PAST PAPERS/ONTRACK LEARNING POINTS Flashcards
Turning Ls into Ws
Child presents with ‘grey-ish white spots. Most likely condition?
Measles.
WHAT ARE THE COMMON SYMPTOMS?1) CHICKEN POX2) MEASLES3) MUMPS4) RUBELLA5) SCARLETT FEVER
1) red vesicles/lumps2) white spots, conjunctivitis3) salivary glands swelling4) red, spotty rash, swollen glands back of neck5) sandpaper blanching rash on trunk, strawberry tongueNHS RASH PICTURES
What is the mechanism of action of ‘SGLT2s’? Examples?
inhibits SGLT2 in the renal proximal convoluted tubulereduce glucose reabsorptionsincreases urinary glucose excretion.E.g. canaglifloxin, dapagliflozin.
What test result must be normal before starting clozapine? MOA? Why? Used in?
Antipsychotic, 2nd-gen. Risk of neutropenia, therefore, leucocyte and diff. blood counts must be normal. Schizophrenia/PD.
What are the important tests for ATORVASTATIN?
Serum transaminase levels >3x upper limit? STOPCreatinine kinase >5x upper limit? Repeat in 7dSTOP STATIN.Diabetes risk? Check HBA1c.
What does Boostrix-IPV injection protect against?
DPTP?diptheria, pertussis (whooping cough), tetanus & poliomyelitis (polio).
Non-bullous impetigo, MOST appropriate treatment?Widespread non-bullous, MOST appropriate treatment?Bullous, systemically unwell, MOST appropriate treatment?
Non-bullous? Hyrogen peroxide 1% creamWidespread non-bullous? Topical- Fusidic acid, L? Mupirocin, L? Oral flucloxacillin, L? (pen allergy) Clari/eryhtromycin.Bullous? Oral flucloxacillin–> Clari/erythromycin.
TIP: Lithium? Other drugs, formulation switch? Dose?
Divided doses, BE CAREFUL.
Influenza vaccine community pharmacy requirements?
18-50 at risk: copd, chd, ckd, cld, asthma>50immunocompromised and relatives long-stay care, allowancehealthcare workers
Vet med cascade, dispensing label legal requirements?
1) Keep out of reach of children2) N+A of animal ownee 3) N+A of pharmacy4) ID+Species of animal5) vet surgeon still The words: ‘For animal treatment only’• The words: ‘Keep out of reach of children’.
What antibiotics are associated with C-diff. resistance?
Cefaclor, ciprofloxacin, clindamycin & co-amoxiclavWHY?!
Use of folic acid in pregnancy? Higher risk of neural tube defects?
Folic acid 400mcg tabs, pre-conception+till week 12.Higher risk? Epilepsy/diabetic/sickle-cell, give 5mg instead.sickle cell is throughout
Depression first-line in CHILDREN?
Fluoxetine, SSRI
Hydroxychloroquine key info?
Vision disorders, annual monitoring required in patients taking >5 years.
Dalteparin DVT- prophylaxis/treatment no. of units?
Prophylaxis- 5000units/24 hoursTreatment- 10000units/24 hours
Coeliac disease, diet?
Gluten free best, chicken, meat, beef.AVOID cheese/bread/pizza/soup/roll wheat,barley, all that
Warfarin tablets and colours?
0.5MG WHITE1MG BROwn3MG BLUe5MG PINK
Symptoms of meningitis (2yr old)?
Capillary refill time>2secsCold hands and feetDrowsinesssleepinessPoor urine (dry nappes!)Rash that does NOT BLANCH under pressure
Patient with epilepsy, travelling to malaria region, best treatment?
Atovaquone w/ proguanil. AVOID CHLOROQUINE, can lower seizure threshold, cautioned.
Patient, red eye, no trauma, no meds, no symptoms. Best action?
No treatment- self-limiting
Hypoglycaemia treatment adult?
> 4mmol/L? Have a snack, bread, meal.<4mmol/L? 15-20g oral glucose/200ml juice/4 spoons of sugar
EXPLAIN HYPERTHYROIDISM
Weight loss, fast heartbeat, tachy. Fast, nervousness. low TSH (HIGH T3/T4), thyroid making too much hormone, TSH stimulates the release of thyroxine, hence HYPER.
EXPLAIN HYPOTHYROIDISM
fatigue, cold, dry skin, constipation, hoarseness, weak. High TSH (low T3/T4), thyroid not being stimulated enough to make thyroxine, hence HYPO.goitre- swelling of the neck
GTN spray counselling?
Spray under tongue, close mouth immediatelySit down before and after spray (risk of postural hypotension)SE- headache & flushingSymptoms not resolved after 3 doses? SEEK MEDICAL ATTENTION!
Gout Treatment,Acute?Long-term?
Acute? Colchicine or NSAID (naproxen, X aspirin. Be wary of renally cleared drugs & hyponatraemia).Long-term? Allopurinol–> Febuxostat
Heartburn Management?
Dietary–>Antacid (Gaviscon)–> Esomeprazole (14days)–> Ranitidine (unlicensed)
Eczema management?
Mild? Emollient–> emollient+topical corticosteroid, hydrocortisone.Moderate atopic? Topical pimecrolimus?Severe? Tacrolimus
What product is air added for easy removal of liquid inside?
Sealed vial
EHC AGES?
Levonelle/levonorgestrel, >16, 72hrsellaOne/ulipristal, any age, 120hrs
1) Simple linctus age?2) Fluconazole 150mg age?3) Tamusolsin age?
1) >122) 16-603) 45-75
Sildenafil advice?
Take 1hr pre-SE, AVOID with food, can delay onset of effect.
digoxin therapeutic range? toxicity and action?
0.7-2ng/mL. 2.5mcg/L toxic? STOP
TYPE 2 DIABETES MANAGEMENT? Initial/1st/2nd intensification?
Initial? MetforminFirst? Metformin+one fo the following:Sulphonylurea (gliclazide/tolbu)PioglitazonDPPI (Linagliptin)SGLT2 (dapagliflozin)—> only when sulfonylureas are contra-indicated or not tolerated, or if the patient is at significant risk of hypoglycaemia or its consequences.Second?Metformin+Sulphonylurea+DPPI4Metformin+Sulphonylurea+PioglitazoneMetformin+Sulphonylurea+SGLT2Metformin+Pioglitazone+SGLT2 (Note: Dapagliflozin not recommended in TT with pioglitazone).
Sereteide (fluticasone with salmeterol) age?
100 Accu/Evohaler? 12-17& adult50 Evohaler? 4-17 & adult, <4 off-label, lack of alternative
Cellulitis treatment?
Flucloxacillin, penicillin allergy? Clindamycin.
Side-effects of trimethoprim?
Leucopenia, thrombo, hyperkalaemia & high plasma Cr concs.
Levonorgestrel, Ulipristal breastfeeding?
Levonelle? Nil effectUlipristal? Avoid for 1 week post.
Modifiable risk factors CVD?
Smokingnon-HDLactivitydietalcoholobesity.
POM requirements?
N+A of patientN+A of prescribersignaturedate (6months)age if under 12.
Gestational hypertension?
Labetalol. L? Nifedipine. L? Methyldopa
Beta-blockers minimal nightmares?
CANSCeliprololAtenololNadololSotalol
LOW RESPIRATORY TRACT INFECTIONCOPDLow BPAtypical pathogen?
Streptococcus pneumoniae (neither gram - OR +)
FENTANYL PATCHES KEY INFO?
EVERY 72 HOURSEXCESSIVE HEAT= SIDE-EFFECT, OD BREATHING L? REMOVE IMMEDIATELYROTATE SITES
SPC Qs tipBE CAREFUL CAFFEINE CITRATE IS NOT =/= CAFFEINE BASE
Caffeine citrate 2 mg ≡ caffeine base 1 mg
HEARTBURN REFERRAL?
DYSPHAGIAUNEXPLAINED WEIGHT LOSSGI BLEEDVOMITING
ALLI COUNSELLING?
LOW FAT, HYPOCALORIC DIETFAT-SOLUBLE VITS (ADEK) IMPAIREDBMI>28kg/m^2180/360mg MAX OTC ALLI, MAX 6 MONTHS
16 year old, symptoms of menorrhagia, action?
Refer to GPCan’t sell OTC tranexamic acid,18-45 years only
MALARIAMEFLOQUINE CONTRA?DOXYCLINE CONTRA?
MEFLOQUINE CONTRA? depressionDOXYCLINE CONTRA? <12 years childrenATO+PROG COMBINED BEST
SILDENAFIL+ALPHA BLOCKERS/ACE-i/ARB?
hypotension side effect, significant!
Scarlett fever1ST LINE?2ND LINE?
1ST LINE? phenoxymethylpenicillin qds for 10 days2ND LINE? Azithromycin 300 mg once daily for 5 days
SLAPPED CHEEK SYNDROME S&S?
FEVERRUNNY NOSERED RASHPLENTY FLUID+PARACETAMOLCAN STILL GO SCHOOL
SHINGLES S&S?
BURNINGITCHYONE-SIDED RASHREFER GP ANTIVIRAL
CLOPIDOGREL+PPI?
BIG NO NO- OMEPRAZOLEPANTOPRAZOLE IS BESTLANS/RABEP close second
STATIN IN SECONDARY PREVENTION OF CVD?
ATORVASTATIN 80MG OD
SITAGLIPTIN vs LINAGLIPTIN?
SITA- renal dose adjustmentLINA- as you please
valproate bipolar pregnant women?
contraindicated
NITROFURANTOIN URINE COLOUR?
DARK YELLOW/BROWN
RIFAMPICIN URINE COLOUR?
REDDISH-ORANGE
LITHIUM MONITORING?
BMI, weight gainELECTROLYTESeGFRTHYROIDnot liver function
METHOTREXATE- LIVER TOXICITY S&S?
N&VSTOMACH ACHEAPPETITEFATIGUEYELLOWING
METHOTREXATE AND OMEPRAZOLE?
METHOTREXATE CONC. BEZERK
AZATHIOPRINE, UNEXPLAINED BLEEDING?
POSSIBLE BONE MARROW SUPPRESSION- GP ASAP
SPCPRACTICE FERINJECT Qs?
DRUGS CAUSING HYPERTHYROIDISM?
AMIODARONELEVOTHYROXINELIOTHYRONINELITHIUM
CALCIUM & LEVOTHYROXINE?
Reduces levo absorption, don’t take at same time!
HRT RISKS?
BREAST CANCERSTROKEOVARIAN CANCERVTE
HRT LEAST LIKELY?
OSTEOPOROSIS, reduced risk with HRT!
LEG ULCER1ST LINE?2ND LINE?
1ST LINE? FLUCLOXACILLIN2ND LINE? DOXY/CLARI/ERY PREGNANCY)
PRESSURISED MDI technique?
SLOW AND STEADY
DPI TECHNIQUE?
QUICK AND DEEP
HAS-BLED estimates?
Risk of bleeding in patients with AF who are being offered anticoagulation
HAS-BLED RISK FACTORS?Hypertension. Abnormal renal and liver function. Stroke. Bleeding.
AGEALCOHOLHYPERTENSIONLIVER DISEASENOT CONGESTIVE HEART FAILURE, THAT’S CHADVASC SCOREHypertension. Abnormal renal and liver function. Stroke. Bleeding.
eGFR<60 flozin?
DAPAGLIFLOZIN NOT RECOMMENDED
GLIBENCLAMIDE IN ELDERLY?
NOT RECOMMENDEDHIGHER RISK OF HYPOGLYCAEMIAOLD+RENAL IMPAIRMENTcos longer action
METFORMIN POOR RENAL FUNCTION?
NOT RECOMMENDED, HIGH RISK OF LACTIC ACIDOSIS IN AKI
SITAGLIPTIN RENAL IMPAIRMENT?
YEAH CALM, JUST REDUCE DOSE
SYMPTOMS OFNEUROLEPTIC MALIGNANT SYNDROME?
MENTAL STATE CHANGE
MUSCULAR Ls
HYPERTHERMIA
AUTONOMIC INSTABILITY
RED/PURPLE RASH SIGN OF?
STEVENS-JOHNSON SYNDROMEANTIEPILEPTIC ASSOCIATED+others
WARFARIN TARGETSAF/DVT/PE/HEART VALVE?RECURRENT DVT/PE?MECHANICAL HEART VALVE?
AF/DVT/PE/HEART VALVE? 2.5RECURRENT DVT/PE? 3.5MECHANICAL HEART VALVE? 3-4, even higher
ACUTE ISCHAEMIC STROKEINITIAL?ALTERNATIVE?
INITIAL? 300mg aspirin, (first 2 weeks)ALTERNATIVE? clopidogrel 75mg OR 300mg loading dose STEMI vs NSTEMI
Behaviours such as smoking, lack of physical activity, unhealthy diet, alcohol consumption, being overweight or obese, and loneliness that can be changed to reduce the risk of developing dementia.
SPC- use the info slow!
You are running a weight loss clinic and one of your clients explains to you that whilst she knows she needs to start exercising, she just doesn’t have the motivation to start yet. She recently thought about buying an exercise bike to use at home, but then lost her job and can no longer afford it.STAGE OF BEHAVIOUR CHANGE?
Contemplation
SCIATICA/CAUDA EQUINA SYNDROME S&S?
BLADDER LsNEUROLOGICAL WEAKNESSBILATERAL RADICULOPATHYINCAPACITATING NIGHT PAINUNRELENTING NIGHT PAINSTEROIDS/IV DRUGS
CKS guidelines for suspected cancer pathway referral (for an appointment within 2 weeks) if?
they are aged 40 and over with unexplained weight loss and abdominal pain or• they are aged 50 and over with unexplained rectal bleeding or• they are aged 60 and over with either iron-deficiency anaemia or changes in their bowel habit, or• tests show occult blood in their faeces• Consider a suspected cancer pathway referral for colorectal cancer in adults aged under 50 with rectal bleeding and any of the following unexplained symptoms or findings:- abdominal pain- change in bowel habit- weight loss- iron-deficiency anaemia
VINCRINSTINE/VINFLUNINE/VINORELBINEMETHOD OF ADMINISTRATION?
INTRAVENOUS ONLY!INTRAVENOUS ONLY!INTRAVENOUS ONLY!intrathecal-severe neurotoxicity-fatal
IMPETIGO BULLOUS TREATMENT?
FLUCLO, THEN CLARI/ERY
IMPETIGO NON-BULLOUS TREATMENT?
HYDROGEN PEROXIDETHEN FUSIDIC ACID, THEN MUPIROCINWIDE-SPREAD? SECOND LINE ABOVE
ANTIBIOTICS CAUSING C DIFF?
CEPHALOPSORINSCLINDAMYCINCO-AMOXICLAVQUINOLONESNOT AMINOGLYCOSIDESNOT DOXYCYCLINE
SEPSIS?
Slurred speech/confusionExtreme shivering/muscle painPassing no urineSevere breathlessnessIt fees like death wthSkin mottled/pale
MEDS THAT SHOULD NOT BE STOPPED PRIOR SURGERY?
ANTIEPILEPTICS
ANTIPARKINSONS
ANTIPSYCHOTICS
BRONCHODILATORSGLAUCOMA DRUGSIMMUNOSUPPRESSANTS
ALCOHOL MAXIMUM WEEKLY UNITS?
14
METHOTREXATE+CLOZAPINE/OLANZAPINE RISK?
NEUTROPENIA/AGRANULO…
GPHC 4 CPD ENTRIES
that’s TWO planned1 peer discussion1 reflective account
CHICKEN POX OTC ITCH PAEDS?
CHLORPHENAMINE 1MG EVERY 4-6HRS
CLINICAL AUDIT ETHICS APPROVAL?
NOT NEEDED SILLY, IS NOT A TRIAL
FOOD REFERENCE INTAKES?
Saturated fat 30g men, 20g womenSugars 30gSalt 6g
PURINE RICH FOOD?
RED MEATSEA FOODAVOID GOUT
HEP B VACCINE FACTS?
ACCELERATED SCHEDULESYMPTOMS- JAUNDICE/LOSS OF APPETITE/FEVERDELTOID SITE BEST- IM INJECTIONSTANDARD SCHEDULE- 20MCG- ZERO/ONE/SIX MONTHS
HIGH RISK INFECTIONENDEMIC AREASPOOR SANITATION/FOOD HYGIENEVACCINE?
TYPHOID
ROSACE SYMPTOMS TRIGGERS?
EMOTIONAL STRESSEXERCISESMOKINGSPICY FOODALCOHOLHOT/COLD TEMP.HOT DRINKS, NOT COLD
STEROIDSMILD?MODERATE?POTENT?VERY POTENT?
MILD? HydrocortisoneMODERATE? ClobetasonePOTENT? BetamethasoneVERY POTENT? Clobetasol
PPI CAUTIONS?
RISK OF FRACTURESGI INFECTIONSMAY MASK SYMPTOMS OF GASTRIC CANCERMAY REDUCE ABSORPTION OF VITAMIN B12, LONG-TERMPATIENTS AT RISK OF OSTEOPOROSIS
ATENOLOL CAUTION?
Sudden cessation of a beta-blocker may cause a rebound worsening of myocardial ischaemia & may cause exacerbation of anginaAnd impotence? ..
ADRENALINE ANAPHYLAXIS DOSING?CHILD UP TO 6 MONTHS?CHILD 6 MONTHS–5 YEARS?CHILD 6–11 YEARS?CHILD 12?+every 5 mins
CHILD UP TO 6 MONTHS- 0.1–0.15 mLCHILD 6 MONTHS–5 YEARS- 0.15 mLCHILD 6–11 YEARS- 0.3 mLCHILD 12–17 YEARS- 0.5 mL | 0.3 mL should be given if child is small or prepubertal300 micrograms to be administered if child is small or prepubertal.0.3 mL should be given if child is small or prepubertal300 micrograms to be administered if child is small or prepubertal.ADULT 500 micrograms- 0.5 mL repeat after 5mins if necessary…
CARBIMAZOLE MHRA WARNING- AGRANULOCYTOSIS/NEUTROPENIA?
SORE THROATMALAISEFEVERBRUISINGnot diarrhoea!
COMMUNITY, HYPOGLYCAEMIA 1ST LINE?
150-200ml fruit juice15-20g glucose/sucroseGlucagon injection ONLY if hypoglcaemic unresponsive/can’t use oral route
WHAT IS A MISSED PILL?
> /=24 HOURS LATE
SCABIES- webbing of fingers/toes, papulesTREATMENT?
permethrin 5% cream over the counter and applies it to the whole body paying special attention to the areas between the fingers and toes and under the nails.
NSAIDs warnings?
BLEEDINGBLACK STOOLSCOFFEE GROUND VOMIT!
GTN DISCARD?
8 WEEKS AFTER OPENING! G
ISPAGHUA HUSK/BULK-FORMING ADVICE?
W/ PLENTY OF FLUIDS, TO AVOID INTESTINAL OBSTRUCTION+DO NOT TAKE BEFORE BED
AMINOSALICYLATESSORE THROATFEVERNOSEBLEED?
BLOOD DYSCRASIS? GP ASAP!
AMIODARONE-unintended weight losspalpitationshyperactivityBEST TEST?
THYROID TESTSYMPTOMS OF HYPERTHYROIDISM!
PATIENT TAKING WARFARINDIZZZINESS DARK STOOLSTEST?
HAEMOGLOBIN- SYMPTOMS OF GI BLEED
LITHIUMDIZZINESSCONFUSIONTEST?
SODIUM- risk of hyponatraemia
ADULT MALE, ANAPHYLAXIS COMMUNITY?
300MCG???
black triangle- limited experience
REPORT ALL ADRs!
SEVERE MUSCLE JOINT PAINTTENDONITISADMITTEDCIPRO/QUINOLONES
ESTABLISHED BUT SERIOUS SO REPORT!
DOMPERIDONE+FLUCONAZOLE?
INCREASES QT INTERVAL PROLONGATION, AVOID!
CLOPIDOGREL+ESCITALOPRAM?
RISK OF BLEEDING!
SPIRONOLACTONE+FUROSEMIDE RISK?
K+ sparing and loop?HYPONATRAEMIA RISK!
TRANEXAMIC ACID DOSING?
2 TABS TDS 4 DAYS, SYMPTOMS ALLEVIATED
ORLISTAT, ADEK?
IMPAIRS ABSORPTION OF FAT SOLUBLE VITAMINS, GIVE MULTIVTAMIN SUPPLEMENT BEDTIME!
OMEPRAZOLE MAXIMUM OTC SUPPLY?
2 WEEKS AS P!
IBUPROFEN AND CHICKEN POX?
AVOID!SEVERE SKIN/SOFT TISSUE COMPLICATIONS!
DRY ITCHY PATCHES KNEES/ELBOWS?
ATOPIC ECZEMA
REPEAT TREATMENT TWO WEEKS AFTER INITIAL?
THREADWORM
LITHIUM+SERTRALINE/SSRI?
RISK OF SEROTONIN SYNDROME!
ISOTRETINOIN FEMALE, PPP, SHORT EXPIRY?
7 DAYS- UNDER PPP, DISPENSE ASAP
SATIVEX PRESCRIPTION VALIDITY?
28 DAYS- SCHEDULE 4
POM/PRIVATE PRESCRIPTION RECORDS DURATION?
2 YEARS
VET PRESCRIPTION DURATION?
5 YEARS!
MEDS THAT NEED TO BE STOPPED PRIOR TO SURGERY?
HRTPILLLITHIUMACEANTICOAGMUST NOT BE STOPPED? ANTIEPILEPTICS, cmon
COMMON HYPO IN SHORT BOWEL PATIENTS?
HYPOMAGNESAEMIA
KIDNEY STONES TREATMENT
PARACETAMOL NSAIDs- check dosing, when is it PR/rectum/when required?OPIOIDSTAMSULOSIN, FEMALE, UNLICENSED
ANTIDIABETIC DRUG ACUTE PANCREATITIS?
DULAGLUTIDE
DEMENTIA, WITH LEWY BODIES, FIRST LINE?
DONEPEZIL
CITALOPRAM, SSRI, FLUOX, PRACTICALLY FIRST LINE
RAMIPRIL CAUSES HYPER..?
HYPERKALAEMIA
WHICH ANTICOAGULANT NEEDS TO BE TAKEN WITH FOOD?!
RIVAROXABAN, THEREFORE DIET KEY! AAAAH
SIMVASTATIN+AMLODIPINE?
RHABDOMYOLYSIS
METFORMIN INITIAL DOSING?
OD, increasing to TDS after 2 weeks
HYPOGLYCAEMIA TREATMENT?
TWO TUBES OF 40% GLUCOSE GEL
HYPERTHYROIDISM TREATMENT?
LOW TSH, HIGH T3/T4
HYPOTHYROIDISM TREATMENT?
HIGH TSH, LOW T3/T4
Valproate, PPP, best contraceptive?
IUD
DOXYCYLINE INAPPROPRIATENESS?
BABIES, TEETH, STAINING, ETC, CMON!12 YEARS+!
ORBIT TOOL?
most accurate for predicting the risk of bleeding in people with AFhasbled basically same
TRAMADOL+SSRI?
SEROTONIN SYNDROME!
VACCINE, POST-IMMUNISATION PYREXIA?
meningitis B
MEBENDAZOLEMINIMUM AGEPREGNANCYMAX. SINGLE DOSEMAX. PACK SIZE
2+AVOID100MG800MG
RHINITIS TREATMENT?AVOID?
TREATMENT?antihistamineschlorphenaminedecongestantseye dropsAVOID? NASAL STEROIDS- only for 18+, max. 3 months use
WARFARIN+DOXYCYCLINE?inhibitor
HIGH INR SKRR
DRUG CLASSESCHLORTHALIDONE?INDOMETHACIN?RANOLAZINE?
DIURETICNSAIDfor ANGINAREMEMBER DAMNdiurecticsacemetforminnsaidscan stop top first two safe
UTI BACTERIA?
E COLI!
CAP/MENINGITIS? UTI? THRUSH? CELLULITIS?
CAP/MENINGITIS? Streptococcus PneumoniaeUTI? Eschericia ColiTHRUSH? Candida AlbicansCELLULITIS? Staphylococcus Aureus
NITRATES SIDE-EFFECTS?
DIZZINESSFLUSHINGHEADACHESPALPITATIONSSYNCOPENOT MALIGNANT HYPERTHERMIA!!!
METFORMING SELF-MONITORING?
NOT NEEDED G
DRUGS THAT CAUSE GORD?
A-BLOCKERS BENZODIAZEPINE B-BLOCKERS COCORTICOSTEROIDS NSAIDs NITRATES TCAs
CAN CAUSE GORD?NOT?
CAN CAUSE GORD?alendronic acidamlodpinenaproxenprednisoloneNOT?indapamide
SEDATING ANTIDEPRESSANT?
MIRTAZAPINE!
LITHIUM MONITORING?
BMIeGFRThyroidUrea+electrolytesNOT LIVER
CCB OD TREATMENT VERAP?
ACTIVATED CHARCOAL in 1hr
Iron tablets, consipation, GI, nausea, action?
TAKE THE MEDICATION WITH OR AFTER FOOD
PATIENT WITH RECURRENT DEPRESSIONHOW LONG TREATMENT?
AT LEAST 2 YEARS
CHILDTEETHINGCHEWING BITING?
Paracetamol suspension calm
DYSLIPIDAEMIAPRIMARY?SECONDARY?
PRIMARY? Inherited genetic mutation to LDLR geneSECONDARY?Excessive alcohol consumptionHypothyroidismLiver diseaseUncontrolled diabetes mellitus
IBUPROFEN IN CHICKEN POX????
NO WAY!!!!!!!!
HEAD LICE ADVICE?
GO SCHOOL KIDCOMBINGTREAT EVERYONE SAME DAYWASH CLOTHES/BED SHEETS HIGH TEMP
URTICARIA S&S?
Batches of red/skin-coloured weltsSevere itchingSwelling angio, lips/eyelids/sore throat
VITAMIN FORFATIGUE?LETHARGIC?FAINT?
VITAMIN B12
FINASTERIDE, CYTOTOXIC, DOSEETE LLOW IT
GABAPENTIN, SCHEDULE 3 SO PRIVATE FORM?
NEEDS CORRECT SCRIPT FP10PCD
OLANZAPINE, NRT, STOPS SMOKING, ACTION?
REDUCE OLANZAPINE DOSE!
OLANZAPINE, NRT, STOPS SMOKING, ACTION?
REDUCE OLANZAPINE DOSE!
IMPETIGO NON-BULLOUS FIRST LINE?
HYDROGEN PEROXIDE|||FUSIDIC ACID
PHARMACY RECORD BOOK YEARS?
5
DPI TECHNIQUE?
STRONG AND DEEP
pMDI technique?
SLOW AND DEEP
ISOTRETINOIN PPPVALIDITY?
7 DAYS>30 DAYS SUPPLY IS CALM IF NOT UNDER PPP!
PATIENT SILDENAFIL ON PRESCRIPTIONCAN GET SUPPLY NEXT WEEKLLOW OTCSALBUTAMOL ISSUE YES BUT ITS PRN?
THEOPHYLLINE TOXICITY?
AGITATIONCONVULSIONSDILATED PUPILSVOMITINGNOT BRADYCARDIA
LANSOPRAZOLE SUMMARY?
MEASURE MG2+FRACTURESGI INFECTIONSGASTRIC CANCERREDUCE ABSORPTION OF VITAMINB12 W/ treatmentOSTEOPOROSIS
OPIOID OD TREATMENT?
NALOXONE
MICONAZOLE, FUNGAL DIRECTIONS?
SKIN- apply twice daily continuing for 10 days after lesions have healedORAL- 2.5ml QDS+ 7 days after
prednisolone received repeated courses in a year?
a 5-day course of prednisolone 40 mg then wean gradually
NUTRITIONAL DEFICIENCYBLEEDING GUMS?
VITAMIN C
NUTRITIONAL DEFICIENCYPROLONGED BLEEDING AFTER SMALL CUT?
VITAMIN K
NUTRITIONAL DEFICIENCYdermatitis sun-exposed skin/diarrhoea/depressionRECENT TB TREATMENT?
VITAMIN B6 (PYRIDOXINE)
BASAL BOLUS REGIMEN, TYPE 1?
NovoRapid (insulin aspart) three times daily with meals and Lantus at night
INTERMEDIATE-ACTING REGIMEN?
INSULTARDISOPHANEHUMULIN I
MOLLUSCUM CONTAGIOSUM S&S?
PINKISH/PEARLY WHITE PAPULESSWELLINGROUND FIRMMOST COMMON AGED 1-4
MILIARIA/HEAT RASH S&S?
RED BUMPSPRICKLY/ITCHY FEELINGTINY BLISTERSINFLAMMATION
An infection of the dermis and subcutaneous tissues, commonly in the lower leg. Affected skin feels warm, may look swollen and looks red and inflamed. The infected area may spread and is usually tender. Sometimes blisters occur on the skin.
cellulitis!
RUNNY NOSECOUGHFEVERCONJUNCITIVITIS?
MEASLES
HEADACHEUNILATERAL PAIN BEHIND EYE, COMES AND GOESWATER EYELID SWELLINGFLUSHINGEVERY 3 MONTHS
CLUSTER!
HEADACHE OVER WHOLE HEAD- TIGHT BANDWORSENS AS DAY GOES ONNO NAUSEA/PHOTOPHOBIA (migraine)
TENSION!
A 42-year-old man complains of a severe headache of sudden onset 3 hours ago, likened to being kicked in the back of the head. He has vomited twice and is now feeling stiff in his neck
SUBARACHNOID HAEMORRHAGE!
SSRI DROWSY CONFUSED, LEVELS?
HYPONATRAEMIA!
SALBUTAMOLTIREDFATIGUECONSTIPATION?
HYPOKALAEMIA!
CROUP TREATMENT?
STEROID, PREDNISOLONE!
PROPYLTHIOURACILHIGH BILIRUBIN LEVELSFATIGUEJAUNDICEABDOMINAL PAIN
LIVER DISORDER!!
ROPINIROLE ADR?
BINGE EATING!STOP
TRIMETHOPRIM BLOOD DYSCRASIA?
MOUTH ULCERS!
ZOLEDRONIC ACID/BISPHOS CAUTION?
OSTEONECROSIS OF JAWREDUCED DENTAL MOBILITYsame thing kinda
TAMSULOSIN OTC BPHCAPSULES STRENGTHAGEDURATION?
400mcg caps45-75UP TO 6 WEEKS
AIZTHROMYCIN OTC CHLAMYDIAAGEMAXIMUM DOSE/DAILY DOSE/PACK SIZE?
16+1G ONLY!
ORLISTAT OTCMINIMUM AGE?
18 YEARS
HYDROCORTISONE 1% CREAM OTCMINIMUM AGE?DURATION?
10+1 weekdermatitis/insect bites/mild-moderate eczema
A mother brings her 6-year-old son into your pharmacy. The child has had a cold for the past two days, but his symptoms have worsened. He now complains of mild headache, general aches and tiredness. This morning he has developed an itchy rash on his face and body. The child has no other medical conditions and no known allergies?
CHICKEN POXPARACETAMOLAVOID IBUPROFEN NO NEED FOR GP
RESPIRATORY TRACT INFECTION ORGANISM
STREPTOCOCCUS PNEUMONIAE!
HIGH CREATININELOW EGFRDRUG
NAPROXEN!
3 YEAR OLD PARACETAMOL DOSE?
180MG! QDS
A woman with type 2 diabetes needs to commence insulin treatment and would like to use an insulin preparation that is injected subcutaneously twice daily with meals. SUITABLE INSULIN?
Humalog Mix25 (biphasic insulin lispro)NOT NovoRapid, that requires another, combo
You want to obtain guidance on the record keeping requirements for the management and monitoring of vaccine stocks in a pharmacy.SOURCE?
Immunisation against infectious disease(known as the Green Book)
RIVAROXABAN & DIPYRIDAMOLE?
BOTH ANTIPLATELETSHIGHER RISK OF BLEEDING!
LOWER BACK PAINWhilst gardeningBest analgesic?
ibuprofen 400mg tablets
ESCITALOPRAM (SSRI) & DABIGATRAN (antiplatelet)interaction?
bleeding risk increased
METHADONE & CITALOPRAM INTERACTION?
QT-INTERVAL PROLONGATION
FLUOXETINEdrowsinessnauseaconfusionSIDE-EFFECT?
HYPONATRAEMIA
FUROSEMIDE- worsened heart failurefatiguedizzinessmuscle spamsSIDE-EFFECT?
HYPOKALAEMIA
DRUG, BLACK TRIANGLE, mild headache/side-effect?
limited experience of the use of this product– report
Purpose of benzalkonium?
it prevents microbial growth in the drops after the bottle is opened
A 55-year-old man approaches you regarding his nasal congestion. He tells you in addition to congestion in his facial sinuses, he has a continuously runny nose and can feel mucus in his throat. He is not experiencing other symptoms and OTC medicines haven’t helped. He does not have watery eyes and he is not sneezing very often.MOST likely?Seasonal?Persistent?
MOST likely? persistent allergic rhinitisSeasonal? sneezing and watery eyesPersistent? congestion with post nasal drip
Erythromycin, alternative to azithromycin (1g single dose), chlamydiaBUT..?
Needs 14 days
Hypokalaemia symptom?
NAUSEAFATIGUETINGLING
serum phosphate level?
1.12 to 1.45 mmol/L
HOW TO DISPOSE OF CD AEROSOL/SPRAY?
aerosols and pump sprays should be discharged directly into the denaturing kit. Once empty the can or pump spray can be thrown away with the pharmacy waste
Drugs that cause confusion?
THINK SEDATIVE/ELECTROLYTE IMBALANCESOxazepamGliclazideCo-codamolBendroflumethiazideNOT Ramipril
Chemotherapy, MOST likely N&V?
Platinum, cisplatin
A new mother comes to ask for advice about her two-month-old son. She tells you that she is at her ’wits end’ as he won’t stop crying. No matter what she does to console him it doesn’t work. She tells you that this has happened for the last month and that he is worse in the evening. You also find out that her son is bottle fed, drinks well without posseting, is gaining weight as expected and is passing stools regularly. She tells you that she has changed his formula two weeks ago and tried Woodward’s gripe mixture to no effect. She wants to know if there is anything you can do or whether she should go to the GP.
E. The baby is healthy but does cry excessively, try to set up a sleep routine and give him lots of attention. It might be appropriate to signpost her to a support organisation as she appears not to be coping.(A month early for teething)
A 19-year-old man has come to ask for advice about his embarrassing hair. He has had to stop using hair products as he has a very dry, itchy and flaky scalp. On examining his scalp you find that the skin is very dry and badly scratched but there are no signs of inflammation or reddening. There are pale yellow-white flakes on the head and in the hairline. He wants to know if there is anything that will treat the problem and wants to know what is causing these symptoms.
seborrhoeic dermatitis
renal calculi symptoms?
Larger kidney stones can cause symptoms, including:pain in the side of your tummy (abdomen) or groin – men may have pain in their testicles.a high temperature.feeling sweaty.severe pain that comes and goes.feeling sick or vomiting.blood in your urine.urine infection.
Her consultant increased the dose of her atomoxetine again up to 80mg per day which she has been taking for the past month. She says that she has been feeling quite sad and tearful, for the past couple of weeks and often doesn’t want to do anything or see anyone. Today she has thought that everyone would be better off without her.
The correct answer is: she is experiencing a recognised side effect of the medicine, and that she should continue to take this as prescribed, as she will develop tolerance to it but should inform her consultant about how she feels.
An 86-year-old woman with low severity community acquired pneumonia has been prescribed amoxicillin to treat the infection. Cultures also revealed presence of staphylococcal involvement and the patient requires additional adjunct therapy. Add-on therapy?
Flucloxacillin can be used as an adjunct in pneumonia for infections due to beta-lactamase-producing staphylococciDoxycycline, clarithromycin and erythromycin are alternative antibiotics for atypical pathogens
Serevent drug?
SalmeterolGive the yutes salamol/salbutamol!
She explains that the child has a rash on their lower limbs which has spread to the rest of the body. The child has a high temperature which has not responded to doses of paracetamol and the child has been sick.
Meningitis, classic, spreading rash?!
A 4-year-old boy has been diagnosed with nocturnal enuresis. Despite following advice on diet and fluid intake given by the GP, his parents are still using absorbent pads on the child’s mattress and the boy goes to bed wearing pull up pants (training pants). The parents are asking for advice about medicines as they are finding it hard to afford the pads and pants on a limited budget.
For children under 5 years, treatment is usually unnecessary as the condition is likely to resolve spontaneously. Reassurance and advice can be useful for some families. an alarm would be the next step but may cause distress for such a young childThe correct answer is: reassurance and advice on management techniques
A 45-year-old man has been experiencing tiredness, reduced ability to exercise, breathlessness, occasional light-headedness, chest pain and heart palpitations. He is referred by his GP to hospital where he is diagnosed with atrial fibrillation.Following admission to the cardiology department of his local hospital, the patient is prescribed amiodarone.
Liver and thyroid function should be checked every 6 months not yearly
A 65-year-old man was diagnosed with heart failure due to left ventricular systolic dysfunction. He is currently prescribed enalapril 10mg bd and his doctor wishes to add a beta blocker at a very low dose which will be titrated very slowly over a period of weeks.
bisoprolol combined with an ACE inhibitor is the first line treatment for heart failure to reduce morbidity and mortality regardless of age.
A 58-year-old man has been admitted to hospital as an emergency patient. He has been diagnosed with a supraventricular arrhythmia (atrial fibrillation). The cardiologist considers prescribing an intravenous emergency loading dose but instead recommends oral therapy for rapid digitalisation.Which of the following statements regarding the use of loading doses of digoxin is least accurate?
Intravenous loading doses do not increase a risk of hypokalemia but may affect electrolyte balance and can affect renal function
A 45-year-old man has recently had eye surgery and has been given topical corticosteroids to take home and apply to reduce inflammation. He has read the patient information leaflet and is very concerned about using steroids as he has heard lots of ‘bad things’ about them.
Steroid eye drops do not cause conjunctivitis medicamentosa, glaucoma medication and reaction to other ingredients in a product is a more likely causeDOESN’T HAPPEN-> corneal infiltrates and corneal staining
A 66-year-old man has stable angina which is currently managed with sublingual glyceryl trinitrate. He is experiencing an exacerbation of symptoms and his GP decides that regular drug therapy is now required. The patient also has some left ventricular dysfunction.
A 66-year-old man has stable angina which is currently managed with sublingual glyceryl trinitrate. He is experiencing an exacerbation of symptoms and his GP decides that regular drug therapy is now required. The patient also has some left ventricular dysfunction.
Side-effects of high dose levothyroxine?
diarrhoeanervousnessinsomniatremors
A 46-year-old man has been administered 10 mg of midazolam by slow IV infusion prior to undergoing biopsy removal of a small lump in the side of his neck. Two minutes after commencing the infusion his respiratory rate was noted to be four breaths per minute. It is decided that sedation needs to be reversed urgently.
Flumazenil is the drug of choice for reversal of side effects of benzodiazepines as it is a benzodiazepine antagonist
A 46-year-old man with type 2 diabetes currently takes oral antidiabetic drugs. Recently he has been experiencing nocturnal symptoms such as waking with a headache, feeling unusually tired and experiencing seemingly unprovoked sleep disturbance. His doctor suspects that his blood sugar is not well controlled overnight and suggests the addition of insulin therapy.
Insulin glargine is a long-acting human insulin analog often administered at bedtime to patients with type 2 diabetes. It reduces fasting blood glucose levels more efficiently and with less nocturnal hypoglycemic events
A 56-year-old woman has acute angle closure glaucoma. She is experiencing stress incontinence when she exercises, coughs or laughs which she finds extremely embarrassing. She is fed up with using Tena lady pads which are expensive, inconvenient and uncomfortable and seeks medical advice. You are asked by her prescriber to recommend an effective treatment.
Duloxetine is effective for stress incontinence and will not affect her glaucoma. Other products are either contraindicated or less effective for stress incontinence
A 54-year-old woman is going through the menopause. She tells you that she feels dry ‘down there’ and that she has recently been experiencing itching. There is no discharge or odour. She tells you that sexual intercourse with her husband is painful as a result.
The patient does not have an infection and appears to be suffering from menopausal atrophic vaginitisA cream containing an oestrogen may be applied on a short-term basis to improve the vaginal epithelium The correct answer is: topical vaginal oestrogens
A newborn baby is to have a blood sample taken using a heal prick test after the parent verbally consented to testing
The heal prick test is used to screen for 9 rare conditions: sickle cell, cystic fibrosis, congenital hypothyroidism, phenylketonuria (PKU), medium-chain acyl-CoA dehydrogenase deficiency (MCADD), maple syrup urine disease (MSUD), isovaleric acidaemia (IVA), glutaric aciduria type 1 (GA1), homocystinuria (pyridoxine unresponsive) (HCU)
A 65-year-old man has been offered an ultrasound screening test as part of a national screening programme for men age 65 – 74 aimed at reducing mortality
Abdominal Aortic Aneurism screening has been rolled out across the UK for men over 65 who are at the highest risk of problemsThe correct answer is: abdominal aortic aneurism
A woman who is 12 weeks pregnant has consented to a blood test after being offered a screening test by her midwife at her first appointment
Screening for Down’s syndrome , Edwards’ syndrome and Patau’s syndrome is available between weeks 10-14 of pregnancyThe correct answer is: Down’s syndrome
A 7-year-old child comes into the pharmacy with his mother. The child has one reddened eye with a purulent discharge, he tells you he feels a gritty sensation in his eye. He is not experiencing any pain, there is no sensitivity to light and he does not use contact lenses
The child is exhibiting symptoms of bacterial conjunctivitis and as there are no additional symptoms of concern this can be treated effectively over the counter with a recommendation to refer if symptoms do not improveThe correct answer is: recommendation of an over the counter medicine product, with referral to GP if symptoms persist after 5 days
A 3-year-old child comes into the pharmacy with her mother. The child is suffering from nasal congestion and cold symptoms. Her mother tells you that the child has been pulling at her ear and has been withdrawn for the past couple of days
the child is likely to have otitis media which cannot be treated effectively over the counter. the child is likely to be in pain and should be referred to see GP promptlyThe correct answer is: no recommendation of an over the counter medicine sale but immediate referral to GP
An 8-year-old child comes into the pharmacy with his father. The father explains the child fell off some play equipment in the park quite heavily about 10 minutes ago and is complaining of a headache. The father also tells you the child had a nosebleed in the park which has now stopped. On talking to the child it becomes apparent that he is experiencing blurred vision to some degree
The parent should take the child to A+E as there is evidence of a concussion. The child is coherent and able to speak so an ambulance is unnecessary unless the parent cannot get to the hospital.The correct answer is: no recommendation of an over the counter medicine sale but immediate referral to secondary care
A 7-year-old child requires a reliever medication for their worsening asthma, which reliever medication should not be prescribed for this child unless they were regularly using a steroid inhaler?
Formoterol is a long acting beta2 agonist and should only be prescribed alongside inhaled corticosteroids. a short acting reliever should be prescribed of acute symptoms as formoterol will not act quickly enough in the event of an asthma attackThe correct answer is: formoterol
An 8-year-old child has been admitted to hospital exhibiting symptoms of Churg-Strauss Syndrome. Which of the medicines listed above if taken by this child would most likely be responsible for the symptoms?
Churg-Strauss syndrome has occurred very rarely in association with the use of montelukast; in many of the reported cases the reaction followed the reduction or withdrawal of oral corticosteroid therapy.The correct answer is: montelukast
A 6-year-old child has been taking an inhaled short acting beta2 agonist, regular high dose inhaled corticosteroid and an inhaled long acting beta 2 agonist. Their asthma has recently worsened and their doctor has decided to trial additional medication for 6 weeks. Leukotriene receptor antagonists and modified release oral beta 2 agonists have been tried without success. Which would be the next appropriate trial option for this patient
If MART therapy fails and other agents are not suitable a trial of an additional drug such as modified release theophylline may be considered. In reality this child needs referring to specialist careThe correct answer is:theophylline
A 53-year-old woman takes medication for hypertension which is well controlled. Her GP diagnoses her with depression and decides to prescribe an antidepressant. Which of the above drugs is the most likely to cause hypertension and affect control of her blood pressure?
Venlafaxine is known to commonly affect blood pressure causing hypertension as a side effect. This drug should be avoided in the patient.The correct answer is: venlafaxine
A 55-year-old man had a myocardial infarction 3 weeks ago; whilst under his consultants care he was diagnosed with depression The consultant decides it is necessary to treat with medication. Which of the above drugs would be contraindicated for this patient?
Amitriptyline is contraindicated in the immediate recovery period after a myocardial infarction and should not be used.The correct answer is: amitriptyline
A 45-year-old female asks to purchase Feminax Ultra for period pain. When asked about prescribed medication she informs you he is taking fluoxetine 20mg OD for depression.
Both naproxen and fluoxetine can increase the risk of bleeding. the answer is A
A 52-year-old man asks to purchase pseudoephedrine for nasal congestion, when asked about prescribed medication he informs you he is taking phenelzine 15mg OD for depression.
Pseudoephedrine is predicted to increase the risk of a hypertensive crisis when given with phenelzine. Manufacturer advises avoid and for 14 days after stopping the MAOI.
A 76-year-old woman, takes amiodarone for heart failure. She was prescribed domperidone 10mg TDS two days ago for the relief of nausea and vomiting.
Domperidone increases the risk of QT-prolongation when given with amiodarone. Manufacturer advises avoid.The correct answer is: prolonged QT interval
TAMSULOSIN OTC SUPPLY?
MALE 45-75MINIMUM 3 MONTHS SYMPTOMSContraindication: glaucoma/cataract
OTC MAALOF (ATOVAQUONE W/ PROGUANIL)?
18+, >40KGREPEAT DOSE IN 1HR IF VOMITUP TO 12 WEEKSONE DAILY
ANTI-EPLIEPTICSAFE IN PREGNANCYX teratogenicity?
LEVETIRACETAM
Fidaxomicin treats C. dif, not increase risk!
PPI increase risk of?
C diff
osteonecrosisear painpain swallowingwhat drug?
alendronic acid!
EllaOne+POP?
Reduces effectiveness, don’t start POP yet, use barrier method!
Oramorph 10mg/5ml schedule?
schedule 5!
CD EMERGENCY SUPPLIES?
SCHEDULE 5 YH3 EXCEPTION, PHENOBARBITAL
Inappropriate antibiotic for Candidal vulvitis or Vaginal candidiasis infections?
Metronidazole- NOT fungal, issa fungal infection
Tinea cruris?
ThighsButtocksJock itch!
ultra-long acting insulin?
Tresiba- DEGLUDEC
NOT notifiable disease?
Chicken poxCellulitis
Food rich in vitaminb12?
EGGS! N meat, vegans lacking
Sevelamer treats?
Hyperphosphataemia
Chloramphenicol issues?
AgranulocytosisGrey-baby syndrome
CD FAXED SUPPLY?
UNACCEPTABLE!
RITONAVIR+OMEPRAZOLE?
NO INTERACTION! HIV
SCHEDULE 4 PART 2?
CLENBUTEROL
ACICLOVIRVIALS QBREAK IT DOWNSIMPLEST!
WHISTLEBLOW FIRST!
Bisphosphonates, renal impairmentDO NOT USE?
CrCL <30 mL/min
cough with or without sputum, general malaise, and fever?
Viral infection probs
CD, LEGAL RESTRICTION ON SUPPLY?
Home Office ‘advise’ 30 daysNo actual restriction though… clarify if>1month
No regular meds, bleeding gums?
Floss your teeth akh
Lorazepam, schedule 4, repeatable?
yes
Symptoms of psoriasis?
red, scaly lesionssilver scalesplaqueknees/hands/elbow/scalpNOT fever
Isosorbide mononitrate side-effect?
Headache
BisphosphonatesAvoidCrCl
30ml/min
EXENATIDEGLP-1 RECEPTOR..?
AGNOISTNOT ANTAGONIST!
Indapamide time of day?
MORNING!
What are signs of primary dysmenorrhoea?
back paindull & continouspain decreases once period beginspain starts just before period starts
What schedule is Temazepam?
Schedule 3
What schedule is Diazepam?
Schedul 4 part 1
What b-blocker is NOT good for OD dosing?
Propranolol, acting, etc
How do you treat a penicillin-allergic patient with cellulitis near the eyes or nose?
Clarithromycin with metronidazole
What are the legal requirements for CD requisitons?
name of recipientpurposesignature of recipienttotal quantity
osmotic diuresis- uncontrolled diabetes- hypokalaemia- digoxin toxicity
Maximum number of days advised for CDs?
30
What is a safe laxative in pregnancy?
Lactulose
What is the risk with Simvastatin with bezafibrate?
Rhabdomyolysis
What are secondary complications of type 2 diabetes?
Cardiovascular disease, diabetic nephropathy and neuropathy are secondary complications of diabetes.
What is the written info needed for patients taking cytotoxic meds?
intended regimentreatment planmonitoring arrangementsprotocolspecialist contact
What does MDRD stand for?N
MDRD stands for ‘modification of diet in renal disease’.
Can we use suppositories in proctitis?
NO, contraindicated, can cause rectal irritation
What drug requires a dose reduction with verapamil?
Dabigatran
Alendronic acidAVOIDCrCl
35mL/min
Tell me about clarithromycin and renal impairment?
For immediate-release preparations, use half normal dose if creatinine clearance less than 30 mL/minute, max. duration 14 days.For modified-release preparations, use half normal dose if creatinine clearance 30–60 mL/minute.
What is the best long-term relief in osteoarthritis?
Paracetamol
What facilitates absorption of calcium?
Colecalciferol
What are some risk factors for coronary heart disease?
diabetesdyslipidaemiahypertensionlack of exercise
What are signs of pyelonephritis?
dysuriafeverflank pain
What is the advice regarding miconazole and breastfeeding?
Apply to nipples after feeding the baby
What is the interaction between amphotericin & digoxin?
Increased risk of digoxin toxicityconfusion/arrhythmias/nausea/visual disturbances
What are prednisolone side-effects?
increased appetitite- weight gain
Phenytoin injectable form
Risk of death?
What is appropriate cream treatment for athlete’s foot?
Recommend clotrimazole cream 1% applied twice daily and continuing for two weeks after the infection has cleared1% FOR ATHLETES2% FOR EXTERNAL VAGINAL THRUSH
What is age for xylometazoline?
6+
P.c meaning?
after food
Absorption of what drug is affected by magnesium trisilicate?
Tetracycline
Fludrocortisone/mineralcorticoid side-effects?
HYPERTENSIONhigh fluid retention, low anti…
GLUCOCORTICOID SIDE-EFFECTS?
AVASCULAR NECROSISDIABETESMUSCLE WASTINGOSTEOPOROSIS
Ramipril, tachy or brady?
Tachycardia
> 55 OR AFRO-CCB culture?
CCB START
<55 OR TYPE 2 DIABETIC?
ACE OR ARB
What are MHRA check points for avoiding prescribing errors?
right doseright medicineright patientright timeNOT right strength
What is yasmin?
Monophasic 21-day preparation
What’s the risk with fluoxetine+phenelzine?
SEROTONIN SYNDROME!CAN!
hypurin porcine neutral INSTRUCTION?
After subcutaneous injection onset of action occurs within 30-60 minutes”. Therefore it should be injected 30 minutes before meal.
What are symptoms of theophylline toxicity?
TACHYCARDIAVOMITINGAGITATIONRESTLESSNESSHYPERGLYCAEMIACONVULSIONSHYPOKALAEMIA
S&S?
Scabies- Babies could develop small blisters (that contain pus on the feet and palms of the hands). Distinct signs of burrowing are not always evident in babies.
What drugs can cause falls?
BenzodiazepinesDiureticsOpioidsPhenothiazinesNOT nsaids
Common reactions are those that occur in greater than and equal to 1/100, equating to 1% to <10%.U
Rifampicin in acute porphyria?
UNSAFE!
Mrs Smith has been taking 800 units of ergocalciferol for 2 weeks now because she has a lack of vitamin D.She develops nausea and has now vomited. What is the likely reason for this?
The vitamin D may have led to an increase in serum calcium causing the symptoms
What drug can induce convulsions?
Ciprofloxacin is a quinolone. The CSM has warned that quinolones may induce convulsions in patients with or without a history of convulsions; taking NSAIDs at the same time may also induce them.
What’s the condition?Mrs D administers two sprays of ipratropium bromide into each nostril twice daily for rhinorrhoea associated with allergic rhinitis. She is currently suffering from nose-bleeds secondary to the use of this medication.
Epistaxis
What is haematuria?
Blood in urine
What’s the issue?A patient is prescribed ertapenem for the treatment of a diabetic foot infection and has black, tarry stools as a side effect of this medication.
Melaena
What’s the issue?A patient is suffering from excessive skin sensitivity to non-noxious stimuli secondary to the use of nilotinib for the treatment of chronic myeloid leukaemia.
Hyperaesthesia
Issue presenting?
A 38-year-old male who presents with excruciating pain in his right ankle at night. He described the ankle as being ‘red, inflamed and feels warm’.Gout commonly affects the large toe but may also affect the ankles, heels, knees, wrists, fingers and elbows. It commonly occurs at night and may last 3-10 days.
S&S of anaphylaxis?
Common immediate signs of anaphylaxis are trouble breathing, reduced blood pressure and syncope. The following symptoms may also present: hives, swelling, a tingling feeling, itchiness, skin rash, nausea, vomiting, dizziness, diarrhoea and stomach cramps.
Methotrexate contraception treatment in male/female patient?
Manufacturer advises effective contraception during and for at least 6 months after treatment in men and women.
Treatment for alcohol cravings?
AcamprosateAcamprosate is indicated as therapy to maintain abstinence in alcohol-dependent patients. It should be combined with counselling. Disulfiram could be used, however, it acts by causing an acute sensitivity when Mr K drinks alcohol instead of resolving the alcohol cravings.
Treatment?Mr S, a 46-year-old security guard, presents with acute confusion, leg tremors and droopy eyelids. He recently been enrolled on an alcohol dependence programme but states that it’s a ‘waste of time’.
Parenteral thiamineMr S is experiencing effects caused by acute, severe thiamine deficiency, secondary to alcoholism.WERNICKE’S ENCEPHALOPATHY!
Potassium chloride and spironolactone issue?POTASSIUM SPARING DUH!!!
Cardiac arrhythmias- Spironolactone is a potassium-sparing diuretic and, taken together with potassium supplements, increases the risk of developing hyperkalaemia which may cause cardiac arrhythmias. This is a well-known drug interaction which may be fatal.
Warfarin and oral piroxicam issue?
Warfarin is predicted to increase the risk of bleeding events when given with piroxicam.GASTRO high piro
bee venom+ace?
ANAPHYLAXIS!
CCB OVERDOSE?
Single activated charcoal within 1hrRepeated if it is MR
Key issue with zonisamide?SR
Avoid overheating and ensure adequate hydration especially in children, during strenuous activity or if in warm environment (fatal cases of heat stroke reported in children).
BACLOFEN ISSUE?
DROWSINESS!
carbimazole serious issues?
Report symptoms including sore throat, mouth ulcers, bruising, fever, tiredness or non-specific illnesses to your doctor immediately
Digoxin and quinine issue?
Digoxin and quinineThe BNF states: plasma concentration of digoxin increased by quinine. Nausea and vomiting may be early signs of an excessive dose of digoxin
Pimozide and ketoconazole issue?
Pimozide and ketoconazoleKetoconazole is predicted to increase the exposure to pimozide. Manufacturer advises avoid. Ventricular arrhythmias are are potential effect of overdose with pimozide.
Sildenafil and isosorbide mononitrate issue?
hypotensive effect which may be fatal
This medication is indicated for bacterial vaginosis and is usually given at a dose of one applicatorful daily for 3-7 nights?
Clindamycin
MYCOPHENOLATE- MALE, YOU & PARTNER CONTRAMYCOPHENOLATE- FEMALE, TWO TYPES OF CONTRA
TreatmentMiss W is a 19-year-old patient who has developed several painful red lumps and patches (that measure 1-5 cm) on her lower legs.
Rest and ibuprofenThese lumps are characteristic of erythema nodosum. Treatment is usually rest and painkillers such as NSAIDs.
TreatmentMrs D comes into your pharmacy with her 5-year-old son. She tells you that her husband was diagnosed with ringworm one month ago and shows you a picture of a large swelling on a section of his scalp?
GriseofulvinScalp infection requires systemic treatment. The swelling on his scalp is a kerion, which could develop in severe ringworm infections, in this case tinea capitis. If left untreated it could result in hair loss and permanent scarring. It’s treated using griseofulvin.
Treatment?Mr A is a 42-year-old man who comes into your pharmacy. He shows you hyperpigmented patches on his trunk and back. They are not red or itchy
Ketoconazole shampooPityriasis versicolor, sometimes called tinea versicolor, is a common condition that causes small patches of skin to become scaly and discoloured (hypo/hyperpigmented). They usually occur on the trunk and back and upper arms. Pityriasis versicolor is caused by a type of yeast called Malassezia and is treated by ketoconazole shampoo.
Treatment?Miss Q is a 32-year-old female. She is a regular at your pharmacy. For the past year she has been suffering from a malar rash on her face, facial flushing, burning and itching papules and pustules. She has tried potent corticosteroid creams, which initially helped but then worsened her rash considerably.
was TetracyclineHer symptoms are those of acne rosacea which worsens with the use of topical steroids. The treatment is oral tetracycline.
ulipristal warning?!
MHRA/CHM advice: Ulipristal acetate 5 mg (Esmya®): further restrictions due to risk of serious liver injury (February 2021)
Haemoptysis
blood in the sputum
Measles very conatgious! vac
Wake up at on+wet bed?
Mebendazole
14 year old girl, inappropraite treatment cold/cough?
Aspirin 300 mg tabletsAspirin is contraindicated for use in children. Owing to an association with Reye’s syndrome aspirin containing preparations should not be given to children under 16. In this instance; Paracetamol can be used for mild-moderate pain and pyrexia. Ibuprofen can be used for fever with discomfort and pain. Guaifenesin and levomenthol solution can be used as an expectorant. Xylometazoline 0.1% nasal spray can be used as a decongestant.
Impulse disorders, levo or ropi?
RopiniroleImpulse control disorders (compulsive gambling, hypersexuality, binge eating, or obsessive shopping) can develop in a person with Parkinson’s disease who is on any dopaminergic therapy at any stage in the disease. Levodopa is also associated with impulse control disorders, however the answer reference given states: ‘Conversely, excessive sleepiness, hallucinations, and impulse control disorders are more likely to occur with dopamine-receptor agonists than with levodopa.’ Thus ropinirole is the best answer.
GLUCO SIDE-EFFECTS?
Glucocorticoid side-effects include diabetes, osteoporosis and muscle wasting. The other listed side-effects are associated with mineralocorticoids.
Usual thaizide bendro hypertensions dose?
2.5MG OD
Swollen gums, gingival hyperplasia, what drug?
migra
What drug?Brush teeth for one minute before spitting out. Avoid drinking or rinsing mouth for 30 minutes after use.
Duraphat®Sodium fluoride
It is important to ensure adequate hydration at all times in patients receiving higher-strength preparations of this drug.What drug?
Pancreatin
This drug is licensed for use in narcolepsy?
Dexamfetamine sulfateDexamfetamine sulfate is indicated and licensed for narcolepsy. Methylphenidate is indicated for use in narcolepsy but it is an off-licence use. No methylphenidate product is licensed for use in narcolepsy.
QT prolongation drugs The Amazing SpiderMan Q
TCA amiodarone SSRIS anti antipsychotics malaria quinine/quinolone
SICK DAY RULESSAD MAN
SGLT2ACEiDIURETICSMETFORMINARBsNSAIDs
SUPRAVENTRICULAR TACHYCARDIAS ONLY?
VERAPAMIL
Interaction with oral contraceptive pill?
St John’s Wort extract tabletsSt John’s Wort is a drug that induces hepatic enzyme activity. It interacts with the combined oral contraceptive pill and can considerably reduce its effectiveness by increasing its metabolism.INDUCE INHIBIT
A woman presents in your pharmacy asking for advice. She has been breastfeeding her child for 5 weeks. She is experiencing pain in both breasts which has recently started. Her baby has been unsettled during this time and also has bad nappy rash, along with white spots on it’s tongue.Which of the following is the lady most likely experiencing?
Thrush in the nipple/breastThe symptoms described are those of thrush (candida) infection in the breast. Breastfed babies can also develop thrush in their mouths, a sign for which in some babies is nappy rash that won’t clear up.
What are symptoms of mastitis?
swollenwedge-shape/hardburning
emergency supply prescription prescriber, present within?
72 hours
Miss T comes into your Pharmacy. She asks you about contraception. She’s on a combined oral contraceptive and wonders whether this is sufficient or if she should take further contraceptive precautions based on her medication.Which of the following medications do NOT result in the need for additional contraceptive precautions?
METOCLOPRAMIDEDoes need additional?Examples of drugs which induce liver enzymes are:antibacterials e.g. rifampicinantiepilepticsantiretroviralsSt John’s wort.
An elderly woman presents in the pharmacy on a Friday morning complaining of a bothersome headache.Which one of the following symptom clusters require you to make an urgent referral to the doctor?
Unilateral headache with malaise- could be temporal arteritis
Unilateral headache with associated nausea suggests?
Migraine
bilateral generalised headache and bilateral headache with symptoms that worse as the day progresses suggests?s
tension-type headache
unilateral frontal headache which worsens on bending down suggests?
sinusitis
METFORMINDIABETES/POLYCYSTIC OVARY SYNDROME DOSING?
500mg OD 1 week500mg BD 1 week500mg TDS 1 week
Impetigo organism?
Staphylococcus aureus
Which of the following types of literature would be deemed to provide ‘the best available evidence’?
Systematic reviewsSystematic reviews take into account all literature created, therefore, provide the best evidence in research.
Which one of the following is most likely to increase the anticoagulant effect of warfarin?
Cranberry juiceCranberry juice is an enzyme inhibitor. It slows the metabolism of warfarin, therefore, increasing its anticoagulant effect
What would decrease anticaogulant effect of warfarin?
Spinach and kale contain vitamin k which can reduce the anticoagulant effect of warfarin.
A mother of a 7-year-old boy asks you to look at her son’s sore right eye. On examination you notice that the eyelid has a slight swelling and the eyelid is a little red.Based on this information, what is the most likely diagnosis?
StyeThe most likely condition in this age group is either bacterial conjunctivitis or stye. As the boy has local pain associated with his eyelid, then stye is the most likely condition based on the symptoms listed. Chalazions are not normally associated with pain.
Effectiveness of thiazide diuretics is eradicated if eGFR
<30 mLs
FP10PCDs+ normal drugs, private scripts?
The doctor should be contacted as the paracetamol should be prescribed on a different prescriptionFP10PCD should be used for CD schedule 2 and 3, then original sent to NHS agency, whereas a private prescription for paracetamol needs to be retained in the pharmacy and therefore should not be prescribed on FP10PCD.
A 13-month-old child has bilateral, red, watery eyes with some pus noticeable at the corners of both eyes. Her mother takes her to the GP who diagnoses simple conjunctivitis.Which antibiotic is the most appropriate to treat this patient?
ChloramphenicolSome chloramphenicol preparations may be contraindicated in under 2s in the product literature. However, an MHRA review concluded that the benefits of chloramphenicol eye drops containing borax or boric acid outweigh the potential risk to children, including those aged 0 to 2 years.
You are working as the responsible pharmacist in a community pharmacy. A patient presents you with a prescription for oxycodone. The patient’s address and the prescriber’s address is in Geurnsey.What is the best course of action with this prescription?
Advise the patient to see a local prescriber to get a new prescriptionPrescriptions for schedule 2 and 3 CDs should be written by a prescriber with an address in the UK. The GMC advises that Guernsey is not in the UK. The patient should be advised to see a local prescriber to get a prescription so that they are not left in pain.
NSAIDs are commonly used for both their analgesic and anti-inflammatory properties.Which of the following NSAIDs has a maximum daily dose of 600 mg?
Etodolac
Mrs G, a 30-year-old female who is 4 months pregnant and lives alone, comes into your pharmacy complaining of persistent perianal pruritis that’s been keeping her up all night for the last couple of weeks. She is currently not taking any medicines or has any pre-existing medical conditions but does occasionally take lactulose for pregnancy-induced constipation. Also, one of her children was diagnosed with threadworm a month ago but this was treated successfully. What is the most appropriate advice you should give Mrs G?
Advise her to maintain hygiene measures for six weeks (e.g. cut finger nails and launder bedding and towels on a daily basis)It is likely the patient has caught threadworm from her child, but anthelmintics are not recommended during pregnancy and so the patient should be given advice regarding hygiene measure only, which should be followed for six weeks.
A 34-year-old woman has come in with her prescription for carbamazepine 200 mg three times daily. She asks you what the likely reason is for her maintenance dose to be higher than the dose she was started on, as her symptoms have not worsened since the start of treatment.What is the most appropriate explanation to give to this patient?
Carbamazepine is an enzyme autoinducer and thus a lower loading dose is required. Carbamazepine induces its own metabolism and so the maintenance dose is higher than the initial doses
You are providing some training on situation where patients may see blood in their faeces.Which of the following conditions does NOT cause rectal bleeding?
Hiatus herniaThe other conditions are associated with rectal bleeding.References:
Which schedule includes clenbuterol?
Schedule 4 Part 2
Which of the following could you sell to the patient without a prescription if you had a Pharmacy (P) pack of the product?
Atovaquone 250 mg with proguanil hydrochloride 100 mg tabletsMaloff Protect 250 mg/100 mg film-coated tablets (atovaquone with proguanil hydrochloride) was launched as a Pharmacy (P) medicine in June 2017.
Benzodiazepine OD treatment?
Flumazenil!
19-year-old male with signs of ataxia, dysarthria and nystagmus?
Alcohol
25-year-old female with dilated pupils, dry mouth and urinary retention.
Amitriptyline
Mr K, an 11-month-old boy, presents with a hoarse barking cough. He has had a cold for the past 2 days and his body temperature is 37.6°C?
Croup (or laryngotracheobronchitis) is a common condition which affects infants between the ages of 3 months and 6 years. Typically, the symptoms include a barking cough.
Mr L, a 9-year-old boy, presents with halitosis and dysphagia. His parents tell you that he coughs at night and is complaining of a burning sensation in his upper abdomen.
Gastro-oesophageal reflux disease (GORD) is a clinical condition which results from episodes of reflux of acid. It is characterised by heartburn. Further specialist investigations are required for this patient.
ppm=
mg/L
Cold sores treatment?
aciclovir 5%, 5 days
A 14-year-old boy and his mum ask for your advice as he has a sore mouth. A visual inspection reveals two small circular lesions on the inside of the gums. He says they are painful.Based on this information, what is the most likely diagnosis?
Leuoplakia and lichen planus are seen as patches rather than circular lesions; major ulcers are large; and trauma ulcers are irregular shaped.
You are treating Mr P who is a smoker. Medicine doses may have to be adjusted in smokers. Which ONE of the following is likely to require dose adjustment due to a drug interaction if patient starts or stops smoking?
Smokers may require higher doses of theophylline as it is cleared quicker in these patients. Those who stop smoking will need to have their dose adjusted, as they will no longer require the higher doses as in smokers.
This is your first shift at a registered pharmacy that prepares unlicensed medicines.With respect to the ingredients used in the preparation of an unlicensed medicine, which of the following is NOT a requirement for the record keeping process?
You should keep detailed records of the preparation of unlicensed medicines in order to safeguard patients (i.e. If there is an incident where a patient’s safety is affected, or the medicine should be recalled, the method of preparation could be reconstructed). For the ingredients used in the preparation, the following should be recorded:source (manufacturer, brand, wholesaler/distributor)certificate of conformitycertificate of analysisbatch numberexpiry datequantity used and details of person measuring and person double-checking quantitiesTSE guidance should be followed (where ingredient or product contact material is of animal origin)description of container/closure used (for example, were they were glass/plastic)
Mrs R is a patient who has AIDS. She has been diagnosed with mild pneumocystis pneumonia. She is unable to tolerate trimethoprim.Which single medication is the most likely treatment option for her pneumonia?
AtovaquoneAtovaquone is licensed for the treatment of mild to moderate pneumocystis infection in patients who cannot tolerate co-trimoxazole (co-trimoxazole is made up of sulfamethoxazole and trimethoprim - Note that Mrs R can not tolerate trimethoprim). The other options are suitable for severe pneumocystis infection.
Mrs S is a 26-year-old female who comes into your pharmacy to ask for your advice. Her doctor has asked her to book an appointment to receive the MMR vaccination. She tells you that she is planning to become pregnant and is worried about having this vaccination.Which one of the following is the most suitable response you can give Mrs S?
Rubella vaccination should be given to individuals who do not have immunity to the condition, including woman of child-bearing age. Avoid pregnancy for at least 1 month after vaccinationThis patient is not pregnant yet so can be given the MMR vaccine with advice regarding when it would be suitable to start trying for a baby (leave 1 month after injection).
A mother of a 5-year-old daughter wants some advice. Her daughter has recently developed a red rash on her face after being unwell with cold symptoms.Based solely on this information, which is the most likely condition causing the rash?
Erythema infectiosumPertussis does not have facial rash; psoriasis can have scalp involvement but lesions away from the hairline are rare; pityriasis rosea is associated with a rash on the body. This leaves atopic dermatitis and erythema infectiosum - both could show facial lesions. Based on other ‘cold-like’ symptoms erythema infectiosum is more likely. Its alternative name is ‘slapped cheek disease’.
A pregnant woman comes in to your pharmacy. She tells you that her friend has told her that ‘she should check if she has had a rubella vaccination and if she is immune to rubella’.What can a rubella infection cause in pregnant patients who DON’T have immunity to rubella?
Organ damage to the foetus during the early stages of the pregnancyThe mother passes the virus on the foetus and it damages their organs as they develop. This is known as congenital rubella syndrome (CRS). This includes the eyes (e.g. cataracts), ears (hearing loss), heart and brain. This could affect the child throughout their life.
You are providing a training session on food interactions with medicines.Which of the following is the LEAST likely to interact with grapefruit juice?
WarfarinWarfarin is not noted in the BNF as interacting with grapefruit juice. This gives an indication of the severity of the interaction. As warfarin isn’t listed here, it indicates that it is least likely to interact because there isn’t as much documented evidence.
You have been working on a cytotoxic rotation within your trust and are required to learn the eight side effects of cytotoxic drugs.Which of the following is NOT a side effect of cytotoxic drugs?
Excessive bone marrow productionExcessive bone marrow production is incorrect - cytotoxic drugs can cause bone marrow suppression.YES?alopeciaextravasationbone marrow suppressionhyperuricaemiamucositis
A patient newly started on tuberculosis treatment comes into your pharmacy with a bowel complaint.What is the most likely cause of flatulence?
EthambutolEthambutol can cause flatulence (frequency not known).
You are a registered pharmacist working in a medicines information role speaking to healthcare professionals and completing the occasional locum shift in a community pharmacy.How do the GPhC Standards for Pharmacy Professionals apply to you?
They apply in all your stated job rolesThe GPhC states: The standards apply to all pharmacists and pharmacy technicians. We know that pharmacy professionals practise in a number of sectors and settings and may use different ways to communicate with the people they provide care to. The standards apply whatever their form of practice.
Mr K is a 19-year-old student who presents with a lesion on his lower abdomen. He has been using hydrocortisone 1% cream but says that it hasn’t helped and the lesion is getting bigger.Given that Mr K has tinea corporis, which one of the following treatments is the most suitable to treat his lesion?
Terbinafine 250 mg tabletsDermatophyte infections such as tinea corporis may be exacerbated by prolonged use of topical steroids such as hydrocortisone as these exhibit immunosuppressive properties. Terbinafine is indicated in the treatment of tinea corporis.
You have just finished using a stock bottle of methadone in the pharmacy. You have dealt with any residue remaining in the bottle.How do you dispose of the bottle?
Remove labels and identifiers and place in recycling or general wasteOnce the contents have been dealt with appropriately the bottle can be placed in recycling or general waste after removing identifiers.
You want to obtain guidance on prescribing restrictions for podiatrist independent prescribers.Which of the following is the most appropriate reference source to use to find this information?
Medicines, Ethics and PracticeRestrictions by prescriber types are legal requirements and can be found in the MEP.
CALCS tips?
Mr L experienced an increase in hair growth and a “ringing in the ears” secondary to the use of diazoxide for the treatment of chronic intractable hypoglycaemia.
Hypertrichosis and tinnitus
Mrs R describes herself to you as “constantly active, unable to stop moving and feeling restless all the time”, as well as having “involuntary movements of her face”. You believe this to be side effects of fluphenazine decanoate she is currently using for schizophrenia.
Akathisia and tardive dyskinesia
For each of the following products sold over the counter, select the minimum age that they can be used from. Each option may be used once, more than once, or not at all.Nurofen® for Children 100 mg/5 mL.
3 months
Tramadol capsules 50 mg.
Place on the shelves in the dispensaryTramadol is a schedule 3 CD exempt from safe custody requirements.
Morphine sulfate oral solution 10 mg/5 mL.
Place on the shelves in the dispensaryMorphine sulfate oral solution 10 mg/5 mL is a schedule 5 CD. The requirement to record in the CD register or keep in the CD cupboard do not apply.
Co-codamol 8/500 mg effervescent tablets pack of 32.
Display the product behind the counterCo-codamol 8/500 mg is a schedule 5 CD and in a pack size of 32 tablets can be sold to the public if it has a P licence.
A French patient on holiday requesting citalopram usually prescribed by his local doctor.
Consider making an emergency supply if it can be clarified that the item has been prescribed by a valid prescriber beforeEmergency supplies at the request of an EEA or Swiss patient can be made.
An American mother on holiday in London requesting a salbutamol inhaler for her 18-year-old son which is usually prescribed by his local doctor. He has forgotten his inhaler but he is not currently having an asthma attack.
Advise the patient to see a local prescriber to get a prescriptionEmergency supplies cannot be made to American citizens. As the patient is at no immediate risk referring them to a local prescriber (rather than A&E) would be appropriate.
A Scottish lady in a Scottish pharmacy who is asking for dutasteride for her husband who has taken his last tablet this morning.
Advise that you must speak to the patient themselves before considering further actionThe pharmacist must speak to the patient before an emergency supply at the request of a patient is made.
An English patient visiting a pharmacy in the England, requesting morphine sulfate tablets because she will run out of these tomorrow.
Contact the patient’s prescriber to see if you can get them to send you an electronic NHS prescriptionCD prescriptions can be transferred via EPS and if the patient’s prescriber is happy to prescribe in this way, that prescription could be electronically transferred to the pharmacy.
Daktacort® 30 g cream.
Store at 2-8 °C
Ventolin accuhaler®.
Store at or below 30 °C
Reconstituted Augmentin® suspension.
Store at 2-8 °C
Daktacort® ointment.
Store at or below 25 °C
A 60-year-old Caucasian gentlemen with a recent blood pressure reading of 160/100 mmHg that was taken by the nurse in the surgery and a home blood pressure reading of 150/95 mmHg. He is not on any prescribed medication.Supplement: https://www.nice.org.uk/guidance/ng136/resources/visual-summary-pdf-6899919517
Lacidipine
A 52-year-old Caucasian lady with a recent blood pressure reading of 160/100 mmHg that was taken in the surgery, who has been taking ramipril at the maximum dose for the past 6 weeks. She has a prior history of low potassium levels.
LacidipineSTEPWISE! freshy!thiazide-like hypokalaemia? :(
A 54-year-old Afro-Caribbean gentlemen with a recent blood pressure reading of 160/100 mmHg taken by the nurse in the surgery and a home blood pressure reading of 150/95 mmHg. He is not taking any prescribed medication.
Lacidipine
A 50-year-old Caucasian lady who has been taking ramipril and amlodipine for the past 4 weeks at the maximum licensed doses for hypertension. The patient has a blood pressure reading of 170/105 mmHg that was taken in the surgery.
Indapamide
A 65-year-old Afro-Caribbean gentlemen with type 2 diabetes and with a recent blood pressure reading of 150/100 mmHg taken in the surgery by the nurse. The patient has been taking losartan and verapamil for the past 4 weeks at the maximum doses.
Indapamide
A lady seeks advice regarding an unpleasant condition. The lady complains that her vaginal region is itchy, inflamed with a thick white vaginal discharge.Which of the following would be the most likely causative organism?
Candida albicansThe patient is complaining of symptoms related to vaginal thrush. The common organism causing this kind of condition is candida albicans.
You differentially diagnose thrush in a 32-year-old female.Which symptom is LEAST likely experienced with thrush?
Discharge associated with a strong odourIn thrush, itching is the hallmark symptom; a white discharge does occur in a proportion of patients; dyspareunia and dysuria are possible but uncommon. However, discharge with odour is very unlikely.
You have a patient who is being treated for HIV. There are a variety of different drugs used in the treatment of HIV, one such class is protease inhibitors.Which of the following drugs is a protease inhibitor?
RitonavirRitonavir is a protease inhibitor used in the treatment of HIV.
You are teaching a summer placement student about side effects.Which of the following symptoms is most likely to be attributed to coumarins?
Bruising that may be heavy
A 55-year-old man presents his prescription for oxycodone 20 mg m/r tablets.Which of the following directions would be legally acceptable on a prescription for this medicine?
One as directedAs a minimum the directions for a control drug must include the quantity of the medicine to be taken at each dose.
An 81-year-old woman comes into the pharmacy seeking advice about a build-up of wax in both ears. She reports that there has been some discharge from both ears, however there is no pain. She has no other medical conditions and is not on any regular medication.What is the most appropriate advice to give to this lady?
The GP will be able to prescribe appropriate medication to treat the ear infectionThe discharge indicates an ear infection which would require further investigation by the GP and treatment with an antibiotic ear drop. Inserting cotton buds in the ear may lead to inner ear damage and it is not appropriate to syringe or use olive oil in the ears if they are infected.
You are providing a training session on food interactions with medicines.Which of the following is most likely to interact with grapefruit juice?
CiclosporinGrapefruit juice increases the concentration of ciclosporin. Manufacturer advises avoid.
You are writing a standard operating procedure for making CD records in the pharmacy.Which of the following is legally required to be recorded on receipt of a Schedule 2 CD?
Name of wholesalerThe name and address of whom the CD is received from is legally required to be kept in the CD register.
A patient on warfarin has had a recent decrease in their INR test result.What is the most likely cause of this?
Phytomenadione
A patient is admitted with a upper GI bleed. Which agent is the most likely cause of the bleed in this patient?
ClopidogrelClopidogrel has the highest risk of causing a GI bleed of the drugs listed.
Mrs PJ comes into the pharmacy. She asks your advice on the abdominal discomfort she is experiencing. She says she often suffers with diarrhoea and cramps, and that these symptoms seem to be worse when she feels anxious or stressed. Her Doctor has mentioned it is likely to be IBS.
Crampex (colecalciferol, calcium gluconate and nicotinic acid)All the other four options are indicated or suitable for the treatment of various symptoms of IBS - Crampex isn’t.
A middle aged man presents to the pharmacy complaining of epigastric pain.Which condition is most closely associated with pain seen in this region?
Gastric ulcerAppendicitis has central or right lower quadrant pain; diverticulitis and irritable bowel syndrome are associated with left lower quadrant pain; renal colic pain is usually in the loin area.
You have a patient who has been prescribed naproxen. The prescriber was considering to initiating them on to another medicine but this medicine has a severe interaction with naproxen.Which one of the following medicines has an interaction with naproxen which is graded as severe?
WarfarinThe BNF grades the interaction with warfarin as severe (red) but that with ramipril is graded as less severe (amber).
A patient presents in your pharmacy and asks you for advice.When he was cleaning his teeth this morning, he noticed bleeding from his gums. Which of the following is NOT a cause of bleeding gums?
AsthmaDiabetes, poor oral hygiene, pregnancy and smoking are all known causes of bleeding gums
When working in your community pharmacy, a patient complains about severe dental pain they have been feeling.Which of the patient’s long term regular medications should you flag to the GP as a potential cause of this pain?
Alendronic acidIt is a CHM warning that with bisphosphonates (particularly IV) there is an increased risk of osteonecrosis of the jaw.
A 20-year-old woman is going on holiday to Spain.Which of the following would be suitable advice to give her to help prevent her contracting travellers’ diarrhoea?
Only consume pasteurised milkAll fruits that can be peeled e.g. bananas are ideal for consumption as they are less likely to carry the bacteria that could lead to travellers’ diarrhoea. Uncooked vegetables and fresh salads have a higher chance of carrying bacteria that could lead to travellers’ diarrhoea. Tap water in many countries poses the same risk of bacteria, thus bottled mineral water is recommended for holiday makers. Pasteurised milk is safer to drink than unpasteurised milk as there is a lower risk of bacteria thriving in the milk and causing infective diarrhoea.
You receive a phone call from a doctor on the ward who is seeking advice regarding prescribing antibiotics. The doctor is unsure which antibiotic must be used with caution in patients with a history of epilepsy.Which of the following antibiotics must be used with caution in patients with a history of epilepsy?
CiprofloxacinQuinolones including ciprofloxacin may induce convulsions in patients with or without a history of convulsions. As such they must be used in caution in patients with a history of epilepsy.
You have just finished using a stock bottle of methadone in the pharmacy. You are unable to pour anything out of the bottle, but you can see that there are still traces inside.How do you record the residue liquid in the CD register?
You do not need to make a record of disposal of irretrievable amounts of CDsDisposal of irretrievable amounts of CDs does not need to be recorded.
You receive a requisition for a controlled drug.Which one of the following is NOT a legal requirement for the requisition?
Date of requisitionThe legal requirements for a controlled requisition are: signature of the recipient, name of recipient, address of recipient, profession/occupation, total quantity of drug and purpose of requisition.
A patient attends anticoagulation clinic for a routine INR check. The target INR for this patient is 2.5-3.5, however in clinic the INR reading is 5.2 with no associated bleeding.What is the most appropriate course of action in this instance?
Withold 1 or 2 doses of warfarin and reduce subsequent maintenance dose
Steroid creams are routinely sold over the counter.In which of the following situations can hydrocortisone 1% cream be recommended over the counter?
For contact dermatitis on the neck line of a post-menopausal femaleThis question refers to OTC supply - not prescription. It can be sold to treat allergic contact dermatitis, irritant dermatitis, insect bite reactions and mild to moderate eczema. However it may not be sold to children under 10 or in pregnancy except under medical advice. Contraindications include use on eye or face, anogenital region, broken or infected skin, acne or athletes foot. Use is restricted to a max. of 1 week.
You are training a counter assistant on medicines that may cause a dry mouth.Which ONE the following is most likely to cause dry mouth?
IpratropiumIpratropium is an antimuscarinic drug and therefore can cause dry mouth.
You have been asked to recommend a beta-blocker for a patient who usually suffers from cold extremities.Which of the following beta-blockers is the most appropriate for the patient concerned?
PindololISA and pindolol is the least cardioselective. ISA stands for intrinsic sympathomimetic activity. Intrinsic sympathomimetic activity (ISA, partial agonist activity) represents the capacity of beta blockers to stimulate as well as to block adrenergic receptors. Pindolol has intrinsic sympathomimetic activity; so it tends to cause less bradycardia than the other beta blockers and may also cause less coldness of the extremities.PACO!!!
You are adding some cautionary and advisory labels to medications prior to dispensing. Recommended cautionary and advisory labels are usually added to dispensing labels to inform the patient of key points about their medication. One advisory label tells patients to avoid sunlight and protect skin from exposure to sunlight.Which of the following medications would usually carry the warning to avoid sunlight when taking this medication?
DoxycyclineDoxycyline comes with advisory warnings to protect the skin from sunlight or sunlamps even on a cloudy day. Doxycyline makes the skin more susceptible to UV light and as such more susceptible to UV light damage.
The Misuse of Drugs Regulations 2001 (as amended) classify controlled drugs into 5 schedules according to the different levels of control attributed to each.Which schedule includes ketamine?
Schedule 2Ketamine is a Schedule 2 CD.
You are labelling prescriptions in your pharmacy.Which of the following is legally required on the dispensing label?
Date of dispensingThe date of dispensing is a legal requirement. All other options are good practice.
A 36-year-old woman has been experiencing irregular periods, weight gain and hair loss in the past few months. Her GP has prescribed metformin 500 mg tablets which she has been taking for 2 weeks.She returns to the pharmacy and explains that she is experiencing diarrhoea. What is the most appropriate advice to give to the patient?
She is experiencing a side effect of metformin - slow increases in dose can improve tolerability Gastro-intestinal side-effects are initially common with metformin, and may persist in some patients, particularly when very high doses are given. A slow increase in dose may improve tolerability.
Mrs J, a 41 year old, has a non-productive cough. You believe it to be a viral infection. She has hypertension and suffers from type 1 diabetes.What would be the most appropriate treatment/course of action?
Viral infections are self-limiting and no treatment is necessary, therefore it would be a suitable ‘recommendation’. A demulcent could be tried. As they are diabetic a sugar-free alternative would be useful but it is unlikely that a few days treatment with a demulcent containing sugar will affect their diabetic control. If a demulcent containing sugar is recommended then the person could be told to monitor their blood sugar more regularly. Cough suppressants and antihistamines have no evidence of efficacy and should not be recommended. An expectorant is only suitable for productive coughs.
Measles in community, what do you do?
Go home, call GP ASAP!
Adrenaline auto injectorx1 prescription, issue?
Need x2, carry 1, +1 back up, new script!
Sign of severe allergic reaction?
Change in voice, laryngitis!
Inappropriate TALL-MAN lettering?
GABApentin & preGABAlinbad!
Dentists- emergency buccal midazolamSedation for dental procedures should be limited to conscious sedation. Diazepam and temazepam are effective anxiolytics for dental treatment in adults.
WHAT ARE T H E L E G A L R E Q U I R E M E N T S F O R A CONTROLLED DRUG REQUISITION?
1 Signature of the recipient2 Name of the recipient3 Address of the recipient4 Profession or occupation5 Total quantity of drug6 Purpose of the requisition
Reqs CDsmark the requisition indelibly with the supplier’s name and address (i.e. the name of the pharmacy); where a pharmacy stamp is used this must be clear and legible• Send the original requisition to the relevant NHS agency
CD requisitions, original or copy?
As a matter of good practice, pharmacies should retain a copy of the requisition for two years from the date of supply.
Aspirin in hypertension?
ABSOLUTE NO NO!
Labetalol dosing?
100/200 BD acceptable
bupneorphin + naloxone?
Antagonist, deters IV misuse
Qeutiapine, ABx to avoid?
ErythromycinINHIBITOR!
Neuropathic pain?
GabapentinPregabalinAmitriptylineCapsaicinNOT tramadol
WHAT IS MHRA CLASS 2 DRUG ALERT?
The defect may cause mistreatment or harm to the patient, but it is not life-threatening or serious
WHAT IS MHRA CLASS 1?
The defect presents a risk of death or disability. Thesealerts will be issued via the Central Alerting System(CAS) as National Patient Safety Alerts.
WHAT IS MHRA CLASS 3?
The defect is unlikely to cause harm to the patient, andthe recall is carried out for other reasons, such as noncompliance with the marketing authorisation orspecification.
CLASS 2 ACTION WITHIN?IN
48 HOURS
domperidone+clarithromycin?
inhibitor g! domp levels up
Clear fluid from the wound?
You’re healing, you’re good
Levonelle, high BMI>26 kg/m^2?
DOUBLE THE DOSEOR JUST GIVE ULIPRISTAL!
Abdominal bloating+diarrhoea?
Sorbitol, cah it treats constipationa!
Animal bites treatment?
Co-amoxiclavDoxycyclineCMON
Orlistat+ oral contraceptive? CalmNOT CALM?
Under 18hypothyroidismcolecalciferol, deficinecy? nuts
WARFARIN+POMEGRANTE?
INCREASES INR, BAD!
WARFARIN+CRANBERRY?
POTENTIALLY INCREASES INR
WARFARIN+ SPINACH/KALE, contains vitamin K?MAYBE?
decreases INR!
GLP1 AGONISTS,NAUSEA, VOMITING, DKA
REPORT ASAP!
MOST likely with prostaglandin or timolol?
dry eyeeye lash growthpigmentationstingingNOT subconjunctival haemorrhage
HYPERTHYROIDISM?
YOU’RE ACTIVEYOU LOSE WEIGHT, LET’S GO!
GLP-1 agonist step of diabetes?
RIGHT AT THE END!
atorvastatin in type 2 diabetes?
Need QRISK>10% akh20mg still na?
Tramadol/morphine dosing?
Keep it consistentBD-BD
HRT endometrial cancer?
REDUCED!
hrt stop asap?
stomach pain, bleed PE :(
WHAT CONDITIONS INCREASED RISK OF TB?
Individuals with comorbidities or coexisting conditions (such as HIV, severe liver disease, chronic kidney disease, diabetes, eye disease or vision impairment, a history of alcohol or substance misuse, or who are pregnant or breastfeeding)
Consider the situationPatient collapsed, difficulty breathing, methadone can wait, just monitor symptoms of withdrawal
Concerns about local supply/record of CDs?
Shout the accountable officer!
unlicensed specials/import record keeping?
5 years
VET REQUISITION?CD REQUISITON?
VET ORIGINALCD COPY
VET CDs?
Veterinary prescriptions for CDs do not need to be written on standardised forms and do not need to be submitted to the relevant NHS agency. Forms must be retained for five years.
DOXYCYLINE, SUNNY DAY?
PHOTOSENSITIVITY, AVOID G!
INDEPENDENTS CAN’T DO?
DIAMORPHINEDIPIPANONECOCAINEHOME LICENSE G
FRIDGE ITEMS OUT, BEEN FEW DAYS, FIRST THING?
quarantine g?
tablets in blister packs?
Remove if CD, denature szn!
INJECTION NOT ALLOWED BY PHARMACISTS IN COMMUNITY?
FLUMAZENIL INJECTION!
bg after eating?
5-9! :D
HYPOGLYCAEMIA TREATMENT?
10-20G SUGAR CALM
HYPOKALAEMIA HIGH RISK?
SABASALBUTAMOLcheeky terbutaline!
CLINICAL AUDIT?
RELATE TO NATIONAL STANDARDS GWho cares about personal data? ras
most suitable for mcca?
Bumetanide g
2 drugs in IV infusion?
Myna
WARFARIN+ALCOHOL?
HEAVY REDUCTION IN INR, PEAK
Total cholesterol?
5 OR BELOW G!
hyperlipidaemia?
statins, not omega 3- lols,
APORMORPHINE RISK?
BINGE EATING :(
CICLOSPORIN+ITRACONAZOLE?
CIC LEVELS PEAK!
methylphenidate+amfetamine?
cardiac arrhythmias!NO NARCOLEPSY LLOWED G
FLUCLOXACILLIN BIG BOY SE?
CHOLESTATIC JAUNDICE
SIGNS OF NEPHROTOXICITY?
decreased urination, swelling from fluid retention and high blood pressure
SIGNS OF NEUROTOXICITY?
limb weakness or numbness, loss of memory, vision, and/or intellect, uncontrollable obsessive and/or compulsive behaviors, delusions, headache, cognitive and behavioral problems and sexual dysfunction.
SIGNS OF OTOTOXICITY?
Dizziness.Unsteady gait.Loss of coordination with movement.Vertigo (dizziness)Oscillating vision (in which objects appear to jump or vibrate)Aural fullness (a feeling that something is stuffed in your ear)Tinnitus (ringing in the ear) LOOP, furosemide!
desmopressin hyponatraemia!headachevomitingdisorientated
SIGNS OF HYPERCALCAEMIA?
NAUSEACONSTIPATIONPALPITATIONtook vit D silly
HPV?
2 dose schedulecheeky follow up
INFLUENZA NASAL VAC?
CALM
oral typhoid travelling?
calm
ESCITALOPRAM ELDERLY MAXIMUM?
10MG OD
PROMETHAZINEVERTIGO/NAUSEA MAX. ADULT?
25MG OD
nsaid ANTI-INFLAMMATORY EFFECT?
can take up to 21 days
PPi H PYLORI TEST?
Discontinue 2 weeksAbx 4 weeks
methotrexate monitoring?
have full blood count and renal and liver function tests repeated every 1–2 weeks until therapy stabilised, thereafter patients should be monitored every 2–3 months.
atorvastatin monitoring?
liver enzymes should be measured before treatment, and repeated within 3 months and at 12 months of starting treatment+statins, cholesterol, etc
uritcaria?
desloratadine
folic acid 5mg in old and pregnant? unlikely inappropriate ok
insulin lispro brand?
Insulin lispro is a biological medicine. Biological medicines must be prescribed and dispensed by brand name
5 year old carbocisteine?
250mg TDS
3 YEAR OLD CARBOCISTEINE?
62.5-125 MG QDS
sulfadiazine water?
150ml
x1 Magnesium citrate with sodium picosulfate/Citrafleet water?
150mLManufacturer advises one sachet of sodium picosulfate with magnesium citrate powder should be reconstituted with 150 mL (approx. half a glass) of cold water; patients should be warned that heat is generated during reconstitution and that the solution should be allowed to cool before drinking.
2-year-old child has been prescribed ibuprofen 100mg/5ml for pain from an ear infection. What dose is he most likely to receive?
o One 5 ml spoonful three times a day
HRT RISKS?
BREAST CANCEROVARIAN CANCERSTROKEVTENOT ALOPECIA
t is a cold winter’s morning and a 9-year-old girl is being reviewed at an asthma clinic. During the review she is complaining of increased breathlessness at breaktimes when playing outside and when she goes for bike rides with her family at the weekend when the weather is cold. She is currently on a salbutamol inhaler which she needs to use daily. Her PEFR is 78% at best. She is on no other medication.Which of the following is the most appropriate to add to her current medication?
Recommendations | Asthma: diagnosis, monitoring and chronic asthma management | Guidance | NICE See under pharmacological treatment pathway for children and young people aged 5-16. Note that the question asks for themost appropriate dose which is the lowest (100mcg) for a child of 9 years.
A 40-year-old man is diagnosed with Helicobacter Pylori infection. He has no allergies. Which of the following would be the most suitable treatment regime for this gentleman?
Lansoprazole 30mg capsules B.D, Amoxicillin 1g capsules twice daily and Clarithromycin 500mgtabletstwice daily.
A 16-year-old girl brings in a prescription for doxycycline to the pharmacy to treat her acute sinusitis. Her PMR shows that this is her first time. You counsel the patient. Which of the following is the most likely to be mentioned upon handout?
o Protect your skin from sunlight – even on a bright but cloudy day. Do not use sunbeds.
SIGNS OF SEPSIS?
CONFUSION FEVERLOW BPHIGH HEART RATESOB
Montelukast lickle issue?
Sleep disorders
A man returns his 62-year-old wife’s unused Oxynorm liquid to your pharmacy.Which of the following is the most appropriate course of action?
Store in a segregated area of the CD cabinet before rendering irretrievable.
thiazide-like diuretic AVOID if eGFR< 30EXCEPT?
Metolazone
. A 67-year old man has been recently diagnosed with mild Parkinson’s disease dementia. Which of the following is most likely to be prescribed?
RIVASTIGMINE!
which of the following is least likely to lead to deep vein thrombosis?
cancerskin changes- rednesstendernessthrobbing pain
WHO SHOULD YOU NOT SELL THRUSH MEDICATION TO?
Patients >60DIabeticPregnantFirst timeRepeatedly within 6 months of treatment should be referred to a doctor.
A 57-year-old artist comes to the pharmacy to seek advice from you. Two weeks ago, he noticed that his hands have started to shake, his movement has slowed and his muscles seem to be quite rigid. You ask him whether he has recently started to take any other medicines and he tells you that he has started a new medicine one month ago to reduce nausea and vomiting.Which one of the following medicines is most likely to be the cause of the patient’s symptoms?
Droperidol
Carbimazole blood tests?
you’ll have blood tests every 6 weeks or so. Once your hormone levels are stable, you’ll have a blood test every 3 months, for as long as you continue to take carbimazole
A 45-year-old presents at the pharmacy with an itchy patch of skin on their shoulder. They noticed it when they were on holiday in Egypt last month and assumed that they had been bitten by an insect. However, it is still itchy, isn’t healing and they think it may be spreading. They are asking for a cream to help relieve the itch and help it heal.
o Refer the patient to their GP as they may have a form of skin cancer
S&S of lyme disease?
a flat, circular rash that looks like a red oval or bull’s-eye anywhere on your body.fatigue.joint pain and swelling.muscle aches.headache.fever.swollen lymph nodes.sleep disturbances.
35-year-old male with a history of inflammatory bowel disease has been prescribed azathioprine 50 mg tablets at a dose of two tablets once a day, to manage a flare up in his condition. He asks what the common side effects are.
Infections and infestationsIMMUNOSUPPRESSANT!BONE MARROW SUPPRESSION
WARFARIN+ CRANBERRY
NOT GRAPEFRUIT!
A 30-year-old female patient has been taking lithium for bipolar disorder for the past 18 months. She is currently prescribed Priadel 400 mg at night and her lithium levels have been stabilised at 0.8 mmol/L.Test resultseGFR = 77 (previous results 6 months ago = 82, 12 months ago = 85)Creatinine = 85 (range 45 – 84 µmols/ Litre)
Monitor Lithium plasma concentration levels more frequently and assess deterioration of renal function
. A 30-year-old woman comes into the pharmacy and speaks to you about her options for contraception. Following a check on her records you notice she is taking Carbamazepine 400mg tablets twice a day for epilepsyWhich is the most suitable contraceptive for this patient?
Depo-Provera (medroxyprogesterone acetate 150 mg/1 mL) deep intramuscular injectionNOT AFFECTED BY CARBAMAZEPINE enzyme-inducing drugs
The local primary school has noticed a recent rise in the number of children suffering with asthma and requiring a salbutamol inhaler. The headteacher has contacted your store by phone to place an order for six Ventolin inhalers. What will be the information you need to tell the headteacher?
o A signed order on appropriately headed notepaper is required before supply can be made- NOT A LEGAL REQUIREMENT BRUH
How should I initially manage fungal foot infection?Advise on self-care management strategies:
Wear well-fitting, non-occlusive footwear that keeps the feet cool and dry. Consider replacing old footwear which could be contaminated with fungal spores.Maintain good foot hygiene by wearing a different pair of shoes every 2–3 days.Wear cotton, absorbent socks.Avoid scratching affected skin, as this may spread infection to other sites.After washing the feet, dry thoroughly, especially between the toes.Do not share towels, and wash them frequently, to reduce the risk of transmission.Wear protective footwear when using communal bathing places, locker rooms, and gymnasiums, to reduce the risk of transmission.If a child is affected, it is not necessary to exclude them from school or nursery.
A 15-year-old boy has just been started on Sodium Valproate for generalised tonic-clonic seizures.Which of the following counselling points on the use of sodium valproate is most appropriate?
Patients or their carers should be told how to recognise signs and symptoms of blood or liver disorders and advised to seek immediate medical attention if symptoms develop.PancreatitisPatients or their carers should be told how to recognise signs and symptoms of pancreatitis and advised to seek immediate medical attention if symptoms such as abdominal pain, nausea, or vomiting develop.
A 42-year-old lady with breast cancer has been diagnosed with bone metastases in her spine and has been prescribed ibandronic acid 50mg tabletsadvice?
taken on an empty stomach at least 30 minutes (for most ibandronic acid tablets, 50 mg) or 1 hour (for Bonviva ® tablets, 150 mg) before first food or drink (other than water) of the day, or another oral medicine; patient should stand or sit upright for at least 1 hour after taking tablet.
bonviva counselling? Ibandronic acid
1hr before
A 72-year-old woman is stabilised on co-careldopa therapy, however, she regularly experiences “off episodes”. Which of the following is most likely to be prescribed for when she experiences these?
Refractory motor fluctuations in Parkinson’s disease
SICK DAY RULES?
Just because the patient is ill and not eating does not mean they should stop injecting their insulinill/ infection= stress hormones/ steroids releasedsteroids increase blood glucosestay well hydrated to avoid DKApatient should monitor their BG and urine ketones more frequently and be prepared to inject accordingly
A trainee pharmacist asks you to go through the different types of studies conducted in research in order to produce reliable evidence. Which of the following studies is most likely to produce reliable results?
o Systematic Reviews
Patient, flushing, face, what med?A 2-month-old boy has been admitted to hospital with suspected bacterial meningitisWhich is the most appropriate treatment for this patient?
CCB, amlodipine
A 2-month-old boy has been admitted to hospital with suspected bacterial meningitisWhich is the most appropriate treatment for this patient?
o BENZYL—->Intravenous cefotaxime
Qvar and clenil?
Qvar is twice as potent as Clenil
Canesten in pregnancy?
Canesten pessaries should not be used during pregnancy without seeking medical advice from her GP or midwifeYou should only sell Canestan to a pregnant woman if it is under the advice of a GP or midwife. Although the advice not to use the applicator found in the box is correct, it is not considered the most appropriate answer in this case as the supply of medication would come prior to the counselling.
A 65-year-old woman is due to have a mechanical heart valve replacement in three days. The consultant cardiologist asks for your advice regarding anticoagulation for this patient post-surgery.Which of the following would be the most appropriate to give this patient?
Warfarin
Symptoms of serotonin syndrome?
confusiondiarrhoeatachycardiatremorhyperthermia
A 60-year-old women is taking the following medication following recurrent deep vein thrombosis:• Amlodipine 10 mg tablets once daily• Apixaban 2.5 mg tablets twice daily• Atorvastatin 20 mg tablets once daily• Bendroflumethiazide 2.5 mg tablets once dailyShe has hypertension which is controlled by her medication. She presents with severe facial pain and is diagnosed with trigeminal neuralgia. She is to commence treatment with Carbamazepine 100 mg tablets twice a day for the pain.Which of her existing medicines, if any, should be avoided when taking carbamazepine?
apixabanCarbamazepine is predicted to decrease the exposure to apixaban. Manufacturer advises use with caution or avoid.
A 56-year-old Caucasian woman phones you in the pharmacy for some advice. You are unable to understand what she is saying as her speech is slurred so you invite her for a video consultation instead. When the consultation begins, you notice that her face has drooped on one side and she informs you that since she has woken up, she is unable to lift both arms and keep them there.
alteplaseStroke/tia
A 2-year-old child has a high temperature and is refusing to eat. There are a few ulcers in the mouth and a rash with small blisters which appear on the child’s bottom, thighs and toes
handfootmouth
A 57-year-old male is a regular patient at your pharmacy. Recently his mum has passed away and he’s confided in you that he’s been struggling the last 2 months he has collected his repeat prescription. He asks for your advice on a very painful rash that has appeared on his right-hand side. The rash appears blotchy and is starting to blister.
shingles
A 10-year-old boy has small clusters of raised spots under his left armpit and further down his side. He has had them for around 4 months. They are not painful but can sometimes be itchy. On closer inspection you can see they have a dimple in the middle.
molluscum contagiosum
A 17-year-old male has been prescribed Lymecycline 408mg Capsules – Take one daily. Repeat for 6 months and then review symptoms.
acne
A 72-year-old man with a history of hypertension, presents with impaired visual acuity and describes seeing halos around lights. His eye is red and he is experiencing pain in it. When palpated it is tender and very hard.
glaucoma
An 8-year-old girl whose mother says she is complaining of something in her eye. She says it feels like sand is in it and her vision is blurry. The mother says the eye has been watering and that there has been some sticky discharge.
infective conjunctivitis
WHAT IS THIS?!
PSORIASIS!
WHAT IS THIS?
STYE
EVIDENCE HIERARCHYSYSTEMATIC REVIEW AT THE TOP!!!
Coughs and meds
vet prescription calm?
yes, dispense
H PYLORI
Zomorph 200 mg BD
rash cause?
co-amoxiclav
An 18-month-old boy who has a fever and a bright red rash on both cheeks.
slapped cheek
A 2-year-old child who has had a high temperature for a few days and has lost their appetite has developed red spots, initially on their trunk and they are now spreading to all parts of their body
chicken pox
