Past paper questions Flashcards by Izy Mal

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

Cefalexin

How well did you know this?

Not at all

Perfectly

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

Pethidine

How well did you know this?

Not at all

Perfectly

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

Unexplained bruising or bleeding

How well did you know this?

Not at all

Perfectly

Dose of paracetamol for immunisations?

2.5ml qds (2.5ml = 60mg)

How well did you know this?

Not at all

Perfectly

Can methotrexate cause a miscarriage?

May harm unborn baby but unlikely to cause a miscarriage.

How well did you know this?

Not at all

Perfectly

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

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.

How well did you know this?

Not at all

Perfectly

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

Valsartan

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

How well did you know this?

Not at all

Perfectly

An antihistamine and serotonin antagonist indicated in the prophylaxis of migraines

Pizotfen

How well did you know this?

Not at all

Perfectly

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

Hypo does not cause osteoporosis

How well did you know this?

Not at all

Perfectly

Scurvy is a deficiency of?

Vit C

How well did you know this?

Not at all

Perfectly

Buccastem M is only licensed for what?

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

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

When should sodium valproate be used in absence seizures?

When high risk of generalised tonic-clonic seizures.

How well did you know this?

Not at all

Perfectly

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

Trichomoniasis Vaginalis

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

How well did you know this?

Not at all

Perfectly

Can pregnant women use gaviscon or peptac?

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

How well did you know this?

Not at all

Perfectly

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.

Buprenoprhine

How well did you know this?

Not at all

Perfectly

Is loperamide ok in renal failure?

Yes

How well did you know this?

Not at all

Perfectly

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 toolkitClinical auditsUnpublished patient surveyReaccreditation of servicesRegistering of premises

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.

How well did you know this?

Not at all

Perfectly

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

Hyponatraemia.

How well did you know this?

Not at all

Perfectly

Piroxicam topical treatment should be reviewed after how long?

4 weeks

How well did you know this?

Not at all

Perfectly

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

Warfarin

How well did you know this?

Not at all

Perfectly

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

Gliclazide does not cause hyponatraemia.

How well did you know this?

Not at all

Perfectly

Allopurinol is associated with what syndrome?

Steven-Johnsons Syndrome

How well did you know this?

Not at all

Perfectly

Noriday (norhisterone) is defined as being late when?

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

How well did you know this?

Not at all

Perfectly

Recently prepared means

within 4 weeks

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

Tramadol

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

Prostaglandin inhibitors --> NSAIDs --> Indomethacin or ibuprofen

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

Phenobarbital

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

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

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

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

Insulin glargine: Insulin glulisine:

Glarg: long Glu: fast

Phenoxymethylpenicillin, with or without food?

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

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

Due to the risk of renal failure.

``` 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 ```

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

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

``` Abdominal distension Pallid cyanosis (grey) Circulatory collapse ```

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

increase its levels

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

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

Cetrizine is only licensed for use in what ages?

>2 for liquid.

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

True.

Terbinafine is associated with what skin disorder?

Toxic epidermal necrosis/SJS

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

Yes

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

Hepatotoxicity

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

Piroxicam

Calcium polystyrene resin treats

Hyperkalaemia.

Long-term use of which one of the following laxatives can lead to a weakened bowel?SennaLactuloseDocusateIspaghula husk

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

Clinical outcomes include what?

Length of hospital stay. Adverse drug reactions. Hospital readmissionDeath

Infants have what pH gastric contents?

High pH

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 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

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.

Which heparins have a lower risk of heparin induced thrombocytopenia?

LMWH lower than ufh

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

protein leaks out of kidneys = leaves body in urine = less circulating proteins in serum for these highly protein bound drugs to bind to = thus thier active levels increase

15 yr old T1DM using insulin glargine once daily and novorapid prn. Has a script for Co-amoxiclav. Which of following is most appropriate advice? 1. Do not make any adjustments to your regular blood glucose monitoring. 2. Increase your blood glucose monitoing as well as your insulin dosing 3. As you are not eating, you will not require you regulr insulin doses. 4. Inject your insulin intravenously whilst ill as this will give a rapid response 5. Monitor yourself for hypoglycaemia and reduce your regular insulin dosing.

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

How is hand foot and mouth treated?

PLenty of fluids to avoid dehydration Soft foods Paracetamol or ibuprofen

Perindopril should be taken with or without food?

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

Target INR for DVT prophylaxis

3.5

``` 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 ```

rotavirus protects against rotavirus infection, common cause of childhod diarrhoea & sickness given at 8-12 weeks of age. Rotavirus liquid vaccines given by mouth (orally) to young infants.

``` A 49 year old man is brought into A & E with nausea, vomiting, muscle twitching andtremor. 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 ```

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.

Which of following best describes MOA of amlodipine in reducing blood pressure? ~ It exerts 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 potent vasodilator effect which reduces blood pressure.

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

Indicated for short-term relief (2-4 weeks only) for anxiety that is severe, disabling, or causing patient unacceptable distress: Lorazepam Temazapem

Lorazepam

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

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

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

Vincristine least emetogenic out of those

p.c. means what?

After food

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

First trimester

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

Clarithromycin

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

Lyme disease = caused by bacterial infection from tick bites ~ early symptom = characteristic "bulls eye" rash at site of bite. Not itchy !

Mrs Q goes to her doctor reporting that she has been feeling sick, lethargic and quiteconfused. At night, she says that she has been seeing strange halos around the lightsat home. ``` Ciclosporin Digoxin Gentamicin Lithium Methotrexate Phenytoin Sodium valproate Theophylline ```

Digoxin:

What is the interaction between co-amoxiclav and simvastatin?

Clavulanic acid and simvastatin can increase the risk of hepatotoxicty.

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

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

Which of the following causes HYPOcalcaemia? Bendro Furosemide

Bendro causes: Hyper - glycaemia, natraemia, kalaemia, calcaemia.Hypomagnesia Loops cause hypocalcaemia

What is the target INR for recurrent thromboembolism?

3.5

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

Gaviscon ®Advance NOT used as contains K+ which may be restricted in renal disease. Paracetamol (Hedex ®, Panadol ® ) safe & suitable to treat headaches. For occasional TX of indigestion Gaviscon ® Liquid or tablets can be taken. Remegel ® tablets which contain calcium carbonate also be taken occasionally provided levels of calcium in blood not raised above normal.

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

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

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

Rifampicin = potent enzyme inducer = increase metabolism of particular drugs In this case rifampacin with warfin.

``` 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 ```

Cluster headache.

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

High-dose naproxen associated with less vascular risk than other NSAIDs. High-dose diclofenac & possibly ibuprofen, comparable to coxibs, whereas high-dose naproxen associated with less vascular risk than other NSAIDs.

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

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

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

Ibuprofen

Are madopar dispersible equivalent to madopar capsules of same strength? (Co-beneldopa)

Yes

What are the more water soluble beta blockers?

``` Least likely to cross BBB: Atenolol Celiprolol Nadilol Sotalol ```

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

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

Can people with high Blood pressure use guaifenesin?

Yes

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

Ketoprofen = greatest risk of gastro-intestinal side effects

How should cradle cap be managed?

Brushing, soaking etc.

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

Tendon rupture

Seretide is what?

LABA (Salmeterol) + Fluticasone (ICS)

Freshly prepared means

within 24 hours

Which of the following is recommended for patients visiting Mecca? BCG vaccine Hepatitis B vaccine Influenza vaccine Meningococcal B vaccine Meningococcal quadrivalent ACWY Pneumococcal conjugate vaccine Rotavirus Tetanus

Meningitis ACWY immunisation is recomended for patients visiting Mecca.

Otomize ear spray is usually given as what dosing?

Three times daily

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

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

Mr LK, 54 years old is suffering from congestion for the past 4 days, he tells you his nose is blocked. He currently takes nasal spray recommended by his GP for hay fever. He also stopped taking phenelzine 1 week ago. He finally mentions he has tried steam inhalation. What type of OTC product would be most unsuitable?

Pseudoephedrine NOT appropriate - risk of hypotensive crisis when pseudoephedrine given with MAOIs - avoid psuedoephedrine for at least 2 weeks after stopping MAOI.

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

20-30mins

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

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

Which of these is most likely to have caused gout? Allopurinol Atorvastatin Clopidogrel Indapamide Lisinopril

Indapamide

What is the best monitoring parament for smoking cessation progress?

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

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

Olanzapine

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

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

Why do black patients respond better to diuretics?

Increased salt sensitivity and therefore renal vascualr resistance.

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

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

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

Sertraline

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

All Sch 2 plus diazepam can be prescribed by instalments.

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

The quality payment scheme in the community setting.

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.

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

In stoma care, how should iron be supplemented?

Parenteral if oral not working, NOT MR forms.

``` 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 ```

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

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

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

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

Within 7-10 days.

Which LTRA can cause liver disorder?

Zarfirkulast

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

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.

What electrolyte imbalances can lead to digoxin toxicity?

Hypokalaemia and hypomagnesaemia.

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

Topiramate

Trastuzumab (herceptin) has what side effects?

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

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

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

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

Prochloperazine.

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

* common side-effect of indapamide = HYPOnatraemia * NOT used by breast feeding mothers. * Taken first thing in morning * Usual dose 2.5mg daily. * Risk of cardiac toxicity if taken with digoxin due to hypokalaemia.

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

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

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

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

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

Bypass first pass metabolism

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

Withdraw the phenytoin.

``` 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 ```

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

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

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.

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

Diarrhoea = fluid loss & upset fluid balance. **Oral rehydration powder** (use in diarrhoea) contains both Na & K = **avoided in people with severe kidney** **disease** except with medical advice. If symptoms mild, loperamide (Imodium ®) used to control them

Black patients have what level of circulating renin?

LOW

``` Liver failure can be caused by: Metformin Acarbose Insulin Pioglitazone ```

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

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

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

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.

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

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

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

Simvastatin max dose of 20mg when with which 4 other medication?

Diltiazem Amiodarone Verapamil Amlodipine

The usual flixonase dosing for nasal polyps is

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

What is procyclidine used for?

The EPS of parkinsons and antipsychotics

What type of vaccine is the varicella-zoster vaccine?

Live

Ramiprial can cause which of the following? Bradycardia Tachycardia

Tachycardia.

``` 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 ```

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

Hair falling out can be caused by what anticoagulant?

Warfarin

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

There is a written form but consent can be verbal.

Low sodium has what effect on lithium?

Toxicity

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

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

What is the best treatment option for theophylline overdose?

Activated charcoal

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

Hypokalaemia

Can Pharmacy technicians access a patients SCR?

Yes

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

Warfarin: 1 week. Aspirin: 1 week. Clopidogrel: 1 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

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

Indapamide can cause hyperuricaemia

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

Temazepam

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

Vitamin D deficiency Hypocalcaemia

``` 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 ```

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

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

Procyclidine is an anticholinergic which can cause tachycardia not bradycardia

``` 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 ```

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

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

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.

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

Olanzapine: 2nd gen

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

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

Which is stronger? | Clobetasol butyrate vs Clobetasol propionate

Clobetasol propionate 0.1%

Which is stronger? | Clobetasol vs clobetasone

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

How long does it take for myelosuppresion to occur?

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.

IS the interaction between doxycycline and phenytoin clinically relevant?

Drugs for respiratory depression in elderly care

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.

What is the Green book used for?

Immunisations, vaccines.

What is the Orange Guide for?

Manfucaturing

Apixaban dose for stroke prevention in AF

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

What does CHA2DSVASc stand for?

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

Apixaban dose for VTE prophylaxis following knee surgery

2.5mg BD 10-14 days

What are the cardioselective beta blockers (NAMB)

Atenolol Bisoprolol Metoprolol Nebivolol

What does HASBLED stand for?

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

Which beta blockers are worse in breastfeeding?

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

Apixaban dose for the treatment of DVT/PE

10mg BD 7 days then 5mg BD

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

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

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

Prednisolone

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

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

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

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

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

Iritis

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

Investigating errors associated with the administration of medicines

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

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

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

Revalidation applies to both registered pharmacists and pharmacy technicians

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

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

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

Metronidazole increases the anticoagulant effect of warfarin

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

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

``` 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

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

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 ```

Loratadine 10 mg tablets

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

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

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

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

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

Metformin is only effective in the presence of insulin

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 ```

20 g of sugar dissolved in water

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

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

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 ```

To prevent drug induced peripheral neuropathy

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

Buccolam (midazolam)10 mg/2 mL oromucosal solution

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

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

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 ```

Every 3 years

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 ```

Azithromycin

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 ```

Candesartan

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

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 ```

Indapamide

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

Invoices for temazepam need to be retained for two years

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’

The date the item was dispensed

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 ```

Mirabegron

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 ```

Baseline ECG and LFT’s

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 ```

CD INV POM

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

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

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) ```

Pyroxidine (Vitamin B6)

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 ```

Hypokalaemia

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 ```

Movicol paediatric 6.9 g sachets

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 ```

Naloxegol 25 mg tablets

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 ```

Bisacodyl 10 mg suppositories

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 ```

Lactulose 10 g/15 mL liquid

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 ```

7 days

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 prescribed medicine for the patient. ``` Aspirin Amiodarone Bisoprolol Clopidogrel Digoxin Lisinopril Rivaroxaban Warfarin ```

Lisinopril

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 ```

Measles, Mumps, Rubella (MMR) Vaccine

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 ```

Hyperglycaemia