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1
Q

Which one of the following drugs inhibits the production of glucose in the liver?

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

A

Metformin

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2
Q 
Which one of the following NSAIDs is associated with the greatest risk of gastro-intestinal side effects?
a ) Aspirin
b ) Naproxen
c ) Diclofenac
d ) Ketoprofen
A

Ketoprofen

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3
Q 
POM entries for veterinary prescriptions must be kept for how long after dispensing?
a ) 1 year
b ) 2 years
c ) 5 years
d ) 7 years
A

5 years

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4
Q 
Which one of the following laxatives is licensed for the relief of chronic constipation in women when other laxatives have failed?
a ) Prucalopride
b ) Sodium picosulfate
c ) Docusate sodium
d ) Bisacodyl
A

Prucalopride

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5
Q 
Question 28 ) Which one of the following calcium channel blockers has the most influence on the myocardium?
a ) Verapamil
b ) Diltiazem
c ) Amlodipine
d ) Felodipine
A

Verapamil

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6
Q

Etoricoxib is a better choice than colchicine for a patient with a history of stroke suffering from an acute attack of gout
a ) True
b ) False

A

False - etoricoxib should be avoided in those with a history of stroke. Colchicine would be an acceptable treatment option

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7
Q 
Which one of the following is not an essential pharmacy service?
a ) Repeat dispensing
b ) Signposting
c ) Disposal of unwanted medicines
d ) New medicine service
A

New medicine service

Repeat dispensing, sign positing and disposal of medicines are all essential services.

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8
Q

What is the correct dose of adrenaline required to treat an adult suffering from an anaphylactic reaction?
a ) 100mcg
b ) 300mcg
c ) 500mcg

A

500mcg

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9
Q

Which of the following is NOT a risk factor for venous thromboembolism with combined hormonal contraceptives.
a ) Smoking
b ) Family history of venous thromboembolism
c ) BMI greater than 25
d ) Long-term immobilisation

A

C) BMI>25

A BMI greater than 30 is a risk factor for VTE

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10
Q 
A 32-year old patient comes into the pharmacy on Monday morning complaining of abdominal pain and bloating that is worse soon after meals. He mentions that symptoms began on Saturday morning and have been intermittent for the past 48 hours. He thinks that it may have something to do with having too many take-aways over the weekend. There are no other symptoms. Which one of the following drugs is most suitable to treat this patients' condition?
a ) Simeticone
b ) Hyoscine butylbromide
c ) Magnesium hydroxide
d ) Esomeprazole
A

Magnesium hydroxide - antacids should be first line treatment for indigestion

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11
Q

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

A

3 weeks

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12
Q

In which one of the following scenarios would it NOT be appropriate to sell hydrocortisone 1% cream?
a ) 25 year old man for a shaving rash on his chin
b ) 15 year old girl with mild dermatitis on her hands
c ) 65 year old woman with an uninfected insect bite

A

25 year old man for a shaving rash on his chin
Feedback/Solution :
Steroid based creams cannot be sold for use on the face.

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13
Q

If an emergency supply is dispensed, what additional directions need to be added to the label?

A

In addition to standard labelling requirements, the words ‘emergency supply’ need to be added to the dispensing label.

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14
Q

Supply of salbutamol inhalers to schools - what information should be included in the signed order?

A

The order must be signed by the principal or head teacher and state:
the name of the school for which the medicinal product is required.
the purpose for which that product is required
and the total quantity required.

Ideally, appropriatley headed paper should be used, however this is not a legislative requirement.

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15
Q

How many inhalers can a school obtain through a signed order?

A

The no. of inhalers that can be obtained by individual schools is not specified in legislation

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16
Q

What records need to be kept in the pharmacy following the supply of salbutamol inhalers to a school?

A

The signed order needs to be retained for two years OR an entry made into the POM register. Even where the signed order is retained it is good practice to make a record i POM register for audit purposes.

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17
Q

Under the PPP, prescriptions for isotretinoin are valid for how long?

A

Valid only for 7 days

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18
Q

What is the maximum quantity of isotretinoin that can be supplied under the PPP?

A

30 days

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19
Q

Can a pharmacist independent prescriber, prescribe controlled drugs?

A

Yes - but not cocaine, dipipanone or diamorphine for treating addiction

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20
Q

Can a pharmacist independent prescriber prescribe unlicensed medicines?

A

Yes

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21
Q

In what circumstances may a pharmacy carry out wholesale dealing without a wholesale dealing authorisation?

A

It takes place on an occasional basis
The quantity of medicines supplied is small
The supply is made on a not for profit basis
The supply is not for onward wholesale distrubution

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22
Q

What does use by/use before mean in terms of expiry dates?

A

Product should be used before the end of the previous month. For example 06/17 means use by 31/05/17

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23
Q

Who can sell cosmetic contact lenses?

A

These products can only . be sold under the supervision of a registered optician, dispensing optician or doctor.

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24
Q

Do herbal remedies require a MA?

A

Yes - herbal remedies must either have a full MA or a traditional herbal registration (THR)

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25
Q

Do homeopathic products require a marketing authorisation?

A

No - the MHRA does not currently require homeopathic products to demonstrate efficacy, only quality and safety

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26
Q

What are the prescription requirements for a veterinary medicine?

A
  1. Name address, number, qualification and signature of prescriber. If Sch 2 or 3 CD need registration number.
  2. Name and address of owner
  3. Identification and species of the anmal and its afress
  4. Date
  5. Name, quantity, dose and directions
  6. Any necessary warnings
  7. If appropriate ‘prescribed under the cascade’
  8. Where Sch 2 or 3 CDs have been prescribed a declaration that the item has been prescribed for an animal.
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27
Q

How long are veterinary prescriptions valid for? what about repeats?

A

Prescriptions are valid for 6 months. The veterinary medicines directorate has confirmed in the case of repeatable prescriptions all supplies must be made within 6 months.

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28
Q

What is meant by withdrawal period, in terms of veterinary medicines?

A

The time that must elapse between when an animal receives a medicine and when it can be used for food

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29
Q

What is the maximum days supply of CDs that can be given on a vet prescription?

A

28 days (note different to human prescriptions which is 30 days)

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30
Q

Outline the order of the veterinary cascade

A
  1. Supply a licensed vet medicine
  2. An exisitng licensed vet medicines for another species or different condition can be considered
  3. A licensed human medicines or EU licensed vet medicine
  4. Extemp prep or specials
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31
Q

True/False - all medicines dispensed against a veterinary prescription should be labelled?

A

False - if the medicine is not prescribed under the cascade, the veterinary medicines regulations do not specify that a dispensing label is required

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32
Q

How long are prescriptions for sch 4 CDs valid for?

A

28 days

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33
Q

How long are prescriptions for sch 5 CDs valid for?

A

6 months

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34
Q

What are the legal requirements for a controlled drug requisition? (note - 6 points)

A
  1. signature of recipient
  2. Name of recipient
  3. address of the recipient
  4. profession or occupation
  5. total quantity of drug
  6. purpose of the requisition
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35
Q

Can a CD be supplied in an emergency without a requisition in writing?

A

In an emergency, a doctor or dentist can be supplied with a schedule 2 or 3 CD on the undertaking that requisition will be supplied within the next 24 hours.

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36
Q

What is the standard form that CD requisitions need to be written on?

A

FP10CDF

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37
Q

A registered midwife may use a midwife supply order to obtain what controlled drugs?

A

Diamorphine
Morphine
Pethidine

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38
Q

Is the strength of the drug to be supplied a legal requirement o CD prescriptions?

A

The strength only needs to be written on the prescription if the medicine is available in more than one strength.

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39
Q

When a controlled drug prescription is written by a dentist, what additional prescription requirements exist?

A

Where the CD prescription has been written by a dentist, the words ‘for dental treatment only’ must be present

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40
Q

What must be on an instalment direction for sch 2 or 3 CDs?

A
  1. Amount of medicine per instalment

2. interval between each time the medicine can be prescribed

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41
Q

at what point should you contact the prescriber when patient has missed a methdone dose(s)

A

If the patient has missed 3 days treatment

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42
Q

Can private prescriptions for CDs be written on any form?

A

No - must be written on standardised FP10PCD

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43
Q

True/false - when a sch 2 CD is collected from a pharmacy, the pharmacist is legally required to determine whether the person collecting is a patient, representative or HCP?

A

True

If it is a healthcare professional - the pharmacist should obtain the name of the HCP, address and evidence of identity. If not available then use professional judgement

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44
Q

Is safe custody required for temazepam?

A

Yes

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45
Q

Is safe custody required for phenobarbital

A

No

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46
Q

Is safe custody required for midazolam

A

No

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47
Q

Is safe custody required for tramadol

A

No

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48
Q

Is safe custody required for buprenorphine

A

Yes

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49
Q

Is an authorised witness required for denaturing expired schedule 3 CDs?

A

No but would be good practice to have another staff member as witness

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50
Q

What CDs need to be denatured before disposal?

A

All CDs in schedule 2,3 and 4 (part 1)

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51
Q

How long should the pharmacy record be kept for? (note - this is dependent on whether the record is written or electronic)

A

The pharmacy record should be kept for five years. For electronic records, this is five years from the day the record was created, for written records this is five years from the last day to which the record relates.

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52
Q

If the responsible pharmacist is absent, can the checking technician carry out accuracy checking?

A

Yes

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53
Q

What medicines may be able to be sold while the responsible pharmacist is absent?

A

Sale of GSL medicines - undertaken by suitable trained staff and within an agreed SOP

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54
Q

What details are recorded in the pharmacy record?

A

The responsible pharmacists name
The registration number
The date and time at which the responsible pharmacist became the RP
And details of any absence

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55
Q

You can catch shingles from being in direct contact with someone who has shingles
a ) False
b ) True

A

False - it is possible to catch chicken pox from someone with shingles but not shingles.

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56
Q

Which disease is gentamicin contraindicated in?

A

Myasthenia gravis

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57
Q

INR target in patient taking warfarin for recurrent DVT/PE

A

3.5

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58
Q

INR target in patient taking warfarin for DVT/PE treatment

59
Q

MHRA altert concerning warfarin

A

Rarely warfarin use can lead to calciphylaxis. Report any painful skin rash

60
Q

What are the different strengths of warfarin tablets available? What is the universal colour scheme of the different strengths

A

500mcg - white
1mg - brown
3mg - blue
5mg - pink

61
Q

Apixaban treatment regimen for DVT/PE

A

10mg BD for 7 days, then 5mg BD for atleast 3 months.

62
Q

Edoxaban dosing in AF

A

> 60kg 60mg oD

<60kg 30mg OD

63
Q

Max edoxaban dose in patients also taking ciclosporin

64
Q

Ring worm treatment

A

Topical clotrimazole
or Terbinafine but not licensed in children and is more expensive.
Continue treatment for 1-2 weeks after disappearance of infection

65
Q

How long should you advise a patient with ring worm to treat the infection?

A

Continue for 1-2 weeks after disappearance of infection

66
Q

How is scabies treated?

A

Permethrin
apply all over skin
apply twice, 7 days apart

67
Q

Which of the following headlice treatments is not suitable for people with asthma?

a) dimeticone
b) benzylbenzoate
c) malathion

68
Q

When should a patients asthma treatment be stepped up?

A

If using SABA >3 times per week, symptoms >3 times per week, experiencing nighttime symptoms

69
Q

What is step 3 of the adult asthma guidelines?

A

Consider adding a regular LABA

If no response, discontinue and increase ICS dose.

70
Q

Outline the asthma guidelines for children <5 years

A
  1. SABA PRN
  2. Regular ICS
  3. In children 2-5 years adda LTRA (refer <2 years)
71
Q

Steroid dose and duration for adult experiencing an acute asthma attack

A

Prednisolone 40-50mg for 5 days

72
Q

Are antibiotics indicated in an acute asthma attack?

A

Routine prescribing of antibiotics is not recommended

73
Q

Which LABA can be used for short term symptom relief in asthma?

A

Formeterol (speed of onset is similar to salbutamol)

74
Q

What vaccinations should be given to a patient with COPD?

A

Pneumonococal and influenza

75
Q

Which tiotropium inhaler may be useful for patients with poor dexterity?

A

Spiriva respimat

76
Q

How can ICS be useful in distinguishing between COPD and asthma?

A

If clear improvement of symptoms after 3-4 weeks then suggests asthma

77
Q

Higher doses of ICS may be needed in some patients with COPD. Why might this be?

A

Current and previous smoking reduces the effectiveness of ICS and so higher doses may be necessary in these patients

78
Q

Signs of theophylline toxicity?

A

Vomiting, agitation, restlessness, dilated pupils, sinus tachycardia, hypokalemia

79
Q

Theophylline cautionary labels

A

Take with food

Do not crush

80
Q

Which antihistamine is considered the most sedating?

A

Promethazine

81
Q

Is fexofenadine sedating or non sedating?

A

Non-sedating

82
Q

Adrenaline dose for 14 year old experiencing an anaphylactic reaction

83
Q

Hydroxyzine important safety information

A

Associated with an increased risk of QT interval prolongation and torsades de pointes

84
Q

Common side effects with donepazil?

A

Dose related cholinergic effects

Abnormal dreams, agitation, diarrhoea, dizziness, hallucinations, pruritus

85
Q

If a patient misses more than 3 days of their rivastigmine patch what action needs to be taken?

A

Need to retitrate dose

86
Q

Rivastigmine is cautioned in what patients?

A

Caution if patient weighs <50kg

87
Q

Rivastigmine can commonly cause GI disturbances. What action should be taken if this occurs?

A

Treatment should be withheld if GI side effects occur and restarted once resolved

88
Q

Which AEDs should not be switched between brands?

A

Phenytoin, carbamazepine, phenobarbital, primodine

89
Q

What are the symptoms of antiepileptic hypersensitivity syndrome?

A

Symptoms start 1-8 weeks after exposure
Fever, rash and lymphadenopathy
Liver dysfunction, renal and pulmonary abnormalities

90
Q

Which AEDs are associated with antiepileptic hypersensitivity syndrome?

A

Carbamazepine, lamotrigine, oxacarbazepine and phenytoin

91
Q

Which AED increases the risk of cleft pallate?

A

Topiramate

92
Q

First line treatment for focal seizures?

A

Carbamazepine or lamotrigine

93
Q

First line treatment for tonic clonic seizures?

A

Sodium valproate or lamotrigine

94
Q

First line treatment for absence seizures?

A

Ethosuximide or sodium valproate

95
Q

First line treatment for myoclonic seizures?

A

Sodium valproate, topiramate or lamotrigine

96
Q

First line treatment for atonic seizures?

A

Sodium valproate

97
Q

Valproate and lamotrigine interaction

A

Valproate increases the plasma conc of lamotrigine

98
Q

Which AED may exacerbate parkinsons?

A

Lamotrigine

99
Q

Nystagmus, diplopia, slurred speech, ataxia, confusion and hyperglycemia are signs of toxicity caused by what drug?

100
Q

Essential monitoring with sodium valproate?

A

Monitoring liver function and FBC is essential

101
Q

Atomoxetine monitoring

A

Monitor for worsening, anxiety and depression.

Monitor pulse, BP, appetite, weight and height

102
Q

Side effects of atomoxetine

A

Anorexia, constipation, increased BP, irritability

103
Q

Which SSRI has been shown to be sae in patients with unstable angina or a recent MI?

A

Sertraline

104
Q

How long should antidepressant treatment be continued before considering to switch?

A

at least 4 weeks (6 weeks in elderly)

105
Q

Following remission of depression, how long should antidepressant treatment be continued for?

A

Following remission continue for at least 6 months (12 months in the elderly)

106
Q

Signs of serotonin syndrome

A

Tremor, hyperreflexia, tachycardia, BP, shivering, diarrhoea, agitation, confusion

107
Q

Which TCAs are more sedating?

A

Amitriptyline, clomipramine, dosulepin, trazadone

108
Q

Which TCAs are less sedating?

A

Imipramine, lofepramine, nortriptyline

109
Q

Which TCA has the lowest incidence of side effects?

A

Lofepramine and is less toxic in overdose, but is infrequently associated with hepatotoxicty

110
Q

Other antidepressants should not be started for X number of weeks after MAOInhib have been stopped?

111
Q

A patient presents to your pharmacy complaining of a heading and palpitations. Upon questioning, they tell you they take an MAOi for depression. What do you advise them?

A

Discontinue use as risk of hypertensive crisis

112
Q

Which SSRi has the lowest propensity for interactions?

A

Citalopram

113
Q

Citalopram contraindications

A

C/I in poorly controlled epilepsy and in QT prolongation

114
Q

Paroxetine common side effects

A

Abnormal dreams, raised cholesterol, yawning

115
Q

Venlafaxine contraindications

A

C/I in uncontrolled hypertension

Do not prescribe if patient has had a recent MI, arrhythmias

116
Q

Sumatripan should not be given to patients taking SSRIs. Why?

A

Increased risk of serotonin syndrome

117
Q

Which antidepressant is considered a safer option in patients at high risk of a GI bleed?

A

Mirtazipine

118
Q

Minimum dose of amitriptyline for depression?

A

75mg daily

119
Q

Antidepressants of choice in pregnancy?

120
Q

Why are ergot derived dopamine agonists rarely used?

A

Because of the risk of fibrotic reactions e.g. pulmonary fibrosis

121
Q

True or false. Tardive dyskinesia can be improved by antimuscarinic such as procyclidine?

122
Q

Co-beneldopa counselling points

A

Impulse control disorders
Sudden onset of sleep can occur
Avoid abrupt withdrawal - risk of NMS and rhabdomyolosis

123
Q

What is the drug of choice for motion sickness?

A

Hyoscine hydrobromide - apply 30 minutes before start of journey

124
Q

Domperidone important safety information

A

MHRA alert r/e risk of cardiac side effects - usually limit treatment to one week.
C/I in combination with other drugs that prolong QT interval

125
Q

Metoclopramide common side effects

A

EPS, Gynacomastia, hyperprolactinaemia

126
Q

A women asks you whether she can take co-codamol while breastfeeding. How do you responsd?

A

No - avoid in BF due to differences in ability to metabolise

127
Q

Migraine treatment

A

Aspirin or paracetamol or NSAID. Preferably in soluble/disp form as peristalsis is often reduced during attacks

128
Q

Sumatripan cautionary labels

A

This medicine may make you sleepy.

Read the additional information with this leaflet

129
Q

How should gabapentin be initiated in a patient for neuropathic pain?

A

Need to titrate the dose slowly according to the individual patient

130
Q

Is oxazepam a short, intermediate or long acting benzodiazepine?

131
Q

Is temazepam a short, intermediate or long acting benzodiazepine?

A

Intermediate

132
Q

Is alprozam a short, intermediate or long acting benzodiazepine?

133
Q

Is clobazam a short, intermediate or long acting benzodiazepine?

134
Q

What is acomprasate used for?

A

Maintaining alcohol abstinence in patients concerned about cravings.

135
Q

What advice would you provide a patient starting on varenicline?

A

Seek advice if symptoms of psychiatric illness develop

136
Q

Which antibiotics have a higher risk of c.diff? (7 points)

A

Ampicillin, amoxicillin, co-amox, 2nd and 3rd gen cephalosporins, quinolones, clindamycin

137
Q

What sort of diet is recommended to people with diverticular disease?

A

High fibre diet

138
Q

Why is loperamide and codeine contraindicated in patients with acute UC?

A

Increased risk of toxic mega colon

139
Q

What is the first line treatment for mild-moderate UC?

A

Aminosalicylates

140
Q

Sulfasalazine monitoring points

A

FBC, LFTs and renal function

141
Q

Which laxative should you NOT recommend to patients with IBS?

A

Lactulose - as may cause bloating

142
Q

Almost all cytoxic drugs cause bone marrow suppression, this commonly occurs after how many days after administration?

A

7-10 days

but is delayed for certain drugs inc. carmustine, lomustin and mephlan

143
Q

Which of the following regular medicines may cause painful gums?

a) amlodipine
b) aspirin
c) bendroflumethiazide
d) bisoprolol
e) metformin

A

a) amlodipine

Calcium channel blockers can cause gingival enlargement and overgrowth

Pre-reg (Rosie) (18 decks)

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