Pro24 Flashcards
Mrs H is a 42-year-old woman who comes into your pharmacy with a prescription for canagliflozin 100mg, take one daily.
Which of the following advice would you give Mrs H?
A- Advise Mrs H on how to recognise symptoms of acute pancreatitis and report them immediately if they develop.
B- Inform Mrs H that skin reactions are very common with canagliflozin.
C- Advise Mrs H on routine preventive footcare as canagliflozin increases the risk of lower limb amputation.
D- Inform Mrs H that diabetic ketoacidosis (DKA) is not common with canagliflozin, and she shouldn’t worry.
E- Advise Mrs H that if she experiences swelling or tenderness in a perineal area, she can take paracetamol and ibuprofen to clear it up
C- MHRA warning
A 45-year-old woman has been prescribed morphine to treat pain associated with a back injury following a recent accident at work. She has reported experiencing constipation and has been taking docusate sodium, but has not passed a stool in the past 4 days. The GP would like to add another laxative to treat her symptoms.
Which of the following laxatives would be most appropriate to add to docusate sodium to treat her constipation?
A- Bisacodyl
B- Lactulose
C- Ispaghula Husk
D- Macrogol
E- Methylcellulose
A
An osmotic laxative (docusate) and a stimulant laxative are recommended in opioid induced constipation. Bulk forming laxatives should be avoided
Mr P is a regular customer at your pharmacy and has come in to collect a new prescription. The prescription reads: ‘Clarithromycin 500mg tablets, take one twice a day, mitte 10’. After checking his PMR, you note that he is taking the following medications:
Ramipril 5mg capsules OD
Indapamide 2.5mg OD
Simvastatin 20mg OD
Which of the following is the most appropriate advice for Mr P?
A- Advise Mr P that he must take clarithromycin on an empty stomach.
B- Advise Mr P that he must take clarithromycin with or immediately after a meal.
C- Advise Mr P that he must omit his ramipril dose for 5 days, until the clarithromycin course is finished, as there is a severe interaction between clarithromycin and ramipril.
D- Advise Mr P that he must omit his simvastatin dose for 5 days, until the clarithromycin course is finished, as there is a severe interaction between clarithromycin and simvastatin.
E- Advise Mr P that he must omit his indapamide dose for 5 days, until the clarithromycin course is finished, as there is a severe interaction between clarithromycin and indapamide.
D- Omit statin for 5 days
Severe interaction as clarithromycin is a potent CYP3A4 inhibitor. When co-administered, claritrhomycin increases plasma concentration levels –> increase risk of rehab
A 34-year-old woman has called the pharmacy for advice. She explains that she has recently started taking a new medication and has noticed she has gained weight significantly over the past few months.
Which of the following antipsychotic medication is most likely to be responsible for the patient’s weight gain?
A- Clozapine
B- Haloperidol
C- Risperidone
D- Aripiprazole
E- Flupentixol
Clozapine as it is a second generation antipsychotic which have metabolic side effects such as weight gain
A 43-year-old patient is starting R-CHOP chemotherapy treatment for high grade non-Hodgkin Lymphoma. This is a combination treatment of cyclophosphamide, doxorubicin, vincristine and prednisolone along with rituximab.
Which of these medications is only administered intravenously and is associated with neurotoxicity which is usually fatal if given intrathecally?
A- Cyclophosphamide
B- Doxorubicin
C-Prednisolone
D- Rituximab
E-Vincristine
Vincristine should only be IV only
Mrs H has been treated for hypothyroidism for the past 4 years with levothyroxine tablets 75mcg daily. Her previous thyroid function tests were within target ranges. Following a recent fall and fracture, Mrs A has started taking calcium carbonate 1.25g daily each morning. She is starting to feel cold and fatigued, which were her main symptoms before her hypothyroidism was treated. She asks for your advice when she comes to pick up her prescription.
Which of the following is the most appropriate advice for Mrs A?
A- Advise Mrs H to take space the dose of calcium carbonate and levothyroxine by at least 4 hours.
B- Advise Mrs H to take levothyroxine 2 hours before calcium carbonate.
C- Advise Mrs H to take calcium carbonate at night as it might be more effective at preventing fractures.
D- Advise Mrs H to contact her GP as her levothyroxine dose may need to be reduced.
E- Advise Mrs H that there is nothing to worry about and to continue as normal.
A - oral calcium carbonate is predicted to decrease the absorption of oral levothyroxine. Manufacture recommend separate administration by 4 hours
Miss J is 21-year-old woman with type 1 diabetes. She comes into your pharmacy with a prescription for dexamethasone and tells you she has been unwell for the last week. From her PMR, you notice that she is currently using a regimen of insulin glargine once daily and Humalog (insulin lispro) with meals.
Which of the following is the most appropriate advice for you to provide?
A- Taking high doses of steroids may decrease blood sugar levels and therefore require a decrease in insulin requirements
B- Dexamethasone can cause blood sugar levels to increase and an increased insulin dose may be required
C- Illness does not affect blood sugar levels and she should continue with her insulin regime as normal.
D- Advise increased blood glucose testing whilst she is unwell because of the risk of severe hypoglycaemia.
E- Miss J should stop taking her insulin glargine dose whilst she is unwell.
B- Steroids can increase blood sugar levels, therefore an increase in insulin may be required.
Ms B, a 16-year-old patient who has an acute flare up of her eczema. She complains of severe itching on both hands and both her legs. On inspection, the skin shows no sign of discharge, oozing or bleeding, however the skin does look red, angry, and dry. The doctor would like to prescribe a moderately potent topical corticosteroid.
Which one of the following treatments would be the most appropriate?
A- Betnovate (betamethasone 0.1%) cream
B- Eumovate (clobetasone 0.05%) cream
C- Fucidin H (fusidic acid 2% and hydrocortisone 1%) cream
D- Hydrocortisone 2.5% cream
E- Trimovate (clobetasone 0.05%, nystatin 100,000units & oxytetracycline 3%) cream
Eumovate
A 6-year-old child has recently been prescribed methylphenidate 2.5mg BD for the treatment of ADHD by a specialist clinic. The child will require regular monitoring as a result of taking this medication, at least every 6 months and following dose adjustments.
Which of the following will NOT require measurement and recording?
A- Blood pressure
B- Height
C- Pulse
D- Weight
E- White blood cells
white blood cells
A 26- year-old man has been diagnosed with tonic-clonic seizures and his specialist is considering appropriate treatment options.
Which of the following anti-epileptic medications would require two specialists to independently consider and document that there is no other effective or tolerated treatment?
A- Clonazepam
B- Ethosuximide
C- Levetiracetam
D- Sodium Valproate
E- Topiramate
From January 2024, valproate must not be started in new patients (male or female) younger than 55 years, unless two specialists independently consider and document that there is no other effective or tolerated treatment, or unless there are compelling reasons that the reproductive risks do not apply
Mr G, a 56-year-old man who weighs 75kg. He has been prescribed azathioprine for severe rheumatoid arthritis at a starting dose of 225mg daily. Mr. G is currently taking allopurinol for gout and ramipril for hypertension.
The SPC for azathioprine has been provided.
Which of the following is the most important action for you to take?
A- Advise Mr G that nausea is a common side effect of treatment with azathioprine
B- Advise Mr G to report any signs of infection including sore throat or fever immediately
C- Advise Mr G you will need to contact his prescriber as his azathioprine dose needs to be reduced to 25% as he is taking allopurinol.
D- Advise Mr G to attend for weekly blood tests during the first 8 weeks of treatment
E- Advise Mr G to get the influenza seasonal vaccine as he will be immunocompromised once treatment has started
Dose reduction by 25% is required. When xanthine oxidase inhibitors such as allopurinol and azathioprine are administered together it is essential that only 25% if the usual azathioprine is given since allopurinol decreases the rate of catabolism of azathioprine
A 67-year-old man has been admitted into hospital with Clostridioides difficile infection. He has severe diarrhoea, a high temperature and felt nauseous after taking a long course of antibiotics.
Which of the following medications is most closely associated with Clostridioides difficile infection?
A- Fluconazole
B- Nitrofurantoin
C- Doxycycline
D- Erythromycin
E - Ceftriaxone
E- 3rd gen cephalosporin
A 25-year-old woman has come into the pharmacy asking for advice. She explains that she has been experiencing vaginal itching and has noticed a strong fish-like odour with grey discharge in the last few days. She has burning when urinating.
Which of the following medication would be most suitable to treat the condition described?
A- Fluconazole 150mg capsule - single dose
B- Nitrofurantoin immediate release 50mg QDS for 3 days
C- Metronidazole 500mg BD for 7 days
D- Azithromycin 1g OD for 1 day, then 500mg OD for 2 days
E - Doxycycline 200mg for one day, then 100mg daily maintenance
Metronidazole - BV is caused by an imbalance of bacteria in the vagina. Symptoms include: fishy odor, grey/white discharge, thin/watery discharge. It is NOT an STI.
Miss F is a 16-year-old girl and has recently been diagnosed with type 1 diabetes. Her treatment will be started with several doses of soluble insulin (short acting) which will be given throughout the day, with a long-acting insulin given once daily.
Which of the following is the most suitable insulin preparation that the patient will use daily as a longer acting insulin?
A- Humulin I (Isophane insulin)
B- Lantus (Insulin glargine)
C- Apidra (Insulin glulisine)
D- Novorapid (Insulin aspart)
E - Humalog (Insulin lispro)
Lantus (Insulin glargine) – Long – acting Humulin I (Isophane insulin) –
Apidra (Insulin glulisine) – Rapid – acting Novorapid (Insulin aspart)- Rapid – acting Humalog (Insulin lispro) – Rapid – acting
Mr I, a 67-year-old man, comes to see you with signs of blurred vision and nausea. He is regularly prescribed digoxin 250mcg tablets once daily. After referral to the GP, he is sent for blood tests.
Which of the following ranges is most likely to indicate the progressive increasing toxicity of digoxin?
A- 0.6-1.2ng/ml
B- 0.7-2ng/ml
C- 1.5-3.0ng/ml
D-3.5-4.0ng/ml
E - 4.5-5.0ng/ml
C
Mrs B, a 73-year-old woman, has a 30-year history of hypertension and has recently had consistently high blood pressure readings. Her specialist would like to prescribe spironolactone 25mg each morning.
Which of her following regular medications will need to be changed?
A- Bisoprolol
B- Candesartan
C- Clopidogrel
D- Isosorbide mononitrate
E – Simvastatin
Both candersartan and spironolactone can increase the risk of hypotension and increase the risk of hyperkalemia
Mr A, a 65-year-old man has been experiencing pain in his back and has tried paracetamol over the counter along with pain relief gels. The doctor would like to prescribe him an anti-inflammatory. On his records it is noted that he had a gastric ulcer 4 years ago and was prescribed famotidine for its treatment.
Which if the following anti-inflammatories would be most appropriate to use for Mr A?
A- Piroxicam
B- Ibuprofen
C- Celecoxib
D- Indomethacin
E - Naproxen
Celecoxib - selective for COX-2.
Cox-2 inhibitors are associated with and is therefore preferred to reduce the risk of further incidences
- Mr C has presented in the GP practice with a dog bite. He has redness and swelling around the site of the bite and he has told you it is hot to touch. From his records you are able to see that he has an allergy to penicillin. The doctor has prescribed medication to help treat the infected bite for Mr C.
Which of the following would be the most suitable antibacterial choice of treatment for Mr C?
A- Erythromycin
B- Doxycycline
C- Co-Amoxiclav
D- Doxycycline + Metronidazole
E - Cefuroxime
Alt in penicillin allergy: Doxycycline + Metronidazole
Mrs S comes into your pharmacy and hands you a prescription for alendronic acid 70mg tablets. After checking her PMR, you notice that she has not taken this medication before.
Which of the following counselling points would be appropriate to advise Mrs S?
A- Take the tablet with plenty of water, on an empty stomach, at least 2 hours before breakfast and sit upright for at least 1 hour after.
B- Take the tablet with plenty of water, on an empty at least 15 minutes before breakfast and sit upright for at least 30 minutes after.
C- Take the tablet with plenty of water, on an empty stomach, at least 30 minutes before breakfast and sit upright for at least 30 minutes after.
D- Take the tablet with plenty of water, on a full stomach, after breakfast and sit upright for at least 30 minutes after.
E - Take the tablet with plenty of water, on a full stomach, after dinner.
C-
- Mrs M is to be discharged from the stroke unit. Her specialist wants to discuss secondary prevention options. During her stay in hospital, Mrs M could not tolerate clopidogrel or aspirin.
Which of the following medication regimes is the most appropriate for Mrs M?
A- Clopidogrel 75mg, Atorvastatin 80mg OD, Dipyridamole MR 200mg BD
B- Dipyridamole MR 200mg BD, Atorvastatin 80mg OD
C- Dipyridamole MR 200mg OD, Atorvastatin 20mg OD
D- Warfarin 6mg daily, Atorvastatin 80mg
E - Dipyridamole 25mg QDS, Atorvastatin 80mg
B- Dipyridamole MR 200mg BD and atorva 80mg OD
Treatment with a high intensity statin should be offered at diagnosis of stroke or TIA by secondary care.
A 22-year-old woman has come into the pharmacy asking for advice. She has explained that she has a stuffy nose, feels congested and has sinus pressure for 9 consecutive days. Despite attempting steam inhalation at home, she has not found relief and requests a nasal spray to buy over the counter as she has heard it works very fast. She does not have a temperature, cough, or nasal discharge.
Her current medication is below:
Propranolol 40mg od
Cetirizine 10mg od
Montelukast 10mg od
Salbutamol 100mcg MDI use as directed when required
Phenelzine 15mg on alternate days
The pharmacy first sinusitis clinical pathway has been provided.
Which of the following options is the most suitable course of action for this patient?
A- Sell Sudafed nasal spray (Xylometazoline) over the counter and advise to use for a maximum of 7 days
B- Sell Beconase nasal spray (Beclomethasone) over the counter for use up to a maximum of 14 days
C- Refer the patient to the GP for an appointment
D- Advise the patient that she is eligible for Acute Sinusitis Pharmacy First service
E - No medication is required, ask the patient to continue self-care measures at home as sinusitis usually lasts 2-3 weeks
No medication is required
Patient has BOTH nasal congestion and nasal blockage
But symptoms are under 10 days therefore is
not suitable for pharmacy first
OTC Medication?
and nasal
= therefore, is
Tip: rule out answer options based on general knowledge e.g. OTC age licensing, S/E, C/I to help decide on the answer
Self-care?
* Symptoms have only lasted 9 days, therefore, advise self-care measures e.g. steam inhalation and hydration and she can return back for pharmacy first
days if symptoms persist.
* Steroid nasal sprays (e.g. beclomethasone) can only be used
* Sudafed (Xylometazoline spray) interacts with Phenelzine (MAOI antidepressant) = hypertensive crisis =
GP referral?
* Sinusitis usually lasts 2-3 weeks and is viral – therefore, antibiotics are not usually required
Miss T is a 36-year-old woman who has moderate acute asthma. She has been prescribed prednisolone 50mg daily for 10 days.
Which of the following is the appropriate advice for Miss T?
A- Prednisolone can be stopped without a gradual withdrawal regime as Miss T has been taking it for less than 14 days.
B- Prednisolone can be stopped without a gradual withdrawal regime as Miss T is taking less than 80mg daily.
C- Prednisolone should never be stopped abruptly.
D- Prednisolone should be stopped gradually for Miss T as she is taking more than 40mg daily for at least a week.
E - The prednisolone dose should be reduced rapidly to 8.5mg daily as that is the physiological dose.
Prednisolone should be stopped gradually for Miss T as she is taking more than 40mg daily for at least a week
Gradual withdrawal criteria:
Taken more than 40 mg oral prednisolone daily or equivalent for more than 1 week.
* Taken repeated evening doses of corticosteroids.
* Received more than 3 weeks of corticosteroid
treatment.
* Recently received repeated courses of
corticosteroids (especially if taken for longer than 3 weeks), such as short courses repeatedly prescribed for the treatment of acute exacerbations of asthma.
* A history of previous long-term therapy (months or years).
* Other possible causes of adrenal suppression, such as excessive alcohol consumption or stress
The mother of a 5-year-old child is asking for advice on treating hand-foot and mouth disease. The child has a fever and an itching, blistering rash on the hands and feet. They also have sore ulcers inside the mouth. You offer general advise about keeping hydrated and suggest paracetamol 120mg/5ml oral suspension for the fever and pain of mouth ulcers.
Which of the following is the recommended dose for this child?
A- One 2.5ml spoonful every 4-6 hours, maximum 4 doses per 24 hours
B- One 5ml spoonful every 4-6 hours, maximum 4 doses per 24 hours
C- One 5ml spoonful and One 2.5ml spoonful every 4-6 hours, maximum 4 doses per 24 hours
D- Two 5ml spoonful’s every 4-6 hours, maximum 4 doses per 24 hours
E - Three 5ml spoonful’s every 4-6 hours, maximum 4 doses per 24 hours
2x5ml every 4-6 hours, max 4 doses in 24hours
A customer has come into the pharmacy for advice on vitamin supplements. She has just found out that she is pregnant and has been told she should take a supplement but there are some vitamins she should avoid.
Which of the following vitamins should the patient avoid?
A- Cod liver oil
B- Folic acid
C- Iron
D- Vitamin D
E - Vitamin B12
Cod liver oil - too much can harm the baby development