Past Paper Learning Points Flashcards
LEARN BITCH
Treatment for bacterial meningitis in 2 month old boy
IV benzylpenicillin - 600mg
Treatment advice for pregnant woman using canestan pessaries
Insert without the applicator
Which vitamin can cause peripheral neuropathy when taken regularly, requiring hospital admission?
Vitamin B6
Which medications should be stopped as per ‘Sick Day Rules’
- 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
Risks associated with HRT
- Endometrial cancer
- Ovarian cancer
- Breast cancer
- Venous thromboembolism
- Stroke
Which beta blocker is least likely to give patients sleep disturbances?
Atenolol (water soluble)- least likely to enter the brain
However, more likely to cause renal damage
RTS- over 50 presenting with reflux or dyspepsia to pharmacy
Sell calcium carbonate (rennie) and refer to GP as soon as possible for investigation
Common tell-tale side effect of nitrofurantoin
Dark brown/yellow urine
Which thiazide-like diuretic is still safe in renal impairment
Metolazone
Does ramipril affect potassium levels?
Yes- elderly, diabetics and the renally impaired can become HYPERkalaemic
First line treatment for Parkinson’s disease dementia
Acetylcholinesterase inhibitor- Rivastigmine 1.5mg daily initially
Which statin (+ dose) should be offered to patients in secondary prevention of CVD
High dose atorvastatin (80mg nocte)
When should patients with thrush be referred to GP?
- Over 60
- Pregnant
- First experience
- Recurring experience within 6 months of last bout
What indication can carbimazole be taken for, aside from hyperthyroidism?
Grave’s disease
Monitoring requirements for carbimazole
Bloods every 6 weeks initially
Every 3 months when stable
Does grapefruit juice interact with warfarin?
No- cranberry juice can affect warfarin though
Contraception options for woman taking enzyme-inducing drugs e.g. carbamazepine
Always advised to switch to methods unaffected by enzyme- inducing drugs e.g. copper IUD, depo-provera injection
NSAID most likely to induce adverse gastro effects on patients who have never had GI upset in the past?
Piroxicam
What is prescribed for ‘off-episodes’ in Parkinson’s disease, when patient is controlled by co-careldopa therapy, or other dopaminergics?
Apomorphine
Which class of antihypertensive most likely to cause facial flushing?
Calcium channel blockers e.g. amlodipine
Can Canesten pessaries be used by women during pregnancy?
Yes- but only on advice from GP or midwife
Do NOT sell OTC
Oral anticoagulant of choice for patient with mechanical heart valve replacement (post surgery)
Warfarin
What is the duration of time a prescription for Isotretinoin should be dispensed after being written under the Pregnancy Prevention Programme
Dispensed on the same day
Maximum duration of treatment permitted for a controlled drug Schedule 4 under an emergency supply
5 days
First line treatment for glaucoma
360 degrees selective trabeculoplasty
What class of CD are cannabinoids
Schedule 5
What is dermatophytic onychomycosis?
Fungal infection of the nail
In what scenario should HRT be stopped immediately
- Severe stomach pain
- Sudden severe chest pain
- Sudden breathlessness
- Serious neurological effects
- Liver symptoms
- High BP
- Prolonged immobility after surgery
Reason why pseudoephedrine is used in caution in diabetes
Stimulates release of epinephrine and norepinephrine, cuasing blood glucose to rise as muscles are energised
A patient with bipolar disorder, treated with lithium, requires analgesia.
Which is the LEAST appropriate analgesic for this patient?
NSAIDs- serious interaction, leading to reduced excretion of lithium and subsequent toxicity
Can prescribers outside of the UK prescribe Sch 2 and 3 CDs?
No- patients hsould be advised to get a Rx from a local prescriber
Mrs A presents to the pharmacy complaining of dysuria, fever and flank pain.
Which condition is this symptom cluster most indicative of?
Pyelonephritis
Malaria prophylaxis options during pregnancy
Proguanil
Dose to be started 1 week before enterin endemic area and continued for 4 weeks
Classic symptoms of impetigo
Weeping golden pustules on the peri-oral and nasal region
Why should atenolol be avoided in asthmatic patients
It is a beta blocker and BBs can precipitate bronchospasm
What does MDRD mean in medical notes?
Modification of diet in renal disease
Used to calculate the eGFR of a patient
Can co-codamol eff tabs be sold to the public
yes- but only in a pack size of 32
Pack size of 100 is a POM
How often should SOPs be reviewed by the RP?
At least every 2 years
How long should the RP record be kept after the last entry?
5 years
Second line treatment for patient taking metformin with a high HbA1c
A sulphonylurea e.g. gliclazide
Which painkiller can antagonise the analgesic effect of opioid painkillers
Buprenorphine- is a partial agonist/partial antagonist and will block the effect of other opioids
What is the BCG vaccine indicated against?
Tuberculosis
What vaccines would be indicated for a patient travelling to an area of poor sanitation and poor food hygiene?
- Typhoid
- Cholera
Which laxative can be used for hepatic encephalopathy?
Lactulose- by its MoA, it prevents the reabsorption of ammonia and other toxins from faecal matter which cn cause hepatic encephalopathy
What is the chief underlying mechanism of encephalopathy?
Build up of ammonia in the blood
Which painkiller has a risk of overdose in infants if used in BF due to maternal variation in capacity to metabolise?
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
Safe laxative for use in pregnancy?
Lactulose
When must the first dispensing of a script occur on an Rx stating “repeat x-times”
Within 6 months- after which there is no legal final dispensing date. This is left to clinical judgement
Are repeats permitted on a private/standard script for Sch 4/5 drugs?
Yes- as long as first dispensing was within 28 days of signing
How long after ceasing methotrexate therapy must women continue to use contraception and avoid pregnancy?
6 months
How long after ceasing methotrexate therapy must men continue to use contraception and avoid pregnancy?
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
How to treat blepharitis on the community (OTC)
- 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
How many times can a private Rx be repeated if the number of repeats aren’t stated?
Can be repeated ONCE- so dispensed twice including the first initial dispensing
How many times can a private Rx for combined oral contraceptives be dispensed with “repeat” stated on them?
6 times
Incubation period for chickenpox
11-20 days
Incubation period for slapped cheek disease
13-18 days
Incubation period for whooping cough
7-10 days
Incubation period for mumps
15-24 days
What is the limit on number of months supply on CD scripts?
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
First line treatment for gout prophylaxis
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
Methadone patient drops their dose outside the pharmacy and requests another to replace it. Best course of action?
Advise patient that they must obtain another Rx from their prescriber (it is a Sch 2 drug)
Which hot drinks should a patient taking warfarin avoid?
Green tea- anything containing vitamin K
Most common organism causing vaginal thrush
Candida albicans
Which antipsychotic at high doses requires protection of the skin from UV light?
Promazine
Does ear discharge require referral to GP
Yes, potential infectioin requiring antibiotic ear drops
Recommended cream to prevent itching for 6 year old patient with scabies
Crotamiton cream 10% (Eurax)
Which direct-acting oral anticoagulant should be taken with food?
Rivaroxaban
Due to lack of efficacy on an empty stomach
Signs of digoxin toxicity
- Nausea
- Anorexia
- Diarrhoea
- Visual disturbances- yellow haze or blurred vision
- Arrhythmias
- General malaise
What age is hydrocortisone 1% licensed from?
10 years
What does the Latin p.c. mean on a script?
To be taken after food
Which Parkinson’s medication is associated with impulse control side effects e.g. gambling, binge eating, obsessive shopping etc)
Dopamine-receptor agonists e.g. ropinirole
Signs of theophylline toxicity
- Vomiting
- Agitation
- Restlessness
- Dilated pupils
- Sinus tachycardia
- Hyperglycaemia
Treatment for girl presenting with several red lumps and patches (1-5cm) on lower legs
The lumps are characteristic of erythema nodosum
Treatment: rest and ibuprofen
Treatment for scalp fungal infection (tinea capitis)
Griseofulvin
Treatment for uncomplicated hyperpigmented patches on trunk and back
Ketoconazole shampoo
Can digocin therapy cause hypokalaemia or hyperkalaemia?
HYPOkalaemia
Common treatment of hypertension during pregnancy
Methyldopa
MoA of metformin
Decreases gluconeogenesis by increasing peripheral utilisation of glucose
MoA of acarbose?
Delays the digestion and absorption of starch and sucrose
Drug class of saxagliptin
DDP-4 inhibitor
What Sch. controlled drug is temazepam?
Sch 3
Common neuro SE of baclofen
Hallucinations
What sch. controlled drug is buprenorphine
Sch 3
Which prescriber can not request emergency supply of a POM medicine?
Veterinarians
Mechanism of action of dabigatran etexilate
Dabigatran etexilate is direct thrombin inhibitor with a rapid onset of action
Treatment options of transient ischaemic attack when aspirin and dipyridamole are not tolerated
Clopidogrel
Counselling point for patient starting lamotrigine therapy
If patient develops severe skin reaction in the first 8 weeks, stop treatment immediately
Which drug is commonly prescribed at a dose of 1 gram STAT for uncomplicated genital chlamydial infections
Azithromycin
Medicine-induced colitis is a risk factor with use of this medication
Clindamycin
What is the MoA of cholestyramine
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
Does grapefruit juice interact with warfarin?
No
On which diabetes medication class do you need to be vigilant re diabetic ketoacidosis when withdrawing insulin?
GLP-1 agonists e.g. dulaglitide, semaglutide
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?
Threadworm
Is the warning: ‘Keep out of sight and reach of children’ a legal requirement on dispensing labels?
No, only advised by the RPS
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?
Glandular fever caused by Epstein-Barr virus
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?
HPV- Human papiloma virus vaccine
Which laxative is indicated for constipation in terminally ill patients?
Co-danthramer
What monitoring is required for enoxaparin?
Plasma-potassium concentration for hyperkalaemia
Is the midwife’s name and address needed on a midwife supply order?
No
What is the interaction between MOAI and other antidepressants?
Increased risk of serotonin syndrome
Other antidepressants should not be started for 2 weeks after treatment with an MOAI
Common causes of migraine with aura
- Hormonal changes
- Emotional triggers
- Fatigue
- Dietary triggers e.g. cheese, chocolate or alcohol
- Certain medications
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?
Fucidin H
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?
Sinusitis
Which tuberculosis treatment drugs can cause flatulence?
Ethambutol
In which conditions is pseudoephedrine cautioned
HTN and diabetes
How should private Rx for a sch 3 drug be processed?
Sent to the relevant NHS agency
How should a veterinary Rx/ requisition for Sch 3 CDs be processed
Retained for 5 years- no need to send to an NHS agency
How long should an invoice for Sch 3 CD be retained for, taking into account tax requirements
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
Which illness is characterised by white spots surrounded by a red ring on the inner cheek and gums?
Measles (morbilli)
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
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
Considerations for use of bendro in patients with lowered eGFR
Not effective in patients with eGFR lower than 30ml/min/1.73m2
Which high risk drug for arrhythmias is contraindicated in patients with thyroid dysfunction due to its ability to accentuate thyroid problems
Amiodarone
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
What is the initial recommended daily dose for patients taking metformin for polycystic ovary syndrome?
Can this then be increased?
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
What is the maximum daily dose of etodolac?
600mg
Which OTC topical prep is to be used wit caution in patients taking phenytoin?
Daktarin oral gel
Miconazole enhances the anticonvulsant effect of phenytoin (plasma conc. enhanced
Although with topical use, the risk is lower
What is the maximum duration of treatment which can be given via over the counter chloramphenicol?
5 days
Which side effect of clozapine should patients report due to the risk of fatality?
Constipation- clozapine has been associated with varying degrees of intestinal peristalsis
What is the target INR for patients taking warfarin with a mechanical prosthetic heart valve?
This depends on the type and location of the valve etc
What colour does urine turn for up to 48 hours after doxorubicin is used?
Red
Special circumstances surrounding isotretinoin Rx
- 7-day validity- should be dispensed on the same day
- Pregnancy test taken on day of issue
Patient comes in with mouth ulcers which have been present for 5 days and medical history includes nicorandil, action?
Refer to GP- nicorandil can cause serious skin, mucosal and eye ulceration; including gastro ulcers
H. Pylori regimen for patient allergic to penicillin
metronidazole 400 mg bd, clarithromycin 500 mg bd, lansoprazole 30 mg bd for 7 days
Which diabetic drug is contraindicated in history of heart failure?
Pioglitazone
Is the copper IUD more effective at pregnancy prevention compared to EHC?
Yes
Most appropriate treatment for malignant hypothermia as a result of anaesthesia
Dantrolene sodium
How many and which types of CPD must pharmacists submit annually
4 CPDs (at least 2 planned) , 1 peer review and 1 reflective account
Preferred 1st line antihypertensive in black African or African-Caribbean origin patients?
ARB rather than ACE e.g. candesartan
Directions for admin of bisphosphonates
- Take 30 mins before breakfast (or any other oral medication)
- Plenty of water
- Stand or sit upright for at least 30 mins after taking
Most appropriate route of admin for vincritine
IV
Diabetic drug to avoid in hisotry of hernia
Acarbose- inhibits carbohydrate digestion by competitively inhibiting alpha glucosidase enzyme in small intestine lumen, making hernias worse
Patient presents with this eye, no pain, changes to vision and no trauma to head. BP is well controlled
Action?
Suggest doing nothing; the blood shot appearance should resolve in one to two weeks
Which abnormal result could result in requiring a doxorubicin dose reduction?
Elevated bilirubin
Mesalazine interacts with which laxative
Lactulose- it lowers stool pH, which could precipitate a flare or worsen the condition
Which NSAIDs are associated with lower thrombotic and CVD risk?
Naproxen
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?
Supply mebendazole to the whole family, followed by a repeat dose after 14 days
Licenced age for sale of chloramphenicol eye drops
2+ years
What are hyoscine butylbromide/ hydrobormide indicated for?
BUTYL- abdominal cramps/ spasms and IBS-like symptoms
HYDRO- travel sickness
How long is a script for morphine sulfate soln valid for?
It is Sch 5, so 6 months
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
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
High levels of which vitamin should be avoided in pregnancy?
Vitamin A- present in fish liver oil etc
P value of what indicates statistic significance
Below 0.05
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?
Mirabegron
At which levels of HbA1c, fasting and random blood glucose is a diabetes diagnosis considered?
- 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
Is metformin effective in the absence of insulin?
No- only acts in the presence of endogenous insulin
Most likely drug interaction consequence of metformin and empagliflozin?
Hypoglycaemia
Which drug for urinary incontinence would be most suitable for patient with dementia and is frail i.e. lowest anticholinergic burden?
Mirabegron- acts on beta-3-adrenoceptors therefore minimal anticholinergic burden unlike antimuscarinics (high burden)
Why shouldn’t doxy be used in children
Dental hypoplasia- deposits in teeth and bones
Licenced age for Curanail 5% medicated lacquer?
18 years+
Why should metoclopramide, haloperidol and prochlorperazine not be used in Parkinson’s?
They cross the BBB and can act as a dopamine blockade, resulting in worsening of the condition
Recommended anti emetic used with apomorphine use
Domperidone- however QT prolongation still possible so assessment of cardiac risk factors and ECG monitoring still recommended
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
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
Which microorganism are UTIs usually caused by
Typically those found in the GI tract which have travelled to the urinary tract e.g. E. coli
1st line treatment for UTI
Nitrofurantoin 50mg QDS for 3 days
100mg QDS for 7 days for chronic recurrent UTIs
How long after initial dose should digoxin levels be checked for drug monitoring purposes
6-8 hours after dose
Which type of medical condition are generally contraindicated in combined oral contraceptive use?
Cardiac e.g. HTN
What is typical effective dosing for amitriptyline in severe depression
50mg OD or in divided doses
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?
Most ear infections clear up on their own within 72 hours, do nothing
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
Lansop 30mg OD- PPIs may increase likelihood of limited methotrexate clearance, increasing chances of toxicity
Example of medium intensity statin
Fluvastatin
Which treatment for oral thrush would interact wit warfarin
Miconazole- greatly increases anticoagulant effect of warfarin
Adrenaline dose requirements for anaphylaxis of a 6 month-6 y/o child, 6-12 years and 12 years + child respectively
150mcg IM- 6 month-6 years
300mcg IM- 6-12 years
500mcg IM- 12 years+
1st line antihypertensive for use in pregnancy
Labetalol- initially 100mg BD, increased to 200mg BD
Vitamin D supplement strength recommended for 6 month old baby
8.5-10 mcg vitamin D
Laxative licenced to treat opioid induced constipation
Naloxegol
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
Sexual dysfunction is a common SE of tamsulosin hydrochloride
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
DOAC should be offered e.g. rivaroxaban
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
LMWH are used, enoxaparin however is derived from porcine intestinal mucosa (she is vegan)
Fondaparinux is used as an alternative
Action to take when unable to dispense a medication from outside of the EEA
Refer to appropriate UK prescriber
Do not make emergency supply
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
Digoxin- visual disturbances and yellow visuals are tell-tale signs
Which endocrine condition is a common SE of amiodarone
Hypothyroidism
1st line treatment for impetigo
Topical fusidic acid 2% cream
What term describes ‘asbetstos-like’ scales on the scalp?
Pityriasis amiantacea
Which form of NRT would be most suitable for a pregnant mother suffering from pregnancy-related N&V
Nicotine patch
What class of drug is Phenelzine
A monoamine-oxidase inhibitor (MOAI)
Which corticosteroid is indicated for treatment of postural hypotension
Fludrocortisone
Which antibiotic’s absorption is impacted by dairy and should not be consumed in large amounts concurrently
Ciprofloxacin
Dairy consumption should be restricted to 1-2 hours before tkaing this medication
The use of higher doses in which antipsychotic drug can cause photosensitisation, and sunlight shoould be avoided in its high dose use
Chlorpromazine
Symptoms suggestive of coeliac disease
- Recurrant abdominal pain
- Loose and pale stools
- Poor growth
What is hydroxyzine indicated for?
Pruritus- itch
What are the active ingredients in Atripla, and what is it indicated for?
Efavirenz, emitricitabine & tenofovir disoproxil fumurate
Indicated as single tablet regimen of a triple therapy for HIV
How long can the RP be absent from the pharmacy for a given 24 hour period?
2 hours
Which skin condition classically affects lower extremeties
Discoid eczema
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?
Refer to dentist for ulcer lasting >2 weeks to rule out oral cancer
Which type of fruit juice is most likely to interact with warfarin and induce a bleeding event
Cranberry juice
Above which BP are oral contraceptive pills required to be stopped?
Systolic 160 mmHg
OR
Diastolic 100 mmHg
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?
This is a normal SE of metformin- slow increases in dose can improve tolerability
or a formulation change can be considered
What is NOT required on a midwife supply order
Address of the midwife
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?
Co-trimaxazole
What does the latin abbreviation a.c. mean on an Rx?
Before food
First line treatment for treatment of osteoporosis in mean at high risk of fractures?
Risedronate 35mg once weekly
Which medications are known for interacting with sumatriptan?
Antidepressants and Tramadol
Increases the risk of Serotonin Syndrome
Asthmatic patient with gout requires pain relief for a flare up. Most suitable option?
Paracetamol- NSAIDs are known to precipitate bronchospasm in asthmatics
Which classes of drugs are known to cause dyspepsia?
- CCBs
- Nitrates
- Theophylline
- Bisphosphonates
- Corticosteroids
- NSAIDs
Which Sch of CDs are growth hormones part of?
Sch 4 Part 2
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?
Thyrotoxicosis
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?
Coeliac disease
Steatorrhoea (fat in stools) due to malabsorption of fats
Which antibiotic is associated with severe optic neuropathy and should be monitored closely if using for more then 28 days?
Linezolid
This antibiotic is cautioned when used by inhalation in those suffering with haemoptysis
Aztreonam
With with other group of medications is sumatriptans similar to and should be avoided in their allergy
Sulfonamides- sumatriptan contains a sulfonamide group and should be avoided in intolerance to sulfonamides
This medication is used to terminate pregnancy following mifepristone administration
Misoprostol
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
Oxytocin
Which oral side effect is common in ciclosporin use?
Gingival hyperplasia (swollen gums)
Can private Rx be repeated when ‘repeat x3 etc’ is stated on the script?
Yes- private scripts can be repeated on any form
Can standard NHS Rx with instructions to ‘repeat x2 etc’ be repeat dispensed?
No- Specific forms must be used in England AND Wales
What Sch of CDs is clenbuterol in?
Sch 4 Part 2
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?
Breastfeeding is safe when using Pen V
Are faxed CD requisitions acceptable?
No
What are the recommended check points to avoid errors in prescribing?
- Right patient
- Right medicine
- Right dose
- Right route
- Right time
Which laxative can cause urine to turn red
Co-danthramer
Common SE of phenindione
Can colour urine pink/orange
What Sch of CD is methadone
Sch 2
How long must vet Rx be retained for
5 years
The invoice for Sativex® is recommended by NICE to be retained for this length of years for the purpose of HM Revenue and Custom
6 years
The number of times a private prescription for an oral contraceptive may be repeated
No mention of repeat usually means can be repeated once
Oral contraceptives can be repeated 5 times
Which antibiotics can cause choleastatic jaundice, and may occur up to 8 weeks after treatment
Flucloxacillin
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’?
Systemic chloramphenicol
Topical is safe to use in pregnancy
Secondary complications of diabetes
- CVD
- Diabetic neuropathy
- Neuropathy
Appropriate treatment for daytime sleepiness in Parksinson’s patients
Modanifil
What complication can beta 2 agonists cause in diabetic patients
Ketoacidosis- especially in IV salbutamol use
What can chlorpromazine cause if handled inappropriately
Contact sensitisation
Tendon damage, and even rupture, can occur within 48 hours of taking which medications
Quinolones e.g. ciprifloxacin
For which medications should oral health be reviewed before initiating treatment
Bisphosphonates
Can cause osteonecrosis of the jaw
Which medications can induce convulsions in patients with or without a history of convulsions
Quinolones e.g. ciprofloxacin
With which medication does bee venom extract interact with which can cause a severe anaphylactoid reaction
ACE inhibitors
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?
Vitamin B6
Wernicke’s encephalopathy secondary to chronic alcoholism is treated in the long term with the oral administration of this
Vitamin B1 (Thiamine)
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?
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
What is the result of the interaction between baclofen and ACE inhibitors/beta blockers
Increased hypotensive effect
What should patients watch for when first starting treatment with bromocriptine
What class of drug is this
Patients may experience low BP- talk extra care to avoid falls
It is a dopamine receptor agonist
How long until a DMARD patient is likely to see results form treatment
Typically a slow onset of action and can take 2-3 months to take effect
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?
Advise to use expressed milk only while she and the baby are undergoing treatment to prevent re-infection
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?
- Ampicilin
- Clindamycin
- Fluoroquinolones e.g. ciprofloxacin
- Cephalosporins
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?
Zolendronic acid has shown toxicity in animal studies and should be avoided in woman of child-bearing potential
What are the side-effects of glucocorticoid use?
Glucocorticoid side-effects include diabetes, osteoporosis and muscle wasting
What are the side-effects of mineralcorticoid use?
- Calcium loss
- Hypertension
- Potassium loss
- Water retention
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?
- Clarithromycin
- Doxycycline
- Aithromycin
- Erythromycin
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?
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
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?
Unilateral headache associated with sickness in women is highly suggestive of migraine
When should bisphosphonates be avoided
- Abnormalities of oesophagus
- Hypocalcaemia
- Other factors delaying emptying
- IF CrCl is below 35 ml/min
What is the other common name for slapped cheek disease
Erythema infectiosum
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
Betamethasone valerate/clioqionol cream
Step 1 HTN treatment in patients over 55
Calcium channel blocker
A person whose spleen was removed following a road traffic accident is seeing their general practitioner.
Which vaccine is indicated for this patient?
Pneumococcal vaccine
If they have had a splenectomy then they are at an increased risk of pneumococcal infection
Which of the electrolytes is most likely to have an adverse effect on serum lithium levels?
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
What drug class is penicillamine and what do patients need counselling on before initiating treatment?
DMARD
Watch for symptoms of blood disorders e.g. sore throat, fever, infection, unexplained bleeding and bruising, purpura, mouth ulcers or rashes
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
Rifampicin
Which CD Sch Rx is valid for up to 6 months
Sch 5
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?
Measles
What CD Sch is keatmine
Sch 2
When is the effect of thiazide-like diuretics readicated
In renal impairment- eGFR <30 ml/min
Which antibiotics are used to treat C. diff
- Vancomycin
- Fidoximicin
What Sch CD drug is pethidine
Sch 2
Licenced age at which xylometazoline can be used
> 6 years old
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
Cranberry juice- it’s an enzyme inhibitor, therefore increasing anticoagulant effect
Green tea and spinach etc contian vitamin K, so would reduce anticoagulant effect
Where is herpes labialis found?
Oral region
When should canestan soft gel pessaries be used, and how often?
Once at night
What is the glucose level indicating HYPOglycaemia
Below 3.9 mmol/L
What colour can co-danthramer colour patients urine
Pink
Result of digoxin and quinine interaction
Nausea and vomiting
Plasma conc. of digoxin increased by quinine
Result of interaction between pimozide and ketoconazole
Vetricular arrhythmias
Ketoconazole predicetd to increase exposure to pimozide
What is ethosuximide indicated for
Treatment of absence seizures, atypical absence seizures (adjunct) and myoclonic seizures
Counselling point necessary for rotigotine
May affect ability to drive and operate heavy machinery due to potential sudden onset of sleep
Result of interaction between statin and daptomycin
Increased risk of rhabdomyolysis
Which organism commonly causes impetigo
Staphylococcus aureus
What is a female specific side effect of spironolactone use
Menstrual disturbances, such as post-menopausal bleeding
Can ACE inhibitors affect patient’s sleep
Yes
Drugs prescribed for INITIAL treatment phase for TB
Ethambutol, isoniazid, pyrazinamide and rifampicin
Drugs prescribed for continuation phase for TB
Isoniazid and rifampicin, pyridoxine hydrochloride
How long after ceasing mycophenolate therapy should male patients continue to use contraception for
90 days
How long after ceasing mycophenolate therapy should female patients continue to use contraception for
6 weeks
Result of interaction between amiodarone and simvastatin
Increased risk of myopathy (muscle weakness/tenderness)
Result of interaction between warfarin and fluconazole
Anticoagulant effect increased with fluconazole
Result of theophylline and disulfiram interaction
Metabolism of theophylline inhibited by disulfiram therefore and increased risk of theophylline toxicity
Patients of Chinese ancestry have a greater chance of developing Stevens-Johnson Syndrome while taking this medication
Phenytoin
Patients starting this medication should be carefully clinically evaluated and given chest x-rays beforehand
Amiodarone
Associated with serious and sometimes fatal lung toxicity
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
Hyperaesthesia
Result of interaction between warfarin and cimetidine
Increased coagulant effect of warfarin
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?
Midazolam buccally
Why should metformin be held in acute AKI
Increased risk of lactic acidosis in AKI patients
MHRA alert related to pioglitazone
Increased risk of heart failure
MHRA alert related to empagliflozin
Increased risk of diabetic ketoacidosis
Antidepressant also indicated for stress urinary incontinence
Duloxetine
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
Benzydamine hydrochloride- Difflam spray
Patients starting this medication must have regular eye checks because its associated with visual field defects
Vigabatrin
In which patient group is temporal arteritis typically seen
Elderly women
Condition associated with a blocked or runny nostril and excruciating attacks of pain one side of the head
Cluster headache
Patient experiencing a dull, overall headache for over a week but can also be characterised by a sudden severe headache. Condition?
Sub-arachnoid haemorrhage
Mrs D, a 58-year-old nurse, is reporting cold hands and feet following the addition of a new drug
Most likely a beta blocker- they can cause coldness of extremities
Result of interaction between atenolol and verapamil
Increased risk of bradycardia. Its a severe interaction
Common endocrine SE of thiazide-like diuretics
Hyperglycaemia
This antibiotic is commonly used in infections where anaerobic bacteria are the suspected cause and it is commonly used in acute pericoronitis
Metronidazole- has a wide spectrum, including targeting anaerobic bacteria
Which antipsychotics at high doses can cause photosensitivity
All of them
Special care is required when handling this antipsychotic. The tablets should not be crushed and solutions should be handled with care
Chlorpromazine
Contraception advice for female patients taking mycophenolate
Use 2 types of contraception during treatment
Which anticoagulant medication required a dose reduction if used contaminant with verapamil
Dabigatran
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?
Verruca
At what kind of dose should a patient be considered for reducing steroid regimen?
Those receiving more than 40mg daily for more than 1 week
Which antibiotics should be used in caution in patients with a history of epilepsy
Quinolones e.g. ciprofloxacin
May induce convulsions in patients with or without a history of convulsions
What is the medical term defined as shortness of breath on lying down?
Othopnea
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
Dry eyes- not listed as an SE for amitript
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?
Amoxicillin
Patient comes to pharmacy displaying signs of anaphylaxis, what is the FIRST appropriate step
Call 999, request an ambulance and state anaphylaxis
THEN administer the EpiPen
Differences between xylometazoline nasal drops and spray in terms of licensing and duration of use OTC
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+
With which other class of drug can convulsions be induced in patients with or without a history of them
NSAIDs
Can emergency supply be made at the request of an EEA or Swiss patient
Yes
Common SE of entacapone
Colours urine reddish-brown
