Questions need To Go Over Flashcards
Causes of spina bifida in pregnancy
What increases the risk of spina bifida
Lack of vitamin b9 folate
Family hx
Valproate and carbamazepine
Obesity
Diabetes
Rash extending from face down to chest.
Rash is made up of small red brown, slightly raised spots that join together into larger blotchy patches. He has runny nose, conjunctivitis, grey white spots with a red ring in mouth
Measles - Measles usually starts with cold-like symptoms, followed by a rash a few days later. Some people may also get small spots in their mouth.
The spots of the measles rash are sometimes raised and join together to form blotchy patches. They’re not usually itchy.
The rash starts on the face and behind the ears before spreading to the rest of the body.
Small white spots may appear inside the cheeks and on the back of the lips a few days later. These spots usually last a few days.
Spreads- get MMR vaccine
Controlled drugs: No therapeutic use and require license for production, possession and supply?
Schedule 1
Which vaccine would you supply to someone travelling to an area of poor sanitation and poor food hygiene ?
Typhoid
Hep A
Cholera
Which antimalarials can be given to pregnant women
PC
Proguanil and Cloroquine
Patient has been receiving 180mg BD of MST continus (morphine sulfate sustained release)
Her doctor now wants to change her to morphine sulfate oral solution every 6 hours as she is finding it difficult to swallow tablets. What daily dose of morphine sulfate oral solution will provide an equivalent dose for this patient?
180mg * 2 = 360mg
24 hours / 6 hours = 4 times
360/ 4 = 90mg / 6 hours
Mouth ulcer > 2 weeks
Refer - dentist
Oral cancer ?
Allergy to metal in ring
Contact dermatitis - inflamed blistered dry cracked skin
Caused by irritant (soap/ detergent) - may not immediately cause problem, maybe after frequent exposure. Symptoms appear within 48 hours
Caused by allergen- makeup/ jewellery, take several days to develop
If you can avoid being re-exposed to the substance responsible for the reaction your skin will usually clear up within a few days or weeks.
Infection- discharge, increasing pain, existing symptoms get rapidly worse, feeling hot or shivery
Beta 2 agonist - salbutamOl can cause HYPOkalaemia
True
Do Cannabis base products for medicinal use (CBPM) need to be recorded in the controlled drug register
CBPM should be treated as controlled drugs and therefore all prescription writing and control requirements apply
Dronabinol schedule 2 treats loss of appetite in people with aids and treat sever N&V caused by chemo
What schedule drugs are the licensed cannabis products?
Licensed products:
Sativex- schedule 4 used in MS
Nabilone POM
Epidyolex schedule 5 used for seizures
In the incidence of a patient safety incident, what should be done ?
A root analysis should be carried out
Are anthelmintics for treating threadworms recommended during pregnancy?
No,
Patient should be given advice regarding hygiene measures only for 6 weeks
How do you dispose of used methadone bottle ?
Remove labels & identifiers and place in recycling or general waste
Rough, raised papules with a cauliflower like appearance and black dots on the their surface, what is it?
Warts are caused by the human papillomavirus
Contagious
Take upto 12 weeks to disappear, should be filed once weekly to remove dead, hardened skin and enable treatment to penetrate.
Bazuka gel/ verrugon/ salactol
Contain salicylic acid which helps to soften and destroy skin to aid removal of infected tissue
Referral-
facial / genital / multiple/ change in size or colour warts
Bleeding, itching, no improvement in 3 months
Children <6 and elderly, diabetes, immunocompromised, hx of PVD
Yasmin
Ethinylestradiol 30 micrograms Drospirenone 3 mg
Combined Oral Contraceptives Monophasic 21-day preparations
Microgynon® 30
Femodene®
Yasmin®
Combined Oral Contraceptives Monophasic 28-day preparations
Femodene® ED
Microgynon® 30 ED
Zoely®
Coffee ground vomit and weight loss
Refer maybe oesophageal/ gastric carcinoma
Patient admitted with status epilepticus
Sertraline is an SSRI and can lower seizure threshold
Chloroquine given daily or weekly ?
Chloroquine 310mg is given once weekly
Dyspepsia heart burn/acid reflux can be caused by which medicines
Caused by
Bisphosphonates
CCB
Nitrates
Theophylline
NSAIDs
Doxycycline
Excess alcohol
Corticosteroids
Terminally ill patient is constipated what laxative can be given?
Co-danthramer
Can you give quinolones (cipro) to someone with a hx of epilepsy ?
Quinolones may induce convulsions
Impulse control disorder more likely with levodopa or ropinerole?
Impulse control disorders (gambling, hyper sexuality, binge eating or obsessive shopping) can develop in a person with Parkinson’s disease who is on DRA therapy.
DRA
Amantadine hydrochloride
Apomorphine hydrochloride
Bromocriptine
Cabergoline
Pramipexole
Quinagolide
Rotigotine
Lorazepam ‘repeat x 3’
Is it allowed to be issued via a repeat prescription ?
Yes, schedule 4 CD is allowed on repeats
Rash on lower leg
Which rash is most likely to present on lower extremities?
Discoid eczema
Clozapine can cause agranulocytosis therefore what monitoring is done?
Leukocyte and neutrophil count Clozapine requires differential white blood cell monitoring weekly for
18 weeks,
fortnightly for up to one year,
and then monthly
Maximum day supply of fentanyl patches
Fentanyl patches are schedule 2
Validity of prescription is 28 days
Recommended length of supply is 30 days
Clarithromycin + dabigatran (doac)
Increased risk of bleeding 🩸
Stop clarithromycin whilst undergoing treatment with dabigatran
Dutasteride- 5a reductase inhibitor
BPH
Women of childbearing potential should avoid handling leaking capsules of dutasteride.
Cases of male breast cancer have been reported. Patients or their carers should be told to promptly report to their doctor any changes in breast tissue such as lumps, pain, or nipple discharge.
Dutasteride is excreted in semen and use of a condom is recommended if sexual partner is pregnant or likely to become pregnant.
Side-effects
Common or very common
Breast disorder; sexual dysfunction
Uncommon
Alopecia; hypertrichosis
Doxycycline labels
Do not take indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine
Protect your skin from sunlight—even on a bright but cloudy day. Do not use sunbeds
Take with a full glass of water
Minor injuries such as sprains and strains can often be intially treated at home using PRICE for 2-3 days
PRICE
Protection (support)
Rest (avoid physical activity)
Ice (15-20 mins every 2-3 hours) wrap ice pack in towel so no ice burn
Compression- to limit swelling use elastic compression bandages
Elevation- keep injured body above level of your heart wherever possible. May help reduce swelling
Do CBPMs need to be recorded in the controlled register?
CBPMs need to be recorded in the controlled drugs register
CBPMs should be treated as controlled drugs and therefore all prescription writing and control requirements apply.
painful to urinate, burning, stinging type of pain, urinate frequently but only passing small amounts of urine. urine is quite dark and smells strongly.
What am I ?
Cystitis is an inflammation of the bladder
Symptoms described are indicative of cystitis. If fever, discharge present then its another condition?
which schedule drug allows for a prescription to be dispensed up to 6 months after the appropriate date?
Schedule 5 Rx valid for 6 months
Prescriptions with sch2,3,4 are only valid for 28 days!
Which schedule drugs are pregabalin
gabapentin
midazolam
phenobarbital
tramadol
pentazocine
meprobamate
mazindol
phentermine
Pregabalin and gabapentin will be included in the list of “exempted drugs” in the safe custody regulations which means that they will not be required to be kept in the CD cabinet.
sore ear- last 3 days
local itching and pain
what am I?
Otitis externa
Acute — itch, pain, or discharge of the ear canal; hearing loss; tenderness of the tragus and/or pinna; red and oedematous ear canal; tympanic membrane erythema
consider use of OTC acetic acid 2% ear drops or spray.
Perichondritis - outer ear structure swelling
otitis media - pain but no itching; Meniere’s disease exhibits dizziness, fullness in ear.
local inflammation is unlikely to present with itching
Baby’s feet scabies
Babies could develop small blisters (that contain pus on the feet and palms of the hands). Distinct signs of burrowing are not always evident in babies.
Which food contains large amounts of vitamin K?
Certain foods such as liver, broccoli, brussels sprouts and green leafy vegetables contain large amounts of vitamin K.
An 18-year-old girl enters your pharmacy and asks for your advice regarding a sore throat, tiredness and swollen glands in her neck.
What do you suspect may be her condition and most likely cause?
Glandular fever caused by Epstein-Barr virus.
Ritonavir = used in HIV
Ritonavir is a protease inhibitor used in the treatment of HIV.
Which details of midwife are required on a supply order of diamorphine?
Name of midwife
Name of patient
Occupation of midwife
Purpose for which the diamorphine is required
Which of the following types of literature would be deemed to provide ‘the best available evidence’?
Case-control studies
Cohort studies
Expert opinion
Randomised controlled trials
Systematic reviews take into account all literature created, therefore, provide the best evidence in research.
Which schedule is anabolic steroids/ androgernic steroids/ clenbuterol/ growth hormones?
Clenbuterol, steroids, growth hormones = Schedule 4 (part 2) CD.
Can you have long baths whilst wearing fenatyl patches
Exposure of fentanyl patches to heat sources can increase concentrations of fentanyl which have been associated with serious adverse reactions and death.
symptoms of migraine
on 1 side of the head
a pulsating pain
severe enough to prevent you carrying out daily activities
made worse by physical activity or moving about
accompanied by feeling and being sick
accompanied by sensitivity to light and noise
A 42-year-old woman comes into the pharmacy stating that she has been seeing flashing lights followed by a throbbing headache on her right side. Her symptoms first begun yesterday morning and she reports no change in vision. She has no other medical conditions and is not on any regular medication.
The woman is showing symptoms of a migraine with an aura. Common triggers for this include hormonal changes, emotional triggers, fatigue, dietary triggers such as eating cheese, chocolate or drinking alcohol and taking certain COC/HRT.
Which drug has a risk of overdosing an infant if used in breastfeeding women due to a maternal variation in capacity to metabolise?
Genetic polymorphism of enzymes involved in the metabolism of codeine to morphine can lead to increased levels of morphine in the mother.
Codeine should only be used to relieve acute moderate pain in children older than 12 years and only if it cannot be relieved by other painkillers such as paracetamol or ibuprofen alone. Furthermore, a significant risk of serious and life-threatening adverse reactions has been identified in children with obstructive sleep apnoea who received codeine after tonsillectomy or adenoidectomy (or both). Codeine is now contraindicated in all children younger than 18 years who undergo these procedures for obstructive sleep apnoea
Which bacteria causes impetigo?
impetigo secondary to infection with bacteria, usually Staphylococcus aureus or Streptococcus pyogenes.
What does Codis® contain
Aspirin + Paracetamol
Are schedule 3 drugs exempt from record keeping?
CD No reg POM
Pregabalin /gabapentin are exempt from record-keeping requirements
Can prescriptions of schedule 2 and 3 be repeated?
sch2 diamorphine? methadone? oxycodone? amfetamines? quinalbarbitone? ketamine?
sch 3 gabapentin, pregabalin, buprenorphine, temazepam, tramadol, midazolam, phenobarbital
No repeats can be issued for sch 2,3 !!!!
can you donate blood when taking isotretinoin?
Patients should not donate blood during therapy and for 1 month following discontinuation of isotretinoin because of the potential risk to the foetus of a pregnant transfusion recipient.
Misoprostol ANTIULCER drug
is an antisecretory and mucosal protectant drugs which may cause severe diarrhoea which may require withdrawal
Misoprostol
Diarrhoea may occasionally be severe and require withdrawal, reduced by giving single doses not exceeding 200 micrograms and by avoiding magnesium-containing antacids.
Pneumocystitis pneumonia
Co-trimoxazole-
sufamethoxazole + trimethoprim
panidol actifast
soluble paracetamol
Nurofen plus
Ibuprofen + codeine
Co-codamol 8/500
Codeine and paracetamol
Anadin® Extra
Aspirin, paracetamol, caffeine
Anadin® original
Aspirin and codeine
PANADOL COLD & FLU ORIGINAL FORMULA
paracetamol, pseudoephedrine hydrochloride and dextromethorphan hydrobromide
Panadol extra advance
paracetamol + codeine
dermatophytic onychomycosis
ringworm of the nail
Quinolone interaction with NSAID? steroids?
Convulsions with NSAIDs
and Tendon damage with steroids
whooping cough
notifiable disease
1st line: macrolide- clarithromycin/erythromycin
Breastfeeding mother develops thrush as well as her baby, what should she do with the expressed milk?
If you express any breast milk while you have thrush, you’ll need to give the milk to your baby while you’re still having treatment. Do not freeze it and use it at a later date, as this could cause the thrush to come back.
Can fusidic acid can be used during breast-feeding
Fusidic acid can be used during breast-feeding but breastfeeding from the affected nipple should be avoided during treatment.
what can be used in a patient diagnosed with osteoarthritis two months ago.
Which of the following medications would be suitable for long-term pain-relief?
Paracetamol should be used first for pain relief in osteoarthritis and soft-tissue disorders. Given that this is a chronic condition, the use of NSAID’s (the other options) long term can result in an increased risk of gastro-intestinal bleeding and ulcers. NSAID’s could be used for the short-term relief of pain in osteoarthritis.
A patient comes into your pharmacy complaining of a very tender big toe. You consider that it might be gout.
Which OTC drug or action would be the most appropriate?
A patient comes into your pharmacy complaining of a very tender big toe. You consider that it might be gout.
Which OTC drug or action would be the most appropriate?
You are running a clinic for patients with diabetes.
You need to be vigilant for signs of diabetic ketoacidosis when withdrawing insulin on patients also taking which medicine?
Diabetic ketoacidosis has been reported in patients with type 2 diabetes on a combination of a GLP-1 receptor agonist and insulin who had doses of concomitant insulin rapidly reduced or discontinued.
Which vaccine is indicated against TB ?
BCG
Fishy smelling vaginal discharge?
Bacterial vaginosis (BV)- no itch/soreness
Trichomoniasis is characterized by a FISHY-smelling, yellow/green frothy discharge that may be associated with itching, soreness, and dysuria.
Odourless curdy vaginal discharge?
Vaginal candidiasis is characterized by a white, odourless, curdy discharge that may be associated with vulval itching and superficial soreness.
vaginal discharge + lower abdominal pain
Cervicitis or pelvic inflammatory disease (PID) caused by chlamydia (or less commonly by gonorrhoea)is characterized by vaginal discharge associated with post-coital (after/during sex) or intermenstrual bleeding, dysuria, deep dyspareunia (pain during sex), or lower abdominal pain
With what category of antileptics does the pharmacist need to confirm with the prescriber if patient should be kept on the same brand?
Category 2
Clobazam, Clonazepam, Eslicarbazepine, Lamotrigine, Oxcarbazepine, Perampanel, Retigabine, Rufinamide, Topiramate, Valproate, Zonisamide
A new born baby whose father had tuberculosis two years ago is due to be vaccinated against tuberculosis.
Which vaccine is indicated for this patient?
BCG (Bacillus Calmette-Guérin) is a live attenuated strain derived from Mycobacterium bovis which stimulates the development of immunity to M. tuberculosis.
Does pomegranate juice interact with warfarin
Pomegranate juice increases the INR in response to warfarin.
A lady seeks advice regarding an unpleasant condition. The lady complains that her vaginal region is itchy, inflamed with a thick white vaginal discharge.
What would be the most likely causative organism?
The patient is complaining of symptoms related to vaginal thrush. The common organism causing this kind of condition is candida albicans.
Does ramipril cause bradycardia or tachycardia?
Tachycardia
A 24-year-old female returns to your pharmacy after having supplied her a hormonal emergency contraceptive pill 2 weeks ago. She complains of lower abdominal pain, what could this be indicative of?
Lower abdominal pain may be indicative of an ectopic pregnancy and medical attention should be sought.
Is verapamil suitable for supraventricular and ventricular arrhythmias?
Verapamil is usually effective for supraventricular tachycardias only.
Daptomycin + simvastatin?
Statins are predicted to increase the risk of rhabdomyolosis when given with daptomycin.
Migraine without aura
Unilateral location (more commonly bilateral in children).
Pulsating quality, ‘throbbing’ or ‘banging’
Moderate or severe pain intensity.
Aggravation by, or causing avoidance of, routine activities of daily life (for example walking or climbing stairs).
Headache with associated symptoms including at least one of:
Nausea and/or vomiting.
Photophobia (sensitivity to light) and phonophobia (sensitivity to sound).
Migraine with aura
Visual symptoms such as zigzag lines and/or scotoma — visual aura is the most common type of aura.
Sensory symptoms such as unilateral pins and needles or numbness.
Speech and/or language symptoms such as dysphasia.
Cluster headache
unilateral orbital, supraorbital and/or temporal pain lasting 15 minutes to 3 hours (untreated)
Conjunctival injection and/or lacrimation.
Nasal congestion and/or rhinorrhea.
Eyelid swelling.
Forehead and facial sweating.
Forehead and facial flushing.
Sensation of fullness in the ear.
Miosis (excessive pupillary constriction)
Tension headache
Bilateral location.
Pressing, tightening, non-pulsating quality (‘like a vice or tight band’). Note: pain often spreads into or arises from the neck, and there may be pericranial tenderness on manual palpation.
Mild or moderate intensity.
Not aggravated by (and does not cause avoidance of) routine physical activity (such as walking or climbing stairs).
Grapefruit juice interacts with rosuvastatin or ciclosporin?
Grapefruit juice increases the concentration of ciclosporin.
A customer requests Flomax Relief MR (tamsulosin hydrochloride) from your pharmacy. He complains of having cloudy urine. What should you do?
Cloudy urine could be a sign of infection (UTI) or chronic retention = urgent referral
Risk factors for developing heart disease
our risk of developing atherosclerosis is significantly increased if you:
smoke
have high blood pressure (hypertension)
have high cholesterol
have high levels of lipoprotein (a)
do not exercise regularly
have diabetes
Other risk factors for developing atherosclerosis include:
being obese or overweight
having a family history of CHD – the risk is increased if you have a male relative under the age of 55, or a female relative under 65, with CHD
Miss RG asks your advice on taking her combined oral contraceptive as she is 5 hours late in taking her next tablet. She is at the middle of her cycle.
1 pill missed in week 2 or week 3 after hormone free interval (or subsequent consecutive weeks of continuous pill-taking) EC not
required if consistent, correct use in the previous 7 days. Take the missed pill as soon as possible, continue the remaining pills at the usual time, no additional contraceptive precaution required.
dispensing label LEGAL requirement
legal requirement
Name of patient
Name + address of pharmacy
Name of medicine
Directions
Precautions
Date of dispensing
is a legal requirement
Not needed:
BNF warnings
Expiry date of medicine
“Keep out of the sight and reach of children”
address of prescriber
What effect do
cranberry juice
kale
spinach
have on warfarin?
Cranberry juice is an enzyme inhibitor–> inhibits breakdown of warfarin–> increasing its anticoagulant effect. Spinach and kale contain vitamin k (phytomenindione) which can reduce the anticoagulant effect of warfarin.
Interaction
Omeprazole + clopidrogrel
Omeprazole is known to reduce the anti-platelet effect of clopidogrel and as such these drugs should not be co-prescribed.
Is the name or address of wholesaler from whom the CD2 is obtained legally required to be kept in the CD register?
The name and address of whom the CD is received from is legally required to be kept in the CD register.
What is the maximum TOTAL daily dose of Ibuprofen in an adult when used as a GSL product?
1.2g
Adults can take 200 mg-400 mg every FOUR hours if required, however, they must not exceed 1.2 g in 24 hours when taking over-the-counter.
Steroid creams are routinely sold over the counter.
In which situations can hydrocortisone 1% cream be sold otc?
It can be sold to treat
allergic contact dermatitis, irritant dermatitis, insect bite reactions and mild to moderate eczema. However it may not be sold to children under 10 or in pregnancy except under medical advice. Contraindications include use on eye or face, anogenital region, broken or infected skin, acne or athletes foot. Use is restricted to a max. of 1 week.
longterm use of steroids cause alopecia?
Long term use of steroid creams can cause hypertrichosis which is overgrowth of hair and not alopecia - loss of hair.
Adrenal suppression, skin atrophy are also a side effects
Which Controlled Drugs are most likely to require a license for import/export as well as the need to retain the invoice for 2 years?
schedule 3
buprenorphine
temazepam
tramadol
midazolam
phenobarbital
gabapentin
pregabalin
which CD drugs should be in Safe custody ?
CD 1 and CD 2
Buprenorphine + temazepam = CD3
What is the recommended check point for avoiding prescribing errors?
Double checking when prescribing or administering any medicine is important to avoid any medication errors. You can double check it is the: right medicine, right patient, right dose, right route, right time.
Interaction
Phenytoin + Daktarin® oral gel
Miconazole enhances anticonvulsant effect of phenytoin (plasma concentration enhanced) although with topical use, the risk is lower.
Promazine is an antipsychotic, do patients on this medication require to wear sun block?
Promazine makes the skin more susceptible to the UV rays from the sun. As such, a patient on promazine therapy is more susceptible to burning/sun burn and must take precaution in sunlight.
Miss J is a 23-year-old female who has just been admitted into hospital after a car accident requiring a hip replacement surgery and has been prescribed Zoledronic acid.
Zolendronic acid has shown toxicity in animal studies and should be avoided in woman of child-bearing potential.
Young lady is planning on getting her MMR vaccine, how long after can she get pregnant?
Zolendronic acid has shown toxicity in animal studies and should be avoided in woman of child-bearing potential.
Tibolone can cause vaginal bleeding, which if continues beyond 6 months or after stopping treatment can indicate endometrial cancer. What about nipple pain?
Nipple pain is a side effect of tibolone
What does confidential information include?
• electronic and hard copy data
• personal details
• information about a person’s medication
(prescribed and non-prescribed)
• other information about a person’s
medical history, treatment or care that
could identify them, and
• information that people share that is not
strictly medical in nature person disclosing it would expect to be kept confidential
Confidential information does not include:
• anonymous information − information
from which individuals cannot
reasonably be identified
• pseudonymised information −
information from which individuals
cannot reasonably be identified, but
which allows information about different
people receiving care to be
distinguished (for example, to identify
drug side effects)
• information that is already legitimately
in the public domain
vitamin k antagonists and pregnancy
For all vitamin K antagonists
Should not be given in the first trimester of pregnancy.
Warfarin, acenocoumarol, and phenindione cross the placenta with risk of congenital malformations, and placental, fetal, or neonatal haemorrhage, especially during the last few weeks of pregnancy and at delivery. Therefore, if at all possible, they should be avoided in pregnancy, especially in the first and third trimesters
Stopping these drugs before the sixth week of gestation may largely avoid the risk of fetal abnormality.
Interaction
cimetidine + warfarin
Inhibits the metabolism of warfarin
Intravenous Salbutamol given in diabetes can cause?
ketoacidosis
Patient in your pharmacy is having an anaphylaxis, what do you do?
The patient is demonstrating signs of anaphylaxis. She will need emergency assistance so it is important to call 999 asap. As you have other staff available to do this, it would be appropriate to get them to do this instantly while you then deal with the emergency. The MEP states that: “If a pharmacist administers adrenaline they must also ensure that an ambulance is called by dialling 999 and reporting that there is a case of suspected anaphylaxis.” EpiPen training provides similar guidance. When managing anaphylaxis it is crucial that the ambulance gets to the patient as soon as possible. Therefore, the initial first step to get the assistant to phone 999 would be prudent while you are in the process of locating and administering the adrenaline pen in order to avoid undue delay in the patient getting the next step in their care.
Diagnosed with mild pneumocystis pneumonia, unable to tolerate trimethoprim.
Which single medication is the most likely treatment option for pneumonia?
Atovaquone is licensed for the treatment of mild to moderate pneumocystis infection in patients who cannot tolerate co-trimoxazole (co-trimoxazole is made up of sulfamethoxazole and trimethoprim
She is breastfeeding her four week old baby and the baby has oral thrush. She has been prescribed miconazole cream for herself but she is unsure what to do with it. What is the best advice to give to the lady?
The cream should be applied after feeding the baby.
Which of the following drugs is a weak opioid and as such can be used for the relief from moderate pain in adults?
Buprenorphine Codeine Ibuprofen Morphine Paracetamol
The correct answer was Codeine
Ibuprofen and paracetamol are not opioids, morphine and buprenorphine are strong opioids.
Adriana has a non-productive cough. You believe it to be a viral infection. She has hypertension and suffers from type 1 diabetes.
What would be the most appropriate treatment/course of action?
Viral infections are self-limiting and no treatment is necessary, therefore it would be a suitable ‘recommendation’. A demulcent could be tried. As they are diabetic a sugar-free alternative would be useful but it is unlikely that a few days treatment with a demulcent containing sugar will affect their diabetic control. If a demulcent containing sugar is recommended then the person could be told to monitor their blood sugar more regularly. Cough suppressants and antihistamines have no evidence of efficacy and should not be recommended. An expectorant is only suitable for productive coughs.
Mrs G comes into your pharmacy and tells you that she is in pain. When you inquire further, she tells you that the pain is in her eye. She describes it as ‘constant aching pain in her right eye that goes to her forehead’. She also tells you that she ‘can not see properly out of that eye’. When you look at her eye you notice that it is red and the pupil is dilated, but there is no discharge and her eye isn’t itchy. She usually wears glasses for her hyperopia.
What is the likely cause of her signs and symptoms?
Acute angle closure glaucoma
Her signs and symptoms are indicative of acute angle closure glaucoma which is more common in elderly patients who have hyperopia (i.e. are long-sighted). Acute angle-closure glaucoma occurs when the outflow of aqueous humour from the eye is obstructed by bowing of the iris against the trabecular meshwork.
Been less than 2 hours since patient missed Cerazette® pill (POP), what advice would you give?
Women who vomit within 2 hours of taking a POP should be advised to take another pill as soon as possible.
If this means that the subsequent pill is taken more than 3 hours late (12 hours for a DSG pill-12-hour progestogen-only pill (desogestrel progestogen-only pill) then the missed pill rules for POP should be followed. This would also apply if a woman were to continue to vomit or have very severe watery diarrhoea.
You are dispensing a prescription for a patient for an emollient which contains 40% paraffin.
The patient tells you he’s seen on the television that such emollients can catch fire and asks you for a paraffin-free alternative from the shelves in your shop. What advice would you give him?
There is also a risk of fire with emollients that don’t contain paraffin.
There is a fire risk with all paraffin-containing emollients, regardless of paraffin concentration, and it also cannot be excluded with paraffin-free emollients. A similar risk may apply for other products which are applied to the skin over large body areas, or in large volumes for repeated use for more than a few days.
Miss U presents to the pharmacy complaining of dysuria, fever and flank pain.
Which condition is this most indicative of?
Pyelonephritis is associated with fever and flank pain, compared to trichomoniasis whose predominant feature is discharge. Presents to the pharmacy complaining of dysuria, fever and flank pain.
Which condition is this symptom cluster most indicative of?
Drug interaction:
Smoking + theophylline
Smokers may require higher doses of theophylline as it is cleared quicker in these patients. Those who stop smoking will need to have their dose adjusted, as they will no longer require the higher doses as in smokers.
A parenteral drug misuser is seen in the clinic.
Which vaccine is indicated for this patient?
Hepatitis A vaccine
Is dry eyes a side effect of amitriptyline?
Dry eyes is not listed as a side effect of amitriptyline
Constipation, dry mouth, drowsniess, QT prolongation are side effects of amitriptyline
Can dose of midazolam for buccal administration be split?
It may be split so that a dose is given into each cheek to avoid accidental swallowing.
Which is the best contraception method?
An Intrauterine device is more than 99% effective. With typical use the combined oral contraceptive is around 91% effective. With typical use male condoms are around 82% effective. With typical use diaphragms are around 71-88% effective, the natural family planning method is around 76% effective.
Does penicillamine cause side effects such as -any sore throat, fever, infection, unexplained bleeding and bruising, purpura, mouth ulcers or rashes
Penicillamine has been associated with blood disorders. Therefore, patients should be counselled to report these signs immediately to their doctor, if and when they develop.
Double checking when prescribing or administering any medicines is important to avoid any medication errors. What is NOT an MHRA recommended check point for avoiding prescribing errors?
Answer: strength
You can double check it is the: right medicine, right patient, right dose, right route, right time.
Interaction: Baclofen + Acei
enhanced hypotensive effect
Do coumarins cause heavy bruises?
YES
A doctor in A&E is seeing a patient with a history of alcohol misuse and is querying which laxative can be used for hepatic encephalopathy.
Lactulose
Through its mechanism of action lactulose prevents the reabsorption of ammonia and other toxins from faecal matter in the gut which can cause hepatic encephalopathy
This drug can be used in the treatment of post-traumatic stress disorder.
Who am I?
Paroxetine
This drug is an SSRI, which is indicated for the treatment of PTSD.
Interaction
BB + digoxin
Beta blockers such as atenolol would increase the risk of digoxin-related bradycardia.
Interaction
sildenafil + citalopram
QT prolongation
lithium toxicity
Blurred vision, resting tremor, muscular weakness etc are characteristics to lithium intoxication
interaction
gliclazide + miconazole
Individuals using gliclazide should not be prescribed the antifungal miconazole due to an increase in the hypoglycaemic effect
5-year-old daughter tires easily, is reluctant to walk and it looks like her legs are bowed
what is wrong with her, can she take anything for it?
Vitamin D
The child’s symptoms are indicative of rickets, as a result of vitamin D deficiency.
What are these symptoms of?
feel very tired and weak all the time
feel irritable and sad all the time
have severe joint or leg pain
have SWOLLEN, BLEEDING GUMS (sometimes teeth can fall out)
develop red or blue spots on the skin, usually on your SHINS
have skin that BRUISES easily
scurvy (vitamin C deficiency). Although rare, it could occur in very elderly patients who may find it harder to cook or maintain a healthy diet.
Based on days/packs supplied, what is the maximum number of days/packs of medication that you could legally give to a patient as an emergency supply for the following medications, if any?
Zoely®. Please give number of day(s).
Zoely is a 28-day preparation with 24 active tablets and 4 inactive tablets, rather than a seven day tablet free interval. Under emergency supply regulations, a full cycle of a contraceptive may be supplied so in this case 28 days would be classed as the full cycle even with the inactive tablets.
what is the maximum number of days/packs of medication that you could legally give to a patient as an emergency supply for the following medications, if any? Each option may be used once, more than once, or not at all.
Rifaximin for travellers’ diarrhoea. Please give number of day(s).
For an orally administered liquid antibiotic, the smallest quantity to provide a full course should be given. For tablet antibiotics, the maximum supply is 30 days treatment, but a pharmacist should consider the appropriateness regarding the amount they supply. For the case of an antibiotic with a fixed course, the amount to complete the course would be appropriate - which at the most would be 3 days.
A patient is admitted to the ward after suffering an acute bronchospasm. Which medication should be AVOIDED in this patient?
Atenolol is a beta blocker. This medication should be avoided in patients with history of acute bronchospasm.
Is chloramphenicol contraindicated in acute porphyrias?
The use of chloramphenicol is contraindicated in patients with acute porphyrias.
Does thyrotoxicosis cause palpitations?
Symptoms of thyrotoxicosis: this includes weight loss, palpitations (associated with atrial fibrillation) and insomnia.
coeliac disease cause foul smelling steatorrhoea, weight loss and dermatitis herpetiformis on her elbows and buttocks?
coeliac disease (autoimmune response to gluten, a dietary protein found in various foods such as cereal, bread and pasta). symptoms are abdominal pain, foul smelling steatorrhoea (fatty greasy stools due to malabsorption), weight loss and dermatitis herpetiformis (a type of skin rash that is itchy and has blisters that burst when scratched).
coeliac disease cause foul smelling steatorrhoea, weight loss and dermatitis herpetiformis on her elbows and buttocks?
coeliac disease (autoimmune response to gluten, a dietary protein found in various foods such as cereal, bread and pasta). symptoms are abdominal pain, foul smelling steatorrhoea (fatty greasy stools due to malabsorption), weight loss and dermatitis herpetiformis (a type of skin rash that is itchy and has blisters that burst when scratched).
coeliac disease cause foul smelling steatorrhoea, weight loss and dermatitis herpetiformis on her elbows and buttocks?
coeliac disease (autoimmune response to gluten, a dietary protein found in various foods such as cereal, bread and pasta). symptoms are abdominal pain, foul smelling steatorrhoea (fatty greasy stools due to malabsorption), weight loss and dermatitis herpetiformis (a type of skin rash that is itchy and has blisters that burst when scratched).
does captopril cause insomnia
Yes
Interaction
Digoxin + quinine
plasma concentration of digoxin increased by quinine. Nausea and vomiting may be early signs of an excessive dose of digoxin.
Ketoconazole (enzyme inhibitor) + pimozide (antipsychotic)
Ketoconazole is predicted to increase the exposure to pimozide. Manufacturer advises avoid. Ventricular arrhythmias are are potential effect of overdose with pimozide
Methotrexate and contraception?
Women must not get pregnant during methotrexate therapy, and effective contraception must be used during treatment with methotrexate and at least 6 months thereafter.
Sexually active male patients or their female partners are recommended to use reliable contraception during treatment of the male patient and for at least 6 months after cessation of methotrexate. Men should not donate semen during therapy or for 6 months following discontinuation of methotrexate
Mastitis breastfeeding
Advising on measures to relieve pain and discomfort, such as the use of simple analgesics and applying a warm compress to the breast.
Encouraging breastfeeding women to continue feeding if possible, including from the affected breast.
Flucloxacillin
Pen allergy clarithromycin/erythromycin
Sore throat
Paracetamol
Ibuprofen
Phenoxymethylpenicillin
Pen allergy clarith
Pregnant erythro
Acute otitis media
Paracetamol ibuprofen
Amoxicillin
Pen allergy Clarithromycin
Pregnant erythromycin
Acute otitis
externa
analgesia
apply localised heat (such as a warm flannel)
Second line: topical acetic acid
topical neomycin sulphate with corticosteroid
