselling on before initiating treatment?

A

DMARD

Watch for symptoms of blood disorders e.g. sore throat, fever, infection, unexplained bleeding and bruising, purpura, mouth ulcers or rashes

249
Q

A patient calls into the community pharmacy in which you are working, complaining that the soft contact lenses they wear keep becoming discoloured. The patient wants to know if any of the medications they are taking may be a causing this.

Which of the patients’ medications is likely to be causing the discolouration of the contact lenses?

Amiloride
Azithromycin
Codeine
Finastaride
Rifampicin

A

Rifampicin

250
Q

Which CD Sch Rx is valid for up to 6 months

A

Sch 5

251
Q

Mr F comes into your pharmacy with his 2-year-old son. His son has a rash which extends from the face down to the chest. The rash is made up of small red-brown, slightly raised spots that join together into larger blotchy patches. He has a runny nose, conjunctivitis and has greyish-white spots with a red ring in the mouth.

Which childhood infections are these symptoms most likely to represent?

A

Measles

252
Q

What CD Sch is keatmine

A

Sch 2

253
Q

When is the effect of thiazide-like diuretics readicated

A

In renal impairment- eGFR <30 ml/min

254
Q

Which antibiotics are used to treat C. diff

A
  • Vancomycin
  • Fidoximicin
255
Q

What Sch CD drug is pethidine

A

Sch 2

256
Q

Licenced age at which xylometazoline can be used

A

> 6 years old

257
Q

Mr T is 55 years old and has come to your pharmacy to collect his first prescription for warfarin.

Which one of the following is most likely to increase the anticoagulant effect of warfarin?

Beer
Cranberry juice
Grapefruit juice
Green tea
Spinach, kale, ginger and apple juice

A

Cranberry juice- it’s an enzyme inhibitor, therefore increasing anticoagulant effect

Green tea and spinach etc contian vitamin K, so would reduce anticoagulant effect

258
Q

Where is herpes labialis found?

A

Oral region

259
Q

When should canestan soft gel pessaries be used, and how often?

A

Once at night

260
Q

What is the glucose level indicating HYPOglycaemia

A

Below 3.9 mmol/L

261
Q

What colour can co-danthramer colour patients urine

A

Pink

262
Q

Result of digoxin and quinine interaction

A

Nausea and vomiting

Plasma conc. of digoxin increased by quinine

263
Q

Result of interaction between pimozide and ketoconazole

A

Vetricular arrhythmias

Ketoconazole predicetd to increase exposure to pimozide

264
Q

What is ethosuximide indicated for

A

Treatment of absence seizures, atypical absence seizures (adjunct) and myoclonic seizures

265
Q

Counselling point necessary for rotigotine

A

May affect ability to drive and operate heavy machinery due to potential sudden onset of sleep

266
Q

Result of interaction between statin and daptomycin

A

Increased risk of rhabdomyolysis

267
Q

Which organism commonly causes impetigo

A

Staphylococcus aureus

268
Q

What is a female specific side effect of spironolactone use

A

Menstrual disturbances, such as post-menopausal bleeding

269
Q

Can ACE inhibitors affect patient’s sleep

A

Yes

270
Q

Drugs prescribed for INITIAL treatment phase for TB

A

Ethambutol, isoniazid, pyrazinamide and rifampicin

271
Q

Drugs prescribed for continuation phase for TB

A

Isoniazid and rifampicin, pyridoxine hydrochloride

272
Q

How long after ceasing mycophenolate therapy should male patients continue to use contraception for

A

90 days

273
Q

How long after ceasing mycophenolate therapy should female patients continue to use contraception for

A

6 weeks

274
Q

Result of interaction between amiodarone and simvastatin

A

Increased risk of myopathy (muscle weakness/tenderness)

275
Q

Result of interaction between warfarin and fluconazole

A

Anticoagulant effect increased with fluconazole

276
Q

Result of theophylline and disulfiram interaction

A

Metabolism of theophylline inhibited by disulfiram therefore and increased risk of theophylline toxicity

277
Q

Patients of Chinese ancestry have a greater chance of developing Stevens-Johnson Syndrome while taking this medication

A

Phenytoin

278
Q

Patients starting this medication should be carefully clinically evaluated and given chest x-rays beforehand

A

Amiodarone

Associated with serious and sometimes fatal lung toxicity

279
Q

A patient is suffering from excessive skin sensitivity to non-noxious stimuli secondary to the use of nilotinib for the treatment of chronic myeloid leukaemia

Which medication SE is this

A

Hyperaesthesia

280
Q

Result of interaction between warfarin and cimetidine

A

Increased coagulant effect of warfarin

281
Q

A patient experiencing an epileptic seizure is brought into Accident and Emergency for treatment.

What is the most appropriate treatment for patients to be prescribed for treatment of status epilepticus should they experience this in their day-to-day life?

A

Midazolam buccally

282
Q

Why should metformin be held in acute AKI

A

Increased risk of lactic acidosis in AKI patients

283
Q

MHRA alert related to pioglitazone

A

Increased risk of heart failure

284
Q

MHRA alert related to empagliflozin

A

Increased risk of diabetic ketoacidosis

285
Q

Antidepressant also indicated for stress urinary incontinence

A

Duloxetine

286
Q

A dentist wants to prescribe a medication for a patient suffering with painful inflammatory conditions of the oro-pharynx and asks can you advise accordingly

A

Benzydamine hydrochloride- Difflam spray

287
Q

Patients starting this medication must have regular eye checks because its associated with visual field defects

A

Vigabatrin

288
Q

In which patient group is temporal arteritis typically seen

A

Elderly women

289
Q

Condition associated with a blocked or runny nostril and excruciating attacks of pain one side of the head

A

Cluster headache

290
Q

Patient experiencing a dull, overall headache for over a week but can also be characterised by a sudden severe headache. Condition?

A

Sub-arachnoid haemorrhage

291
Q

Mrs D, a 58-year-old nurse, is reporting cold hands and feet following the addition of a new drug

A

Most likely a beta blocker- they can cause coldness of extremities

292
Q

Result of interaction between atenolol and verapamil

A

Increased risk of bradycardia. Its a severe interaction

293
Q

Common endocrine SE of thiazide-like diuretics

A

Hyperglycaemia

294
Q

This antibiotic is commonly used in infections where anaerobic bacteria are the suspected cause and it is commonly used in acute pericoronitis

A

Metronidazole- has a wide spectrum, including targeting anaerobic bacteria

295
Q

Which antipsychotics at high doses can cause photosensitivity

A

All of them

296
Q

Special care is required when handling this antipsychotic. The tablets should not be crushed and solutions should be handled with care

A

Chlorpromazine

297
Q

Contraception advice for female patients taking mycophenolate

A

Use 2 types of contraception during treatment

298
Q

Which anticoagulant medication required a dose reduction if used contaminant with verapamil

A

Dabigatran

299
Q

A young man visits the pharmacy and asks you to look at an inward growth on the sole of his foot. You notice that the lesion has tiny black dots on its surface. He says that it is painful when he walks.

Which condition is he most likely to be suffering from?

A

Verruca

300
Q

At what kind of dose should a patient be considered for reducing steroid regimen?

A

Those receiving more than 40mg daily for more than 1 week

301
Q

Which antibiotics should be used in caution in patients with a history of epilepsy

A

Quinolones e.g. ciprofloxacin

May induce convulsions in patients with or without a history of convulsions

302
Q

What is the medical term defined as shortness of breath on lying down?

A

Othopnea

303
Q

A patient is prescribed amitriptyline at night and is worried about side effects.

Which side effect is LEAST likely to be caused by amitriptyline?

Constipation
Drowsiness
Dry eyes
Dry mouth
QT prolongation

A

Dry eyes- not listed as an SE for amitript

304
Q

Mrs F is a 34-year-old lady who is breast feeding her 6-month-old baby. She is diagnosed with low-severity community acquired pneumonia by her GP. The GP phones you to recommend an antibacterial for Mrs F as she wishes to continue to breast feed whilst on treatment.

Which antibacterial would you recommend for Mrs F?

A

Amoxicillin

305
Q

Patient comes to pharmacy displaying signs of anaphylaxis, what is the FIRST appropriate step

A

Call 999, request an ambulance and state anaphylaxis

THEN administer the EpiPen

306
Q

Differences between xylometazoline nasal drops and spray in terms of licensing and duration of use OTC

A

Nasal drops can be used in children between ages 6 and 12 but NOT used for longer than 5 days in children aged 6-11. May be used for 7 days in 12+

Spray is only indicated for children 12+

307
Q

With which other class of drug can convulsions be induced in patients with or without a history of them

A

NSAIDs

308
Q

Can emergency supply be made at the request of an EEA or Swiss patient

A

Yes

309
Q

Common SE of entacapone

A

Colours urine reddish-brown

310
Q
A

Pre-Reg November Exam '24 (10 decks)

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