PP: Great questions to go over again

Question 1

A 40-year-old female patient was hospitalised following a severe asthma attack. She was treated with the following medicines and her asthma is now more stable:
- Salbutamol 5mg nebulisers
- Hydrocortisone 100mg IV
- Ipratropium 500mcg nebulisers
- Theophylline 200mg tablets BD
2 days after her admission she has developed hospital-acquired pneumonia and is prescribed ciprofloxacin.

Which one of the following is the most at risk?
a) Worsening of asthma control
b) Hyperkalaemia
c) Convulsions
d) Prolonged QT interval
e) Tendon rupture

Answer 1

e) Tendon rupture

Concomitant use of quinolones and corticosteroids = increases the risk of tendonitis = tendon rupture/damage

Question 2

A 60-year-old man presents to the pharmacy and asks you for advice on erectile dysfunction. Which one of the following drugs is NOT a common cause of erectile dysfunction?
a) Amitriptyline
b) Ramipril
c) Bisoprolol
d) Haloperidol
e) Metformin

Answer 2

E, METFORMIN

ED risk factors =
Drugs- antihypertensives, antipsychotics,
antidepressants, cytotoxic drugs, recreational drugs

Question 3

A 30-year old female has given birth to her first child. She has previously taken Cilest (Ethinylestradiol/Norgestimate) for contraception and would like to start taking this again. She plans to breastfeed her baby for as long as possible. When can she safely start taking Cilest again?
a) After day 21 post-partum
b) After day 28 post-partum
c) After day 7 post-partum
d) She cannot use Cilest whilst breastfeeding
e) Immediately

Answer 3

If you start the pill later than 21 days after giving birth, you will need additional contraception (such as condoms) for the next 7 days. If you are breastfeeding, you’re not advised to take the combined pill until 6 weeks after the birth.

Question 4

A diabetic patient is prescribed vardenafil for erectile dysfunction on an NHS prescription. Which one of the following is true about this prescription?
a) It must state ‘Do not take more than 2 tablets per day
b) It must be endorsed as ‘SLS’
c) No more than 14 days of treatment should be
prescribed
d) All patients must pay prescription fees for this
medication
e) The prescription is only valid for 28 days

Answer 4

b) It must be endorsed as ‘SLS’

The drugs used for erectile dysfunction are not available on NHS prescription except to treat erectile dysfunction in men.

The prescription must be endorsed ‘SLS’
- Generic sildenafil can be prescribed on the NHS
- Those who are not exempt from the prescription fees,
must pay as per usual prescription payment requirements

Question 5

An 18-year old female presents with tiredness, shortness of breath and palpitations which are indicative of anaemia. This is likely secondary to menorrhagia. She has no other medical conditions but does take Microgynon (Ethinylestradiol and Levonorgestrel) for contraception. Which one of the following is the first line treatment for menorrhagia for this patient?
a) Intrauterine system (Mirena)
b) Tranexamic acid
c) Combined oral contraceptive pill
d) Long-acting progestogen
e) Copper intrauterine device

Answer 5

A – Intrauterine system (Mirena)
- 1st line→ Intrauterine system (Mirena)- releases levonorgestrel
- Combined oral contraceptive pill
- Long-acting progestogens
- Mefenamic acid or tranexamic acid started on the first
day of the period, if contraception is declined

Question 6

A 50-year-old man presents with right-sided loin to groin pain. He is diagnosed with renal colic and requires analgesics to control his pain. He has no other medical conditions and does not take any other drugs. Which one of the following is the first-line treatment for this man’s pain?
a) Ibuprofen
b) Paracetamol
c) Morphine
d) Codeine
e) Tramadol

Answer 6

A – Ibuprofen

Pain management:
➢1st line→NSAIDs
➢2nd line→Paracetamol
➢3rd line→Opioids
➢ Avoid antispasmodics

Offer NSAIDs as first line treatment for the management of pain associated with suspected renal colic or renal and ureteric stones.

Question 7

A 30-year old female has given birth to her first child. She has previously taken Cilest (Ethinylestradiol/Norgestimate) for contraception and would like to start taking this again. She plans to breastfeed her baby for as long as possible. When can she safely start taking Cilest again?
a) After day 21 post-partum
b) After day 28 post-partum
c) After day 7 post-partum
d) She cannot use Cilest whilst breastfeeding
e) Immediately

Answer 7

A – After day 21 post-partum

Contraception is not required in the first 21 days post-partum but if the woman wishes to most methods can be safely initiated immediately, with the exception of combined hormonal contraception (CHC)

Question 8

A 55-year old female presents to the pharmacy as she was alarmed by an episode of blood in her urine this morning. She reports no other urinary symptoms and has been well otherwise. Which one of the following is the most appropriate advice?
a) Refer to A&E
b) Supply potassium citrate sachets
c) Refer to GP
d) Reassure her as this was a one-off problem
e) Advise her to drink cranberry juice

Answer 8

haematuria - blood in the urine

Causes
➢UTI and pyelonephritis ➢Renal stones
➢Malignancies of urinary tract

Refer
➢45 years or older if there is unexplained visible haematuria without UTI, or visible haematuria persisting or recurring despite successful treatment of UTI
➢60 years or older with unexplained non-visible haematuria and either dysuria or raised white cell count
➢60 years or older with recurrent or persistent unexplained urinary tract infection

Question 9

An 18-year old female is prescribed Gedarel (Ethinylestradiol/Desogestrel). This is the first time she is taking a contraceptive pill and she asks you when she should start taking it. Her menstrual cycle is 28 days long and are
regular. Which one of the following is the most appropriate response?
a) She must check with her GP
b) She must start on the first day of her next period
c) She must start on the last day of her next period
d) She can start at any time but she must use additional
contraception for the first 5 days
e) She can start at any time and does not need any
additional contraception

Answer 9

first day of your next period (day 1-5 of a 28- day cycle)

Question 10

A GP calls you for advice on treating a candida infection in a 12-week pregnant woman. She has no drug allergies and does not take any other medication other than folic acid 400mcg. Which one of the following is the most appropriate treatment for her?
a) Clotrimazole pessary
b) Fluconazole tablet
c) Clotrimazole cream
d) Itraconazole capsule
e) Metronidazole tablet

Answer 10

C – clotrimazole cream

• Treated with vaginal application of an imidazole (such
  as clotrimazole), and a topical imidazole cream for vulvitis
• Pregnant women need a longer duration of treatment, usually
  about 7 days, to clear the infection
• Tablets are to be avoided in pregnancies - only pessaries or creams

Question 11

A patient is being switched from Yasmin (ethinylestradiol/drospirenone) to Noriday (norethisterone) for contraception. Which one of the following is the most appropriate regarding the switch?
a) Additional protection is required for the first 7 days following the switch
b) Start on the day following completion of the combined oral contraceptive course without a break
c) A 14-day pill free interval is required before starting Noriday
d) Start Yasmin at end of the 7 pill free days
e) Take Yasmin and Noriday together for the first week
before omitting Yasmin

Answer 11

B - Start on the day following completion of the combined oral contraceptive course without a break

• Immediate protection achieved if continued directly from the end of a pill packet i.e. day 21
• Additional precaution is required for 2 days only if the switch occurs in the first week of taking combined oral contraception

Question 12

A female patient wants to use a diaphragm for contraception. Which one of the following is the most appropriate regarding use of diaphragms?
a) Avoid using spermicide with diaphragms
b) It provides protection from sexually transmitted
infections
c) It should not be removed until at least 6 hours after
sexual intercourse
d) Condoms must not be used with diaphragms
e) Remove diaphragm immediately after sexual
intercourse

Answer 12

C – It should not be removed until at least 6 hours after sexual intercourse

• Diaphragms and caps must be used in conjunction with a spermicide (nonoxinol) and should not be removed until at least 6 hours after the last episode of intercourse.
• Diaphragms and caps do not provide protection against STIs- still need to be used with condoms

Question 13

A 17-year old female is 6 weeks pregnant and is due to undergo medical abortion. Which one of the following drugs is used for this?
a) Methotrexate
b) Oxytocin
c) Ergotamine
d) Mifepristone
e) Gemeprost

Answer 13

D – Mifepristone

• Mifepristone→antiprogestogenic steroid, sensitises the myometrium to prostaglandin-induced contractions and ripens the cervix. Therefore, abortion occurs in a shorter time and with a lower dose of prostaglandin.
• Gemeprost→a prostaglandin administered vaginally as pessaries, is licensed for the medical induction of abortion in the second trimester of pregnancy

Question 14

You are a hospital pharmacist and receive a request for misoprostol. Which one of the following is NOT an indication for misoprostol?
a) Termination of pregnancy
b) Prophylaxis of NSAID-induced ulcer
c) Treatment of peptic ulcers
d) Induction of labour
e) Reduction of postpartum haemorrhage

Answer 14

e) Reduction of postpartum haemorrhage

Question 15

A 30-year old female presents to the pharmacy complaining of itching in the genital area. Upon further questioning, she reveals she has also had offensive green- coloured vaginal discharge. Which one of the following is the most likely cause?
a) Trichomonas vaginalis
b) Bacterial vaginosis
c) Candida albicans
d) Chlamydia
e) Gonorrhoea

Answer 15

a) Trichomonas vaginalis

Question 16

4

Answer 16

E – Add montelukast

Question 17

6

Answer 17

C – Use her salbutamol immediately before exercise

• 1st line→ An inhaled SABA used immediately before exercise is the drug of choice
• If exercise is a specific problem in patients already taking an ICS who are otherwise well controlled, consider adding either:
  ➢ LTRA
  ➢ LABA
  ➢ Sodium cromoglicate or nedocromil sodium ➢ Theophylline

Question 18

A patient presents to A&E with vomiting and severe palpitations. His drug history includes:
- Salbutamol inhaler
- Symbicort turbohaler (budesonide and formoterol) - Theophylline
- His theophylline level is reported back as 30mg/L.
Which one of the following is most likely to cause this presentation in this patient?
a) Smoking cessation
b) Starting St John’s Wort
c) Starting smoking
d) Alcohol excess
e) Renal impairment

Answer 18

A – smoking cessation
The plasma-theophylline concentration is decreased in
smokers, and by alcohol consumption, and enzyme
inducers

Question 19

17

Answer 19

B – Salmeterol and tiotropium, offer LABA and LAMA as pt has no asthmatic features

Question 20

24

Answer 20

A – Administer to midpoint of outer thigh

Question 21

25

Answer 21

C – Churg Strauss syndrome
Eosinophilic granulomatosis with polyangiitis (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.

Prescribers should be alert to the development of eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, or peripheral neuropathy.

Question 22

28

Answer 22

D – Verapamil, 2nd line tx of stable angina

• Beta-blockers can precipitate bronchospasm
• When there is no suitable alternative, it may be necessary
  for a patient with well-controlled asthma, or COPD to receive treatment with a beta-blocker for a co-existing condition.
  A cardio-selective beta-blocker should be selected and initiated at a low dose by a specialist; the patient should be closely monitored for adverse effects.

Cardio-selective BAtMAN:
➢ Bisoprolol
➢ Atenolol
➢ Metoprolol
➢ Acebutolol
➢ Nebivolol
(has lowest bronchospasm effect)

Question 23

32

Answer 23

Peak Expiratory Flow rate (PEFR) =measures how quickly you can blow air out of your lungs

-to be repeated 3 times, and the highest of the 3 measurements should be recorded as your peak flow score in your peak flow diary

Question 24

A 65-year old male is being investigated for chronic obstructive pulmonary disease (COPD). Spirometry reveals a FEV1 of 45% and FEV1/FVC ratio of 65%. How would you classify the severity of this patient’s COPD?
a) Mild
b) Moderate
c) Severe
d) Very severe
e) Life-threatening

Answer 24

C. Severe

Question 25

40

Answer 25

A – 88-92%
* In most acutely ill patients with a normal or low arterial carbon dioxide, oxygen saturation should be 94–98% oxygen saturation
* In patients at risk of hypercapnic respiratory failure (e.g. COPD), a lower target of 88–92% oxygen saturation is indicated

Question 26

One week after his hospital admission, the patient develops diarrhoea. A stool sample confirms the presence of Clostridium difficile infection. Doctors decide to stop the lansoprazole and review the antibiotic for his infection.
Which ONE of this patient􏰀s medications listed below is MOST likely to require temporary discontinuation in view of his Clostridium difficile infection?
A Ferrous sulphate
B Finasteride
C Ibuprofen
D Levothyroxine
E Paracetamol

Answer 26

A Ferrous sulphate = cx diarrhoea

Question 27

You are discussing aspirin and the risk of reye’s syndrome with your pre-registration trainee. You state that there can be variation in the licensing of different medicines containing salicylic acid.

Which ONE of the following is the LEAST appropriate for the indication stated?

A. Acnisal® salicylic acid 2%w/w Cutaneous Solution for a fifteen-year-old boy with acne
B. Bazuka® extra strength gel for the treatment of a wart on the knee of a five-year-old boy
C. Bonjela® original gel for a thirteen-year-old girl who has mouth ulcers from recently fitted braces
D. Capasal® Therapeutic Shampoo (salicylic acid, coconut oil, distilled coal tar) for cradle cap in a 6-month-old infant
E. Radian B® relief spray (Acetylsalicylic Acid 1.2%w/v and Methyl Salicylate 0.6%w/v for
a 16-year-old girl who has backache and bruising from a hockey match

Answer 27

C. Bonjela® original gel for a thirteen-year-old girl who has mouth ulcers from recently fitted braces.

bonjela is suitable for 16 year olds

Question 28

Six months later, the patient is admitted to the hospital for emergency surgery for an aortic aneurysm. Surgeons need to quickly reverse the effects of dabigatran before operating.

Which ONE of the following agents is MOST suitable to use for reversal of the anticoagulant effect?
A. Flumazenil
B. Idaracizumab
C. Naloxone
D. Phytomenadione
E. Protamine

Answer 28

B. Idaracizumab

Question 29

Which ONE of the following guidance regarding the use of dabigatran during the perioperative period is the LEAST appropriate?

A) After removal of the epidural catheter, an interval of at least 2 hours should elapse before dabigatran is restarted
B) Dabigatran can be re-started 24 hours after the administration of the reversal agent if the patient is clinically stable
C) Dabigatran should be restarted after the surgical intervention as soon as possible provided adequate haemostasis has been established
D) If dabigatran is prescribed and used as directed in the SPC incision site, haemorrhage is rare
E) Tramadol should not be used as post-surgery analgesia due to a possible interaction with dabigatran and increased risk of bleeding

Answer 29

E) Tramadol should not be used as post-surgery analgesia due to a possible interaction with dabigatran and increased risk of bleeding.

• there is NO interaction between the two

Question 30

He takes regular paracetamol at maximum dosage. He was diagnosed with hypertension 5 years ago, for which he takes amlodipine 5mg OD. The local GP has called you to ask about prescribing NSAIDs for this patient.

Which ONE of the following medicines, used in divided doses, would be the MOST appropriate choice?
A Diclofenac 150mg daily dose
B Ibuprofen 2.4g daily dose
C Indometacin 75mg daily dose
D Naproxen 1g daily dose
E Piroxicam 20mg daily dose

Answer 30

D Naproxen 1g daily dose

Question 31

There is a note on 􏰎he 􏰒a􏰎ie􏰌􏰎􏰀􏰋 PMR about an allergy to aspirin with no other specific details. You are aware that NSAIDs are contraindicated for patients hypersensitive to aspirin. You ask about the reaction he experienced when he took aspirin in order to differentiate between a side effect and hypersensitivity reaction.
Which ONE of the following is LEAST likely to occur as a result of hypersensitivity to aspirin?
A Angioedema
B Bronchospasm
C Haemorrhagic stroke
D Rhinitis
E Urticaria

Answer 31

D Rhinitis

Question 32

You are working in a community pharmacy a when a 42-year old male, hands in a private prescription for sildenafil. After a quick check of the prescription you identify that it is not legally valid and therefore you cannot dispense it.
Which ONE of the following would make the prescription legally INCOMPLETE?
A The form of the medication has not been specified
B The prescription is hand written on non-headed paper
C The prescription specifies ‘Repeat x 2’ and has been dispensed twice previously
D The prescribing doctor is registered in Australia
E The prescription has not been endorsed with SLS by the prescriber

Answer 32

D The prescribing doctor is registered in Australia. – not approved country to px

Approved countries comprise EEA countries and Switzerland:
Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Republic
of Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, The Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland.

Question 33

You are working a shift as responsible pharmacist in a community pharmacy when you receive a worried phone call from the pharmacy technician at another branch. The regular pharmacist for that branch has had a car accident and has not arrived at work this morning. A locum pharmacist has been arranged but they have not arrived yet at the pharmacy.
Which ONE of the following is the MOST appropriate course of action with respect to the other branch?

A ) Ensure that the pharmacy remains closed until you arrive and sign in as responsible pharmacist at both pharmacies as they are owned by the same company.
B) Instruct that the pharmacy remains closed until the locum arrives. The staff should not generate labels, remove items from the dispensary shelves, assemble items or label any medication containers until the pharmacist signs in as responsible pharmacist.
C) Instruct that the pharmacy remains closed until the locum arrives, however the staff may continue with all other dispensary tasks.
D) Advise that the pharmacy is opened but in the absence of a responsible pharmacist they can only sell non-medical items and GSL medications.
E) Advise that the pharmacy is opened but in the absence of a responsible pharmacist they may only hand out POMs which have already been checked by a pharmacist. They may not sell any items until the pharmacist arrives.

Answer 33

B) Instruct that the pharmacy remains closed until the locum arrives. The staff should not generate labels, remove items from the dispensary shelves, assemble items or label any medication containers until the pharmacist signs in as responsible pharmacist.

Question 34

A 78-year-old obese male is admitted to hospital with severe abdominal pain which has been diagnosed as renal colic. During his admission, the patient also begins to complain of tenderness in his right big toe joint. The pain started very suddenly and worsened over a period of hours. On examination, the toe appears to be red, hot and is extremely tender. His medical history includes hypertension and heart failure. His current medication includes:
􏰖 Enalapril tablets 5 mg OD
􏰖 Bendroflumethazide tablets 5mg OD
􏰖 Atenolol tablets 50 mg OD
􏰖 Nu-Seals Aspirin 75mg tablets OD

Which ONE of the following medicines would be the MOST appropriate treatment for the painful big toe?
A Allopurinol
B Colchicine
C Diclofenac
D Indometacin
E Meloxicam

Answer 34

B . Colchicine
SE - nausea, diarrhoea, abdominal pain, vomiting

• renal colic: Renal or ureteric stones can cause pain and obstruct urine flow
• unilateral abdominal pain radiating to the groin.
• Gout occurs:
  > Any joint can be affected by gout, but it usually affects joints towards the ends of the limbs, such as the toes, ankles, knees and fingers.
  > Signs and symptoms of gout include severe pain in one or more joints. the joint feeling hot and very tender.

Question 35

max dose of simvastatin and bezafibrate

Answer 35

simvastatin 10mg OD

Question 36

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?
A Hypercalcaemia
B Hyperkalaemia
C Hypernatremia
D Hypokalaemia
E No effect on electrolytes

Answer 36

D Hypokalaemia - due to the initiation of insulin

Question 37

Her medications include the following: amlodipine and indapamide for hypertension, amiodarone for cardiac arrhythmia, cetirizine for urticaria and zopiclone to help with insomnia. She has been called back to her GP to discuss her blood results: raised free thyroxine (T4) and tri-iodothyronine (T3). Her GP diagnoses hyperthyroidism.
Which ONE of her medications is MOST likely to be associated with her recent diagnosis?
A) Amiodarone
B) Amlodipine
C) Cetirizine
D) Indapamide
E) Zopiclone

Answer 37

A) Amiodarone = SE of cx hyper/hypothyrodism

Question 38

The doctor decides to treat 􏰎hi􏰋 􏰒a􏰎ie􏰌􏰎􏰀􏰋 thyrotoxicosis with carbimazole 5mg TDS. One month after commencing treatment, she begins to complain of a sore throat and mouth ulcers.
What is the MOST likely cause of this patients presenting complaints?
A Agranulocytosis - lowered white blood cell count
B Aplastic anaemia - deficiency of red blood cells, white blood cells, and platelets
C Haemolytic anaemia - red blood cells are destroyed faster than they are made
D Megaloblastic anaemia - the bone marrow produces unusually large, structurally abnormal, immature red blood cells
E Thrombocytopenia 􏰝 low platelet count

Answer 38

A. Agranulocytosis - lowered white blood cell count

Question 39

A young boy is taken to his doctor by his mother. The whole family has had colds and fevers over the last few weeks. The boy has also been feeling sick. His mother is worried that he does not appear to have had much of an appetite. Also, she is worried that his symptoms do not appear to be improving. The GP makes a diagnosis of type 1 diabetes. His blood glucose level is measured at 22mmol/L.
Which ONE of the following is LEAST likely to be a presenting symptom of type 1 diabetes?
A Abdominal pain
B Enuresis
C Fatigue
D Flatulence
E Weight loss

Answer 39

D Flatulence

Question 40

You are asked for advice by a newly qualified pharmacist colleague on which documents and records need to be retained in community pharmacy settings and for how long.
Which ONE of the following relevant documentation must legally be kept for the LONGEST time?

A. A patient safety incident report which details the dispensing error that resulted in the
death of a patient last month
B. An MUR record from last week for a targeted review with minor clinical intervention
C. Consignment note for hazardous waste medicines collected from the pharmacy today
D. Records of receipt and supply of POM-V & POM-VPS veterinary medicines last month
E. The PMR for a patient who passed away last week

Answer 40

A. A patient safety incident report which details the dispensing error that resulted in the
death of a patient last month

Question 41

A 56-year-old man has had a cold for the last three days. He has been taking pseudoephedrine for his blocked nose. He comes in to ask you for advice. You notice that he seems pale, sweaty and anxious. He is suffering from a severe headache with nausea and vomiting. He explains that he is also experiencing chest pressure and shortness of breath.
His medication history includes the following:
􏰖 Amlodipine 5mg OD for hypertension 􏰝 commenced three months ago
􏰖 Gaviscon tablets 1-2 tablets up to QDS for indigestion
􏰖 Levothyroxine 100mcg OD for hypothyroidism 􏰝 reduced from 125mcg 4 weeks ago
􏰖 Phenelzine 15mg alternate days for depression - discontinued last week
􏰖 Prednisolone 5mg OD 􏰝 for polymyalgia 􏰝 reduced from 7.5mg last week

Which ONE of the medications is the most likely cause of this gentleman􏰀s presenting symptoms?
A Amlodipine
B Gaviscon tablets
C Levothyroxine
D Phenelzine
E Prednisolone

Answer 41

D. Phenelzine = maoi-ai

Risk of postural hypotension and hypertensive responses. Discontinue if palpitations or frequent headaches occur.

Question 42

58 􏰝year-old female has been brought in to the accident and emergency department by her daughter. The patient complains of feeling feverish and having some pain on one side of her chest. Her daughter says that her mother has been like this for the last 2 or 3 days and has become increasingly breathless and has been asking for her husband, who passed away 2 years ago. The patient has continued to eat and drink.
PMH: NSTEMI (2017); ventricular tachycardia (2018)
DHx: Aspirin 75mg od, Atorvastatin 80mg od, Bisoprolol 2.5mg om, Ramipril 5mg od Allergies: penicillin 􏰝 rash
On examination, the following is noted: respiratory rate: 37 breaths per min
􏰖 Temp: 38.6 oC
􏰖 Pulse: 110 bpm
􏰖 BP: 105/50 mmHg
􏰖 An x-ray shows left lower lobe consolidation
􏰖 Blood results: WCC: 27 x 10 9/L (4-11)
􏰖 CRP 70 mg/L (< 10)
􏰖 Urea 9 mmol/L (2-7)
A diagnosis of severe community acquired pneumonia is made and a SARS-CoV2 polymerase chain reaction test is sent to the lab.

Which ONE of the following is the most appropriate antibiotic for this patient?
A Cefuroxime + clarithromycin
B Co-amoxilav + clarithromycin
C Co-trimoxazole
D Doxycycline
E Levofloxacin

Answer 42

E Levofloxacin

Question 43

During your weekly visit to a nursing home, the nurse in charge comes to see you. One of their residents has returned from hospital after being treated for an ischaemic stroke. All of his medications need to be crushed or given in liquid form, until his next swallow assessment. Nursing staff are concerned about administering this pt’s finasteride after being told to observe cautions when handling them.
What is the most significant reason that staff should avoid handling crushed or broken finasteride tablets?
A Pharyngeal irritation if particles are inhaled
B Risk to the male foetus
C Risk of absorption into semen
D Risk of decreased libido
E The drug is cytotoxic

Answer 43

B Risk to the male foetus

Question 44

A regular patient of yours, is taking Buscopan® (hyoscine butylbromide) three times a day to treat her abdominal cramps. She returns to your pharmacy complaining of specific side effects which relate to the Buscopan® tablets.
Which ONE of the following side effects would NOT be caused by Buscopan®?
A Pupil dilatation
B Increased bronchial secretions
C Dry mouth
D Urinary retention
E Constipation

Answer 44

B Increased bronchial secretions = reduces bronchial secretions

Question 45

A 54-year-old man comes into your pharmacy. He tells you that he has difficulty when going to the toilet, as his stools are hard and dry; this is despite increasing the amount of fibre in his diet, maintaining his fluid intake and eating the recommended amount of fruit and vegetables. He does not have any symptoms that require immediate referral and asks you to advise on a suitable laxative preparation. He reports no drug allergies but states he is intolerant to lactose.
Which ONE of the following would it be MOST appropriate to recommend?
A Bisacodyl tablets
B Docusate Sodium capsules
C Ispaghula husk sachets
D Lactulose liquid
E Senna tablets

Answer 45

B Docusate Sodium capsules

Question 46

A second semester university student has presented in your pharmacy with a sore throat that has lasted over two weeks. On questioning, you identify that he is using regular paracetamol but is still in a lot of pain and feeling quite run down and lethargic. He has spent a lot of time in bed. He plays for the university rugby team and is keen to get back into training. You ask to see his throat.

What is the MOST likely diagnosis for his symptoms?
A Glandular fever
B Strep throat
C Epiglottitis
D Laryngitis
E Quinsy

Answer 46

A. Glandular fever; symptoms

a very high temperature or you feel hot and shivery
a severe sore throat
swelling either side of your neck – swollen glands
extreme tiredness or exhaustion
tonsillitis that is not getting better

Question 47

A 42-year-old female is being treated for cellulitis with IV vancomycin. She has suffered anaphylaxis with penicillin. She has a history of rheumatoid arthritis for which she takes regular paracetamol and diclofenac. Doctors are happy with her progress and require advice on an appropriate IV to oral switch.
Which ONE of the following would be the MOST appropriate agent to recommend?
A Cefalexin
B Ciprofloxacin
C Clarithromycin
D Co-amoxiclav
E Vancomycin

Answer 47

C. Clarithromycin

Question 48

tranexamic acid tablets can be sold OTC as a P medicine for the treatment of heavy menstrual bleeding in a pack of 18 x500mg tabs
To which pt can this product be sold?

Answer 48

Do not give to children under 18 years of age.

Question 49

Romeo is 25 y/o man seking tx for a couple of small 4mm painful sores on his inner cheek. He also is feeling under the weather and requests the popular cold & flu remedy - day nurse)

He takes the following meds – sulfalazine, prednisolone suppositories and paracetamol for crohn’s disease. He has recently been started on Sulfasalazine – which he says is taking its time to kick in as he usually gets these symptoms during actue flare up. He has booked a routine appointment with his GP but needs something in the meantime. What is the best course of action?

a) Refer for FBC
b) Refer to dentist
c) advise him to wait until for his GP appointment
d) refer to specialist for r/v of sulfasalazine and tx of acute IBD flare up
e) sell bonjela (choline salicylate) and day nurse

Answer 49

a) Refer for FBC

As he takes sulfasalazine which causes blood dyscrasias. His mouth ulcers and malaise is a likely result of this.

An acute IBD flare up would include diarrhoea - which pt is not experience.

Symptoms of acute iBD - mouth ulcers, fever, malaise, recurrent diarrhoea

Question 50

Sienna is a 25 y/o catwalk model, requesting for Cymalon. Since yesterday she has been visiting the loo often and experiences extreme burning pain when urinating.

She recognises these symptoms having had an episode 4 months ago.

She mentions feeling thirsty and tired and has lost weight but puts this down to the stress of Fashion Week. She also requests Savlon for a cut on her leg from falling over 2 weeks ago, which is healing poorly.

a) Refer immediately to the doctor for Metformin
b) Sell Cymalon. Dysuria is a classic sign of cystitis. Sell Savlon to help heal the cut.
c) Refer to the GP for trimethoprim. OTC treatment is only for mild symptoms present for less than 24 hrs.
d) Refer to GP immediately. Unexplained weight loss could be a sign of kidney or bladder cancer
e) Refer to the gP for gentamicin. Her symptoms indicate progression to kidney infection.

Answer 50

a) Refer immediately to the doctor for Metformin.

Pt is most likely undiagnosed with diabetes due to having thirst, fatigue, weight loss and slow-healing wounds being the symptoms cx by underlying hyperglycaemia