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1
Q

True or false - verapamil is suitable for the treatment of supraventricular and ventricular arrhythmias?

A

False - usually effective for suprventricular tachycardias only.

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2
Q

Name two drugs that can lower the seizure threshold

A

SSRIs, tramadol, tapendalol, ciproflox, TCAs

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3
Q

Patient currently taking sodium valproate reports abdominal pain, nausea and vomiting… what do you do?

A

Refer to A&E - signs of sodium valproate induced pancreatitis

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4
Q

What schedule CD is clenbuterol?

A

Schedule 4 (anabolic steroid)

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5
Q

What schedule CD does ketamine belong to?

A

Schedule 2

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6
Q

What is the maximum duration of treatment which can be given via OTC chloramphenicol?

A

5 days

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7
Q

How long should signed orders be retained for after supply?

A

2 years

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8
Q

How long should private prescription records be kept?

A

2 years

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9
Q

what is nalidixic acid used for?

A

Urinary tract infections

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10
Q

How long after stopping flucloxacillin can choleostatic jaundice develop?

A

up to 2 months after stopping

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11
Q

How often should SOPs be reviewed?

A

every 2 years

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12
Q

Private prescriptions for COC that state ‘repeat’ can be dispensed a total number of times?

A

can be dispensed a total of 6 times in 6 months

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13
Q

How should daktocort cream be stored? what about ointment?

A

In fridge

ointment below 30 degrees

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14
Q

Digoxin and quinine interaction

A

Plasma concentration of digoxin is increased by quinine and so can lead to toxicity

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15
Q

Why should sildenafil and nitrates not be prescribed together?

A

Can cause a marked hypotensive effect

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16
Q

What three drugs must NEVER be put in a syringe driver?

A

Diazepam, prochloperazine and chlorpromazine

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17
Q

cyclizine antagonising the effect of what antiemteic?

A

Metoclopramide - no point giving together

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18
Q

Confusion or memory loss, muscle spasms, numbness and tingling in the hands/feet, depression, hallucinations, weak and brittle nails…are all signs of what electrolyte disturbance?

A

Hypocalcemia

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19
Q

Loss of appetite, N&V, constipation and abdo pain, increased thirst and frequent urination, muscle pain, confusion and difficultly thinking….are all signs of what electrolyte disturbance?

A

Hypercalcemia

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20
Q

Signs of hyponatremia

A

Nausea and vomiting

headache, confusion, loss of energy and fatigue, restlessness and irritability, muscle weakness, crapms, seizures, coma

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21
Q

constipation, palpitations, fatigue, muscle weakness are signs of what electrolyte disturbance?

A

Hypokalemia

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22
Q

Tiredness or weakness, a feeing of numbness or tingling, trouble breathing, chest pain, irregular heart beats/palpitations are signs of what electrolyte disturbance?

A

Hyperkalemia

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23
Q

What electrolyte disturbance can mirtazipine cause?

A

Hyponatremia

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24
Q

Mrs Smith has been taking 800units of ergocalciferol for 2 weeks now because she has a lack of vitamin D.
She develops nausea and has now vomited. What is the likely reason for this?

A

The vitamin D may have led to an increase in serum calcium causing the symptoms

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25
Q

Sumatripan (and other triptans) are contraindicated in what disease?

A

Coronary vasospasm; ischaemic heart disease; mild uncontrolled hypertension; moderate and severe hypertension; peripheral vascular disease; previous cerebrovascular accident; previous myocardial infarction; previous transient ischaemic attack

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26
Q

What is the first line treatment for migraine?

A

Treatment of a migraine attack should be guided by response to previous treatment and the severity of the attacks. A simple analgesic such as aspirin, paracetamol (preferably in a soluble or dispersible form) or a NSAID is often effective; concomitant antiemetic treatment may be required.

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27
Q

Why might simple analgesics not be effective in treating migraine?

A

Most migraine headaches respond to analgesics such as aspirin or paracetamol but because peristalsis is often reduced during migraine attacks the medication may not be sufficiently well absorbed to be effective; dispersible or effervescent preparations are therefore preferred. Compound preparations containing analgesics and antiemetics are available

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28
Q

Which NSAID is specifically licensed for the treatment of migraine?

A

tolfenamic acid

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29
Q

Simvastatin and benzafibrate interaction

A

Increased risk of rhadomyolosis

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30
Q

Why can ACE inhibitors sometimes cause a rapid decline in renal function?

A

Renal impairment may occur in patients with bilateral renal artery stenosis who have been initiated on an ACEI. Such patients rely on angiotensin II to maintain glomerular capillary pressure via vasoconstriction on the efferent arteriole. This is blocked by the ACEI, lisinopril, causing an abrupt decline in the glomerular filtration rate.

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31
Q

Hyperglycemia is more common with loop or thiazide like diuretics?

A

Hyperglycemia is a side effect of both but more likely with Thiazide like diuretics

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32
Q

How should dimeticone be used?

A

Apply once weekly for 2 doses, rub into dry hair and scalp, allow to dry naturally, shampoo after minimum 8 hours (or overnight).

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33
Q

What is the recent MHRA advice concerning headlice?

A

MHRA/CHM advice: Head lice eradication products: risk of serious burns if treated hair is exposed to open flames or other sources of ignition (March 2018

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34
Q

A mother brings her child into the pharmacy, she wants something for his headlice. Who needs to be treated?

A

only affected memebers of the household

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35
Q

Malathion is used for the treatment of headlice. What patients should you not recommend malathion to?

A

Alcoholic lotions not recommended for head lice in children with severe eczema or asthma, or for scabies or crab lice; children under 6 months

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36
Q

What can be used to eliminate crab lice? What directions would you give the patient?

A

Permethrin and malathion.
allowed to dry naturally and washed off after 12 hours; a second treatment is needed after 7 days to kill lice emerging from surviving eggs. All surfaces of the body should be treated, including the scalp, neck, and face (paying particular attention to the eyebrows and other facial hair). A different insecticide should be used if a course of treatment fails.

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37
Q

Recent MHRA safety warning concerning mycophenolate mofetil?

A

Available clinical evidence does not indicate an increased risk of malformations or miscarriage in pregnancies where the father was taking mycophenolate medicines, however mycophenolate mofetil and mycophenolic acid are genotoxic and a risk cannot be fully excluded; for further information, see Conception and contraception and Patient and carer advice. The MHRA advises to exclude pregnancy in females of child-bearing potential before treatment—2 pregnancy tests 8–10 days apart are recommended. Women should use at least 1 method of effective contraception before and during treatment, and for 6 weeks after discontinuation—2 methods of effective contraception are preferred. Male patients or their female partner should use effective contraception during treatment and for 90 days after discontinuation

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38
Q

What monitoring is required with mycophenolate?

A

Monitor full blood count every week for 4 weeks then twice a month for 2 months then every month in the first year (consider interrupting treatment if neutropenia develops).

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39
Q

Can oral EC be used if there has also been UPSI earlier in the cycle?

A

EC providers can offer a woman UPA-EC or LNG-EC if she has had UPSI earlier in the same cycle as well as within the last 5 days, as evidence suggests that UPA-EC and LNG-EC do not disrupt an existing pregnancy and are not associated with fetal abnormality.

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40
Q

Can oral EC be used more than once in a cycle?

A

There is evidence that oral EC does not cause abortion or harm to a very early pregnancy. Both
UPA-EC and LNG-EC can therefore be used if a woman has also had UPSI earlier in the same
cycle. Both UPA-EC and LNG-EC can be used more than once in the same cycle if this is indicated
by further UPSI

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41
Q

When should you double the dose of levonelle? And for ellaone?

A

If BMI >26 or weight >70kg or if taking an enzyme inducing drug

Use of double dose EllaOne is currently not recommended

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42
Q

How does emergency contraception work? (in basic terms)

A

inhibits/delays ovulation this prevents fertilisation or prevents implantation

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43
Q

What is the most effective method of emergency contraception?

A

EC providers should advise women that the Cu-IUD is the most effective method
of EC.

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44
Q

Are there any comorbidity contraindications to oral emergency contraception?

A

UPA-EC is not suitable for use by women who

have severe asthma controlled by oral glucocorticoids.. They can have levonelle

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45
Q

If vomiting occurs within X hours, emergency contraception should be repeaten

A

3 hours

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46
Q

A patient earlier this month received emergency contraception from your pharmacy. She is concerned that her period is 3 days late, what advice do you give?

A

Advise her to complete a pregnancy test if more than seven days late - it is normal to experience some delay.

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47
Q

Which one of the following drugs can cause sudden onset of sleep: Omeprazole, adrenaline, pyrazinamide, levodopa, ondansetron?

A

Levodopa - Excessive daytime sleepiness and sudden onset of sleep can occur with co-careldopa.

Patients starting treatment with these drugs should be warned of the risk and of the need to exercise caution when driving or operating machinery. Those who have experienced excessive sedation or sudden onset of sleep should refrain from driving or operating machines until these effects have stopped occurring.

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48
Q

Outline the common side effects of procyclidine

A

Antimuscarinic - blurred vision, constiaption, droawsiness and urinary retention

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49
Q

What HbAlc value would be diagnostic of diabetes?

A

> 48mmol/mol

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50
Q

A target HbAlc concentration of X is generally recommended when T2DM is managed by diet or one oral antidiabetic drug not associated with hypoglycemia

A

<48

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51
Q

Adults prescribed a single drug associated with hypoglycemia or two or more antidiabetic drugs in combination should usually aim for a HbA1c concentration of ….

A

53 mmol/mol

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52
Q

Which of the following is a toxic effect of theophylline: bruising, drowsiness, convulsions, goitre, watering eyes?

A

Convulsions

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53
Q

Which of the following antiepileptic drugs is not know to be an enzyme inducer: carbamazepine, oxacarbamazepine, levetiracetam, phenobarbital and sodium valproate

A

Leveriracetam

Sodium valproate is an enzyme inhibitor

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54
Q

Is troponin I specific to cardiac muscle?

A

Yes - troponin I and T is specific to cardiac muscle. Troponin can be found in skeletal muscle as well but is troponin C

55
Q

When should troponin levels be taken after a suspected myocardial infarction?

A

It can take 10-12 hours after a heart attack for troponin levels to rise

56
Q

true/false: iron preparations can cause constipation and diarrhoea?

A

True

57
Q

Which of the following is not a notifiable disease? Food poisoning, Toxic shock syndrome, meningitis, measles, whooping cough

A

Toxic shock syndrome

58
Q

At Mrs As annual review it is found that her HbA1c is much lower than usual. Which of the following drugs that Mrs A has been started on in the last 3 months, is the most likely cause? Aspirin, chlortalidone, lisinopril, prednisolone, warfarin

A

Lisinopril - all ACEi may cause hypoglycaemia

Chlortalidone is a thiazide like diuretic and can exacerbate diabetes

Prednisolone can raise BG levels

59
Q

True or false: carbocisteine has no known drug interactions

A

True

60
Q

How many public health and health promotion campaigns are suggested for community pharmacies to run per year according to the community pharmacy contractual framework?

A

6

61
Q

How long should treatment with an antidepressant be continued for before considering whether to switch antidepressant due to lack of efficacy?

A

should be continued for at least 4 weeks (6 weeks in the elderly)

62
Q

Following remission, antidepressant treatment should be continued at the same dose for at least X months

A

6 months (about 12 months in the elderly)

63
Q

Patients with a history of recurrent depression should receive maintenance treatment for at least X years

A

2 years

64
Q

When a prescriber writes ‘REPEAT’ for an oral contraceptive pill the prescription may be dispensed how many times?

A

6 times

65
Q

Why should beclometasone dipropionate MDI inhalers be prescribed by brand? (MHRA advice 2008)

A

Beclometasone MDI are not interchangeable and should be prescribed by brand name; QVAR has extra-fine particles, is more potent than traditional beclometasone containing inhlaers, and is approximately twice as potent as clenil

66
Q

Which of the following medicines is least suitable for dispensing into a NOMAD tray? Levothyroxine, calcichew, lyrinyl XL, ferrous sulfate, alendronic acid

A

Alendronic acid

note: Lyrinyl is oxybutynin

67
Q

A patient informs you they feel nauseas, dizzy, tired and their vision has been affected, describing all objects as having a yellow hue. What medicine might they be taking?

A

Digoxin

68
Q

What drug is the most widely used IV anasthetic due to quicker patient recovery and less hangover effect?

A

Propofol

69
Q

What is the recommended treatment for gestational diabetes after lifestyle changes have failed? Patients fasting glucose level is <7mmol

A

Metformin

70
Q

What is the recommended treatment for gestational diabetes after lifestyle changes have failed? Patients fasting glucose level is >7mmol

A

Offer insulin treatment with insulin with or without metformin

71
Q

Which sulfonylurea can be considered in gestational diabetes?

A

Glibenclamide

72
Q

What are the two first line options for constipation in pregnancy?

A

A bulk-forming laxative is the first choice during pregnancy if fibre supplements fail. An osmotic laxative, such as lactulose, can also be used.

73
Q

Which of the following medicines should be avoided in chicken pox? calamine lotion, chlorphenamine, ibuprofen, menthol in aq cream or paracetamol?

A

Ibuprofen Should avoid NSAIDS

74
Q

Which marker is often raised in patients who have a liver blockage?

A

ALP

75
Q

Binds to acidic drugs…

A

Albumin

76
Q

Only antipsychotic licsend for the management of behavioural and psychological symptoms of dementia

A

Risperidone

77
Q

Drug given to patients taking high doses of cyclophosphamide

A

Mesna - to prevent haemorrhagic cystitis

78
Q

Dose limiting side effect of capecitabine

A

Diarrhoea - need to give loperamide

79
Q

What CD schedule does midazolam belong to?

A

Schedule 3

80
Q

Manufacturers state avoid metformin if eGFR is < ?

A

30

81
Q

Amphotericin and digoxin interaction

A

Amphotericin is predicted to increase the risk of digoxin toxicity

82
Q

Max dose of simvastatin when in combination with amlodipine

A

20mg

83
Q

Which drugs increases the risk of convulsions when used in combination with ciprofloxacin?

A

NSAIDS

84
Q

Does amiodarone cause hypothyrodism or hyper?

A

Both

85
Q

What is bromocriptine used for?

A

Suppression of lactation

Sometimes used as a dopamine agonist in PD

86
Q

Piogliatazone can lower the risk of bone fractures T/F

A

False - increases risk!

87
Q

What important safety information is there concerning bromocriptine

A

Bromocriptine has been associated with pulmonary, retroperitoneal, and pericardial fibrotic reaction

Exclude cardiac valvulopathy with echocardiography before starting treatment with these ergot derivatives for Parkinson’s disease or chronic endocrine disorders (excludes suppression of lactation); it may also be appropriate to measure the erythrocyte sedimentation rate and serum creatinine and to obtain a chest X-ray. Patients should be monitored for dyspnoea, persistent cough, chest pain, cardiac failure, and abdominal pain or tenderness. If long-term treatment is expected, then lung-function tests may also be helpful.

88
Q

Which antimalarial drugs are NOT suitable to give to a patient with epilepsy?

A

mefloquine - CI if Hx of convulsions

and chloroquine

89
Q

What is the principle benefit of nitrates in treating angina?

A

Nitrates have a useful role in angina. Although they are potent coronary vasodilators, their principal benefit follows from a reduction in venous return which reduces left ventricular work.

90
Q

Outline some unwanted side effects associated with nitrates

A

Unwanted effects such as flushing, headache, and postural hypotension may limit therapy, especially when angina is severe or when patients are unusually sensitive to the effects of nitrates.

91
Q

Hydralazine is given as an adjunct to other antiHTN for the treatment of resistant hypertension but is rarely used. When used alone it causes….

A

Tachycardia and fluid retention

92
Q

What is the major disadvantage with using clonidine as an antihypertension?

A

sudden wthdrawal may cause severe rebound hypertension

93
Q

H.pylori treatment regimen

A

PPI + amoxicillin + clarithromycin or metronidazole

94
Q

Preparations that do not contain what sugars are classed as sugar free?

A

Glucose, sucrose and fructose

95
Q

Which EHC can you use more than once in a cycle?

A

Levonelle can be taken more than once

EllaOne - can only be used once per menstrual cycle

96
Q

Risk of bulk forming laxatives in opioid use?

A

may predispose pt taking opioids to faecal impacting

97
Q

What type of service is the minor ailments scheme?

A

Is a locally commissioned enhanced service

98
Q

Why are ACEi contraindicated in renal artery stenosis?

A

Disrupts the autoregulation of perfusion

99
Q

Which of these NSAID has the lowest risk of cardiovascular events?

Ibuprofen
Diclofenac
Naproxen

A

Naproxen

or low dose of ibuprofen

100
Q

Which of these NSAID has the lowest risk of of gastro-intestinal side effects?

Ibuprofen
Diclofenac
Naproxen

A

Ibuprofen

101
Q

What drug should be considered for long-term gout control if allopurinol is not tolerated?

A

Febuxostat

102
Q

A patient presents to the pharmacy with a prescription for buprenorphine 10mg patches that has been written by a prescriber in France. Legally, you can dispense the prescription providing all usual prescription requirements are met…T/F?

A

False

Buprenorphine is a schedule 3 controlled drug. Prescriptions for schedule 2, 3, or 4 controlled drugs that are written by EEA or Swiss prescribers cannot be dispensed in the UK

103
Q

What CD schedule is tramadol?

A

Schedule 3

104
Q

A patient should be referred to their GP if a mouth ulcer persists for longer than how long?

A

3 weeks

105
Q

Liver failure can most commonly occur as a result of treatment with which one of the following anti-diabetic medicines

a) Pioglitazone
b ) Metformin
c ) Sitagliptin
d ) Lixisenatide

A

Pioglitazone - Rare reports of liver dysfunction; discontinue if jaundice occurs.

Patients should be advised to seek immediate medical attention if symptoms such as nausea, vomiting, abdominal pain, fatigue and dark urine develop.

106
Q

Loss of visual acuity and colour blindness is associated with what anti TB drug?

A

Ethambutol

107
Q 
Which one of the following is a schedule 3 controlled drug that is exempt from safe custody requirements?
a ) Phenobarbital
b ) Temazepam
c ) Oxycodone
d ) Buprenorphine
A

Phenobarbital

108
Q 
Which one of the following drugs is an enzyme inducer?
a ) Phenobarbital
b ) Erythromycin
c ) Cimetidine
d ) Ciprofloxacin
A

Phenobarbital

109
Q 
n patients treated with antibacterial drugs, H.pylori 13C-urea breath tests should not be carried out until how long after treatment has finished?
a ) 2 weeks
b ) 1 week
c ) 4 weeks
d ) 8 weeks
A

4 weeks

110
Q

Repeat dispensing prescriptions for schedule 5 controlled drugs must be dispensed for the first time within 28 days
a ) True
b ) False

A

False
Feedback/Solution : Repeat dispensing prescriptions for schedule 5 controlled drugs must be dispensed for the first time within 6 months

111
Q

Loop diuretics have a longer duration of action than thiazide like diuretics. true/false?

A

False
Loop diuretics have a shorter duration of action than thiazide diuretics and can be given twice daily without diuresis interfering with sleep as diuresis lasts about 6hrs

112
Q

Oral decongestants are associated with rebound congestion if used for longer than 5 days
a ) True
b ) False

A

no

Nasal decongestants are associated with rebound congestion if used for longer than 5 days. Rebound congestion does not occur with oral decongestants

113
Q

What medication is used for dissolution of gallstones?

A

Ursodeoxycholic acid

114
Q

Omeprazole has a quicker onset of action than ranitidine
a ) True
b ) False

A

Proton pump inhibitors have a slower onset of action than H2 receptor antagonists

but tend to be more effective

115
Q

GSL medicines can be sold whilst the pharmacist is absent from the pharmacy premises
a ) True
b ) False

A

true

116
Q 
Which one of the following drugs is an enyzme inducer?
a ) Carbamazepine
b ) Cimetidine
c ) Ketoconazole
d ) Warfarin
A

carbamazepine

117
Q 
Liver function tests are routinely recommended for patients who take which one of the following drugs?
a ) Spironolactone
b ) Warfarin
c ) Digoxin
d ) Simvastatin
A

Simvastatin

118
Q

Celecoxib is a better choice than colchicine for treating an acute attack of gout in a patient with a history of myocardial infarction
a ) True
b ) False

A

False - COX-2 selective NSAIDs, like celecoxib, have been associated with increased risk of myocardial infarction

119
Q

A patient presents to the pharmacy at 12:15pm. They took their combined hormonal contraceptive at 9:15am the same morning but were sick at 11:30am. The patient should be advised to take another pill as soon as possible
a ) True
b ) False

A

False - A second pill is only necessary if a patient vomits within 2 hours of taking a contraceptive pill

(Note: for EHC the rule is 3 hours)

120
Q

Liquid antacid preparations are generally more effective at treating symptoms of dyspepsia than tablet preparations
a ) True
b ) False

A

True

121
Q 
Which one of the following is a stimulant laxative?
a ) Ispaghula husk
b ) Macrogol
c ) Lactulose
d ) Bisacodyl
A

Bisacodyl

122
Q 
mpotence is a well-documented side effect of which one of the following antihypertensive drugs?
a ) Ramipril
b ) Amlodipine
c ) Furosemide
d ) Atenolol
A

Atenolol

Impotence is a side effect of beta blockers (such as atenolol)

123
Q

Requisitions for schedule 2 or 3 controlled drugs must state the purpose for which the medicine is required
a ) True
b ) False

A

True - requisitions for sch 2 and 3 controlled drugs must state the purpose for which the medicine is required

124
Q

A box of thirty-two paracetamol 500mg tablets can be sold over-the-counter to a customer if the pharmacist is absent from the pharmacy premises
a ) True
b ) False

A

False - 32 pack is a P medicine. Can see 16 pack size.

125
Q 
Which one of the following is a long-acting insulin?
a ) Soluble insulin
b ) Insulin detemir
c ) Isophane insulin
d ) Insulin aspart
A

Insulin determir

126
Q

Simvastatin has a significant interaction with which of the following?
Verapamil
Diltiazem
Erythromycin

A

All three!

There is increased risk of myopathy when simvastatin is given with diltiazem, erythromycin or verapamil

127
Q

The virus responsible for shingles is primarily transmitted through respiratory secretions
a ) True
b ) False

A

False

The shingles virus is primarily transmitted by direct contact with fluid from blisters on the skin

128
Q

When selling co-codamol over the counter to a patient, they should be advised to use it for no longer than 5 days
a ) True
b ) False

A

False - should be advised not to use for longer than 3 days

129
Q

Chickenpox is infectious from one or two days before the rash develops and until all blisters have scabbed over
a ) True
b ) False

A

True

130
Q

Question 29 ) Requisitions for schedule 1, 2, or 3 controlled drugs should be made using FP10PCD
a ) True
b ) False

A

Requisitions for sch 1, 2 and 3 CDs should be made used FP10CDF

131
Q

A steroid card should be issued to a patient if their course of prednisolone exceeds how long?

A

3 weeks

132
Q

What drug should be given to someone with severe IBS and constipation?

A

Lincoclotide

133
Q

What drugs increase the risk of tendon damage when used in combination with ciprofloxacin?

A

the risk of tendon damage is increased by the concomitant use of corticosteroids

Pre-reg (Rosie) (18 decks)

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