Random 4 Flashcards
Adrenaline dose in children 1 month - 5 years
150mcg
Adrenaline dose aged 6- 11 years
300mcg
Adrenaline dose 12-17 years
500mcg
What is hydroxyzine?
Antihistamine used for pruritis
Important safety advice with hydroxyzine
Associated with risk of QT interval prolongation and torsades de points. Should be avoided in elderly as increased risk of s/e (max dose is 50mg in elderly)
What could be given for the management of cough in palliative care?
Morphine
Donepazil side effects?
Dose related cholinergic side effects. Abnormal dreams, agitation, diarrhoea, dizziness, hallucinations, cramps
Memantine should be used in caution in patients with what medical condition?
Epilepsy
Which AEDs cannot be switched between brands?
Phenytoin, carbamazepine, phenobarbital and primodine
Signs of antiepileptic hypersensitivity sydrome
Fever, rash and lymphadenopathy
Liver dysfunction, renal and pulmonary abnormalities
What action should be taken if you suspect antiepileptic hypersensitivity syndrome?
Withdraw AED immediately, do not re-expose
Which antiepileptics are associated with antiepileptic hypersensitivity syndrome?
Carbamazepine, oxacarbazepine, phenytoin and lamotrigine
Which AED is first line for focal seizures?
Carbamazepine or lamotrigine
Which AED is first line in tonic clonic seizures
Sodium valproate or lamotrigine
Which AED is first line in absence seizures
Sodium valproate or ethosuximide
Which AED is first line in myoclonic seziures?
Sodium valproate or levetiracetam or topiramate
Which AED is first line atonic seizures?
Sodium valproate
Which AED may exacerbate parkinsons disease?
Lamotrigine
Nystagmus, diplopia, slurred speech, ataxia, confusion and hyperglycemia as signs of what drug toxicity?
Phenytoin
What monitoring is essential with sodium valproate?
Monitor liver function and FBC
What is the first line treatment for bipolar?
Antipsychotics - olanzapine, quietiapine, or risperidone normally
Which TCA is associated with the lowest incidence of side effects?
Lofepramine and is less dangerous in overdose
Which TCAs are particularly dangerous in over dose?
Amitriptyline, dosulepin
How long after stopping an MAOI can other antidepressants be started?
2 weeks after stopping
How long after stopping a TCA can you started a MAOI?
Wait 7-14 days after stopping a TCA before starting a MAOi
How long after stopping fluoxetine can you start a MAOI?
5 weeks
What type of insulin is insulin glargine?
Long acting
What type of insulin is insulin determir
Long acting
What type of insulin is insulin aspart?
Rapid acting
Pharmacy waste should not be stored for longer than?
3 months
Total cholesterol target level?
<4mmol/l
A patient presents to the pharmacy with a headache. They describe the headache as a sharp piercing sensation that has come on suddenly. The sensation is on one side of the head. What type of head ache do they have?
Cluster headache
Patient presents to the pharmacy with a headache. They describe the headache as a constant ache on both sides of their head. They have had the headache for about half an hour
Tension type headache
A patient presents to the pharmacy with a headache, nausea and complains that it hurts to look at the sun. What is wrong with them?
Migraine
How often should women have a cervical screen?
Every 3 years
What is glossitis?
Sore mouth
which sulfonylurea can cause a disulfiram like reaction?
Tolbutamide
How often should serum lithium levels be monitored?
Monitor every 3 months and after any dose changes
Can pharmacies receive waste from residential homes?
Yes CAN receive from residential homes (just not nursing homes)
Can pharmacies receive waste from nursing homes?
No
A grade A clean room has a max no. of particles per m3 of what?
20
Bonjela OTC age
16 years as it is a salicylate and so there is a risk of reyes syndrome
Tramadol CD requirements
Full prescription writing requirements
Do not need to write in CD register
Exempt from safe custody
When might a meglitinide, such as repaglinide be useful in T2DM?
In patients without a meal pattern - has a rapid onset of action so can be used flexibly around meal times
Verapamil and dabigatran interaction
Verapamil increases the levels of dabigatran so need to dose reduce.
Why is chloroform water often included in pharmaceutical preparations?
it is a preservative agent
Platelet count should be monitored with all heparins if given for longer than how many days’?
4 days
Patients with diabetes at high risk of peripheral arterial disease should aim to maintain HbA1c < than what?
<48
What needs to be monitored with methotrexate?
Renal function, LFTs and FBC
Why is nifedipine not suitable for MDS trays?
It is very light sensitive
Fludrocortisone storage requirements
Can be stored up to 30 days at room temperature
How is lithium overdose treated?
Haemodialysis
Which of the following is contraindicated in patients with risk factors of QT prolongation:
Erythromycin
Clarithromycin
Domperidone
Citalopram
Domperidone
all prolong QT interval and should be used with caution, but only domperidone is contraindicated
A mother comes into your pharmacy for advice. Her child is due her vaccines later that day but has developed a minor cold, can she still receive her vaccines?
Yes - vaccines should not be post poned in children with minor illness and no fever.
A 20 year old asks to speak to you in private. He tells you he has an unusual yellow/green discharge and is not sure what it might be?
Yellow-green discharge is a sign of gonorrhoea
A customer tells you they have been experiencing, intense itching all over, especially between their fingers. The itching is worse at night. What should you offer them?
Patient has symptoms of scabies. Give permethrin
Viral conjunctivitis is caused by what virus mainly?
Adenovirus
When do patients need a license to travel with CDs?
If travelling with >3 months supply
A patient tells you they have missed their progesterone only pill. What advice do you give them?
Take the next pill when it is due and use barrier contraception for 2 days
What is the most common cause of food poisoning in the UK?
Campylobacter
How many clinical audits should a pharmacy participate in each year?
2 - at least one is PCT determined
NSAIDs are contraindicated in which of the following patients:
Patient with crohns
Patient with severe heart failure
An elderly patient >80 years old
Patient Hx of a GI bleed from taking ibuprofen
C/I in severe heart failure and in patient with Hx of bleed.
Cautioned in elderly and crohns
BNP and NT-prop BNP are investigations used to diagnose what?
Heart failure
Phenelzine + pseudoepherine interaction
Hypertensive crisis
Theophylline and ciprofloxacin interaction
Ciprofloxacin increases the levels of theophylline. This can increase the risk of convulsions.
How often should oxycodone Longtec be given
Twice a day
Mirtazipine counselling points
Blood Disorders
Patients should be advised to report any fever, sore throat, stomatitis or other signs of infection during treatment. Blood count should be performed and the drug stopped immediately if blood dyscrasia suspected.
What is akathesia?
Inner restlessness
Are first or second gen antipyschotics more likely to cause hyperprolactinaemia?
First generation
Which of the following in most likely to cause weight gain:
aripiprazole
haloperidol
olanzapine
amisulpride
Olanzapaine
others are first generation or a partial antagonsit
If a patient with schizophrenia, predominantly has negative symptoms, what class of antipyschotics may be more beneficial?
Second generation antipyschotics tend to be more effective in negative symptoms.
When could clozapine be considered?
Clozapine should not be started unless two other antipsychotics have been tried and failed
Why are ergot derived dopamine agonists rarely used?
Risk of fibrotic reactions e.g. pulmonary and pericardial
What is Topcapone? what is it monitoring requirements?
COMT inhibitor
Test liver function before treatment, and monitor every 2 weeks for first year, every 4 weeks for next 6 months and then every 8 weeks thereafter (restart monitoring schedule if dose increase. Patients should be told how to recognise signs of liver disorder and advised to seek immediate medical attention if symptoms such as anorexia, nausea, vomiting, fatigue, abdominal pain, dark urine, or pruritus develop
How should vomiting during pregnancy be managed?
If an antiemetic is needed should use either promethazine, prochlorperazine or metoclopramide
Which antiemetic is most effective in treating motion sickness?
Hyoscine hydrobromide
Post op nausea and vomiting risk factors
Female Non-smoker Hx of post op N+V or motion sickness Use of opioids Length of surgery and type (e.g. higher risk with GI)
Which antiemetics are ineffective in managing motion sickness?
Domperidone, metoclopramide and 5HT3 antagonists
Domperidone MHRA alert
MHRA/CHM advice—Domperidone: risk of cardiac side-effects—restricted indication, new contra-indications, reduced dose and duration of use
The benefits and risks of domperidone have been reviewed. As domperidone is associated with a small increased risk of serious cardiac side-effects, the following restrictions to indication, dose and duration of treatment have been made, and new contra-indications added:
Domperidone should only be used for the relief of the symptoms of nausea and vomiting;
Domperidone should be used at the lowest effective dose for the shortest possible duration (max. treatment duration should not normally exceed 1 week);
Domperidone is contra-indicated for use in conditions where cardiac conduction is, or could be impaired, or where there is underlying cardiac disease, when administered concomitantly with drugs that prolong the QT interval or potent CYP3A4 inhibitors, and in severe hepatic impairment;
The recommended dose in adults and adolescents over 12 years and over 35 kg is 10 mg up to 3 times daily;
The recommended dose in children under 35 kg is 250 micrograms/kg up to 3 times daily;
Oral liquid formulations should be given via an appropriately designed, graduated oral syringe to ensure dose accuracy.
Metoclopramide common side effects
EPS in children and young adults, gynacomastia, hyperprolactinaemia
Arepitant is used in combination with what?
Must be used in combination with a 5HT3 antagonist and dexamethasone in very emotegneic chemotherapy
Important arepitant interaction
Reduces the effectiveness of hormonal contraceptives
Ondansetron common side effects
Prolongs QT interval
Constipation, flushing headache
How would you advice someone to use hyoscine hydrobromide before a journey?
Apply patch behind ear up to 30 minutes before the journey
What is the maximum number of buprenorphine patches that can be used at one time?
2
Buprenorphine monitoring
Monitor liver function; when used in opioid dependence baseline liver function test is recommended before commencing therapy, and regular liver function tests should be performed throughout treatment.
Is co-codamol safe in breast feeding?
NO - avoid in in BF due the risk in differences in ability to metabolise
Codeine is contra-indicated in all children that undergo what procedure?
Removal of tonsils for the treatment of sleep apnoea
Excessive use of acute treatments for migraine is associated with what?
Medication overuse headache
Why might metoclopramide and domperidone be useful antiemetics in migraine?
Peristalsis is often impaired during an attack, these antiemetics have the advantage of promoting gastric emptying
Patients with neuropathic pain may be given the choice of what 4 oral drugs?
Duloxetine, amitriptyine, gabapentin or pregbalin
Capsacin cream counselling
May cause transient burning sensation during initial treatment
How should gabapentin be dosed?
Need to titrate slowly according to the individual patient
Which of the following would be useful in a patient who has given up alcohol but is concerned about getting cravings?
Acamprosate
Disulfram
Nalmfene
Acamprosate and reduce cravings
Why should opioid withdrawal be avoided in the first trimester?
Increased risk of spontaneous discharge
What diet is recommended in patients with diverticular disease?
High fibre diet
Why is loperamide and codeine contraindicated in acute UC?
Increased risk of toxic megacolon
What is the first line treatment for mild-moderate UC?
Aminosalicylates
Which of the following could be given to someone is TPMT deficient?
Methotrexate
Azathiopurine
Mercaptopurine
Methotrexate
Amiosalicylates monitoring requirements
Monitor FBC, LFTs and renal function
Nausea is a common side effect of lactulose, how could you minimise this s/e?
Take with meals
macrogols are cautioned in what patients?
Cardiovascular impairment (should not take more than 2 ‘full-strength’ sachets or 4 ‘half-strength’ sachets in any one hour); discontinue if symptoms of fluid and electrolyte disturbance
Bismuth antacids are not usually recommended, why?
B/C absorbed bismuth can be neurotoxic causing encephalopathy
Why should alginates be avoided in patients with HTN, heart failure?
Contain large amounts of sodium so can cause fluid rretnation
h pylori treatment regimen
1 week triple therapy
PPI + metroniazole/amoxicillin + clarithromycin
What is the test for h pylori and how should it be carried out?
13C-urea breathtest - collect breath samples before and after ingestion of solution.
Note - should not perfom test if within 4 weeks of abx treatment or 2 weeks of a PPI
Why might PPIs be given to patients with CF?
PPIs can be used to decrease degradation of pancreatic enzyme supplements in patients with CF
1st, 2nd and 3rd line treatment for GORD in pregnancy
1st - alginate or antacid
2nd - ranitidine
3rd - omeprazole
Hysocine butylbromide injection MHRA warning
associated with serious adverse cardiovascular effects
What is the drug of choice for cholestatic pruritus in pregnacy?
Ursodeoxycholic acid
When should orlistat be stopped as it is considered ineffective?
If weight has not exceeded 5% after 12 weeks.
Why should local anaesthetics only be used for a short period of time in hameorrhoiads
May cause sensitisation of the skin
Topical corticosteroids are useful in managing haemorrhoids, how long can they be used for?
7 days max
which topical haemorrhoid preparation is licensed for use in pregnancy?
NONE
What antihypertensive should be given 1st line to patients with diabetes?
ACE inhibitors
A patient is on holiday and comes into your pharmacy requesting an emergency supply for GTN spray as they have left theirs at home. What do you do?
GTN spray is a P medicine so can be sold OTC
Mercaptopurine monitoring
Liver function
What is the risk of giving empaglifolozin to a patient taking ramipril for hypertension?
Need to monitor BP as empagliflozin can lower BP and so ramipril dose may need to be reduced
Rifampicin and simvastatin interaction
Rifamipicin is an enzyme inducer and so can increase the metabolism of simvastin and decrease control of cholesterol levels
Which NSAID is associated with the lowest thrombotic risk?
Naproxen
Leflunomide + warfarin interaction
Leflunomide, via its active metabolite inhibits the enzyme that metabolises warfarin anf may lead to bleeding
What does the ‘CE’ mark mean on medical devices?
Conformite europenne
Can other pharmacy staff make the record in the responsible pharmacist record on your behalf?
NO - must make the record personally
Theophylline has a narrow therapeutic index. When should you monitor serum levels after starting?
Measure 5 days after starting oral treatment. usually take blood samples 4-6 hours after dose.
Theophylline has a narrow therapeutic index. When should you monitor serum levels after dose adjustments?
3 days after dose adjustment
4-6 hours after dose
Clobazam is not prescribable on the NHS unless what requirements are met?
Can only be prescribed for epilepsy andso should be endorsed SLS
Why should the MMR vaccine not be given before 12 months?
Immunisation before 12 months may not be effective due to residual maternal antibidies
Records relating to the supply of unlicensed medicines must be kept for how long?
5 years!
What age can nicotine replacement therapy be given OTC?
> 12 years
How long before surgery should clopidogrel be stopped?
7 days
What is the 1st line treatment for obstructive cholestasis secondary to gall stones?
Ursodeoxycholic acid
Which of the following is not a once daily dose:
Loratidine
Chlorphenamine
Ceterizine
Chlorphenamine - can be given 4- 6hours
Joyrides can be give over what age OTC
3 years
Which of the following could joyrides be given to:
50 year old with glaucoma A 4 year old 25 year old taking amitriptyline 30 year old pregnant lady 60 year old taking tamulosin
6 year old
Hyoscine hydrobromide is contracindicated in glaucoma
Side effects a potentiated with TCAs
Not known to be safe in pregnancy
S/E are antimuscarinic and so can worsen urinary retention
When should you refer a patient with a wart to their GP?
Refer if the wart is on the face or genitals
Or if very painful or bleeding
Definition of a missed progesterone only pill
More than 12 hours late
What advice would you give someone who has missed a progesterone only pill?
Need emergency contraception if they have had UPSI during the previous two tablets. Need extra contraception for the next 2 days.
How should lithium be managed before surgery?
Stop 24 hours before major surgery
Continue as normal in minor surgery
How should amiloride be managed before surgery?
stop K+ sparing diuretics on morning of surgery as risk of hyperkalemia if renal perfusion is impaired
What can be given to reduce extraneous muscle movements associated with propofol?
Extraneous muscle movements can be minimised by an opioid analgesic or a short acting benzodiazpine just before induction
How long after general anaesthetic should driving be avoided?
24 hours
Prolonged exposure of nitrous oxide can lead to what?
Prolonged exposure can lead to megaloblastic anaemia owing to interference with the action of vitamin B12
OTC age for gripe water?
4 weeks
OTC age for simeticone?
From birth
OTC age for bonjela teething gel?
2 months
OTC for fluriprofen?
12 years
Safety warning about sucralfate?
Risk of bezoar formation (solid mass of indigestible materials that accumulates in the GI tract)
What advice should be given to patients taking high doses of pancreatin?
Advise patient to maintain adequate hydration
Can mesalazine be switched between brands?
Yes - but if it is necessary to switch a patient to a different brand, the patient should be advised to report any symptoms of blood disorders
Labetolol monitoring
Monitor for liver damage
Itraconazole should be prescribed with caution to patients with what medical condition?
Heart failure
Voriconazole monitoring?
Renal and liver function
Can cause phototoxicity
What should a patient do if they miss a dose of exenatide?
If a dose is missed, skip and continue with next schedule dose. DO NOT ADMINISTER AFTER MEALS
How should levothyroxine be started in patients with cardiac disease?
Start with a lower dose
Should also do a baseline ECG
Finasteride counselling
Contraception - drug excreted in semen
Risk of male breast cancer - reporting any changes in breast tissue
What is the OTC age for penciclovir?
12 years
Colestyramine may interupt the absorption of what vitamins?
Fat soluble
What is the risk of prescribing bendroflumethiazide with lithium?
Bendroflumethiazide can cause hyponatremia so will increase lithium levels
What causes megaloblastic anaemia?
Vitamin b12 or folate deficiency
What causes microcytic anaemia?
Iron deficiency
A patient that was started on carbamazepine 3 weeks ago has since developed a rash. What action should you take?
tell them to stop taking carbamazepine immediately
True/False - NSAIDs may be useful in the management of psoriasis
False - NSAIDs can exacerbate psoriasis
Prolonged use of metronidazole is associated with what?
Peripheral neuropathy
What is UKDILAS?
UK Drugs in lactation advisory service
How might you step someones asthma ICS treatment DOWN
Step down controlled asthma every 3 months, decreasing the dose by 25-50% each time
