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
A A 20-year-old woman presents with localised swelling near the bottom left eyelid. Her eye is watering, but they say there has been no pain or discharge from the eye
Stye
Maximum duration of treatment permitted for a controlled drug Schedule 4 under an emergency supply
5 days
Length of validity of a prescription for Morphine Sulfate 10mg/5ml oral suspension
6 months
Length of time required to keep an invoice for a schedule five controlled drug
2 years
A 35-year-old woman with circulatory disease who requires a combined oral contraceptive?
Ethinylestradiol 20 mcg/Gestodene 75 mcg
A 31-year old woman who smokes and has high blood pressure who is looking for short term contraception for the next two months
Desogestrel
A 47-year-old man reporting general tiredness and frequently feeling thirsty, despite urinating more than was previously normal. This is particularly troublesome at night. Symptoms built up slowly but are starting to become quite noticeable to the patient.
type 2 diabetes
A 27-year-old woman reporting persistent tiredness and difficulty sleeping. She also reports nervousness, mood swings, and twitching of her arms and hands, which are becoming more frequent. Recently, she has noticed that her heart rate seems fast, even at rest.
hyperthyroidism
A 12-year-old girl reports over the last couple of months recurrent thrush infections, fruit smelling breath with no obvious cause, unintentional weight loss and feeling tired, which she puts down to having to get up in the night more frequently to urinate
type 1 diabetes
A 78-year-old man has been taking warfarin for several years for atrial fibrillation. His granddaughter has persuaded him to eat more vegetables and less meat to reduce global warming. Because of the change in his diet, the INR clinic has had to increase his dose of warfarin.
vitamin K
A couple in their late 60s ask if they should be taking a daily supplement of this during the autumn and winter each year.
vitamin D
34-year-old woman has been admitted to hospital because of loss of feeling in her arms and legs. During the medicines reconciliation process, it has been established that she has been taking 200 mg of this vitamin daily for the last three months as she felt she was run down.
vitamin b6, peripheral neuropathy
A first dose of vaccine should be given at 12-13 months of age and a second dose before starting school at 3 years and 4 months to 5 years of age.
MMR
A first dose of vaccine should be given at 12-13 months of age and a second dose before starting school at 3 years and 4 months to 5 years of age.
MMR
A first dose of vaccine should be given at 2 months of age and the second at 3 months of age. The vaccine should not be started in children of 15 weeks of age or older.
Rotavirus
For primary immunisation of children aged between 2 months and 10 years, vaccination is recommended in the form of 3 doses, separated by 1-month intervals and given in a combination vaccine with tetanus, pertussis, hepatitis B, poliomyelitis and haemophilus influenza type b.
diptheria
SODIUM VALPROATE
Valproate use by women and girlsThe MHRA advises women and girls should not stop taking valproate without first discussing it with their doctor.Blood or hepatic disordersPatients 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.Pregnancy Prevention ProgrammePharmacists must ensure that female patients have a patient card—see also Important safety information.
LYME DISEASERASH?
BUT NOT ITCHY
A new medicine is available for the treatment of rheumatoid arthritis. The literature suggests that this medicine is safer with fewer side effects and more efficacious than the current medicines on the market for the same indication. Which of the following sources is the strongest form of evidence to base a clinical decision?
Meta analyses is the strongest form of EBM. A meta-analysis is a statistical analysis that combines the results of multiple clinical trials. When a study compares a placebo against a new medicine it offers a very limited insight as to the safety and efficacy profile compared to other medicines. A direct comparison with other medicines allows to compare the relative safety / efficacy profile and is considered a stronger form of evidence base. It is important to ensure that all medicines are compared fairly with similar dosages.The correct answer is: the medicine was compared to an existing medicine for rheumatoid arthritis in a meta-analysis of five clinical trials with 5000 patients
A 21-year-old female who has not been in the sun for 4 months develops redness on her chest after lying in the sun for 15 minutes. The next day she applies sunscreen and develops the same amount of redness on her back in 2.5 hours. Which of the following was the sun protection factor (SPF) of sunscreen she was using?
(Minutes to burn without sunscreen) x (SPF number) = (maximum sun exposure time) SPF = Maximum sun exposure time / min to burn without sunscreen SPF = 150 min/15 min = 10The correct answer is: 10
DEPRESSION CITALOPRAM, AF?
would not be suitable because citalopram has been associated with QT prolongation and the patient has existing AF and there is an absolute contraindication between citalopram and amiodarone.
A middle-aged man presents in your community pharmacy with a history of a red right eye for the last 24 hours.Which one of the following symptoms should alert you to a more serious condition that requires onward referral?
irregular pupil
discomfortexcess wateringmucopurulent dischargeredness located in the forniceissue?
conjunctivitis, myna
You have 100 mL of a 4% solution of chlorhexidine in your pharmacy and have been asked by a local vet to produce a 1:500 solution.What is the volume in litres of a 1:500 solution of chlorhexidine can be produced?
100 mL x 4% = 400 1:5000 = 0.2%400 /0.2% = 2000 mL = 2 LThe correct answer is: 2
A 35-year-old woman wants some advice about a headache she has been experiencing. She tells you that she has had the symptoms for four or five days. She complains of a dull throbbing pain in the front of her head.Which of the questions listed below would be most discriminatory in assessing if it was a migraine or a tension-type headache?
Nausea?
A 35-year-old woman wants some advice about a headache she has been experiencing. She tells you that she has had the symptoms for four or five days. She complains of a dull throbbing pain in the front of her head.Which of the questions listed below would be most discriminatory in assessing if it was a migraine or a tension-type headache?
Nausea?In almost all case of migraine nausea is experienced. Nausea is not a symptom associated with tension-type headache. Severity is subjective and not very discriminatory. Pain, whilst relatively good discriminating question [eg one sided pain in migraine] is not as discriminatory. The correct answer is: do they feel nauseous?
A 35-year-old woman wants some advice about a headache she has been experiencing. She tells you that she has had the symptoms for four or five days. She complains of a dull throbbing pain in the front of her head.Which of the questions listed below would be most discriminatory in assessing if it was a migraine or a tension-type headache?
Nausea?
A 31-year old woman presents with a self-diagnosis of period pain. On further questioning you ascertain that the aching pain, which can be quite severe, seems to be worse a few days before her period, and during intercourse.Which condition is she most likely to be suffering from?
Carcinomas associated with older women and irregular bleeding; PID shows signs of infection; PD pain is just prior to period and then subsides and is cramping rather than aching in qualityThe correct answer is: endometriosis
A young adult, approximately 30 years of age, presents with symptoms of abdominal pain and discomfort in the right lower quadrant. Based only on the location of the symptoms, which one of the following conditions is the most likely cause?
All other options do not present in RLQ as the major presenting symptom. Duodenal and gastric ulcer tends to be epigastric; IBS is usually left lower quadrant and Gall stones right upper quadrant.The correct answer is: appendicitis
A 27-year-old woman enters your community pharmacy and asks for advice on a mole that is bothering her. What symptom/sign is least associated with suspected skin malignancy?
. change in sensation B. colour change C. irregular border D. lesion growth E. symmetry FeedbackYour answer is correct.Answer is EAll other options can be seen as ‘sinister’ when using criteria checklists eg ABCDE rules) where changes are seen to mole appearance.The correct answer is: symmetry
A 56-year-old woman enters your pharmacy, complaining of severe chest pains. She tells you that having used her GTN spray twice, the symptoms are worsening. She is short of breath and is extremely tired. On further questioning, she tells you she has pain in her jaw and arm as well. She has no known allergies.What is the most appropriate course of action for her?
Refer to St Johns Ambulance website and Medical emergencies in the community BNF. Her symptoms are suggestive of a heart attack. Aspirin 300 mg tablet should be chewed, ensuring she does not have any allergiesThe correct answer is: she is having a heart attack, call 999, supply aspirin 300 mg tablets and get her on the floor leaning against a wall with knees bent and head and shoulders supported
A 45-year-old man is unconscious and not breathing in your pharmacy. You are first aid trained so you will need to do CPR (cardiopulmonary resuscitation). What is the current recommended compression‐ventilation ratio for emergency cardiopulmonary resuscitation of an adult with one rescuer present?
The compression‐ ventilation ratio for 1 rescuer adult CPR and 2 rescuer adult CPR is 30:2. Ref – Resus Council Guidelines. (If you are untrained or unable to do rescue breaths, give chest compression only CPR (i.e. continuous compressions at a rate of at least 100–120 min-1))The correct answer is: 30:2
QUININE MALARIA?
TREATMENT, NOT PROPHYLAXIS
A 42-year-old man enters your pharmacy complaining of a nosebleed. He tells you it only began a few minutes ago and he would like your advice on how to deal with it. Which of the following options is the most suitable course of action?
St John Ambulance website states: If someone is having a nose bleed, your priority is to control the bleeding and keep their airway open.Get them to sit down (not lie down) as keeping the nose above the heart will reduce bleeding.Get them to lean forward (not backwards), to make sure the blood drains out through their nose, rather than down their throat which could block their airway.Ask them to breathe through their mouth and pinch the soft part of the nose, taking a brief pause every ten minutes, until the bleeding stops.Encourage them not to speak, swallow, cough, spit or sniff because this may break blood clots that may have started to form in the nose.If the bleeding is severe, or if it lasts more than 30 minutes, call 999 or 112 for medical help.The correct answer is: sit him down, tilt his head forwards and ask him to pinch above his nostrils
A locum pharmacist is spotted by a healthcare counter assistant drinking alcohol during her lunch break, and comes to you for advice. You look at the GPhC Standards for raising concerns, before taking further action. Which of the following statements regarding the GPhC guidance on raising concerns is INCORRECT?
You have a professional responsibility to take action to protect the well-being of patients (not colleagues) and the public. Refer to guidance for raising concerns The correct answer is: you have a professional responsibility to take action to protect the well-being of colleagues
Patient returns to your pharmacy to collect his regular diabetes medication. He complains of feeling light-headed and is sweating and mentions he is also feeling very sick. He suddenly collapses. He remains conscious, and you determine that he is suffering from hypoglycaemia. Using information in the resource pack provided, which of the following would be most appropriate to give the patient?
Glucose or sucrose: ADULT and CHILD OVER 2 YEARS: approx. 10–20 g (110–220 mL Lucozade® Energy Original or 100–200 mL Coca-Cola®—both non-diet versions or 2–4 teaspoonfuls of sugar or 3–6 sugar lumps) repeated after 10–15 minutes if necessaryDiet versions of drinks not suitable, 2-4 teaspoonfuls of sugar or 3-6 sugar lumps.The correct answer is: Lucozade Original, 150 mL
A woman has come in to the pharmacy to buy Clarinaze allergy control nasal spray (mometasone furoate 50 micrograms/spray) over the counter. After agreeing that the medicine is appropriate for the symptoms described, you begin giving advice on how to use the spray.Which of the following statements regarding the use of the mometasone nasal spray is INCORRECT?
If the patient sees no improvement of their symptoms within 14 days, they should visit their GP. All other options are true statements from the RPS guide to Clarinaze on the RPS website.The correct answer is: if the patient sees no improvement of their symptoms within 5 days, they should visit their GP
The owner of an animal brings a prescription from the local vet into your pharmacy. Your counter assistant is unsure whether the prescription is valid and brings it into the dispensary for your attention. You note that the prescription contains a Veterinary Medicinal Product (VMP) which is also a Schedule 2 Controlled Drug. Which of the following criteria for a VMP, which is also a Schedule 2 Controlled Drug, is INCORRECT?
One difference between human and vet Rx’s for CDs is that vet good practice is for 28 days, whereas human is 30 daysThe correct answer is: it is considered good practice for only 30 days’ worth of treatment to be prescribed on veterinary prescriptions
A customer visits your pharmacy wishing to buy some medication as he is experiencing congestion. After a consultation, you both decide on a number of products containing systemic decongestants. Which of the possible theoretical combinations would it be acceptable for you to legally sell the patient in one transaction?
Phenylephrine supply is not controlled; ephedrine and pseudo are. Therefore any combo of ephedrine/pseudo is not allowed, any supply above restricted quantity is not allowed, but any combo with phenylephrine is fine as long as the restricted drug is below the legal limit.MEP 43 p39The correct answer is: one pack of 12 tablets, with each tablet containing 60 mg pseudoephedrine and another pack of 12 tablets, with each tablet containing 12 mg phenylephrine
OTCPSEUDOEPHEDRINE MAX?
720MG
OTCEPHEDRINE MAX?
180MG
Strict regulations govern the supply of Schedule 2 and 3 Controlled Drugs. Regarding the use of approved requisition forms when requesting such medicines, which of the following statements is INCORRECT?
GPhC registered pharmacies are not included in this legislation; Home Office wording is that they ‘should’, not ‘must’: legal difference. See MEP p91/92 for more info. The correct wording is in a pink box labelled ‘Practice Issues’ All pharmacies registered by the GPhC are included in the legal requirement to supply a requisition in writing and should do so before CDs can be supplied to them.The correct answer is: pharmacies are exempt from record keeping when lending each other Schedule 2 or 3 Controlled Drugs
Mrs S has been admitted into hospital after suffering with convulsions, visual disturbances, confusion and a visible coarse tremor. Mrs S has a history of mania and is treated with lithium carbonate 800 mg daily. Two weeks ago she was diagnosed with hypertension and her GP started bendroflumethiazide 2.5 mg daily. On admission, tests for urine and electrolytes were performed. Which of the following would you expect to be abnormal?
The symptoms the patient is presenting with are indicative of lithium toxicity (additional symptoms include vomiting/diarrhoea, muscle weakness/drowsiness/lack of coordination). Lithium toxicity is made worse by sodium depletion therefore concurrent use of thiazide diuretics should be avoided.BNF 78+ page 357. The correct answer is: sodium
Mr FT has come into your pharmacy wanting to discuss a ‘private’ problem with you. You take him into the consultation room and he tells you he may have haemorrhoids. You complete a consultation and agree with his self-diagnosis.Which of the following symptoms would indicate referral to the GP?
Dark tarry stool should be referred to GP to eliminate GI bleed. Slight rectal bleeding is often associated with haemorrhoids and can be visible on the toilet bowl or on the surface of the stool. Usually blood on the stool is a direct referral sign but if the cause is haemorrhoids this can be treated. The other symptoms C, D and E are typical of haemorrhoid.The correct answer is: dark tarry stool
Mrs LK, 20 years old, comes into your pharmacy seeking advice about a rash on her arm. She tells you that it appeared 2 weeks ago and is itchy. She has no other symptoms and suffers from no other medical conditions. The appearance of her arm is shown below.
Tinea corporis is a defined infection of the skin surfaces that does not involve the face, hands, groins or scalp. Usual characteristics are itchy pink or red scaly slightly raised patches with well-defined inflamed border. Over time the lesions often show ‘central healing’ as the central area is relatively resistant to colonisation. The correct answer is: tinea corporis
Mrs LT presents in your pharmacy wanting to purchase some cystitis treatment. You ask Mrs LT about her symptoms to decide on the most appropriate treatment plan. Which of the following symptoms would suggest referral to the GP?
Flank pain is indicative of infection in the upper urinary tract and can be diagnosed as pyelonephritis which is characterised by signs of systemic infection such as fever, chills, flank or loin pain and possibly nausea and vomiting. Others would not indicate referral.The correct answer is: flank pain
You decide to hold a training a session on the sale and supply of Nexium Control (esomeprazole 20mg tablets) with your pharmacy team since it has been recently reclassified from POM to GSL. You decide to focus on when staff can make a supply of this product.What is the most appropriate piece of information to tell your team?
Older patients are at higher risk of stomach cancer and Nexium control can mask symptoms – new symptoms should be investigated with the GP. See SPC for Nexium control section 4.4 - Special warnings and precautions for use.The correct answer is: refer patients to a GP if they are over 55 years of age and present with new symptoms
Mrs PO comes into your pharmacy and tells you that she was trimming her hedges 3 days ago when a branch went into her right eye. Since then she has experienced severe pain, with watery discharge and cannot look directly into bright light. On inspecting her eye, you see redness around the iris.Which of the following conditions is this most likely to be?
Ectropion-Is the condition of the eyelid turning outwards exposing the conjunctiva and cornea to the atmosphere. )Episcleritis-Pain is of dull nature, eye can appear red which is segmental and affects only part of the eye.Keratitis- Often results from recent trauma in this case branch in the eye. Severe pain is the prominent feature and patients complains of photophobia and watery discharge. Subconjunctival haemorrhage- is not associated with painViral conjunctivitis- is not associated with painThe correct answer is: keratitis
Mrs PK has come into your pharmacy wanting buy something to treat her toenail infection. She has recently seen adverts on TV about Curanail (amorolfine 5% nail lacquer) and was wondering whether this would be suitable. You are satisfied it is a fungal nail infection and proceed to make a supply. Which one of the following statements is true regarding the supply of Curanail (amorolfine 5% nail lacquer)?
Curanail 5% w/v medicated nail lacquer SPC. The product only covers the treatment if up to two toenails are affected and should be used between 6-9 months for optimum effect. It is only licensed for 18 years and over and cannot be used in diabetic or patients with peripheral arterial disease. It is licensed for treatment where fungal infection has originated from the distal or lateral areas of the toenail. The correct answer is: can be sold for mild cases of distal lateral subungual onychomycosis
Mr LN has suffered from hay fever for the past 10 years. Usually he manages the symptoms without the need for medication but this year he requires some antihistamines. He tells you that he is a teacher and therefore does not want to be effected by sedation. He does not take any regular medication.Using information in the resource pack provided, which is the most appropriate antihistamine to sell Mr LN?
As the patient teaches the most appropriate treatment option would be a non-sedating antihistamine such as loratadine. All of the other antihistamines are regarded as sedative.The correct answer is: loratadine
Mr H has just brought 4-weeks’ worth of unused blister packs to the pharmacy that belonged to his father who died one week ago. All of the tablets in the blister packs were prescription-only. What is the most appropriate course of action for the pharmacy to take?
MEP 43 p.114 states that for tablets and capsules, blister strips can be removed from their inert outer packaging but tablets and capsules should not be de-blistered. Following this advice, the blister packs should not be deblistered.The correct answer is: place the blister packs into a secure waste container without deblistering
Which of the following is the least appropriate advice to give as part of the correct technique for a metered dose inhaler?
Patients should inhale gently and slowly with a MDI inhaler. Inhaler technique should be checked at every opportunity with the patient. 10.2.2 Identifying appropriate advice on the use of medicines. See Asthma UK website https://www.asthma.org.uk/advice/inhalers-medicines-treatments/using-inhalers/ The correct answer is: inhaling hard and fast
You are counselling Mr Jones on his repeat medication and he tells you that he really enjoys country drives with his wife and children.For which of his repeat medicines would it be most appropriate to tell him about the drug driving offence?
See selegiline SPC section 5.2, MEP 40 page 90 and BNF 72 Guidance on Prescribing page 2It is metabolised to methamphetamine. 10.2.2 Mechanism of action, administration, absorption, distribution, metabolism and excretion of medicines.The correct answer is: selegiline
Mrs A, a 53-year-old woman, who is one of your regular patients visits your pharmacy. She is clearly distressed and on further questioning volunteers the information that she has recently started playing cards and using roulette wheels and she constantly uses them.Which of her medicines is the most likely cause of this?
Treatment with dopamine-receptor agonists and levodopa is associated with impulse control disorders, including pathological gambling, binge eating, and hypersexuality. Patients and their carers should be informed about the risk of impulse control disorders. 10.2.2, Recognising and managing adverse effects of medicines. See BNF 72 page 387. The correct answer is: pramipexole
You are discussing metformin with your pharmacy technician and its various uses. Which of the following statements about metformin is CORRECT?
Use of licensed, off-label and unlicensed medicines including providing information to patientsA metformin 2000 mg/5 mL oral solution sugar free is an unlicensed preparationC metformin is a biguanideD metformin use in diabetes mellitus is licensedE metformin use in polycystic ovary syndrome is unlicensed thus off-labelSee BNF section 10.2.2The correct answer is: metformin can be used in pregnancy
A 56-year-old man would like to purchase some Anadin Extra [aspirin, paracetamol and caffeine]. You recall that he is prescribed lithium on prescription and explain to him why Anadin Extra is not appropriate for him. Which of the following is the correct clinical consequence of the interaction?
Interactions that occur between medicines (either prescribed or purchased), and between these medicines and food or other substances- renal excretion of Lithium is reduced by aspirinA additive toxicity: It is not additive as additive toxicity is when the drugs have the same effect so adding them both together increases the toxic symptoms. Aspirin causes lithium to not be cleared, it does not ADD to its toxic effectsB increased risk of bleeding: yes aspirin increases risk of bleeding but this is not the interaction with lithiumC increased risk of NSAID-induced nephrotoxicity: yes aspirin increases chance of renal impairment but this is not the interaction with lithiumD increased sedation: not a NSAID side effectE aspirin at NSAID dose reduce clearance of lithium through kidney, therefore can cause toxic levelsSee BNF interactions (Appendix 1) or Minor Illness or Major Disease, 6th Edition, page 79. 10.2.2The correct answer is: renal excretion of lithium reduced
A 57-year-old man presents in your clinic and is complaining of muscle weakness. He is on atenolol 50 mg, furosemide 20 mg and atorvastatin 40 mg. He has had a blood test and his potassium levels are 2.9 mmol/L. Which of the following is the most appropriate course of action?
Mr NJ is suffering from hypokalaemia. Normal K levels are 3.5-5.0mmol/L. 10.2.2 Normal ranges for test results, and actions to take when results are out of the normal rangeA Hypokalaemia can occur with both thiazide and loop diuretics. The risk of hypokalaemia depends on the duration of action as well as the potency and is thus greater with thiazides than with an equipotent dose of a loop diureticC He is on the lowest dose of furosemideD This would make the hypokalaemia worseE Hypokalaemia could get worse if left untreated See BNF and any clinical biochemistry textbookThe correct answer is: add spironolactone
You are working in care home and a doctor is asking for advice as to which anticoagulant to start in a patient who has had a recent diagnosis of atrial fibrillation. Which of the following anticoagulants would be least appropriate if the patient has a poor appetite?
Under rivaroxaban (BNF 78): The MHRA has received a small number of reports suggesting a lack of efficacy (thromboembolic events) in patients taking 15 mg or 20 mg rivaroxaban tablets on an empty stomach. Healthcare professionals are advised to remind patients to take rivaroxaban 15 mg or 20 mg tablets with food. In those who have difficulty swallowing, these tablets can be crushed and mixed with water or apple puree immediately before, and followed by food immediately after, ingestion.The correct answer is: rivaroxaban
Mr AJ has moderate COPD and is prescribed a salbutamol MDI when required. Before adding on any other inhaler, which of the following tests would be the most useful?
If the Forced Expiratory Volume in 1 second (FEV1), is 50% of predicted or more, either a long-acting antimuscarinic bronchodilator or a long-acting beta2 agonist should be used. If FEV1 is less than 50% of predicted, either a long-acting antimuscarinic bronchodilator or a long-acting beta2 agonist with a corticosteroid in a combination inhaler should be used. 10.2.2 Selecting appropriate diagnostic or physiological testing techniques for use in clinical decision-making and to promote health. See BNF (NICE)The correct answer is: Forced Expiratory Volume in 1 Second (FEV1)
Mr and Mrs K are collecting their monthly repeat prescriptions and you skilfully bring the conversation to smoking cessation. Mr K currently smokes and is thinking about stopping so you direct him to your smoking cessation service. Mrs K stopped smoking 4 weeks ago so you give her advice on fighting cravings. At what stages of the ‘stages of change’ model are they both currently at?
See Kings Fund, Using Information to promote healthy behaviours, 2008. The transtheoretical model was developed by Prochaska and DeClemente. 10.2.2 Behavioural change as a tool to support health promotion.The correct answer is: Mr K contemplation and Mrs K maintenance
Mr AB is newly diagnosed with gastric cancer. He has a past medical history of hypothyroidism, hypertension and end-stage chronic kidney disease. He is started on opioids to manage his pain. Which of the following is the most appropriate opioid combination for Mr AB?
Patient should be on MR preparation BD and immediate release preparation for breakthrough PRN, therefore B and E not appropriateAs patient has end stage CKD, morphine should be avoided as per BNF, therefore A, B, C not appropriateD is correct as MR dose BD and immediate release for breakthrough, plus oxycodone preferred over morphine in CKDThe correct answer is: OxyContin MR 10mg BD, Oxynorm 5mg QDS PRN
While counselling Mr AB on his newly initiated opioid regimen, which of the following are not side effects that are commonly experienced while taking opioids?
NOT thirstCalm?constipationdry mouthheadacheN&V
Which of the following is least aligned with principles of prescribing treatments for infectious diseases?
Avoid broad spectrum due to increased risk of clostridium difficile, MRSA and resistant UTIs. See NICE Management of Infection Guidance for Primary Care for Consultation and Local Adaptation – May 2016The correct answer is: avoid narrow spectrum antibiotics where broad-spectrum antibiotics remain effective
A woman who is in the third trimester of pregnancy seeks your advice about receiving a influenza vaccine.Which of the following statements is correct with regards to administration of the flu vaccine in pregnant women?
The flu vaccine is safe during any stage of pregnancy, from the first few weeks up to your expected due date. The vaccine doesn’t carry risks for either you or your baby. If you have flu while you’re pregnant, it could mean your baby is born prematurely or has a low birthweight. The correct answer is: influenza vaccine given to the mother may provide passive immunity to the infant in the first few months of life
Upon receiving new stock into the pharmacy you notice that the packaging of a vaccine has been extensively damaged and suspect particulate contamination of the vaccine. Which one of the following procedures is most appropriate to report the defective vaccine product?
Defects in medicinal products may include errors in the packaging, labels or leaflets, or other product faults, such as particulate contamination of a vaccine. If healthcare professionals suspect that a vaccine is defective, they should not use the product but contact the Defective Medicines Report Centre (DMRC) of the MHRA (see contact details at the end of the chapter). The DMRC assists in the investigation of defective medicines and co-ordinates any action that may need to be taken.The correct answer is: report to the centre of the Medicines and Healthcare products Regulatory Agency
Mr PH is a 72-year-old male who has just been initiated on celecoxib for his rheumatoid arthritis. He is a known smoker, drinks 2 units of alcohol on 3-4 days a week and suffers from type 2 diabetes.Which of the following factors do not put Mr PH at a higher risk of developing gastro-intestinal complications?
Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs. (BNF)Corticosteroids can cause GI ulcers (common side effect) and therefore additive severe interaction (BNF)Specialist sources recommend that concurrent use need not be avoided with moderate alcohol intake, but greater caution is warranted in those who drink more than the recommended daily limits.The risk of GI toxicity is higher in the elderly (BNF)Proton pump inhibitors are used to provide GI protectionThe correct answer is: being prescribed celecoxib for arthritic pain instead of naproxen
Miss J has been admitted to your acute medical unit with confusion. You complete her medicine history and find she is taking sodium valproate and citalopram. When checking her blood tests you find one of her biochemical markers is out of range, contributing to her confusion. Which of the following biochemistry derangements could her medicines cause?
Numerous anticonvulsants and antidepressants can cause hyponatraemia, which can manifest as confusion. Having the treatment card for Sodium valproate is important here as patient is female.The correct answer is: hyponatraemia
Mr F presents to your community pharmacy for his repeat prescription and tells you he has been feeling really tired recently. You assess his symptoms and find his pulse rate to be 47 beats per minute. You believe his tiredness is likely caused by his current medication. Which of the following medicines would you discuss with his GP?
Beta-blockers are well known to cause bradycardia and a symptom of bradycardia is fatigue (tiredness).The correct answer is: atenolol
Miss L is being treated for long term depression, which is not responding to fluoxetine. She has previously tried sertraline and citalopram, so her GP has referred her to a specialist. They have decided to try moclobemide instead. You find that Miss L has not been counselled on how to take this new medicine and you decide to contact her GP. Which of the following would be the most important to discuss with the GP?
An MAOI should not be started until at least a week after an SSRI or related antidepressant (at least 5 weeks in the case of fluoxetine) has been stopped. All important, however this is most important at the moment, as meclobemide will not be started for min. 5 weeks The correct answer is: which day the fluoxetine should stop and which day should meclobemide commence
Mr Q needs to be prescribed vitamin D supplementation and his medical team ask for your advice. Mr Q has end stage chronic kidney disease and has dialysis three times a week. Which of the following vitamin D regimens is most appropriate for him?
Alfacalcidol is the activated form of Vitamin D, which is needed in patients with end stage renal disease who are not able to activate dietary vitamin D. Some patients will use both colecalciferol and alfacalcidol if there is some residual kidney function. This is because alfacalcidol is more likely to cause hypercalcemia and lead to toxicity so able to use a less dose if some residual function there.NICE guidelines: Short-acting, potent vitamin D analogues should only be prescribed in people with renal impairment that is severe enough to impair the hydroxylation of vitamin D to its active metabolite (specialist initiation only). Short-acting, potent vitamin D analogues (such as alfacalcidol and calcitriol) and annual depot vitamin D treatments (oral or parenteral) are not routinely recommended because they have been shown to cause toxicity or not to work.The correct answer is: alfacalcidol 250 nanograms once daily
Which of the following medicine combinations is known to introduce a risk of rhabdomyolysis?
Fluvastatin with Bezafibrate
A mother brings her 2-month-old baby into the pharmacy. She asks for advice regarding which vaccinations her baby should have. According to the 2020 immunisation schedule, which of the following vaccinations does her baby require at 8 weeks?
At 2 months the baby requires diptheria, tetanus and polio and the pneumococcal vaccine.The correct answer is: Diptheria, Tetanus and Polio
Mrs QP takes digoxin regularly. Her doctor prescribes her furosemide as she is complaining of ankle oedema. The GP pharmacist is tasked with monitoring the patient regularly, as there is a potential interaction between the two medicines.Which of the following is a correct explanation of the mechanism of the interaction?
Furosemide is a loop diuretic. One of the side effects that may occur with furosemide therapy is hypokalemia. Hypokalemia predisposes to digoxin toxicity. Therefore, the patient should be monitored for signs of toxicity, such as nausea and bradycardia.The correct answer is: furosemide given with digoxin may induce digoxin toxicity
BT is a 26-month-old toddler, has a fever of 38°C. He has not been sick and does not have a rash.What is the most appropriate dose of paracetamol 120 mg/5 mL to recommend to BT’s parents?
The correct answer is: 7.5 mL QDS PRN
Mrs P is using hypromellose and latanoprost eye drops and asks if she can use them together. Which of the following is the most appropriate response?
The correct answer is: she should leave 5 minutes in between
Mrs P would like an inhaler with a dose counter as she never knows when hers has run out.Which of the following would NOT be suitable for her needs?
The correct answer is: easi-breatheBREATH ACTIVATED FRESHIE
Mr NJ attends your clinic and you are examining the results of his blood tests. Blood test resultsCalcium 2.3 mmol/LGlucose 18 mmol/LMagnesium 0.8 mmol/LPotassium 5 mmol/LSodium 140 mmol/LWhich of the following is the most appropriate drug to prescribe?
Patient has hyperglycaemia. 10.2.2 Normal ranges for test results, and actions to take when results are out of the normal rangeA used to treat hyperkalaemiaB used to treat hypoglycaemia D used to treat hypomagnesaemiaE used to treat hyperphosphataemiaSee BNF 73 and any clinical biochemistry textbookThe correct answer is: insulin
A 49-year-old male is prescribed cisplatin for lung cancer. Cisplatin may cause toxicity in up to 31% of patients treated with a single dose of cisplatin 50 mg/m2 and is manifested by tinnitus.
Ototoxicity has been observed in up to 31% of patients treated with a single dose of cisplatin 50 mg/m2, and is manifested by tinnitus and/or hearing loss in the high frequency range (4000 to 8000 Hz). Cisplatin can also cause nephrotoxicity but as the question states that the toxicity is “manifested by tinnitus” this rules out nephrotoxicity.The correct answer is: ototoxicity
A 56-year-old male has been prescribed doxorubicin for lymphoma. The oncologist requests various tests for monitoring because there is a risk of developing toxicity with doxorubicin. It is recommended not to exceed a maximum cumulative dose of 550 mg/m2
Cardiotoxicity is a risk of anthracycline treatment that may be manifested by early (i.e. acute) or late (i.e. delayed) events.The correct answer is: cardiotoxicity
A 22-year-old has been prescribed bleomycin for Hodgkin Lymphoma. The earliest sign and symptom associated with dose and age related toxicity caused by bleomycin are fine rales and dyspnoea respectively.
Pulmonary toxicity of bleomycin is both dose-related and age-related. The earliest symptom associated with pulmonary toxicity of bleomycin is dyspnoea. Fine rales (crackles in the lungs) are the earliest sign. If pulmonary changes are noted, treatment should be discontinued until it can be determined if they are drug related.The correct answer is: pulmonary toxicity
A neonate at risk of tuberculosis receives a live attenuated strain derived from Mycobacterium bovis.
BCG vaccine is given at birth to babies that are at risk only. The correct answer is: bacillus calmette-guérin (bcg) vaccine
A 75-year-old male receives a vaccine to prevent a skin condition.
Varicella Zoster Vaccine - A shingles vaccination programme was introduced for selected people aged between 70 and 79 years in September 2013 with the aim of reducing the incidence and severity of shingles in older people. The correct answer is: varicella zoster vaccine
A 25-year-old humanitarian relief worker is prescribed an oral vaccine before her travels. You advise her to mix the vaccination with water, and avoid eating, drinking or taking oral medication for an hour before and after having the vaccination.
The cholera vaccine is available to patients while travelling, although most people won’t need it because food and water hygiene precautions are usually enough to prevent infection. The correct answer is: cholera vaccine
The first dose of this live, oral vaccine is delivered at two months to protect young children against gastro-enteritis.
Rotavirus is the most common cause of infantile gastroenteritis. Almost every child in the UK will have an infection before their fifth birthday. Infection in adults is uncommon because immunity is long lasting. An oral rotavirus vaccine, is currently offered as part of the UK national childhood immunization programme. The correct answer is: rotavirus vaccine
A 12-month-old child receives their first dose of this vaccine, with a second booster dose scheduled between 3 – 5 years. This vaccine should not be administered on the same day as yellow fever vaccine and there should be a 4-week minimum interval between the vaccines.
MMR vaccine is administered at 12 months and between the ages of 3 – 5 according the immunization schedule. It should not be administered on the same day as yellow fever vaccine; there should be a 4-week minimum interval between the vaccines. When protection is rapidly required, the vaccines can be given at any interval and an additional dose of MMR may be considered.The correct answer is: measles, mumps, rubella (mmr) vaccine
An adjunct test is ordered for a 79-year-old male with liver disease and who is on a protein restricted diet.
A blood urea nitrogen (BUN) test measures the amount of nitrogen in your blood that comes from the waste product urea. Urea is made when protein is broken down in your body. Urea is made in the liver and passed out of your body in the urine. Levels may be lower in a patient with liver disease. The correct answer is: blood urea nitrogen (bun)
A 36-year-old male who has been diagnosed with human immunodeficiency virus HIV.
A CD4+ count is a blood test to determine how well the immune system is working in people who have been diagnosed with HIV.The correct answer is: cd4+
A 65-year-old male who is at high risk for heart failure.
C-reactive protein (CRP) is an inflammatory marker and predicts the chance of having cardiovascular problems, at least as well as well cholesterol levels.The correct answer is: c-reactive protein
A test is ordered for 68-year-old female with metabolic acidosis. Her results fall out outside of the normal range which is between 60 and 125 micromol/L.
Creatinine levels are measured to give an indication of kidney function and is one of the most frequent tests requested. The correct answer is: creatinine
A 55-year-old female with a suspected case of helicobacter pylori infection.
A stool antigen test can be used to detect H. pylori infection (H. pylori antingens) are present in faeces. Stool antigen testing may be done to help support a diagnosis of H. pylori infection or to confirm whether treatment for an H. pylori infection has been successful.The correct answer is: stool antigen test
A 3-year-old is prescribed fusidic acid to be used three to four times daily, for 7 days. You advise the parent to remove the crusted areas on skin by soaking in soapy water before applying the topical antibiotic.
Impetigo is a common contagious pyogenic infection of the superficial layers of the skin. For more severe cases oral antibiotics can be used.
A moderate-to-highly contagious acute viral infection caused by a paramyxovirus and is spread by direct contact with saliva. Clinical presentations may include swollen parotid glands alongside low-grade fever, headache, earache, malaise, muscle ache, and loss of appetite.
Mumps
A 53-year-old male develops kidney stones while taking this antiepileptic medicine.
topirimate
Patient and carers should be counselled on the signs and symptoms of pancreatitis.
Pancreatitis, which may be severe and result in fatalities, has been very rarely reported. Patients experiencing nausea, vomiting or acute abdominal pain should have a prompt medical evaluation (including measurement of serum amylase). Young children are at particular risk; this risk decreases with increasing age
A 33-year-old male requires treatment for a seizure that has lasted longer than 5 minutes.
Seizures lasting longer than 5 minutes should be treated urgently with intravenous lorazepam (repeated once after 10 minutes if seizures recur or fail to respond). Intravenous diazepam is effective but it carries a high risk of thrombophlebitis (reduced by using an emulsion formulation). Absorption of diazepam from intramuscular injection or from suppositories is too slow for treatment of status epilepticus. Patients should be monitored for respiratory depression and hypotension.The correct answer is: lorazepam
A 23-year-old female should avoid this antiepileptic unless there is no safer alternative.
Valproate is associated with teratogenic risks and should not be used in females of child-bearing potential unless there is no safer alternative—this should be fully considered and discussed before prescribing for females of child-bearing age. The correct answer is: sodium valproate
Mr TG is 75 years of age and is starting medication for type 2 diabetes. Mr TG has a serum creatinine of 250 micromol/L, and his weight is 75 kg. This is his baseline creatinine. The doctor has asked you to calculate Mr TG’s creatinine clearance and identify which of these medicines should not be started. His creatinine clearance is 24 mL/min.
Metformin – should be avoided in eGFR less than 30 (works out to be approx 24 mL/min - exact 23.99 mL/min)Gliclazide – used with care/lowest dose – careful monitoring Insulin- dose reduction in renal impairmentMetformin – avoided in egfr less than 30 mL/minute/1.73 m2.Pioglitazone – ok Repaglinide - use with caution Sitagliptin – dose reduction to 25mg if egfr 30 mL/minute/1.73 m2 not stoppedThe correct answer is: metformin
Miss KB is 67 years old, overweight and has type 2 diabetes, alongside other comorbidities including previous MI. She is currently taking a combination of oral anti-diabetic therapy and insulin, all that are listed above. Miss KB has now been admitted to hospital with shortness of breath and pitting oedema, and has been diagnosed with heart failure. Which of the drugs listed, if Miss KB was taking them all, should be discontinued immediately?
Incidence of HF is increased when pioglitazone is combined with insulin, especially in patients with predisposing factors (eg. MI). Patients taking pioglitazone should be closely monitored for signs of HF, and treatment should be discontinued if any deterioration in cardiac status occurs.The correct answer is: pioglitazone
Mrs DF has epilepsy and takes lamotrigine 100 mg daily. She wants to purchase Feminax Ultra (naproxen 250 mg tablets) to manage her period pain. She recently contracted a severe respiratory tract infection and was prescribed some ciprofloxacin 500 mg bd.
Naproxen potentially increases the risk of seizures when given with ciprofloxacin.The correct answer is: increased risk of seizures
Mr PV has been taking phenelzine 15 mg tds but the doctor has decided to switch him to citalopram 20 mg once daily. The doctor has advised Mr PV to stop treatment with phenelzine and start citalopram immediately.
MAOIs increase CNS effects of SSRIs - increased risk of serious toxicity – (serotonin syndrome). Antidepressants should not be started for 2 weeks after treatment with MAOIs has been stopped.The correct answer is: haematological toxicity risk increased
Mrs TH has a chest infection and is taking clarithromycin 500 mg bd. She requests an OTC supply of fluconazole 150 mg capsule to treat her vaginal candidiasis infection.
Both fluconazole and clarithromycin prolong the QT interval. Most manufacturers advise avoiding the use of two or more drugs that are associated with QT prolongation.The correct answer is: qt interval prolongation
A customer requests treatment for her 4-month-old baby’s sore mouth. After asking the appropriate questions and looking into the baby’s mouth, you diagnose oral thrush.
Daktarin oral gel – Oral thrush is a fungal infection. It can be used in infants over 4 months of age. Miconazole is the active ingredient of daktarin oral gel and can be used in the mouth.
A 45-year-old lady, enters your pharmacy. She has gritty, sticky eyes since yesterday morning. She has not yet tried anything and does not wear contact lenses. Her vision is not affected and there is no pain in her eye apart from irritation.
Chloramphenicol 0.5% drops is licensed for bacterial conjunctivitis.The correct answer is: chloramphenicol 0.5% eye drops
A 30-year-old man requests treatment for a fungal infection between his toes, which appears as flaky skin which is very itchy. You diagnose athletes foot.
Miconazole 2% cream is an anti-fungal cream. Topical application of an anti-fungal would be appropriate.The correct answer is: miconazole 2% cream
A 62-year-old woman, asks to speak to you in the consultation room. She tells you she has a thick white discharge and is very itchy in the vaginal area, which she has never experienced before. There are no other symptoms.
Women over 60, or under 16 - vaginal thrush is rarer in this group of women and the doctor should be consulted to exclude other possible causes before thrush is diagnosed.The correct answer is: no product – refer to GP
ella one action?
ellaOne
With regards to patient confidentiality, which ONE of the following statements is TRUE?
The correct answer is: For disclosures required by law, pharmacists should be satisfied that those requesting confidential information have a legitimate interest
A 46-year-old woman has been admitted to hospital with a transient-ischaemic attack (TIA). Her records indicate a history of migraine with aura, hypertension, and Type 2 diabetes.Her medications on admission were as follows:Ramipril 2.5 mg dailyNovomix 30 ® 20 units twice a dayMetformin 1 g twice a dayAtorvastatin 40 mg dailyPropranolol 10 mg twice a dayWhich of the following antiplatelet agents would be most appropriate for this patient for stroke prevention?
Clopidogrel is recommended if aspirin is not tolerated. Aspirin/dipyridamole would not be recommended for this patient as it may worsen headaches/migraines. Prasugrel and ticagrelor are not indicated for ischaemic stroke/CVA.REF: https://www.nice.org.uk/guidance/ng128/chapter/RecommendationsThe correct answer is: Aspirin
DOXORUBICIN NEUTROPENIA?
Decreased neutrophil levels may be the result of severe infection, liver disease, enlarged spleens or other conditions, such as responses to various medications or chemotherapy
Which ONE of the following statements about supply on a prescription for a Schedule 2 controlled drug is INCORRECT?
The correct answer is: The prescription is valid for 30 days after the appropriate date on the prescription
A 7-year-old boy is prescribed ibuprofen for the management of fever. He is 122 cm tall and weighs 23 kg.Which of the following is the most appropriate ibuprofen dose for this patient?
The recommended dose for children aged 7-9 years is 200 mg 3 times a day.Ref: https://bnf.nice.org.uk/drug/ibuprofen.html#indicationsAndDosesThe correct answer is: 10 mL of 100 mg/5 mL syrup three times a day
A 45-year-old woman with oestrogen-receptor positive with breast cancer. She is prescribed tamoxifen 20 mg daily after a total mastectomy. She has a history of depression for which she is taking paroxetine 20 mg every morning.Which of the following is the most appropriate counselling point for this patient?
Tamoxifen should be taken daily to reduce the risk of the breast cancer returning, with ongoing review of the benefits versus risks of continuing. Tamoxifen may increase the risk of endometrial cancer. Paroxetine reduces the effectiveness of tamoxifen through inhibiting its conversion to its active form. Timing of tamoxifen will not reduce the hot flush which is a common side effect. Tamoxifen increases the risk of venous thromboembolism and a swollen leg could suggest a deep vein thrombosis which requires urgent medical attention in a hospital.Tamoxifen may increase the risk of endometrial cancer. Paroxetine reduces the effectiveness of tamoxifen through inhibiting its conversion to its active form. Timing of tamoxifen will not reduce the hot flush which is a Page 18 of 46common side effect. Tamoxifen increases the risk of venous thromboembolism and a swollen leg could suggest a deep vein thrombosis which requires urgent medical attention in a hospital.The correct answer is: Tamoxifen should be taken daily to reduce the risk of the breast cancer returning
A 70-year-old man with advanced Parkinson’s disease is being started on apomorphine therapy.Which of the following treatment options is the most appropriate for the management of nausea and vomiting as a result of the apomorphine?
Metroclopramide, haloperidol and prochlorperazine should not be used in Parkinson’s disease as they cross the blood brain barrier and cause dopamine blockade, resulting in worsening of symptoms. Ondansetron is contraindicated with apomorphine due to additive QTc prolongation and risk of serious arrhythmia. The manufacturers of apomorphine recommend the use of domperidone to control nausea and vomiting, however there is still a risk of QT prolongation with this combination , hence an assessment of cardiac risk factors and ECG monitoring is recommended to ensure that the benefits outweight the risks.Ref: https://bnf.nice.org.uk/treatment-summary/parkinsons-disease.htmlThe correct answer is: Domperidone
A 30-year-old woman comes into the pharmacy and mentions she would like to buy something to help ease her period pain. You suspect her to have primary dysmenorrhoea. You recommend she takes 250 mg naproxen tablets.Which ONE of the following is the CORRECT information to provide the patient?
The maximum dosage for Naproxen OTC, is one 250 mg tablet 3 times per dayRef: NHS, UK Naproxen, how and when to take, https://www.nhs.uk/medicines/naproxen/The correct answer is: Do not exceed three tablets daily
A 25-year-old man brings in a bag of his unused medicines for your disposal. The bag contains prescribed medicines but also medicines he has purchased over the counter.Which ONE of the following statements about the handling of waste medicines returned to pharmacies is INCORRECT?
REF: MEP p113 and further reading (esp Safe Management of Healthcare Waste V 1.0 DoH-link from PSNC website)The correct answer is: Pharmacies should not remove blister strips from their outer packaging
A 54-year-old man presents with acute back pain. He has a family history of cardiovascular disease, has a BMI of 30 kg/m2, and is a smoker.Which one of the following would be most appropriate for this patient?
Naproxen (1 g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2 g daily or less) have not been associated with an increased risk of myocardial infarction. COX-2 inhibitors), diclofenac and high dose ibuprofen are associated with increased CVD riskREF: https://bnf.nice.org.uk/treatment-summary/non-steroidal-anti-inflammatory-drugs.htmlThe correct answer is: Naproxen
Clinical audit is a way to find out if healthcare is being provided in line with standards and let’s pharmacists know where their service is doing well, and where there could be improvements.Which of the following statements about audits is CORRECT?
Knowledge of audit process from pre-reg year, PSNC Clinical auditThe correct answer is: Re-audit performance is part of the audit cycle
You are supplying a spacer to an adult for use with their newly prescribed Metered Dose Inhaler (MDI).Which of the following is the most appropriate counselling advice in relation to the use of the spacer?
Care should be taken not to scrub the inside of the spacer as it will affect the way it works. Spacers help improve the distribution of the medicine to the intended site of action and reduce the risk of side effects, hence they should be used wherever possible/feasible, not just indoors. Spacers are only compatible with MDs.REF: https://www.asthma.org.uk/advice/inhalers-medicines-treatments/inhalers-and-spacers/spacersThe correct answer is: Spacers should be cleaned before initial use, and then once a month afterwards
AIR DRY SPACERS, NO CLOTH!
A patient has visited your pharmacy to ask for some medicine to help with their cough and sore throat, they have tested NEGATIVE for COVID-19.Which ONE of the following situations would you need to refer to a GP?
Possible Methotrexate toxicity – urgent referral symptomRef: BNF Methotrexate, patient carer advice, https://bnf.nice.org.uk/drug/methotrexate.html#indicationsAndDosesThe correct answer is: A 40-year-old patient taking methotrexate for rheumatoid arthritis
It is a bank holiday and a 40-year-old patient has run out of his metformin 500 mg tablets and asks for an emergency supply.Which ONE of the following statements about an emergency supply at the request of a patient does NOT meet legal requirements?
Legal and professional requirements for prescriptions, to enable the safe and legal supply of medicines; MEP p59The correct answer is: An entry must be made in the POM register within 72 hours
POM-P switches, ODD one out?A. Orlistat and urgent bowel movementsB. Sildenafil and cold hands and feetC. Sumatriptan and tingling sensations in the skinD. Tamsulosin and dizzinessE. Tranexamic acid and diarrhoea
B. Sildenafil and cold hands and feetCORRECTION: Sildenafil is commonly associated with flushes/hot flushes
Which ONE of these patients requesting amorolfine 5% nail lacquer could be sold the product if they have been referred to you by their doctor?
61 year old female is correct. Amorolfine is licensed from 18 years, should not be used in diabetes or in pregnancy. People with three affected nails should be referred. The doctor referring them doesn’t override the licensing
A 21-year-old female suffering from mild acne purchases a tube of benzoyl peroxide at your pharmacy.Which one of the following statements is the most appropriate advice for this patient?
Benzoyl peroxide prevents new lesions rather than shrinking existing ones, and therefore should be applied not just to active lesions. Advise that the face should be washed and left to dry for 20 minutes before applying treatment. Treatment should start with the lower strength product to allow the skin time to adjust to the medication. Acne is notoriously slow to respond to treatment and it can take months to see the maximum benefit.Ref: Symptoms in the pharmacy ebook (Can access via RPS e-library)The correct answer is: During the first few days, the skin is likely to redden and be irritated
When a medicine is supplied by a pharmacy for use in an animal under the veterinary cascade, certain details must appear on the dispensing label unless they already appear on the packaging and are not obscured by the dispensing label.Which ONE of the following requirements is NOT required on the dispensing label when making a supply under the cascade?
The correct answer is: The address of the prescribing veterinary surgeon
A patient suffering with dyspepsia calls you to discuss some symptoms he has been experiencing.Which of the following symptoms requires urgent referral?
Dysphagia requires urgent referral. Urgent endoscopic investigation is required for patients with dysphagia, significant acute gastrointestinal bleeding, or in those aged 55 years and over with unexplained weight loss and symptoms of upper abdominal pain, reflux or dyspepsia.Ref: BNF, Dyspepsia https://bnf.nice.org.uk/treatment-summary/dyspepsia.htmlThe correct answer is: Dysphagia
An 85-year-old man is receiving palliative care for lung cancer has been prescribed morphine sulfate MR capsules (Zomorph ®) 200 mg twice a day to manage his cancer pain. Over the last few days, he has complained of constipation, which he was not suffering from previously.Which of the following is the most appropriate treatment for this patient’s constipation?
Opioids reduce peristalsis, increase the anal sphincter tone, and promote absorption of water from the large intestine; this leads to hard stools and constipation. Ispaghula husk, a bulk-forming laxative, can cause obstruction and increase the risk of faecal impaction in opioid-induced constipation especially if fluid intake is inadequate. Constipation from opioid use is best treated with a stimulant laxative, or a stool-softening laxative, or both if necessary. Adequate fluid intake should be maintained. (Source MHRA)Methylnaltrexone and naloxegol are reserved for where first line therapies have failed.http://www.mhra.gov.uk/opioids-learning-module/con143740?usesecondary=&showpage=6.The correct answer is: Co-dantrhamer
It is Summer and you want to ensure your pharmacy staff are have appropriate knowledge on the sale of medicines for the treatment of hay fever.Which ONE of the products below could be sold over the counter for the associated patient?
Loratadine is the correct product according to licensing which can be sold in the above situations. All other options are unlicensed due to inappropriate age groupsRef: BNF for childrenThe correct answer is: Loratadine for a 12-year-old
You are the Responsible Pharmacist of your pharmacy working alongside another pharmacist. You plan to be away for an authorised absence for two hours and consider the options available to you during this period of absence.Which ONE of the following statements about Responsible Pharmacist legislation is CORRECT?
REF: Further information available in the RPS Responsible pharmacist toolkitThe correct answer is: You can hand over the responsible pharmacist role to the second pharmacist
A 6-year-old boy presents to the pharmacy with his mother. He has a rash around his knee (see image below). He has just come back from vacation with his family where they spent their time playing outdoors in the countryside.Use the image (image c) provided in the resource pack.Which one of the following conditions is most likely to be the cause of this rash?
hives
1Which ONE of these patients with thrush, displaying symptoms for the very first time, could be sold a medicine over the counter?
34 year old male who has symptoms and whose female partner also has thrush. Over 60’s need referral to the GP, also the presence of green discharge maybe an infection that needs GP referral specifically.Ref: NHS conditions, thrush in men and women https://www.nhs.uk/conditions/thrush-in-men-andwomen/#:~:text=You’ll%20usually%20need%20antifungal,partners%20unless%20they%20have%20symptomsThe correct answer is: A 34-year-old male whose female partner has thrush
A patient who is a new mother, comes into your pharmacy. Her 5-year-old daughter has been recently diagnosed with epilepsy and she would like to know what factors trigger epileptic seizures.Which one of the following is NOT a trigger for an epilepsy seizure?
Having a high temperature can be a cause of an epileptic seizureRef: Seizure triggers, https://www.epilepsy.org.uk/info/triggers, on lots of common epilepsy websitesThe correct answer is: Having an illness causing a low body temperature
Regarding medicines which come in tablet form, your dispenser would like to ask what they are commonly made up of.Which of the following is INCORRECT regarding common excipients?Select one:A. Binders are used to help ingredients come togetherB. Colouring agents are used to improve patient acceptabilityC. Diluents are used to provide bulk and accurate dosingD. Film coatings are used to protect the tablet from the environmentE. Glidants are used to allow the tablet to be swallowed with ease
Glidants are used to improve flow of powders during tablet manufacturing (GENERAL knowledge)The correct answer is: Glidants are used to allow the tablet to be swallowed with ease
A 2-year-old girl present with a fever of 38°C. Upon inspection she does NOT have a rash, has not had any other symptoms, and has tested negative for COVID-19.What is the MOST appropriate dose of paracetamol 120 mg/5 mL to recommend for this patient?
7.5 mL QDS PRNRef: BNFc https://bnf.nice.org.uk/drug/paracetamol.html#indicationsAndDosesThe correct answer is: 7.5 mL QDS PRN
One of your diabetic patients has recently passed his driving test. He tells you that he will be visiting his parents this weekend. You advise him that diabetic patients taking insulin to help manage their diabetes are required to notify the Driver and Vehicle Licensing Agency (DVLA).Use the information about diabetes provided in the resource pack.Which of the following statements regarding diabetics receiving insulin and driving is INCORRECT?Select one:A. Diabetics receiving insulin, driving on long journeys should test their blood glucose every four hoursB. Drivers should monitor their blood glucose more frequently when their meal routine has been alteredC. Drivers treated with insulin should ensure that a supply of sugar is always available in the vehicleD. If hypoglycaemia occurs, stop the vehicle in a safe place, wait until 45 minutes after blood glucose has returned to normal before continuing journeyE. If hypoglycaemia occurs, then drivers must stop the vehicle in a safe place and switch off the engine and move from the driver’s seat
They should test their blood glucose every 2 hours.Ref: BNF section on driving/diabetesDetailed guidance is available: https://www.gov.uk/guidance/diabetes-mellitus-assessing-fitness-todrive#impaired-awareness-of-hypoglycaemia–hypoglycaemia-unawarenessThe correct answer is: Diabetics receiving insulin, driving on long journeys should test their blood glucose every four hours
A patient is taking hyoscine butylbromide 10 mg, three times a day to treat abdominal cramps. She returns to your pharmacy complaining of side effects due to the medicine.Which of the following is NOT a side effect of hyoscine butylbromide?
Hyoscine butylbromide causes constipation. Constipation; dizziness; drowsiness; dry mouth; dyspepsia; flushing; headache; nausea; palpitations; skin reactions; tachycardia; urinary disorders; vision disorders; vomitingNOT DIARRHOEA
A 50-year-old woman has just returned from seeing the optician. The optician recommended that she use hypromellose for her dry eyes. She is also taking prescribed latanoprost eye drops. She asks you if she can use them together.What is the most appropriate response?
She should leave 5 minutes in between. No issues with using both togetherRef: BNF Eye drops and eye ointments (two different preparations used) https://bnf.nice.org.uk/treatmentsummary/eye.htmlThe correct answer is: She should leave 5 minutes between using each product
A 32-year-old mother would like to know what symptoms could be associated with meningitis, as she has just had a baby and would like to be aware.Which of the following statements is LEAST appropriate?Select one:A. Bulging hard spot towards the back of the headB. High temperature with a rash that doesn’t fade under a glassC. Irritable behaviourD. Refusing to eat and being more fussyE. Stiff body or neck
Bulging soft spot on the top of the head Ref: BNF for children and NICE CKS, https://cks.nice.org.uk/topics/meningitis-bacterial-meningitismeningococcal-disease/diagnosis/when-to-suspect/The correct answer is: Bulging hard spot towards the back of the head
A 28-year-old man would like to purchase a treatment for ringworm on their scalp, which appeared a few days ago.Which of the following is the MOST appropriate advice to give?
Must refer to GP to treat scalp ringworm.Scaling and hair loss are common symptoms. Hydrocortisone cannot be sold in this situation, ringworm is contagious and transferable through objects and often treatment must continue sometime after the rash has disappearedRef: Fungal infections https://cks.nice.org.uk/topics/fungal-skin-infection-scalp/The correct answer is: Refer to the GP to treat the affected patches
A mother comes in to buy a thermometer. Her 12-month-old baby has recently received some vaccinations. She asks how she should use the thermometer for the most accurate oral temperature reading.Which ONE of the following statements would be MOST appropriate?
Oral temperature is taken by inserting the bulb of the thermometer under the tongue and sealing the lips around the thermometerRef: How do I take a temperature? https://www.nhs.uk/common-health-questions/accidents-first-aid-andtreatments/how-do-i-take-someones-temperature/The correct answer is: Place the thermometer tip under the tongue
A patient has arrived in your pharmacy for their first smoking cessation appointment. They ask you about the side effects that they might experience with nicotine patches.Which ONE of the following is NOT a side effect of nicotine?
Shouldn’t effect sleep, however if taking oral nicotine occasionally insomnia can occurRef: BNF, Nicotine https://bnf.nice.org.uk/drug/nicotine.html#sideEffectsPage 31 of 46The correct answer is: Increased sleepiness
You sell a patient glyceryl trinitrate 400 micrograms spray over the counter for the treatment of acute angina pectoris.Which of the following is the CORRECT advice regarding use of glyceryl trinitrate 400 micrograms spray?
Administer and close mouth, repeat dose again after 5 minutes if no control of symptomsRef: Glyceryl trinitrate indications and dose, https://bnf.nice.org.uk/drug/glyceryltrinitrate.html#indicationsAndDosesThe correct answer is: Spray directly under the tongue and close mouth immediately after use
A customer in the pharmacy, who was recently seen eating a chocolate bar, has suddenly started having a reaction.Which ONE of the following is NOT a sign of anaphylaxis?Select one:A. BradycardiaB. Clammy skinC. CollapseD. Difficulty breathingE. Lightheaded feeling
Anaphylaxis is associated with a fast heartbeat. All the others are common signs of anaphylaxis.Ref: Symptoms of Anaphylaxis https://www.nhs.uk/conditions/anaphylaxis/The correct answer is: Bradycardia
A customer visits your pharmacy and asked to buy some pseudoephedrine for his congestion.Which of the following statements about pseudoephedrine is CORRECT?
The correct answer is: Pseudoephedrine can only be sold from a pharmacy when the responsible pharmacist is present
The Medicines and Healthcare products Regulatory Agency implemented measures in 2020, to support the safe use of stimulant laxatives when sold or supplied over the counter.Which ONE of following statements regarding these changes is INCORRECT?
The correct answer is: There is no limit on pack sizes that pharmacies can hold for supply under the supervision of a pharmacist
A 54-year-old female patient presents in your pharmacy to purchase St John’s Wort. Upon asking her more questions, she tells you that she is also taking warfarin tablets.Which ONE of the following statements about St John’s Wort is the most appropriate advice to provide in this situation?
Taking St Johns wort might decrease the effectiveness of the Warfarin if taken together, as it acts as an enzyme inducer
A 45-year-old woman presents to the pharmacy with symptoms of heartburn and reflux. When counselling this patient, you inform her of symptoms that would indicate that she should contact her doctor, should she experience them.Which of the following would be an example of one of these symptoms?
Unintentional weight loss can be a sign of something more serious, and requires referral to a GP.
Pharmacists may engage in wholesale dealing without a Wholesale Dealer’s License (WDL). When conducting such supplies, pharmacies must comply with several requirements.Which ONE of the following statements about wholesale dealing of medicines from pharmacies is CORRECT?Select one:A. Pharmacies with a WDL do not need any additional licences for commercially trading controlled drugsB. The requirements for wholesale dealing without a WDL still apply if there is exchange of stock between two pharmacies that are part of the same legal entityC. There is an exemption in UK law for pharmacies to hold a WDLD. When supplying a medicine without a WDL, any amount of profit can be made on the supplyE. When supplying
MEP p77-79 wholesale dealingThe correct answer is: When supplying a medicine without a WDL, the supply must not be for onward wholesale distribution
You are observing your patient use their Symbicort Turbohaler® (budesonide/formoterol) device and providing feedback on their inhaler. After you watch them prepare the device, they show you how they inhale their dose.Which of the following best describes the correct technique for inhaler use?
The correct answer is: Form a tight seal around the mouthpiece with their lips, then breathe in quickly and deeply
A 25-year-old male is admitted to hospital feeling unwell with extensive cellulitis caused by methicillinresistant Staphylococcus areus and is subsequently started on intravenous vancomycin 1.5 g every 12 hours. He weighs 78 kg, his height is 185 cm, and his eGFR is >90 m/min/1.73m2.Which of the following is the most appropriate advice in relation to managing vancomycin?
See the BNF: All patients require serum-vancomycin measurement (on the second day of treatment, immediately before the next dose if renal function normal, earlier if renal impairment—consult product literature). The next vancomycin dose should not be withheld whilst awaiting results unless toxicity is suspected. Administration rate should not exceed 10mg/min to reduce the risk of red-man’s syndrome.The correct answer is: A vancomycin trough plasma concentration level should be taken before the 4th dose
A 31-year-old male patient who presents at the pharmacy to collect his prescription for propranolol to help with his anxiety symptoms
Fatigue is a lesser known side effect of beta blockers but important to mention in counselling. Causes bradycardia rather than tachycardia.The correct answer is: Fatigue
A 32-year-old male patient who has been prescribed clindamycin to treat a staphylococcal bone and joint infection
Abdominal Pain. Specific side effects Common or Very Common Abdominal pain, Antibiotic associated colitis, diarrhoea.https://bnf.nice.org.uk/drug/clindamycin.htmlThe correct answer is: Abdominal pain
A 32-year-old male patient who is travelling to India and has been prescribed doxycycline as malaria prophylaxis.
Photosensitivity
A 66-year-old female patient has been prescribed glyceryl trinitrate sublingual spray for the prophylaxis and treatment of angina. You counsel her on the most common side effects associated with nitrates.
Tahycardia - Side effects of GTN include postural hypotension, tachycardia (but paradoxical bradycardia also reported); throbbing headache, dizziness; less commonly nausea, vomiting, heartburn, flushing, syncope, temporary hypoxaemia.The correct answer is: Tachycardia
An 81-year-old woman has been prescribed Trimethoprim 100mg once a day at night for the prophylaxis of recurrent urinary tract infections.
Trimethoprim may cause fungal overgrowth – classed as a common adverse reaction.REF: BNF https://bnf.nice.org.uk/drug/trimethoprim.html#sideEffectsThe correct answer is: Fungal overgrowth
A 45-year-old male patient has schizophrenia and has been prescribed olanzapine to prevent the recurrence of his bipolar disorder. He has no other significant past medical history. Identify the parameters that must be reviewed and recorded before commencing treatment.
Fasting blood glucose – patients taking antipsychotics, particularly olanzapine are susceptible to hyperglycaemia and diabetes therefore fasting BG must be tested at baseline and at regular intervals thereafter.The correct answer is: Fasting blood glucose
A 23-year-old female patient has been taking an oral contraceptive pill (containing ethinylestradiol and levonorgestrel) for the past 4 years. She is not taking any other medicines and has no significant past medical history. She is due a review with the prescriber. Identify the parameter which should be measured before prescribing a repeat prescription
Blood pressure should be measured as hypertension is a known risk factor that increases the risk of arterial disease associated with oral contraceptives.The correct answer is: Blood pressure
A 60-year-old female patient comes into the pharmacy for an NHS health check. Following the assessment, you discover that she has 10-year cardiovascular risk of 25.5 %. You refer her to the GP who prescribes simvastatin 20 mg to be taken at night. Identify the parameter that should be measured before commencing treatment with simvastatin.
(Transaminases (ALT/AST) should be checked 3 and 12 months after commencing treatment by requesting LFTS. Statins should be used with caution in patients with a history of liver disease as they are metabolized by the liver, so hepatic impairment will increase their levels and thus the risk of myopathy. Simvaststin is contraindicated in active liver disease or if transaminases ALT & AST are raised more than 3 times the normal range.The correct answer is: Serum alanine transaminase (ALT)
A 67-year-old male patient has been diagnosed with persistent stage 2 hypertension despite attempting to change their lifestyle. A decision is made with the patient to start antihypertensive drug treatment. He is started on ramipril 1.25 mg once daily. Identify the parameter that should be monitored at regular intervals.
Use clinic blood pressure measurements to monitor the response to lifestyle changes or drug treatment in people with hypertension. NICE NG136: Hypertension in adults: diagnosis and management.The correct answer is: Blood pressure
A 55-year-old male patient suffers from generalised seizures. He has been prescribed sodium valproate and also uses a salbutamol inhaler once or twice a year. Identify the parameter that should be measured before commencing treatment.
Serum ALT – Sodium Valproate is associated with hepatotoxicity therefore liver function should be measured at baseline and at regular intervals throughout therapy.The correct answer is: Serum alanine transaminase (ALT)
A 50-year-old man takes folic acid 5 mg once weekly, methotrexate 10 mg once weekly. He has been newly prescribed amoxicillin 500 mg three times a day for seven days.
Amoxicillin is predicted to increase the risk of toxicity when given with methotrexate. Manufacturer advises monitor.Ref: https://bnf.nice.org.uk/interaction/methotrexate-2.htmlThe correct answer is: Toxicity of either or both drugs
A 63-year-old man takes lisinopril 10 mg daily, amlodipine 10 mg daily. He has been newly prescribed simvastatin 40 mg at night.
Amlodipine slightly increases the exposure to simvastatin. Manufacturer advises adjust simvastatin dose to a max. 20 mg daily with concurrent use of amlodipineRef: https://bnf.nice.org.uk/drug/simvastatin.htmlThe correct answer is: Toxicity of either or both drugs
A 45-year-old woman takes methadone 1 mg/mL oral solution 65 mg daily for opioid addiction. She has been prescribed domperidone 10 mg, three times a day by her GP.
Domperidone increases the risk of QT-prolongation when given with methadone. Manufacturer advises avoid.https://bnf.nice.org.uk/interaction/methadone.htmlThe correct answer is: QT interval prolongation
Which analgesic would be most suitable for the effective treatment of neuropathic pain in an 82-year-old man with diabetes?
REF: BNF, https://bnf.nice.org.uk/drug/gabapentin.htmlThe correct answer is: Gabapentin 300 mg capsules
Which analgesic can be sold to a 24-year-old for the treatment of primary dysmenorrhea?
The correct answer is: Naproxen 250 mg tablets
Which analgesic is contraindicated for a 42-year-old with uncontrolled epilepsy?
The correct answer is: Tramadol 50 mg capsules
A 5-years-old boy, presents with exanthema behind the ears which spread to the face and later to the trunks and extremities and after three days, it begins to fade.
Rubella rash tends to start behind ears and on face before spreading to the rest of the body.REF: https://cks.nice.org.uk/topics/rubella/The correct answer is: Rubella
A 18-month-old girl, presents with general malaise, loss of appetite. She has small erythematous macules on her stomach and arms, and a few some pustules.
Chickenpox is associated with red spots that typically look like blisters. The spots can appear on any part of the body.REF: https://cks.nice.org.uk/topics/chickenpox/The correct answer is: Chickenpox
A 6-month-old boy, presents with sudden onset of a seal-like barking cough with stridor and sternal recession at rest.
Croup is characterised by the sudden onset of a seal-like barking cough, often accompanied by stridor, voice hoarseness, and respiratory distress.REF: https://cks.nice.org.uk/topics/croup/The correct answer is: Croup
A 4–year-old girl, presents with sore throat, low-grade fever and tender lesions in the mouth and papulovesicular lesions of the distal limbs
Hand, foot, and mouth disease is an acute viral illness characterized by vesicular eruptions in the mouth and papulovesicular lesions of the distal limbs. It is not to be confused with foot and mouth disease of animals, which is caused by a different virus. REF: https://cks.nice.org.uk/topics/hand-foot-mouth-disease/The correct answer is: Hand foot and mouth disease
A 2-week-old baby, presents with excessive crying, inconsolable crying which occurs in late afternoon or evening and draws its knees up to abdomen when crying
Classic signs of colic which starts in the first weeks of life and resolves by around 3–4 months of age.REF: https://cks.nice.org.uk/topics/colic-infantile/The correct answer is: Colic
A 68-year-old man, who is taking citalopram for depression, presents with drowsiness, confusion, and convulsions.
Hyponatraemia
A 46-year-old woman, who has recently been prescribed spironolactone 100 mg once daily for oedema in congestive heart failure
Hyperkalaemia
A 25-year-old man is discharged from hospital with lamotrigine 25 mg tablets which he is taking for epilepsy.
The correct answer is: Warning. Do not stop taking this medicine unless your doctor tells you to stop
a 14-year-old boy is discharged from hospital with Penicillin V tablets which he must take for 5 days in order to treat acute sinusitis.
The correct answer is: Take this medicine when your stomach is empty. This means an hour before food or 2 hours after food
A 48-year-old male is discharged from hospital with mirtazapine 15 mg tablets for major depression.
Warning: This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol
A 26-year-old is written a prescription by his GP sulfasalazine 500 mg tablets for maintenance of remission of mild ulcerative colitis.
The correct answer is: This medicine may colour your urine. This is harmless.
A 56-year-old woman taking lithium carbonate 400 mg for prophylaxis for bipolar disorder.
The correct answer is: Warning: Read the additional information given to you with this medicine
A 56-year-old woman taking lithium carbonate 400 mg for prophylaxis for bipolar disorder.
The correct answer is: Warning: Read the additional information given to you with this medicine
A 77-year-old male patient presents at the emergency department complaining of an episode of haematuria. A medical history identifies that he been takes warfarin for atrial fibrillation. His INR is measured and reported as 7.2. A week earlier he started treatment with a course of oral antibiotics for the treatment of a lower respiratory infection. You suspect that the raised INR is due to a drug interaction.Select one:A. AmoxicillinB. BenzylpenicillinC. CiprofloxacinD. ClarithromycinE. ClindamycinF. Co-amoxiclavG. NitrofurantoinH. Trimethoprim
While amoxicillin, benzylpenicillin, clindamycin, ciprofloxacin, co-amoxiclav, tigecycline and trimethoprim all have the potential to interact with warfarin Clarithromycin is in the BNF as a potentially serious interaction. BNF Appendix 1 Interactions.The correct answer is: Clarithromycin
A 61-year-old male patient has been prescribed a course of oral antibiotics for a moderate diabetic foot infection. During the counselling you discover that the patient has a history of tendon disorders. You advise the prescriber that this treatment is contraindicated.
Ciprofloxacin. quinolones are contra-indicated in patients with a history of tendon disorders related to quinolone use. https://bnf.nice.org.uk/drug/ciprofloxacin.html#importantSafetyInformationsThe correct answer is: Ciprofloxacin
A female patient is due to commence a course of fludarabine phosphate at 40 mg/m2for five days. She is 1.68 m tall and weighs 71 kg.How many fludarabine phosphate 10 mg tablets that should be supplied for the five day course? Give your answer to the nearest whole tablet.DOSE*5 day course
Note: Remember to convert height in m to cm (1.68m => 168cm) for the formula.Using the formula = √([71 x 168] ÷ 3600) = √3.313333 = 1.820256 m2Dose is 40 mg x 1.820256 m2 = 72.81024 mgCalculate tablets for one day. You have 10 mg tablets = 70 mg = 7 tabletsSo for five days: 7 X 5 = 35 tabletsTOPIC: Using provided formulae
70-year-old man been diagnosed with pneumonia is prescribed intravenous amoxicillin. He also suffers from chronic kidney disease and his serum creatinine is currently 182 micromol/L. He weighs 58 kg.The Cockcroft and Gault formula for estimating creatinine clearance is provided below:
Convert 1g STAT to 1000MG BOY!
You want to find out the number needed to treat (NNT) for a valproate based migraine treatment. You find the following information from a meta-analysis paper.Valproate was used to treat migraine in five trials. It was found that the number of patients having at least a 50% reduction in the number of migraine attacks over 28 days. The review of the trials showed the following results:• Patients treated with valproate, 241/520 (46 %) patients had the number of migraine attacksreduced by at least half.• With placebo, 69/341 (20 %) had the same outcome.Use the extract about NNT provided in the resource packWhat is the NNT for valproate treatment? Give your answer to the nearest whole number.
sing the formula:AAR = 0.46 - 0.2= 0.26NNT = 1/0.26 => 100/26 = 3.64615.Rounded up (all NNT rounded up) to 4.
NNT?
ROUND UP
NNH?
ROUND DOWN
A patient weighing 82 kg is administered a dose of 50 mg in 2 mL levomepromazine by intramuscular injection.It has been calculated that the volume of distribution of levomepromazine is 15 L/kg. It is also estimated to have a half-life of 20 hours and an effective bioavailability of 80% when given by intramuscular injection.Assuming the patient is not administered any further doses, what is the blood concentration in mcg/L after 60 hours? Give your answer to one decimal place.
80% bioavailability means 50 x 0.8 = 40 mg (40,000 mcg) availableVolume of distribution = 15 x 82 = 1230 LTherefore, the concentration will be 40000 mcg ÷ 1230 LWhich is 32.52 mcg/LThen calculate half-life:At hour 0, there will be 32.52 mcg/LAt hour 20, there will be 16.26 mcg/LAt hour 40, there will be 8.13 mcg/LAt hour 60, there will be 4.065 mcg/LTOPIC: Pharmacokinetics
A solution of benzalkonium chloride is available in a concentration of 1:750 w/v.How many mL of purified water is required to be added to 30 mL of the solution to prepare a 1:5000 solution of benzalkonium chloride for use as a wet dressing for the skin?
1:750 = 1g in 750mL.Therefore there will be 40 mg in 30 mL of benzalkonium solution.Target solution is 1:5000. This is equivalent to 1 g in 5000 mL.We need to have 40 mg in our final solution. So the total volume needed is 200 mL40 mg/200 mL is equivalent to a 1:5000 solution.Started with a 30 mL volume. Need to add 170 mL of water.TOPIC: DilutionThe correct answer is: 170
A 29-year-old lady has been taking ferrous fumarate 210 mg tablets, three tablets daily. Oral bioavailability is 70%. Due to an operation, she is now unable to swallow the tablets and has been changed to Sytron Elixir® (sodium feredetate trihydrate) twice daily, which as an oral bioavailability of 90%.Ferrous fumarate 210 mg tablets contain the equivalent of 70 mg elemental iron.Sytron Elixir® contains sodium feredetate trihydrate 190 mg equivalent to 27.5 mg elemental iron in each 5 mL.What is the equivalent single dose of Sytron Elixir® to be given? Give your answer to the nearest 5 mL.
Patient has 70 mg x 3 = 210 mg of elemental iron per day.Total bioavailable iron = 210 x 0.7 = 147 mgSytron bioavailability is 90%.Therefore 147 mg = 90% of total oral dose.100% = (147 ÷ 90) x 100 = 163.33333 mg iron needed per day of Sytron.Sytron has 27.5 mg elemental iron per 5 mL = 5.5 mg/mLTherefore 163.33333 ÷ 5.5 = 29.69697 mL per dayPatient will need 29.69697 ÷ 2 = 14.84848 mL of Sytron per doseRound to nearest 5 mL => 15 mLTOPIC: Dose and dose regimeThe correct answer is: 15
H PYLORI TREATMENT CHOICE TAKE INTO ACCOUNT?
(treatment choice should take into account previous treatment with clarithromycin or metronidazole).
A 29-year-old woman was started on fluoxetine two weeks ago for depression. At her follow up appointment with her GP, she reports that she has felt more anxious since starting the medication and that her mood has not improved. The GP has called you for advice on the management of this case.Which one of the following is the most appropriate course of action in relation to the patient’s fluoxetine therapy?
Treatment should be continued for at least 4 weeks (6 weeks in the elderly) before considering whether to switch antidepressant due to lack of efficacy. In cases of partial response, continue for a further 2–4 weeks (elderly patients may take longer to respond).Ref: https://bnf.nice.org.uk/treatment-summary/antidepressant-drugs.htmlThe correct answer is: Continue fluoxetine for another 2 weeks and reassess whether there has been any improvement
Which ONE of the following record keeping requirements is NOT required for a supply of a POM-V and POM-VPS?
The expiry date of the product
A 57-year-old female, of African-Caribbean family origin, has just been diagnosed with Stage 1 hypertension. She has type 2 diabetes, and a QRISK2 score of 13%. She has no known allergies and renal function tests are within the normal range.Which of the following drugs is the most appropriate first-line therapy according to national guidance?
NICE guidance NG136 recommends ACE or ARB as step 1 therapy for diabetics of any age or family origin. NICE also recommends an angiotensin II receptor blocker (ARB), in preference to an angiotensin-converting enzyme (ACE) inhibitor in adults of black African or African-Caribbean family origin.The correct answer is: Candesartan
A regular patient from your community pharmacy has been discharged from hospital following a fall associated with hypoglycaemia. He is a 72-year-old man with Type 2 Diabetes who has recently had his medicines changed due to poor glycaemic control.When reviewing his prescription list, which of the following medicines would you be most concerned about in relation to the risk of hypoglycaemia?
Glibenclamide is a long-acting sulphonylurea and is more prone to causing hypoglycaemia, especially overnight, in the elderly. Gliclazide is a shorter acting sulphonylurea. Other classes of oral antidiabetic agents have a lower risk of hypoglycaemia compared with sulphonylureas.Ref: https://bnf.nice.org.uk/treatment-summary/type-2-diabetes.htmlThe correct answer is: Glibenclamide
A 45-year-old male presents to the pharmacy complaining of redness and pain in his left eye, which started last night. He tells you that he has used over the counter antibiotic eye drops in the past for conjunctivitis when his eyes have been ‘uncomfortable and gritty, with sticky discharge’. He asks you about buying these eye drops again for his current symptoms.Which of the following is the most appropriate course of action for this patient?
It can cause a gritty, uncomfortable sensation but should not be painful. Patients should be referred to the GP if it is painful. Conjunctivitis is usually viral in nature, and bacterial conjunctivitis is frequently self-limiting.Ref: Symptoms in the pharmacy (ebook available on RPS e-library)The correct answer is: Refer him to the GP for further investigation
An 84-year-old woman telephones the pharmacy and explains she had the Oxford/AstraZeneca COVID-19 vaccine yesterday. She has been suffering from a headache this morning and believes it’s a side effect. She would like you to report it to her GP.What is the most appropriate course of action in this scenario?
As this is a new medicine is it important to ensure all side effects, no matter how mild are reported using in accordance with usual reporting procedures. This includes known side effects. In this case, the vaccine is known to cause headaches - see SmPC for more information. The Yellow Card Scheme is a national scheme for reporting side effects with any medicine, which can be used by patients and healthcare professionals.REF: MHRA https://yellowcard.mhra.gov.uk/ and Information about Oxford/AztraZeneca COVID-19 Vaccine https://www.gov.uk/government/publications/regulatory-approval-of-covid-19-vaccine-astrazenecaThe correct answer is: Report the side effect using the Yellow Card Scheme
Which of the following bronchodilators is licensed for twice daily dosing as chronic obstructive pulmonary disease (COPD) maintenance therapy?
A summary of licensed agents and dosing schedules for COPD can be found here: https://www.pcrsuk.org/sites/pcrs-uk.org/files/TableofInhaledDrugsFINAL.pdfThe correct answer is: Aclidinium / Formoterol (DuaKlir Genuair®)
Standardised controlled drugs requisition forms are a legal requirement when requisitioning certain controlled drugs in the community.Which ONE of the following statements about standardised controlled drug requisition forms is INCORRECT?
REF: MEP p 93-94.The correct answer is: Supplies made against faxed requisitions are legally acceptable
A 24-year-old-woman is considering starting the combined oral contraceptive pill (COC).Which of the following pieces of information or advice is most appropriate to give to this woman?
For women who are having natural menstrual cycles, the COC pill can be started up to and including day 5 of the menstrual cycleThere is a possible small increase in risk of developing breast cancer, which returns to no increased risk within 10 years after stopping the COC. The estimated failure rate for typical use of COCs is 9% at 1 year. Additional Page 6 of 46contraceptive precautions are not required when antibiotics that do not induce enzymes are used in conjunction with CHCs.REF: https://www.fsrh.org/documents/fsrh-ceu-guidance-recommended-actions-after-incorrect-use-of/fsrhguidance-recommended-actions-after-incorrect-use-of-chc-march-2020.pdfThe correct answer is: For women who are having natural menstrual cycles, the COC pill can be started up to and including day 5 of the menstrual cycle without the need for additional contraceptive protection
How often should this patient have their blood counts monitored when clozapine is initiated?
For the first 18 weeks, blood counts should be monitored every week.REF: https://bnf.nice.org.uk/drug/clozapine.html#indicationsAndDosesThe correct answer is: Weekly
The patient is stabilised on therapy and has remained on the same dose of clozapine for one year. Now that he is feeling an improvement in his symptoms, he decides to work on building healthy habits including regular exercise, and quitting smoking.Which of the following advice would be the most appropriate in relation to his clozapine?
Cigarette smoking induces metabolism of clozapine, resulting in significant increases in levels when quitting, hence dose adjustment and increased monitoring is required. This is not related to the nicotine component, hence the effect is not negated by NRT.REF: https://bnf.nice.org.uk/drug/clozapine.html#interactionsThe correct answer is: Refer to prescriber for a potential dose reduction and monitoring of plasma concentration levels
A 21-year old woman presents to the pharmacy with a prescription for metronidazole 2 g orally as a single dose.Which of the following is the most likely indication for her metronidazole prescription?
The recommended metronidazole doses for the above conditions can be found in the BNF.The correct answer is: Bacterial vaginosis
You are dispensing a new prescription for glyceryl trinitrate patch (Transiderm Nitro®), to be applied once a day, for a 65-year-old male for the management of his angina.Which of the of the following would be the most appropriate advice for this patient on how to apply the patch?
The patch should be applied to the lateral chest every 24 hours. It does not need to be removed for showering/bathing and should be used regularly to prevent angina rather than when required.
Which of the following is the most likely explanation for these symptoms?
Hypokalaemia, which can be caused by potassium-depleting diuretics such as the loop diuretics, increases the toxicity of the digitalis glycosides.REF: Stockley’s drug interactionsThe correct answer is: Hypokalemia due to furosemide
You are due to start work at 9am as the Responsible Pharmacist in a community pharmacy. There are delays on the train, so you arrive 30 minutes late. The dispensing technician would like to carry out some activities before you arrive.Which of the following activities can the dispensing technician carry out when you are not present in the pharmacy
In a NHS pharmacy, there must be a pharmacist present whenever pharmaceutical services are being provided. Activities A-D can only take place when the responsible pharmacist is in charge of the pharmacy and need to take place under the supervision of a pharmacist and the supervising pharmacist will need to be physically present at the pharmacy. Further information also available in the RPS Responsible pharmacist toolkit,MEP pg 137-139 and at www.psnc.org.ukThe correct answer is: Ordering stock from a wholesaler
A 50-year-old man with chronic kidney disease requiring haemodialysis has been discharged from hospital postfracture repair.Which one of the following analgesics would be the most suitable choice for the short-term management of his acute post-operative pain on discharge?
Morphine is metabolised to morphine-6-glucuronide which accumulates in renal impairment, resulting in CNS depression. Similarly, the clearance of codeine, and its metabolites are significantly reduced in renal impairment. The pharmacokinetics of oxycodone is also affected in renal failure, however it may be preferred to morphine in some circumstances. The BNF recommends to avoid codeine in renal failure and to use morphine and oxycodone with caution. The BNF also recommends to avoid ibuprofen (systemic NSAID) in severe renal impairment. Fentanyl patches and slow release tablets are not appropriate for acute pain due to their slow onset of action and long duration of action.REF: https://www.sps.nhs.uk/wp-content/uploads/2018/12/SW_QA_402-4_Nov17_Final.docThe correct answer is: Oxycodone immediate release tablets
She is complaining of nausea and loose stools since starting on methotrexate.Which of the following is the most appropriate strategy to prevent the side effects that the patient is experiencing?
Folic acid is indicated for the prevention of side effects from methotrexate however it needs to be taken on a different day to the methotrexate, otherwise it will reduce the effectiveness of the methotrexate. The use of folinic acid is reserved for use as a part of treatment protocols for methotrexate infusions.The correct answer is: Folic acid 5 mg once a week, taken on a different day to methotrexate
A 26-year-old female has been diagnosed with microcytic anaemia.Which one of the following nutritional deficiencies is most likely to be contributing to this diagnosis?
Microcytic Anaemia (low MCV) most commonly due to iron deficiency.
megaloblastic anaemia?
folic acid OR b12 deficiency
Summary Care Records (SCR) are an electronic record of important patient information. They can be seen and used by authorised staff in other areas of the health and care system involved in the patient’s direct care.Which ONE of the following statements about the SCR is CORRECT?
Pharmacists currently do not have write access to SCR although this may change soon. There is a consent form however verbal consent is also accepted. The use of SCR in the pharmacy setting is linked to quality payment scheme in community pharmacies and is available to technicians. Must seek consent unless in emergency e.g. unconscious patient.See RPS guidance on SCR: http://www.rpharms.com/unsecure- support-resources/summary-care-records.aspThe correct answer is: To access the SCR consent needs to be gained for each patient, at each pharmacy, on a need-by-need basis
An 18 year old man has been prescribed metronidazole 400 mg three for seven days by his dentist for a tooth infection. He wants to know if he can drink alcohol whilst taking the medicine.Which ONE of the following counselling points is the LEAST appropriate advice to give?
Patients should to avoid alcohol drugs while taking metronidazole and for at least 48 hours after stopping the drug. Monitor for flushing, nausea, and vomiting if the combination is used.REF: https://www.medicines.org.uk/emc/medicine/21216#CLINICAL_PRECAUTIONSThe correct answer is: Tell him to limit alcohol consumption
A 23-year-old woman presents to her GP complaining of heavy and irregular menstrual bleeding. She has a past medical history of antiphospholipid syndrome, for which she is treated with warfarin. After conducting investigations, the GP did not find any abnormal uterine pathology.Use the information provided about antiphospholipid syndrome in the resource pack.Which one of the following treatment options would be most appropriate?
Levonorgestrel-releasing intrauterine system.This will also provide contraception which may be important for this patient as she is on warfarin.Page 13 of 46NSAIDs would be contra-indicated as they increase the risk of bleeding when given with warfarin. Tranexamic acid and the combined oral contraceptive pill are also contra-indicated in antiphospholipid syndrome due to the additive increase in thrombosis risk.REF: BNF monographsThe correct answer is: Levonorgestrel-releasing intrauterine system
You are conducting a consultation with your patient, a 40-year-old-man, and he mentions he has recently been diagnosed with diabetes. After gaining his consent you test his blood glucose levels, the result is 3.7 mmol/L.Which ONE of the following is the most appropriate next step?
The patient requires sugar immediately as they are experiencing hypoglycaemia (any reading less than 4 mmol/L). Diabetic chocolate would not contain enough sugar required to increase the sugar level quick enough Ref: BNF Treatment of hypoglycaemia https://bnf.nice.org.uk/treatment-summary/hypoglycaemia.htmlThe correct answer is: Ask him to immediately drink some of his fruit juice that he has got with him
A 38-year-old man presents at the pharmacy with the following symptoms: moderate; nasal itching, congestion, sneezing and rhinorrhoea. The symptoms have lasted over a month. He has had a NEGATIVE COVID-19 test.Which ONE of the following would be the most suitable first line over the counter treatment, to alleviate the patient’s symptoms?
The patient is suffering from allergic rhinitis, therefore the most appropriate treatment is nasal irrigation with saline (local treatment is recommended as first line).Ref: BNF, Rhinitis, drugs used in nasal allergy https://bnf.nice.org.uk/treatment-summary/nose.htmlThe correct answer is: Nasal saline solution
A regular patient comes into the pharmacy and asks for some medicine to treat a wart on their hand.Which ONE of the following statements about warts is CORRECT?
The other options are incorrect - Topical salicylic acid (15–50%) should be applied once or twice daily for up to 12 weeksPage 14 of 46Warts are caused by infection in the outer layer of the skin (epidermis) with a virus called the ‘human papilloma virus’. refer to GP for facial warts. Without any treatment, warts may spontaneously resolve but may take many months or even yearsref: BNF, Warts and Calluses https://bnf.nice.org.uk/treatment-summary/warts-and-calluses.htmlThe correct answer is: Cryotherapy with liquid nitrogen can be carried out to freeze a wart
Pharmacies can legally make a supply of adrenaline auto-injectors to schools under certain conditions.Which ONE of the following statements about the supply of adrenaline auto-injectors to schools is CORRECT?
Legal and professional requirements for prescriptions, to enable the safe and legal supply of medicines; see MEP p62The correct answer is: A written signed order signed by principal/headteacher at the school must be provided
A 24-year-old lady comes into the pharmacy seeking advice for an itchy, inflamed and painful external right ear. She has just returned from a regular swimming lesson and has had similar problems before.Which one of the following is NOT a referral point for her condition?
Temporary hearing loss is a common symptom of Otitis Externa and therefore is not a referral point.Ref: NICE CKS, Otitis externa diagnosis https://cks.nice.org.uk/topics/otitis-externa/diagnosis/diagnosis/The correct answer is: Some degree of temporary hearing loss
A father would like you to recommend how much paracetamol is required for his 4-year-old child who has cold and flu like symptoms.Which ONE of the following doses is MOST appropriate regarding paracetamol?
240 mg every 4-6 hours, maximum 4 times per dayRef: https://bnfc.nice.org.uk/drug/paracetamol.htmlThe correct answer is: 240 mg every 6 hours
Emergency supplies at the request of an EEA or Swiss patient can be made.
ellaOne action
prevents ovulation
Miss L is a 29-year-old bank assistant who is reported to have thyroid dysfunction. You review her current medications and you think this effect may be attributed to one of the drugs.Which one of the following drugs is most likely to have caused Miss L’s thyroid dysfunction?
Amiodarone has been associated with causing thyroid dysfunction and may cause hyper- or hypothyroidism.
A doctor contacts you asking you to suggest a drug to treat a patient who has contracted meningococcal disease.Which drug would be suitable to be given via intravenous infusion in this patient?
Benzylpenicillin sodium is indicated for use in meningococcal disease and is only available in an IV preparation.
Mr R is a 48-year-old male of African family origin. He was previously diagnosed with stage one hypertension. After trying to reduce his blood pressure through changes in diet and physical activity levels, it is still raised. Today he has brought in a prescription for a medication to reduce his blood pressure. He has no other medical conditions.Which one of the following antihypertensives is Mr R most likely to have been prescribed to manage his hypertension?
For patients over 55 years, and patients of any age who are of African or Caribbean family origin and do not have diabetes step 1 in the drug management of hypertension is a calcium-channel blocker (CCB). Amlodipine is the only CCB listed in the answer options.
A patient requires a 500 mL infusion bag containing dopamine 0.1% w/v.Using a 40 mL vial of dopamine 1.25% w/v, what volume of glucose 5% is required to make up the infusion bag?
1.25% solution means 1.25 g in 100 mL or 1250 mg of dopamine in 100 mL of dopamine solution; therefore 500 mg in the 40 mL vial. To make the 500 mg into a 0.1% w/v solution we must dilute it by x 1000. Thus, the vial contents will make 500 mL at this concentration, and so we need to add 460 mL to the 40 mL from the vial. Fortuitously, 500 mL fills the bag specified in the question exactly without leaving a surplus or needing augmentation.
A 28-year-old woman comes into the pharmacy requesting a plaster to help heal the raised hardened skin on her foot that has formed a corn. Upon further questioning you find that the patient must be referred to her GP for further investigation.Which one of the following medical conditions is most likely to warrant this action?
Patients with diabetes are at an increased risk of developing diabetic foot complications, wherein attempting to treat a simple corn could lead to introduction of bacteria and an infection. Due to nerve damage and loss of sensation in the feet this may go undetected, leading to a spread of infection and in severe cases gangrene. Referral is required.
Opiates are known drugs of abuse. You are running a training work shop to educate community pharmacists on the abuse potential of these drugs.Which of the following is NOT a symptom of opioid toxicity?
Incorrect answer ComaIncorrect answer Pinpoint pupilsYou chose the correct answer Pupil dilationIncorrect answer Respiratory depressionIncorrect answer UnconsciousnessYou were correct.The correct answer was Pupil dilationPupil narrowing or ‘miosis’ is an effect of opiate toxicity; pupil dilation is not.
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.In what way should you deal with the disposal of the remaining liquid inside the bottle?
Rinse the bottle with water and pour into a denaturing kitWaste medicines should not be disposed of in the sink. The rinsings should be added to a denaturing kit and disposed as pharmaceutical waste.
You have a new member of staff starting on your pharmacy counter team. You are providing them with training on the sale of over-the-counter (OTC) medicines.Which of the following components of OTC medicines would you NOT require him to exercise additional cautions to sell due to the risk of misuse?
KaolinKaolin and morphine would need to have additional caution, but kaolin itself is not subject to abuse.
You are teaching a trainee about medical terminology.Which of the following terms describes ‘asbestos-like’ scales on the scalp?
Pityriasis amiantaceaPityriasis amiantacea describes ‘asbestos-like’ scales on the scalp.
You have a patient who is diabetic. Some medicines may need to be used with caution in patients with diabetesWhich ONE of the following is most likely to cause ketoacidosis?
Intravenous salbutamolBeta 2 agonists must be used with caution in patients with diabetes. Intravenous salbutamol can cause ketoacidosis.
Miss C is joining your pharmacy team as a work experience student. You receive the morning order of medications and preparations and she is keen to help put them out on the pharmacy shelves.She asks you which one of the following substances is a prescription only medicine?
Mometasone furoate 0.1% cream
A patient presents to the community pharmacy in which you are the Responsible Pharmacist. Upon discussing with the patient you ascertain that she is 28 weeks pregnant and suffers with severe hypertension.Which of the following medications is NOT appropriate to sell OTC to this patient?
Pseudoephedrine tabletsPseudoephedrine is contraindicated in patients suffering with severe hypertension.
A mother brings her 3 year-old child to your pharmacy. They are suffering from the symptoms associated with otitis media, a common complaint in young children.Which of the following symptom groups best describe the signs and symptoms of otitis media in this age group?
Irritability, crying, fever and painPain is the most common symptom and so eliminates options A and B. Crying is also prominent and thus eliminates option C. D and E are both possible but fever is often seen; thus E is the correct option.
You are trying to prevent prescribing errors in your pharmacy.Which of the following is NOT a recommended check point for avoiding prescribing errors?
Right quantityDouble checking when prescribing or administering any medicine is important to avoid any medication errors. You can double check it is the: right medicine, right patient, right dose, right route, right time.
An 18-year-old girl enters your pharmacy and asks for your advice regarding a sore throat, tiredness and swollen glands in her neck. What do you suspect may be her condition and most likely cause?
Glandular fever caused by Epstein-Barr virus
You are working in a community pharmacy on a Saturday. Your counter assistant makes you aware that there is a lady asking for an emergency supply of an EpiPen. On questioning the patient you establish that she is allergic to bees and has been stung. She does not have an EpiPen with her. She reports feeling breathless and having a tight chest.What is the most appropriate initial step in your course of action?
Ask the assistant to telephone 999, request an ambulance and state anaphylaxisThe patient is demonstrating signs of anaphylaxis. She will need emergency assistance so it is important to make this call asap. As you have other staff available to do this, it would be appropriate to get them to do this instantly while you then deal with the emergency. The MEP states that: “If a pharmacist administers adrenaline they must also ensure that an ambulance is called by dialling 999 and reporting that there is a case of suspected anaphylaxis.” EpiPen training provides similar guidance. When managing anaphylaxis it is crucial that the ambulance gets to the patient as soon as possible. Therefore, the initial first step to get the assistant to phone 999 would be prudent while you are in the process of locating and administering the adrenaline pen in order to avoid undue delay in the patient getting the next step in their care.
You are training a summer student on the use of medicines.Which of the following non-prescription topical preparations is an antiviral agent?
Zovirax® 5% cream
You are providing training on side effects of medicines.Which of the following can be a side-effect of ciclosporin?
Hypomagnesaemia
You are training your trainee pharmacist on food interactions with warfarin.Drinking which of the following is most likely to lead to a bleeding event in patients?
Cranberry juiceThere is a possible interaction between warfarin and cranberry juice, in most cases leading to an increase in INR or bleeding event.
For each of the following statements, select the drug that fits most closely. Each option may be used once, more than once or not at all.This drug is commonly used in the treatment of seizure-related medical conditions.
Ethosuximide is indicated in the treatment of absence seizures, atypical absence seizures (adjunct) and myoclonic seizures.
For each of the following statements, select the drug that fits most closely. Each option may be used once, more than once or not at all.This drug may be used in the treatment of cellulitis. It can be administered orally or intravenously for this condition.
ClindamycinClindamycin is indicated in soft tissue infections such as cellulitis. It may be administered orally or via the IM or IV routes.
Indications for this drug include parkinsonism and tremors related to Parkinson’s disease.
Co-beneldopa is a mixture of benserazide hydrochloride and levodopa. It is indicated for parkinsonism and tremors related to Parkinson’s disease.
This medication is cautioned for use in those who suffer with asthma. This drug is also a Schedule 5 controlled substance.
Pholcodine 5 mg/5 mL linctus
A patient walks into the pharmacy in which you work. They wish to discuss symptoms with the pharmacist. Upon consulting with the patient it is apparent the patient has red, scaly and cracked feet. The patient asks if you can recommend some treatment to help resolve the symptoms.
Clotrimazole 1% creamThese symptoms suggest that the patient has athlete’s foot (tinea pedis). Clotrimazole cream can be sold OTC for this indication.
For each question in this section select one answer from the list of eight options above it. Each option may be used once, more than once, or not at all.This medication must not be sold to patients under the age of 16. It can cause Reye’s syndrome and as such is contraindicated in those under the age of 16.
Aspirin 75 mg tabletsAspirin and aspirin containing products are contraindicated in under 16s as it may precipitate Reye’s syndrome which may be fatal.
This medication is most often prescribed by a doctor. If you are to sell this medication OTC to a patient, the indication must be confirmed first and the indication previously diagnosed by a qualified doctor.
Sumatriptan succinate 50 mg tablets
This medication is a sympathomimetic which if used for more than seven days can cause rhinitis medicamentosa.
Xylometazoline 0.1% nasal spray
A patient presents to you complaining of an array of symptoms including achy joints and describes flu like symptoms and pyrexia. What would you recommend the patient takes to help alleviate the symptoms?
Paracetamol 500 mg tabletsParacetamol has analgesic and anti-pyretic properties.
A patient presents to the pharmacy you work at complaining of vulvo-vaginal itching and pain with no discharge. She has previously been treated for this via her GP but is on vacation and wishes to purchase something over the counter. What is the most suitable OTC medication to help alleviate the pain and itching?
Clotrimazole 1% cream is indicated for use in vaginal thrush. It is licensed for sale for this condition.
Adult patients who weigh less than 50 kg should use this drug with caution or adjust the dose as they may be at increased risk of toxicity.
Some patients may be at increased risk of experiencing toxicity at therapeutic doses, particularly those with a body weight under 50 kg.
This medication must be used with caution in patients who have a sensitivity to sulfonamides.
Sumatriptan succinate 50 mg tabletsSumatriptan should be used with caution in patients with sensitivity to sulfonamides.
This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol.
Amitriptyline
This medicine may colour the urine dark red.
Co-careldopaNote that triamterene can also colour the urine - it may look slightly blue in some lights.
A patient presents in the pharmacy asking for your advice about red eyes. Both his eyes are affected and there is a purulent discharge, which made his eyelids stick together this morning. He describes his eyes as feeling ‘gritty’. He does not have any eye pain and his vision is not affected.
Bacterial conjunctivitisSymptoms stated indicative of bacterial conjunctivitis - sticky discharge, both eyes affected, gritty feeling in the eye.
A patient asks you to look at his left eye. You can see that a small segment of the white of his eye is bright red. He thinks it happened when he coughed. There is no pain and his vision is not affected.
Subconjunctival haemorrhageNon-painful blood shot eye that came on suddenly is an indication of subconjunctival haemorrhage.
A lady comes into the pharmacy and asks you to look at her eye lids. Both eye lids appear to have skins flakes around the eyelashes. She says that both eyelids feel irritated and her eyes are quite watery.
BlepharitisSkin flakes around eye lashes accompanied by watery eyes is indicative of blepharitis.
A lady visits your pharmacy. She is just recovering from flu and has noticed that both of her eyes appear red. She tells you that she has a watery discharge coming from each eye.
Viral conjunctivitisViral conjunctivitis usually associated with a cold or flu. Watery discharge reported.
A man asks you to look at his right eye. His upper eyelid is swollen. He describes it as being painful and sensitive to touch.
StyeIndicative of a stye - painful swollen eye lid.
A 15-year-old boy asks to speak to you about his eye. You notice that his left eyeappears red and is watering. The boy informs you that his eye has been like this sincewaking up this morning. His vision has not been affected but his eye is causing himsome pain and he is squinting due to the lights in the pharmacy.
Conjunctivitis is usually associated with a yellow sticky discharge and is described asfeeling ‘gritty’ rather than being painful. Red watery eyes can be signs of dry eye or hayfever; however, eye pain and photophobia are red flag symptoms and require referralto either an optician or a GP for assessment.
Chloramphenicol use?
Bacterial conjunctivitis
Hypromellose use?
Dry eyes
Sodium cromoglicate use?
Seasonal/allergic conjunctivitis
A 35-year-old woman has presented to accident and emergency with signs ofhaemolytic anaemia secondary to G6PD deficiency.Which one of her medications is most likely to have caused her symptoms?
G6PD deficiency is a genetic disorder that some individuals may have, it is commonin males and those originating from Asia, Africa, the Middle East and theMediterranean region. G6PD is an enzyme that supports the functioning of red bloodcells. Individuals with this deficiency are susceptible to haemolytic anaemia whenthey take a number of common drugs. From the options, nitrofurantoin is the onlymedication that is contra-indicated in G6PD deficiency.
what is haemolytic anaemia?
RBCs destroyed rapidly!!
A 28-year-old man presents in the pharmacy asking for information about the smokingcessation service.Which one of the following is most suitable to advise regarding smoking cessation?
The only correct and appropriate option is for a quit date to be agreed to keep thepatient motivated.Combination intervention is better than single intervention when considering smokingcessation options. It should be noted that bupropion is not first line treatment forsmoking cessation; various options should be explored included non-pharma logicalinterventions. E-cigarettes are not licensed for use in smoking cessation, andvarenicline is a POM therefore cannot be supplied to the patient over the counter.Drug treatments for smoking cessation should be made on an individual basis, andconsider:• The individual’s previous experience of smoking cessation drugs.• Their preference for treatment.• Contraindications, cautions, possible interactions and risk of adverse effects of thetreatment
The next two questions relate to a 63-year-old man, who comes into yourpharmacy to ask about a rash that has developed over the past 24 hours.You take him into the consultation room, and he shows you the rash on the left side ofhis abdomen. He says that he is recovering from a heavy cold and feels a bit run down.He has no spots anywhere else on his body. He describes the area as itchy, painfuland burning. You check his medication records and find that he currently takesamlodipine 5mg daily and indapamide M/R 1.5mg daily for hypertension.What is the most likely cause of the patient’s rash?
The symptoms suggest shingles rash caused by varicella zoster. There is usually aprodromal phase with abnormal skin sensations and pain in the affected dermatome(area of skin served by an individual nerve). Within 2–3 days, a rash typically appearsin a dermatomal distribution. It starts as maculopapular lesions then develops intoclusters of vesicles, with new vesicles continuing to form over 3–5 days. The rash isusually painful, itchy, and/or tingly, and, unlike other rashes, does not cross the midlineof the body.
A 58-year-old woman is admitted to hospital following persistent chest pains. Afterroutine investigations, she is diagnosed with angina and prescribed glyceryl trinitrate400 microgram sublingual spray. You have been asked by the nurse to counsel thepatient on how to use the glyceryl trinitrate spray. Which of the following instructions are you most likely to advise the patient?
400–800 micrograms, to be administered under the tongue and then close mouth,dose may be repeated at 5-minute intervals if required; if symptoms have notresolved after 3 doses, medical attention should be sought.
You receive a private prescription for a controlled drug and note that the prescriber isbased in Portugal.Which of the following controlled drugs can legally be supplied on this prescription?
The address of prescriber is required to be within the UK on prescriptions for controlleddrugs, but not for Schedule 4 (part 1 and 2) or Schedule 5 controlled drugs. Codeine isSchedule 5 controlled drug, all other options are Schedule 2 controlled drugs.
A 58-year-old woman is currently taking digoxin 125micrograms daily for the past twomonths. She has no known drug allergies. She has also been taking furosemide 40mgtablets twice a day for the past two weeks. The patient tells you that she has not beenfeeling very well and has been experiencing nausea, diarrhoea, palpitations and feelingfaint.
Advise the patient to stop taking digoxin and refer for medical review urgently. The BNFmonograph recommends that if toxicity occurs, digoxin should be withdrawn as seriousmanifestations can occur requiring urgent specialist management. A digoxin plasmaconcentration within the therapeutic range does not exclude digoxin toxicity.
A patient visits the pharmacy and asks to purchase some chloramphenicol eye dropsf or bacterial conjunctivitis.How would you advise the patient to store the eye drops for the course they are on?
medicine needs to be stored uprightbetween 2-8oC in a refrigerator and protected from light and must be used within fourweeks of opening.
Responsible Pharmacist (RP) regulations mean that the owner of a retail pharmacybusiness must appoint an RP to be in charge of the registered pharmacy.You are discussing the regulations with your pre-registration trainee pharmacist to helpthem with their revision.Which one of the following statements is the most accurate in relation to the RPregulations?
RP, pharmacy, one at a time!!Pharmacy record needs to be kept for 5 years. The RP can be absent for maximum of2 hours. The sale of GSL medicines do need an RP to be in charge. The RP needs todisplay a notice whilst RP.
Parkinson’s patient, N&V?
Dompe!!!Metoclopramide, haloperidol and prochlorperazine should not be used in Parkinson’sdisease as they cross the blood brain barrier and cause dopamine blockade, resultingin worsening of symptoms. Ondansetron is contraindicated with apomorphine due toadditive QTc prolongation and risk of serious arrhythmia. The manufacturers of apomorphine recommend the use of domperidone to control nausea and vomiting,however there is still a risk of QT prolongation with this combination, hence anassessment of cardiac risk factors and ECG monitoring is recommended to ensure thatthe benefits outweigh the risks.
FOLATE DEFICIENCY TREATMENT?
folic acid 5 mg daily for 4 months. Folic acid 400micrograms is usually recommended to women of child-bearing age, to be taken beforeconception and until week 12 of pregnancy, for the prevention of neural tube defects.
A 65-year-old man has been admitted into hospital after a referral from his GP. He issuffering from symptoms that have been getting gradually worse. These include but arenot limited to: swollen ankles, which are worse in the evening; breathlessness, which isworse after walking for 30 minutes; fatigue, which has not improved with multivitamins.BEST TEST?
This patients’ symptoms indicate they have developed heart failure. A pro B-typenatriuretic peptide will measure cardiac function and will be raised in heart failure.HbA1c is a diagnostic for diabetes. Thyroid function test will indicate hyper orhypothyroidism. A CT pulmonary angiogram will help diagnose a pulmonary embolism(PE). Patient does not have any chest pain which may indicate a PE. B12 levels willhelp identify deficiencies – patient does not have any symptoms which may indicateB12 deficiency.
Med, hypokalaemia/hyponatraemia?
Bendroflumethiazide is a thiazide diuretic that causes hypokalaemia by increasingpotassium excretion by the kidney.
Sepsis investigation test?
C-reactive protein is marker for inflammation which is often associated with sepsis.Full blood counts will usually be undertaken, which will include haemoglobin, however,haemoglobin levels are not usually measured in isolation without other blood markers.Anaemia is often present during sepsis which affected haemoglobin levels.A chest x-ray and urine dipstick may help diagnose specific infections, for example,pneumonia or a urinary tract infection, respectively. Sepsis can lead to liver injury,which will require liver function tests.
A 32-year-old-man has recently changed his diet to incorporate more fibre. His stoolsare not as loose, but he has been experiencing more wind, which he findsembarrassing. He therefore asks you to recommend a product to combat the increasedwind.Best treatment?
Simeticone is an anti-foaming agent and is most appropriate for these symptoms. Theother listed options are usually used for other symptoms and conditions.
A 26-year-old man asks for your advice regarding a rash on his knee. The rashappeared two weeks ago and is itchy, burns and sore. He has no other medicalconditions but has recently been feeling quite stressed due to work prioritiesCondition?
Psoriasis often occurs on extensor surfaces (elbows and knees), trunk, flexures, sacraland natal cleft, scalp and behind the ears, and umbilicus. This is an image of plaquepsoriasis, which generally presents as large plaques. There is usually a cleardelineation between normal and affected skin. May be pink or red, but in people withpigmented skin this may not be obvious. Scale is typically silvery in colour.Psoriasis may be caused by infection, drugs (including corticosteroid withdrawal),ultraviolet light exposure, trauma, hormonal changes, stress, smoking, and alcohol.
LEGAL REQUIREMENTSDISPENSING LABELS?
It is a legal requirement for the following to appear on dispensed medicinal products:• Name of the patient• Name and address of the supplying pharmacy• Date of dispensing• Name of the medicine• Directions for use• Precautions relating to the use of the medicine.The Royal Pharmaceutical Society also recommends the following also appears on thedispensing label:• ‘Keep out of the reach and sight of children’• ‘Use this medicine only on your skin’ where applicable
ANTI-EPILEPSY DRUGSWITHDRAWING?
specialist supervision. Avoid abrupt withdrawal, particularly of barbiturates and benzodiazepines, because this can precipitate severe rebound seizures. Reduction in dosage should be gradual and, in the case of barbiturates, withdrawal of the drug may take months.The decision to withdraw antiepileptic drugs from a seizure-free patient, and its timing, is often difficult and depends on individual circumstances. Even in patients who have been seizure-free for several years, there is a significant risk of seizure recurrence on drug withdrawal. In patients receiving several antiepileptic drugs, ONLY ONE DRUG SHOULD BE WITHDRAWN AT A TIME2 YEARS, NUTS
Private CD,What details of the supply NEED need to be recorded in the prescription onlymedicines (POM) register?
Date of supply, prescription date, medicine details (name, quantity, formulation andstrength), prescribed details and patient details should all be recorded in the POMregister. YOU DO NOT NEED TEMAZEPAM BRAND!!!
A 52-year-old man has recently started a new job role that requires extensive use ofthe computer, which has resulted in his eyes feeling dry, irritated and sometimeswatery. He reports that he also suffers from occasional hay fever, which mainly causesa runny nose.
Dry eyes with a known cause such as excessive use of computer screens does notnecessarily warrant a referral to another healthcare professional, thus option B isincorrect.Xailin eye ointment is not the best choice as ointment use can cause temporary blurredvision following administration and is generally recommended at night. Thus, this maynot be ideal for the patient who is likely to be working during the day.Loratadine and avoiding the outdoors would support hay fever symptoms, howeverthese are not the patient’s principal problem and reason for visiting the pharmacy. Thequestion also outlines that he only has a runny nose from hayfever.Note that his eyes sometimes feel watery which can be a symptom of hayfever,however dry eyes can over stimulate the lacrimal eye glands and cause watery eyes
You have been asked to conduct an audit about the prescribing and administration ofantibiotics on your hospital ward so that you can identify areas for improvement. Youhave set yourself an aim of identifying whether local prescribing protocols are beingmet.Which of the follow processes is most appropriate to complete as part of an auditcycle?
Data collection is a key step in an audit cycle. Collecting and analysing data on theadministration of medicines will provide evidence of whether standards are being metand enable you to achieve your aim.Ethics approval is not usually required for audits, however if your evaluation includespatients, you may require approval. If in doubt check with the National Institute forHealth and Care Research (NIHR) Also looking for errors is not usually part ofaudit/improvement process.It is good practice to re-audit after a certain period, however doing this after one monthwould be too soon and is unlikely to provide new or useful results. It is unusual toupdate guidelines and protocols before an audit takes place. This may be arecommendation you action after the audit.
A 28-year-old woman suffering from abdominal pain and dyspepsia has beendiagnosed with a gastric ulcer.Which one of the following medicines is contraindicated in women of childbearing ageunless effective contraception is used?
MISOPROSTOL CMONNNNNNMisoprostol should not be used in women of childbearing potential unless pregnancyhas been excluded. It can be used to terminate pregnancies.
METFORMIN PCOS?
UNLICENSED
A 56-year-old man presents himself at the pharmacy you are working in. He would likesome painkillers after hurting his ankle playing football. He is weight bearing althoughlimping slightly. He has tried nothing so far for the pain in his ankle. You ask the patientif he is on any regular medication, he tells you he takes:• Multivitamins• Omeprazole 20mg once daily• Folic acid 5mg daily (four-month course)• Symbicort turbohaler two puffs twice a day and when requiredbest action?
This patient does not need referring to the GP or the walk in centre as he is able toweight bear, which indicates that an over the counter medicine will be able to help himmanage his symptoms.The patient is using a symbicort inhaler, on a SMART/MART regime which indicates hehas respiratory disease such as asthma or COPD, therefore an NSAID such asibuprofen or diclofenac would not be the most appropriate. Also, he is takingomeprazole which indicates that NSAIDs, in particular, ibuprofen, would not besuitable.
A 40-year-old woman visits your community pharmacy and asks to purchase travelsickness tablets, as she is going on a long-haul flight next week. The counterassistant tells you that she has hypertension, type 2 diabetes and occasional backpain, which are all adequately managed by her regular medication.Which of the following options are you most likely to take next?
The patient’s medical conditions do not interfere or relate to travel sickness and thuscan be supported without referral. Hyoscine HYDRObromide is used for travel sicknessand available to purchase without a prescription and is the most appropriate option.Cinnarizine 15 mg tablets are also suitable and indicated for travel sickness, howeverthis pack size is not reality available as a P medicine (usually sold as Stugeron 15, packsize 15), and selling a pack of 100 is excessive. You may have also chosen to sellhyoscine butylbromide 10 mg tablets, however hyoscine butylbromide is licensed totreat abdominal cramps/spasms and IBS like symptoms. Encouraging fluidconsumption is unlikely to prevent travel sickness, thus is not a suitable cause of actionfor the patient.
A 28-year-old woman has recently undergone surgery to insert a metallic heart valve.She needs to be prescribed an anticoagulant to manage the risk of thrombosis on thevalve and possible embolism.Which of the following medicines is the most appropriate option for this patient?
Warfarin is commonly prescribed as prophylaxis in patients with prosthetic valvereplacements and is the only medicine from the list of options indicated for this use.It should be taken initially at a dose of 5–10 mg on day 1, and subsequent dosesshould be adjusted dependent the patient’s INR reading. The recommended target INRdepends on the type and location of the valve, and patient-related risk factors.
A 33-year-old woman visits your pharmacy and asks to speak to you privately about asensitive issue. She explains that she is experiencing a sharp pain when going to thetoilet.She is finding it difficult to pass stools and on occasions has noticed blood in the toilet.She has been experiencing these symptoms for two weeks. She is otherwise well anddoes not take any other medication.MOST LIKELY?
The symptoms are suggestive of an anal fissure. Typical symptoms are anal painwhich always occurs with passing a stool; the pain is severe and sharp, sometimesdescribed as a tearing sensation, and often followed by deep burning pain that canpersists for some hours. Bleeding may also occur with defecation, which is usuallyseen as a small quantity of bright red blood on the stool or toilet paper.
A woman brings a bag of unused medication to your community pharmacy for disposaland informs you that her husband has recently died. You notice fentanyl 25microgrampatches amongst the medication.Which one of the following actions regarding the destruction of patient-returnedcontrolled drugs would you take?
pharmacist can destroy+tech witnessAn Accountable Officer is only required to witness the destruction of out-of-datecontrolled drugs. Patient-returned controlled drugs should be stored in the controlleddrug cabinet whilst awaiting destruction, clearly segregated from other stock. Thepatient-returned controlled drugs received and destroyed should be recorded in aseparate register kept for this purpose.
A 34-year-old woman visits the pharmacy and asks for advice regarding a cold sorethat appeared two days ago. She experienced similar symptoms about 3 months agobut did not use anything. She would like to purchase a medicine that may help speedup the recovery for her current symptoms.Which of the following products would be most appropriate to supply to manage thepatient’s symptoms?
From the list above, Zovirax 5% cream would be the most appropriate product tosuggest. Zovirax 5% cream contains aciclovir which can treat herpes simplex virusserotype 1 (HSV-1) of the mouth, lips, and eye. Zovirax 5% is only licensed for thetreatment of herpes simplex virus present on the lips and face.
A 36-year-old man visits the pharmacy for advice on his symptoms. He has just eatenat a new restaurant and now feels wheezy and lightheaded with clammy skin and a fastheartbeat. Upon questioning him about his medical conditions, you find out he has anut allergy.Question Which of the following actions is the most appropriate to take?
A 36-year-old man visits the pharmacy for advice on his symptoms. He has just eatenat a new restaurant and now feels wheezy and lightheaded with clammy skin and a fastheartbeat. Upon questioning him about his medical conditions, you find out he has anut allergy.Which of the following actions is the most appropriate to take?
Regulation 238 of the Human Medicines Regulations 2012 allows adrenaline to beadministered by anyone for the purpose of saving life in an emergency. Therefore,pharmacists using their professional and clinical judgement can administer adrenalinein an emergency to persons presenting with symptoms of anaphylaxis.If a pharmacist administers adrenaline, they must also ensure that an ambulance iscalled by dialling 999 and reporting that there is a caseof suspected anaphylaxis. Adrenaline should be given as soon as possible so youwould administer adrenaline before phoning 999.
MOST LIKELY CAUSE OF ANAL FISSURES+SYMPTOMS?
Anal fissures are most commonly caused by damage to the lining of the anus or analcanal, the last part of the large intestine. In many cases, no clear cause can beidentified, however most cases occur in people who have constipation, when aparticularly hard or large poo tears the lining of the anal canal. A low carbohydrate dietcan cause constipation.Other possible causes of anal fissures include persistent diarrhoea; inflammatory boweldisease (IBD), such as Crohn’s disease and ulcerative colitis; colorectal cancer;dermatological conditions such as psoriasis and pruritus ani; bacterial, fungal, or viralskin infections; or a sexually transmitted infection (STI), such as syphilis or herpes,which can infect and damage the anal canal, however the patient’s history does notsuggest any of these causes. In some cases, having unusually tight anal sphinctermuscles can increase the tension in your anal canal, making it more susceptible totearing.
A patient is admitted into medical admissions following urgent referral by their GP, asthey have symptoms that suggest abnormal potassium levels. The patient’s bloodpotassium level is taken and are found to be 6.2mmol/L (3.5–5.3mmol/L).BEST TREATMENT?
Patiromer calcium is used to manage hyperkalaemia. It is a non-absorbed cationexchange polymer that acts as a potassium binder in the gastro-intestinal tract. Thedose is initially 8.4 g once daily; adjusted in steps of 8.4 g as required. Doseadjustments should be made at intervals of at least one week; maximum 25.2 g perday.Magnesium aspartate is used for hypomagnesaemia. Potassium chloride used forhypokalaemia. Sevelamer and calcium acetate are used for hypophosphatemia.
A patient comes into the pharmacy complaining of trouble sleeping since coming offnightshift. They have tried good sleep hygiene techniques, which do not seem to beworking.Which of the following is the most appropriate product to recommend?
Diphenhydramine (Nytol) is the only medication which is licensed for insomnia. Theother options are licensed for other conditions and the management of othersymptoms.Valerian extract (Nytol Herbal) could also be considered, however there is lack ofevidence for its effectiveness compared to medicinal products, therefore is not the mostappropriate option in this scenario.
digoxin, antibiotic, L?
ClarithromycinMacrolides are potent enzyme inhibitors, causing increased serum levels of digoxinand therefore increasing the likelihood of digoxin toxicity.
Add-on therapy? A 54-year-old man with type 2 diabetes requires an add on medication to hismetformin, as his HbA1c is not at his agreed target. He has a past medical history ofbladder cancer. He is currently overweight and needs to lose around 20 kg. He has nohistory of cardiovascular disease.
Based on NICE guidelines, the next step add on therapy (with no history ofcardiovascular disease) is a dipeptidyl peptidase-4 inhibitor (DDP4), pioglitazone, flozinor sulphonylurea.The patient’s history of bladder cancer rules out pioglitazone; sulphonylureas causeweight gain; and DDP4 are neutral. Therefore, a flozin, such as canagliflozin is themost appropriate as this promotes weight loss, and this patient needs to lose weight.Repaglinide can cause mild weight gain and can be associated w
Symptoms of sepsis?
CONFUSION(PRODUCTIVE COUGH)FAST RESP RATEPALE/BLOTCHY SKINSKIN RASH DOES NOT FADE PRESS GLASS
A 66-year-old man started on dapagliflozin 10 mg once a day for two weeks. He hasalso been taking metformin 500 mg three times a day and gliclazide 40 mg twice a dayfor the past four years. When collecting his repeat prescription, he complains of havingstomach pain, feeling sick and frequent urination in the last few days. His blood sugarlevel is normal. He believes that the new tablet may be the reason for his symptoms.BEST ACTION?
Euglycemic diabetic ketoacidosis (EDKA) is a clinical triad comprising increased aniongap metabolic acidosis, ketonemia or ketonuria and normal blood glucose levels<200 mg/dL.It is considered as a serious adverse effect of sodium-glucose cotransporter 2 (SGLT2)inhibitors. Patient should stop the associated medication and receive urgent medicaltreatment in hospitaldka!!!
Sulfasalazine, sore throat, best action?
Sulfasalazine can cause blood disorders - patients receiving aminosalicylates, andtheir carers, should be advised to report any unexplained bleeding, bruising, purpura,sore throat, fever, or malaise that occurs during treatment.GP BRUH!
ANTIBIOTIC FORINFECTIVE COPD?
For adults aged 18 years and over, the first-choice antibiotic for the management of aninfective exacerbation of COPD are amoxicillin, doxycycline or clarithromycin.Doxycycline is prescribed at a dose of 200 mg on first day, then 100 mg once a day for5‑day course in total.
You are reviewing an NHS prescription for methadone. It is coming up to a BankHoliday and the pharmacy will be closed. You need to ensure that the prescriptioncontains appropriate approved wording for you to make a supply to cover the closeddays.Which of the following is the most appropriate wording for supplying methadone onclosed days?
Please dispense instalments due on pharmacy closed days on a prior suitable day.”Also note “If an instalment’s collection day has been missed, please still dispense theamount due for any remaining day(s) of that instalment.”NB: If you decide to supply against a prescription that uses wording not approved bythe Home Office, it will not provide the same protection from enforcement when makingthe supply. In this instance, if practical, you should try to get the prescription amendedby the prescriber to include the approved Home Office wording.
Meds interaction with ciprofloxacin?
Ibuprofen interacts with ciprofloxacin to reduce seizure threshold. This is listed as asevere interaction and the manufacturer advises caution
A 52-year-old woman with hypertension and bipolar disorder, is admitted into hospitaldue to a seizure which she experienced for the first time. According to the patientnotes, no recent dose changes of lithium have been reported however, she wasrecently prescribed a combination preparation enalapril with hydrochlorothiazide. Hermoods have been stable however, the patient complains of constant fatigue. Best action?
The levels of lithium are above normal range, and the presentation of a new seizureindicates severe lithium toxicity, which requires urgent treatment. Furthermore, lithiumexcretion is reduced by angiotensin-converting enzyme inhibitors (ACEI) (enalapril) andby thiazides (hydrochlorothiazide). Creatinine levels are raised indicating reducedrenal function, therefore the most appropriate course of action here is to stop lithiumand stop enalapril/hydrochlorothiazide.It should be noted that lithium salts have a narrow therapeutic/toxic ratio and shouldtherefore not be prescribed unless facilities for monitoring serum-lithium concentrationsare available (as noted in the BNF).
Which of the following scenarios does not require an entry to be made in theprescription only medication (POM) register?
Medicines prescribed on NHS prescriptions do not need to be recorded in a POMregister, however in this case, a controlled drug register entry is legally requiredbecause morphine tablets are a Schedule 2 controlled drug. Lower strengths ofmorphine, such as morphine oral solution 10 mg/5 mL (Oramorph), are Schedule 5controlled drugs, which does not need to be recorded in the controlled drugs register.Although the supply of salbutamol inhalers on a written order does not require POMregister it is good practice for audit purposes.
Which of the following insulins is suitable for once daily administration?
Detemir can be BD or OD?
HUMALOG MIXNOVOMIX?
BIPHASIC, GIVE WITH MEALS, NOT OD!!
TrimethoprimMethotrexateFolic acidL?
Trimethoprim is another anti-folate drug and concomitant use can result in bonemarrow suppression resulting in life threatening infections, anaemia or spontaneoussevere bleeding.
A 79-year-old woman comes into your pharmacy. She has osteoporosis and has beenin hospital for 8 weeks due to a hip fracture and has been discharged on co-codamol8/500mg tablets. She would like to take a medication to help strengthen her bones toreduce the risk of another fracture.BEST treatment?
Calcium and colecalciferol (vitamin D) are recommended for people at high risk ofosteoporotic fracture
A woman calls your community pharmacy as she is concerned about her husband. Heunderwent his first cycle of chemotherapy for lung cancer last week and has begun tofeel unwell. His symptoms include: lethargy; a temperature of 39°C; complaining offeeling hot and cold.ACTION?
This patient could be exhibiting signs of neutropenic sepsis possibly caused bychemotherapy. Symptoms include dysuria, diarrhoea, a productive cough, chills,shivers, rigors, a temperature greater than 38°C.Neutropenic sepsis is a medical emergency and he needs to seek medical attentionimmediately. In this case the fastest option would be to ring 999 for an ambulance.
Cellulitis antibiotic, penicillin allergy?
Doxycycline is most suitable for this patient due to their allergies.Both flucloxacillin and co-amoxiclav are penicillin antibiotics, therefore are notappropriate for this patient.Cefuroxime is only available as intravenous preparation and the pharmacology issimilar to penicillin, which may not be suitable in a true allergy. Cephalexin is availableas an oral formulation but is a cephalosporin, which may result in a cross-sensitivityreaction, and should be used with caution.
A regular patient comes in and asks for advice regarding their pet. They explain thatthey have run out of repeat medication for their cat and would like some more. Theyshow you an empty bottle of hypromellose eye drops that they administer to their catBEST action?
You should refuse the request and refer the individual to the vet.It is not legal to make an emergency supply in this situation, also the licensing of P andGLS products is for human use not animals and pets. It should be noted that the dosein humans is not equivalent to in doses of medicines used in animals; and a vet wouldbe the most appropriate person to advise on clinical appropriateness.Furthermore, there are specific labelling requirements for veterinary products when theprepared medicine is for animal use, which has been prescribed by a veterinarypractitioner under the cascade
A 33-year-old woman is due to undergo cholecystectomy, a major surgery in 2 months’time. She is currently taking a regular contraceptive that should be stopped at least 4weeks before the procedure.
Levonorgestrel/ethinylestradiol is a combined hormonal contraceptive which increasesthe risk of thrombosis in patients undergoing major surgery and should be discontinuedat least 4 weeks prior to major surgery.Progestogen-only pills, injections, implants, and intra-uterine systems are suitable foruse as contraceptives in females undergoing surgery. Combined hormonecontraceptive may be recommenced 2 weeks after full remobilisation.
Phenytoin enteral feeding?
Enteral feeding (interrupt feeding for 2 hours before and after dose; more frequent monitoring may be necessary); may exacerbate absence and myoclonic seizures
Antidepressants hyponatraemia L?
Falls, stress
WITH EXTRACT Qs ALWAYS CONSIDER THE MAXIMUM, BE CAREFUL!
A
Meningococcal infections treatmetn?
For the treatment of meningococcal diseases benzylpenicillin is recommended,cefotaxime (if allergic to penicillin). If there is history of immediate hypersensitivityreaction (including anaphylaxis, angioedema, urticaria, or rash immediately afteradministration) to penicillin or to cephalosporins, chloramphenicol can be used.Tigecycline (tetracycline antibiotic) is contraindicated in children under the age of 8years old due to the risk of deposition in growing bones and teeth.Teicoplanin should not be given by mouth for systemic infections because it is notabsorbed significantly. It is also not indicated to treat meningitis.
Sildenafil, refuse sale, condition?
There are several precautions for the sale and supply of sildenafil. Contraindications foruse of sildenafil include severe cardiovascular disorder such as recent (6 months)acute myocardial infarction (AMI) or stroke, unstable angina, or severe cardiac failure,sexual activity may be inadvisable. These patients should be referred this their GP,even if they have been prescribed his previously to ensure that they can resume sexualactivity. Consider referring the patient if they are already using a different dose ofsildenafil, or a different treatment for erectile dysfunction.
Sildenafil+antibiotic L?
Sildenafil metabolism is principally mediated by the cytochrome P450 (CYP) isoforms3A4 (major route) and 2C9 (minor route). Therefore, inhibitors of these isoenzymesmay reduce sildenafil clearance and inducers of these isoenzymes may increasesildenafil clearance.Both sildenafil and erythromycin prolong the QT interval. This noted as a severeinteraction and most manufacturers advise avoiding the use of two or more drugs thatare associated with QT prolongation.
CAUSE of symptoms?A 34-year-old man is taking moclobemide 150 mg twice a day for depression and hasrecently been prescribed amitriptyline 25 mg for neuropathic pain. In the next few days,the patient presents with tremor and mental confusion and is rapidly deteriorating. Hispartner asks if the tremor is a sign that his epilepsy is no longer under control andwhether this could be linked with his binge drinking.
The presenting symptoms suggest a drug interaction. Simultaneous administration ofamitriptyline and moclobemide may cause serotonin syndrome (a combination ofsymptoms, possibly including agitation, confusion, tremor, myoclonus, andhyperthermia). The interaction is listed as severe and the manufacturer advised toavoid concomitant use
What is a biosimilar medicine?
A biosimilar is a biologic medicine that is similar to an already licensed biologicmedicine in terms of quality, safety and efficacy. A biosimilar is specifically developedand licensed to treat the same disease(s) as the original innovator product. A biosimilarcan only be marketed after the patent protecting the originator product and anyperiod of marketing exclusivity have expired
A 38-year-old man with type 2 diabetes visits your community pharmacy to collect hisrepeat medication. You overhear him conversing with the counter assistant aboutulceration on his left foot.
Poor diabetes control can increase the likelihood of foot infections due to neuropathy –a long-term complication of type 2 diabetes. The patient should be referred to the footprotection service for review of the patient’s foot symptoms and appropriatemanagement.It is also important to refer the patient to their GP for a review of their medicines and torequest blood glucose levels to ensure adequate glycaemic control, however this is asecondary intervention; foot ulceration should be the prime concern here.The other listed options are not appropriate as they will not adequately manage thesymptoms or could make them worse.
You are a GP practice pharmacist conducting an asthma review. The adult patient youare currently reviewing is still symptomatic despite being on salbutamol 100micrograminhaler one to two puffs when required and a Qvar 100microgram inhaler two puffstwice a day. You have confirmed they have the appropriate inhaler technique, so it isdecided to step up treatment.NEXT step?
According to the BTS/SIGN guidelines you would add an inhaled LABA (salmeterol) tolow or medium dose ICS as initial add on therapy for asthma management.
Acne first-line?
. Both benzoyl peroxide and isotretinoin gel areindicated for the treatment of acne, however isotretinoin is prescription only.Clotrimazole, Diprobase, and E45 are not indicated for acne, and therefore notappropriate.
UTIPREGNANT- 10 WEEKSPENICILLIN ALLERGYTREATMENT?
Nitrofurantoin is usually first choice and should be prescribed for 7 days in pregnancy(additional info: Nitrofurantoin should be avoided at term (36-42 weeks)).Amoxicillin & pivmecillinam would be inappropriate due to penicillin allergy.Manufacturers advise to avoid trimethoprim during pregnancy, particularly in the firsttrimester due risk of teratogenicity.Cefalexin is safe to use in pregnancy and duration of 7 days is appropriate for pregnantwomen but there is around a 10% a risk of allergy in cephalosporins with penicillinallergic patients. Although the previous reaction was mild, cefalexin is best avoided inthis patient.
ULCERATIVE COLITIS COLONOSCOPY?
Inflammation and continuous partial thickness in the rectum that extends throughthe colonBOWEL INFLAMMATION
anti-epilepticdehydrationoverheatingwhat drug?
ZONISAMIDE!
A 42-year-old man with a past medical history of asthma has been admitted to hospitalwith difficulty speaking, body weakness, and tremor. They are also repetitively cleaningand washing their hands.Which of the following medicines is most likely to have caused this patient’ssymptoms?
MONTELUKAST!!!!Uncommon and rare adverse effects of montelukast include akathisia, asthenia,abnormal behaviour, and obsessive-compulsive symptoms.An adverse effect of steroids, such as fluticasone and prednisolone, is also abnormalbehaviour. However, the other symptoms experienced by the patient are not reportedadverse effects of fluticasone or prednisolone
A 38-year-old woman with a past medical history of asthma is exhibiting symptoms ofsevere vomiting, appears agitated and has a racing heartbeat.Which of the following medicines is most likely to have caused this patient’ssymptoms?
T for tachycardia/theophylline!!!Theophylline in overdose can cause vomiting (which may be severe and intractable),agitation, restlessness, dilated pupils, sinus tachycardia, and hyperglycaemia. Moreserious effects are haematemesis, convulsions, and supraventricular and ventriculararrhythmias. Severe hypokalaemia may develop rapidly.
A 61-year-old man recently had a stroke. He is now having difficulty swallowing hismedicines and asks for your advice on what to do.Which of the following healthcare professionals would be the most appropriate to referthis patient to?
Speech and language therapists can aid patients who have swallowing difficultiesensuring they are suffering no form of aspiration. This can help pharmacists advise onthe most appropriate forms of medication
A 96-year-old woman is scheduled to be discharged from hospital. She lives alone afterher husband passed away and her two children live abroad. You are slightly concernedthat she may struggle to adjust to being on her own again after discharge.Which of the following healthcare professionals would be the most appropriate to referthis patient onto?
Social workers help their patients to live their lives more successfully by findingsolutions to their problems.
A 33-year-old man currently in the first month of tuberculosis treatment is reportingsymptoms of muscle aches, weakness and pins and needles in his feet. He takesisoniazid, rifampicin, pyrazinamide and ethambutol.Which of the following medicines is most suitable for managing these adverseeffects?
Typical symptoms of isoniazid induced neuropathy. Pyridoxine is licensed to managethis.
A 42-year-old woman with a history of gastro-oesophageal reflux disease who hasbeen taking omeprazole 40mg once daily for the past six months is reporting nauseaand vomiting, pins and needles, fatigue and muscle twitches.Which of the following medicines is most suitable for managing these adverseeffects?
MAGNESIUM ASPARTATE SACHETSA known side effect of omeprazole is hypomagnesaemia, which these are typicalsymptoms of.
A patient has suspected unstable angina and a glyceryl trinitrate spray is ineffective.Which of the following medicines is most suitable to manage the emergency situation?
Dispersible aspirin is used in addition to GTN sprat for the treatment of unstable angina
A patient has presented at their GP surgery with photosensitivity, a non-blanching rashand a stiff neck. The patient has a documented skin rash allergy to amoxicillin.Which of the following medicines is most suitable to manage the emergency situation?
Can give cefotaxime injectionSigns of meningitis. 1st line is benzylpenicillin but unsuitable due to penicillin allergy.Cefotaxime can be used as no history of immediate anaphylactic reaction to penicillins.
Cephalosporins/cefotaxime ideal to avoid, penicillins, but if minor rash, calmIMMEDIATE/ANAPHYLACTIC REACTION, YH AVOID!
SIGNS OF VERRUCA?
Verrucae are also known asplantar warts and usually appear on the sole of the feet. They often have central darkdots (thrombosed capillaries) and may be painful.
A 45-year-old man has skin condition affecting his toes. The nail on two toes of his leftfeet are discoloured and look a bit flaky. The surrounding skin is a little red. There is nopain or itching. He is diabetic and takes metformin to manage his condition.CONDTION?
Fungal nail infection
A 26-year-old man has the following foot condition. He has been using an emollientcream on the area as the skin is flaky and cracks.CONDITION?
athlete’s footThe main symptoms areitchy white patches between the toes, usually between the fourth and fifth toes, but itcan affect others. The skin may also appear red, cracked, scaly or macerated. Thearea under the exposed peeling skin can sometimes be sore. Some patients describethe skin as looking wet.
An 18-year-old woman has a rash on her lower legs which has been for two days. Therash is red, sore, itchy, and there appears to be small, raised bumps. She mentionsthat she recently had hair removal treatment.CONDITION?
The symptoms indicate dermatitis which is most likely to be associated with the hairremoval treatment the patient has had. Acute contact dermatitis typically presents witherythema and vesiculation, dryness, scaling and bullae may also be present.
A 35-year-old man has a growth on his right index finger. It appeared two weeks ago.The growth is firm, raised and skin coloured. He is experiencing minor pain and itchingwhere the growth is.
The symptoms suggest a wart. They can appear on palms, knuckles, knees, andfingers, and occur in clusters. Warts are firm to touch, have raised papules with a roughsurface that resembles a cauliflower, and are usually skin coloured but may appeardarker on dark skin; they sometimes itch and cause minor pain. They will often resolveon their own but may take months or even years.
A 34-year-old woman, with a BMI of 32, requests an over-the-counter medication. Shealso takes levothyroxine 100 micrograms and desogestrel 75 micrograms. You adviseher that this medicine is not recommended because of potential interactions.MED CONTRAINDICATED?
orlistat!!!- Hypothyroidism and/or reduced control of hypothyroidism may occur when orlistat andlevothyroxine are co-administered. Patients taking levothyroxine should consult adoctor before starting treatment with Alli, as orlistat and levothyroxine may need to betaken at different times and the dose of levothyroxine may need to be adjusted.- Orlistat may indirectly reduce the availability of oral contraceptives and lead tounexpected pregnancies in some individual cases. The use of an additionalcontraceptive method is recommended to prevent possible failure of oral contraceptionthat could occur in case of severe diarrhoea.
A 65-year-old man requests an over the counter medicine. He also takes co-beneldopadispersible tablets for Parkinson’s disease. You advise him that this medicine is notsuitable for him because of his medical condition.CONTRAINDICATED?
PROCHLORPERAZINE!! EPSE :(
WHAT IS THIS?!
PSORIASIS!
A 56-year-old man presents himself at the pharmacy you are working in. He would likesome painkillers after hurting his ankle playing football. He is weight bearing althoughlimping slightly. He has tried nothing so far for the pain in his ankle. You ask the patientif he is on any regular medication, he tells you he takes:• Multivitamins• Omeprazole 20mg once daily• Folic acid 5mg daily (four-month course)• Symbicort turbohaler two puffs twice a day and when requiredBEST ACTION?
Sell him paracetamol 500 mg capsules and advise him to rest the joint This patient does not need referring to the GP or the walk in centre as he is able toweight bear, which indicates that an over the counter medicine will be able to help himmanage his symptoms.The patient is using a symbicort inhaler, on a SMART/MART regime which indicates hehas respiratory disease such as asthma or COPD, therefore an NSAID such asibuprofen or diclofenac would not be the most appropriate. Also, he is takingomeprazole which indicates that NSAIDs, in particular, ibuprofen, would not besuitable.
A doctor contacts you asking you to suggest a drug to treat a patient who has contracted meningococcal disease.Which drug would be suitable to be given via intravenous infusion in this patient?
Benzylpenicillin sodium is indicated for use in meningococcal disease and is only available in an IV preparation.
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.In what way should you deal with the disposal of the remaining liquid inside the bottle?
Rinse the bottle with water and pour into a denaturing kitWaste medicines should not be disposed of in the sink. The rinsings should be added to a denaturing kit and disposed as pharmaceutical waste.
You are teaching a trainee about medical terminology.Which of the following terms describes ‘asbestos-like’ scales on the scalp?
Pityriasis amiantaceaPityriasis amiantacea describes ‘asbestos-like’ scales on the scalp.
Miss C is joining your pharmacy team as a work experience student. You receive the morning order of medications and preparations and she is keen to help put them out on the pharmacy shelves.She asks you which one of the following substances is a prescription only medicine?
Mometasone furoate 0.1% cream
A mother brings her 3 year-old child to your pharmacy. They are suffering from the symptoms associated with otitis media, a common complaint in young children.Which of the following symptom groups best describe the signs and symptoms of otitis media in this age group?
Irritability, crying, fever and pain
You are working in a community pharmacy on a Saturday. Your counter assistant makes you aware that there is a lady asking for an emergency supply of an EpiPen. On questioning the patient you establish that she is allergic to bees and has been stung. She does not have an EpiPen with her. She reports feeling breathless and having a tight chest.What is the most appropriate initial step in your course of action?
Ask the assistant to telephone 999, request an ambulance and state anaphylaxisThe patient is demonstrating signs of anaphylaxis. She will need emergency assistance so it is important to make this call asap. As you have other staff available to do this, it would be appropriate to get them to do this instantly while you then deal with the emergency. The MEP states that: “If a pharmacist administers adrenaline they must also ensure that an ambulance is called by dialling 999 and reporting that there is a case of suspected anaphylaxis.” EpiPen training provides similar guidance. When managing anaphylaxis it is crucial that the ambulance gets to the patient as soon as possible. Therefore, the initial first step to get the assistant to phone 999 would be prudent while you are in the process of locating and administering the adrenaline pen in order to avoid undue delay in the patient getting the next step in their care.
This drug may be used in the treatment of cellulitis. It can be administered orally or intravenously for this condition.
ClindamycinClindamycin is indicated in soft tissue infections such as cellulitis. It may be administered orally or via the IM or IV routes.
This medication must be used with caution in patients who have a sensitivity to sulfonamides.
Sumatriptan succinate 50 mg tabletsSumatriptan should be used with caution in patients with sensitivity to sulfonamides.
DOACSDirect thrombin?Factor Xa inhibitor?
Direct thrombin? Dabigatran Factor Xa inhibitor? Rivaroxaban
DOAC for dyspepsia?
Edoxaban/apixabanRivaroxaban/dabigatran can cause it!
DOACs+vitamin K?
DOESN’T MATTER, INR silly
doacs+inr?
not needed, just monitor for blleding/anaemia
METHOTREXATE MISSED DOSINGWITHIN 2 DAYS?>/= 3 DAYS?DOUBLE DOSE?
METHOTREXATE MISSED DOSINGWITHIN 2 DAYS? take asap+next dose as normal>/= 3 DAYS? doctor/specialistDOUBLE DOSE? NEVER to make up missed dose
What is a serious shortage protocol?
The protocols, for use in the event of a serious shortage of a medicine, may give community pharmacies the ability to dispense less, or give a different strength, or pharmaceutical form, or provide an alternative generic product, or provide an alternative product; following appropriate discussions with the patient.
Aspects of a SSP?
proposed on opinion of ministerclinicians involvedissued only in exceptional circumstancesmore likely for alnterative strength blah blahless likely to be for generic/therapeutic substituion
What chemo agents cause bone marrow suppression?
ALLExceptvincristine & bleomycin
ISSUES WITH VINCRISTINE?
HYPERURICAEMIAALOPECIATHROMBOEMBOLISMEXTRAVISATION OF IV DRUGSMUCOSITISTERATOGENIC (1st trimerster) LHIGHLY EMETOGENIC, n&v (cisplatin/dacarbazine/lots of cyclophosphamide)
FLUCLOXACILLIN ADVERSE EFFECTS?
CHOLESTATIC JAUNDICEDIARRHOEAHYPERSENSITIVITYSKIN REACTIONSTHROMBOCYTOPENIA
WHAT IS THIS?
STYE
FEATURES OF A STYE?
small, painful lump on or inside the eyelid or around the eye.skin around the stye may be swollen and red and the stye may be filled with yellow pus.eye may be red and watery, but the vision should not be affected.
advice on treating a stye?
- Soak a clean flannel in warm water.2. Hold it against your eye for 5 to 10 mins.3. Repeat this 3 or 4 times a day.warm compress
stye…
the cause is bacterial, but antibiotic therapy is not usually needed. A warm compress should be applied for 5-10 minutes three to four times a day to reduce swelling
stye referral?
very painful/swollendoes not get better in a few weeksaffects vision
WHEN IS MORPHINE SCHEDULE 2?
ABOVE 13MG/5ML
CARBIMAZOLE BLOOD DISORDERS REFERAL?
sore throat, mouth ulcers, bruising, fever, malaise, or non-specific illness develops
ISONIAZID ADVICE?
PERIPHERAL NEUROPATHY, PYRIDOXINE VITAMIN B6LIVER DISORDER, JAUNDICEAVOID TYRAMINE-RICH FOODS- TACHY/PALPI/FLUSHI L
MICROVASCULAR COMPLICATIONS?
Retinopathy Visual disability and blindnessNeuropathy Peripheral neuropathyAutonomic neuropathyNephropathy Renal failureFoot problems MetabolicDyslipidaemiaKetoacidosis Hyperosmolar hyperglycaemic state (HHS
MACROVASCULAR COMPLICATIONS?
Coronary heart disease Cardiomyopathy ArrhythmiasCerebrovascular disease Peripheral artery disease
pseudoephedrine in diabetse/hypertension?
The question shows that the patient is being treated for hypertension and therefore the use of sympathomimetic agents is contraindicated and not advised without a prescriber’s supervision. It is best to recommend another OTC remedy
extravasation injury, cytotoxic drug?xtravasation management1. The infusion should be stopped immediately but the cannula should not be removed until after an attempt has been made to aspirate the area (through the cannula) in orderto remove as much of the drug as possible.2. Corticosteroids are usually given to treatinflammation. Hydrocortisone or dexamethasone can be given either locally or intravenously3. Antihistamines and analgesics may be required for symptom relief
Stop the infusion immediately, administerhydrocortisone and analgesia
extravasation management?
xtravasation management1. The infusion should be stopped immediately but the cannula should not be removed until after an attempt has been made to aspirate the area (through the cannula) in orderto remove as much of the drug as possible.2. Corticosteroids are usually given to treatinflammation. Hydrocortisone or dexamethasone can be given either locally or intravenously3. Antihistamines and analgesics may be required for symptom relief
levothyroxine advice?
The medication needs to be taken in the morning at least 30-60 minutes before any food, caffeine-containing liquids (e.g. coffee, tea) or other medications.
Patients with a confirmed proximal DVT or PE duration?
At least 3 months, 3-6 months if active cancer
provoked DVT or PE duration?
3 months, 3-6 months if active canceror when provoking factor gone
unprovoked DVT or PE?
beyond 3 months, beyong 6 months for those with active cancer
warfarin+miconazole? Absolute Lalternative?
nystatin, but it’s a POM!!! so refer to GP
blood glucose driving conc?
> 5
ASTHMA INHALERSFLIXOTIDE EVOHALER?SYMBICORT TURBOHALER?SERETIDE EVOHALER?FOSTAIR NEXT?RELVAR ELLIPTA?
FLIXOTIDE EVOHALER? pMDISYMBICORT TURBOHALER? cylindricalSERETIDE EVOHALER? pMDIFOSTAIR NEXT? glock, not redRELVAR ELLIPTA? blue, egg
ACCUHALER?
DPI, breathe in quickly and deeply
Easi-breathe/BAI/Autohaler/pMDI/Evohaler?
breathe in slowly and steadily
METRONIDAZOLE KEY LABELLING?
Warning: Do not drink alcoholSpace the doses evenly throughout the day. Keep taking this medicine until the course is finished, unless you are told to stopTake with or just after food, or a mealSwallow this medicine whole. Do not chew or crushTake with a full glass of water
Why metronidazole with meals? spaced dosing?
Improves absorbance+maximises bacterial death
NMS serviceELIGIBLE CONDITIONS?
.Asthma and COPD:2.Diabetes (Type 2);3.Hypertension;4.Hypercholesterolaemia;5.Osteoporosis;6.Gout;7.Glaucoma;8.Epilepsy;9. Parkinson’s disease;10. Urinary incontinence/retention;11. Heart failure;12. Acute coronary syndromes;13. Atrial fibrillation;14. Venous thromboembolism/embolism;15. Stroke / transient ischemic attack; and16. Coronary heart diseaseNOT TYPE 1 SADLY!! :(
ADULTS 19-64 PHYSICAL ACTIVITY ADVICE?
At least 150 minutes of moderate intensity activity a week or 75 minutes of vigorousintensity activity a weekAdults should aim to do strengthening activities on at least 2 days a week – this must work all the major muscle groups
ANGINA MANAGEMENT ORDER?
B-BLOCKER OR RATE-LIMITING CCBTHENB-BLOCKER+STANDARD CCBTHENLONG-ACTING NITRATE
WHAT VITAMIN DO YOU AVOID IN PREGNANCY?
VITAMIN A, RETINOL, E.G. COD LIVER OIL
NSAIDS+GI RISKS?HIHEST TO LOWEST?
PIROXICAM/KETOPROFEN/KETOROLACINDOMETACIN/DICLOFENAC/NAPROXEN (>1G)/ IBUPROFEN (>1.2G)IBURPROFEN (<1.2G)/NAPROXEN(<1G)
DISPENSED LABEL LEGAL REQUIREMENTS?
NAME OF PATIENTNAME+ADDY OF PHARMACYDATENAME OF MEDDIRECTIONS/DOSEPRECAUTIONSEXTERNAL USE ONLY+REACH/SIGHT CHILDREN NOT A LEGAL REQUIREMENT
What is medicines optimisation?
Medicines optimisation looks at how people use medicines and acknowledges that the way people use medicines over time may change. It may involve stopping some medicines as well as starting others and considers opportunities for lifestyle changes and non-medical therapies to reduce the need for medicines.
Loperamide serious OD?
QT prolongation!
Patient has been reinitiated on lithium therapy for the management of bipolar disorderfollowing a relapse 2 weeks ago which required her to be admitted into a secure psychiatric unit.As part of the Trust guidelines, the patient will need to undertake therapeutic dose monitoring toensure that her serum lithium concentration remains within the desired rangeWhich of the following is the most appropriate target concentration for Mrs Hʼs serumlithium level?
0.8-1
Lithium 0.8-1mmol/L?
A target serum-lithium concentration of 0.8–1 mmol/litre is recommended for acute episodes of mania, and for patients who have previously relapsed or have sub-syndromal symptoms. It is important to determine the optimum range for each individual patient.
This should be done weekly after initiation and after each dose changeuntil concentrations are stable • Then every 3 months for the first year• Then every 6 months thereafter
A target serum-lithium concentration of 0.8–1 mmol/litre is recommended for acute episodes of mania
Alendronic acid advice?
Manufacturer advises tablets should be swallowed whole and oral solution should be swallowed as a single 100 mL dose. Doses should be taken with plenty of water while sitting or standing, on an empty stomach at least 30 minutes before breakfast (or another oral medicine); patient should stand or sit upright for at least 30 minutes after administration.
vet prescriptions as direct?
not acceptable
WHEN/WHAT TO REPORT TO MHRA?
everything that is serious, medically significant, or result in harm.Anaphylaxis, blood disorders, endocrine disturbances, effects on fertility, haemorrhage from any site, renal impairment, jaundice, ophthalmic disorders, severe CNS effects, severe skin reactions, reactions in pregnant women, and any drug interactionsopioid constipation/TCA dry mouth mynaaaa
clinical bp 200/130?
HOSPITAL/SAME DAY ASAP?
TOUJEO TO LANTUS?
GLARGINE20% DOSE REDUCTIONRISK OF HYPOGLYCAEMIA
CHEMOMILD N&V?
FLUOURACILETOPOSIDEMETHOTREXATE
CHEMOMODERATE N&V?
TAXANESDOXORUBICINLIL CYCLOPHOSPHAMIDELOTS OF METHOTREXATE
CHEMOSEVERE N&V?
CISPATINDACARBAZINELOTS OF CYCLOPHOSPHAMIDE
EVIDENCE HIERARCHYSYSTEMATIC REVIEW AT THE TOP!!!
gradual withdrawal of corticosteroids?
received more than 40 mg prednisolone (or equivalent) daily for more than 1 week;• been given repeat doses in the evening;• received more than 3 weeks’ treatment;• recently received repeated courses (particularly if taken for longer than 3 weeks);• taken a short course within 1 year of stopping long-term therapy;• other possible causes of adrenal suppression.
Patient, valproate, unplanned pregnancy, advice?
Continue taking, just refer asap
STATINS & NON-HDL CHOLESTEROL % REDUCTION?
Atorvastatin 80mg once daily is an example of a high-intensity statin, to be a high-intensity statin it has to produce a minimum reduction in LDL- cholesterol of 40% or greater.Medium- intensity – 30%Low-intensity - 20 %
CELLULITIS TREATMENT?
FLUCLO 1G 7 DAYS
RIFAMPICIN CAUTIONS?
Hepatotoxicity, colors soft contact lenses and urine red/orange, enzyme-inducer, effectiveness of hormonal contraceptives is reduced. Monitor liver function.
PYRAZINAMIDE CAUTIONS?
C/I in acute attack of gout• Hepatotoxicity • Monitor renal and hepatic function
ETHAMBUTOL CAUTIONS?
C/I in optic neuritis & poor vision• Ocular toxicity• TDM: peak (2-6 mg/L) and trough (<1mg/L)
ISONIAZID CAUTIONS?
C/I in drug-induced liver disease, given with Pyridoxine to prevent peripheral neuropathy.• Enzyme inhibitor, avoid tyramine-rich foods, or histamine-rich foods. • Monitor liver function.
Excessive alcohol drinking?–> Thiamine deficiencySIGNS?
Fatigue Loss of appetite Weight lossGastrointestinal upset Nausea Weakness
SEVERE THIAMINE DEFICIENCY?
mental confusion Paralysis of extremitiesHeart problemsLoss of appetite
sources of thiamine?
enriched white rice or egg noodlesfortified breakfast cerealtroutblack beanssunflower seedsacorn squashyogurt
Relvar elipta shelf-life?
6 weeks, 42 days
PATIENT PREGNANTSICKLE CELL DISEASEFOLIC ACID?
5MG DAILYBEFORE AND THROUGHOUT PREGNANCY!
INITIAL ACS MANAGEMENT?MONA
M – morphine for pain O – oxygen if requiredN – GTN/ Nitrate spray A – Loading dose of Aspirin should be given asap
symptoms of ACS?
ain in the chest or other areas (for example the arms, back, or jaw) lastslonger than 15 minutes.Chest pain is: • Dull, central, and/or crushing.• Associated with nausea and vomiting,sweating or breathlessness, or acombination of these
ACS, LOW RISK OF BLEEDINGASPIRIN+?
ASPIRIN+TICAGRELOR
ACS HIGH BLEEDING RISK?
CLOPDIOGREL+ASPIRINORASPIRIN ALONE
prasugrel? for pciclopi? for high bleeding riskaspirin? for high bleeding risk
Patient taking combined pillMissed 2 days during week 1 following HFI+UPSIAction?
Provide emergency contraception. A barrier method should be used for the next 7 daysfrom the last missed pill
Patient taking desogestrel, missed their 8am pill, it’s 4pm now, advice?
<12hours so it’s calmTake the missed pill as soon as possible and continue todayʼs pill at its normal time. Nobarrier method is necessary
What’s in microgynon?
Combined, ethinylestradiol+levonorgestrel
Patient taking microgynon,missed 2 doses in last week of pack, prior to HFI, advice?
The most recent pill should be taken, and she should skip her pill free week (omit HFI) and move onto the next pack immediately
Norehisterone, what is it? Missed dose?
Standard POP3hrs
Patient, norehisterone, missed dose by 12hours, advice?
Take the missed pill as soon as possible and continue today’s pill at its normal time. Use a barrier method for the next 48 hours
RED MAN SYNDROME= MACULOPAPULAR RASH!!!VANC, ENDOCARDITIS, ETC
VANCOMYCIN FAT PARA
Vancomycin can be used in the treatment of Complicated skin and soft tissue infections, bone infections, joint infections, community-acquired pneumonia, hospital-acquired pneumonia, infective endocarditis, acute bacterial meningitis, bacteraemia, and Clostridium difficile infection.Infusion-related reactionsRapid bolus administration (i.e. over several minutes) may be associated with exaggerated hypotension (including shock and, rarely, cardiac arrest), histamine like responses and maculopapular or erythematous rash (“red man’s syndrome” or “red neck syndrome”).Vancomycin should be infused slowly in a dilute solution over a period not less than 60 minutes to avoid rapid infusion-related reactions.Monitoring: auditory function, blood count, hepatic and renal function, leucocyte count
adult, asthma, SABA+ICS, next step, BTS guideline?
LABA, salmeterol, done before increasing corticosteroid dose or adding LTRA by the way
Patient, COPD, symptoms not controlled with ipratropium, SAMA, next step up?
In patients who continue to be breathless or have exacerbations, offer a longacting beta2 agonist (LABA) and a long-acting muscarinic antagonist (LAMA). Discontinue SAMA treatment if a LAMA is given. Treatment with a SABA as required may be continued in all stages of COPD
EPILEPSY TERATOGENIC RISK?HIGHEST?
SODIUM VALPROATE
EPILEPSY TERATOGENIC RISK?INTERMEDIATE?
CARBAPAZEMINEPHENYTOINPHENOBARBITALTOPIRAMATE
EPILEPSY TERATOGENIC RISK?LOWEST?
LAMOTRIGINELEVETIRACETAM
diltiazem+bisoprolol interaction?
CARDIODEPRESSION!!! (bradycard+hypotension)
sertraline+tramadol interaction?
serotonin syndrome
RAMIPRIL RENAL IMPAIRMENT DOSING30-60mL/min?<30mL/min?
30-60mL/min? max. 5mg OD<30mL/min? max. initial 1.25mg OD, do not exceed 5mg OD
Metformin, eGFR is 25 mL/min/1.73 m?
DO NOT START IF(eGFR) is less than 30 mL/min/1.73 m2.During treatment with metformin monitor renal function:• At least once a year in people with normal renal function.• At least twice a year in people with additional risk factors for renal impairment,such as the elderly, or if deterioration in renal function is suspected.• Review the dose of metformin if eGFR is less than 45 mL/min/1.73 m2.Stop treatment with metformin:• If eGFR is less than 30 mL/min/1.73 m2.• In people at risk of tissue hypoxia orsudden deterioration in renal function
INDAPAMIADE, <30mL/min?
AVOID!!!
Patients whose Hb1Ac rises to 58mmol/mol or higher should have their treatment intensified
HbA1c is 75 mmol/mol or higher, type 2?
Neutral Protamine Hagedorn (NPH) insulin• NPH + Short-acting insulin
WHEN DO YOU USE GLP-1?
When triple therapy is an L but… have a body mass index (BMI) of 35 kg/m2 or higher (adjust accordingly for people from Black,Asian and other minority ethnic groups) and specific psychological or other medical problemsassociated with obesity or• have a BMI lower than 35 kg/m2 and:– for whom insulin therapy would have significant occupational implications or– weight loss would benefit other significant obesity related comorbidities.
VIGABATRIN? VISUALTOPIRAMATE? GLAUCOMA
MIGRAINE PROPHYLAXIS?
PROPRANOLOLMETOPROLOLNADOLOLAMITRIPTYLINEVALPROATEPIZOTIFENNOT TRIPTAN- TREATS IT!
nicotine hyperglycaemia?
nrt diabetes caution, not contra
PAROXETINE TIME OF DAY?
MORNING
PIOGLITAZONE HEPATIC IMPAIRMENT?
AVOID
PHENYTOIN, RASH?
BLOOD/SKIN DISORDER, A&E ASAP! LIFE THREATENING
antidepressants, SSRIs?
best taken int he AM!
Codeine maximum dose/day?
240mg
How many days of co-codamol 30/500mg tablets could you give maximum as an emergency supply?
5 days maxAs co-codamol contains codeine 30mg which is a schedule 5 CD!
Diazepam/Temazepam dental?
Hypnotic of choice
metoclopramide?
diarrhoea
ferrous sulphate?
constiaption/diarrhoeamore so constipation
common pneumonia causes?
steptohaemophilus
FENTANYL PATCH COUNSELLING?
WATERPROOF PATCH, no need to remove in showerDO NOT CUT, don’t touch adhesive bitdry, flat, undamaged skin, avoid hairy areaSAvoid sunlightThe same area can be used after 7 daysFold patch in half, adhesive inwards, BIN
What is pharmaceutical care?
the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve the patient’s quality of life
what is medicines management?
A system of processes and behaviours that determines how medicines are used by the NHS and patients
what is patient-centred care
Providing care that supports people to achieve the health outcomes that give them the best opportunity to lead the life that they want.
rifampicin pancreatitis?
rare
dry, irritating cough, no mucus, 7 yr old kid, first line?
pholcodine linctus
Coughs and meds
s&s of rosacea?
redness nose, cheek, forehead, chin, comes n goesburning/stinging with water/skincarebroken blood vessels, don’t go
risedronate counselling?
Swallow tablets whole with a full glass of water; on rising 30 minutes before the first food or drink of the day
High tsh, low t3, t4, hypothyroidism, give levothyroxine. But then low TSH happens?
reduce levo dose
levothyroxine monitoring?
tsh every 3 months till stable, then yearly
levothyroxine in pregnancy?
higher dose requiredLevothyroxine may cross the placenta.Excessive or insufficient maternal thyroid hormones can be detrimental to fetus.Levothyroxine requirement may increase during pregnancy.
bmi ranges
Healthy weight — BMI of 18.5–24.9 kg/m2• Overweight — BMI of 25–29.9 kg/m2• Obesity l — BMI of 30–34.9 kg/m2• Obesity ll — BMI of 35–39.9 kg/m2• Obesity lll — BMI of 40 kg/m2 or more
coronary heart disease modifiable risk factors?
Obesity• Hypertension• High cholesterol (high LDL, low HDL)• Lack of exercise • Diabetes
CD MAXIMUM QUANTITY?
30 DAYS!
RISK FACTORS FOR AKI?
65+LIVER DISEASEDIABETESSEPSISOLIGURIA
Patient feels r S feels lethargic, low mood, skin colour has a paler yellow tinge?
give vitamin b12
Management of osteoarthritic pain?
Topical/oral NSAID+exerciseparacetamolexercise, weight lossDO NOT USE RUBBEFACIENTS/GLUCOSAMINE FOR OSTEROARTHRITISDO NOT OFFER ACCUPUNTURE EITHER
WARTS/VERRUCA VIRUS CAUSE?
HUMAN PAPILLOMA VIRUS!
WARTS/VERRUCA REFERRAL?
KEEPS COMIN BACKVERY LARGE/PAINFULBLEEDS/CHANGESFACE/GENITALS
BUPRENORPHINE W/ NALOXONE/SUBOXONE DRUG CLASS?
3, NO REG
COC/POP/PATCH/VAGINAL RING/EHC efficacy?
REDUCES SIGNIFICANTLY WITH INDUCERS• Carbamazepine• Eslicarbazepine• Nevirapine• Phenobarbital• Primidone• Ritonavir• St John’s wort • TopiromateETCbarrier/depo/IUD IS ADVISED
PREGABALIN TREATMENT CESSATION?
Avoid abrupt withdrawal (taper over at least 1 week).
LAMOTRIGINE TAPERING?
2 WEEKS OR LONGER!
WHEN TO STOP HRT (not give aspirin lol)?
CHEST PAINBREATHLESSNESSSWELLING/LEG PAINSTOMACH PAINBP 160>HEPATITISIMMOBILITY SURGERY
tiaprofenic acid indication?
Pain and inflammation in rheumatic disease and other musculoskeletal disorders
PPI side-effect?
hypomagnesaemia
SICK DAY, diarrhoea, vomiting?
THINK SADMAN!!!!
4 year old child, burn on hand, blistering?
A&E ASAP!
SYMPTOMS OF STROKE?
numbness, weakness, slurred speech, or visual disturbanceVISION LOSS THAT IS
LEVOTHYROXINE, DAMN, SPC USE WHOLE TEXT
If necessary, Levothyroxine Oral Solution can be administered via a nasogastric feeding tube that should be rinsed twice with 10 ml of water immediately after administration.
3 year old, nystatin, oral thrush?
1ml QDS, 7 days+2 days after lesions have healed
HPV VACCINE?
Children aged 9-14 yrs:• A 2-dose schedule is recommended for children who receive the first dose before the age of 15 yrs• The first dose is usually given at 11 yrs old and the second dose 6-24 months after. If given less than 6 months apart it should not be considered adequate to provide long-term protection. A third dose should be given in that case.Children and adults aged 15-25 yrs:Individuals remain eligible to receive the HPV vaccine up to the age of 25 years if they did not receive the vaccine when scheduled. A 3-dose schedule is recommended, with the second and third dose given 1 month and 4–6 months after the first dose, respectively. All 3 doses should be given within a 12-month period
HPV PROTECTION YEARS?
AT LEAST 10
VILDAGLIPTINS LIVER?
HEPATOXIC REPORT!
cd 3/4/5 emergency supply max days?
5but phenobarbital no max if prescriber
B-BLOCKER MASKS SYMPTOMS OF HYPOYGLYCAEMIA, EXCEPT SWEATING! CRAZY Q
Beta blockers mask signs and symptoms of hypoglycaemia (e.g. tachycardia, tremor, blurred vision, hunger & headache) except sweating; also impair insulin release and glycogenolysis; cardioselectiv
HYPOGLYCAEMIA?
3-4 TEASPOONS OF SUGAR CALM,150-200 MLL JUICE FRULLY
threadworms does not require referral to gp, can treat OTC, only refer if under2/breast feeding
Recommend that Miss Y’s son wears under wear at night, which she should change in the morning
Sildenafil+tamsulosin?
risk fo hypotension
BABIES, DEHYDRATION?
DRY NAPPIES! REFER
KIDS WITH DEHYDRATION?
seem drowsybreathe fasthave few or no tears when they cryhave a soft spot on their head that sinks inwards (sunken fontanelle)have a dry mouthhave dark yellow pee or have not had a pee in last 12 hourshave cold and blotchy-looking hands and feet
HRT, INCREASES RISK WITHIN 1 YEAR OF STARTING BUT DECREASES WITHIN 5 YEARS OF STOPPING?
BREAST CANCER!
valproate, prescriber, ppp?
dispense+take regs
immunisation w/ yellow fever?
take at least 10 days before travelling!
Pregnant lady, gphc renewal looming, action?
She can still renew her GPhC registration without submitting all the records if she contacts the GPhC to explain her circumstances as soon as possible
METHOTREXATE+TRIMETHOPRIM?
anti folate, haematological toxicity!
doxycycline capsules?
swallow wholeplenty of fluidsit/stand
SIGNS OF HYPERCALCAEMIA?
Loss of appetite• Nausea and vomiting• Constipation and abdominal (belly) pain• The need to drink more fluids and urinate more• Tiredness, weakness, or muscle pain• Confusion, disorientation, and difficulty thinking• Headaches• Depression
hyponatraemia sign?
muscle weaknessconfusion Weakness• fatigue or low energy• Headache• Nausea• Vomiting• Muscle cramps or spasms• Confusion • Irritability
signs of hyperkalaemia?
Feeling very tired or weak• Stomach pain or nausea• Dizziness• Muscle pain or cramps• Trouble breathing• Weakness in the arms and/or legs• Unusual heartbeat or chest pains
hypomagnesaemia range?
0.8-1 somethings
Lithium+NSAIDs/ACE?
Increases lthium conc
Naproxen+cipro?
lowers seizure threshold, convulsions risk!
AVOID NSAIDS/B-BLOCKERS IN ASTHMA
migraine, nsaids, need quick treatment?
soluble paracetamol!
For swelling and inflammation (throbbing with pain) of an injury, an NSAID would be a more suitable option.
IBUPROFEN
back+knees, painful and stiff, gardner, first line?
paracetamol, then up the ladder
LTHIUM+AMITRIPTYLINE INTERACTION?
NEUROTOXICITY
cd prescriptions ‘twice a day’ insufficientbe clear!
gestational hypertension, yes labetalol, etc but other advice?
top ACE inhibitors, ARBs, thiazide or thiazide-like diuretics due to an increased risk of congenital abnormalities.
pyelonephritis management?
cefalexin or ciproORsensitivity known? co-amoxiclav or trimethoprim
impetigo systemic?
fluclo->clari
SINUSITIS TREATMENT?
PHENOXYMETHYLPENICILLINVery unwell? Co-amoxiclav(pen allergy? Doxycycline/Clarithromycin/Ery in pregnancy
Chronic eczema, tried betamethasone 0.25%, next best option in primary care setting?
Hydrocortisone butyrate 0.1% cream
Scarlett fever in OTC?
Gotta refer, Abx treatment, not paracetamol silly
Pregnant, severe itching, atnight?
REFER, GP, CHOLESTATSIS SOMETHINGS!
sidenafil+sickle-cell disease?
caution :?
headlice, only treat on live heads
permethrin whole body, wash after12hours, repeat after a week
contact dermatitis, itchy, rash, cleaning?
emollient+steroid
What is solpadeine?
co-codamol, containing codeine, 3 days max
pseudoside-effects?
sleep Lheart quick
dry sore patches, knees, elbows?
atopic eczema
deodorant, skin irritated?
use hydrocortisone 1%
HYDROCORTISONE NOT FOR ANGULAR CHELLITISce
ON THE FACE OBVS
17 year old hayfeversneezing, nasal Ltreatmetn?
cetirizine tablets
HEAD LICES KILLED, STILL EGG CASES?
IT’s fine
patient promethazine, hay fever, has glaucoma?
give alternative
3 thrush attacks in 6 months= refer
smoking cessation in asthmatics?
not gum?
CD on VET form?
NOT standardised form, private, charge and keep 5 years!
only tabs/caps CDs needing denaturing should be debilisterd!
patient fails to collect their methadone, when do i contact prescriber?
after 3 days L
fmp10mda methadone duration?
2 weeks
vet prescription calm?
yes, dispense
NO RPNO SIGN INNADA CAN DO?
ORDER STOCKRECEIVE STOCK/RETURNS (excluding CDs)PUT STOCK AWAY (excluding CDs)
CD pick up, on behalf, MUST?
REQUEST PROOF OF IDENTITY?
HCP acting on behalf, schedule 2 CD?
nameaddressrequest evidence of identity
family member/representative on behalf, sch 2 CD?
upto pharmacist
patient returned sch 2 CD?
just dispose as directed, no-one cares, staff witness is good practice
diazepamtemazepam Schedule?
43
CD2 TECHNICAL ERRORS?
Where a prescription for a Schedule 2 or 3 CD contains a minor typographical error or spelling mistake, or where either the words or figures (but not both) of the total quantity has been omitted, a pharmacist can amend the prescription indelibly so that it becomes compliant with legislation.
patient requests their data?
may be charged a fee
ACCOUNTABLE OFFICER ROLE?
they don’t personally supervise destruction, they appoint witnesses, and otehr thigns
haemorrhoids likely?
nausea, acupressure bands
PPIs do not make stools black!
ALENDRONIC ACID REFERRAL SERIOUS?
Severe oesophageal reactions (oesophagitis, oesophageal ulcers, oesophageal stricture and oesophageal erosions) have been reported; patients should be advised to stop taking the tablets and to seek medical attention if they develop symptoms of oesophageal irritation such as dysphagia, new or worsening heartburn, pain on swallowing or retrosternal pain.
STOOLS, HARD, DRY, FIBRE FLUID, TREATMENT?
stool softner
omeprazole starting dose?
10mg OD?
lansoprazole, peptic ulcer treatment?
hypomagnesaemia
spasmodic, cramping?
giveatropinehyoscine hydrobromide- no CNS effects
dompierdone 7 days max, not appropriate for long jourenys
alternative to mebeverine?
hyoscine
hard stools Faecal impactionprescription?
macrogol
pregnant, lifestyle, advice, L, constipatedfirst line?
bulk forming, ispag, standard
diarrhoea, kid, 24 hrs, bug?
rehydration sachets!
traveller’s diarrhoea, standby?
loperamideazibismus?
end stage renal failure?
there’s elevated phosphate
eGFR <15mL/min, biochemical abnormality?
hypocalcaemia!
yellow-brown urine, Abx?
nitrofurantoin
Miss J, aged 16-years, comes into the pharmacy asking to speak to the pharmacist privately. Miss J explains that she is experiencing very heavy periods and often bleeds through her bedding at night. She also needs to change her sanitary protection every two hours throughout the day which is preventing her from doing her normal everyday activities. She read online that there are medicines she can buy to help with this. She is currently not taking any other medicines and has no allergies.
UNDER 18S, REFER!!!
TRANEXAMIC ACID- BLEEDINGPERIOD PAIN- IBUPROFEN 12+, FEMINAX ULTRA 15-50
ramipril dosing eGFR of 58ml/min?
5mg OD
Max. daily dose 5 mg if creatinine clearance 30–60 mL/minute; max. initial dose 1.25 mg once daily (do not exceed 5 mg daily) if creatinine clearance less than 30 mL/minute. See
RAMIPRIL!
Which of the following statements is INCORRECT in relation to the treatmentfailure of NuvaRing?.
A if the ring was out of the vagina for an unknown amount of time, you may not be protectedfrom pregnancy.B if the ring has been out of the vagina for less than 2 hours, you are not protected againstpregnancy. ANSWER!!C if the ring has been out of the vagina for more than 3 hours during the 1st and 2nd week, itmay not protect you from pregnancy. You should put the ring back in the vagina as soon as youremember and leave the ring in place without interruption for at least 7 days.D if the ring has been out of the vagina for more than 3 hours in the 3rd week it may not protectyou from pregnancy. You should discard that ring and insert a new ring immediately.E if the ring has been out of the vagina for less than 3 hours, it will still protect you frompregnancy. You should put the ring back in as soon as possible but only if the ring has been outof the vagina for less than 3 hours.
cleft palate preg 12 weeks?
MHRA/CHM advice: Ondansetron: small increased risk of oral clefts following use in the first 12 weeks of pregnancy (January 2020)Epidemiological studies have identified a small increased risk of cleft lip and/or cleft palate in babies born to women who used oral ondansetron during the first trimester of pregnancy. Healthcare professionals are advised that if there is a clinical need for ondansetron in pregnancy, patients should be counselled on the potential benefits and risks, and the final decision made jointly.
CLOTRIMAZOLE CREAM+CARBAMAZEPINE?
yh avoid, epssary
A 22-year-old female has come to the pharmacy asking for your advice regarding her painfulperiods that has started a few months ago. Upon questioning the patient, you find out thatshe is suffering from lower abdominal pain and backache, which starts several days beforeher period begins. She tells you that her menstrual cycle used to be very regular but nowtends to vary and some occasions she has 2-3 weeks between her periods. She alsomentions that her pain continues throughout menstruation and it is quite severe in nature.She has tried ibuprofen and has had no effect on her pain symptoms. Which of the followingconditions best describes the patient’s symptoms?
secondary dysmenorrhiae
GLP rapidly discontinued?
DKA!
H PYLORI REGIME, PENICILLIN ALLERGY?
CLARI 250 BD!
H PYLORI
A 10-year-old boy is brought into the Pharmacy by his father. He thinks that his son has hurt his ankle whilst playing rugby yesterday. The boy looks to be in pain although he denies any discomfort. On examination, there seems to be some bruising and mild swelling.
A 10-year-old boy is brought into the Pharmacy by his father. He thinks that his son has hurt his ankle whilst playing rugby yesterday. The boy looks to be in pain although he denies any discomfort. On examination, there seems to be some bruising and mild swelling.
Recommend the application of frozen peas to the ankleno pain management needed
sulphonylureas, G6PD deficiency
ST JOHN WORT+THEOPHYLLINE? POTENTIALLYSMOKING BIG NO NO
A 30-year-old lady comes to your pharmacy and asks to speak to you in private. She says that she haƐ iƚchiŶg ͞dŽǁŶ belŽǁ͟ aŶd ƐaLJƐ ƚhaƚ ƚheƌe iƐ a lŽƚ Žf diƐchaƌge ǁhich iƐ fƌŽƚhLJ͕ ƐŵellLJ aŶd iƐ yellow-green in colour. She has been delaying getting any medical attention as she is very embarrassed
Trichomoniasis Vaginalis
bacterial vag
fishy smelly
BV
The most common symptom of bacterial vaginosis is unusual vaginal discharge that has a strong fishy smell, particularly after sex. You may notice a change to the colour and consistency of your discharge, such as becoming greyish-white and thin and watery.
TRICH VAG
Women with trich may notice: Itching, burning, redness or soreness of the genitals; Discomfort when peeing; and. A clear, white, yellowish, or greenish vaginal discharge (i.e., thin discharge or increased volume) with a fishy smell.
A patient safety incident report which details the dispensing error that resulted in the death of a patient last month
KEEP THE RECORD, LONGER THAN VET!
INFECTED EYES, GLAUCOMA?
REFER, DON’T TREAT SILLY
A lady comes into your pharmacy to buy some Optrex® for her eye. On questioning she tells you that her eyelids are itchy, sore, and always swollen. She is always having to wipe away the crust on her eyelashes and has noticed that they have started to fall out. She has a medical history of glaucoma, arthritis and seborrhoeic dermatitisTreat?
Advise her to wipe lids twice a day with cotton wool dipped in diluted baby shampoo
finasteride, female handling?
Risk to the male foetus
hyoscine butylbromide side-effects?inf
bronchial Ldry mouthurinary retentionconstipationNOT? dilated pupils
77-year-old retired primary school teacher enters your pharmacy requesting treatment for a mouth ulcer that he has now had for 3 weeks. He explains that he bit his tongue a few weeks ago which he thinks may be the cause. On questioning you find out that he is not experiencing any pain from the ulcer, and there is a single ulcer 1 cm in diameter?
SQUAMOUS CELL CARCINOMA
PAINLESS ULCER?
CANCER, REFER!
pioglitazone MOA?
reduces peripheral insulin resistance+reduces glucose in bloodstream
A 14-year schoolboy has just been administered the Men ACWY vaccine. He is experiencing neurally mediated syncope due to a psychogenic response to the needle injection. He has collapsed to the ground.AC
RAISE LEGS
COPDLAMA NOT LICENSE FOR OD DOSING?
Maintenance treatment of chronic obstructive pulmonary diseasefor aclidinium bromideBy inhalation of powderAdult375 micrograms twice daily.
ANTIBIOTICS CAUSING C DIFF?
CEPHALOPSORINSCLINDAMYCINCO-AMOXICLAVQUINOLONESNOT AMINOGLYCOSIDESNOT DOXYCYCLINE
c diff morbidities, risk factors, L
A 75-year old patient comes to the community pharmacy to collect her repeat medication. She started taking prednisolone 40mg OD three days ago, for a period of 10 days. She tells you that she has been feeling very irritable and ‘seeing things’ that are not there. She asks you if her feelings have been brought on by the new tablet
She is experiencing prednisolone side effects so should see her GP as soon as possible
PREDNISOLONE, CORTICOSTEROID BAD REACTION?
Psychiatric reactionsSystemic corticosteroids, particularly in high doses, are linked to psychiatric reactions including euphoria, insomnia, irritability, mood lability, suicidal thoughts, psychotic reactions, and behavioural disturbances. These reactions frequently subside on reducing the dose or discontinuing the corticosteroid but they may also require specific management. Patients should be advised to seek medical advice if psychiatric symptoms (especially depression and suicidal thoughts) occur and they should also be alert to the rare possibility of such reactions during withdrawal of corticosteroid treatment. Systemic corticosteroids should be prescribed with care in those predisposed to psychiatric reactions, including those who have previously suffered corticosteroid–induced psychosis, or who have a personal or family history of psychiatric disorders.STOP, GP GO
sulfasalazine breast feeding?
AVOIDBreast feedingBreast feedingFor sulfasalazineSmall amounts in milk (1 report of bloody diarrhoea); theoretical risk of neonatal haemolysis especially in G6PD-deficient infants.
nicorandil, heart burn?
GP review
NICORANDIL SE
Side-effects, further informationNicorandil can cause serious skin, mucosal, and eye ulceration; including gastrointestinal ulcers, which may progress to perforation, haemorrhage, fistula or abscess. Stop treatment if ulceration occurs and consider an alternative.
most URGENT QUERY DOCTOR/
woman prescribed an increased dose of Zomorph® capsules from 10mg BD (prior to hospital admission) to 100mg BD (post discharge) mad increase
DESMOPRESSIN, TREATS URINARY INCONTINENCE, SO OFCOURSE YOU GNNA PEE A LOT!
CODEINE USELESS IN BONE METASTASES, CANCER
TUMOUR NERVE PAIN FINE OPTIONS?
AMITRIPTYLINEGABAPENTINDEXAMETHASONEIMIPRAMINE
25 with a 12 patchit’s allowed!!
Diamorphine 30mgx Hyoscine hydrobromide 40mg?
iamorphine 30mgx Hyoscine hydrobromide 40mg
A 27-year-old woman presents with nausea and vomiting, diarrhoea, constipation, weight loss, polyuria, sweating, headache, thirst, vertigo, and raised concentrations of calcium and phosphate in plasma and urine. She is thought to have overdosed vitamin?
Calcitriol
A 68-year-old has been diagnosed with mild heart failure which has been exacerbated by an additional treatment resistant chronic condition. You are also given the following information:creatinine clearance is 89 ml/min, blood sugars: 5mmol/ml; alanine transaminase and bilirubin within range
AnaemiaAnemia is a frequent comorbidity of heart failure and is associated with poor outcomes. Anemia in heart failure is considered to develop due to a complex interaction of iron deficiency, kidney disease, and cytokine production, although micronutrient insufficiency and blood loss may contribute.
A 68-year-old lady is collecting her regular repeat prescription for osteoporosis. You ask how she and the family are and she tells you that several members of the family have been suffering with diarrhoea on and off since their recent trip to Pakistan. They have all been given a course of antibiotics to take. She says they will not visit whilst they are unwell
GiardiasisHow do you get giardiasis?You can get giardiasis if you swallow Giardia germs. Giardia spreads easily and can spread from person to person or through contaminated water, food, surfaces, or objects. The most common way people get sick is by swallowing contaminated drinking water or recreational water (for example, lakes, rivers, or pools).
A customer wants advice regarding her son aged 11 who is going on a school trip to London. He has had diarrhoea and she is worried that the other school children or his 2 younger siblings may also get it. His diarrhoea started yesterday; he went to the toilet about 6 times and was sick once but has not been sick since. He has cramping pains but is generally well and anxious not to miss his trip. Yesterday he had pie and chips from the local chip shop whilst his siblings had sausage and chips.
Salmonella
SPUTUMA twenty-nine-year-old lady has an acute infection and exacerbation of bronchiectasis for the last 3 days and has started a course of co-amoxiclav this morning. She is short of breath and bilateral basal crackles are present during auscultation.THEO
Thick bright yellow/green mucus
A 64-year-old woman who is overweight and a smoker has had 2 weeks off work as she has sprained her ankle and her sister has come to stay with her to look after her. She is on the HRT Premarin® and Ibuprofen 400mg three times a day for the sprain. Recently she has been experiencing shortness of breath and chest pain and her usual cough has changed
Rust coloured mucus
A 78-year-old man who has undergone a cardiac bypass operation has developed malignant hyperthermia due to the muscle relaxant used alongside the general anaesthetic
A 78-year-old man who has undergone a cardiac bypass operation has developed malignant hyperthermia due to the muscle relaxant used alongside the general anaesthetic
ANAESTHESIA IN CAESARIAN?
ISOFLURANE
An eighty-year-old retired doctor has been admitted to hospital for a total hip replacement. He requires an opioid in his syringe driver, but his renal function has deteriorated over the last 24 hours.
go for alfentanyl
The doctor who is reviewing an 88-year-Žld͛Ɛ pain management wants to prescribe an opioid with mixed agonist and antagonist activity at opioid receptors as she has chronic respiratory disease.
MEPTAZINOL
A patient has been complaining of pins and needles since starting chemotherapy for pancreatic cancer. He is experiencing peripheral paraesthesia, loss of tendon reflexes, abdominal pain, and constipation.
VINCRISTINE
On examination by the oncologist, a lady is found to have cƌeƉiƚaƚiŽŶ͛Ɛ at both lung bases. The medical team think that her symptoms may be associated with her current chemotherapy, which is associated with dose-related progressive pulmonary fibrosis.
BLEOMYCIN
A twenty-three-year-old collapsed in your pharmacy and has been having a seizure for the last 6 minutes with no sign of improvement. She is epileptic and has had a convulsive seizure 3 weeks ago after deterioration of her condition. The ambulance is on its way.
Diazepam rectal solution(OR buccal midazolam)THINK ,DO NOT RUSH
A male type 2 diabetic patient has been admitted to hospital with acute exacerbation of asthma due to a chest infection. He also has mild heart failure for which he takes an angiotensin 2 inhibitor, beta blocker and loop diuretic. His blood sugars are measured at 24mmol/L. He is commenced on a variable rate insulin infusion. What is the MOST likely effect of his condition and subsequent treatment on his electrolytes?
Hypokalaemia
Prochlorperazine in PD?
Absolute L, avoid
Patient with cold, run down, itchy, painful, burning?
The symptoms suggest shingles rash caused by varicella zoster. There is usually aprodromal phase with abnormal skin sensations and pain in the affected dermatome(area of skin served by an individual nerve). Within 2–3 days, a rash typically appearsin a dermatomal distribution. It starts as maculopapular lesions then develops intoclusters of vesicles, with new vesicles continuing to form over 3–5 days. The rash isusually painful, itchy, and/or tingly, and, unlike other rashes, does not cross the midlineof the body
SHINGLES TIP?
NEVER CROSSES MIDLINE OF BODY
Patient is experiencing post-herpetic neuralgia, best option?
Amitriptyline ON
TCA what level to look at, experienced fall?
sodium levels!
heart failure/cardiac function test?
PEPTIDE TING
hba1c test?
diabetes
thyroid test?
hyper/hypothyroidism
CT pulmonary test?
PE
b12 fatigue test
MENINGOCOCCAL DISEASE/MENINGITIS?
BENZYLPENICILLIN—> CEFOTAXIME—-> CHLORAMPHENICOLdon’t forget penicillin allergy, cross-sen
Tigecycline AGE?
Tigecycline (tetracycline antibiotic) is contraindicated in children under the age of 12years old due to the risk of deposition in growing bones and teeth
oRAL Teicoplanin?
should not be given by mouth for systemic infections because it is notabsorbed significantly. It is also not indicated to treat meningitis
ADULT ASTHMAICS+SABA, LNEXT STEP?
Replace Qvar inhaler with Fostair (beclomethasone/formoterol)
LEGAL REQUIREMENT FOR CD RECORDING?
It is a legal requirement to keep CD registers (paper and electronic) for two years fromthe date of the last entry.The other options are not legal requirements. It is not necessary to have both writtenand electronic CD registers. Registers in general shouldn’t be amendable at a laterdate, however there may be some instances where an error has been made with anentry therefore an amendment will be required. For most organisations stock checksshould be at least once a week but may be more or less frequent based on risk.Keeping a running balance in a CD register is good practice requirement not yetmandatory
Chloramphenicol storage?L
Chloramphenical information leaflet states that the medicine needs to be stored uprightbetween 2-8oC in a refrigerator and protected from light and must be used within fourweeks of opening.
RARE SIDE-EFFECT OF CISPLATIN?
CONVULSION
AUDIT SUMMARY?
Data collection is a key step in an audit cycle. Collecting and analysing data on theadministration of medicines will provide evidence of whether standards are being metand enable you to achieve your aim.Ethics approval is not usually required for audits, however if your evaluation includespatients, you may require approval. If in doubt check with the National Institute forHealth and Care Research (NIHR) Also looking for errors is not usually part ofaudit/improvement process.It is good practice to re-audit after a certain period, however doing this after one monthwould be too soon and is unlikely to provide new or useful results. It is unusual toupdate guidelines and protocols before an audit takes place. This may be arecommendation you action after the audit.
A 40-year-old woman visits your community pharmacy and asks to purchase travelsickness tablets, as she is going on a long-haul flight next week. The counterassistant tells you that she has hypertension, type 2 diabetes and occasional backpain, which are all adequately managed by her regular medication. Which of the following options are you most likely to take next?
SELL APCK OF 12 HYOSCINE HYDRO, 300MCG TABSThe patient’s medical conditions do not interfere or relate to travel sickness and thuscan be supported without referral. Hyoscine HYDRObromide is used for travel sicknessand available to purchase without a prescription and is the most appropriate option.Cinnarizine 15 mg tablets are also suitable and indicated for travel sickness, howeverthis pack size is not reality available as a P medicine (usually sold as Stugeron 15, packsize 15), and selling a pack of 100 is excessive. You may have also chosen to sellhyoscine butylbromide 10 mg tablets, however hyoscine butylbromide is licensed totreat abdominal cramps/spasms and IBS like symptoms. Encouraging fluidconsumption is unlikely to prevent travel sickness, thus is not a suitable cause of actionfor the patient.
amiodarone does not need?
full blood count!
what drugs are used in urgency urinary incontinence?
oxybutynin, tolterodinemirabegronduloxetine, stress
DRUG WITH LEAST ANTICHOLINERGIC SIDE-EFFECTS?
MIRABEGRON
Gout, acute, can’t tolerate nsaids or colchicine?
A short course of oral corticosteroid or a single injection of intramuscular corticosteroid are effective alternatives in those who cannot tolerate NSAIDs or colchicine
Quinolones, cipro+ibuprofen?
tendons, it’s peak
patient with swelling, elderly, no ccb, next up?
indapamide 2.5 mg dailyoedema ramipril L
A 72-year-old woman presents to A&E with a tingling sensation in the hands and feet which gradually progresses to pain. Onexamination, the palms and soles are noted to be swollen and tender on palpation. The patient has recently completed her first cycleof chemotherapy 3 days ago for breast cancer.Which chemotherapy agent is most likely to be causing the patients symptoms?
fluorouracil?
statins remember, check hba1c prior if diab
ramipril no effect on sugar levels, least likely, just potassium
inappropriate way to manage statin intolerance?
discontinuing it, silly
Mrs M, a 32-year-old woman who had her first child last year, decides she would like to lose weight in a healthy way. She has not beenlooking after herself and has stopped exercising and is constantly snacking. She is hoping to get back to her pre-maternity weight andhas today signed up to her local gym and a local weight loss support programme.Which of the following stages of behavioural change is Mrs M at?
Preparation
How long after stopping fluoxetine must the patient wait before starting phenelzine?
5 weeks g
A pharmacist is checking a prescription for carbamazepine tablets for an 80-year-old patient with trigeminal neuralgia. The patient hasbeen taking carbamazepine for 6 months and had their dose slowly raised so that they are no longer suffering any pain.An extract from the SmPC for carbamazepine 100 mg tablets is shown below.Which of the following dosages and monitoring would be most appropriate for this patient?https://www.medicines.org.uk/emc/product/1040/smpc#gref
carbamazepine 200 mg TDS, no levels/monitoring required
APPROPRIATE empirical treatment of an infective exacerbation of COPD?
AMOXICILLIN/DOXYCYCLINECLARITHROMYCINCO-AMOXICLAVCO-TRIMOXAZOLELEVOFLOXACINTHAT ORDER
A man is on the medical ward being treated for COVID-19. The guideline recommends dexamethasone 4 mg OD for a total of 10 days.Information on the equivalent anti-inflammatory doses of corticosteroids is shown below.prednisolone 5mg- dexamethason 750mcgequivalent 10 day dose?
267 mg
A 12-year-old child requires amoxicillin 500 mg TDS for 10 days, for a lower respiratory tract infection. She has no known drug allergiesand takes no regular medication.Which of the following quantities of amoxicillin 250 mg/5 mL suspension is the most suitable to supply for her to complete thecourse?
3 bottles, 100ml/ bottle?
A patient with known epilepsy is at home and having her third seizure within one hour. The family have removed their glasses andmoved harmful objects out of reach.Having made sure the patient is safe from injury, which of the following would be the most appropriate treatment for theseizure?
midazolam given buccally
what does neonate mean?
birth to 28 days
An acutely ill 80-year-old man has been admitted to your medical ward. You are reviewing his medications and decide he requirespharmacological venous thromboembolism (VTE) prophylaxis.Which of the following medications would be most appropriate for VTE thromboprophylaxis in this patient?
ENOXAPARIN IS STANDARD, YOU SEE ON CHARTS ALL THE TIME!
Zomorph 200 mg BD
reason for proton pump inhibitor is often prescribed for patients peri-operatively?
to reduce the risk of regurgitation and aspiration of gastric contents
NHS fruit n veg advice?
30g (1 heaped tablespoon) of dried fruit such as raisins and apricots also count as one portiona portion of fruit of vegetables is 80g or a slice of a large fruit such as a melon or a bowl of mixed saladover a third of the diet should come from fruit and vegetablesthree tablespoons of cooked vegetables would count as one portion
LFTs, we don’t care in lithium!! onyly…
BMI RENAL ELECTROLYTES THYROID
WHEN WOULD YOU REPORT ON YELLOW CARD SCHEME?
amoxicillin- diarrhoeast john’s wort- jaundiceviagra- fakeamitriptyline, hospital- dizzinesNOT? codeine constipation
Which of the following drugs should not be used in combination with methotrexate due to the increased risk ofagranulocytosis?
Olanzapine, antipsychotic, erghhh
CHC missed pill?
> /= 24hrs L
vet cd SUPPLY?
28 days is good practice, weird don’t ask
You receive a phone call from a worried mother, who tells you that her son, aged 7, looks unwell and appears confused. You ask furtherquestions and establish that the child is breathing rapidly and hasnʼt passed urine for the last 36 hours.
sepsis call 999 peak
A man has come into the pharmacy to buy Allevia (fexofenadine) 120 mg tablets. He has used them before for himself and would like totake a pack on holiday for his family.Which of the following statements regarding the use of Allevia 120 mg tablets is correct?
12+Apple juice and orange juice decrease the exposure to fexofenadine.120mg in adults and children!
A woman has come into the pharmacy to purchase Hana (desogestrel) 75 microgram tablets over-the-counter. Before making thesupply, you decide to refresh your knowledge on the use of Hana to ensure you have all the required information. The woman hasnever used them before and is buying them for the first time.Which of the following statements regarding the use of Hana is the most appropriate advice to give?
the woman should start taking Hana on day 1 of her period. She can start on days 2-5 but will need to use an additional barrier method(e.g. condom) for the first 7 days
This medicine should be prescribed with caution in patients with lactose intolerance as it may cause diarrhoea.
LACTOSE INTOLERANCE!
The method of emergency contraception that is suitable for a 15-year-old child who had unprotected sexual intercourse 2days ago with a boy of a similar age. No safeguarding concerns were identified, and the patient prefers not to have an invasiveprocedure.
ulipristal acetate 30 mg tablets5mg is fibroids smh!!!
A parent presents to the pharmacy with their 5-year-old child who is complaining of dry, itchy, cracked skin on the backs oftheir knees and on their hands which they have had for two weeks now. The child has asthma and the only medication theytake is a Clenil Modulite 50 microgram per actuation inhaler and Ventolin 100 microgram Evohaler. They have no known drugallergies and have not tried anything.
EMOLLIENT FIRST CMON! UNDER 10 AS WELL LOL
ALWAYS ELIMINATE, GIVE REASONS AND RATIONALISE!GO WITH GUT BUT SLOW
A concerned parent presents to the pharmacy with their 4-year-old child as they are concerned about a red blanching rashthat has recently developed on the childʼs chest and tummy. They explain that initially, a couple of days ago, they had a hightemperature (39 degrees centigrade) and a sore throat. A white coating has started to develop on the childʼs tongue thismorning which the parent describes as “looking like a strawberry”. The rash has now spread to the rest of the body and has arough texture. They are not on any medication, have no known allergies and have not tried anything.
SCARLETT FEVER?GP :
You dispense a prescription for an antibiotic. Upon handing out the antibiotic, you counsel the patient on the warning labelthat states “Do not take milk, indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take thismedicine”
cipro!
A 23-year-old patient presents to your minor ailment clinic in a GP practice with an insect bite. They think they were bitten lastnight but they are not sure what insect has bitten them, and there is no recent travel abroad. You look at the bite, and there isno visible infection. It is not visibly a tick bite. The patient does not have any other allergies, and takes only the combinedcontraceptive pill. Information on antimicrobial prescribing in insect bites and stings is shown below.
no antibiotic treatment required
A 28-year-old woman who has been taking quetiapine for the last two years has been given a course of clarithromycin to treatacute otitis media.
QT interval prolongation
Hydroxylated derivatives are required for patients with severe renal impairment?
vitamin D!
Vitamin D requires hydroxylation by the kidney to its active form, therefore the hydroxylated derivatives alfacalcidol or calcitriol should be prescribed if patients with severe renal impairment require vitamin D therapy. Calcitriol is also licensed for the management of postmenopausal osteoporosis.Vitamin D requires hydroxylation by the kidney to its active form, therefore the hydroxylated derivatives alfacalcidol or calcitriol should be prescribed if patients with severe renal impairment require vitamin D therapy. Calcitriol is also licensed for the management of postmenopausal osteoporosis.
Vitamin D requires hydroxylation by the kidney to its active form, therefore the hydroxylated derivatives alfacalcidol or calcitriol should be prescribed if patients with severe renal impairment require vitamin D
INR, 9.4, MINOR BLEEDING, BEST ACTION?
stop warfarin, iv phytomenadioneIN A MAJOR BLEED- IV PHYTOMENADIONE+DRIED PROTHROMBIN
Alendronci acid, ear pain?
osteneocrosis, GP referral, not A&E, not life-threatening
DRUGS AND SAFE CUSTODY? TALK TO ME
ALL SCHEDULE 1+2, buprenorphine, temazepam and sativexEXCEPTIONS:PregabalinGabapentin
ACS, STEMI, WHAT’S DISCONTINUED?
CLOPI, ONLY 12 MONTHA
1st line, diabetes, afro-caribbean?
ARB, LOSARTAN!
haloperidol, levomepromazine, what drug next?
aripiprazole, second gen, first gens were an L, give clozapine if aripiprazole is an L
theophylline measuring levels?
10-20mg/L4-6hrs after a dose5 days after starting3 days after changing dose
we do not sell amorolfine in pregnant/breastfeeding!
WHAT DRUGS TO DENATURE?
2/3/4 part, 5 NO
first line constipation in children, no faecal impaction?L?Still hard stools?
first line constipation in children, no faecal impaction? diet+macrogolL? stimulantStill hard stools? lactulose/docusate
ANAPHYLAXIS DOSE+FREQUENCY?-6MONTHS?-5YEARS?-11YEARS?12+?
-6MONTHS? 100-150MCG-5YEARS? 150MCG-11YEARS? 300MCG12+? 500MCG (300mcg if small/prepubertal)/5 MINS
CHILD, DIARRHOEA, PAST 2 DAYS, NO FLUIDS, BEST ACTION?
HOSPITAL, HYDRATVE, IV FLUIDS
ATORVASTATIN ALT MONITORING?
/3 MONTHS/12 MONTHS
HRT BEFORE SURGERY?
STOP 4-6 WEEKS BEFORE
GESTATIONAL DIABETESFasting BG<7mmol/L?
- Diet+Exercise. L?2. Metformin (unlicensed). L?3. InsulinIF REQUIREMENTS NOT MET IN 1-2 WEEKS!
GESTATIONAL DIABETESFasting BG>7mmol/L?
diet, exercise, insulin and MAYBE metforminno longer glinbeclamide!
ANTIBITOCIS WITH FOOD?
METRNOIDAZOLENITROFURANTOINCLARITHROMYCIN MRPIVMECILLINAM
Test for DVT?
D-dimer
preferred dvt home, pregnancy?
LMWH!
DONEPEZIL SIDE-EFFECTS? ACH/DEMENTIA DRUGS? THINK DUMBBELLS!
DUMB BELSDiarrhoeaUrinary IncontinenceMuscle WeaknessBradycardiaBronchospasmsEmesisLacrimationSalivation
ACID REFLUX SYMPTOSM/GORD REFERRAL?
GI BLEED55+UNEXPLAINED WEIGHT LOSSDYSPHAGIA
ORLISTAT, FAT SOLUBLE VITAMINS DEPRIVED?
ADEK
1st gen antihistamines?
APC^2alimemazinepromethazinechlorphenaminecyclizine
WHAT TYPE OF PILL IS NOREHISTERONE?WHEN IS ADDITIONAL PRECAUTIONS NEEDED?
WHAT TYPE OF PILL IS NOREHISTERONE? Progestogen-only, take everyday, no pill-free periodWHEN IS ADDITIONAL PRECAUTIONS NEEDED?Take in first 5 days of cycle, nothing else neededAfter 5 days? 2 days precaution
h pyloritests?ppi?abx?
tests? urea 13c, SATppi? 2 weeksabx? 4 weeks
MINERALCORTICOSTEROID S-E?
high fluid retention, low anti-inflammatory effectoedemahypertensionhypokalaemiahypocalcaemia
rifampicin?
colour urine, stains lenseshepatotoxic- fatigue, yellowing of skin
ABSENCE SEIZURES, STEPS?
ETHOSUXIMIDE (only if absence)SODIUM VALPROATE (only high risk of generalsied tonic-clonic/other seizures)LAMOTRIGINE when above 2 an L
DOSE CHANGE IN EPILEPTIC, DRIVING?
6 MONTHS BAN :(
Patient,headache, blurred vision, BP 184/127?
A&E, BP>180/120 EEK
MHRA DRUGS TO REPORT?
BLACK TRIANGLESERIOUS SIDE-EFFECTSDEVICESE-CIGSVACCINESHERBALS
MEDS WITH RISK OF FALLS?
BenzodiazepinesDiureticsOpioidsPhenothiazinesZ-drugs, etcNOT nsaids, NOT CODEINE LOL
PPI, gord, fatigue, muscle spasm, electrolyte L?
HYPOMAGNESAEMIA
CD REGISTER, EXPIRED STOCKNOT DENATURED?DENATURED/PATIENT RETURNED?
CD REGISTER, EXPIRED STOCKNOT DENATURED? 2 YEARSDENATURED/PATIENT RETURNED? 7 YEARS
REPEATS OF VET PRESCRIPTIONS MUST BE DISPENSED WITHIN?
6 MONTHS OF PRESCRIPTION DATE
EDOXABAN+PREDNISOLONE INTERACTION?
risk of bleed :/any DOAC imma just hit bleed i thinkQT prolongation does not exist, silly
ondansetron+quetiapine?
increased QT prolongation
DRUGS THAT CAUSE QT PROLONGATION?
ANTIARRHYTHMICSMACROLIDESQUETIAPINEHALOPERIDOLSSRIsTCAsDOMPERIDONEHALOPERIDOLANTIFUNGALS
GLYCOPEPTIDES+INFUSION?
ANAPHYLACTIC RISK, AVOID RAPID INFUSION, MONITOR ISTE, ETC
METHOTREXATE GI SIDE-EFFECTS SO../
DIARRHOEA/STOMATITIS TELL-TALE SIGNS
METHOTREXATE BIG BOY SIDE-EFFECTS?
BPLGBLOOD DISORDERS- sore throat/bruising/mouth ulcersLIVER - nausea/vomiting/abdominal discomfort/jaundice/dark urine/itchy skinPULMONARY - SOB/coughingG-I - stomatitis/diarrhoea
ANTIDOTESNALOXONE?PROCYCLIDINE?FLUMAZENIL?DESFERRIOXAMINE?ACETYLCYSTEINE?PHYTOMENADIONE?PROTAMINE?ANDEXANET ALFA?IDARUCIZUMAB?ACTIVATED CHARCOAL?
NALOXONE? OpioidsPROCYCLIDINE? Phenothiazine- prochlorperazineFLUMAZENIL? Benzodiazepines, unless within an hour- activated charcoalDESFERRIOXAMINE? IroACETYLCYSTEINE? ParacetamolPHYTOMENADIONE? WarfarinPROTAMINE? Enoxaparin/heparinANDEXANET ALFA? ApixabanIDARUCIZUMAB? DabigatranACTIVATED CHARCOAL? Aspirin/TCAs/SSRIs/second-gen antipsychotics/benzos/b-blockers/CCB/theophylline
preferred sulphonylurea in elderly?
gliclazide, SHORT-ACTING
Name three bile acid sequestrats and when other meds can be taken in relation to them
Colesvelam - 4h before or after
Colestipol & cholestyramine - 1 hour before or 4-6 hours after
Which schedules of CDs can be dispensed from an EEA Rx?
Schedule 4
Minimum age for OTC amorolfine
18
Chloramphenicol minimum age for OTC use
2 years
Hydrocortisone cream minimum age for OTC
10 years
Levonorgestrel minimum age for OTC sale
16
Naproxen minimum age for OTC sale
16 years
What to avoid up to a month after PO isotretinoin
Blood donation
S/e of isotretinoin (5)
Psychiatric effects Visual disturbance Peeling of skin Haemorrhagic diarrhoea Pancreatitis of triglycerides are over 9mmol/l
Pregnancy PRESCRIPTION rules for isotretinoin
Prescription limited to 30 days supply, to be dispensed within 7 days of date started
Pregnancy TESTING rules for isotretinoin
Exclude preg 3 days before treatment, every month during treatment and 5 weeks after stopping
pregnancy SAFE SEX rules for isotretinoin
At least one mode of contraception - better if 2.
oral POP is not considered effective
Barrier methods alone are not enough
How long before and after treatment with isotretinoin should preg be avoided
1 month before and after
What should not be done for 6 months after isotretinoin
PO
Waxing and dermabrasion
Counselling for isotretinoin apart from pregnancy
- avoid exposure to UV
- symptoms of anxiety and depression
Minimum age for daktarin oral gel OTC
3 months
Minimum age for piriton syrup OTC
12 months
Germoloid HC spray minimum age
16 years
Becomsase hayfever relief nasal spray licenced from what age OTC
18 years
Regaine for men extra strength is licensed for what age OTC
Up to 65 years
OTC licensed dose of esomeprazole
20 mg OD - nexium control- for short term reflux symptoms
Total gastetoctomy requires what vitamin supplementation
Vit b12 (hydroxycobalamin)
Four vaccines that should not be received by patients with HIV
BCG
Influenza nasal spray (unless stable infection and receiving antiretroviral therapies)
Typhoid
Yellow fever
Fluenz tetra or fularix tetra is a live vaccine? Administered how?
Fluenz tetra is intranasal live attenuate flue vaccine
Fluenz tetra or fluarix is contraindicated in on who come into close proximity with HIV
Fluenz tetra
Name an every day Monophysic COC
Femodene ED
Microgynon 30 ED
Zoley
What type of prep is qlaira
Phasic ever day COC
Substance misuse treatment that should be stopped after 7 weeks of abstinence is not achieved
Bupropion
Substance misuse treatment that can’t be used with alcohol containing mouthwash
Disulfuram
Misuse treatment that might be appropriate for a high risk drinker who does not experience withdrawal symptoms
Nalmefene
Licenced for opioid withdrawal symptoms
Lofexidine
What substance misuse type treatment should be discontinued with new onset depression or suicidal thoughts
Varenicline
OTC directions and dose for naproxen
Ages you can use this for
2x250mg tabs initially plus another 250mg tab if pain persists 6-8 hours later
Max 3x250mg in a day
Women 15-50years
OTC directions and doe for ibuprofen
400mg TDS
Max 1200mg in a day
OTC ranitidine directions
What is the minimum age
75mg prn, if symptoms persist take another 75mg
Max 150mg in 24 hours
Drugs that prolong the QT interval 8
Antidepressants - TCAs, citalopram/ecitalopram Antiarrhythmics - amiodarone, sotalol Domperidone antiphycotics Macorlides Quinilones antimalarials Methadone
INJECTION TECHNIQUE?
IM 90 DEGREES, COOL
TESOTGEL HORMONE SCHEDULE?
4, PART 2
lucozade orginal 110-220ml?
hypogylcaemia
A 22-year-old female has come to the pharmacy asking for your advice regarding her painful
periods that has started a few months ago. Upon questioning the patient, you find out that
she is suffering from lower abdominal pain and backache, which starts several days before
her period begins. She tells you that her menstrual cycle used to be very regular but now
tends to vary and some occasions she has 2-3 weeks between her periods. She also
mentions that her pain continues throughout menstruation and it is quite severe in nature.
She has tried ibuprofen and has had no effect on her pain symptoms. Which of the following
conditions best describes the patient’s symptoms
SEONDARY DYSMONERRHOEA
private scripts only, not vet?
The first dispensing must be made within six months of the appropriate date, following
which there is no legal limit for the remaining repeats.
sumatriptan gap?
2hrs
test for heart failure?
-terminal pro-B-type natriuretic peptide
over 70 HF start?
Ramipril 1.25 mg OD & Nebivolol 1.25 mg OD
eye L in tuberculosis, what drug?
ethambutol
NOT legal on label?
‘sight and reach’ OF CHILDREN
medical waste?
nacl nebules
red urine?
doxorubicin
rifamp- reddish orange
danthron
Dulcolax?
OSMOTIC
) Mrs Barbara Reid is one of your regular patients who passed away two weeks ago, and her
daughter returned six morphine 30mg ampoules and a sealed 500 mL bottle of Oramorph 10
mg/5mL. Which one of the following statements is legally correct?
Record the return of morphine amps in sperate register and store in the CD cabinet
away from existing stock until a member of staff can witness their destruction. Place
the bottle of Oramorph solution into the pharmaceutical waste.
oramorph schedul 5, no-one cares, no need for dentauring
A
Amoxicillin child dose?
250mg TDS
procyclidine?
YOU DON’T GET BRADY
A 45-year-old man has attended the emergency department at the hospital with shortness
of breath and tachycardia. He has recently been on a business travel from America and
landed in the country yesterday. After examination and laboratory testing the junior doctor
confirms that the man has pulmonary embolism and will need to commence on
anticoagulants as soon as possible but is unsure which anticoagulant should be used. Which
of the following anti-coagulant regimen should be used in the initial management of a
suspected pulmonary embolism?
ENOXAPARIN 1.5MG/KG 24 hrs, low risk preferred L:/
SULFSALAZINE FERTILITY L
. Which of the following is the
recommend dose for starting a patient for the treatment of vitamin d deficiency?
800 units colecalciferol
leflunomide contraception?
during+2 years after
STAPHYLO INFECTION?
GIVE FLUCLO
fusidic acid osteomyelitis? okay
Take this medicine when your stomach is empty. This means an hour before food or 2 hours
after food?– Do not take indigestion remedies, or medicines containing iron or zinc, 2 hours before or after
you take this medicine
propantheline bromide
levofloxacin instruction?
– Do not take indigestion remedies, or medicines containing iron or zinc, 2 hours before or after
you take this medicine
tamsulosin instruction?
Warning: This medicine may make you sleepy. If this happens, do not drive or use tools or
machines
MYOCLONIC?
TOPRAIMATE, don’t give valp without PPP
A 55-year-old male has come to the pharmacy complaining of a troublesome cough that has
occurred over the past week. The patient also mentioned that this morning his temperature was
38.9°C and feels her mouth is sore. The patient mentions that this occurred after being started on
a new medication.
METHOTREXATE
anti-depressant, appetite increased?
mirtazapine
A 35-year-old male has been recently diagnosed with severe depression accompanied by
post-traumatic stress disorder as a veteran in the army. The patient has tried multiple antidepressant medication, but all his therapies have failed to help with his sleep. He requires an antidepressant that will help manage his depression and help with his sleep.
trazodone :/
A 31-year-old female has been recently prescribed an antidepressant. She has come to your
pharmacy complaining of troublesome side effects. The patient mentions that after being started
on this new antidepressant they have notice their mouth is always dry, feeling cold all the time
and tends to overreact with sudden arm movements.
DOSULEPIN, TCA, ETC
duloxetine class?
SNRI
COLD FT ARE THE OFFENSIVE DRUGS!
“MEDICAL DEFENCE”?
E Ms P taking prescribed morphine, whereby the drug level is higher than specified limits and driving is not
impaired.
rash cause?
co-amoxiclav
fexofenadine pom to gsl!
you don’t need quantity on label!
Owingds?
from date of prescription
AMISULPRIDE, NMS, TACHYCARDIA, TREMO ETC
Lithium level?
12 hours psot dose
SEBORRHOEIC dermatitis, scalp, OTc, shampoo, oil, etc
QUETIAPINE?
WEIGHT GAIN STILL OK, COWQ
EYE REFER?
Red flags which indicate the need for urgent ophthalmological assessment such as:
- Soft contact lens use with corneal symptoms (such as photophobia and watering).
- Reduced visual acuity.
- Marked eye pain, headache or photophobia - always consider serious systemic conditions such as meningitis in a person presenting with photophobia.
- Red sticky eye in a neonate (within 30 days of birth).
- History of trauma (mechanical, chemical or ultraviolet) or possible foreign body.
- Copious rapidly progressive discharge - may indicate gonococcal infection.
- Infection with a herpes virus.
ST JOHN+VENLA?
SERONONT…
CONTRAINDICATION IS WORSE THAN CAUTION, BE CAREFUL!
DOUBLE CHECK ANSER
VELAN, MIRTAZ SWITCH?
A. Gradually reduce the dose of the venlafaxine, while starting mirtazapine at a low dose and then gradually increase this dose as the venlafaxine is withdrawn
sertraline, diarrhoea, advice?
side-effects, yes, continue
DIARRHOEA SERTRALINE? NOT DOSE-RELATED
55+, oedema L, hypertension, give?
thiazide-like, indapamide
LONG-TERM LOOP SIDE-EFFECT?
hyperuricaemia n the rest
hyponataraemia/magnesamiea/kalaemia
DIGOXIN TOICITY RISK?
hypomagnesamia
rales- lung clicking?
heart failrue
COPD, not improved after 3months?
step down from triple!
Symptoms of cauda equina syndrome
- Severe low back pain.
- Motor weakness, sensory loss, or pain in one or commonly both legs.
- Saddle anaesthesia (unable to feel anything in the body areas that sit on a saddle)
- Bladder dysfunction (such as urinary retention or incontinence)
- Bowel incontinence.
SILDENAFIL INCORRECT STATEMENT?
E when taken with food the onset of activity may be delayed compared to a fasted state
so it doesn’t delay hm
Which of the following statements regarding gout and the use of colchicine is INCORRECT?
A. Certain drugs can increase the risk of developing gout by raising plasma urate levels, such as ACE inhibitors, beta-blockers and diuretics.
B. Colchicine should be avoided in people with an eGFR less than 10, women who are pregnant or breastfeeding, or those with severe hepatic impairment.
c. Mr R should have 500 micrograms of colchicine, two to four times a day, until pain relief is achieved, or diarrhoea or vomiting occurs.
D. Mr R should be advised to not exceed a total dose of 6 mg of colchicine and to not repeat treatment within three days.
E. Purine-rich foods, such as green leafy vegetables, increase the risk of gout, as higher purine intake is associated with uric acid levels above 150 micromol/L.
Answer: E (Purine-rich foods, particularly red meat and seafood, increase the risk of gout as higher purine intake is associated with higher uric acid levels. For maintenance treatment, the aim is for serum uric acid levels below 300 micromol/L.)
PIOGLITAZONE CMMON SE?
FRACTURES!!!!!
AVOID TRIMETHOPRIM IN FIRST TRIMESTER!
- A GS-year-old patient has been reviewed by a GP following a fracture of the radius bone. The risk of osteoporotic fracture depends on the person’s risk of falls, their bone strength (determined by bone mineral density [BM DJ), and other risk factors.
Which of the following factors reduces bone strength WITHOUT reducing BMD?
A chronic kidney disease
B Crohn’s disease
C diabetes mellitus
D immobility
E smoking
Answer: E ( Smoking)
Factors that do NOT reduce BMD include:
- Age - risk increases with age and is at least partly independent of BMD.
- Oral corticosteroids (dependent on the dose and duration of treatment).
- Smoking.
- Alcohol (3 or more units daily).
- Previous fragility fracture (risk increases with increasing number of fractures). Risk is highest for previous hip fractures and lowest for previous vertebral fractures.
- Rheumatological conditions such as rheumatoid arthritis, and other inflammatory arthropathies.
- Parental history of hip fracture.
Following a bone scan, the patient has been identified to be osteopenic, with a T-score of -2.5. The GP has prescribed risedronate 35mg tablets as new a medication.
Which of the following counselling points would be the most appropriate to mention concerning the new medication?
A if a dose is missed, take on the day that the tablet is remembered and then return to the original schedule
B remain upright for 30 minutes before taking the tablet
C swallow the tablet whilst standing or lying down
D take the tablet at the same time every day
E take the tablet with breakfast to reduce the risk of gastrointestinal irritation
Answer: A ( if a dose is missed, take on the day that the tablet is remembered and then return to the original schedule)
- Need to take tablet sitting or standing as the medication can cause oesophageal reactions.
- Patient should stand or sit upright for at least 30 minutes after administration.
- Tablet should be swallowed whole not crushed or dissolved with plenty of water.
- Tablet needs to be taken on an empty stomach 30 minutes before breakfast or another oral medicine.
- Two tablets should NOT be taken on the same day. Patients should return to taking one tablet once a week, as originally scheduled on their chosen day.
- Risedronate should be taken before breakfast; however, if this is not practical, it can be taken between meals or in the evening at the same time each day
ALENDRO/RISED, HEART BURN?
OESOPHAGITIS, GP ASAP!!
- Baby D, aged 13 months and weighing 13 kg, has reflux oesophagitis. She has been prescribed ranitidine liquid 75 mg/5 ml at a dose of 4 mg/kg twice daily for 14 days.
What volume of ranitidine liquid, in ml, will Baby D receive per day?
6.9ml
Dose= 4 mg/kg BD = 4 mg x 13 kg= 52 mg BD = 104 mg/day
The product contains ranitidine 75 mg/5 ml, which is the same as 15 mg/ml
Therefore, if there is 75 mg in 5 ml, there will be 104 mg in just under 7 ml, as there is 15 mg/1 ml (i.e.7 ml would therefore contain 105 mg)
Without a calculator, we can see that the answer must be 6.9 ml.
- A 48-year-old female and has been experiencing menopausal symptoms and would like to trial hormone replacement therapy (HRT). Her medical record shows a previous hysterectomy. After assessing the patient’s family history and physiological health parameters, the patient satisfies the criteria for HRT.
Which of the following would be the most appropriate choice of HRT for this patient?
A Desomono 75microgram tablets (Desogestrel 75 microgram)
B Estraderm MX 25 patches (Estradiol 25 microgram per 24 hour)
C Evorel Conti patches (Estradiol 50 microgram & Norethisterone 170 microgram per 24 hour)
D FemSeven Sequi (Estradiol 50 microgram& Levonorgestrel 7 microgram per 24 hour)
E Femoston-conti 0.5mg/2.5mg tablets (Dydrogesterone 2.5 mg & Estradiol 500 microgram)
B (Estraderm MX 25 patches)
An oestrogen alone is suitable for continuous use in women without a uterus.
- Women with a uterus should use a HRT with small doses of an oestrogen together with a progestogen (endometrial cancer is reduced by a progestogen)
- Options C, D and E contain a progesterone.
- Desogestrel (alone) is progesterone indicated for contraception.
testogel pump vs pump, be carefulgive
alfacalcidol
or
calcitrol
VITAMIN D DEFIENCYE, KIDNEYS?
ALFACALCIDOL
CALCITROL
- A parent has come into the pharmacy to buy a cough syrup for their 4-year-old daughter.
Which of the following ingredients found in over-the-counter cough preparations would be most appropriate to recommend?
A. citric acid monohydrate B. dextromethorphan C. guaifenesin D. pholcodine linctus E. pseudoephedrine
A (Paediatric simple linctus, containing citric acid monohydrate.)
- A mother contacts the community pharmacy by telephone to seek further advice regarding an antibiotic prescription that had been supplied for her 3-year-old daughter. Her daughter has been diagnosed with scarlet fever and is required to commence flucloxacillin 125 mg/5 ml oral suspension, at a dose of 5 ml QDS for 10 days.
Which of the following statements regarding flucloxacillin is INCORRECT?
A. cholestatic jaundice may occur very rarely, up to 6 months after treatment with flucloxacillin has been stopped.
B. flucloxacillin can cause gastro-intestinal disturbances, which are common side effects.
C. flucloxacillin should be used with caution in patients with hepatic impairment.
D. flucloxacillin should be taken on an empty stomach, which means one hour before food or two hours after food.
E. if the patient vomits within 30 minutes of taking a dose of flucloxacillin, they should receive the same dose again.
A (Cholestatic jaundice may occur very rarely, up to 2 months after treatment with flucloxacillin has been stopped. There is an important safety information warning under the fluelox monograph which trainees should be familiar with.)
- A 82 year old man who presents to hospital with jaundice. His liver function tests show raised bilirubin and alkaline phosphatase.
CO AMOXICLAV
- A 68 year old woman with newly diagnosed pulmonary fibrosis
A 54-year-old woman who has recently completed a 7-day course of ciprofloxacin develops diarrhoea. Clostridium difficile infection is confirmed and oral metronidazole is commenced. She also takes the following medication:
• Allopurinol
• Atorvastatin
• Lansoprazole
• Ramipril
• Sertraline
In light of her recent diagnosis which of her current medication would you recommend be stopped if possible?
PPI C DIFF!
A 54-year-old woman whose has a BMI of 34 kg/m2 has asked you for some diet advice as she wishes to lose weight. You explain that she should eat at least 5 portions of fruit and veg each day. She asks for examples of what a portion of fruit and vegetables consists of.
What would be the most appropriate answer?
1 PEAR
www.nhs.ukLinks to an external site. - A portion is:
• 80 g of fresh, canned or frozen fruit and vegetables
• 30 g of dried fruit
• 150 mL glass of fruit juice
Just 1 apple, banana, pear or similar sized fruit is 1 portion
A slice of pineapple or melon is also 1 portion, and 3 heaped tablespoons of vegetables is another portion
Adding a tablespoon of dried fruit, such as raisins, to your morning cereal is an easy way to get 1 portion
A 46-year-old woman, who weighs 50 kg, takes hydroxychloroquine 400mg tablets each day (Mondays to Fridays only) as part of her treatment regimen for rheumatoid arthritis. She has no renal impairment or any additional risk factors for retinal toxicity. She has taken the drug for 3 months and has had a baseline ophthalmology assessment and asks when she will next require an eye examination.
The SPC states - All patients should have an ophthalmological examination before initiating treatment with Hydroxychloroquine sulfate . Thereafter, ophthalmological examinations must be repeated at least every 12 months.
Please note that the BNF now states the following for monitoring for retinopathy. A review group convened by the Royal College of Ophthalmologists has updated guidelines on monitoring for chloroquine and hydroxychloroquine retinopathy (Hydroxychloroquine and Chloroquine Retinopathy: Recommendations on Monitoring 2020). Recent data have highlighted that hydroxychloroquine retinopathy is more common than previously reported.
A mother of an 18-month-old child requests treatment for head-lice. She has found live lice in her daughter’s hair and has tried the wet combing method. However, her daughter hates it when she is trying to remove the lice in this way and gets very distressed and cries until she is sick. Therefore, the mother wishes to purchase an OTC treatment.
Which of the following would be the most appropriate to recommend?
A Derbac M® (Malathion) 0.5% liquid
B Full Marks® (Cyclomethicone, isopropyl myristate) Solution
C Hedrin® (dimeticone) 4% solution
You Answered
D Lyclear® (Permethrin) cream rinse
E Vamousse® (isopropyl Myristate, Isopropyl Alcohol) Mouss
Hedrin® (dimeticone) 4% solution is licensed from 6 months of age. Full Marks Solution is recommended from 2 years of age. Vamousse® is recommended from 2 years of age. Lyclear® and Derbac M® are licensed from 6 months. Resistance has developed to permethrin, in addition to this the administration of Lyclear® cream rinse means there is insufficient contact time, so it would be ineffective. Therefore, Derbac M® is the only insecticide recommended in the UK now but resistance has developed. Therefore, CKS recommend either wet combing or dimeticone 4% solution first-line for pregnant or breastfeeding women, young children aged 6 months to 2 years, and people with asthma
A 35-year-old man who normally takes Tegretol® (carbamazepine) 600 mg twice daily for epilepsy has come to collect his repeat prescription. He only has 2 days treatment of Tegretol® left at home.
You do not have any Tegretol® in stock and there is none available locally due to a manufacturing delay. You have both the Medreich and Novartis pharmaceutical brands of carbamazepine in stock.
What would be the most appropriate action to take?
A - contact the prescriber to inform them of the issue and gain agreement to dispense an alternative brand to maintain continuity of supply
Correct!
B discuss the manufacturing delay with the patient and the prescriber to gain agreement to supply an alternative brand to maintain continuity of supply
C discuss the manufacturing delay with the patient to gain agreement to supply an alternative brand to maintain continuity of supply
D dispense the carbamazepine you have in stock to maintain continuity of supply and endorse the prescription with the details of what you supplied
E Inform the patient that you do not have any stock, produce an owing slip and tell the patient you will give them a call once they are back in stock
BNF. The CHM concluded that reports of loss of seizure control and/or worsening of side-effects around the time of switching between products could be explained as chance associations, but that a causal role of switching could not be ruled out in all cases. Carbamazepine is classed as a category 1 antiepileptic where doctors are advised to ensure that their patient is maintained on a specific manufacturer’s product. Dispensing pharmacists should ensure the continuity of supply of a particular product when the prescription specifies it. If the prescribed product is unavailable, it may be necessary to dispense a product from a different manufacturer to maintain continuity of treatment of that antiepileptic drug. Such cases should be discussed and agreed with both the prescriber and patient (or carer).
A 67-year-old woman who has Parkinson’s Disease. She is having selegiline 10 mg daily added to her co-careldopa therapy as she has developed motor fluctuations. She currently takes:
• Sinemet® (carbidopa (as carbidopa monohydrate) 25 mg, levodopa 250 mg) tablets, One tablet four times a day
• Fluoxetine 20 mg capsules, one capsule each day
• Normacol® (sterculia 620 mg per 1 g) granules, one heaped 5 mL spoon twice daily
Resource: Eldepryl (selegiline) SmPC (Links to an external site.)
The prescriber asks if any alterations need to be made to her current medication given her new prescription. How would you respond?
A a gradual reduction of 300 mg levodopa will be needed over the next month and fluoxetine should be discontinued at least 1 week before initiation
B a gradual reduction of 500 mg levodopa will be needed over the next month and fluoxetine should be discontinued at least 2 weeks before initiation
C fluoxetine should be discontinued on initiation
Correct!
D initially a reduction of 100 mg levodopa should be made to her daily dose and the fluoxetine should be discontinued at least 5 weeks before initiation
E no adjustments are required
Selegiline is predicted to increase the effects of levodopa the SmPC states:
When selegiline is added to a levodopa regimen it is possible to reduce the levodopa dosage by an average of 10 -30%. Reduction of the levodopa dose should be gradual in steps of 10% every 3 to 4 days. An initial 10% reduction would be 100 mg of levodopa.
The SPC also states ‘Since fluoxetine has a very long elimination half-life, at least 5 weeks should be allowed after stopping fluoxetine and before starting selegiline.’
A 22-year-old man has been initiated on topiramate for generalised tonic-clonic seizures.
Which of the following would be appropriate counselling to give him?
A different formulations of oral preparations may vary in bioavailability. He must be maintained on a specific manufacturer’s product
B He will need to have his eyes tested annually during treatment
C to be alert for symptoms and signs of bone marrow failure, such as anaemia, bruising or infection
D to seek immediate medical attention if symptoms such as fever, rash, mouth ulcers, bruising or bleeding develop as they could be a sign of blood, liver or skin disorder
Correct!
E to seek medical attention if he has any mood changes, distressing thoughts, or feelings about suicide or self-harming develop
Topiramate is a category 2 antiepileptic so the need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with the patient and/or carer. The advice in A would be necessary for category 1 antiepileptics.
Topiramate is not one of the antiepileptic drugs associated with bone marrow suppression and does not have the warning about blood, liver or skin disorders.
Although topiramate is associated with ocular side-effects there is no requirement to have regular eye examinations.
MARTINDALE?
WHOLE DRUG WORDL
tiotropium, antimuscarinic, dry mouth!
rivaroxaban, crcl 15-49?
15mg OD
A 35-year-old woman requests treatment for her skin. She has inflammatory papules and pustules in the centrofacial region, with persistent centrofacial redness. She said that she also experiences flushing of the face when she goes out in either hot or cold weather or goes to the gym. She is currently breastfeeding her 4-month-old daughter.
What would be the most appropriate treatment to recommend?
Correct answer
A azelaic acid 15% gel
You Answered
B benzoyl peroxide 5% gel
C ivermectin 10mg/g cream
D oral doxycycline
E oral oxytetracycline
Answer - A
Rationale
BNF - Benzoyl peroxide is licensed for acne not rosacea. Ivermectin, doxycycline and oxytetracycline are not suitable as this woman is breastfeeding.
Combined oral contraceptives (COCs) are contraindicated in patients who have migraine with aura. Progesterone only contraceptives are more appropriate. Choices B-E are all COC.
This question relates to the same 65-year-old man in the previous question, with severe heart failure, who has just been diagnosed with his first acute attack of gout. He currently takes the following medicines:
• Bisoprolol 10 mg daily
• Furosemide 80 mg daily
• Losartan 100 mg daily
• Spironolactone 50 mg twice daily
He has been stable on his current medication for the last the last 6 months.
How often should his serum potassium and renal function be monitored?
BNF - Once the target, or maximum tolerated dose is achieved, treatment should be monitored monthly for 3 months and then at least every 6 months.
A 4-year-old girl, who is complaining of pain in her right ear, visits you with her mom for advice. The mom says she has been off colour for the past few days with symptoms of a cold. She also has eczema and asthma. On examination you diagnose acute otitis media.
What would be the most appropriate advice?
Paracetamol, control the pain
Symptoms usually resolve within 3-7 days. Earcalm® is not licensed for children under 12 and is not used for this indication, it is indicated for otitis externa.
Most simple cases of acute otitis media resolve without antibiotic therapy, pain and fever should be managed with paracetamol or ibuprofen, as this child has asthma paracetamol would be the most appropriate choice.
A 5-year-old boy has developed constipation. His mom said he has had symptoms for the last 6 days and has only managed to go to the toilet 3 times in 6 days. He has stomach pain and when he does go to the toilet his stools are hard and small. She has increased the fruit in his diet but would like to buy something OTC to also help him go.
What would be the most appropriate advice?
Children under the age of 12 should be referred to their GP. Children under 12 should be treated first line with macrogol in combination with a balanced diet, fluids and behavioural interventions. Stimulant laxatives are second line treatments. The laxatives listed are not available to purchase over the counter for this age group.
A 35-year-old woman hands over a veterinary prescription for diazepam for her dog.
Which of the following statements are NOT true about the prescription and record keeping for this prescription?
The declaration ‘prescribed for the treatment of an animal or herd under my care’ is only required for schedule 2 and 3 CDs. Diazepam is a schedule 4 CD.
An 18-month-old boy who has a fever and a bright red rash on both cheeks.
slapped cheek
A 4-year-old child who initially had cold-like symptoms has now developed sore red eyes that are sensitive to the light and a red-brown, slightly raised rash.
measles!
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
A 55-year-old woman, with breast cancer and taking tamoxifen, is prescribed this antidepressant for menopausal symptoms as per the BNF recommended dose. It is not licensed for this indication.
Venlafaxine is used for menopausal symptoms, but it is not licensed for this indication. Fluoxetine and paroxetine are also used but not for those women on tamoxifen (due to interaction).
A 67-year-old man, who has Parkinson’s Disease, who has had ropinirole added to their regular treatment
For ropinirole the BNF states: Hypotensive reactions can occur in some patients taking dopamine-receptor agonists; these can be particularly problematic during the first few days of treatment and care should be exercised when driving or operating machinery.
A 45-year-old man, who has been initiated on lithium
For lithium the BNF states: Patients should be advised to report signs and symptoms of lithium toxicity, hypothyroidism, renal dysfunction (including polyuria and polydipsia), and benign intracranial hypertension (persistent headache and visual disturbance).
TB MEDS
RIP? Hepatotoxic
E? Visual
Miss Tina Lopez, a 67-year-old female, comes to collect her prescription
medicines from a pharmacy you are locuming in. She takes the following
medications:
• Ramipril 5mg tablets
• Amlodipine 10mg tablets
• Sulfasalzaine 500mg tablets
• Hyoscine butylbromide (Buscopan®) 10mg tablets
• Tibolone 2.5mg tablets
You go through the prepared medicines with Miss Lopez prior to testing her
blood pressure and realise that baclofen 10mg tablets have been dispensed
instead of Buscopan® 10mg tablets. This error is corrected. You then
proceeded to test Miss Lopez’s blood pressure three times, of which the
average was found to be 165/98.
Which of the following is the most appropriate action to take?
stop tibolone!
Which of the following statements regarding the faxed prescription is
correct?
The faxed copy of the prescription is not a legally valid prescription
Which of the following is not a notifiable disease in the UK?
a) Food poisoning
b) Zika virus
c) Malaria
d) Smallpox
e) Coronavirus (COVID-19)
ZIKA VIRUS
Mr Smith, a 65-year-old patient who has been
admitted to hospital with symptoms of tachycardia, confusion, lightheadedness and blurred vision. The doctor has informed him that this has
been caused by an imbalance in one of his serum electrolyte levels,
potentiating the side effects of one of his medications
HYPOKALAEMIA–> POTENTIATES DIGOXIN TOXICITY
Before proceeding, the surgeon and anaesthetist want to check the severity
of Lateysha’s renal function. Her estimated glomerular filtration rate (eGFR) is
20ml/min/1.73 m2.
What level of renal function does Lateysha have?
SEVERE REDUCTION
first trimester, pregnancy, exempt, DOUBLE CHECK ANSWERS!!! SELECTED!
NAPROXEN+PREDNISOLONE?
GI BLEED!!!
bisphosphonates contraindicated in?
hypocalcaemia
cabergoline side-effect?
gambling as well, ergot derived, etc
Mr Bains asks you if he can buy anything to relieve his symptoms of acute
gout, until he can get an appointment with his doctor. He has had gout before
but it has been a long time since his last attack. On looking at his PMR, you
notice that there have been a number of changes to his medicines recently
and you suspect that one of them may have precipitated this attack of gout.
Which of the following drugs is the most likely cause of Mr Bains’
current episode of gout?
FUROSEMIDE!
A 12-year-old girl was admitted to hospital following a focal seizure. She was
initiated on phenytoin and is now stabilised at a dose of 200mg twice daily.
Three weeks after her seizure, she experienced a high fever and was
prescribed paracetamol and erythromycin tablets for seven days. She soon
developed a rash and flu-like symptoms. A blood test was carried out.
What is the best course of action?
WITHDRAW PHENYTOIN, RASH, DYSCRASIA, ETC!
Mrs Levi has recently become very confused and forgetful since the death of
her husband. She is not taking care of herself and often forgets to take her
medication. You discuss your concerns with her son and you both agree that
Mrs Levi may benefit from a monitored dosage system (MDS).
Which of the following would not be safe to put in an MDS?
Hydroxycarbamide 500mg capsuleS?
Mr Thomas comes into the pharmacy on Monday with a rash that is very
itchy, he has a high temperature above 38°C, aches, pains and a general
feeling of being unwell. You have established that he has chicken pox
urgent care, not paracetamol
Liothyronine is more rapidly metabolised than levothyroxine
Lawrence has just turned 50 recently and has decided to book a health check
in your pharmacy. He feels he hasn’t been leading a very healthy lifestyle
recently and would like to see what impact this has had.
Lawrence’s results from the health check are:
Blood pressure: 138/80 mm/Hg
Total Cholesterol: 6
BMI: 29.5
Given the results above, what is the most suitable advice that you
would give to this patient?
Explain to Lawrence that his blood pressure and cholesterol are high and
BMI is in the overweight range. Advise him to reduce his salt intake,
recommend a balanced diet and ask him to maintain regular exercise to help
get all of these measures within the healthy range. Also recommend that he
books an appointment with his GP
Mr Wilkins, a 27-year-old man, comes into your pharmacy for advice. He
initially had a headache, then developed a burning, tingling rash that is
moderately painful. He has no other medical conditions.
What is the best drug treatment option for Mr Wilkins?
Valaciclovir
You receive a prescription for Nathan, a 12-year-old boy, for nystatin 100,000 units
to be taken four times daily to treat oral thrush. You have 30mL bottles containing
100,000 units/mL.
How long should Nathan take the nystatin for?
7 days and continued for 48 hours after the lesions have resolved
Jennifer is 37 years of age and has four children. She does not want to have
any more children and would like to take the combined oral contraceptive pill,
which she used to take when she was younger. However, she is not sure if
her GP will prescribe it to her, as she is a smoker (40 cigarettes a day). She
does not have any medical conditions and does not take any medication. Her
BMI is 23.5.
What can you advise Jennifer about the suitability of the combined oral
contraceptive pill for her?
She will not be able to take the combined oral contraceptive as she has
two risk factors for venous thromboembolism and/or arterial disease
Mr Kolosov has a discussion with you on diabetic ketoacidosis from his
research. You decide to use this to further test your pre-registration student. A
patient weighing 74kg suffering from diabetic ketoacidosis will require soluble
insulin to be diluted in sodium chloride 0.9% and administered by intravenous
insulin.
How much insulin will be administered after two hours if the
concentration is 1 unit/mL and the dose is 0.1 units/kg/hr?
14.8ml
Tony, a 50-year-old regular patient of yours, comes into your pharmacy
presenting with symptoms of yellowing of his skin and the whites of his eyes.
He also has started to feel bloated lately and his stomach is distinctly larger
than usual. You check his PMR to see his medication history; he takes
atenolol 50mg tablets once daily, aspirin 75mg tablets once daily and
terbinafine tablets 250 mg once daily. He also had a yellow fever vaccine in
your pharmacy two weeks ago.
Which of the following is the most likely cause of his symptoms?
Side effects from the terbinafine tablets
TERBINAFINE IS HEPATOXIC, YELLOW VISION ,EC
You are conducting a presentation to train pharmacy support staff on high risk
medicines. You are including a section on non-steroidal anti-inflammatory
drugs (NSAIDs).
Regarding NSAIDS, which of the following would be incorrect
information to include in the presentation?
a) All patients using NSAIDs should receive gastro-protective treatment
b) Naproxen 1g daily is associated with a lower thrombotic risk than ibuprofen
2.4g daily
c) All NSAID use is associated with an increased risk of thrombotic events
d) Naproxen is associated with a higher risk of gastro-intestinal events than
ibuprofen
e) Oral piroxicam use is associated with serious skin reactions
All patients using NSAIDs should receive gastro-protective treatment
Mrs Atkins’ recent blood test shows raised levels of T3 and T4, and an
extremely low TSH level. She has noticed excessive sweating and diarrhoea
for the last few weeks.
What is the most appropriate advice to give her?
Stop taking the amiodarone tablets and see her doctor urgently
THYROID DISORDER OII
Tim has been taking Priadel® 400mg tablets at a dose of one tablet daily, for
the last 2 months. He has recently started experiencing side effects of a skin
rash, nausea and muscle weakness. He has come to the hospital for a blood
test.
Which of the following blood serum levels of lithium is Tim most likely
to have?
1.2-1.6, COOL
Dante, a 53-year-old man, has already tried psychological therapy. He is going through a
divorce which is causing him to feel guilty and have low self-esteem. He has stopped
joining his friends for the weekly pub quiz. He is not enjoying his job and he feels a lack of
motivation to start the day every morning. He currently takes aspirin 75mg tablets, digoxin
125mcg tablets, simvastatin 10mg tablets and ramipril 2.5mg capsules.
Mirtazapine
Sandra, who is 38-years-old, should be advised not to drive as this
medication causes drowsiness.
METHYLDOPA!
Suky has been experiencing symptoms of Raynaud’s syndrome since she
was 18-years-old, but it has recently been getting worse, despite her taking
precautions to prevent her hands and feet from getting cold. Her GP has
suggested a trial of this drug as prophylaxis, starting at 5mg three times a
day
NIFEDIPINE
Steven, a regular patient, who has just recovered from a hip fracture, has
come to your pharmacy to return some medicines that he no longer needs to
use. This medication requires entry into the Controlled Drugs patient returns
register but does not require an authorised witness to be present when it is
destroyed
Oxycodone?
Mrs Ella Feather, a 42-year-old woman, has come into the pharmacy suffering from
low back pain and would like some recommendations to manage her condition. She
cannot take non-steroidal anti-inflammatory drugs. She has tried applying a heat
patch to the area but remains uncertain of how beneficial the approach was. She is
considering a visit to the doctor to obtain a prescription. She asks you what you can
recommend.
manual?
A 16-year-old girl with a stoma has been suffering from iron deficiency
anaemia so she has been initiated on ferrous fumarate oral solution. She
takes 10mLs once a day. However, she has started to experience
troublesome loose stools and soreness.
WITHDRAW GRADUALLY
Chris, a 5-year-old boy, suffers from seasonal hay fever. He does not like oral
antihistamines so his mother would prefer another option. You suggest a
suitable product to Chris’ mother that his GP will need to prescribe for him.
azelastine wow
Chloe, a 19-year-old customer, is suffering from itchy eyes and has puffy eyelids for
the first . Her doctor has prescribed lodoxamide eye drops for allergic conjunctivitis,
and recommended a medicine for her to purchase over the counter, but she cannot
remember what it was. Her symptoms are mild and she has not tried anything else.
You provide the most appropriate recommendation
Sodium cromoglicate eye drops
APOMORPHINE, OFF PERIODS!
