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Pre-reg (Rosie) > Random 4 > Flashcards

Random 4 Flashcards

1
Q

Adrenaline dose in children 1 month - 5 years

A

150mcg

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2
Q

Adrenaline dose aged 6- 11 years

A

300mcg

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3
Q

Adrenaline dose 12-17 years

A

500mcg

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4
Q

What is hydroxyzine?

A

Antihistamine used for pruritis

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5
Q

Important safety advice with hydroxyzine

A

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)

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6
Q

What could be given for the management of cough in palliative care?

A

Morphine

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7
Q

Donepazil side effects?

A

Dose related cholinergic side effects. Abnormal dreams, agitation, diarrhoea, dizziness, hallucinations, cramps

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8
Q

Memantine should be used in caution in patients with what medical condition?

A

Epilepsy

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9
Q

Which AEDs cannot be switched between brands?

A

Phenytoin, carbamazepine, phenobarbital and primodine

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10
Q

Signs of antiepileptic hypersensitivity sydrome

A

Fever, rash and lymphadenopathy

Liver dysfunction, renal and pulmonary abnormalities

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11
Q

What action should be taken if you suspect antiepileptic hypersensitivity syndrome?

A

Withdraw AED immediately, do not re-expose

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12
Q

Which antiepileptics are associated with antiepileptic hypersensitivity syndrome?

A

Carbamazepine, oxacarbazepine, phenytoin and lamotrigine

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13
Q

Which AED is first line for focal seizures?

A

Carbamazepine or lamotrigine

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14
Q

Which AED is first line in tonic clonic seizures

A

Sodium valproate or lamotrigine

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15
Q

Which AED is first line in absence seizures

A

Sodium valproate or ethosuximide

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16
Q

Which AED is first line in myoclonic seziures?

A

Sodium valproate or levetiracetam or topiramate

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17
Q

Which AED is first line atonic seizures?

A

Sodium valproate

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18
Q

Which AED may exacerbate parkinsons disease?

A

Lamotrigine

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19
Q

Nystagmus, diplopia, slurred speech, ataxia, confusion and hyperglycemia as signs of what drug toxicity?

A

Phenytoin

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20
Q

What monitoring is essential with sodium valproate?

A

Monitor liver function and FBC

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21
Q

What is the first line treatment for bipolar?

A

Antipsychotics - olanzapine, quietiapine, or risperidone normally

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22
Q

Which TCA is associated with the lowest incidence of side effects?

A

Lofepramine and is less dangerous in overdose

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23
Q

Which TCAs are particularly dangerous in over dose?

A

Amitriptyline, dosulepin

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24
Q

How long after stopping an MAOI can other antidepressants be started?

A

2 weeks after stopping

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25
Q

How long after stopping a TCA can you started a MAOI?

A

Wait 7-14 days after stopping a TCA before starting a MAOi

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26
Q

How long after stopping fluoxetine can you start a MAOI?

A

5 weeks

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27
Q

What type of insulin is insulin glargine?

A

Long acting

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28
Q

What type of insulin is insulin determir

A

Long acting

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29
Q

What type of insulin is insulin aspart?

A

Rapid acting

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30
Q

Pharmacy waste should not be stored for longer than?

A

3 months

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31
Q

Total cholesterol target level?

A

<4mmol/l

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32
Q

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?

A

Cluster headache

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33
Q

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

A

Tension type headache

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34
Q

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?

A

Migraine

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35
Q

How often should women have a cervical screen?

A

Every 3 years

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36
Q

What is glossitis?

A

Sore mouth

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37
Q

which sulfonylurea can cause a disulfiram like reaction?

A

Tolbutamide

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38
Q

How often should serum lithium levels be monitored?

A

Monitor every 3 months and after any dose changes

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39
Q

Can pharmacies receive waste from residential homes?

A

Yes CAN receive from residential homes (just not nursing homes)

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40
Q

Can pharmacies receive waste from nursing homes?

A

No

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41
Q

A grade A clean room has a max no. of particles per m3 of what?

A

20

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42
Q

Bonjela OTC age

A

16 years as it is a salicylate and so there is a risk of reyes syndrome

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43
Q

Tramadol CD requirements

A

Full prescription writing requirements
Do not need to write in CD register
Exempt from safe custody

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44
Q

When might a meglitinide, such as repaglinide be useful in T2DM?

A

In patients without a meal pattern - has a rapid onset of action so can be used flexibly around meal times

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45
Q

Verapamil and dabigatran interaction

A

Verapamil increases the levels of dabigatran so need to dose reduce.

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46
Q

Why is chloroform water often included in pharmaceutical preparations?

A

it is a preservative agent

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47
Q

Platelet count should be monitored with all heparins if given for longer than how many days’?

A

4 days

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48
Q

Patients with diabetes at high risk of peripheral arterial disease should aim to maintain HbA1c < than what?

A

<48

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49
Q

What needs to be monitored with methotrexate?

A

Renal function, LFTs and FBC

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50
Q

Why is nifedipine not suitable for MDS trays?

A

It is very light sensitive

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51
Q

Fludrocortisone storage requirements

A

Can be stored up to 30 days at room temperature

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52
Q

How is lithium overdose treated?

A

Haemodialysis

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53
Q

Which of the following is contraindicated in patients with risk factors of QT prolongation:

Erythromycin
Clarithromycin
Domperidone
Citalopram

A

Domperidone

all prolong QT interval and should be used with caution, but only domperidone is contraindicated

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54
Q

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?

A

Yes - vaccines should not be post poned in children with minor illness and no fever.

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55
Q

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?

A

Yellow-green discharge is a sign of gonorrhoea

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56
Q

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?

A

Patient has symptoms of scabies. Give permethrin

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57
Q

Viral conjunctivitis is caused by what virus mainly?

A

Adenovirus

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58
Q

When do patients need a license to travel with CDs?

A

If travelling with >3 months supply

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59
Q

A patient tells you they have missed their progesterone only pill. What advice do you give them?

A

Take the next pill when it is due and use barrier contraception for 2 days

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60
Q

What is the most common cause of food poisoning in the UK?

A

Campylobacter

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61
Q

How many clinical audits should a pharmacy participate in each year?

A

2 - at least one is PCT determined

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62
Q

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

A

C/I in severe heart failure and in patient with Hx of bleed.

Cautioned in elderly and crohns

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63
Q

BNP and NT-prop BNP are investigations used to diagnose what?

A

Heart failure

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64
Q

Phenelzine + pseudoepherine interaction

A

Hypertensive crisis

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65
Q

Theophylline and ciprofloxacin interaction

A

Ciprofloxacin increases the levels of theophylline. This can increase the risk of convulsions.

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66
Q

How often should oxycodone Longtec be given

A

Twice a day

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67
Q

Mirtazipine counselling points

A

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.

68
Q

What is akathesia?

A

Inner restlessness

69
Q

Are first or second gen antipyschotics more likely to cause hyperprolactinaemia?

A

First generation

70
Q

Which of the following in most likely to cause weight gain:

aripiprazole
haloperidol
olanzapine
amisulpride

A

Olanzapaine

others are first generation or a partial antagonsit

71
Q

If a patient with schizophrenia, predominantly has negative symptoms, what class of antipyschotics may be more beneficial?

A

Second generation antipyschotics tend to be more effective in negative symptoms.

72
Q

When could clozapine be considered?

A

Clozapine should not be started unless two other antipsychotics have been tried and failed

73
Q

Why are ergot derived dopamine agonists rarely used?

A

Risk of fibrotic reactions e.g. pulmonary and pericardial

74
Q

What is Topcapone? what is it monitoring requirements?

A

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

75
Q

How should vomiting during pregnancy be managed?

A

If an antiemetic is needed should use either promethazine, prochlorperazine or metoclopramide

76
Q

Which antiemetic is most effective in treating motion sickness?

A

Hyoscine hydrobromide

77
Q

Post op nausea and vomiting risk factors

A 
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)
78
Q

Which antiemetics are ineffective in managing motion sickness?

A

Domperidone, metoclopramide and 5HT3 antagonists

79
Q

Domperidone MHRA alert

A

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.

80
Q

Metoclopramide common side effects

A

EPS in children and young adults, gynacomastia, hyperprolactinaemia

81
Q

Arepitant is used in combination with what?

A

Must be used in combination with a 5HT3 antagonist and dexamethasone in very emotegneic chemotherapy

82
Q

Important arepitant interaction

A

Reduces the effectiveness of hormonal contraceptives

83
Q

Ondansetron common side effects

A

Prolongs QT interval

Constipation, flushing headache

84
Q

How would you advice someone to use hyoscine hydrobromide before a journey?

A

Apply patch behind ear up to 30 minutes before the journey

85
Q

What is the maximum number of buprenorphine patches that can be used at one time?

A

2

86
Q

Buprenorphine monitoring

A

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.

87
Q

Is co-codamol safe in breast feeding?

A

NO - avoid in in BF due the risk in differences in ability to metabolise

88
Q

Codeine is contra-indicated in all children that undergo what procedure?

A

Removal of tonsils for the treatment of sleep apnoea

89
Q

Excessive use of acute treatments for migraine is associated with what?

A

Medication overuse headache

90
Q

Why might metoclopramide and domperidone be useful antiemetics in migraine?

A

Peristalsis is often impaired during an attack, these antiemetics have the advantage of promoting gastric emptying

91
Q

Patients with neuropathic pain may be given the choice of what 4 oral drugs?

A

Duloxetine, amitriptyine, gabapentin or pregbalin

92
Q

Capsacin cream counselling

A

May cause transient burning sensation during initial treatment

93
Q

How should gabapentin be dosed?

A

Need to titrate slowly according to the individual patient

94
Q

Which of the following would be useful in a patient who has given up alcohol but is concerned about getting cravings?

Acamprosate
Disulfram
Nalmfene

A

Acamprosate and reduce cravings

95
Q

Why should opioid withdrawal be avoided in the first trimester?

A

Increased risk of spontaneous discharge

96
Q

What diet is recommended in patients with diverticular disease?

A

High fibre diet

97
Q

Why is loperamide and codeine contraindicated in acute UC?

A

Increased risk of toxic megacolon

98
Q

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

A

Aminosalicylates

99
Q

Which of the following could be given to someone is TPMT deficient?

Methotrexate
Azathiopurine
Mercaptopurine

A

Methotrexate

100
Q

Amiosalicylates monitoring requirements

A

Monitor FBC, LFTs and renal function

101
Q

Nausea is a common side effect of lactulose, how could you minimise this s/e?

A

Take with meals

102
Q

macrogols are cautioned in what patients?

A

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

103
Q

Bismuth antacids are not usually recommended, why?

A

B/C absorbed bismuth can be neurotoxic causing encephalopathy

104
Q

Why should alginates be avoided in patients with HTN, heart failure?

A

Contain large amounts of sodium so can cause fluid rretnation

105
Q

h pylori treatment regimen

A

1 week triple therapy

PPI + metroniazole/amoxicillin + clarithromycin

106
Q

What is the test for h pylori and how should it be carried out?

A

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

107
Q

Why might PPIs be given to patients with CF?

A

PPIs can be used to decrease degradation of pancreatic enzyme supplements in patients with CF

108
Q

1st, 2nd and 3rd line treatment for GORD in pregnancy

A

1st - alginate or antacid
2nd - ranitidine
3rd - omeprazole

109
Q

Hysocine butylbromide injection MHRA warning

A

associated with serious adverse cardiovascular effects

110
Q

What is the drug of choice for cholestatic pruritus in pregnacy?

A

Ursodeoxycholic acid

111
Q

When should orlistat be stopped as it is considered ineffective?

A

If weight has not exceeded 5% after 12 weeks.

112
Q

Why should local anaesthetics only be used for a short period of time in hameorrhoiads

A

May cause sensitisation of the skin

113
Q

Topical corticosteroids are useful in managing haemorrhoids, how long can they be used for?

A

7 days max

114
Q

which topical haemorrhoid preparation is licensed for use in pregnancy?

A

NONE

115
Q

What antihypertensive should be given 1st line to patients with diabetes?

A

ACE inhibitors

116
Q

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?

A

GTN spray is a P medicine so can be sold OTC

117
Q

Mercaptopurine monitoring

A

Liver function

118
Q

What is the risk of giving empaglifolozin to a patient taking ramipril for hypertension?

A

Need to monitor BP as empagliflozin can lower BP and so ramipril dose may need to be reduced

119
Q

Rifampicin and simvastatin interaction

A

Rifamipicin is an enzyme inducer and so can increase the metabolism of simvastin and decrease control of cholesterol levels

120
Q

Which NSAID is associated with the lowest thrombotic risk?

A

Naproxen

121
Q

Leflunomide + warfarin interaction

A

Leflunomide, via its active metabolite inhibits the enzyme that metabolises warfarin anf may lead to bleeding

122
Q

What does the ‘CE’ mark mean on medical devices?

A

Conformite europenne

123
Q

Can other pharmacy staff make the record in the responsible pharmacist record on your behalf?

A

NO - must make the record personally

124
Q

Theophylline has a narrow therapeutic index. When should you monitor serum levels after starting?

A

Measure 5 days after starting oral treatment. usually take blood samples 4-6 hours after dose.

125
Q

Theophylline has a narrow therapeutic index. When should you monitor serum levels after dose adjustments?

A

3 days after dose adjustment

4-6 hours after dose

126
Q

Clobazam is not prescribable on the NHS unless what requirements are met?

A

Can only be prescribed for epilepsy andso should be endorsed SLS

127
Q

Why should the MMR vaccine not be given before 12 months?

A

Immunisation before 12 months may not be effective due to residual maternal antibidies

128
Q

Records relating to the supply of unlicensed medicines must be kept for how long?

A

5 years!

129
Q

What age can nicotine replacement therapy be given OTC?

A

> 12 years

130
Q

How long before surgery should clopidogrel be stopped?

A

7 days

131
Q

What is the 1st line treatment for obstructive cholestasis secondary to gall stones?

A

Ursodeoxycholic acid

132
Q

Which of the following is not a once daily dose:

Loratidine
Chlorphenamine
Ceterizine

A

Chlorphenamine - can be given 4- 6hours

133
Q

Joyrides can be give over what age OTC

A

3 years

134
Q

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
A

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

135
Q

When should you refer a patient with a wart to their GP?

A

Refer if the wart is on the face or genitals

Or if very painful or bleeding

136
Q

Definition of a missed progesterone only pill

A

More than 12 hours late

137
Q

What advice would you give someone who has missed a progesterone only pill?

A

Need emergency contraception if they have had UPSI during the previous two tablets. Need extra contraception for the next 2 days.

138
Q

How should lithium be managed before surgery?

A

Stop 24 hours before major surgery

Continue as normal in minor surgery

139
Q

How should amiloride be managed before surgery?

A

stop K+ sparing diuretics on morning of surgery as risk of hyperkalemia if renal perfusion is impaired

140
Q

What can be given to reduce extraneous muscle movements associated with propofol?

A

Extraneous muscle movements can be minimised by an opioid analgesic or a short acting benzodiazpine just before induction

141
Q

How long after general anaesthetic should driving be avoided?

A

24 hours

142
Q

Prolonged exposure of nitrous oxide can lead to what?

A

Prolonged exposure can lead to megaloblastic anaemia owing to interference with the action of vitamin B12

143
Q

OTC age for gripe water?

A

4 weeks

144
Q

OTC age for simeticone?

A

From birth

145
Q

OTC age for bonjela teething gel?

A

2 months

146
Q

OTC for fluriprofen?

A

12 years

147
Q

Safety warning about sucralfate?

A

Risk of bezoar formation (solid mass of indigestible materials that accumulates in the GI tract)

148
Q

What advice should be given to patients taking high doses of pancreatin?

A

Advise patient to maintain adequate hydration

149
Q

Can mesalazine be switched between brands?

A

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

150
Q

Labetolol monitoring

A

Monitor for liver damage

151
Q

Itraconazole should be prescribed with caution to patients with what medical condition?

A

Heart failure

152
Q

Voriconazole monitoring?

A

Renal and liver function

Can cause phototoxicity

153
Q

What should a patient do if they miss a dose of exenatide?

A

If a dose is missed, skip and continue with next schedule dose. DO NOT ADMINISTER AFTER MEALS

154
Q

How should levothyroxine be started in patients with cardiac disease?

A

Start with a lower dose

Should also do a baseline ECG

155
Q

Finasteride counselling

A

Contraception - drug excreted in semen

Risk of male breast cancer - reporting any changes in breast tissue

156
Q

What is the OTC age for penciclovir?

A

12 years

157
Q

Colestyramine may interupt the absorption of what vitamins?

A

Fat soluble

158
Q

What is the risk of prescribing bendroflumethiazide with lithium?

A

Bendroflumethiazide can cause hyponatremia so will increase lithium levels

159
Q

What causes megaloblastic anaemia?

A

Vitamin b12 or folate deficiency

160
Q

What causes microcytic anaemia?

A

Iron deficiency

161
Q

A patient that was started on carbamazepine 3 weeks ago has since developed a rash. What action should you take?

A

tell them to stop taking carbamazepine immediately

162
Q

True/False - NSAIDs may be useful in the management of psoriasis

A

False - NSAIDs can exacerbate psoriasis

163
Q

Prolonged use of metronidazole is associated with what?

A

Peripheral neuropathy

164
Q

What is UKDILAS?

A

UK Drugs in lactation advisory service

165
Q

How might you step someones asthma ICS treatment DOWN

A

Step down controlled asthma every 3 months, decreasing the dose by 25-50% each time

Pre-reg (Rosie) (18 decks)

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