Random Flashcards
How do you usually treat torsades de pointes?
IV Mg sulphate
What is the treatment of choice for supra-ventricular arrythmias?
Adenosine - has a very short duration of action (8-10seconds)
What is the interaction between adenosine and dipyridamole?
Duration of action of adenosine is usually very short, its duration is prolonged in those taking dipyridamole
Sympathomimetic decongestants are effective due their vasoconstrictor effect. They should be avoided in patients with what co-morbidity?
Should be avoided in hypertension
A 14 year old requests an emergency supply for insulin. You check the patients records and they have had this before. Can you supply?
Yes - there is no age limit to an emergency supply
How should cluster headaches be treated?
Cluster headaches rarely respond to standard analgesics.
Sumatriptan given by S/C injection is the treatment of choice.
What time of day should flupentixol be taken?
Flupentixol has an alerting effect - do not give after 4pm
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?
Yes - do not need authorisation
What is the max quantity of industrial denatured alcohol can be supplied without a license/authorisation?
20L
What are the target oxygen saturations in a patient not at risk of hypercapnic respiratory failure?
94-98%
What are the target oxygen saturations in a patient with COPD?
88-92%
Name 3 factors that would put a patient at risk of hypercapnic respiratory failure?
COPD, cystic fibrosis, lung scarring from TB, overdose on benzos or opioids
What is the minimum period the pharmacy record must be kept for?
5 years
A mother enters the pharmacy requesting hydrocortisone cream for her 8 year old son. How do you respond?
Refuse sale - hydrocortisone cream not suitable OTC if <10 years
What is the max duration hydrocortisone cream should be used for OTC?
1 week
What is the interaction between ciprofloxacin and warfarin?
Ciprofloxacin is an enzyme inhibitor, therefore increases the anticoagulant effect of warfarin
At what time after administration should you measure the digoxin plasma conc?
6 hours after dose
Why is it important that tetracyclines are not used after there expiry date?
They become more nephrotoxic after their expiry date
What is the max supply of isotretinoin that can be given to a women under the PPP?
Max 30 days supply
For how long is a prescription for isotretinoin valid for, if the patient is part of the PPP?
28 days
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?
Symptoms are typical of croup.
Croup usually gets better on its own at home within 48 hours - advise rest and fluids.
How do the doses of amitriptyline differ between depression and neuropathic pain?
Depression - initially 75mg daily , increased up to 150-200mg.
Neuropathic pain - initially 10mg daily, increased up to 75mg.
What four drugs could be used for hypersecretions in palliative care?
Hyoscine hydrobromide/butylbromide, glycopyronnium or atropine
What are the fat soluble vitamins?
ADEK
Patients should have an eGFR above what for nitrofuratoin to be safe and effective?
Above 45 ml/min
Consider if above 30
Sodium citrate can be used to treat cystitis. Can you give OTC to a pregnant women?
NO
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 ?
Scarlet fever
Refer to GP for antibiotics
A patient has been prescribed carbamazepine. You advise the patient requires HLAB1502 testing - why?
Required in patients of Thai origin. It is a marker for carbamazepine induced stevens johnson syndrome.
A patient has been prescribed orlistat. What vitamins are you concerned they will become deficient in?
Concerned over deficiency in fat soluble vitamins esp. vitamin A and D
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?
pioglitazone should be avoided in cardiovascular disease due to the risk of heart failure.
True or false: advance supplies of EHC cannot be made
False - if pharmacist believes appropriate, they can make an advance supply
What is the max duration ranitidine can be used OTC?
2 weeks
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
All except asthma relieved by salbutamol
How long can doxycycline be used for the prophylaxis of malaria?
Up to 2 years
What age range can you supply fluoconazole OTC for thrush?
16-60 years. Need to refer if outside these ages
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?
No - clinically significant interaction. Results in reduced valproate plasma concentrations.
Why should you avoid prescribing domperidone and erythromycin concomitantly?
Both prolong QT interval
The minor ailments service is classed as what type of service: essential, advanced, enhanced?
Enhanced - locally commissioned service
Clinical governance is classed as what type of service: essential, advanced, enhanced?
Essential
Private prescriptions for CDs are on what colour prescription?
Pink
What is the first line treatment for acute gout?
NSAID - continue for 48 hours after the attack has resolved
What do you give a patient that has overdosed on diazepam?
Flumazenil injection
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?
Because the patient has also taken a TCA they are at risk of seizures and arrythmias
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?
No - phenytoin is a category 1 AED and must be kept the same
A patient comes to the pharmacy for a prescription for lamotrigine. You do not have their usual brand in stock, what do you do?
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
Too much zinc can lead to what complications?
Genitourinary infections, urinary retention and BPH
How do the manufacturers advice you taper a dose of pregablin?
SPC advises you can taper over 1 week
Why should verapmail and diltiazem not be prescribed in patients with HF?
Cause depression of cardiac function
Pregnant women with a BMI >30 should be advised to take what dose of folic acid?
5mg for the first 12 weeks of pregnancy
How might you convert a patient from oral morphine to a fentanyl patch?
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
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?
Yes - need to half the dose digoxin as amiodarone will increase its concentration
Is night nurse suitable for patients with hypertension?
Yes - doesn’t contain a decongestant
What vitamin D should a patient with CKD be prescribed?
activated vitamin D such as alfacalcidol and calcitrol
You are counselling a patient newly started on vigabtrin. You advise the patient to report any symptoms of what?
Any new visual symptoms or disturbances
How should phenytoin be administered IV?
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.
What is the most important thing to monitor with sodium valproate?
LFTs
What type of drugs must be avoided in patients with myasthenia gravis?
Anticholinergics
Why should parkinson disease medicines never be stopped abruptly?
Risk of neuromalignant syndrome
Isotretinoin is best taken with or without food?
With food
Colchicine has two main indications, what are they?
Pericarditis and gout
What medicines should a patient be given after a stroke?
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.
What side effects would you counsel a patient on who is starting a nitrate?
Flushing, headache and postural hypotension
Levodopa colours the urine what colour?
Dark reddish
Entacpone colours the urine what colour?
Orange
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?
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.
Side effect commonly associated with fluorouracil, MTX and anthracylcines….
Mucositis
Which cancer is highest risk of tumour lysis syndrome?
Non-hodgkins lymphoma
All cytotoxic drugs cause bone marrow suppression, except X and Y?
Bleomycin
Vincristine
Mesna is given to patients taking cyclophosphamide to prevent what?
Prevent onset of haemorrhagic cystitis
What are the common side effects of verapamil?
Constipation, ankle oedema, dizziness, flushing
What is the max dose of simvastatin that can be prescribed in patients also taking verapamil?
20mg
What is the maximum rate and concentration potassium can be prescribed at?
40mmol
rate of 20mmol/hr
concentrations greater than this are painful and may cause severe phlebitis
What should be monitored with daptomycin?
Creatine Kinase
How many times a day is ipratropium administered?
3-4 times a day
Preparations that do not contain X, Y and Z can be classed as sugar free?
Fructose, glucose and sucrose
What is the primary mechanism of ellaOne?
Inhibition or delay or ovulation
Why is hypothyroidism associated with microcytic anaemia?
Thyroid hormone helps in the production of RBC
True/False: ACEi are used in the treatment of renal artery stenosis
False - ACEi are contraindicated in renal artery stenosis as disrupts auto-regulation of perfusion
Diuretic that can cause hyperkalemia and gynacomastia
Spironolactone
How long should the CD register be kept for following the final entry?
2 years
What important monitoring is necessary with doxorubicin?
Cumulative dose must be monitored due to the risk of myopathy
How can you treat theophylline overdose?
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
Which anti-malarial drug should be avoided in depression and psychiatric disorders?
Mefloquine
A patient that usually takes desmopressin has got a stomach bug, what do you advise?
Stop taking desmopressin if experiencing nausea and vomiting
What is pancytopenia?
Deficiency of all three cellular components - RBC, WBC and platlets
What is the interaction between mirabegron and clarithromycin?
Increases mirabegron levels - should reduce dose during treatment
Patients taking pioglitazone should be instructed to report what symptoms? why?
Patient should report any N & V, abdominal pain, fatigue and dark urine. Rare reports of liver dysfunction with treatment
What monitoring is required with pioglitazone?
LFTs - before treatment and periodically throughout
Warning label on perindopril….
Take 30 to 60 minutes before food
GTN tablets warning label….
Discard 8 weeks after opening (legal requirement)
Can nitrofurantoin be taken during pregnancy?
Avoid at term as may cause neonatal haemolysis
How long must a POM register be kept for?
2 years
How long must the responsible pharmacist register be kept for?
5 years
Tramadol and warfarin interaction
Tramadol can enhance the anticoagulant effect of warfarin.
Amiodarone monitoring (oral route)
Thyroid function
LFTs
Potassium
Chest X-ray
Statin treatment for the primary prevention of CVD should be considered in adults with T1DM and who are…. (4 points)
- > 40 years
- Had diabetes >10 years
- Have established nephropathy
- Other CVD risk factors
When should statin treatment be started in individuals with T2DM?
Assess QRISK2 and start atorvastatin 20mg if risk >10%
How might bendroflumethiazide affect serum calcium levels?
Increases ca levels
How might bendroflumethiazide affect glucose levels
Increases glucose levels
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?
LTRA e.g. montelukast. As patient is <5 years old. If >5 years then would add a LABA
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?
Refer to GP - sore red tongue, mouth ulcers, extreme tiredness and pins and needles are signs of anaemia. Metformin can lower B12 levels.
Activated charcol can be used to manage overdose of a number of medicines. Name 3 drugs, when this should NOT be used.
Should NOT be used for alcohol, iron and lithium over dose.
How can we treat UTI in pregnancy?
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
Pioglitazone in combination with insulin increases the risk of what?
Heart failure
True or false - a repeat prescription from germany can be legally dispensed in the uk?
True - prescriptions and repeat Rx from EEA counties and switzerland are legally recognised in the UK.
Can you give emergency supplies to patients from an EEA country?
Yes - must satisfy usual UK criteria
What prescriber details are required on an EEA prescription for you to be able to dispense it?
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
If a prescription from Spain is not written in english can you legally dispense it?
Yes - if written in a foreign language it is legally acceptable.
How emetogenic is cisplatin and cyclophosphamide?
Very >90% risk
Example of chemo agents with low emetogenic risk
Bleomycin, vincalkoids
Rituxamab - generally low risk with the mabs
Flurouracil - low or high emetogenic risk?
Low/moderate
Signs of neuroleptic malginant sydrome
Raised temperature, tachycardia, increased RR, muscle rigidity, excessive sweating
POM, P or GSL: Calpol infant suspension 200ml
P
POM, P or GSL: Calpol infant suspension 100ml
GSL
POM, P or GSL: Calpol 6+ suspension 100ml
P - 80ml is GSL
Outline the CHMP restrictions for piroxicam (systemic)
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
Why are there concerns with piroxicam prescribing?
Risk of GI side effects and serious skin reactions
You recieve a prescription for ketoconazole 200mg tds. What might the indication be?
Cushings syndrome
Ketoconazole inhibits the enzymes involved in the synthesis and degradation of steroids and therefore decreases cortisol levels
Other indications are topical routes
What monitoring is required with oral ketoconazole?
Must do an ECG before and 1 week after
Adrenal function - monitor serum cortisol and for symptoms
LFTs
Which antibiotics are associated with the greatest risk of c.diff?
Ampicillin, amoxicillin and co-amox
2nd and 3rd gen cephalosporins
Clindamycin
Quinolones
Max ramipril dose in a patient with an eGFR of 40?
5mg - max dose if eGFR is 30-60
Caution should be taken in patients with an allergy to what, when giving the flu vaccine?
Egg allergy - either give egg free vaccine or one with a low content (need access to anaphylaxis treatment).
When should patients be moved up from step 1 to step 2 of the asthma guideline?
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
How does the dose of beclometasone and fluticasone differ?
Fluticasone provides equal activity to beclometasone at half the dosage
How often are ICS given usually? Which steroid is an exception to this rule?
Usually given BD - unless good control is established then OD can be considered. Ciclosenide is always OD.
Step 3 of the children asthma guidelines
In children 2-5 years add a LTRA if not already added during step 2.
> 5 years add a LABA
How might you step someone down from their dose of ICS? (referring to asthma patients)
Reductions should be considered every three months, decreasing dose by approximatley 25-50% each time
Outline the management of an acute asthma attack in adults
- Oxygen (target usually 94-98)
- Salbutamol nebs
- Prednisolone 5 days
- Ipratropium nebs
consider Mg sulphate in patients with severe acute asthma who have not had a good initial response to inhaled bronchodilatory therapy.
Why is chlordiazepoxide or diazepam the benzodiazepine of choice for managing alcohol dependence?
Long acting
What is the first line treatment for delierium tremens?
Lorazepam
What should be given to patients with suspected wernickes encephalopathy?
Parental thiamine (pabrinex), followed by oral thiamine - dose depends on severity of deficiency
What is acamprosate used for?
Used for the maintenance of abstinence in alcohol dependence
What is the treatment of choice for aspergillosis?
Voriconazole
liposomal amphotericin is an alternative agent if voriconazole cannot be used
What must you do before administering amphotericin IV for the first time? Why?
Test dose of 1mg - observe for 30 minutes. as anaphylaxis can occur
How long after starting an ICS for asthma would you expect to see improvement?
Alleviation of symptoms usually occurs 3 to 7 days after initiation
How would you manage croup?
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
What is metyrapone used for?
Cushings syndrome
What is the first line treatment for heart failure?
An ACE inhibitor (titrated to max tolerated dose) with a beta-blocker
If a patient with HF does not tolerate an ACEi what could you offer them instead? Patient already taking bisoprolol
An ARB - a relatively high dose may be required to produce benefit
When can eplerenone be used in heart failure?
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
What monitoring is required with aldosterone antagonists?
Serum creatine, eGFR and potassium
Patients with HF who cannot tolerate an ACE inhibitor or ARB, may be given what?
Isosorbide dinitrate with hydralazine but this combination may be poorly tolerated
