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
A 36-year-old man has come to the GP for his haemorrhoids. He is experiencing swelling, slight bleeding, itchiness and pain. He would like something to relieve the discomfort as he is struggling at work.
Which of the following analgesia would be most suitable for his haemorrhoids?
A- Paracetamol
B- Ibuprofen
C- Co-codamol 8/500 (codeine and paracetamol)
D- Naproxen
E - Aspirin
Paracetamol
Opioids can cause constipation
NSAIDS can worsen rectal bleeding
Mrs H is a 36-year-old woman who is seeking contraceptive advice. She is 40 weeks post-partum. Since the birth of her daughter Mrs H has had a low mood. She has found taking St Johns Wort has been helpful and continues to take it. Mrs. H takes no other medication, has no know allergies and is needle phobic. She has no other relevant medical conditions.
Which of the following would be the most appropriate contraceptive recommendation?
A- Microgynon 30 tablets (ethinylestradiol 30mcg, levonorgestrel 150mcg)
B- Cerazette (75mcg desogestrel) tablets
C- Nexplanon implant (etonogestrel 68mg)
D- Norgeston 30 (levonogestrel 20 mcg) tablets
E - Mirena intrauterine device (levonorgestrel)
E
St John wort decreases the efficacy of COC. MHRA advises avoid
Mrs L is a 62-year-old woman and has been admitted to the stroke unit following a cerebrovascular accident (CVA).
Which of the following statements about the initial management of stroke is correct?
A- Alteplase is suitable if given within 6 hours onset along with aspirin 300mg.
B- An antiplatelet should be initiated within 24 hours if alteplase was administered.
C- Alteplase is suitable if given within 4.5 hours onset
D- Antihypertensive medication is needed immediately
E - An aspirin 75mg dispersible tablet should be given immediately
Alteplase c
16-year-old has been diagnosed with glucose-6-phosphate dehydrogenase (G6PD) deficiency following a blood test indicating he had acute haemolytic anaemia. He has been told that some medication, certain foods, and infections can increase the susceptibility to developing the condition.
Which of the following medications holds a definite risk of haemolysis in most G6PD-deficient individuals?
A- Sulfonylureas
B- Quinine
C- Aspirin
D- Chloroquine
E – Ciprofloxacin
Cipro
Miss H, a 21-year-old woman, has been prescribed isotretinoin for the treatment of severe acne. Consistent with other teratogenic medication for women of childbearing age, Miss H is to be supported on a pregnancy prevention programme (PPP).
Which of the following is NOT a recommended requirement for prescribing oral retinoids for women on the pregnancy prevention programme (PPP)?
A- Exclude pregnancy before treatment
B- Six months prescription validity
C- Thirty-day supply only
D- Use highly effective contraception
E - Repeat prescriptions are not to be accepted
six month rx validity
A patient has contacted the pharmacy asking for advice. She usually takes methotrexate 7.5mg once weekly on the same day each week for rheumatoid arthritis. She has forgotten to take her dose and 2 days have passed.
What is the most suitable advice to give to this patient regarding her missed dose of methotrexate?
A- Skip the missed dose and take the next dose as scheduled, on the usual day
B- Take the missed dose today and take the next dose as scheduled, on the usual day
C- Take 2 doses to make up for the missed dose today
D- Contact the prescriber as missing a dose requires a re-titration
E - Stop the methotrexate and switch to another medication which may be easier to remember to take
B- Take missed dose today
If a dose of methotrexate is missed it should be taken as soon as remembered within one or two days. Doses which are three or more days should be omitted entirely
Mr A has a 10% risk of developing cardiovascular disease over the next 10 years. His GP has taken a full lipid profile and advised treatment with a statin. Mr A is currently well and does not take any other regular medications.
Which is the most appropriate first line treatment?
A- Atorvastatin 10mg
B- Atorvastatin 20mg
C- Simvastatin 10mg
D- Simvastatin 20mg
E - Simvastatin 40mg
Atorva 20mg
. A 29-year-old woman has come into the pharmacy for advice. She has been experiencing flu-like symptoms and pain when breastfeeding for the past few days. She has noticed one of her breasts has become swollen, hot and is painful to touch. She has noticed a small amount of red discharge and can feel a lump in her left breast.
What would be the most suitable advice to offer to help relieve her symptoms?
A- Sell paracetamol and advise the patient to continue to breastfeed
B- Sell Lemsip Max Cold and Flu sachets and ask the patient to stop breastfeeding till symptoms pass
C- Sell Aspirin and ask the patient to continue to breastfeed
D- Refer patient to see her GP
E - Refer the patient to A&E
Symptoms describe mastitis. Caused by blocked milk ducts and is very common and does not need urgent medical treatment. Continue breastfeeding but use paracetamol
. Mrs C, a 67-year-old Female, has been taking Warfarin for 6 months following a diagnosis of Atrial Fibrillation. INR has been stable and near her target of 2.5 for the last 5 months. At this clinic visit, her INR is found to be 4.5. On questioning she tells you that 3 days ago she bought an OTC medication from the Pharmacy but can’t remember its name.
Which of the following OTC medications is most likely the cause of an increase in her INR?
A- Sudafed (pseudoephedrine) decongestant tablets
B- Canesten (clotrimazole) 1% Cream
C- Daktarin (miconazole)oral gel
D- Ovex (mebendazole) chewable tablets
E -Cetirizine 10mg tablets
Miconazole greatly increases the anticoagulant effect of warfarin. MHRA advises avoid unless INR can be closely monitored.
Mrs D is a 58-year-old woman who is currently taking a triple therapy regimen for her type 2 diabetes.
Her current medication is shown below:
Metformin 500mg tds
Gliclazide 80mg bd
Empagliflozin 10mg od
Her BMI is 35kg/m2 and she also has inflammatory bowel disease. Her HbA1c is still not controlled to below the agreed threshold and the specialist would like to step up her treatment and initiate a GLP-1 receptor agonist.
Which of the following statements is most appropriate for the initiation of a GLP-1 agonist for Mrs D?
A-GLP-1 receptor agonist should be added in combination to the current triple therapy regimen
B- Liraglutide is the most appropriate GLP-1 agonist for this patient and should replace either Gliclazide or Empagliflozin in the triple therapy regimen
C- Semaglutide is the most appropriate GLP-1 agonist for this patient and should replace either Gliclazide or Empagliflozin in the triple therapy regimen
D- GLP-1 receptor agonists have a high hypoglycaemic risk therefore advise Mrs D to take it with caution
E - GLP-1 receptor agonists can result in weight again, therefore are not appropriate for this patient has her BMI indicates she is obese
C
Liraglutide is CI in IBD
A 12-year-old girl is experiencing symptoms of an acute bacterial sore throat. She has had the symptoms for 2 days, has a high temperature, pain when swallowing and soreness. On examination she has some inflammation and exudate at the back of her throat. The girl does not have a cough and has NKDA.
Which of the following is the most suitable first line drug treatment for her bacterial sore throat?
A- Amoxicillin
B- Benzylpenicillin
C- Clarithromycin
D- Flucloxacillin
E - Phenoxymethylpenicilli
Phenoxymethylpenicilin
You have just attended basic life support training.
What is the correct ratio of chest compressions to rescue breaths required for an adult who is unconscious and requires cardiopulmonary resuscitation (CPR)?
A- 30:2
B- 2:30
C- 15:2
D- 40:3
E - 35:2
30:2
- Mr H has been taking Levothyroxine 50mcg daily for 3 months. His thyroid function tests are shown in the table below:
Test
Result
Reference range
TSH
6.1
0.4-0.5 mU/L
Total T4
40
60-150nmol/L
Free T4
6
9-25pmol/L
Total T3
0.4
0.9–2.7nmol/L
What is the most likely symptom that Mr H may be displaying?
A- Weight loss
B- Diarrhoea
C- Sore throat
D- Weight gain
E - Heat intolerance
High TSH and LOW ft4 -> hypothyroidism
weight gain
A 45-year-old man has had many previously failed treatments for schizophrenia. He has tried zuclopenthixol, haloperidol and olanzapine in the past. His consultant would like to start clozapine therapy and explain to him the monitoring required for this new mediation.
The SPC for clozapine has been provided.
Which of the following is the correct advice for white blood cell monitoring in this patient?
A- Before treatment starts, at 3 months, then yearly
B- Before treatment starts, 6 monthly for one year and then yearly
C- Before treatment starts, weekly for 12 weeks, then at least at 4-week intervals thereafter and 4 weeks after discontinuation
D- Before treatment starts, weekly for 18 weeks, then monthly for up to one year, and then annually
E - Before treatment starts, weekly for 18 weeks, then at least 4-week intervals thereafter and 4 weeks after discontinuation
Before treatment starts, weekly for 18 weeks and then at least 4 week intervals thereafter and 4 weeks after stopping
Mrs E, a 54-year-old female patient, presents at the pharmacy and explains that she is experiencing chest pain. Upon questioning, she informs you that the pain occurred suddenly, and she does not remember doing anything strenuous. She has no history of heart conditions and does sometimes have mild heartburn especially after she eats a heavy meal for which she takes 10ml Gaviscon, which helps. She tells you that the pain is in the mid chest and is not radiating anywhere else.
Mrs E’s current medication is shown below:
Paracetamol 500mg caplets, one-two caplets when required up to four times a day
Elleste Duet 1mg tablets (estradiol/norethisterone), use as directed
Levothyroxine 100mcg tablets daily
Which of the following is the best course of action?
A- Sell omeprazole 10mg capsules to Mrs E and advise her to take 2 capsules daily until symptoms subside
B- Advise Mrs E that she should see her GP as her levothyroxine dose may require adjusting
C- Provide Mrs E with aspirin 300mg dispersible tablets and GTN spray; call 999
D- Provide Mrs E with aspirin 75mg dispersible tablets and GTN spray; call 999
E - Advise Mrs E to stop taking Elleste Duet 1mg tablets and visit her GP urgently
Stop HRT if any sudden chest pain or SOB occur
Mr S is a 55-year-old man with type 2 diabetes. He has a history of hypertension and dyslipidaemia, for which he takes the following medication:
metformin 1000mg BD
ramipril 10mg OD
atorvastatin 40mg OD
His most recent HbA1c level was 8.5%. His GP would like to intensify treatment and add another therapy. During a review Mr. S expresses concern about his diabetes management and asks about the target HbA1c level.
What is the most appropriate target HbA1c level for Mr S considering his current clinical status and treatment regimen?
A- 6.5%
B- 7.0%
C- 7.5%
D- 8.0%
E- 8.5%
7%.
In adults in TYP2, if hb1ac is not adequately controlled by a single drug and rise to 58 mmol/mol (7.5%) or above this is the target
. Mrs D, a 56-year-old woman, has recently been admitted to the cardiac unit after experiencing episodes of fast atrial fibrillation. The specialist prescribes amiodarone 200mg TDS for one week, followed by 200mg BD for one week, then maintaining on 200mg OD thereafter.
Which of the following clinical tests is required before initiation of treatment?
A- Body mass index (BMI)
B- Chest X-ray
C- Full blood count
D- Kidney function (eGFR)
E - Retinal screening
cHEST X RAY
Baseline monitoring;
- chest x ray
- Thyroid function test
- Liver function
- Serum electrolytes and urea
Mr K calls your pharmacy and asks for his prescription for warfarin to be delivered, as he is not well enough to pick it up. After further questioning, you find out that Mr K has tested positive for COVID-19.
Which of the following counselling points would you advise Mr J?
A- Advise Mr K to avoid taking paracetamol as it interacts with warfarin, causing an increase in anticoagulant effect.
B- Advise Mr K to contact his anticoagulation clinic, as his COVID-19 infection may exaggerate the effect of warfarin and a dose reduction may be required.
C- Advise Mr K to contact his anticoagulation clinic, as his COVID-19 infection may reduce the effect of warfarin and a dose increase may be required.
D- Advise Mr K to omit his warfarin doses until he has recovered.
E - Inform Mr K that you will deliver his prescription and no further action is necessar
Contact clinic, COVID-19 may exaggerate effect of Warfarin, dose reduction may be needed
Miss H is a 14-year-old girl, who has been diagnosed with asthma. Her symptoms are an infrequent, short-lived wheeze. She otherwise has normal lung function.
Which of the following treatments is the most appropriate for symptom relief for Miss H?
A- Short-acting beta agonist alone
B- Long-acting beta agonist alone
C- Oral course of prednisolone
D- High dose inhaled corticosteroid
E- Low dose inhaled corticosteroid
SABA alone
A 26-year-old has come into the pharmacy for advice. He has recently been experiencing symptoms of migraines. He describes an intense throbbing headache on one side of his head. He often feels nauseous and has to sit in a dark quiet room until his symptoms have passed. He has requested Migraleve Complete (paracetamol, codeine and buclizine) tablets over the counter but is confused about the different coloured tablets.
You explain that the pink tablets contain paracetamol, codeine and buclizine, and the yellow tablets contain paracetamol and codeine.
Which of the following directions would you provide to this patient to ensure that he does not exceed the maximum doses of each tablet?
A- Maximum 2 pink and 2 yellow tablets in 24 hours
B- Maximum 2 pink and 3 yellow tablets in 24 hours
C- Maximum 2 pink and 6 yellow tablets in 24 hours
D- Maximum 3 pink and 4 yellow tablets in 24 hours
E- Maximum 3 pink and 8 yellow tablets in 24 hours
Max 2 pink, 6 yellow in 24 hrs
Mr N is a 52-year-old man, who has been treated for hypertension for the last 12 months. He is currently taking:
ramipril 10mg once daily
amlodipine 10mg once daily
indapamide 2.5mg once daily
Nytol (Diphenhydramine) one tablet at night
In his recent blood pressure review, his GP decides to step up his treatment and initiate a beta blocker. Mr N is concerned about side effects as he’s heard beta blockers can cause sleep disturbance and nightmares. Mr N has no known allergies.
Considering Mr N’s concerns, which of the following beta blockers is most likely to cause CNS side effects due to its lipophilic nature?
A- Atenolol
B-Celiprolol
C- Nadolol
D- Propranolol
E - Sotolol
Propanolol is the only lipid soluble beta blocker mentioned here. OTHER EXAMPLES OF LIPID SOLUBLE: labetalol, metoprolol, pindolol
Mrs G comes to collect her prescription for carbimazole 15mg tablets. You ask her how she is, and she informs you that she has had a sore throat for the last 2 days.
What is the most appropriate advice to give Mrs G?
A- Advise Mrs G that there is a cold going around and she should drink lots of fluids.
B- Offer Mrs G OTC paracetamol and advise her to rest.
C- Advise Mrs G to book a blood test in the next few weeks to check her white cell count and continue taking carbimazole as normal.
D- Advise Mrs G to omit the next two carbimazole doses then continue as normal.
E- Contact Mrs G’s GP for an urgent appointment and advise Mrs C to stop taking carbimazole
E
Which of the following medicines started in hospital is the most likely cause of Mrs G’s abnormal results?- High serum creatine and low egfr
A- Amoxicillin
B- Dihydrocodeine
C- Enoxaparin
D- Naproxen
E- Paracetamol
Naproxen, the MHRA advises to avoid NSAID where possible in causes of renal impairment. Should be avoided if cdcl is below 30
A 28-year-old woman is currently taking lamotrigine for the treatment of focal seizures without secondary generalisation. She intends to start a family and has been advised to take folic acid to reduce the risk of neural tube defects during pregnancy.
Which of the following is the most suitable folic acid regimen for this patient?
A- 400mcg once daily taken before conception and until 12 weeks of pregnancy
B- 400mcg once weekly taken before conception and until 12 weeks of pregnancy
C- 5mg once weekly to be taken before conception and until 12 weeks of pregnancy
D- 5mg once daily to be taken before conception and until week 12 of pregnancy
E - 5mg once daily to be taken before conception and throughout pregnancy
5mf OD to be taking before conception and until week 12 of preg
Mrs K is a 63-year-old woman with type 2 Diabetes. She was prescribed metformin but experienced gastro-intestinal disturbances and did not tolerate it. Her GP has decided to change Mrs K to empagliflozin 10mg once daily as monotherapy. Mrs K also takes ramipril 5mg for hypertension. She takes no other medication and has no other relevant medical history.
Mrs K’s medical records show the following results, recorded at a review 4 weeks ago:
BMI 24kg/m2
eGFR 60 mL/min/1.73 m2
BP 133/84
Total cholesterol: 4.9mmol/L
HbA1c 8mmol/L
In addition to its glucose-lowering effects, what other beneficial effect may empagliflozin provide that is relevant to Mrs K?
A- Reduction in body weight
B- Lowering of blood pressure
C- Improvement in lipid profile
D- Preservation of renal function
E- Enhancement of insulin secretion
Preservation of renal function
SGLT2i slow down the progression of kidney disease, reduces risk of heart failure, lowers risk of kidney failure and complications from CKD and type 2 diabetes
You have signed into the responsible pharmacist log for a 9am-5pm shift at your local pharmacy. You have to go for an emergency meeting at the next-door surgery and are absent for 20 minutes. You annotate the log to show you are absent.
Which of the following activities can take place in your absence?
A- Delivering medication by the pharmacy delivery driver
B- Handing already checked medication to patients
C- Professional check of a prescription
D- Selling P medicines
E- Wholesale of medicine
A
Miss M, a 14-year-old girl is at a party where she gets drunk and has unprotected intercourse with a 16-year-old boy from school who she knows. Miss M cannot tell her parents what happened and, the next day she visits the pharmacy for emergency hormonal contraception.
According to the Fraser guidelines, which of the following actions should the pharmacist take prior to supplying EHC to Miss M?
A- Contact Miss M’s parents to obtain their consent for treatment
B- Establish whether Miss M has used EHC in the past
C- Inform Miss M that she is below the legal age of consent
D- Interview the 16-year-old boy Miss M had intercourse with
E- Try to encourage Miss M to inform her parents that she is seeking contraceptive advic
E
Mrs S, a 55-year-old woman has come into the GP for advice on her foot.
She takes the following repeat medication:
Warfarin: as per anticoagulant clinic
Atorvastatin 20mg tablets one daily
Allopurinol 100mg daily
Ramipril 10mg daily
Diazepam 5mg tablets
She is experiencing pain in her right foot; it is hot, swollen and red, and it started 3 days ago. She has not taken anything over the counter as she was not sure what was causing it.
A- Continue allopurinol and start colchicine for flare up of gout
B- Stop Allopurinol and start colchicine for flare up of gout. Allopurinol can be re-started once the acute flare up has passed
C- Take a high dose of Naproxen for the pain and discomfort
D- Explain to the patient that she has a bunion and can buy aspirin over the counter for the discomfort
E- Initiate antibiotics for cellulitis
Continue allopurinol and start colchicine for flare up
Unable to use naproxen as bleeding risk as warfarin
Baby L, an 8-week-old infant, is scheduled for their meningitis B vaccination. Baby L’s parents express concerns about potential fever following the vaccination and ask about preventative measures. Baby L has no known allergies or medical conditions.
What is the most appropriate recommendation for Baby L’s parents?
A- Give one 2.5ml dose of paracetamol 120mg/5ml thirty minutes prior to vaccination
B- Give 2.5ml of paracetamol 120mg/5ml as soon as the vaccination has been given and repeat twice more at 4-6 hour intervals
C- Give 2.5ml of ibuprofen 100mg/5ml as soon as the vaccination has been given and repeat twice more at 6 hour intervals
D- Offer reassurance that the Men B vaccine does not normally cause fever and to monitor the baby following vaccination
E- If the parents are concerned about side effects they can delay the vaccination until the baby is older.
B- Give 2.5ml of paracetamol 120mg/5ml as soon as the vaccination has been given and repeat twice more at 4-6 hour intervals
You are presented with a signed order from a local school requesting a supply of salbutamol inhalers.
Which of the following is required, for you to supply the inhalers?
A- Authorisation by a local GP
B- The name of the pupils who may require administration
C- Name of the school nurse
D- The signature of the headteacher of the school
E- The order must be written on approved paper
Signature of the headteacher of the school
In line with legislation requirements, the order must be signed by the principal or head teacher at the school concerned and state:
* The name of the school for which the
medicinal product is required
* The purpose for which that product is
required
* The total quantity required
Ideally, appropriately headed paper should be used; however, this is not a legislative requirement
Mr F has atrial fibrillation and congestive heart failure. He is on several medications including digoxin 250mcg tablets daily. His most recent biochemistry results show several abnormalities.
Which of the following abnormalities would be most likely to increase the risk of digoxin toxicity?
A- Hypokalaemia
B- Hypernatraemia
C- Hypermagnesaemia
D- Hyperkalaemia
E- Hypocalcaemia
Hypokalaemia
Mr E is a 52-year-old, Afro-Caribbean man. His clinic blood pressure is recorded as 155/92mmHg. After ambulatory blood pressure monitoring (ABPM), Mr M’s average 24-hour blood pressure is recorded as 148/94mmHg.
Which of these medications should be initiated for Mr M as part of pharmacotherapy treatment?
A- Losartan 100mg OD
B - Furosemide 20mg OD
C- Ramipril 5mg OD
D- Amlodipine 5mg OD
E - Candesartan 32mg OD
Amlodipine 5mg OD
Mrs P, a 57-year-old woman who has recently been treated for tuberculosis. Mrs P has completed her initial treatment phase for 2 months and is now due her 4-month continuation phase.
She has visited the pharmacy and mentions that she has been experiencing a tingling sensation in her hands and feet and has noticed it worsening in the cold. Sometimes the numbness can cause pain and discomfort.
Which of the following medications is most likely responsible for the tingling sensation Mrs P is experiencing?
A- Rifampicin
B - Isoniazid
C- Ethambutol
D- Pyridoxine
E – Pyrazinamide
Isoniazid can cause peripheral neuropathy such as tingling, numbness
Mrs P, a 57-year-old woman who has recently been treated for Tuberculosis. Mrs P has completed her initial treatment phase for 2 months and is now due her 4-month continuation phase.
Which of the following medications would be prescribed alongside her regular medication to help prevent Mrs P’s symptoms? (tingling)
A- Ethambutol
B - Isonizaid
C- Pyrazinamide
D- Pyridoxine
E – Rifampicin
Pyridoxine (vitamin B6) is given both for prophylaxis and treatment of isoniazid induced neuropathy.
Master B, aged 7, has presented to the GP practice with suspected impetigo. He has crusted golden patches around his mouth with itchy sores around his nose and chin. He has no other symptoms, but the itching is starting to bother him. He is not systemically unwell and has no known drug allergies.
Which of the following would be the most suitable treatment for Master B’s impetigo?
A- Oral Amoxicillin for 7 days
B - Oral Flucloxacillin for 7 days
C- Topical Fusidic acid for 7 days
D- Topical Hydrogen Peroxide 1% cream
E - Topical Mupirocin
The patient has sores not blisters which are not widespread. Hydrogen peroxide 1% cream is most suitable as it is localised non bulbous and is not systemically unwell
Mr L is a 63-year-old man who has asthma, hypertension and atrial fibrillation. He smokes 20 cigarettes a day and is eager to give up smoking. He has come to the pharmacy for advice on smoking cessation products that would be suitable for him.
Which of the following medications would be most likely to require a dose adjustment?
A- Ramipril
B - Digoxin
C- Theophylline
D- Bisoprolol
E - Rivaroxaban
The dose of theophylline may need to be reduced by about one quarter to one third one week after withdrawal.
However, it may take several weeks for enzyme induction to dissipate. Monitor theophylline concentration periodically.
* Advise the person to seek help if they develop signs of theophylline toxicity such as palpitations or nausea.
- You are completing an audit on Controlled Drugs (CDs) and notice that you have a number of expired CDs that require disposal.
For which of the following would it be most important to arrange for an authorised witness to be present whilst you denature the CDs?
A- Expired pharmacy stock of dipipanone hydrochloride 10 mg / cyclizine hydrochloride 30 mg tablets
B - Expired pharmacy stock of suboxone 2 mg/500 mg tablets
C- Expired pharmacy stock of morphine sulphate 10 mg/5 mL oral solution
D- Five buprenorphine 400 mcg tablets returned by a patient who no longer requires them; the tablets have not yet expired
E - Five expired diamorphine hydrochloride 10 mg tablets returned by a patien
Dipipanone hydrochloride with cyclizine is a schedule 2 drug - all schedule 2/3 and 4 (part 1) should be denatured before disposa
Suboxanone is CD3
d AND e are pt returns
Mr S, a 45-year-old man who is being treated for community-acquired pneumonia with iv antibiotic infusion. The nurses on the wards notice that he is very red and flushed with a rash on his face, neck, and upper torso. The patient complains of intense itching and discomfort.
Which of the following medications is most likely to be responsible for his symptoms?
A- Gentamicin
B - Amoxicillin
C- Cefotaxime
D- Teicoplanin
E – Vancomycin
Vancomycin- symptoms described are red man syndrome which is the rate dependent infusion reaction which can be caused by vancomycin when the infusion rate is set too fast
Mr S, a 45-year-old man who is being treated for community-acquired pneumonia with iv antibiotic infusion. The nurses on the wards notice that he is very red and flushed with a rash on his face, neck, and upper torso. The patient complains of intense itching and discomfort.
The pharmacy team are reviewing Mr S’s response to the IV infusion as part of clinical governance following the incident.
Which of the following options is most likely to be responsible for Mr S’s symptoms?
A- Adverse drug reaction
B - Allergic reaction
C- Slow infusion rate
D- Rapid infusion rate
E - High infusion dose
Rapid infusion rate
The infusion should be stopped, premedication with an antihistamine should be given to limit the
reaction and a longer infusion time should be set to restart the patient on Vancomycin.
A 32-year-old woman has been admitted to hospital following a loperamide overdose. She experienced tachycardia, agitation, and loss of consciousness. Due to the cardiac complications, she is being monitored to detect any possible complications.
Which of the following would be given as an antidote to treat Loperamide overdose?
A- Protamine
B - Activated charcoal
C- Acetylcysteine
D- Flumazenil
E - Naloxone
Naloxone
You are a medicines information pharmacist. You receive a call regarding a particular medicine that requires you to look into the current literature available to you for evidence-based information.
Which of the following is the most robust form of evidence?
A- Case-control study
B - Case reports
C- Cohort studies
D- Cross-sectional studies
E - Randomised controlled trial
RCT
A 27-year-old woman has been diagnosed with suspected H. Pylori and has been advised to take a Urea (13C) breath test to confirm the diagnosis before starting eradication treatment with antibiotics. She has just completed a course of amoxicillin for a dental infection today and has been told she must wait before taking the Urea (13C) breath test in order to avoid false negative results.
How long must she wait till she is able to take the Urea (13C) breath test?
A- 1 day
B - 5 days
C- 1 week
D- 2 weeks
E - 4 weeks
PHE advises that the urea 13c breath test and SAT should not be performed within 2 weeks of treatment with a PPI or within 4 weeks of antibacterial treatment as it can lead to false negative results
A 48-year-old man has been invited for an asthma review. During the review he explains he has been feeling low recently and is starting to lose interest in activities he used to enjoy. He has noticed that he is not eating as much and is losing concentration at work.
He is currently taking the following medication:
Montelukast 10mg at night
Tamsulosin 400mcg daily at night
Finasteride 5mg daily
Salbutamol 100mcg MDI two puffs as needed
Beclomethasone 100mcg MDI two puffs twice daily
Which of the following would be the most suitable action to take for this patient?
A- Refer patient to GP
B - Stop montelukast and report to GP
C- Stop finasteride and report to GP
D- Refer patient to CBT classes
E - Continue with normal medication and review patient again in 4 week’s time if mood has not improved
Stop finasteride and report to GP
Finasteride can cause mood alterations such as depressed mood and suicidal ideation, must monitor patients for psych symptoms and advise to stop immediately and inform the prescriber if depression occurs.
MHRA warning for montelukast - MHRA advises patients and carers to seek urgent medical attention if changes in speech or behaviour occur
n order to prevent disease outbreaks and epidemics, health care professionals are required to report to the ‘proper officer’ at the local council or local health protection team of any notifiable diseases in the area.
Which of the following conditions would require a report to be sent to the proper officer?
A- Chickenpox
B - Influenza
C- Norovirus
D- Strep throat
E - Whooping cough
Whooping cough is the only notifiable disease listed
You are working at a general practice and undertake a medicine use audit to identify medications which can be switched from branded to generic to reduce prescribing costs. One of the most expensive prescribing areas is epilepsy. Due to an MHRA warning on antiepileptics, some medication must be prescribed by brand to prevent any adverse effects for patients, these medications are considered ‘Category 1 antiepileptics”.
Which of the following antiepileptics must be prescribed by brand (Category 1 antiepileptic) to prevent the risk of adverse effects?
A- Carbamazepine
B- Levetiracetam
C- Oxcarbazepine
D- Topiramate
E - Cyclophosphamide
Carbamazepine
A 42-year-old woman has been struggling with her sleep for the past 3 weeks. She explains that she was previously advised to maintain good sleep hygiene measures. She has tried to keep her bedroom dark and quiet, did not use her mobile phone an hour before sleeping and has avoided large meals and caffeine before bedtime. Upon questioning, she explains that she does not have any problems initially getting to sleep, but she experiences difficulty maintaining the sleep, waking up every hour and struggling to achieve restful sleep.
Which of the following is the most appropriate treatment for her symptoms?
A- Diazepam
B - Loprazolam
C- Temazepam
D- Zolpidem
E- Zopiclone
Diazepam
Patient has difficulty maintaining sleep and require a long acting BDZ
A 28-year-old woman who is 3 months post-partum has visited the GP as she is noticing involuntary urine leakage when she laughs, coughs and sneezes. She is finding it embarrassing and wants to know what the treatment options are.
Which of the following would be most suitable option for this patient?
A- Discuss the use of incontinence products
B - Recommend restricting fluid intake and reduce alcohol and caffeine consumption
C- Recommend pelvic floor muscle training for 3 months
D- Recommend a trial of duloxetine therapy
E- Referral to secondary care for surgery
All are viable options – however A and B
(incontinence products and fluid intake) do not help treat the cause of the stress incontinence. This patient has just had a baby so it’s likely the pelvic floor has been weakened during pregnancy and labour.
* Pelvic floor exercise most appropriate option to start with.
* D (duloxetine) and E (referral) would only follow once all other options failed.
Mr A, a 29-year-old man, with type 1 diabetes is being treated with insulin. He has been prescribed Freestyle Libre to monitor blood glucose levels. He wants more guidance on when to test his blood glucose when driving and how to interpret his results.
Which of the following is the most appropriate advice to give?
A- Blood glucose concentration should be at least 4 mmol/L while driving.
B - If Mr A’s blood glucose is 5mmol/L or less a snack should be taken.
C- If blood glucose concentration is less than 4 mmol/L, Mr A should wait 30 minutes after blood-glucose levels are back to normal to continue driving.
D- Mr A should check his blood glucose levels, no more than 3 hours before driving and every 2 hours while driving.
E - Mr A does not need to carry a capillary blood glucose meter and test trips when driving as he uses a CGM system
B
28-year-old woman has asked for advice. She has been experiencing nausea and vomiting during her first trimester and has already tried dietary changes, eating ginger, keeping hydrated and resting however, the symptoms still persist. She would like to receive treatment for it as she is finding it difficult to manage at work.
Which of the following antiemetics is most suitable to recommend for nausea and vomiting in pregnancy?
A- Cinnarizine
B- Domperidone
C- Hyoscine hydrobromide
D- Aprepitant
E- Promethazine teoclate
Promethazine
. Mrs O is a 62-year-old woman who has presented to A&E with pain, swelling and tenderness of the wrist after she fell whilst playing with her grandchildren at the park. After a physical exam and X-ray, a broken wrist is confirmed. A DXA scan is performed which results in a T-score of –2.7, supporting a diagnosis of osteoporosis.
Which of the following would be the most appropriate treatment option for Mrs O?
A- Alendronic acid 10mg once a week
B- Alendronic acid 70mg daily
C- Alendronic acid 70mg once a week
D- Risedronate 10mg once daily
E- Risedronate 35mg once daily
C- Alendronic acid 70mg once a week
A 45-year-old man comes into your pharmacy and asks for a bottle of codeine linctus 15mg/5ml for a dry cough he’s had for the past week. He has purchased it in the past and found it very effective. He is not taking any other medication and has no known allergies.
Which is the most appropriate action to take?
A- Sell a 100ml bottle of codeine linctus and give appropriate advice regarding short term use; that the product can cause addiction and may affect his ability to drive or operate machinery
B- Ask the man what quantity he would like to purchase. You can supply the required amount from your 5L dispensing bottle as long as you label it correctly and supply a PIL
C- Advise that codeine linctus is prescription only and offer guaifenesin syrup as an alternative
D- Advise that codeine linctus is prescription only and offer pholcodine linctus as an alternative
E- Advise that codeine linctus is prescription only and offer glycerine honey and lemon as an alternative
E
