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1
Q

How do you usually treat torsades de pointes?

A

IV Mg sulphate

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2
Q

What is the treatment of choice for supra-ventricular arrythmias?

A

Adenosine - has a very short duration of action (8-10seconds)

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3
Q

What is the interaction between adenosine and dipyridamole?

A

Duration of action of adenosine is usually very short, its duration is prolonged in those taking dipyridamole

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4
Q

Sympathomimetic decongestants are effective due their vasoconstrictor effect. They should be avoided in patients with what co-morbidity?

A

Should be avoided in hypertension

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5
Q

A 14 year old requests an emergency supply for insulin. You check the patients records and they have had this before. Can you supply?

A

Yes - there is no age limit to an emergency supply

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6
Q

How should cluster headaches be treated?

A

Cluster headaches rarely respond to standard analgesics.

Sumatriptan given by S/C injection is the treatment of choice.

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7
Q

What time of day should flupentixol be taken?

A

Flupentixol has an alerting effect - do not give after 4pm

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8
Q

As an authorised pharmacist, can you legally supply industrial denatured alcohol (IDA) to a medical practitioner without the MP having being authorised by HM Rev and Customs?

A

Yes - do not need authorisation

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9
Q

What is the max quantity of industrial denatured alcohol can be supplied without a license/authorisation?

A

20L

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10
Q

What are the target oxygen saturations in a patient not at risk of hypercapnic respiratory failure?

A

94-98%

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11
Q

What are the target oxygen saturations in a patient with COPD?

A

88-92%

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12
Q

Name 3 factors that would put a patient at risk of hypercapnic respiratory failure?

A

COPD, cystic fibrosis, lung scarring from TB, overdose on benzos or opioids

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13
Q

What is the minimum period the pharmacy record must be kept for?

A

5 years

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14
Q

A mother enters the pharmacy requesting hydrocortisone cream for her 8 year old son. How do you respond?

A

Refuse sale - hydrocortisone cream not suitable OTC if <10 years

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15
Q

What is the max duration hydrocortisone cream should be used for OTC?

A

1 week

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16
Q

What is the interaction between ciprofloxacin and warfarin?

A

Ciprofloxacin is an enzyme inhibitor, therefore increases the anticoagulant effect of warfarin

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17
Q

At what time after administration should you measure the digoxin plasma conc?

A

6 hours after dose

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18
Q

Why is it important that tetracyclines are not used after there expiry date?

A

They become more nephrotoxic after their expiry date

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19
Q

What is the max supply of isotretinoin that can be given to a women under the PPP?

A

Max 30 days supply

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20
Q

For how long is a prescription for isotretinoin valid for, if the patient is part of the PPP?

A

28 days

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21
Q

A mother asks for advice. Her daughter has a cough which sounds like barking, and is having difficulty breathing? What do you think the daughter has? What advice do you provide?

A

Symptoms are typical of croup.

Croup usually gets better on its own at home within 48 hours - advise rest and fluids.

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22
Q

How do the doses of amitriptyline differ between depression and neuropathic pain?

A

Depression - initially 75mg daily , increased up to 150-200mg.
Neuropathic pain - initially 10mg daily, increased up to 75mg.

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23
Q

What four drugs could be used for hypersecretions in palliative care?

A

Hyoscine hydrobromide/butylbromide, glycopyronnium or atropine

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24
Q

What are the fat soluble vitamins?

A

ADEK

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25
Q

Patients should have an eGFR above what for nitrofuratoin to be safe and effective?

A

Above 45 ml/min

Consider if above 30

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26
Q

Sodium citrate can be used to treat cystitis. Can you give OTC to a pregnant women?

A

NO

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27
Q

Diagnose the following:
Patient has a sore throat, headache, temperature.
Also has a pink-red rash that feels like sand paper and looks like a sunburn.

What do you advise the patient to do ?

A

Scarlet fever

Refer to GP for antibiotics

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28
Q

A patient has been prescribed carbamazepine. You advise the patient requires HLAB1502 testing - why?

A

Required in patients of Thai origin. It is a marker for carbamazepine induced stevens johnson syndrome.

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29
Q

A patient has been prescribed orlistat. What vitamins are you concerned they will become deficient in?

A

Concerned over deficiency in fat soluble vitamins esp. vitamin A and D

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30
Q

You have a patient with diabetes and heart failure. They are currently taking metformin for diabetes but they require further glucose control. What oral antidiabetic drug should the patient NOT be prescribed?

A

pioglitazone should be avoided in cardiovascular disease due to the risk of heart failure.

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31
Q

True or false: advance supplies of EHC cannot be made

A

False - if pharmacist believes appropriate, they can make an advance supply

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32
Q

What is the max duration ranitidine can be used OTC?

A

2 weeks

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33
Q 
Which of the following patients would you advise to get a flu vaccine?
Diabetic
Pregnant 
COPD
Asthma relieved by salbutamol
Chronic bronchitis 
Asthma relieved by Seretide
A

All except asthma relieved by salbutamol

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34
Q

How long can doxycycline be used for the prophylaxis of malaria?

A

Up to 2 years

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35
Q

What age range can you supply fluoconazole OTC for thrush?

A

16-60 years. Need to refer if outside these ages

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36
Q

Your patient has epilepsy and is currently prescribed sodium valproate. The doctors wish to start meropenum for an infection and ask you if this okay?

A

No - clinically significant interaction. Results in reduced valproate plasma concentrations.

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37
Q

Why should you avoid prescribing domperidone and erythromycin concomitantly?

A

Both prolong QT interval

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38
Q

The minor ailments service is classed as what type of service: essential, advanced, enhanced?

A

Enhanced - locally commissioned service

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39
Q

Clinical governance is classed as what type of service: essential, advanced, enhanced?

A

Essential

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40
Q

Private prescriptions for CDs are on what colour prescription?

A

Pink

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41
Q

What is the first line treatment for acute gout?

A

NSAID - continue for 48 hours after the attack has resolved

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42
Q

What do you give a patient that has overdosed on diazepam?

A

Flumazenil injection

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43
Q

A patient presents to AMU after ovedosing on diazepam and amitriptyline. The FY1 wants to prescribed flumazenil, you advise that he uses this with caution. Why?

A

Because the patient has also taken a TCA they are at risk of seizures and arrythmias

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44
Q

A patient comes to the pharmacy with a prescription for phenytoin. You do not have their usual brand in stock, can you supply what you have available?

A

No - phenytoin is a category 1 AED and must be kept the same

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45
Q

A patient comes to the pharmacy for a prescription for lamotrigine. You do not have their usual brand in stock, what do you do?

A

Lamotrigine is a category 2 AED - can swap based on clinical judgement. You should try to source supply from elsewhere, or speak with GP to determine whether appropriate to switch

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46
Q

Too much zinc can lead to what complications?

A

Genitourinary infections, urinary retention and BPH

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47
Q

How do the manufacturers advice you taper a dose of pregablin?

A

SPC advises you can taper over 1 week

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48
Q

Why should verapmail and diltiazem not be prescribed in patients with HF?

A

Cause depression of cardiac function

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49
Q

Pregnant women with a BMI >30 should be advised to take what dose of folic acid?

A

5mg for the first 12 weeks of pregnancy

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50
Q

How might you convert a patient from oral morphine to a fentanyl patch?

A

Conversion of 100:1
Steady state concentrations are reached by the second 72 hours application - the patient should be prescribed breakthrough analgesia for the first 3 days
Should also adjust the dose of laxatives as fentanyl is less constipating

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51
Q

Your patient is prescribed 250mcg of digoxin. The doctor wishes to start a loading regimen of amiodarone. Do you need to make any changes to the patients medication?

A

Yes - need to half the dose digoxin as amiodarone will increase its concentration

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52
Q

Is night nurse suitable for patients with hypertension?

A

Yes - doesn’t contain a decongestant

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53
Q

What vitamin D should a patient with CKD be prescribed?

A

activated vitamin D such as alfacalcidol and calcitrol

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54
Q

You are counselling a patient newly started on vigabtrin. You advise the patient to report any symptoms of what?

A

Any new visual symptoms or disturbances

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55
Q

How should phenytoin be administered IV?

A

Phenytoin has a very high pH when given IV. It should be given via a volumetric pump and must go through a filter due to precipitation.

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56
Q

What is the most important thing to monitor with sodium valproate?

A

LFTs

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57
Q

What type of drugs must be avoided in patients with myasthenia gravis?

A

Anticholinergics

58
Q

Why should parkinson disease medicines never be stopped abruptly?

A

Risk of neuromalignant syndrome

59
Q

Isotretinoin is best taken with or without food?

A

With food

60
Q

Colchicine has two main indications, what are they?

A

Pericarditis and gout

61
Q

What medicines should a patient be given after a stroke?

A

Aspirin 300mg for 14 days. Then clopidogrel 75mg for liife. If the patient has AF they may also be prescribed an anticoagulant. A statin should also be started 48 hours after onset irrespective of the cholesterol concentration.

62
Q

What side effects would you counsel a patient on who is starting a nitrate?

A

Flushing, headache and postural hypotension

63
Q

Levodopa colours the urine what colour?

A

Dark reddish

64
Q

Entacpone colours the urine what colour?

A

Orange

65
Q

How do you counsel a patient who has been prescribed two different types of eye drops to be used in the morning? Can they administer them at the same time?

A

Dilution or overflow can occur if given at the same time.
Leave an interval of at least 5 minutes - longer interval is needed for gels and eye ointments should be applied after drops.

66
Q

Side effect commonly associated with fluorouracil, MTX and anthracylcines….

A

Mucositis

67
Q

Which cancer is highest risk of tumour lysis syndrome?

A

Non-hodgkins lymphoma

68
Q

All cytotoxic drugs cause bone marrow suppression, except X and Y?

A

Bleomycin

Vincristine

69
Q

Mesna is given to patients taking cyclophosphamide to prevent what?

A

Prevent onset of haemorrhagic cystitis

70
Q

What are the common side effects of verapamil?

A

Constipation, ankle oedema, dizziness, flushing

71
Q

What is the max dose of simvastatin that can be prescribed in patients also taking verapamil?

A

20mg

72
Q

What is the maximum rate and concentration potassium can be prescribed at?

A

40mmol
rate of 20mmol/hr

concentrations greater than this are painful and may cause severe phlebitis

73
Q

What should be monitored with daptomycin?

A

Creatine Kinase

74
Q

How many times a day is ipratropium administered?

A

3-4 times a day

75
Q

Preparations that do not contain X, Y and Z can be classed as sugar free?

A

Fructose, glucose and sucrose

76
Q

What is the primary mechanism of ellaOne?

A

Inhibition or delay or ovulation

77
Q

Why is hypothyroidism associated with microcytic anaemia?

A

Thyroid hormone helps in the production of RBC

78
Q

True/False: ACEi are used in the treatment of renal artery stenosis

A

False - ACEi are contraindicated in renal artery stenosis as disrupts auto-regulation of perfusion

79
Q

Diuretic that can cause hyperkalemia and gynacomastia

A

Spironolactone

80
Q

How long should the CD register be kept for following the final entry?

A

2 years

81
Q

What important monitoring is necessary with doxorubicin?

A

Cumulative dose must be monitored due to the risk of myopathy

82
Q

How can you treat theophylline overdose?

A

Activated charcol is <1 hr since ingested
IV KCl to treat the hypokalemia
Lorazepam/diazepam for convulsions

If patient is not asthmatic then can use a short acting beta blocker

83
Q

Which anti-malarial drug should be avoided in depression and psychiatric disorders?

A

Mefloquine

84
Q

A patient that usually takes desmopressin has got a stomach bug, what do you advise?

A

Stop taking desmopressin if experiencing nausea and vomiting

85
Q

What is pancytopenia?

A

Deficiency of all three cellular components - RBC, WBC and platlets

86
Q

What is the interaction between mirabegron and clarithromycin?

A

Increases mirabegron levels - should reduce dose during treatment

87
Q

Patients taking pioglitazone should be instructed to report what symptoms? why?

A

Patient should report any N & V, abdominal pain, fatigue and dark urine. Rare reports of liver dysfunction with treatment

88
Q

What monitoring is required with pioglitazone?

A

LFTs - before treatment and periodically throughout

89
Q

Warning label on perindopril….

A

Take 30 to 60 minutes before food

90
Q

GTN tablets warning label….

A

Discard 8 weeks after opening (legal requirement)

91
Q

Can nitrofurantoin be taken during pregnancy?

A

Avoid at term as may cause neonatal haemolysis

92
Q

How long must a POM register be kept for?

A

2 years

93
Q

How long must the responsible pharmacist register be kept for?

A

5 years

94
Q

Tramadol and warfarin interaction

A

Tramadol can enhance the anticoagulant effect of warfarin.

95
Q

Amiodarone monitoring (oral route)

A

Thyroid function
LFTs
Potassium
Chest X-ray

96
Q

Statin treatment for the primary prevention of CVD should be considered in adults with T1DM and who are…. (4 points)

A
  1. > 40 years
  2. Had diabetes >10 years
  3. Have established nephropathy
  4. Other CVD risk factors
97
Q

When should statin treatment be started in individuals with T2DM?

A

Assess QRISK2 and start atorvastatin 20mg if risk >10%

98
Q

How might bendroflumethiazide affect serum calcium levels?

A

Increases ca levels

99
Q

How might bendroflumethiazide affect glucose levels

A

Increases glucose levels

100
Q

4 year old child with asthma is currently taking a low dose ICS and is needing to use their salbumamol inhaler regularly. What treatment would you recommend?

A

LTRA e.g. montelukast. As patient is <5 years old. If >5 years then would add a LABA

101
Q

A patient presents to the pharmacy with a sore mouth and mouth ulcers. You ask if they take any medication. The patient takes ramipril 10mg OD, metformin 1g BD. What action do you take?

A

Refer to GP - sore red tongue, mouth ulcers, extreme tiredness and pins and needles are signs of anaemia. Metformin can lower B12 levels.

102
Q

Activated charcol can be used to manage overdose of a number of medicines. Name 3 drugs, when this should NOT be used.

A

Should NOT be used for alcohol, iron and lithium over dose.

103
Q

How can we treat UTI in pregnancy?

A

Penicillins and cephalosporins are suitable
Nitrofurantoin - can be used, but avoid at term
Quinolones should be avoided in pregnancy (Risk of arthropathy)
Trimethoprim - ideally avoid, esp in 1st trimester

104
Q

Pioglitazone in combination with insulin increases the risk of what?

A

Heart failure

105
Q

True or false - a repeat prescription from germany can be legally dispensed in the uk?

A

True - prescriptions and repeat Rx from EEA counties and switzerland are legally recognised in the UK.

106
Q

Can you give emergency supplies to patients from an EEA country?

A

Yes - must satisfy usual UK criteria

107
Q

What prescriber details are required on an EEA prescription for you to be able to dispense it?

A

Full name, qualification, direct contact details (email address and phone/fax no.)
Should check the reg status of the prescriber but if not able to then use professional judgement

108
Q

If a prescription from Spain is not written in english can you legally dispense it?

A

Yes - if written in a foreign language it is legally acceptable.

109
Q

How emetogenic is cisplatin and cyclophosphamide?

A

Very >90% risk

110
Q

Example of chemo agents with low emetogenic risk

A

Bleomycin, vincalkoids

Rituxamab - generally low risk with the mabs

111
Q

Flurouracil - low or high emetogenic risk?

A

Low/moderate

112
Q

Signs of neuroleptic malginant sydrome

A

Raised temperature, tachycardia, increased RR, muscle rigidity, excessive sweating

113
Q

POM, P or GSL: Calpol infant suspension 200ml

A

P

114
Q

POM, P or GSL: Calpol infant suspension 100ml

A

GSL

115
Q

POM, P or GSL: Calpol 6+ suspension 100ml

A

P - 80ml is GSL

116
Q

Outline the CHMP restrictions for piroxicam (systemic)

A

Should only be initiated by experienced prescribers
Should not be used first line
Limited use to OA, RA and ankolysing spondlytis
Max dose is 20mg
Consider prescribing a PPI

117
Q

Why are there concerns with piroxicam prescribing?

A

Risk of GI side effects and serious skin reactions

118
Q

You recieve a prescription for ketoconazole 200mg tds. What might the indication be?

A

Cushings syndrome
Ketoconazole inhibits the enzymes involved in the synthesis and degradation of steroids and therefore decreases cortisol levels
Other indications are topical routes

119
Q

What monitoring is required with oral ketoconazole?

A

Must do an ECG before and 1 week after
Adrenal function - monitor serum cortisol and for symptoms
LFTs

120
Q

Which antibiotics are associated with the greatest risk of c.diff?

A

Ampicillin, amoxicillin and co-amox
2nd and 3rd gen cephalosporins
Clindamycin
Quinolones

121
Q

Max ramipril dose in a patient with an eGFR of 40?

A

5mg - max dose if eGFR is 30-60

122
Q

Caution should be taken in patients with an allergy to what, when giving the flu vaccine?

A

Egg allergy - either give egg free vaccine or one with a low content (need access to anaphylaxis treatment).

123
Q

When should patients be moved up from step 1 to step 2 of the asthma guideline?

A

Move to step 2 if the patient presents with anyone of the following features: is using an inhaled SABA three times a week or more, symptomatic 3 times a week or more, experiencing night time symptoms at least once a week or has had an asthma attack in the last 2 years

124
Q

How does the dose of beclometasone and fluticasone differ?

A

Fluticasone provides equal activity to beclometasone at half the dosage

125
Q

How often are ICS given usually? Which steroid is an exception to this rule?

A

Usually given BD - unless good control is established then OD can be considered. Ciclosenide is always OD.

126
Q

Step 3 of the children asthma guidelines

A

In children 2-5 years add a LTRA if not already added during step 2.

> 5 years add a LABA

127
Q

How might you step someone down from their dose of ICS? (referring to asthma patients)

A

Reductions should be considered every three months, decreasing dose by approximatley 25-50% each time

128
Q

Outline the management of an acute asthma attack in adults

A
  1. Oxygen (target usually 94-98)
  2. Salbutamol nebs
  3. Prednisolone 5 days
  4. Ipratropium nebs

consider Mg sulphate in patients with severe acute asthma who have not had a good initial response to inhaled bronchodilatory therapy.

129
Q

Why is chlordiazepoxide or diazepam the benzodiazepine of choice for managing alcohol dependence?

A

Long acting

130
Q

What is the first line treatment for delierium tremens?

A

Lorazepam

131
Q

What should be given to patients with suspected wernickes encephalopathy?

A

Parental thiamine (pabrinex), followed by oral thiamine - dose depends on severity of deficiency

132
Q

What is acamprosate used for?

A

Used for the maintenance of abstinence in alcohol dependence

133
Q

What is the treatment of choice for aspergillosis?

A

Voriconazole

liposomal amphotericin is an alternative agent if voriconazole cannot be used

134
Q

What must you do before administering amphotericin IV for the first time? Why?

A

Test dose of 1mg - observe for 30 minutes. as anaphylaxis can occur

135
Q

How long after starting an ICS for asthma would you expect to see improvement?

A

Alleviation of symptoms usually occurs 3 to 7 days after initiation

136
Q

How would you manage croup?

A

Mild croup is largely self-limiting, but treatment with a single dose of dexmethasone by mouth may be of benefit.

More severe croup calls for hospital admission - dexamethasone given

137
Q

What is metyrapone used for?

A

Cushings syndrome

138
Q

What is the first line treatment for heart failure?

A

An ACE inhibitor (titrated to max tolerated dose) with a beta-blocker

139
Q

If a patient with HF does not tolerate an ACEi what could you offer them instead? Patient already taking bisoprolol

A

An ARB - a relatively high dose may be required to produce benefit

140
Q

When can eplerenone be used in heart failure?

A

If spironolactone cannot be used, eplerenone may be considered for the management of heart failure after an acute myocardial infaraction with LVSD or for chronic mild heart failure with LVSD

141
Q

What monitoring is required with aldosterone antagonists?

A

Serum creatine, eGFR and potassium

142
Q

Patients with HF who cannot tolerate an ACE inhibitor or ARB, may be given what?

A

Isosorbide dinitrate with hydralazine but this combination may be poorly tolerated

Pre-reg (Rosie) (18 decks)

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