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Past paper questions Flashcards

1
Q

Pregnant lady with a UTI (12/40 weeks gestation), which is most appropriate?Amoxicillin
Cefalexin
Clindamycin
Erythromycin
Flucloxacillin

A

Cefalexin

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2
Q

Which one of the following has been associated with convulsions in cases of overdosage?
Morphine
Pethidine
Methadone
Fentanyl
Codeine

A

Pethidine

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3
Q

Mrs T normally takes carbamazepine, which of the following should she urgently report?
Diarrhoea
Drowsiness
Hirsutism
Hyponatraemia
Nausea
Neural tube defects
Unexplained bruising or bleeding

A

Unexplained bruising or bleeding

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4
Q

Dose of paracetamol for immunisations?

A

2.5ml qds (2.5ml = 60mg)

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5
Q

Can methotrexate cause a miscarriage?

A

May harm unborn baby but unlikely to cause a miscarriage.

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6
Q

Which of these are/is ACh inhibitor(s):
Galantamine
Memantine
Rivastigmine
Donepezil

A

Memantine: NMDA antagonists with a neuroprotective effect.
Donepezil: ACh inhibitor
Galantamine: ACh inhibitor
Rivastigmine: Licensed as a twice daily dose for mild to moderate dementia associated with Parkinsons disease.

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7
Q

Which of the following should be added to existing treatment of amlodipine in a 56 year old African patient?
Atenolol
Bendroflumethiazide
Indapamide
Ramipril
Valsartan

A

Valsartan

ARBs are preffered second line after a CCB in treating a 56-year old, African patient.

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8
Q

An antihistamine and serotonin antagonist indicated in the prophylaxis of migraines

A

Pizotfen

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9
Q

Which of the following does NOT need to be excluded before starting treatment for osteoporosis?Hyperparathyroidism
Hyperthyroidism
Hypothryroidism
Osteomalacia

A

Hypo does not cause osteoporosis

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10
Q

Scurvy is a deficiency of?

A

Vit C

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11
Q

Buccastem M is only licensed for what?

A

Nausea and vomiting in previously diagnosed migraine, in adults aged 18 and over.

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12
Q

Which of the following is LEAST appropriate in renal failure?Chlorphenamine
Fybogel
Omeprazole
Paracetamol
Senna

A

Bulk-forming laxatives such as fybogel are best avoided in patients with renal impairment as they require high volumes of fluid intake to work. There is also the risk of dehydration with laxatives. Senna tablets/liquid are more suitable in patients with renal impairment.

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13
Q

When should sodium valproate be used in absence seizures?

A

When there is a high risk of GTC seizures.

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14
Q

Itching down below, female, lot of discharge which is frothy-smelling and is yellow-green in colour.
Bacterial vaginosis
Trichomoniasis Vaginalis
Candida albicans
Cervical polyps
Toxic shock syndrome

A

Trichomoniasis Vaginalis

BV: thin, white fishy-smelling discharge.
Cadida albicans: white, cottage-cheese like TV: frothy, yellow-green smelly

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15
Q

Can pregnant women use gaviscon or peptac?

A

Yes. Following the lifestyle and dietary advice, an alginate preparation is advisable.

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16
Q

Has both opiod agonist and antagonist properties. Sublingually, it is an effective analgesic for 6-8 hours. Its effects are only partially reversed by naloxone hydrochloride.

A

Buprenoprhine

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17
Q

Is loperamide ok in renal failure?

A

Yes

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18
Q

Which of the following best describes a mandatory activity that must be completed by pharmacy contractors on an annual basis as part of clinical governance?
Clinical governance toolkit
Clinical audits
Unpublished patient survey
Reaccreditation of services
Registering of premises

A

Two clinical audits must be completed each year under clinical governance.
Survery results must be published.
Registering of pharmacy premises happens every year but does not form part of clinical governance.

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19
Q

Carbamazepine and SSRs (and other antidepressants) can both cause what electrolyte imbalance?

A

Hyponatraemia.

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20
Q

Piroxicam topical treatment should be reviewed after how long?

A

4 weeks

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21
Q

Gliclazide has a black dot interaction due to enhanced hypoglycaemic effect when taken with what drug?

A

Warfarin

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22
Q

Which of the following does NOT cause hyponatraemia?
Glimepiride
Gliclazide
Glipizide

A

Gliclazide does not cause hyponatraemia.

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23
Q

Allopurinol is associated with what syndrome?

A

Steven-Johnsons Syndrome

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24
Q

Noriday (norethisterone) is defined as being late when?

A

more than 3 hours late, all progestogen only are the same except for desogestrel which is 12 hours.

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25
Q

Recently prepared means

A

within 4 weeks

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26
Q

Analgesic with both an opiod effect and enhances the serotonergic and adrenergic pathways

A

Tramadol

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27
Q

What is used to treat patent ductus arteriosus other than surgery?

A

Prostaglandin inhibitors –> NSAIDs –> Indomethacin or ibuprofen

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28
Q

AED and can be given once daily due to long-half life:
Topiramate
Carbamazepine
Phenobarbital
Levetirecatam

A

Phenobarbital

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29
Q

Patient started on this drug needs to take extra precautions and to protect their skin from sunlight:
Indapamide
Lithium carbonate
Pizotifen
Promazine
Ramipril

A

Promazine makes the skin more susceptible to the UV rays from the sun.As such, a patient on Promazine therapy is more susceptible to burning/sun burn and must take precautions in sunlight.

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30
Q

Should statins be discontinued if there is an increase in the blood-glucose concentration or HbA1c?

A

BNF 2.12 states that statins should not be discontinued if there is an increase in the blood-glucose concentration. NICE guidance following an MI states to use a high propensity statin (such as atorvastatin) initially with a view to switching over to a more cost-effective alternative such as simvastatin after a set period of time.

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31
Q

Insulin glargine: Insulin glulisine:

A

Glarg: longGlu: fast

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32
Q

Phenoxymethylpenicillin, with or without food?

A

Take phenoxymethylpenicillin when stomach is empty, this means an hour before or two hours after food.

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33
Q

Why would metformin need to be stopped in a patient undergoing examination using an iodine-containg contrast agent?

A

Due to the risk of renal failure.

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34
Q

Mr C, who is 62 years old, has been seen by the GP as he is currently suffering from persistent breathlessness due to his COPD. His is already prescribed a salbutamol inhaler which is not controlling his symptoms. He has a FEV 1 60%. Which of the following is the ONE most appropriate treatment option?
SAMA
LAMA
LABA+ICS combo
LAMA + LABA + ICS
Domicilliary oxygen

A

At this stage the options are either LABA or LAMA alone, as LAMA alone is only option presented this is the correct choice.

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35
Q

Chloramphenicol can cause gray baby syndrome if excessive doses are used in neonates with immature hepatic metabolism. How does this present?

A

Abdominal distension
Pallid cyanosis (grey)
Circulatory collapse

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36
Q

Amiodarone, azola antifungals and macrolides have what effect on simvastatin?

A

increase its levels

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37
Q

What are the long-term PPI use risks? (4)

A
  1. C.diff
  2. Fractures (osteoporosis)
  3. Hypomagnesia
  4. CAP
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38
Q

Cetrizine is only licensed for use in what ages?

A

> 2 for liquid.

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39
Q

MOAi are cautioned for use in cardiovascular disease. True or False?

A

True.

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40
Q

Terbinafine is associated with what skin disorder?

A

Toxic epidermal necrosis/SJS

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41
Q

Can aspirin be used for prevention of cardiovascular events in someone with COPD who has previously had a CV event?

A

Yes

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42
Q

The following are symptoms of what?
Rash, Blood in stools, Itchy skin, Jaundice

A

Hepatotoxicity

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43
Q

What topical NSAID is associated with more frequent serious skin reactions?

A

Piroxicam

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44
Q

Calcium polystyrene resin treats

A

Hyperkalaemia.

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45
Q

Long-term use of which one of the following laxatives can lead to a weakened bowel?Senna
Lactulose
Docusate
Ispaghula husk

A

Senna is a stimulant laxative that can cause weakening of the bowel if used for prolonged periods.

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46
Q

Clinical outcomes include what?

A

Length of hospital stay. Adverse drug reactions.
Hospital
readmission
Death

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47
Q

Infants have what pH gastric contents?

A

High pH

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48
Q

Patient with AKI, LEAST appropriate advice RE pain relief is:
The patient should only be given oral paracetamol up to three times a day
The patient should be monitored for signs indicative of coma.
Codeine must be avoided due to an increased risk of serious adverse reactions
The patient may have increased sensitivity to central nervous system side effects
Dihydrocodeine is the drug of choice and may be used at normal dosing irrespective of renal function

A

The advice regarding dihydrocodeine is the least appropriate as it is not the opioid of choice and care must be taken in renally impaired patients who require opioids.

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49
Q

Which heparins have a lower risk of heparin induced thrombocytopenia?

A

LMWH lower than ufh

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50
Q

What impact does severe renal impairment have on the plasma serum concentrations of highly protein bound drugs?

A

Severe renal impairment: protein leaks out of the kidneys and leaves the body in the urine, as a result there are less circulating proteins in the serum for these highly protein bound drugs to bind to and thus their active levels increase

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51
Q

15 yr old type 1 diabetic using insulin glargine once daily and novorapid prn. Has a script for Co-amoxiclav. Which of the following is most appropriate advice?
Do not make any adjustments to your regular blood glucose monitoring. Increase your blood glucose monitoing as well as your insulin dosing.
As you are not eating, you will not require you regulr insulin doses.
Inject your insulin intravenously whilst ill as this will give a rapid response
Monitor yourself for hypoglycaemia and reduce your regular insulin dosing.

A

During periods of illness, diabetics are more likely to encounter diabetic acidosis therefore increased monitoring is required and insulin requirement may be increased.

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52
Q

How is hand foot and mouth treated?

A

PLenty of fluids to avoid dehydration
Soft foods
Paracetamol or ibuprofen

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53
Q

Perindopril should be taken with or without food?

A

Perindopril should be taken on an empty stomach, preferabbly 60mins before eating.

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54
Q

Target INR for DVT prophylaxis

A

3.5

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55
Q

A newborn baby at 8 weeks is given a vaccine via the oral route. Which ONE of the following vaccines did the child receive?
Bacillus Calmette-Guerin (BCG)
Diptheria, Tetanus, and Pertusis (DTaP)
Hep B vaccine
Human papillomavirus (HPV)
Rotavirus vaccine

A

The rotavirus protects against rotavirus infection, a common cause of childhod diarrhoea and sickness. It is given at 8 and 12 weeks of age. Rotavirus liquid vaccines are given by mouth (orally) to young infants.

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56
Q

A 49 year old man is brought into A & E with nausea, vomiting, muscle twitching and tremor. He is very unsteady on his feet and seems unable to co-ordinate hismovements. He appears to be dehydrated and says that he has managed to keeptaking all of his medications even though he has not been eating and drinking
Ciclosporin
Digoxin
Gentamicin
Lithium
Methotrexate
Phenytoin
Sodium valproate
Theophylline

A

Lithium toxicity - acute poisoning - nausea, vomiting, cramping and sometimes diarrhoea. Progession of acute toxicity can involve neuromuscualr signs such as tremulousness, dystonia hyperreflexia, ataxia and cardiac dysrhythmias.

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57
Q

Which of the following best describes the mechanism of action of amlodipine in reducing blood pressure?It exerts a positive inotropic effect which decreases myocardial stress and reduces blood pressure.It inhibits the movement of potassium ions into vascular and myocardial smooth muscle cells.It reduces myocardial contractility thus reducing electrical contractility and blood pressure. It exerts a negative inotropic effect by inhibiting calcium in myocardial tissue which leads to vasodilation.It blocks myocardial beta-adrenoceptors having a potent vasodilator effect which reduces blood pressure.

A

CCBs work by exerting a negative inotropic effect as well as inhibiting calcium in myocardial tissue, which leads to vasodilation and reduced blood pressure.

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58
Q

Indicated for the short-term relief (two to four weeks only) of anxiety that is severe, disabling, or causing the patient unacceptable distress:
Lorazepam
Temazapem

A

Lorazepam

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59
Q

Why should chlorphenamine be used with caution or not at all in patients with decreased liver function?

A

Increased risk of drowsiness as chlorphenamine hepatic metab, risk of coma

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60
Q

Out of the following which is the least emetogenic treatment:
Cisplatin
Doxorubicin
Mitoxantione (anthracycline derivative)
Vincristine
Cyclophosphamide

A

Vincristine least emetogenic out of those

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61
Q

p.c. means what?

A

After food

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62
Q

Drug use at all is not recommended during what stage of pregnancy?

A

First trimester

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63
Q

What is an alternative to flucloxacillin for cellulitis in pen-allergic?

A

Clarithromycin

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64
Q

Which of the following conditions is associated with a rash which is not itchy?
Ringworm
Impetigo
Dermatitis herpetiformis
Nappy Rash
Lyme disease

A

Lyme disease is caused by a bacterial infection from tick bites. An early symptom of this condition is a characteristic “bulls eye” rash at the site of the bite. Not itchy.

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65
Q

Mrs Q goes to her doctor reporting that she has been feeling sick, lethargic and quite confused. At night, she says that she has been seeing strange halos around the lightsat home.

Ciclosporin
Digoxin
Gentamicin
Lithium
Methotrexate
Phenytoin
Sodium valproate
Theophylline

A

Digoxin:

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66
Q

What is the interaction between co-amoxiclav and simvastatin?

A

Clavulanic acid and simvastatin can increase the risk of hepatotoxicty.

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67
Q

Amiodarone has a black dot interaction with which (if any) of the following:
Grapefruit juice
Amitriptyline
Simvastatin

A

Amiodarone interacts with grapefruit juice but just avoid the juice.
Amiodarone interacts with amitriptyline as increased risk of ventricular arrhythmias.
Amiodarone and simvastatin (max 20mg) both increase each others plasma concentration and both can cause myopathy. (NB: amiodarone and amitriptyline react with parenteral erythromycin only)

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68
Q

Which of the following causes HYPOcalcaemia?
Bendro
Furosemide

A

Bendro causes: Hyper - glycaemia, hypnatraemia, hypokalaemia, hypercalcaemia.Hypomagnesia

Loops cause hypocalcaemia

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69
Q

What is the target INR for recurrent thromboembolism?

A

3.5

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70
Q

Which of the folllowing is LEAST appropriate in renal failure?
Panadol
Gaviscon Liquid
Gaviscon Tablets
Remegel Tablets
Gaviscon Advance

A

Paracetamol (Hedex ®, Panadol ® ) is safe and suitable to treat headaches.

For occasional treatment of indigestion a product such as Gaviscon ® Liquid or tablets can be taken. Gaviscon ®Advance should not be used as it contains potassium which may be restricted in renal disease. Remegel ® tablets which contain calcium carbonate can also be taken occasionally provided levels of calcium in the blood are not raised above normal.

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71
Q

When can pertusis immunity be transferred to the child from a pregnanct mum?

A

If she is immunised between 28-32 weeks of pregnancy.

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72
Q

Which of the following medicines may affect a patients regular warfarin?
Ethambutol
Isoniazid
Omeprazole
Pyrazinamide
Rifampicin

A

Rifampicin is a potent enzyme inducer and therefore will increase the metabolism of particular drugs. In this case it is rifampacin with warfin.

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73
Q

Unilateral pain within and above the eye in the temporal region which lasts for two hours and occurs three times a day is:
Chronic daily headache
Cluster headache
Medication-overuse headache
Migraine
Tension-type headache

A

Cluster headache.

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74
Q

Which of the following carries the lowest risk of cardiovascular side-effects when used in standard doses?
Diclofenac
Ibuprofen
Indomethacin
Naproxen
Piroxicam

A

High-dose naproxen is associated with less vascular risk than other NSAIDs.

High-dose diclofenac and possibly ibuprogen, are comparable to coxibs, whereas high-dose naproxen is associated with less vascular risk than other NSAIDs.

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75
Q

Which of the following is the most appropriate treatment for pernicious anaemia?
Cyanacobalamin
Epoetin alfa
Ferrous sulfate
Folic acid
Hydroxocobalamin

A

The drug of choice is hydroxocobalamin, as cyanocobalamin is poorly absorbed.

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76
Q

Which one of the following medicines carries the lowest risk of gastro-intestinal side-effects when used in standard doses?
Diclofenac
Ibuprofen
Indomethacin
Naproxen
Piroxicam

A

Ibuprofen

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77
Q

Are madopar dispersible equivalent to madopar capsules of same strength?

A

Yes

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78
Q

What are the more water soluble beta blockers?

A

Least likely to cross BBB:
Atenolol
Celiprolol
Nadilol
Sotalol

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79
Q

Which of the following has the broadest spectrum of activity?
Amoxicillin
Ciprofloxacin
Clarithromycin
Co-amoxiclav
Doxycyline

A

Co-amoxiclav consists of amoxicillin and clav acid which is a beta-lactamase inhibitor.

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80
Q

Can people with high Blood pressure use guaifenesin?

A

Yes

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81
Q

Which of the following is associated with the greatest risk of gastro-intestinal side effects?
Aspirin
Naproxen
Diclofenac
Ketoprofen

A

out of those: Ketoprofen is associated with the greatest risk of gastro-intestinal side effects

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82
Q

How should cradle cap be managed?

A

Brushing, soaking etc.

83
Q

The use or oral prednisolone and ciprofloxacin increases the risk of what?

A

Tendon rupture

84
Q

Seretide is what?

A

LABA (Salmeterol) + Fluticasone (ICS)

85
Q

Freshly prepared means

A

within 24 hours

86
Q

Which of the following is recommended for patients visiting Mecca?
BCG vaccineHepatitis B vaccine Influenza vaccineMeningococcal B vaccineMeningococcal quadrivalent ACWY Pneumococcal conjugate vaccineRotavirus Tetanus

A

Meningitis ACWY immunisation is recomended for patients visiting Mecca.

87
Q

Otomize ear spray is usually given as what dosing?

A

Three times daily

88
Q

Which of the following symptoms is most likely to be associated with acute sinusitis?Dull, diffuse bilateral pain that often eases on bending downDull, diffuse bilateral pain that is often worse on bending downDull, localised unilateral pain that often eases on bending downDull, localised unilateral pain the is often worse on bending downSharp, localised bilateral pain that often eases on bending down

A

Dull, localised unilateral pain the is often worse on bending down

89
Q

Mr LK, 54 years old is suffering from congestion for the past 4 days, he tells you his nose is blocked. He currently takes a nasal spray recommended by his GP for hay fever. He also stopped taking phenelzine one week ago. He finally mentions he has tried steam inhalation.What type of OTC product would be most unsuitable?

A

Pseudoephedrine would not be appropriate - there is a risk of hypotensive crisis when pseudoephedrine is given with MAOIs - avoid psuedoephedrine for at least two weeks after stopping MAOI.

90
Q

SL GTN typically provides relief for:2-5mins10-15mins20-30mins60-80mins

A

20-30mins

91
Q

Which one of the following is indicated in phenytoin toxicity?Nystagmus is a late complication Alopecia is a complicationAgranulocytosisVitamin D metabolism abnormalities can occurIncrease in deep tendon reflexes are a manifestation of phenytoin toxicity.

A

Vit D metab abnormalities in phenytoin. Nystagmus happens early on.

92
Q

Which of these is most likely to have caused gout?Allopurinol Atorvastatin ClopidogrelIndapamideLisinopril

A

Indapamide

93
Q

What is the best monitoring parament for smoking cessation progress?

A

Carbon monoxide monitoring is useful in following up smoking cessation treatment compliance. It is worth noting that the lungs will contain some residual carbon monoxide from road pollution.

94
Q

Which of the following is most likely to have worsened a patients diabetic control?
Amlodipine
Atorvastatin
Citalopram
Olanzapine
Zopiclone

A

Olanzapine

95
Q

Daptomycin is a lipopeptide antibacterial that only treats what type of infection?

A

Gram Positive, skin and skin structure infections, only via IV, works by disrupting cell membrane function.

96
Q

Why do black patients respond better to diuretics?

A

Increased salt sensitivity and therefore renal vascualr resistance.

97
Q

If amiodarone is found to be causing hyperthyroidism, what should happen?

A

It should be withdrawn, at least temporarily to help achieve control.

98
Q

Best antidepressant in a patient with unstable angina, or a recent heart attack?

A

Sertraline

99
Q

Which of the following cannot be prescribed in instalments? BuprenorphineBuprenorphine/naloxoneChlordiazepoxideDiazepamMethadone

A

All Sch 2 plus diazepam can be prescribed by instalments.

100
Q

The use of the SCR in the pharmacy setting is linked to what payment scheme?

A

The quality payment scheme in the community setting.

101
Q

A patient brings in a rx for isosorbide mononitrate 20mg tablets, one to be taken three times each day. Which of the following is the most appropriate advice to give?He will need to return to his GP as isosorbide mononitrate is given twice daily. Development of tolerance is not associated with tablet formulations of isosorbide mononitrate
He needs to ensure he takes it regularly at 6 hourly intervalsHe is unlikely to experience any headache or flushing with this drug. He can chew on the tablets if a heart attack is suspected whilst somone calls an ambulance.

A

Needs to be taken so that there is at least an 8 hour nitrate free interval

102
Q

In stoma care, how should iron be supplemented?

A

Parenteral if oral not working, NOT MR forms.

103
Q

Which of the following can be used IV and acts by inhibiting sodium and potassium activated myocardial adenosine triphosphate?
Adenosine
Amiodarone
Amphotericin
Ciclosporin
Infliximab
Insulin
Phenytoin
Tacrolimus

A

Amiodarone works by inhibiting myocardial ATPase activity via sodium and potassium channel inactivation.

104
Q

Which of these is licensed as a twice daily dose for mild to moderate dementia associated with Parkinsons disease?
Galantamine
Memantine
Rivastigmine
Donepezil

A

Answer: Rivastigmine

Memantine: NMDA antagonists with a neuroprotective effect.
Donepezil: ACh inhibitor
Galantamine: ACh inhibitor

105
Q

When should someone seek advice if the symptoms of slapped cheek have not improved?

A

Within 7-10 days.

106
Q

Which LTRA can cause liver disorder?

A

Zarfirkulast

107
Q

Which of the following is the LEAST appropriate in renal failure?
Zantac (ranitidine)
Pepcid (famotidine)
Gaviscon Liquid
Tagamet (cimetidine)
Remegel tablets

A

Ranitidine (Zantac ®), famotidine (Pepcid ®, Boots Excess Acid Control ®) and nizatidine can also be purchased for short term relief of heartburn, particularly when the symptoms are related to consumption of food and drink.

Cimetidine (Tagamet ®) is also available to buy but can lead to a rise in the blood test for Creatinine, which will make it seem as if kidney function has got worse – so best avoided if there is an alternative.

108
Q

What electrolyte imbalances can lead to digoxin toxicity?

A

Hypokalaemia and hypomagnesaemia.

109
Q

Which AED carries with it an increased risk of cleft palate if taken in the first trimester?

A

Topiramate

110
Q

Trastuzumab (herceptin) has what side effects?

A
  1. Asthenia: abnormal physical weakness, lack of energy
  2. Peripheral neuropathy
111
Q

Which of the following is not a risk factor for GORD?
Smoking
Verapamil
Stress
Travelling abroad
Obesity

A

Risk factors for triggering GORD are:Drugs which lower oesophageal sphincter relaxation (e.g. calcium channel blockers).
Smoking
Alcohol
Obesity Stress

112
Q

A dopamine receptor antagonist which acts centrally by blocking the chemoreceptor trigger zone:
Promethazine
Prochlorperazine

A

Prochloperazine.

113
Q

Which of the following regarding indapamide is correct? A common side-effect is hypernatraemia It can be taken by breast feeding mothersIt is taken in the morning. The usual dose is 5mg daily There is no risk of cardiac toxicity if taken together with digoxin

A

A common side-effect of indapamide is HYPOnatraemia not HYPER.
It should not be used by breast feeding mothers.
It is taken first thing in the morning. The usual dose is 2.5mg daily.
There is a risk of cardiac toxicity if taken with digoxin due to hypokalaemia.

114
Q

Which of the following is most appropriate for endoscopy pre-med in extremely anxious person?Temazepam 10mg orally night beforeDiazepam 10mg orally 2 hours pre-opMidazolam 2.5mg SC, 5-10 mins pre-opLorazepam 3mg oral the night before the procedure

A

Midazolam is best option as need a short-acting agent with rapid onset of action

115
Q

The patient has been prescribed penicillin V for tonsillitis. She asks whether she will be okay to continue breastfeeding her 5 month old baby. What is the best advice for the patient?She should avoid feeding the baby for 45 minutes after taking the medicine when it is at peak concentrationShe should stop breastfeeding until after the course is completePen V is considered compatible for breastfeeding but the infant should be monitored. The patient should be referred to her health visitor The treatment is not compatible with breastfeeding and the patient should be referred back to her GP

A

Pen V is considered safe but baby should be monitored. Ceph too.

116
Q

Using an enema to deliver a medicine gives acces to the haemorrhoidal veins, what is the benefit of this?

A

Bypass first pass metabolism

117
Q

If a patient is taking phenytoin for epilepsy and develops blood or skin disorders, how should this be managed?

A

Withdraw the phenytoin.

118
Q

Which of the following is considered an active failure leading to a medication administration error?
Clinical negligence
Communication
Errors in execution
Safety culture
Team structure

A

Errors in execution such as slips and lapses are considered active failures in the medication error model. All other options are latent failures.

119
Q

All suspected adverse reactions in children should be reported to the MHRA even if the black triangle status has been removed.
True or False?

A

False.
In September 2014 the advice on which suspected adverse drug reactions (ADRs) to report in children was changed to be the same as adults. Originally, the MHRA requested yellow card reporting of all suspected ADRs in children but this is no longer necessary.

120
Q

Which of the following is LEAST appropriate for use in renal failure?
Zantac (ranitidine)
Pepcid (famotidine)
Oral Rehydration Sachets
Loperamide

A

Diarrhoea can result in fluid loss and upset fluid balance. Oral rehydration powder is sold for use in diarrhoea but since it contains both sodium and potassium it should be avoided in people with severe kidney disease except with medical advice. If the symptoms are mild, loperamide (Imodium ®) can be used to control them.

121
Q

Black patients have what level of circulating renin?

A

High

122
Q

Liver failure can be caused by:
Metformin
Acarbose
Insulin
Pioglitazone

A

The thiazolidinediones, like pioglitazone, have occasionally been associated with liver failure (Acarbose not after abdominal surgery)

123
Q

OTC tamsulosin should not be supplied and referral should be considered for symptoms of BPH of less than what length of time?

A

Symptoms <3 months.
Referral if any leaking of urine (incontinence) in the last 3 months as this may indicate chronic urinary retention.

124
Q

Which of the following describes the morbidity rate?
The number of deaths per thousand population per year, scaled to population size.
Refers to the incidence rate of disease within a population.
The presence of two concomitant disease states, or conditions, in a patient at the same time.
The ratio of the risk of disease, or death, among people who are exposed to the risk factor, to the risk among people who are unexposed.
The number of deaths per hundred thousand people per year, scaled to population size.

A

Morbidity: incidence rate of disease within a person, so morbidity rate: incidence rate of disease within a population.

125
Q

Which of the following is it most appropriate to counsel to be taken with or just after food?
Amiodarone
Metronidazole
Co-beneldopa

A

Metro and co-beneldopa

NB: neither co-beneldopa or co-careldopa have warning labels regarding drowsiness….

126
Q

Simvastatin max dose of 20mg when with which other medication?

A

Diltiazem
Amiodarone
Verapamil
Amlodipine

127
Q

The usual flixonase dosing for nasal polyps is

A

6 drops in each nostril daily. Flixonase nasaluse contain 12 drops per pouch.

128
Q

What is procyclidine used for?

A

The EPS of parkinsons and antipsychotics

129
Q

What type of vaccine is the varicella-zoster vaccine?

A

Live

130
Q

Ramiprial can cause which of the following?Bradycardia
Tachycardia

A

Tachycardia.

131
Q

Which of the following is NOT a clinically significant interaction?
Amiodarone + Grapefruit juice
Codeine phosphate + Grapefruit juice
Colchicine + grapefruit juice
Fexofenadine + grapefruit juice
Pravastatin + grapefuit juice

A

Rosuvastatin, fluvastatin and pravastatin can be safely taken with grapefruit juice.

132
Q

Hair falling out can be caused by what anticoagulant?

A

Warfarin

133
Q

Written consent is needed for the SCR, true or false?

A

There is a written form but consent can be verbal.

134
Q

Low sodium has what effect on lithium?

A

Toxicity

135
Q

Which of the following are stimulant laxatives?
Senna
Lactulose
Docusate
Arachic oil
Glycerol

A

Senna is a stimulant laxative which stimulates contractions of the gut.

Docusate sodium stimulates the gut and softens the stool.
Lactulose draws fluid from the blood and the fluid it is drunk with.
Arachis oil softens impacted stools
Glycerol causes peristalsis by irritating the area
Bulk-forming laxatives cause stimulation by increaseing faecal mass

136
Q

What is the best treatment option for theophylline overdose?

A

Activated charcoal

137
Q

Children with stoma are at particular risk of what electrolyte imbalance?

A

Hypokalaemia

138
Q

Can Pharmacy technicians access a patients SCR?

A

Yes

139
Q

When should the following be stopped prior to surgery?
Warfarin
Aspirin
Clopidogrel
Dabigatran
Apixaban/rivaroxaban/edoxaban

A

Warfarin: one week.
Aspirin: one week.
Clopidogrel: one week (irreversible platelet binding, platelets lives ~7days)
Dabigatran: Major and ok renal: 48h or Minor and ok renal: 24h
Apixaban/rivaroxaban/edoxaban: Major and any renal: 48h or Minor and ok renal: 24h

140
Q

Which of the following may cause hyperuricaemia?
Allopurinol
Febuxostat
Colchicine
Indapamide
Sulfinpyrazone

A

Indapamide can cause hyperuricaemia

141
Q

Indicated for conscious sedation for dental procedures 30-60 minutes before procedure:
Lorazepam
Temazepam

A

Temazepam

142
Q

What disturbances of calcium metabolism need to be corrected before starting zoledronic acid treatment?

A

Vitamin D deficiency
Hypocalcaemia

143
Q

Which one of the following drugs should be omitted in order to have the greatest reduction in risk of complications associated with the insertion of an epidural catheter?
Candersartan
Levothyroxine
Dabigatran
Gliclazide
Dalteparin

A

NOACs carry a risk of causing epidural haematoma (collection of blood in between skull and dura mater); no evidence of risk with LMWH.

144
Q

Which of the following is not a side effect of procyclidine?
Blurred vision
Constipation
Bradycardia
Dry mouth
Urinary retention

A

Procyclidine is an anticholinergic which can cause tachycardia not bradycardia

145
Q

What is the correct order of the following with regards to audit cycle?
Select criteria to review
Make improvements
Prepare for audit
Measure performance
Sustain improvements

A
  1. Prepare for audit
  2. Select criteria to review
  3. Measure performance level
  4. Make improvements5. Sustain improvements
146
Q

How should the normal H.pylori treatment be modified in a patient who is penicillin allergic, takes ciclosporin and clopidogrel?

A

Omeprazole and esomeprazole = NO with clopidogrel. Lansoprazole ok.

Penicillin allergic so NO amoxicillin: left with clarithromycin or metronidazole.

Ciclosporin and Clarithyromycin: NO. So has to be metronidazole.

147
Q

Which of the following medications would be suitable for a 24 year old male with an acute psychotic episode?
Paloperidone decanoate 50mg monthly
Olanzapine 10mg daily
Haloperidol 10mg qds
Clozapine 100mg tds
Flupenthixol decanoate 200mg every two weeks

A

Olanzapine: 2nd gen

148
Q

Can a child taking carbamazepine for epilepsy be treated with Ovex?

A

Yes

Ovex (mebendazole) is fine, it only interacts with cimetidine, increased mebendazole.

149
Q

Which is stronger?
Clobetasol butyrate vs Clobetasol propionate

A

Clobetasol propionate 0.1%

150
Q

Which is stronger?
Clobetasol vs clobetasone

A

Clobetasone butyrate 0.05% = moderate. Clobetasol propionate = very potent

151
Q

How long does it take for myelosuppresion to occur?

A

If you’re in chemotherapy, your blood cell counts will begin to decrease between 7 to 10 days after starting treatment. In mild cases of myelosuppression, treatment is not necessary. Blood count production will return to normal in a matter of weeks.

152
Q

IS the interaction between doxycycline and phenytoin clinically relevant?

A

No

153
Q

Drugs for respiratory depression in elderly care

A

Breathlessness at rest may be relieved by regular oral morphine in carefully titrated doses. Diazepam may be helpful for dyspnoea associated with anxiety. A corticosteroid, such as dexamethasone, may also be helpful if there is bronchospasm or partial obstruction.

154
Q

What is the Green book used for?

A

Immunisations, vaccines.

155
Q

What is the Orange Guide for?

A

Manfucaturing

156
Q

Apixaban dose for stroke prevention in AF

A

5mg BD or reduced to 2.5mg BD if over 80, <60kg or Creatine >133

157
Q

What does CHA2DSVASc stand for?

A

Coronary Heart Disease
Hypertension
Age >65 = 1
Diabetes Stroke or TIA =2
Vascular disease
Age >75 = 2Sex category, women = 1 point

158
Q

Apixaban dose for VTE prophylaxis following knee surgery

A

2.5mg BD 10-14 days

159
Q

What are the cardioselective beta blockers (NAMB)

A

Atenolol Bisoprolol Metoprolol Nebivolol

160
Q

What does HASBLED stand for?

A

HypertensionAbnormal liver or renalStrokeBleeding already lol or predisposedLabile INR (up then down then up then down etc)ElderlyDrugs alcohol etc

161
Q

Which beta blockers are worse in breastfeeding?

A

Water soluble beta blockers are present in breast milk in greater amounts that other BB

162
Q

Apixaban dose for the treatment of DVT/PE

A

10mg BD 7 days then 5mg BD

163
Q

When should SSRIs be taken? What about TCAs? What about Mirtazepine?

A

SSRI’s- take in the morning as they are mildly stimulating
TCA’s- take at night as can cause drowsiness
Mirtazapine (tetracyclic)- take at night as can cause drowsiness

164
Q

Which of the following medications is most likely to cause hypernatremia?
Beclometasone inhaler
Bisoprolol
Felodipine
Prednisolone
Salbutamol inhaler

A

Prednisolone

165
Q

Isosorbide mononitrate, 10mg twice a day counselling:Headache occurrence tends to decrease with continued therapyTablets should be discarded 8 weeks after opening the packetTablets should be stored in a glass containerDoses should be spread evenly throughtout the dayTablets may be dissolved under the tongue for faster relief of chest pain

A

Headache occurence will decrease, other stuff is for GTN tablets i think.

166
Q

Which of the following statements is false?phytomenadione is a lipid-soluble analogue of vitamin k
phytomenadione prevents the hepatic synthesis of active
prothrombinphytomenadione is indicated in babies at birth in order to prevent vitamink deficiency bleeding
vitamin k deficiency bleeding may manifest in intracranial bleeding
vitamin k deficiency may occur in neonates due to medications taken by the mother during pregnancy, for example: carbamazepine

A

Phytomenadione
Promotes the hepatic synthesis of active prothrombin, so encourages clotting preventing haemorrhage

167
Q

Pain in the eye, red and watery, photophobia, difficulty reading small print, no trauma:bacterial conjunctivitis Iritis Allergic conjuctivits Sub-conjunctival haemorrageviral conjunctivitis

A

Iritis

168
Q

You have been asked to conduct an audit about the administration of medicines on your hospital ward so that you can identify areas for improvement.
Which of the follow processes is least appropriate to complete as part of an audit cycle?

Analysing the administration of medicines Collecting data on the administration of medicines
Identifying standards for the administration of medicines
Investigating errors associated with the administration of medicines
Re-auditing the administration of medicines after a 12-month period

A

Investigating errors associated with the administration of medicines

169
Q

A 20-year-old woman presents with a skin rash on the face. After questioning you diagnose the rash as impetigo and tell her she needs to see the doctor for appropriate treatment. You also advise hygiene measures to help control the spread of the rash.
Which of the following pieces of advice is most appropriate?

She should stay away from work until the rash has gone whilst taking antibiotics
She should stay away from work until she has been taking antibiotics for 24 hours
She should stay away from work until she has been taking antibiotics for 48 hours
She should stay away from work until she has completed the course of antibiotics
She does not have to stay away from work whilst she has the rash

A

She should stay away from work until she has been taking antibiotics for 48 hours

170
Q

According to the General Pharmaceutical Council (GPhC), revalidation is a process which helps to show that the trust members of the public have in pharmacy professionals, is well placed.
Which one of the following statements is the most accurate in relation to revalidation?

In the first year that you submit revalidation records, you will need to carry out, record and submit one CPD record
For revalidation you need to carry out, record and submit two CPD records, a peer discussion record, and a reflective account record
Revalidation submissions are only made when the GPhC call registrants to submit
Revalidation applies only to pharmacists working in patient facing roles
Revalidation applies to both registered pharmacists and pharmacy technicians

A

Revalidation applies to both registered pharmacists and pharmacy technicians

171
Q

A 40-year-old man presents in general practice for his annual medication review. He is taking finasteride for benign prostatic hyperplasia
Which of the following pieces of advice is most appropriate to provide this patient?

Continuous lifelong use of finasteride is recommended
Finasteride is contraindicated in patients who smoke
Finasteride is excreted in semen therefore, if sexually active, use of a condom is recommended
Finasteride is known to benefit patients with a history of depression
The patient requires annual urea and electrolytes monitoring, and blood pressure checks

A

Finasteride is excreted in semen therefore, if sexually active, use of a condom is recommended

172
Q

At his next clinic appointment, the patient’s international normalised ratio (INR) is unexpectedly outside of the normal range. There have been no changes to his diet and no concerns of adherence. However, he has been initiated on a recent course of antibiotics.
Which of the following effects is most likely to occur in relation to antibiotics and warfarin?

Clarithromycin decreases the anticoagulant effect of warfarin
Doxycycline decreases the anticoagulant effect of warfarin
Erythromycin decreases the anticoagulant effect of warfarin
Metronidazole increases the anticoagulant effect of warfarin
Rifampicin increases the anticoagulant effect of warfarin

A

Metronidazole increases the anticoagulant effect of warfarin

173
Q

A regular patient comes in and asks for advice regarding their pet. They explain that they have run out of repeat medication for their cat and would like some more. They show you an empty bottle hypromellose eye drops that they administer to their cat.
Which of the following actions is most appropriate to take in response to the request?

Sell the hypromellose eye drops and advise the patient to continue the treatment until the symptoms have eased in their cat
Sell the hypromellose eye drops and advise the patient to phone the vet to confirm how long to use the medicine for
You refuse the supply and advise the patient to contact the vet for a further supply of hypromellose eye drops
You supply hypromellose eye drops as an emergency supply and make a record of this on your patient medication record (PMR)
You supply hypromellose eye drops as an emergency supply and make a record in the prescription only medicines (POM) register

A

You refuse the supply and advise the patient to contact the vet for a further supply of hypromellose eye drops

174
Q

Responsible Pharmacist (RP) regulations mean that the owner of a retail pharmacy business must appoint an RP to be in charge of the registered pharmacy. You are discussing the regulations with your pre-registration trainee pharmacist to help them with their revision.
Which one of the following statements is the most accurate in relation to the RP regulations?

RP can only be the RP for one pharmacy at any given time
The pharmacy record detailing the RP information must be kept for a period of three years
The RP may be absent for a maximum of four hours in the pharmacies business hours
The RP only needs to display the RP notice when they are absent
The sale of GSL medicines does not require a RP to be in charge of the pharmacy

A

RP can only be the RP for one pharmacy at any given time

175
Q

A 16-year-old patient visits your pharmacy asking for advice. She has been taking chlorphenamine tablets for allergic rhinitis which she suffers from every year through the summer, however, they make her extremely drowsy, so she has stopped taking them.

She would like to purchase an alternative medicine over the counter for her allergic rhinitis to avoid the drowsiness she is currently experiencing.
What is the most appropriate product to provide the patient?

Beclomethasone 50 mcg nasal spray
Cetirizine 10 mg tablets
Loratadine 10 mg tablets
Sodium cromoglycate eye drops
Sterimar nasal spray

A

Loratadine 10 mg tablets

176
Q

You have received a prescription for a schedule 2 Controlled Drug (CD) and have supplied it to a patient. You record the supply in the appropriate CD register.
Which of the following is a professional and legal requirement with regards to CD register records?

A running balance is mandatory to be recorded in the CD register Incorrect
CD stock balance checks must be completed once a week on the same day each week
Electronic CD registers may allow entries to be amended at a later date
Electronic CD registers should be kept for two years from the date of the last entry
Written CD registers must be maintained alongside electronic registers at the premises

A

Electronic CD registers should be kept for two years from the date of the last entry

177
Q

A 54-year-old man visits his GP, complaining of increasing frequency of urination at night and excessive thirst. His GP checks his blood glucose levels and HbA1c (glycated haemoglobin).

Which of the following would most likely lead to suspected diagnosis of type 2 diabetes?

HbA1c of 44 mmol/mol and fasting plasma glucose of 5.0 mmol/L
HbA1c of 44 mmol/mol and random plasma glucose of 7.0 mmol/L
HbA1c of 46 mmol/mol and random plasma glucose of 10.0 mmol/L
HbA1c of 48 mmol/mol and fasting plasma glucose of 5.0 mmol/L
HbA1c of 48 mmol/mol and random plasma glucose of 12.0 mmol/L

A

HbA1c of 48 mmol/mol and random plasma glucose of 12.0 mmol/L

178
Q

The patient is provided with dietary and lifestyle advice and initiated on a new medicine. He brings in a prescription to the pharmacy for metformin 500 mg once a day.

Which of the following counselling points regarding metformin is most appropriate to provide the patient?

Gliclazide is associated with a lower risk of hypoglycaemia compared to metformin
Hypoglycaemia commonly occurs with metformin use
Metformin can cause weight gain and is usually prescribed if symptoms persist despite adequate attempts at dieting and weight loss
Metformin exerts its effect mainly by increasing gluconeogenesis in the liver
Metformin is only effective in the presence of insulin

A

Metformin is only effective in the presence of insulin

179
Q

You suspect a man in your pharmacy is experiencing a hypoglycaemic episode. He is sweaty, feeling dizzy but is conscious and responsive. He is 45 years old.

Which of the following would be the most appropriate management of his hypoglycaemia?

1 mg glucagon injection
2 glucose tablets
20 g of sugar dissolved in water
100 mL of pure fruit juice
200 mL of diet coke

A

20 g of sugar dissolved in water

180
Q

You are delivering training to the healthcare assistants that work with you in your community pharmacy. The training is regarding medication for constipation, and you discuss the use of senna tablets.

Which one of the following statements regarding senna is most appropriate to advise the healthcare assistants?

Select one:
Senna can be used in patients with intestinal obstruction
Senna is not safe in pregnancy
Senna is the first line treatment for constipation when treating over the counter
Senna tablets are licensed for use in adults and children over 2 years old
Senna tablets can be sold for anyone over 12 years old over the counter

A

Senna tablets can be sold for anyone over 12 years old over the counter

181
Q

A 38-year-old man is started on treatment for tuberculosis. He has been prescribed rifampicin, ethambutol, pyrazinamide, isoniazid, and pyridoxine.

What is the most likely reason to prescribe pyridoxine as part of this regimen?

Select one:
To correct B12 deficiency
To improve absorption of isoniazid
To improve efficacy of rifampicin
To prevent drug induced peripheral neuropathy
To reduce side effects of pyrazinamide

A

To prevent drug induced peripheral neuropathy

182
Q

Some Controlled Drug (CD) medicines legally need to be stored under safe custody.
You are training a pre-registration pharmacist who wants to know more about CDs and safe custody requirements.

Which one of the following medicines does not need to be kept under safe custody?

Buccolam (midazolam)10 mg/2 mL oromucosal solution
MST Continus (morphine sulfate) 10 mg tablets
Oramorph (morphine sulfate) 20 mg/mL concentrated oral solution
Oxycontin (oxycodone hydrochloride) 10 mg prolonged release tablets
Temazepam 10 mg tablets

A

Buccolam (midazolam)10 mg/2 mL oromucosal solution

183
Q

A 15-year-old girl has been given a prescription by her GP for H. pylori eradication therapy. She has no known drug allergies and takes no other medication.

Which one of the following options is most appropriate as first line treatment?

Select one:
Amoxicillin 1 g three times a day, clarithromycin 500 mg twice a day, and a PPI for 7 days
Amoxicillin 1 g twice a day, clarithromycin 500 mg twice a day, and a PPI for 7 days
Amoxicillin 1 g twice a day, clarithromycin 500 mg twice a day, and a PPI for 14 days
Clarithromycin 500 mg twice a day, metronidazole 400 mg twice a day, and a PPI for 7 days
Clarithromycin 500mg twice a day, metronidazole 400 mg twice a day, and a PPI for 14 days

A

Amoxicillin 1 g twice a day, clarithromycin 500 mg twice a day, and a PPI for 7 days

184
Q

A 25-year-old woman is taking the combined oral contraceptive pill and enquires about how frequently she should go undergo routine cervical screening. She has no known medical conditions and is not taking any other medicines.

Which of the following is the most appropriate f frequency at which routine cervical screening should be undertaken?

Select one:
Every 1 year
Every 2 years
Every 3 years
Every 4 years
Every 5 years

A

Every 3 years

185
Q

An 8-year-old boy requires treatment with antibiotics for a chest infection. He has a history of asthma and an allergy to penicillin. His drug history includes salbutamol 100 mcg inhaler two puffs as required, and beclometasone (Qvar) 50 mcg one puff twice daily.

Which one of the following antibiotics would be most appropriate to treat the patient’s chest infection?

Select one:
Amoxicillin
Azithromycin
Ciprofloxacin
Co-amoxiclav
Doxycycline

A

Azithromycin

186
Q

A 65-year-old, black-African man, with persistent stage 2 hypertension, needs to be initiated on hypertension treatment. He has no known drug allergies and currently takes metformin 500 mg three times a day.

Which of the following antihypertensive medicines would be most appropriate to initiate?

Amlodipine
Candesartan
Indapamide
Nifedipine
Ramipril

A

Candesartan

187
Q

A 37-year-old woman presents at your pharmacy to purchase pseudoephedrine to control symptoms of nasal congestion. She has a medical history of hypertension and heart disease, and get dialysis three times a week for end stage renal disease.

Which of the following statements regarding pseudoephedrine is most appropriate to provide to the patient?

A maximum of 720 mg of pseudoephedrine can be sold at any one time, but is not suitable for this patient
A product containing pseudoephedrine and a product containing ephedrine can be purchased over the counter at the same time
Pseudoephedrine can be used in patients with heart disease without concern
Pseudoephedrine can be used in patients with severe renal impairment without concern
Women who are pregnant or breastfeeding can buy and take pseudoephedrine over the counter

A

A maximum of 720 mg of pseudoephedrine can be sold at any one time, but is not suitable for this patient

188
Q

A 65-year-old Caucasian man experiences swelling and pain in his right foot. His GP assesses the patient and diagnoses him with an acute flare of gout and initiates the patient on colchicine. He has a past medical history of hypertension, gout, and benign prostatic hyperplasia. His repeat medicines include amlodipine, ramipril, allopurinol, indapamide, and tamsulosin.

Which one of his medicines most likely contributed to the exacerbation of gout?

Allopurinol
Amlodipine
Indapamide
Ramipril
Tamsulosin

A

Indapamide

189
Q

You have received a delivery of temazepam from your pharmacy wholesaler in your hospital pharmacy.

Which of the following record keeping requirements is most appropriate for temazepam?

Select one:
A running balance of temazepam must be recorded in the Controlled Drugs register
Invoices for temazepam do not need to be retained
Invoices for temazepam need to be retained for five years
Invoices for temazepam need to be retained for two years
The receipt of temazepam must be recorded in the Controlled Drugs register

A

Invoices for temazepam need to be retained for two years

190
Q

You are a checking the accuracy of some dispensed medication within your pharmacy to ensure it contains all the necessary legal requirements.

Which of the following is most likely to be a legal requirement required on dispensed medication labels?

The brand and generic name of the product
The date the item was dispensed
The expiry date of the product
The formulation of the product
The warning ‘Keep out of the reach and sight of children’

A

The date the item was dispensed

191
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 of the following medicines has most likely been prescribed for the patient?

Finasteride
Mirabegron
Oxybutynin
Propiverine
Solifenacin

A

Mirabegron

192
Q

A 65-year-old woman is admitted to hospital with an exacerbation of chronic obstructive pulmonary disease (COPD). She has had five exacerbations in the last 12 months.

Her current inhaler therapy is Trimbow (beclometasone dipropionate, formoterol fumarate dihydrate, glycopyrronium) and salbutamol. The respiratory specialist decides to initiate azithromycin as a prophylactic antibiotic.

Which of the following monitoring requirements is most appropriate for this patient?

Baseline ECG and LFT’s
Baseline ECG and U and E’s
Baseline chest x-ray and LFT’s
Baseline chest x-ray and U and E’s
U and E’s and LFT’s

A

Baseline ECG and LFT’s

193
Q

You receive an NHS prescription for a controlled drug in your pharmacy. You notice that the prescription was written four months ago and remains legally valid.

Which of the following controlled drugs is most likely to have been prescribed?

CD ANAB POM
CD BENZ POM
CD INV POM
CD NO REGISTER POM
CD POM

A

CD INV POM

194
Q

A 32-year-old woman with has a known history of childhood asthma presents for a medication review with you in general practice. You decide to change her treatment from her Clenil inhaler (beclometasone dipropionate) to Fostair inhaler (beclometasone dipropionate and formoterol fumarate dihydrate).

Which one of the following statements regarding Fostair inhaler is correct?

Fostair can be used as maintenance and reliever therapy in response to COPD symptoms
Fostair has extra fine particle size distribution which can produce a more potent effect
Fostair is a dry powder inhaler
Fostair is unlicensed for use in asthma
Fostair is unlicensed for use in COPD

A

Fostair has extra fine particle size distribution which can produce a more potent effect

195
Q

A 48-year-old man takes isoniazid as part of his treatment regimen for tuberculosis. As he is diabetic, he is at higher risk of developing peripheral neuropathy. He hands in a new prescription to help reduce the effects of peripheral neuropathy.

Select from the list of options the most appropriate vitamin for the patient.

Ascorbic acid (Vitamin C)
Cholecalciferol (Vitamin D3)
Folic acid
Pantothenic acid (Vitamin B5)
Phytomenadione (Vitamin K)
Pyroxidine (Vitamin B6)
Retinol (Vitamin A)
Tocopherols (Vitamin E)

A

Pyroxidine (Vitamin B6)

196
Q

A 7-year-old girl having regular salbutamol nebules for an exacerbation of asthma. An ECG has been performed due to a potential adverse reaction that salbutamol has caused.

Select from the list of options the most likely adverse drug reaction.

Constipation
Diarrhoea
Hyperkalaemia
Hypernatremia
Hypokalaemia
Hyponatraemia
QTc prolongation
Rash

A

Hypokalaemia

197
Q

A 6-year-old child has been diagnosed with faecal impaction (first presentation), they have been referred to the specialist but treatment has been initiated until the specialist can review them (two week wait).

Select from the list of options the most appropriate constipation medicine for the patient.

Bisacodyl 10 mg suppositories
Co-danthramer 25 mg capsules
Docusate 100 mg capsules
Lactulose 10 g/15 mL liquid
Movicol 13.8 g sachets
Movicol paediatric 6.9 g sachets
Naloxegol 25 mg tablets
Senna 7.5 mg tablets

A

Movicol paediatric 6.9 g sachets

198
Q

A 46-year-old patient requires treatment for opioid induced constipation. Previous treatment has been trialled and found to be inadequate.

Select from the list of options the most appropriate constipation medicine for the patient.

Select one:
Bisacodyl 10 mg suppositories
Co-danthramer 25 mg capsules
Docusate 100 mg capsules
Lactulose 10 g/15 mL liquid
Movicol 13.8 g sachets
Movicol paediatric 6.9 g sachets
Naloxegol 25 mg tablets
Senna 7.5 mg tablets

A

Naloxegol 25 mg tablets

199
Q

A 35-year-old woman presents to her GP with constipation. She would prefer to be prescribed a quick acting agent.

Select from the list of options the most appropriate constipation medicine for the patient.

Bisacodyl 10 mg suppositories
Co-danthramer 25 mg capsules
Docusate 100 mg capsules
Lactulose 10 g/15 mL liquid
Movicol 13.8 g sachets
Movicol paediatric 6.9 g sachets
Naloxegol 25 mg tablets
Senna 7.5 mg tablets

A

Bisacodyl 10 mg suppositories

200
Q

A 25-year-old pregnant patient who has developed constipation in her third trimester. She has not previously taken anything and would like to be prescribed medication that is safe in pregnancy.

Select from the list of options the most appropriate constipation medicine for the patient.

Bisacodyl 10 mg suppositories
Co-danthramer 25 mg capsules
Docusate 100 mg capsules
Lactulose 10 g/15 mL liquid
Movicol 13.8 g sachets
Movicol paediatric 6.9 g sachets
Naloxegol 25 mg tablets
Senna 7.5 mg tablets

A

Lactulose 10 g/15 mL liquid

201
Q

he validity of an NHS prescription for isotretonin capsules for use under the Pregnancy Prevention Programme.

Select from the list of options the most appropriate value that relates to this scenario.

3 days
5 days
7 days
28 days
30 days
3 months
6 months
12 months

A

7 days

202
Q

A 43-year-old man who has attended accident and emergency with a potassium of 6.5 mmol/L, attributed to one of their cardiac medicines which they have been taking for two weeks.

Select from the list of options the most appropriate drug causing this?

Aspirin
Amiodarone
Bisoprolol
Clopidogrel
Digoxin
Lisinopril
Rivaroxaban
Warfarin

A

Lisinopril

203
Q

A 12-month-old child receives their first dose of this vaccine, with a second booster dose scheduled between 3 – 5 years. This vaccine should not be administered on the same day as yellow fever vaccine and there should be a 4-week minimum interval between the vaccines.

Select from the list of options the most appropriate vaccine for the patient.

Bacillus Calmette-Guérin (BCG) Vaccine
Cholera Vaccine
Influenza Vaccine
Infanrix Hexa ®
Measles, Mumps, Rubella (MMR) Vaccine
Rotavirus Vaccine
Tetanus Vaccine
Varicella Zoster Vaccine

A

Measles, Mumps, Rubella (MMR) Vaccine

204
Q

You are concerned about side effects she may experience because of treatment with intravenous hydrocortisone.

Which one of the following is most likely an expected glucocorticoid side-effect associated with hydrocortisone?

Hyperglycaemia
Hypertension
Hypokalaemia
Sodium retention
Water retention

A

Hyperglycaemia

My Pham Notes (22 decks)

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