Plat Flashcards by Simon Evans

As part of a lunchtime teaching session on asthma at your GP practice. You are running through the signs of an asthma attack. Which of the following would NOT be a sign of an acute severe asthma attack?
PEF of 33-50%
Unable to complete one sentence
PEF >50-75%
Respiratory rate of >25/min
Heart rate of 120 beats/min

PEF >50-75%

This is not a sign of an acute severe asthma attack. Instead, it indicates moderate asthma exacerbation rather than a severe attack.

Signs of an acute severe asthma attack (as per BTS/SIGN guidelines):
✅ PEF 33-50% of best or predicted
✅ Unable to complete sentences in one breath
✅ Respiratory rate >25/min
✅ Heart rate ≥110 beats/min

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Inhaled corticosteroids are a cause of oral candidiasis and there are ways to prevent this. Which of the following would be the most appropriate advice?
Advise her to rinse her mouth after using her corticosteroid inhaler
Use her inhaler after food
Advise her to rinse her mouth before using her corticosteroid inhaler
Advise her to take the doses every other day to reduce the risk of candidiasis
Use her inhaler 30 mins before food

Advise her to rinse her mouth after using her corticosteroid inhaler

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Mr X, a regular patient of yours comes into the pharmacy and during a general conversation with him he mentions how he thinks his new inhaler is not really helping him because when he uses it he doesn’t think he receives a dose and so has not been using it for the past week. You take him into the consultation room, to show him how to improve his inhaler technique. What would be the most appropriate technique for using Fostair nexthaler?
Inhale fast and deep
Inhale slow and steady
Inhale into the nexthaler
Shaking the nexthaler after use
Breathing into the nexthaler before use

DPI- Inhale deep + Fast

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What is the target level for satisfactory bronchodilation with theophylline?
10-20mcg/L
15-20mcg/L
5-10mcg/L
2-5mcg/L
4-12mcg/L

10-20 mcg/L

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A patient comes in enquiring about nicotine replacement patches as he is considering stopping smoking as he is aware of how harmful smoking is and does not want it to also impact his family. As he is a regular patient you are aware that he takes medication for asthma and he has severe asthma. You gain consent to check his PMR to see if he is on any certain medications and if it would interact. You find that amongst his inhalers he also takes theophylline. Which of the following would be the most appropriate advice to provide the patient?
Refer him to his GP as his theophylline dose would need decreasing if he is considering stopping smoking
Advise him on the range of nicotine patches available
Refuse the sale as he is not old enough to buy nicotine patches
Refer him to his GP as his theophylline dose would need increasing if he is considering stopping smoking
Advise him to stop taking theophylline whilst on nicotine patches.

Refer him to his GP as his theophylline dose would need decreasing if he is considering stopping smoking.

Why?
Smoking induces CYP1A2, an enzyme that increases the metabolism of theophylline, leading to lower drug levels in smokers.
If the patient stops smoking, CYP1A2 activity reduces, causing theophylline levels to increase, which can lead to toxicity (nausea, vomiting, arrhythmias, seizures).
To prevent toxicity, theophylline dose should be reduced upon smoking cessation, which requires GP supervision and monitoring of theophylline levels.

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You are working as a locum in a regular store on a hot, sunny day. You are aware the pollen count has been high over the past few days. A young lady comes in and explains she is on her lunch break at work but is finding it hard to concentrate at work today as she is constantly sneezing, her eyes have been watering all day and her nose has been leaking. She has forgotten her antihistamines at home because she does not take them every day and does not remember the name of them. She asks if you can recommend something for hayfever?
Loratadine
Chlorphenamine
Diphenhydramine
Beconase nasal spray
Optrex hayfever eye drops

Loratadine is a non-drowsy second-generation antihistamine, making it ideal for someone who is at work and needs to concentrate.
It provides all-day relief from sneezing, watery eyes, and a runny nose.
Since she doesn’t take antihistamines daily, it’s a convenient once-daily dose.

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You are providing the flu vaccination service and a young gentleman aged 25 years old has come in for a flu jab. He has not previously had one before. You ask him to fill out a form and explain about the flu jab and counsel him appropriately. You administer the flu jab and ask him to sit outside for 10 minutes to ensure he is okay and no reaction follows. You go back into the dispensary to check prescriptions which are calling back. A few minutes later, he approaches the counter and explains he is finding it hard to breathe, he has gone pale and his face is swelling. You decide to administer an epipen as you believe he is having an allergic reaction from the flu jab. Which dose is most appropriate to administer?
150mcg
100mcg
300mcg
200mcg
500mcg

500mcg?

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Which of the following electrolyte imbalance occurs with beta blockers and concomitant administration of theophylline?
Hyperkalaemia
Hypokalaemia
Hypernatraemia
Hyponatraemia
Hypercalcaemia

Hypokalaemia

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A lady comes in to enquire about the flu jab this season as she is keen to get one this year. She asks what age she has to be for her to get it on the NHS?
50 years old
64 years old
65 years old
70 years old
75 years old

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COPD is an irreversible condition and Mr S has been managing his COPD for a while now. He is currently taking a short acting beta agonist, he has stopped smoking for about a year now but is feeling more breathless then usual over the past couple of weeks. What would be the most appropriate next step for Mr S?
LABA + LAMA
SAMA
LAMA
Prednisolone
LABA, LAMA, ICS

LABA + LAMA

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You are working at the GP practice, and you urgently get called to reception. There is a young lady who appears to be breathless, wheezing, short of breath. One of the receptionists explains she is an asthmatic and suspects she is having an asthma attack. The patient pulls out a blue inhaler and she starts using it. What would be the most appropriate number of puffs for the patient to take before calling an ambulance?
2
4
5
10
20

The standard emergency treatment for an asthma attack is:
1️⃣ Take 1 puff of the reliever inhaler (usually blue, e.g. salbutamol) every 30-60 seconds, up to a maximum of 10 puffs.
2️⃣ Call 999 if symptoms do not improve after 10 puffs or if the patient is getting worse.
3️⃣ While waiting for emergency help, the patient can continue taking 10 puffs every 10-15 minutes if needed.

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A COPD patient is prescribed a rescue pack of antibiotics for her to keep at home. Which of the following antibiotics would be most appropriate to prescribe?
Prednisolone
Amoxicillin
Cefelaxin
Methylprednisolone
Flucloxacillin

Amox

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A mother comes into the pharmacy, explaining her child who is 3 years old has got chickenpox which is bothering him as he is constantly touching his face and is feeling uncomfortable, and itchy everywhere. She asks if there is anything you can recommend. What would be the most appropriate antihistamine?
Chlorphenamine oral solution
Cetirizine
Fexofenadine
Acrivastine
Loratidine

Chlorphenamine oral sol

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A patient is being assessed for their risk of developing cardiovascular disease. The QRISK2 scale is being used to assess the risk. Which of the following is a factor in the QRISK 2 calculator?
Smoking status
Thyroid disease
Respiratory disease
Pregnant or breastfeeding
Alcohol consumption

Smoking

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Amlodipine is an example of a dihydropyridine calcium channel blocker. Which of the following is a common side effect of calcium channel blockers?
Flushing
Cold hands and feet
Fatigue
Hypotension
Sleep disturbances

Flushing

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Which of the following is a caution for initiating a patient on clozapine?
Agranulocytosis
Uncontrolled epilepsy
History of neutropenia
Bone marrow disorders
Severe CNS depression

Agranulocytosis

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Mrs P has recently been diagnosed with schizophrenia but has tried most antipsychotic drugs and has not worked therefore it is decided to initiate her on clozapine and for her to be part of the clozapine monitoring service. Which of the following would be appropriate to monitor initially?
Leucocytes and differential blood counts
Potassium levels
Calcium levels
Red blood cell count
Oxygen saturation

Leucocytes and differential blood counts

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Which of the following drugs is most likely to cause weight gain?
Risperidone
Olanzapine
Quetiapine
Lithium
Sodium valporate

Olazapine

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Parkinson disease is a neurodegenerative disease, which is managed by a range of medications depending on how quality of life is affected. Which of the following Parkinson drugs is most likely to cause fibrotic reactions?
Bromocriptine
Co-careldopa
Entacopone
Tolcapone
Selligiline

Bromocriptine is an ergot-derived dopamine agonist.
Ergot-derived dopamine agonists (e.g. bromocriptine, cabergoline, pergolide) have been associated with fibrotic reactions, including:
Pulmonary fibrosis
Retroperitoneal fibrosis
Cardiac valve fibrosis
Regular monitoring (e.g. echocardiograms, lung function tests) is required if used long-term.

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A 30 year old woman comes in to collect her prescription. This is a new medication for her, she explains when you hand out the medication. She has been prescribed Mirtazapine 15mg at night. What would be the most appropriate counselling point?
Advise her to report any fever, sore throat, or signs of infection when taking mirtazapine.
No specific counselling is required
Advise her to take her tablet with orange juice
Advise her to take it 30 mins before bed
Advise her of diarrhoea developing which is an uncommon side effect and should stop taking the medication.

Mirtazapine can rarely cause agranulocytosis, a serious condition where white blood cell levels drop, increasing the risk of infections.
Symptoms such as fever, sore throat, or persistent infections should be reported immediately to a doctor.

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What would be the maximum dose of sertraline that can be prescribed?
150mg
50mg
100mg
200mg
125mg

200mg

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Which of the following antidepressants are associated with a higher risk of withdrawal effects?
Sertraline
Mirtazapine
Venlafaxine
Fluoxetine
Moclobencamide

Venlafaxine (an SNRI) has a short half-life, meaning the drug leaves the body quickly, increasing the risk of withdrawal symptoms if stopped abruptly.

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Patient Z is a regular customer for the past 10 years who you know very well. He comes in looking down as he has been prescribed another medication as his depression has been getting worse and his previous medication is not working which he has stopped as requested by the doctor so he is able to take the new one that is prescribed which is Moclobemide. The doctor mentioned something about alcohol but he forgot and he knows he will be drinking this weekend as it is his daughter’s birthday. What would be the most appropriate advice?
Advise patient Z to not drink any alcohol because there is an interaction with his new medication
He is fine to drink alcohol and should drink the recommended amount which is 20 pints a week
He is fine to drink alcohol and should drink the recommended amount which is 14 pints a week spread across 3 days
No advice is necessary
Advise the patient he can drink low alcohol drinks

Advise patient Z to not drink any alcohol because there is an interaction with his new medication.”

Why?
Moclobemide is a reversible MAOI (Monoamine Oxidase Inhibitor).
Alcohol can increase the risk of side effects, such as:
Increased drowsiness & dizziness
Worsening depression symptoms
Increased blood pressure (hypertensive crisis) if combined with certain alcoholic drinks like red wine or beer (which contain tyramine

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Co-codamol can be supplied over the counter for a maximum of duration of how many days?
14 days
7 days
2 days
3 days
5 days

3 days

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Which of the following antihistamines can be used for the prevention of a cluster headache? Pizotifen Loratadine Acrivastine Chlorphenamine Levocetirizine

Piztoifen

Sumatriptan was changed from a prescription medication to a pharmacy only medication and is now available over the counter following a consultation. Which of the following would there be a need to refer a patient to their GP? A patient who is 24 years old comes in requesting sumatriptan A patient has had five attacks in one month A patient who has one attack in a month A patient who takes anti histamines A patient who is 19 years old

5 attacks in one month

Nitrates are used in the treatment of angina, they come in different forms such as sublingual tablets and patches. Patches have the caution of causing tolerance in patients and so patients should have a nitrate free period. What would be the most appropriate nitrate free period? 8-12 hours 12-24 hours 6-12 hours 2-4 hours 2-6 hours

8-12 hrs

You are checking a prescription for glyceryl trinitrate sublingual tablets for a patient who is waiting. As you go down to hand out the prescription you provide some advice regarding his medication. What would be the most appropriate advice? Advise the patient to discard the tablets after 4 weeks Advise the patient to discard the tablets after 8 weeks The tablets have a shelf life of 24 months No specific advice needed for this medication The tablets have a shelf life of 12 months

Glyceryl trinitrate sublingual tablets are highly sensitive to moisture and light, which can affect their potency. Once the bottle is opened, the tablets should be discarded 8 weeks after opening to ensure their effectiveness.

A 75 year old woman has been on loop diuretics for a while now for the treatment of her oedema. She has been taking Bumetanide 500micrograms daily. Which of the following electrolyte imbalance can occur? Hyperkalaemia Hypercalcaemia Hypernatraemia Hypokalaemia Hypoglycaemia

Hypokalaemia

Weak diuretics include triamterene which can cause urine discolouration. What colour would triamterene cause the urine to be? Red Pink Blue Brown Orange

Blue

Mr T, has recently been discharged from the hospital after he had an NSTEMI when he was gardening. He has been started on a range of medication to help with the management after having a heart attack. Which of the following medications is likely to be initiated? Verapamil Heparin Ramipril Dabigatran Rivaroxaban

Ramipril is an ACE inhibitor commonly used in the management of patients after an NSTEMI (heart attack) to help: Lower blood pressure, reducing the workload on the heart. Prevent further heart damage by improving heart function. Reduce the risk of heart failure and other complications post-heart attack. Protect the kidneys, especially in patients with diabetes or hypertension.

Which of the following antipsychotics can cause QT interval prolongation? Haloperidol Quetiapine Olanzapine Risperidone Clozapine

Haloperidol

Antipsychotics can cause extrapyramidal side effects as well as many other side effects including sexual dysfunction, hyperprolactinaemia. Which of the following is a symptom of hyperprolactinemia? High blood pressure Menstrual disturbances Weight gain Hot flushes Sweating

Menstrual disturbances

Mrs E, a 70 year old woman suffers from dementia and has recently been having difficulty sleeping. This is affecting her during the day and she has come in asking for advice. What is the most appropriate advice to provide? Contact the GP for her to be prescribed sleeping tablets for short term use Advise her on sleep hygiene such as keeping the room very dark This is a common symptom and it should resolve in a few days Contact the GP for her to be prescribed sleeping tablets for long term use Contact the GP as it can be a side effect of one her medications used to manage her dementia

Sleep hygiene

Donepezil is an anticholinesterase used in the treatment of dementia. Mr R, has been switched from normal tablets to orodispersible tablets as he increasingly finds it hard to swallow normal tablets. Which of the following is the most appropriate advice regarding the administration of orodispersible tablets? Swallow whole with a glass of water Crush the tablets and mix with orange juice Swallow the tablet whole 30 min before food. Place the tablet on the tongue and allow the tablet to disperse and then swallowed Place the tablet under the tongue and allow the tablet to disperse and then swallowed

Place the tablet on the tongue and allow the tablet to disperse and then swallowed

A dad calls 111 as his 3 year old daughter has a very high temperature and is worried as she has just suffered from a seizure known as febrile convulsions. He is concerned and does not know what to do. What would be the most appropriate advice? Advise the dad febrile convulsions are common and require no specific treatment. Giving the child paracetamol 120mg/5ml, 7.5ml four times a day will help with the temperature Advise the dad febrile convulsions are common and require no specific treatment. Giving the child paracetamol 120mg/5ml, 5ml four times a day will help with the temperature Advise the dad febrile convulsions are common and require no specific treatment. Giving the child paracetamol 120mg/5ml, 2.5ml four times a day will help with the temperature No treatment is necessary, and self-care advice is provided Refer the child to A&E.

Advise the dad febrile convulsions are common and require no specific treatment. Giving the child paracetamol 120mg/5ml, 5ml four times a day will help with the temperature." Why? Febrile convulsions (seizures caused by a fever) are relatively common in young children between the ages of 6 months and 5 years. They usually last for a few minutes and are typically not harmful. However, it’s important to manage the fever to reduce the risk of further convulsions. Paracetamol can help lower the fever and make the child more comfortable, but it does not prevent seizures.

Which of the following drugs is associated with causing cleft palate? Topiramate Sodium Valporate Ethosuximide Carbamazepine Lamotrigine

Topiramate

A recent MHRA advice regarding the use of benzodiazepines and opioids together can increase the risk of which of the following? Respiratory depression High blood pressure Hyperkalaemia Muscle pain Visual disturbances

Respiratory depression

Which of the following is the appropriate lithium level elderly patients should maintain? 0.8-1mmol/litre 0.4-1mmol/litre 0.2-0.4mmol/litre 0.4-0.8mmol/litre 0.2-0.8mmol/litre

0.4-1.0 mmol/l

How often should thyroid function be monitored in patients on lithium treatment? 4 months 12 months 24 months 6 months 3 months

6 months

A 23-year-old patient with type 1 diabetes mellitus walks into your community pharmacy with a prescription for Fiasp® FlexTouch 100units/ml solution for injection 3ml prefilled pens. Which type of insulin preparation is Fiasp®? Rapid-acting insulin Short-acting insulin Intermediate-acting insulin Long-acting insulin Ultra-long-acting insulin

Rapid acting

A 47-year-old woman is admitted to the coronary care unit (CCU) and is diagnosed with infective endocarditis. On day 3 of her hospital admission, she is complaining of a ringing sound from her ears. Which antibiotic is most likely to be responsible for these symptoms? Amoxicillin Linezolid Gentamicin Pivmecillinam Ceftazidime

Gentamicin

A 55-year-old patient on an acute medical ward is found to have Pseudomonas aeruginosa in his blood. The junior doctor on the ward asks you which antibiotics can be used to treat Pseudomonas aeruginosa empirically until the sensitivities are available. Which of the following antibiotics can be used to treat an infection caused by Pseudomonas aeruginosa? Ciprofloxacin Amoxicillin Vancomycin Pivmecillinam Co-amoxiclav

Ciprofloxacin is a fluoroquinolone antibiotic that has activity against Pseudomonas aeruginosa, making it an appropriate option for empirical treatment of infections caused by this pathogen, especially in critically ill or immunocompromised patients. It is often used in the initial empiric treatment for Pseudomonas infections, pending the results of sensitivities.

A 33-year old patient is due to undergo surgery, the patient requires venous thromboembolism prophylaxis and is renally impaired. Which of the following pharmacological options is the preferred option for patients that are renally impaired? Aspirin Edoxaban Heparin (unfractionated) Rivaroxaban Warfarin

Unfractionated heparin (UFH) is not dependent on renal clearance, making it a preferred choice for patients with renal impairment. Its dose can be easily adjusted based on aPTT (activated partial thromboplastin time) to ensure therapeutic anticoagulation, reducing the risk of bleeding complications, especially in patients with renal dysfunction.

A 53-year-old patient with type 2 diabetes mellitus has commenced on a new medication for his diabetes. He is advised by his general practitioner that there is a rare risk of diabetic ketoacidosis associated with this new medication. Which of the following medications is he likely to have been prescribed? Linagliptin Canagliflozin Gilbenclamide Metformin Pioglitazone

Canagliflozin is an SGLT2 inhibitor (sodium-glucose co-transporter 2 inhibitor) used for the treatment of type 2 diabetes. SGLT2 inhibitors, including canagliflozin, work by preventing the kidneys from reabsorbing glucose, thereby increasing glucose excretion in the urine. A rare but serious risk associated with SGLT2 inhibitors is the development of diabetic ketoacidosis (DKA), even in patients with normal blood glucose levels. This is known as euglycemic DKA and is associated with dehydration and electrolyte disturbances.

A 47-year-old patient has recently started on a low molecular weight heparin (LMWH) and starts to develop bruising of the skin. What is the likely cause of the bruising? Hyperkalaemia Hypokalaemia Hypersensitivity Thrombocytopenia Lymphocytopenia

Thrombocytopenia

A 55-year-old female is admitted to the acute admissions ward with diarrhoea and fever. She is diagnosed with a Clostridium difficile infection. Which of the following antibiotics is most likely to increase the risk of a Clostridium difficile infection? Vancomycin Amoxicillin Clindamycin Pivmecillinam Co-amoxiclav

Clindamycin

A 34-year-old pregnant woman is admitted to the hospital and has a history of deep vein thrombosis (DVT). Which of the following pharmacological options is the preferred option for pregnant patients with a history of deep vein thrombosis? Aspirin Apixaban Clopidogrel Low molecular weight heparin (LMWH) Warfarin

LMWH (e.g., enoxaparin, dalteparin) is the first-line treatment for venous thromboembolism (VTE) in pregnancy, including deep vein thrombosis (DVT) and pulmonary embolism (PE). LMWH is preferred because it does not cross the placenta, making it safe for the developing fetus. It also reduces the risk of thrombosis without significantly increasing the risk of bleeding, making it ideal during pregnancy.

A 54-year-old patient with type 2 diabetes mellitus walks into your community pharmacy with a prescription for a new medication for her diabetes. She is concerned as she has read a news article about this new medication stating it increases the risk of bladder cancer. Which of the following medications is he likely to have been prescribed? Gliclazide Metformin Canagliflozin Pioglitazone Saxagliptin

Pioglitazone is a thiazolidinedione (TZD) used in the treatment of type 2 diabetes to improve insulin sensitivity. There have been concerns raised about its potential association with bladder cancer based on studies, especially with long-term use. The FDA has issued warnings regarding this risk, recommending that pioglitazone should be avoided in patients with a history of bladder cancer.

A 55-year-old patient is admitted to the acute stroke unit following an ischaemic stroke. The patient has no co-morbidities or allergies. According to NICE guidelines, which secondary prevention therapy should be initiated in a patient following a stroke with no other co-morbidities? Aspirin 75mg OD Aspirin 75mg OD and Clopidogrel 75mg OD Clopidogrel 75mg OD Rivaroxaban 20mg OD Warfarin 3mg OD

For secondary prevention of ischaemic stroke, antiplatelet therapy is recommended to reduce the risk of further strokes. Clopidogrel (75mg once daily) is the preferred option for most patients following an ischaemic stroke, especially if they have no contraindications and are not at risk of bleeding. If the patient has no contraindications, combination therapy with aspirin and clopidogrel may be used in the very acute phase (within 24 hours) after an ischaemic stroke, but long-term therapy usually involves only clopidogrel.

A 31-year-old female patient, Miss Smith, attends a routine prenatal clinic. She is diagnosed with hypertension. Which anti-hypertensive can be safely and suitably commenced for Miss Smith? Amlodipine Bisoprolol Hydralazine Methyldopa Ramipril

Methyldopa

A 57-year-old patient with type 2 diabetes mellitus has commenced on a new medication. He is informed by the general practitioner that he may experience gastrointestinal disturbances, however these are usually transient and will resolve over time. Which of the following medications is he likely to have been prescribed? Glipizide Metformin Canagliflozin Sitagliptin Pioglitazone

Metformin

You are working as a responsible pharmacist in a small community pharmacy. A 64-year-old patient comes into the pharmacy complaining of severe pain near his left heel. After further questioning, you notice that this pain began after starting a new antibiotic. Which antibiotic may be responsible for this pain? Gentamicin Clindamycin Co-amoxiclav Amoxicillin Ciprofloxacin

Cipro

You are working as a responsible pharmacist in a small community pharmacy. A patient walks in with a prescription for erythromycin. Which antibiotic class does erythromycin belong to? Aminoglycosides Macrolides Glycopeptides Penicillins Lincosamides

Macrolides

You are working as a pharmacist in an acute admissions ward. A patient is diagnosed with a Clostridium difficile infection. The ward doctor asks you which antibiotics are effective against C. difficile infection, Which of the following antibiotics can be used for a Clostridium difficile infection? Oral vancomycin Oral doxycycline Intravenous co-amoxiclav Intravenous vancomycin Oral clindamycin

Oral vancomycin is the first-line treatment for mild to moderate C. difficile infections and is considered the treatment of choice for severe cases. It works locally in the gut, which is essential for managing C. difficile infections.

A 57-year-old male patient, Andrew Smith, is admitted to the coronary care unit and diagnosed with an ST- elevation myocardial infarction. Long-term management following a STEMI involves several medications which should be started which should be started prior to discharge from hospital. Medication on discharge: Aspirin 75mg OD, Clopidogrel 75mg OD, Bisoprolol 2.5mg OD, Atorvastatin 80mg OD, GTN spray 1-2 sprays PRN. You assess the discharge letter and notice a medication is missing. Which of the following medications, if appropriate, should be prescribed for Mr Smith on discharge? Amlodipine Ramipril Rivaroxaban Verapamil Warfarin

Ramipril is an angiotensin-converting enzyme inhibitor (ACE inhibitor), which is commonly prescribed after an STEMI for its cardioprotective benefits. ACE inhibitors help to: Reduce the workload on the heart Lower blood pressure Improve outcomes by reducing the risk of heart failure, recurrent infarction, and mortality Prevent the development of heart failure in patients post-STEMI, especially those with reduced ejection fraction

A patient on an acute admissions ward is commenced on dexamethasone for severe COVID-19. Which of the following is not likely to be a side effect associated with glucocorticoids? Diabetes mellitus Osteoporosis Muscle wastage Hypernatremia Peptic ulceration

Hypernatremia is not a common or direct side effect of glucocorticoids. Glucocorticoids can lead to sodium retention in the kidneys, which may result in mild fluid retention or hypertension; however, hypernatremia specifically (high sodium levels in the blood) is not a typical side effect. In fact, glucocorticoid therapy can sometimes cause hyponatremia (low sodium levels), especially with concurrent use of diuretics or in patients who are at risk for fluid imbalances.

A 31-year-old patient with type 1 diabetes mellitus walks into your community pharmacy with a prescription for Tresiba® FlexTouch 100units/ml solution for injection 3ml prefilled pens. Which type of insulin preparation is Tresiba®? Rapid-acting insulin Short-acting insulin Intermediate-acting insulin Long-acting insulin Ultra-long-acting insulin

Ultra

A 49-year-old patient is admitted to hospital with severe persistent abdominal pain. He is diagnosed with acute pancreatitis and this is likely to be associated with a medication he was prescribed for type 2 diabetes mellitus. Which of the following medications is he likely to have been prescribed? Metformin Pioglitazone Glibenclamide Acarbose Sitagliptin

Sitagliptin is a DPP-4 inhibitor (dipeptidyl peptidase-4 inhibitor) used in the treatment of type 2 diabetes mellitus. One of the known but rare side effects of DPP-4 inhibitors (gliptins) is acute pancreatitis.

During the current pandemic, you are informed that COVID-19 is a notifiable disease. Which of the following conditions is not a notifiable disease? Malaria Leprosy Anthrax Pneumonia Scarlet fever

Pneumonia

You are the responsible pharmacist in a community pharmacy. The pharmacy technician recently read that there are five generations of cephalosporin antibiotics. Which of the following cephalosporins belongs to the third generation? Cefalexin Cefuroxime Ceftaroline Ceftazidime Cefradine

Ceftazidime

A 37-year-old patient on the ward is diagnosed with aspergillosis, the doctor on the ward is not familiar with the treatment options for aspergillosis. Which antifungal is the treatment of choice for aspergillosis? Fluconazole Amphotericin B Caspofungin Clotrimazole Voriconazole

The correct answer is Voriconazole. Explanation: Aspergillosis is a fungal infection caused by Aspergillus species, primarily affecting immunocompromised patients (e.g., those with neutropenia, transplant recipients, or long-term corticosteroid use).

It has been a few months since Andrew Smith has been discharged from hospital following an ST-elevated myocardial infarction. He has been experiencing nightmares which are affecting his sleep. Which medication is likely to be responsible for his nightmares? Bisoprolol GTN spray Aspirin Clopidogrel Atorvastatin

Bisoprolol

A 54-year-old patient is admitted to hospital and is commenced on Verapamil by slow intravenous infusion for the treatment of supraventricular arrhythmias. Which of the following side effects commonly occurs in patients prescribed verapamil by intravenous infusion? Bradycardia Hypertension Hyponatraemia Hypoglycaemia Hypokalaemia

Verapamil is a non-dihydropyridine calcium channel blocker (CCB) used in the treatment of supraventricular arrhythmias (e.g., atrial fibrillation, paroxysmal supraventricular tachycardia). It works by blocking calcium channels in the heart, leading to: Reduced heart rate (negative chronotropic effect) Reduced myocardial contractility (negative inotropic effect) Slowed atrioventricular (AV) node conduction Common Side Effect of IV Verapamil: Bradycardia is the most common adverse effect due to its action on the AV node, which slows conduction and decreases heart rate.

A 54-year-old patient walks into your community pharmacy with a prescription for a new medication to aid smoking cessation. Which of the following is not a suitable treatment to aid smoking cessation? Bupropion Inositol nicotinate NRT lozenges NRT patches Varenicline

Inositol nicotinate is not a licensed treatment for smoking cessation. It is a nicotinic acid derivative used as a vasodilator in conditions like intermittent claudication and Raynaud’s phenomenon, but it does not have any role in smoking cessation.

A 44-year-old patient walks into your community pharmacy with a prescription for Dipyridamole 200mg MR capsules. What would be the most appropriate counselling advice for a patient prescribed Dipyridamole 200mg MR capsules for the first time? Take with or after food Discard any remaining capsules 6 weeks after opening Disperse the contents of the capsule into water Avoid exposure to sunlight or sun lamps Swallow whole with plenty of fluid

Discard any remaining after 6 weeks

A 57-year-old woman is diagnosed with primary heterozygous familial hypercholesterolaemia and has a contraindication to statins. Which of the following medications is the preferred alternative monotherapy? Atorvastatin 80mg OD Fluvastatin 40mg OD Ezetimibe 10mg OD Cilostazol 100mg OD Prasugrel 10mg OD

Ezetimibe

You are a pharmacist working in a GP surgery, A 42-year-old patient is diagnosed with an acute exacerbation of chronic obstructive pulmonary disease (COPD) by the general practitioner. What is the first-line treatment for a patient with an acute exacerbation of COPD? The patient is not severely unwell and is able to take oral medication. Meropenem Clarithromycin Tigecycline Levofloxacin Co-trimoxazole

For an acute exacerbation of COPD, the first-line treatment typically includes: Bronchodilators (e.g., short-acting beta-agonists like salbutamol or antimuscarinics like ipratropium) Oral corticosteroids (e.g., prednisolone 30mg OD for 5 days) Antibiotics (if signs of bacterial infection are present, such as increased sputum purulence, volume, or breathlessness) First-Line Antibiotic for an Acute COPD Exacerbation: First-line: Amoxicillin, Doxycycline, or Clarithromycin Clarithromycin is a macrolide antibiotic commonly used when a bacterial infection is suspected in a COPD exacerbation.

You are the ward pharmacist working on a respiratory ward. The medical student on the ward wants to learn about which antibiotics should not be given to a patient with a penicillin allergy. Which of the following antibiotics should not be given to a patient with a penicillin allergy? Co-trimoxazole Tigecycline Ciprofloxacin Piperacillin/tazobactam Azithromycin

Piperacillin/tazobactam

You are the ward pharmacist working on an acute admissions ward and a 39-year old male patient, Ryan Smith, is diagnosed with cellulitis. Which of the following antibiotics would be the most appropriate treatment option for cellulitis? Mr Smith has a penicillin allergy Gentamicin Nitrofurantoin Ciprofloxacin Doxycycline Ertapenem

Doxy

You are the ward pharmacist working on a respiratory ward, a 45-year-old male patient is diagnosed with hospital-acquired pneumonia and the junior doctor on the ward asks you about the treatment options. Which of the following antibiotics would be the most appropriate first-line treatment option for hospital- acquired pneumonia? The patient does not have any drug allergies, does not have any severe signs or symptoms and is not at high risk of resistance. Gentamicin Teicoplanin Meropenem Co-amoxiclav Tigecycline

For patients who do not have severe symptoms and are not at high risk of resistant pathogens, Co-amoxiclav (or Piperacillin/Tazobactam in some guidelines) is a suitable first-line option.

You are the ward pharmacist working on a cardiology ward, a 52-year-old female patient is diagnosed with infective endocarditis caused by streptococcus species and is due to be started on teicoplanin and low-dose gentamicin. Which antibiotic class does teicoplanin belong to? Aminoglycosides Glycopeptides Macrolides Tetracyclines Penicillins

Glycopeptides

A patient is commenced on fludrocortisone acetate alongside other medication for the treatment of adrenocortical insufficiency resulting from septic shock. Which of the following is not likely to be a side effect associated with mineralocorticoids? Hypertension Hypokalaemia Hypernatraemia Hyperglycaemia Water retention

Fludrocortisone is a mineralocorticoid that primarily affects electrolyte balance and fluid retention rather than glucose metabolism. It mimics aldosterone, increasing sodium retention and potassium excretion in the kidneys. Common Side Effects of Mineralocorticoids (Fludrocortisone): ✅ Hypertension – Due to sodium and water retention. ✅ Hypokalaemia – Caused by increased renal excretion of potassium. ✅ Hypernatraemia – Due to increased sodium reabsorption. ✅ Water retention – Caused by sodium retention leading to oedema. Why Not Hyperglycaemia? Hyperglycaemia is more associated with glucocorticoids (e.g., prednisolone, dexamethasone) rather than mineralocorticoid

A 36-year-old patient with type 1 diabetes mellitus walks into your community pharmacy with a prescription for Humalog® KwikPen 100units/ml solution for injection 3ml prefilled pens. Which type of insulin preparation is Humalog®? Rapid-acting insulin Short-acting insulin Intermediate-acting insulin Long-acting insulin Ultra-long-acting insulin

Humalog

A 47-year-old patient with type 2 diabetes mellitus is prescribed a new medication to be taken alongside his insulin to improve his diabetes control. The general practitioner informs him that he will be closely monitored for signs of heart failure. Which of the following medications is he likely to have been prescribed? Gliclazide Pioglitazone Acarbose Sitagliptin Metformin

Pioglitazone is a thiazolidinedione (TZD) used in the management of type 2 diabetes mellitus (T2DM). It improves insulin sensitivity but has a known risk of fluid retention and heart failure exacerbation. Why Pioglitazone? It can cause fluid retention, leading to peripheral oedema and worsening of heart failure. NICE and MHRA caution its use in patients with a history of heart failure or those at risk. Patients on pioglitazone require monitoring for signs of heart failure, such as shortness of breath, oedema, and weight gain.

A 35-year-old is commenced on a basal bolus regimen to manage his type 1 diabetes mellitus. Which of the following insulins is not an example of a basal insulin? Insulin glargine Insulin detemir Insulin degludec Insulin glulisine Insulin isophane

Insulin glulisine

A 63-year-old patient is admitted into hospital with hyperkalemia. He was recently diagnosed with a non-ST elevation myocardial infarction and was started on several medications for long-term management. Which of the following medications is likely to have caused hyperkalaemia? Clopidogrel Aspirin Atorvastatin Rampiril Bisoprolol

Ramipril

A 54-year-old patient walks into the community pharmacy with a prescription for Naftidrofuryl oxalate 100mg TDS. What is the likely indication? Asthma Ischaemic heart disease Hypertension Chronic obstructive pulmonary disease Peripheral vascular disease

Naftidrofuryl oxalate is a vasodilator used primarily for the treatment of peripheral vascular disease (PVD), particularly intermittent claudication in patients with chronic peripheral arterial disease (PAD). Why Naftidrofuryl for PVD? It improves blood flow by blocking 5-HT2 receptors, leading to vasodilation. Enhances oxygen supply to ischemic tissues, reducing pain and cramps during walking (claudication). Recommended by NICE as an option for patients with PVD who cannot undergo revascularisation and need symptom relief.

What are the monitoring requirements for Naftidrofuryl oxalate 100mg TDS? LFT's after 3 months Renal function after 3-6 months Assessed for improvement after 3-6 months U&E's after 6 months LFT's and U&E's after 3 months

Assess for improvement after 3-6 months

A 61-year-old man with a history of asthma has been taking Verapamil for long term prevention of chest pain due to stable angina. He is still experiencing symptoms despite being on Verapamil for the past few months. Which of the following is a suitable medication that can be added to control angina symptoms? Atenolol Amlodipine Ivabradine Metoprolol Ramipril

Ivabradine is used in the management of stable angina in patients who have normal sinus rhythm but a high heart rate that isn't controlled by traditional medications like beta-blockers or calcium channel blockers. Ivabradine works by selectively inhibiting the If current in the sinoatrial node, which reduces the heart rate without affecting blood pressure significantly. It is particularly useful for patients with angina who have a high heart rate (often greater than 70 bpm) despite being on optimal doses of beta-blockers. Why Ivabradine might be the right choice for this patient: The patient already takes Verapamil, which is a calcium channel blocker (like Amlodipine). If symptoms persist, it suggests that the heart rate might be contributing to angina and needs further management. Ivabradine is especially useful in cases where beta-blockers or other heart rate-lowering medications (such as Verapamil) aren't sufficient in controlling heart rate and, therefore, angina symptoms. Importantly, Ivabradine is heart-rate specific and doesn't have the same bronchodilator effects as Verapamil, so it would not worsen asthma.

A 23-year-old patient with type 1 diabetes mellitus is commenced on an insulin to be taken for meals. She is informed to inject her insulin 15-30 minutes before food. Which of the following insulin preparations is she likely to have been prescribed? Fiasp® Tresiba® Apidra® Actrapid® Humalog®

Actarapid

A 45-year-old patient visits his general practitioner as he is concerned about the fact that he has noticed inflammation of the foreskin and glans penis since starting a new medication for type 2 diabetes mellitus. Which of the following medications is he likely to have been prescribed? Pioglitazone Empaglifozin Acarbose Gliclazide Metformin

Empaglifozin

A 44-year-old patient walks into your community pharmacy with a prescription for prednisolone. The preregistration pharmacist in your pharmacy is learning about glucocorticoid activity and wants to know which of the following corticosteroids has the highest glucocorticoid activity. Which of the following corticosteroids has the highest glucocorticoid activity? Prednisolone Dexamethasone Fludrocortisone Hydrocortisone Deflazacort

Dexamethasone

A 79-year-old patient is admitted into hospital due to a fall. You are the ward pharmacist and are asked by the junior doctor to review his medication to identify whether a medication the patient was taking may have increased their risk of falls. Which of the following medications is likely to have increased the patient’s risk of a fall? Metformin Acarbose Gilbenclamide Empagliflozin Pioglitazone

Glibenclamide, a sulfonylurea, can increase the risk of hypoglycemia, which could lead to falls, especially in elderly patients.

You are currently working as the responsible pharmacist in a community pharmacy. The pre-registration pharmacist is currently learning about gentamicin. Which of the following side effects is not associated with gentamicin? Ototoxicity Nephrotoxicity Peripheral neuropathy Thrombocytosis Antibiotic associated colitis

Thrombocytosis

You are working as the ward pharmacist in the accident and emergency department and a 32-year-old female patient is diagnosed with a lower urinary tract infection. The junior doctor on the ward wants to learn about the bacteria that cause urinary tract infections. Which bacteria has been found to most commonly cause urinary tract infections? Escherichia coli Staphylococcus aureus Streptococcus pneumoniae Pseudomonas aeruginosa Serratia marcescens

E.coli

You are currently working as a pharmacist in a hospital pharmacy. You are clinically checking a prescription for dalbavancin for an acute bacterial skin infection. Which antibiotic class does dalbavancin belong to? Aminoglycosides Macrolides Glycopeptides Lincosamides Penicillins

Glycopeptides

You are currently working as the ward pharmacist on a respiratory ward. A 37-year old male patient is diagnosed with tuberculosis. He is started on four antibiotics as part of the initial phase of treatment for tuberculosis Which one of the following antibiotics is not used for the treatment of tuberculosis? Isoniazid Rifampicin Pyrazinamide Fosfomycin Ethambutol

Fosfomycin

A 41-year-old patient is diagnosed with stable angina by the general practitioner due to chest pain on exertion. Which of the following medications is not indicated to treat a patient with stable angina? Bisoprolol Verapamil Eplerenone Nicorandil Ranolazine

Eplerone

A 72-year-old patient is started on atorvastatin. Three months later the patient attends a follow-up appointment with regards to the new medication. Which blood test should be taken after 3 months to monitor for any side effects associated with atorvastatin? Full blood count Liver function tests Thyroid function tests HbA1c level Brain natriuretic peptide

LFT

A 54-year-old patient who is known to you, Andrew Smith, was started on a new medication for the treatment of atrial fibrillation. He comes into the community pharmacy as he has noticed visual impairment and is concerned that it is associated with the new medication. Which of the following medications is likely to have been prescribed for the treatment of atrial fibrillation? Bisoprolol Ramipril Amiodarone Verapamil Losartan

Amiodarone

QUESTION 15 A 47-year old male patient starts to experience chest pain on exertion, he visits the cardiorespiratory admission unit at the hospital as he is concerned. He is diagnosed with stable angina. Which of the following medications is likely to be prescribed as first-line for a patient with stable angina to prevent further episodes of chest pain? Spironolactone Ivabradine Glyceryl trinitrate Amlodipine Bisoprolol

Bisoprolol

A 54-year old patient is admitted to the coronary care unit following a non-ST elevation myocardial infarction. During his admission, he is diagnosed with heart failure with a left ventricular ejection fraction of 30%. The cardiology consultant wants to commence the patient on an aldosterone antagonist alongside his current therapy. Which of the following medications is the most suitable aldosterone antagonist for a patient with heart failure post myocardial infarction? Ranolazine Ivabradine Eplerenone Spironolactone Verapamil

The most suitable aldosterone antagonist for a patient with heart failure post-myocardial infarction is Spironolactone or Eplerenone. Both are aldosterone antagonists, but Eplerenone is preferred in some cases due to fewer side effects, especially with regard to hormonal side effects like gynecomastia.

A patient is diagnosed with type 1 diabetes mellitus and is initiated on a basal bolus regimen to control their diabetes mellitus. Which of the following insulins is not an example of a bolus insulin? Insulin lispro Insulin aspart Insulin degludec Insulin glulisine Insulin soluble

Insulin degludec

A patient is due to be prescribed 30mg prednisolone on a cardiorespiratory admissions unit for suppression of an inflammatory disorder, however the medical team on the ward are also considering using methylprednisolone. What is the equivalent anti-inflammatory dose of methylprednisolone? 20mg 22mg 24mg 26mg 30mg

24mg

You are working on an acute admissions ward and the medical student on the ward is learning about corticosteroids and wants to ask you a question in relation to glucocorticoid activity. Which of the following corticosteroids has the lowest glucocorticoid activity? Dexamethasone Prednisolone Betamethasone Hydrocortisone Deflazacort

Hydrocortisone

You are working on an endocrinology ward and a patient has been started on an antibiotic to treat a diabetic foot infection caused by Methicillin-resistant Staphylococcus aureus (MRSA). The patient has noticed that his vision is blurred and he is struggling to discern details when looking at objects since starting the antibiotic and is concerned. Which of the following antibiotics is most likely to be associated with this side effect? Doxycycline Amoxicillin Dalbavancin Ertapenem Linezolid

The antibiotic most likely to be associated with blurred vision as a side effect in this case is Linezolid. Linezolid is an antibiotic used to treat MRSA infections, and it is known to cause optic neuropathy and blurred vision in some patients, especially with prolonged use or higher doses. This is a well-documented side effect of the drug.

You are working on an acute admissions ward with a pharmacy student, A patient is admitted with an infection and currently takes sodium valproate for epilepsy. The pharmacy student wants to know whether there are any antibiotics that should not be given to a patient with epilepsy. Which of the following antibiotics should be avoided in a patient taking sodium valproate? Amoxicillin Ertapenem Co-trimoxazole Linezolid Teicoplanin

The correct answer is Ertapenem. Ertapenem should be avoided in patients taking sodium valproate because it can reduce the plasma levels of sodium valproate, potentially leading to loss of seizure control in patients with epilepsy. This is due to ertapenem’s ability to interfere with the binding of valproate to plasma proteins, which lowers its concentration.

The echinocandin antifungal agents act by inhibiting the synthesis of 1,3-β-d-glucan in the fungal cell wall. Which of the following is an example of a echinocandin? Fluconazole Amphotericin B Clotrimazole Caspofungin Nystatin

Caspofungin

A 38-year-old patient with type 1 diabetes mellitus walks into your community pharmacy with a prescription for Actrapid® 100units/ml solution for injection 10ml vials. Which type of insulin preparation is Actrapid®? Rapid-acting insulin Short-acting insulin Intermediate-acting insulin Long-acting insulin Ultra-long-acting insulin

Short acting

A 42-year-old patient with type 1 diabetes mellitus walks into your community pharmacy with a prescription for Novorapid® 100units/ml solution for injection 10ml vials. Which type of insulin preparation is Novorapid®? Rapid-acting insulin Short-acting insulin Intermediate-acting insulin Long-acting insulin Ultra-long-acting insulin

Rapid acting

Gradual withdrawal of systemic corticosteroids may need to be considered in some cases to prevent adverse effects, such as adrenal insufficiency. Which of the following scenarios does not require gradual withdrawal? Received more than three weeks of treatment Recent received repeated courses Been given repeat doses in the evening Received 30mg prednisolone daily for 1 week Taken a short course within 1 year of stopping long-term therapy

30mg pred daily for one week

A 47-year-old patient with type 2 diabetes mellitus has commenced on a new medication for his diabetes. He is advised by his general practitioner that there is a rare risk of lactic acidosis. Which of the following medications is he likely to have been prescribed? Pioglitazone Gliclazide Sitagliptin Metformin Empagliflozin

Metformin

A 54-year-old patient walks into the community pharmacy with a prescription for glyceryl trinitrate sublingual tablets for prophylaxis of angina. Which of the following is the correct administration advice for patients prescribed glyceryl trinitrate sublingual tablets indicated for prophylaxis of angina? 1 tablet, to be administered prior to activity likely to cause angina 1 tablet, the dose may be repeated at 5-minute intervals if required; if symptoms have not resolved after 3 doses, medical attention should be sought 400–800micrograms, to be administered under the tongue and then close mouth prior to activity likely to cause angina 400–800micrograms, to be administered under the tongue and then close mouth, the dose may be repeated at 5-minute intervals if required; if symptoms have not resolved after 3 doses, medical attention should be sought 2-3 sprays under the tongue and then close mouth, the dose may be repeated at 5-minute intervals if required; if symptoms have not resolved after 3 doses, seek medical attention

1 tablet, to be administered prior to activity likely to cause angina

A 54-year-old walks into your community pharmacy as he is experiencing side effects to his new medication, he was recently started on propranolol for the treatment of arrhythmias. Since starting his new medication, he experiences nightmares and he is concerned. Which of the following beta blockers is less likely to cause nightmares? Labetalol Metoprolol Pindolol Atenolol Ramipril

Atenolol

A 57-year-old patient is started on a new medication for heart failure alongside ramipril, he walks into the community pharmacy as he has started to notice swelling of his face and lips. Which of the following medications is likely to cause these side effects when taken alongside ramipril? Spironolactone Eplerenone Amiloride Sacubitril/valsartan Bisoprolol

The medication most likely to cause facial and lip swelling (angioedema) when taken alongside ramipril is Sacubitril/valsartan. Sacubitril/valsartan is an angiotensin receptor neprilysin inhibitor (ARNI) that is commonly used in heart failure. When taken with an ACE inhibitor like ramipril, there is an increased risk of angioedema due to the synergistic effect of inhibiting both the neprilysin enzyme and the angiotensin-converting enzyme (ACE), leading to elevated levels of bradykinin, which can cause swelling.

You are the hospital pharmacist working on a respiratory ward and a patient is diagnosed with community- acquired pneumonia (CAP). The patient is prescribed doxycycline. Which of the following is not a likely side effect of doxycycline? Photosensitivity Dysphagia Visual disturbances Teeth discolouration Nephrotoxicity

Nephrotoxicity

You are the hospital pharmacist working on a respiratory ward and a patient is diagnosed with community acquired pneumonia caused by Legionella pneumophila. Which of the following antibiotics is effective against Legionella pneumophila? Co-amoxiclav Amoxicillin Piperacillin/tazobactam Ceftazidime Levofloxacin

The antibiotic effective against Legionella pneumophila is Levofloxacin. Legionella infections are often treated with antibiotics that are effective against atypical organisms, and fluoroquinolones like levofloxacin are commonly used for this purpose. Other antibiotics, such as co-amoxiclav, amoxicillin, piperacillin/tazobactam, and ceftazidime, are not typically used to treat Legionella, as they are not effective against this pathogen.

You are the hospital pharmacist working on an admission ward with a pre-registration pharmacist. The preregistration pharmacist wants to learn more about the spectrum of activity of antibiotics. Which of the following antibiotics has a narrow spectrum of activity? Co-amoxiclav Meropenem Doxycycline Fidaxomicin Ciprofloxacin

The antibiotic with a narrow spectrum of activity is Fidaxomicin. Fidaxomicin is primarily used to treat Clostridium difficile infections and has a narrow spectrum of activity, focusing specifically on Gram-positive bacteria, particularly anaerobes, such as C. difficile.

A 32-year-old patient is commenced on a medication for hypothyroidism. The general practitioner explains the importance of remaining on the same brand, as other brands of the medication may not be bioequivalent. Which of the following medications is he likely to have been prescribed? Carbimazole Levothyroxine Propylthiouracil Atenolol Liothyronine

Liothryonine

A 24-year-old is newly diagnosed with type 1 diabetes mellitus and has been informed that he needs to ensure he tests his blood-glucose concentration no more than 2 hours before driving. What should the blood-glucose concentration be prior to driving according to the Driver and Vehicle Licensing Agency (DVLA)? At least 4 mmol/litre At least 5 mmol/litre At least 6 mmol/litre At least 8 mmol/litre At least 10 mmol/litre

At least 5mmol/litre

A 37-year-old patient with type 1 diabetes mellitus walks into your community pharmacy with a prescription for Insuman Basal® 100units/ml suspension for injection 3ml prefilled SoloStar pens. Which type of insulin preparation is Insuman Basal®? Rapid-acting insulin Short-acting insulin Intermediate-acting insulin Long-acting insulin Ultra-long-acting insulin

Intermediate acting

A 63-year-old patient is started on a medication for the treatment of atrial fibrillation and he has started to notice a predominance of yellow in vision. Which of the following medications is likely to cause this side effect? Ramipril Bisoprolol Losartan Amiloride Digoxin

This is a classic side effect of digoxin toxicity, where patients may experience visual disturbances such as xanthopsia (seeing everything with a yellow tint). Digoxin is a cardiac glycoside used to treat atrial fibrillation and heart failure, and visual disturbances are one of the common signs of digoxin toxicity, which can also include nausea, vomiting, confusion, and arrhythmias.

A 72-year-old patient calls your community pharmacy and is concerned that he has overdosed on his warfarin by mistake. He has taken five pink tablets and did not notice they were a different colour to the tablets he usually takes. How many milligrams of warfarin is he likely to have taken? 5mg 10mg 15mg 25mg 30mg

25mg

Mr Dye Rhea, 34, has been diagnosed with Clostridioides difficile infection. He is prescribed vancomycin for the treatment of his infection for a duration of 10 days. Which of the following is the correct dose and frequency? 750mg 12 hourly orally 750mg 12 hourly intravenously 125mg 6 hourly orally 125mg 6 hourly intravenously 1000mg 6 hourly intravenously

125mg 6 hourly orally. Oral vancomycin is used to treat C. difficile infection because it works locally in the gut, where the infection occurs. The standard dosage for an adult patient is 125mg every 6 hours for 10 days.

Mr Van Co, 56, was diagnosed with a severe diabetic foot infection. He was prescribed Vancomycin intravenously. He is currently experiencing ringing in the ears and he is concerned as he thinks it may be due to the new antibiotics. The medical team ask for your opinion. Which of the following would you advise? Continue the antibiotics and monitor Extend the duration of the antibiotics Lower the dose of the antibiotics Discontinue the antibiotic Increase the dose of the antibiotics

Discontinue The patient is experiencing ringing in the ears (tinnitus), which is a common side effect of vancomycin, especially when administered intravenously. This side effect is typically due to ototoxicity. Ototoxicity can cause tinnitus, hearing loss, and other auditory issues. If a patient develops tinnitus while on vancomycin, it is generally recommended to discontinue the antibiotic and consult with the medical team to consider alternative treatments. Vancomycin-induced ototoxicity can be dose-dependent, but the presence of tinnitus is an indicator that the current dose may be too high for the patient.

Miss H is currently on Sertraline. She has been initiated on Diclofenac for pain she has been experiencing for the past couple of weeks. Which of the following electrolyte imbalance is most likely to occur? Hyperkalaemia Hypomagnesemia Hypernatremia Hypercalcaemia Hyponatraemia

Hyponatraemia

Mr W suffers from Parkinson’s disease and has been drooling saliva more than normal recently. What would be the most appropriate first line treatment? Refer him to the speech and language therapist There is no treatment for this side effect Glycopyrronium bromide Salivix pastilles Botulinum toxin type A

Refer

According to the MHRA advice for Metoclopramide. What would be the most appropriate dose to prescribe? 10mg repeated up to four times a day for seven days 10mg repeated up to three times a day for five days 10mg repeated up to three times a day for seven days 10mg repeated up to four times a day for five days 10mg repeated up to three times a day for ten days

10mg repeated up to three times a day for five days

A patient comes in explaining he has been binge eating for the past two weeks and he just cannot seem to stop and he is a bit concerned because he has gained a lot of weight in the past two weeks. Which of the following medications is most likely to cause this? Co-careldopa Risperidone Sertraline Bromocriptine Selegiline

Co-careldopa is a combination of levodopa and carbidopa, typically used for Parkinson's disease. One of the side effects of levodopa, which is a precursor to dopamine, can be dopamine dysregulation, leading to impulsivity, including binge eating, as well as potential weight gain. This phenomenon is sometimes referred to as dopamine dysregulation syndrome, where patients may develop addictive behaviors, including overeating.

Which of the following antidepressants are the most sedative? Trazadone Imipramine Lofepramine Nortriptyline Sertraline

Trazadone

How many weeks should you wait before starting Tranylcypromine for a patient previously on Mirtazapine? 1 week 2 weeks 4 weeks 3 days 5 weeks

When switching from Mirtazapine (or other serotonergic medications) to an MAOI like Tranylcypromine, a washout period of 1 week is generally recommended to reduce the risk of serotonin syndrome.

Which of the following is a symptom of serotonin syndrome? Tachycardia Bradycardia Constipation Hypothermia Hyperkalaemia

The correct symptom of serotonin syndrome is tachycardia. Other common symptoms of serotonin syndrome include: Hyperreflexia Clonus Agitation Sweating Tremors Fever

Which of the following is best described as an extra pyramidal side effect? Tardive dyskinesia Weight gain Hyperglycaemia QT interval prolongation Sexual dysfunction

Tardive dyskinesia is an extrapyramidal side effect (EPS) that involves involuntary, repetitive movements, such as grimacing, tongue protrusion, and other abnormal body movements. It is often caused by long-term use of antipsychotic medications, particularly first-generation antipsychotics.

For how long should patients be monitored for relapse after withdrawing from antipsychotic medication? 1 month 1 year 2 years 6 months 3 years

2 years

As part of a teaching session on antipsychotics you produce a presentation regarding first and second generation antipsychotics. Both generations can be used in treating schizophrenia. However, they have different side effect profiles. Which of the following antipsychotics would have the most extrapyramidal side effects? Chlorpromazine Periciazine Prochlorperazine Sulpiride Pimozide

Chlorpromazine

Mrs P comes in to collect her son's repeat prescription. She explains how she requested another spacer device which has been dispensed. She asks if cleaning it once a week is enough. What is the most appropriate advice? Explain that once a week cleaning is fine to do Explain that the spacer device does not need cleaning Explain that the spacer should be cleaned once a month with detergent and water Explain that the spacer should be cleaned once a month with detergent and water and air dry Explain that the spacer should be cleaned once every two months with detergent and water and air dry

Explain that the spacer should be cleaned once a month with detergent and water and air dry

A pre registration pharmacist is sitting in on an asthma clinic with an asthma nurse. A patient comes in who is currently taking salbutamol two puffs when required, Qvar inhaler two puffs twice a day. However, the patient explains he is waking up at night and has to use their salbutamol inhaler every day. What would be the most appropriate next step according to the NICE guidelines? Montelukast Salmeterol Theophylline Tiotropium Prednisalone

Montelukast

pratropium bromide can be used in the treatment of asthma. Which of the following would be the most appropriate advice to provide a patient? Diarrohea is a common side effect of ipratropium Counsel patients on administration of ipratropium ensuring patients are made aware of accidental contact with the eye No specific advice is needed Patients should not use this inhaler if they have glaucoma Inhale fast and deep when using this inhaler

Counsel patients on administration of ipratropium ensuring patients are made aware of accidental contact with the eye

Montelukast is an example of a leukotriene receptor antagonist which is used in the treatment of asthma. Mrs S has been newly prescribed Montelukast at a dose of 10mg in the evening. What would be the most appropriate counselling advice to provide when handing out medication? Patients should be counselled on neuropsychiatric reactions and should seek immediate medical attention if any changes to speech and behaviour occur. It should be taken 30 mins before bed Vomiting and diarrhoea are common side effects Crush the tablet before taking it It can be crushed and mixed with orange juice if needed.

Patients should be counselled on neuropsychiatric reactions and should seek immediate medical attention if any changes to speech and behaviour occur.

Intermediate-acting insulins have an intermediate duration of action, designed to mimic the effect of endogenous basal insulin. Which of the following is an example of an intermediate-acting insulin? Humulin S Fiasp Humulin I Tresiba

Humulin I

Fluoroquinolones and quinolones are a class of broad-spectrum antibiotics that are active against bacteria of both Gram-negative and Gram-positive classes. Which of the following is an example of a quinolone antibiotic? Doxycycline Amoxicillin Ertapenem Meropenem Delafloxacin

Delafloxacin

Antimuscarinics can be used in the treatment of asthma and COPD. Which of the following is NOT a common side effects of antimuscarinics? Dry mouth Constipation Skin reactions Diarrhoea Urinary disorders

Diarrhoea

A patient has newly been prescribed a QVAR inhaler as her symptoms were not being controlled from salbutamol alone. You gain consent for her to participate in the new medicine service the pharmacy provides and you counsel her on the correct inhaler technique. Which of the following would be the most appropriate technique for her new QVAR pMDI inhaler? Inhale fast and deep Inhale slow and steady Breathe into the inhaler before you take a dose Do not shake the inhaler before use Hold your breath for one minute before exhaling

Inhale slow and steady

Which of the following MHRA advice is associated with corticosteroid use? Visual disturbances as there is a risk of serous chorioretinopathy Candidiasis Diabetes Osteoporosis Hypernatraemia

Visual disturbances as there is a serious risk of chorioretinopathy

Miss T has been using a salbutamol inhaler for the past year. She has been getting on with it fine and has rarely needed to use it. But she comes in to collect a new prescription of a low dose inhaled corticosteroid. Which of the following statements warrants Miss T the addition of a corticosteroid inhaler? Using her salbutamol inhaler once a week Symptomatic three times a week or more Not waking up at least one night a week Never using her Salbutamol inhaler Her Salbutamol inhaler has finished

Symptomatic three times a week or more