rps21

Question 1

A 62-year-old man visits his GP for a routine blood test and is found to have a plasma
potassium of 5.9 mmol/L. He was recently admitted to hospital and treated for a non-ST-
elevation myocardial infarction (NSTEMI). He was treated with aspirin, clopidogrel,
atorvastatin, bisoprolol and ramipril. He has a past medical history of congestive heart
failure and is also taking furosemide.
Which one of the following medicines is most likely to have contributed to the
abnormal potassium reading?
Select one:
Aspirin
Bisoprolol
Clopidogrel
Furosemide
Ramipril

Answer 1

Ramipril

Risk of hyperkalaemia with ACE inhibitors

Question 2

A 35-year-old female presents in your pharmacy complaining of a migraine which
started suddenly this morning. She has had a migraine once before but does not
remember what she took to ease the symptoms. She is not taking any regular
medication and has no other medical conditions or allergies. She took 1 g of
paracetamol two hours ago, after breakfast, which has not helped.
What is the most appropriate advice to provide to the patient?
Select one:
It is unlikely to be a migraine as she did not experience an aura beforehand
She can take one ibuprofen 400 mg tablet now to ease the pain
She can take one Imigran (sumatriptan) 50 mg tablet to relieve the migraine as
she has had a migraine before
She can take two yellow Migraleve tablets (paracetamol and codeine) now to
help relieve the pain
She should be referred to her GP for further investigation

Answer 2

Answer: She can take one ibuprofen 400 mg tablet now to ease the pain
Migraine can occur with or without ‘aura’. Patient has had paracetamol two hours ago
therefore cannot suggest Migraleve tablets.
Can’t suggest Imigran as she only has a history of one migraine prior to this.

Question 3

A 60-year-old man is admitted to hospital with chest pain and is initiated on the Acute
Coronary Syndrome (ACS) protocol. He is prescribed aspirin 75 mg daily, clopidogrel 75
mg daily, bisoprolol 2.5 mg daily and ramipril 2.5 mg daily. He has no allergies and no
other past medical history.
On reviewing the drug chart, which one of the following medicines is most
appropriate to initiate?
Select one:
Atorvastatin 80 mg daily
Bendroflumethiazide 2.5 mg daily
Candesartan 4 mg daily
Simvastatin 20 mg once at night
Spironolactone 25 mg once in the morning

Answer 3

Answer: Atorvastatin 80 mg daily
Patients should be given DAPT, beta-blocker, ACE inhibitor, nitrate and statin.
Simvastatin 20 mg only recommended for primary hypercholesterolaemia.
Atorvastatin 40-80 mg for secondary prevention of cardiovascular events

Question 4

You are concerned about side effects she may experience because of treatment with
intravenous hydrocortisone.
Which one of the following is most likely an expected glucocorticoid side-effect
associated with hydrocortisone?
Select one:
Hyperglycaemia
Hypertension
Hypokalaemia
Sodium retention
Water retention

Answer 4

Answer: Hyperglycaemia
Hyperglycaemia/diabetes is a glucocorticoid side effect.
The others are all mineralocorticoid side effects

Question 5

You have been asked to conduct an audit about the administration of medicines on your
hospital ward so that you can identify areas for improvement.
Which of the follow processes is least appropriate to complete as part of an audit
cycle?
Select one:
Analysing the administration of medicines
Collecting data on the administration of medicines
Identifying standards for the administration of medicines
Investigating errors associated with the administration of medicines
Re-auditing the administration of medicines after a 12-month period

Answer 5

Answer: Investigating errors associated with the administration of medicines
Looking for errors is not part of audit/improvement process. This should be more around
identifying topic

Question 6

A 20-year-old woman presents with a skin rash on the face. After questioning you
diagnose the rash as impetigo and tell her she needs to see the doctor for appropriate
treatment. You also advise hygiene measures to help control the spread of the rash.
Which of the following pieces of advice is most appropriate?
Select one:
She should stay away from work until the rash has gone whilst taking antibiotics
She should stay away from work until she has been taking antibiotics for 24 hours
She should stay away from work until she has been taking antibiotics for 48 hours
She should stay away from work until she has completed the course of antibiotics
She does not have to stay away from work whilst she has the rash

Answer 6

Impetigo is contagious and risk mitigation measures are needed. Current advice is 48
hours should elapse after initiation of an antibiotic before returning to work

Question 7

A 68-year-old woman visits the pharmacy with a new prescription for theophylline. She
has been told that she will need to be monitored regularly by her doctor and is
concerned about potential side effects.
Which one of the following is most likely to be a sign of toxicity caused by
theophylline?
Select one:
Diarrhoea
Hyperthermia
Hypoglycaemia
Tachycardia
Wheezing

Answer 7

Tacycardia is the only clear red warning sign

Question 8

An 82-year-old woman is admitted to hospital
with suspected ischaemic stroke. She has
a history of hypertension and
currently taking amlodipine 10mg daily. She has no known
drug allergies.
Which of the following is the most appropriate antiplatelet regime to initiate?
Select one:
Aspirin 75 mg once a day long-term and
clopidogrel 75 mg once a day for 12
months
Aspirin 300 mg immediately plus clopidogrel 300 mg immediately, then aspirin 75
mg once a day long-term and clopidogrel 75 mg once a day long-term
Aspirin 300 mg immediately plus clopidogrel 300 mg
immediately, then aspirin 75
mg once a day long-term and clopidogrel 75 mg once
a day for 12 months
Aspirin 300 mg once a day for 14 days, then
clopidogrel 300 mg once a day long-
term, thereafter
Aspirin 300 mg once a day for 14 days then
clopidogrel 75 mg once a day long-
term, thereafter

Answer 8

Initial treatment with aspirin 300 mg for 14
days. Secondary prevention with clopidogrel
75 mg daily thereafter.

Question 9

According to the General Pharmaceutical Council
(GPhC), revalidation is a process
which helps to show that the trust members of
the public have in pharmacy
professionals, is well placed.
Which one of the following statements is the most accurate in relation to
revalidation?
Select one:
In the first year that you submit revalidation records, you will need to carry out,
record and submit one CPD record
For revalidation you need to carry out, record and submit two CPD records, a
peer discussion record, and a reflective account record
Revalidation submissions are only made when the GPhC call registrants to
submit
Revalidation applies only to pharmacists working in patient facing roles
Revalidation applies to both registered pharmacists and pharmacy technicians

Answer 9

Applies to both registered pharmacists and pharmacy technicians

Question 10

A 28-year-old man presents in the pharmacy
asking for information about the smoking
cessation service.
Which one of the following is most suitable to advise regarding smoking
cessation?
Select one:
A quit date should agreed to keep the patient motivated
A single intervention is better than a combination
Bupropion is first line for smoking cessation
E-cigarettes are licensed for use in smoking cessation
The patient should purchase varenicline for smoking cessation

Answer 10

Quit date should be agreed to keep the patient motivated.

Combination is better than single

Question 11

A 40-year-old man presents in general practice
for his annual medication review. He is
taking finasteride for benign prostatic
hyperplasia
Which of the following pieces of advice is most appropriate to provide this
patient?
Select one:
Continuous lifelong use of finasteride is recommended
Finasteride is contraindicated in patients who smoke
Finasteride is excreted in semen therefore, if sexually active, use of a condom is
recommended
Finasteride is known to benefit patients with a history of depression
The patient requires annual urea and electrolytes monitoring, and blood pressure
checks

Answer 11

Finasteride is excreted in semen therefore, if
sexually active, use of a
condom is recommended

Question 12

A 46-year-old
woman visits the pharmacy and hands you a bag of unused medicine.
She is very
distressed and tells you that there is some morphine in the bag that
belonged
to her late mother.
Which
of the following options with regards to patient returns of morphine is the
most appropriate action to take?
Select one:
A record should be made in the appropriate Controlled Drug register
The destruction of the morphine must be witnessed by another member of staff
The destruction of the morphine should preferably be witnessed by a registered
healthcare professional
The unused morphine can be disposed of in the drug disposal bin
The unused morphine will require destruction by the area Controlled Drugs officer

Answer 12

The
destruction of the morphine should preferably be witnessed by a
registered
healthcare professional
Medication
can be destroyed and denatured by the Responsible Pharmacist. A witness
is preferable not mandatory
and preferably it should be a registered healthcare
professional.
Reference: P104 MEP 2019

Question 13

a 74-year-old man with a history of atrial
fibrillation (AF)
is taking warfarin for the prevention of stroke. His usual
dose is 2 mg daily on Monday to
Friday, and 3 mg daily on Saturday and Sunday.
He has no known drug allergies.
Which of the following is the most appropriate
target international normalised
ratio (INR) range for the patient?
Select one:
1.0 – 2.0
1.5 – 2.5
2.0 – 3.0
2.5 – 3.5
3.0 – 4.

Answer 13

AF target is 2.0-3.0

Question 14

At his next clinic appointment, the patient’s
international normalised ratio (INR) is
unexpectedly outside of the normal
range. There have been no changes to his diet and
no concerns of adherence.
However, he has been initiated on a recent course of
antibiotics.
Which of the following effects is most likely to occur in relation to antibiotics and
warfarin?
Select one:
-Clarithromycin decreases the anticoagulant effect of warfarin
-Doxycycline decreases the anticoagulant effect of warfarin
-Erythromycin decreases the anticoagulant effect of warfarin
-Metronidazole increases the anticoagulant effect of warfarin
- Rifampicin increases the anticoagulant effect of warfarin

Answer 14

Answer: Metronidazole increases the anticoagulant effect of warfarin
Rifampicin decreases anticoagulant effect. Clarithromycin, doxycycline, erythromycin
and metronidazole increase anticoagulant effect.

Question 15

A 69-year-old woman comes into your pharmacy to complain that she is suffering from
constipation. She has a range of chronic conditions and takes a number of prescribed
medicines and believes that one of them may have caused this adverse effect.
Which one of the following medicines has most likely caused this adverse effect?
Select one:
Amlodipine
Metformin
Oxybutynin
Paracetamol
Vitamin D

Answer 15

Oxybutynin

Question 16

You have diagnosed headlice in a 6-year-old girl and are deciding upon the most
appropriate course of action. Her mother tells you that her daughter has epilepsy and
asthma.
Which of the following medicines would be most suitable for treating headlice?
Select one:
Dimeticone lotion
Dry combing
Electrical comb
Isopropyl myristate and isopropyl alcohol aerosol
Permethrin cream

Answer 16

Dimeticone lotion is the most effective

Question 17

A 33-year-old man patient presents in your pharmacy asking to buy some medication to
treat heartburn. You confirm he has no red-flag symptoms, and you are satisfied it is
safe to recommend a medication for this patient to buy.
He has no known drug allergies, takes no other medication, and has tried a proton
pump inhibitor (PPI) previously which worked to treat symptoms.
Which one of the following medicines and dosage is most appropriate to supply
over the counter to the patient?
Select one:
Lansoprazole 15 mg capsules at a maximum dose of 15 mg once a day for four
weeks
Lansoprazole 15 mg capsules at a maximum dose of 30 mg once a day for four
weeks
Omeprazole 10 mg capsules at a maximum dose of 10 mg once a day for four
weeks
Omeprazole 10 mg capsules at a maximum dose of 20 mg once a day for four
weeks
Omeprazole 20 mg capsules at a maximum dose of 20 mg once a day for four
weeks

Answer 17

Omeprazole 10 mg capsules at a maximum dose of 20 mg once a day for
four weeks
Only preparation able to be sold OTC, so has to be C or D. Maximum dose is D.

Question 18

You receive a private prescription for a controlled drug and note that the prescriber is
based outside the UK.
Which of the following controlled drugs can legally be supplied on this
prescription?
Select one:
Codeine
Ketamine
Morphine
Oxycodone
Pethidine

Answer 18

Codiene
B-E are Schedule 2. A is Schedule 5. The address of prescriber is required to be within
the UK for Schedule 2 drug but not for Schedule 5

Question 19

A father of a 10-year-old girl with a diagnosis of epilepsy visits your pharmacy to collect
a prescription for buccal midazolam. He would like some advice on how to administer
the medicine.
Which one of the following is most likely to be included in your advice?
Select one:
Shake the syringe before administration
Starting a ketogenic diet may help prevent seizures
Store in the fridge to help keep the medication stable
The dose can be re-administered if the patient vomits
Wait five minutes before administering as the seizure may stop on its own

Answer 19

Wait five minutes before administering as the seizure may stop on its
own
A - Does not need to be shaken
B - May have some evidence supporting this but this is a very burdensome diet,
especially for a child
C - Does not need to be stored in the fridge
D - The medicine is administered buccally so this would mean that an extra dose has
been given. If the patient vomits while having a seizure you would recommend calling
an ambulance
E - Correct option

Question 20

You have started work in the medicine information department at your local hospital. You
have received a query about biosimilar medicines.
Which of the following statements is the most accurate description of a biosimilar
medicine?
Select one:
A biosimilar is a medicine developed to treat a similar disease category as the
original product
A biologic medicine that is similar to an already licensed biologic medicine in
terms of quality, safety and efficacy
A biologic medicine that is similar to an unlicensed biologic medicine in terms of
quality
A biologic medicine that is similar to an unlicensed biologic medicine in terms of
safety
A biologic medicine that is similar to an unlicensed biologic medicine in terms of
safety and efficacy

Answer 20

A biologic medicine that is similar to an already licensed biologic
medicine in terms of quality, safety and efficacy

Question 21

A 45-year-old man, weighing 65 kg, is started on gentamicin intravenously 325 mg daily.
His pre-dose plasma concentration is checked on day three and found to be 5 mg/L.
Which one of the following is most likely an adverse effect associated with
gentamicin toxicity?
Select one:
Agranulocytosis
Myopathy
Ototoxicity
Tachycardia
Visual disturbances

Answer 21

Ototoxicity

Question 22

Your pharmacy dispensing technician is confused about record keeping requirements
for the supply of medicines and asks you about situations where records are legally
required and not required.
Which of the following scenarios does not require an entry to be made in the
prescription only medication (POM) register?
Select one:
You make an emergency supply of metformin tablets at the request of a doctor
You make an emergency supply of a salbutamol inhaler at the request of a
patient
You make a supply of amlodipine tablets prescribed on a veterinary prescription
You make a supply of morphine tablets prescribed on an NHS prescription
You make a supply of salbutamol inhalers requested
on a written order signed by
the principal or head teacher

Answer 22

You make a supply of morphine tablets prescribed on an NHS
prescription

Question 23

A father brings his 8-month-old daughter into the pharmacy and would like some advice.
She has been experiencing a dry cough that tends to be worse at night. He says she
has a barking cough, takes a gasp for breath between coughs and seems to have noisy
breathing.
Which one of the following conditions is most likely to be associated with the
presenting symptoms?
Select one:
Asthma
Bacterial upper respiratory tract infection
Bronchitis
Croup
Pertussis

Answer 23

Croup
Upper Respiratory Tract Infection associated with cold-like symptoms and fever; Asthma
unlikely in an 8-month-old and pertussis associated with congestion and vomiting

Question 24

A 52-year-old man has visited your pharmacy to obtain codeine liquid, as advised by his
GP, for a cough. He has been advised to take 15 mg three times a day for two weeks,
and then see his GP again for review.
Codeine linctus is available over the counter in the strength 15 mg/5 mL, in 200 mL
bottles.
How many millilitres of codeine linctus 15 mg/5 mL should you supply the patient
for a course of 14 days treatment?
Select one:
150 mL
200 mL
250 mL
300 mL
400 mL

Answer 24

5 mL x 3 x 14 = 210 mL.
200ml is closest bottle size
You can’t pack down OTC medicines and 400 mL is too much

Question 25

A 32-year-old woman presents to your GP clinic to discuss her medication. She is a primary school teacher and is keen to ensure her long-term condition is managed to prevent sick leave. Her current medication is: Desogestrel tablets, one to be taken once a day Beclometasone (Clenil) 200 micrograms inhaler one puff twice a day Salbutamol 100 micrograms inhaler, one to two puffs up to four times a day Which of the following scenarios regarding asthma is most appropriate to refer to a GP? Select one: The patient feels breathless usually after strenuous exercise The patient has noticed a cough at night causing waking The patient informs you she has noticed white spots in her mouth since the initiation of her beclometasone (Clenil) inhaler The patient is using her short acting beta agonist (SABA) twice a week The patient thinks she may not be using her preventative inhaler correctly

Answer 25

The patient has noticed a cough at night causing waking

Question 26

A regular patient comes in and asks for advice regarding their pet. They explain that they have run out of repeat medication for their cat and would like some more. They show you an empty bottle hypromellose eye drops that they administer to their cat. Which of the following actions is most appropriate to take in response to the request? Select one: Sell the hypromellose eye drops and advise the patient to continue the treatment until the symptoms have eased in their cat Sell the hypromellose eye drops and advise the patient to phone the vet to confirm how long to use the medicine for You refuse the supply and advise the patient to contact the vet for a further supply of hypromellose eye drops You supply hypromellose eye drops as an emergency supply and make a record of this on your patient medication record (PMR) You supply hypromellose eye drops as an eme

Answer 26

You refuse the supply and advise the patient to contact the vet for a further supply of hypromellose eye drops Can’t provide an emergency supply. Dose in adults is not equivalent to in humans. Licensing of OTC products is for humans. There are specific labelling requirements for veterinary products when the prepared medicine is for animal use, which has been prescribed by a veterinary practitioner under the cascade

Question 27

30-year-old woman sees her GP with symptoms of a urinary tract infection (UTI) and has started on empirical therapy. She weighs 60 kg, has an allergy to penicillin causing a rash, and is not taking any regular medication. A midstream specimen of urine (MSU) sample has been sent to microbiology. Which bacterial organism is the most likely cause of the urinary tract infection (UTI)? Select one: Chlamydia trachomatis Escherichia coli Haemophilus influenza Staphylococcus aureus Streptococcus pneumonia

Answer 27

Escherichia coli UTIs are predominantly caused by bacteria from the gastrointestinal tract entering the urinary tract, with Escherichia coli being the most common cause

Question 28

The GP would like to prescribe the patient with some antibiotics for initial empirical treatment of the UTI. Which following antibiotics is the most appropriate treatment choice for this patient? Select one: Amoxicillin 500 mg three times a day for five days Co-amoxiclav 625 mg three times a day for five days Gentamicin 300 mg once a day for three days Metronidazole 400 mg three times for three days Nitrofurantoin 50 mg four times a day for three days

Answer 28

Nitrofurantoin 50 mg four times a day for three days Nitrofurantoin (or trimethoprim) are oral first line options. Amoxicillin only to be used if culture sensitivities (also not appropriate due to patient’s allergy status)

Question 29

Responsible Pharmacist (RP) regulations mean that the owner of a retail pharmacy business must appoint an RP to be in charge of the registered pharmacy. You are discussing the regulations with your pre-registration trainee pharmacist to help them with their revision. Which one of the following statements is the most accurate in relation to the RP regulations? Select one: RP can only be the RP for one pharmacy at any given time The pharmacy record detailing the RP information must be kept for a period of three years The RP may be absent for a maximum of four hours in the pharmacies business hours The RP only needs to display the RP notice when they are absent The sale of GSL medicines does not require a RP to be in charge of the pharmacy

Answer 29

RP can only be the RP for one pharmacy at any given time Pharmacy record needs to be kept for 5 years RPS absent for max 2 hours Sale of GSL medicines do need an RP to be in charge RP needs to display a notice whilst RP

Question 30

A mother presents in the pharmacy with her 6-month-old son asking for advice on a rash he has recently developed. She says the rash is primarily on the buttocks but has spread to the creases inside his thighs. You diagnose nappy rash caused by a candida infection. Which medicine would be most appropriate to supply in this situation? Select one: Canesten bifonazole cream (bifonazole 1%) Canesten cream (clotrimazole 1%) Daktarin Activ cream (miconazole 2%) Eurax cream (crotamiton 10%) Lamisil cream (terbinafine 1%)

Answer 30

Only canister cream (clotrimazole 1%) is licensed for nappy rash

Question 31

A 16-year-old patient visits your pharmacy asking for advice. She has been taking chlorphenamine tablets for allergic rhinitis which she suffers from every year through the summer, however, they make her extremely drowsy, so she has stopped taking them. She would like to purchase an alternative medicine over the counter for her allergic rhinitis to avoid the drowsiness she is currently experiencing. What is the most appropriate product to provide the patient? Select one: Beclomethasone 50 mcg nasal spray Cetirizine 10 mg tablets Loratadine 10 mg tablets Sodium cromoglycate eye drops Sterimar nasal spray

Answer 31

Loratadine 10 mg tablets C causes less drowsiness than Cetirizine and patient is an appropriate age to be >30 kg. A. Beclometasone nasal spray is only available from 18 years and over. D. Her symptoms do not include her eyes as a priority, so these drops are not needed. E. Sterimar may help to give temporary relief to the sinuses but she is looking for an alternative to her current antihistamine

Question 32

A 24-year-old woman would like to discuss her prescription with you. She informs you that she was recently diagnosed with a urinary tract infection by her GP and was provided with a prescription that she collected three days ago from the pharmacy. She has noticed her urine has changed to a brownish colour since taking the medication. Which one of the following medicines is the most likely cause of urine discolouration? Select one: Amoxicillin Cefalexin Nitrofurantoin Pivmecillinam Trimethoprim

Answer 32

Nitro can discolour the urine

Question 33

You have received a prescription for a schedule 2 Controlled Drug (CD) and have supplied it to a patient. You record the supply in the appropriate CD register. Which of the following is a professional and legal requirement with regards to CD register records? Select one: A running balance is mandatory to be recorded in the CD register CD stock balance checks must be completed once a week on the same day each week Electronic CD registers may allow entries to be amended at a later date Electronic CD registers should be kept for two years from the date of the last entry Written CD registers must be maintained alongside electronic registers at the premises

Answer 33

Electronic CD registers should be kept for two years from the date of the last entry Don’t need to have both written and electronic. Registers shouldn’t be amendable at a later date. For most organisations stock checks should be at least once a week but may be more or less frequent based on risk. Registers should be kept 2 years from the date of the last entry. Running balance is good practice not yet mandatory.

Question 34

You are reviewing medication for a 74-year-old man with dementia. He is being treated in hospital as he has recently deteriorated and is often confused. You are calculating the Anticholinergic Cognitive Burden (ACB) score. Which of the following medicines has the most significant contribution to the patient’s anticholinergic burden? Select one: Aspirin Donepezil Oxybutynin Ranitidine Simvastatin

Answer 34

This can also be worked out through knowing the pharmacology of each of the above Oxybutinin is an antimuscarinic drug and has the most significant contribution A - No relevant mechanism B - treats dementia – acetylcholine esterase inhibitor -> inhibits enzyme that breaks down acetylcholine -> cholinergic stimulation Although quetiapine and ranitidine also contribute - this is not as significant as oxybutynin

Question 35

54-year-old man visits his GP, complaining of increasing frequency of urination at night and excessive thirst. His GP checks his blood glucose levels and HbA1c (glycated haemoglobin). Which of the following would most likely lead to suspected diagnosis of type 2 diabetes? Select one: HbA1c of 44 mmol/mol and fasting plasma glucose of 5.0 mmol/L HbA1c of 44 mmol/mol and random plasma glucose of 7.0 mmol/L HbA1c of 46 mmol/mol and random plasma glucose of 10.0 mmol/L HbA1c of 48 mmol/mol and fasting plasma glucose of 5.0 mmol/L HbA1c of 48 mmol/mol and random plasma glucose of 12.0 mmol/L

Answer 35

Based on HbA1c of 48 mmol/mol (6.5%) or more, fasting plasma glucose level of 7.0 mmol/L or more or random plasma glucose of 11.1 mmol/L or more in the presence of symptoms or signs of diabetes

Question 36

The patient is provided with dietary and lifestyle advice and initiated on a new medicine. He brings in a prescription to the pharmacy for metformin 500 mg once a day. Which of the following counselling points regarding metformin is most appropriate to provide the patient? Select one: Gliclazide is associated with a lower risk of hypoglycaemia compared to metformin Hypoglycaemia commonly occurs with metformin use Metformin can cause weight gain and is usually prescribed if symptoms persist despite adequate attempts at dieting and weight loss Metformin exerts its effect mainly by increasing gluconeogenesis in the liver Metformin is only effective in the presence of insulin

Answer 36

Metformin exerts its effect mainly by decreasing gluconeogenesis and by increasing peripheral utilisation of glucose; since it acts only in the presence of endogenous insulin it is effective only if there are some residual functioning pancreatic islet cells

Question 37

Which one of his medications is most likely to have contributed to the abnormal result of low potassium? Select one: Amitriptyline Amoxicillin Bumetanide Co-codamol Paracetamol

Answer 37

bumentanide is a loop diuretic, therefore hypokalaemia can occur

Question 38

A mother presents at the pharmacy to purchase some lactulose over the counter for her 3-year-old son, as recommended by her GP. The child takes lactulose regularly and is taking 5 mL twice a day. How many bottles of 200 mL lactulose is most appropriate to supply for 28 days of treatment? Select one: 0.5 bottle 1 bottle 2 bottles 3 bottles 4 bottles

Answer 38

5 mLs x 2 = 10 mL per day. 10 x 28 = 280 mL for 28 days. Not appropriate to split bottles for OTC purchase, and long-term treatment so supply 2 bottles.

Question 39

A 29-year-old man recently presented to his GP due to episodic bouts of diarrhoea. He also experienced flatulence, abdominal cramps, and bloating. He was diagnosed with irritable bowel syndrome (IBS). He was prescribed medicines to help relieve his long term IBS symptoms. Which one of the following medicines is most likely to have been prescribed for the presenting symptoms? Select one: Fybogel sachets, one to be taken once daily Laxido sachets, one to be taken once daily Loperamide 2 mg capsules, one to two to be taken as required Mebeverine 135 mg tablets, one to be taken three times a day Mefenamic acid 500 mg tablets, once to be taken three times a day

Answer 39

Mebeverine 135 mg tablets, one to be taken three times a day. For symptomatic relief of IBS symptoms- loperamide could be given however question asks re long term symptomatic management

Question 40

A patient comes into the pharmacy as they have run out of nifidipine 10 mg tablets. You check their record and determine that it is appropriate for you to provide an emergency supply of the medicine. Which of the following is the most appropriate action to take with regards to the supply? Select one: You can give a full two months supply of medication You can lend the medicine to the patient and deduct the quantity from their next prescription You must give 28-day supply of medication You must give five days supply of medication You need to make a record of the form of the medication supplied

Answer 40

Answer: You need to make a record of the form of the medication supplied Lending medication would be very difficult to justify if an emergency supply could have been used. See P18 MEP See requirements of recording and general requirements of Emergency supply at request of patient, P58 or MEP You cannot supply more than 30 days treatment. Reference: P18 and P58 MEP

Question 41

A 43-year-old woman presents to your pharmacy complaining of pins and needles in her feet. She tells you that she has recently been very fatigued and has not had the energy to complete daily tasks. Alongside this, she has had a low mood for the past few weeks. She tells you that she has a good vegetarian diet, although her recent mouth ulcers have made eating a little more difficult. Which one of the following tests are you most likely to advise? Select one: C reactive protein Ferritin Mean cell volume Platelets Vitamin B12

Answer 41

Vitamin B12 Symptoms highlighted indicate b12 deficiency- also indicated by vegetarian diet

Question 42

You suspect a man in your pharmacy is experiencing a hypoglycaemic episode. He is sweaty, feeling dizzy but is conscious and responsive. He is 45 years old. Which of the following would be the most appropriate management of his hypoglycaemia? Select one: 1 mg glucagon injection 2 glucose tablets 20 g of sugar dissolved in water 100 mL of pure fruit juice 200 mL of diet coke

Answer 42

20 g of sugar dissolved in water 15–20 g (3–4 heaped teaspoonfuls of sugar dissolved in water, or 150–200 mL pure fruit juice, or 4–7 glucose tablets) repeated after 10–15 minutes if necessary Glucagon only used if patient unresponsive/no oral rout

Question 43

You are the responsible pharmacist at a community pharmacy. A 24-year-old patient visits your pharmacy and complains that they have been given the wrong medication. Upon further investigation you find the prescription and notice that the incorrect medicine was supplied the previous day when another pharmacist was on duty as the responsible pharmacist. Which of the following is the most appropriate initial actions to take? Select one: Apologise for the error made and make a correct supply of the medicine Ask the patient to come back when the regular pharmacist is in as they need to know about the error Explain that the error is not very serious, so the patient does not complain further Find out who made the error and escalate the issue to senior colleagues Never apologise, as this is an admission of guilt

Answer 43

Apologise for the error made and make a correct supply of the medicine

Question 44

A 24-year-old man asks to buy the new POM to P antihistamine, fexofenadine (Allevia) to treat his hay fever. You find out he is taking an antibiotic for sinusitis, but he cannot remember the name of the antibiotic. Which antibiotic should most likely be avoided when taking fexofenadine? Select one: Amoxicillin Cefalexin Doxycycline Erythromycin Flucloxacillin

Answer 44

Erythromycin - co-administation has been found to result in 2-3 times increase in the level of fexofenadine

Question 45

You are delivering training to the healthcare assistants that work with you in your community pharmacy. The training is regarding medication for constipation, and you discuss the use of senna tablets. Which one of the following statements regarding senna is most appropriate to advise the healthcare assistants? Select one: Senna can be used in patients with intestinal obstruction Senna is safe in pregnancy however needs to be prescribed Senna is the first line treatment for constipation when treating over the counter Senna tablets are licensed for use in adults and children over 2 years old Senna tablets can be sold for anyone over 12 years old over the counter

Answer 45

E is only true option. C/I in obstruction, 3rd line for medication treatment, is safe in pregnancy, and licensed as POM > 6 years old. The focus of this question is about a supply over the counter as you are training a healthcare assistant, therefore clinical cautions and legal restrictions need to be considered. Also healthcare assistants need to know that it is safe in pregnancy but the patient would need a prescription. It would be part of their role to refuse a supply and direct the patient to a GP.

Question 46

A 32-year-old woman is currently eight weeks pregnant. She has been advised by her midwife to take the higher dose of folic acid, 5 mg tablets once a day, for the first 12 weeks of her pregnancy. She has no known allergies. Which of the following is the most likely reason for the higher dose folic acid? Select one: Patient’s first pregnancy Patient had a low body mass index prior to pregnancy Patient has iron deficiency anaemia Patient is a diabetic Patient takes low dose antibiotics for urinary tract infection prevention

Answer 46

Patient is a diabetic Higher dose recommended for those with history of neural tube defects, diabetic, overweight, antiepileptic medication / antiviral for HIV prescribed

Question 47

A 37-year-old woman is booked in for a routine medication review. Upon reviewing her notes, you notice she was prescribed subcutaneous methotrexate 20 mg once weekly by the outpatient hospital team. Which one of the following is the most appropriate advice to provide the patient about folic acid? Select one: Folic acid 400 microgram tablets is usually prescribed for those patients using subcutaneous methotrexate Folic acid 5 mg tablets are not required as the patient is prescribed subcutaneous methotrexate rather than oral methotrexate Folic acid 5 mg tablets should be taken once a day every day Folic acid 5 mg tablets should be taken on the same day as taking methotrexate Folic acid 5 mg tablets to be taken daily except on the day of taking methotrexate

Answer 47

Folic acid 5mg tablets to be taken daily except on the day of taking methotrexate Same clinical rationale if patient were to be prescribed oral methotrexate – to continue with folic acid apart from on the day of taking methotrexate

Question 48

You are reviewing an NHS prescription for a new patient who has not visited your pharmacy before. You notice the prescription does not legally meet prescription requirements. The item is for aciclovir 200 mg. The prescription is dated 2 April 2021. Which of the following details makes the prescription legally invalid? Select one: The prescription does not specify the formulation of the medicine The prescription does not specify the particulars of the prescriber The prescription does not specify the patient’s date of birth The prescription does not specify the patient’s middle name The prescription does not specify the quantity of the medicine to supply

Answer 48

No particulars

Question 49

A 19-year-old woman presents to your pharmacy with a prescription for ferrous sulfate tablets 200 mg to be taken three times a day. She is worried about the potential side effects that she may experience and would like some advice on the medicine. Which of the following is the most appropriate counselling point for the use of ferrous sulfate? Select one: Crush the tablets and mix in yoghurt to aid palatability Go to accident and emergency if stools are discoloured Magnesium hydroxide is a useful laxative to alleviate constipation Stop taking the medicine if constipation occurs Take the medicine after food to help reduce gastrointestinal side effects

Answer 49

A - ascorbic acid improves absorption B - Normal side effect- expected and not always harmful C - Magnesium hydroxide may impair absorption of ferrous sulfate - avoid due to interaction D - normal side effect – can take laxatives or increase fiber instead E - Correct - taking after food may help to reduce GIT side effects

Question 50

A 38-year-old man is started on treatment for tuberculosis. He has been prescribed rifampicin, ethambutol, pyrazinamide, isoniazid, and pyridoxine. What is the most likely reason to prescribe pyridoxine as part of this regimen? Select one: To correct B12 deficiency To improve absorption of isoniazid To improve efficacy of rifampicin To prevent drug induced peripheral neuropathy To reduce side effects of pyrazinamide

Answer 50

Pyridoxine should be given alongside isoniazid to prevent neuropathy

Question 51

Some Controlled Drug (CD) medicines legally need to be stored under safe custody. You are training a pre-registration pharmacist who wants to know more about CDs and safe custody requirements. Which one of the following medicines does not need to be kept under safe custody? Select one: Buccolam (midazolam)10 mg/2 mL oromucosal solution MST Continus (morphine sulfate) 10 mg tablets Oramorph (morphine sulfate) 20 mg/mL concentrated oral solution Oxycontin (oxycodone hydrochloride) 10 mg prolonged release tablets Temazepam 10 mg tablets

Answer 51

Temazepam schedule 3 – not exempt from safe custody B,C,D - Schedule 2 therefore require safe custody A (midazolam) Schedule 3 - exempt from safe custody

Question 52

A father brings his 3-year-old child into the pharmacy. The child’s symptom of perianal night-time itching leads you to conclude that he has threadworm. Which one of the following is the most appropriate course of action? Select one: Do not supply mebendazole as he is too young and provide hygiene advice instead Supply mebendazole as a single dose to the child only Supply mebendazole as two doses, at a 14-day interval to the child only Supply mebendazole to all family members as a one-off dose Supply mebendazole to the whole family, followed by a repeat dose after 14 day

Answer 52

Supply mebendazole to the whole family, followed by a repeat dose after 14 days Mebendazole is drug of choice to people over the aged of two. It is recommended that all family members should be treated and a repeated dose should be given

Question 53

A 15-year-old girl has been given a prescription by her GP for H. pylori eradication therapy. She has no known drug allergies and takes no other medication. Which one of the following options is most appropriate as first line treatment? Select one: Amoxicillin 1 g three times a day, clarithromycin 500 mg twice a day, and a PPI for 7 days Amoxicillin 1 g twice a day, clarithromycin 500 mg twice a day, and a PPI for 7 days Amoxicillin 1 g twice a day, clarithromycin 500 mg twice a day, and a PPI for 14 days Clarithromycin 500 mg twice a day, metronidazole 400 mg twice a day, and a PPI for 7 days Clarithromycin 500mg twice a day, metronidazole 400 mg twice a day, and a PPI for 14 days

Answer 53

Amoxicillin 1 g twice a day, clarithromycin 500 mg twice a day, and a PPI for 7 days A, C, E – wrong doses/durations of medication D – for penicillin allergic patients. She is not penicillin allergic

Question 54

A 25-year-old woman is taking the combined oral contraceptive pill and enquires about how frequently she should go undergo routine cervical screening. She has no known medical conditions and is not taking any other medicines. Which of the following is the most appropriate f frequency at which routine cervical screening should be undertaken? Select one: Every 1 year Every 2 years Every 3 years Every 4 years Every 5 years

Answer 54

Every 3 years Women aged 24.5 years should receive their first invitation to ensure they can be screened before they are aged 25 years. Those who are 25–49 years should be offered screening every 3 years. Women who are 50–64 years should be offered screening every 5 years.

Question 55

A 46-year-old patient with a history of epilepsy is admitted with sepsis of unknown origin. The consultant wishes to initiate broad-spectrum antibiotics. Which of the following medicines is most likely to be contraindicated? Select one: Amoxicillin Ceftriaxone Ciprofloxacin Clindamycin Piperacillin -Tazobactam

Answer 55

Answer: Ceftriaxone Ciprofloxacin lowers seizure threshold

Question 56

An 8-year-old boy requires treatment with antibiotics for a chest infection. He has a history of asthma and an allergy to penicillin. His drug history includes salbutamol 100 mcg inhaler two puffs as required, and beclometasone (Qvar) 50 mcg one puff twice daily. Which one of the following antibiotics would be most appropriate to treat the patient’s chest infection? Select one: Amoxicillin Azithromycin Ciprofloxacin Co-amoxiclav Doxycycline

Answer 56

Azithromycin Amoxicillin and co-amoxiclav is not appropriate due to allergy Doxycycline – deposits in bones/teeth so not ideal for children

Question 57

A 17-year-old girl comes into the pharmacy presenting with small red pustules on the face which are tender to touch. You believe she has mild acne. Which one of the following is most appropriate to be recommended over the counter as treatment for her symptoms? Select one: Azelaic acid 20% cream Benzoyl peroxide 5% gel Benzoyl peroxide 10%, potassium hydroxyquinoline 5% cream Hydrocortisone 1% ointment Nicotinamide 4% gel

Answer 57

B

Question 58

A patient has attended your pharmacy to purchase treatment over the counter for mouth ulcers. He has no known drug allergies and takes methotrexate and folic acid for rheumatoid arthritis. There is no recent trauma to the mouth, and the patient has been well with no other concerns. Which one of the following is the most appropriate advice to provide with regards to his mouth ulcers? Select one: Mouth ulcers can be a side effect of folic acid and are not cause for concern Mouth ulcers can be a side effect of folic acid and are treatable over the counter Mouth ulcers can be a side effect of methotrexate and are not cause for concern Mouth ulcers can be a side effect of methotrexate and are treatable over the counter Mouth ulcers can be a sign of methotrexate toxicity and this patient needs to be referred to their doctor immediatel

Answer 58

Mouth ulcers can be a sign of methotrexate toxicity and this patient needs to be referred to their doctor immediately

Question 59

A 2-year-old boy has been suffering with hay fever symptoms. His mother would like to purchase some medicine from the pharmacy to control his symptoms. Which one of the following medicines and doses would be most appropriate for the patient? Select one: Beclometasone nasal spray 50 mcg (50 mcg) two puffs twice a day Cetirizine oral solution 2.5 mL (2.5 mg) twice a day Chlorphenamine oral solution 5 mL (2 mg) four times a day Loratadine oral solution 10 mL (10 mg) daily Pseudoephedrine 5 mL (30 mg) three times a day

Answer 59

Cetirizine oral solution 2.5 mL (2.5 mg) daily A, C to E are appropriate doses but for children older than 2 years of age

Question 60

You are working alongside a commissioning pharmacist to improve patient health outcomes in your local area. You have been asked to present to the local healthcare professionals in your area about the importance of primary prevention in cardiovascular disease (CVD). Which one of the following statements regarding primary prevention is most accurate? Select one: Aspirin is recommended in the primary prevention of CVD Consider a risk assessment in patients with a CVD 10-year risk of 10 % or more QRISK2 is the only CVD risk calculator currently available The risk of CVD is lower in certain ethnic backgrounds such as South Asian Total cholesterol, HDL-cholesterol, and non-HDL-cholesterol concentrations should be checked six months after starting treatment with a high-intensity statin

Answer 60

Consider a risk assessment in patients with a CVD 10-year risk of 10 % or more

Question 61

A patient was admitted into hospital for a coronary bypass surgery. A parenteral nutrition bag was mistaken for a cardioplegic solution for the coronary bypass surgery resulting in a significant medication error. Following this medication error, the hospital pharmacy conducted a root cause analysis. Which of the following is the most appropriate action regarding a root cause analysis in this case? Select one: A root cause analysis is inappropriate to be used in this case A root cause analysis should be used to confirm that a medication error has taken place A root cause analysis should be used to identify all factors that could have contributed to this error for analysis A root cause analysis should be used to identify the pharmacist who made the error A root cause analysis should be used for indemnity insurance purposes

Answer 61

A root cause analysis is used to identify all factors that could have contributed to this error for analysis A root cause analysis is not intended to focus on blame but on all factors that could have been related to this error and therefore prevented by better systems. Factors might include training of pharmacist and technicians, the label etc. Reference: NHS Improvement https://www.england.nhs.uk/w

Question 62

A midwife calls the pharmacy about a 32-year-old woman, who is five months pregnant and has a BMI of 40. She requires further information about pain relief during labour. Which of the following is most likely to be used for acute labour pain? Select one: Codeine Fentanyl Levobupivacaine Morphine Tramadol

Answer 62

Levobuprivacine is indicated for acute labour pain. The other options are not

Question 63

A 65-year-old, black-African man, with persistent stage 2 hypertension, needs to be initiated on hypertension treatment. He has no known drug allergies and currently takes metformin 500 mg three times a day. Which of the following antihypertensive medicines would be most appropriate to initiate? Select one: Amlodipine Candesartan Indapamide Nifedipine Ramipril

Answer 63

As the patient is diabetic (on metformin) ACEIs and ARBs are first line - irrespective of age (see the NICE guidelines and flow chart). B or E are also suitable options, however ARBs are preferred over ACEIs due to the patient's ethnicity, therefore B is the single best answer.

Question 64

A 46-year-old man presents with a rash around his wrists that is raised and shows fine white streaks on their surface. You suspect lichen planus. He is taking medicines for hypertension. Which of the following medicines is most likely to cause symptoms similar to lichen planus? Select one: Atenolol Atorvastatin Bendroflumethiazide Losartan Nifedipine

Answer 64

Bendroflumethiazide Rash is possible with all but a lichenoid drug eruption has been reported with thiazide diuretics

Question 65

A 37-year-old woman presents at your pharmacy to purchase pseudoephedrine to control symptoms of nasal congestion. She has a medical history of hypertension and heart disease, and get dialysis three times a week for end stage renal disease. Which of the following statements regarding pseudoephedrine is most appropriate to provide to the patient? Select one: A maximum of 720 mg of pseudoephedrine can be sold at any one time, but is not suitable for this patient A product containing pseudoephedrine and a product containing ephedrine can be purchased over the counter at the same time Pseudoephedrine can be used in patients with heart disease without concern Pseudoephedrine can be used in patients with severe renal impairment without concern Women who are pregnant or breastfeeding can buy and take pseudoephedrine over the counter

Answer 65

A maximum of 720 mg of pseudoephedrine can be sold at any one time, but is not suitable for this patient

Question 66

An 81-year-old woman brings in a prescription for her 82-year-old husband who has dementia. He has been prescribed donepezil 5 mg tablets, to be taken once a day. Which one of the following statements regarding donepezil is most accurate? Select one: Aggression is a common side effect of donepezil Caution when prescribing in the elderly is not required for donepezil Donepezil is not indicated for dementia in Alzheimer’s disease Donepezil should be used with caution in renal impairment The dose of donepezil usually starts at 10 mg to be taken once a day

Answer 66

Aggression is a common side effect of donepezil Dose usually starts at 5 mg, prescribe cautiously in elderly, no renal restrictions (as per BNF and manufacturer)

Question 67

You are reviewing an NHS prescription for methadone. It is coming up to a Bank Holiday and the pharmacy will be closed. You need to ensure that the prescription contains appropriate approved wording for you to make a supply to cover the closed days. Which of the following is the most appropriate wording for supplying methadone on closed days? Select one: Please dispense instalments due on Bank Holiday on the day prior to this Please dispense instalments due on closed days on the day prior to this Please dispense instalments due on pharmacy closed days on the next suitable day Please dispense instalments due on pharmacy closed days on a prior suitable day Please dispense instalments in advance for closed days and the Bank Holiday

Answer 67

lease dispense instalments due on pharmacy closed days on a prior suitable day

Question 68

A 74-year-old man is taking methotrexate 20 mg once a week for his psoriasis. He has recently been experiencing abdominal pain and his urine is a dark colour. Which of the following investigations is the most appropriate for this patient? Select one: Chest x-ray Inflammatory markers Liver function tests Neurological examination Urea and electrolytes

Answer 68

Dark urine is attributed to liver disease - LFTs

Question 69

A 65-year-old Caucasian man experiences swelling and pain in his right foot. His GP assesses the patient and diagnoses him with an acute flare of gout and initiates the patient on colchicine. He has a past medical history of hypertension, gout, and benign prostatic hyperplasia. His repeat medicines include amlodipine, ramipril, allopurinol, indapamide, and tamsulosin. Which one of his medicines most likely contributed to the exacerbation of gout? Select one: Allopurinol Amlodipine Indapamide Ramipril Tamsulosin

Answer 69

Indapamide Thiazides and related diuretics can exacerbate diabetes, and gout

Question 70

You have received a delivery of temazepam from your pharmacy wholesaler in your hospital pharmacy. Which of the following record keeping requirements is most appropriate for temazepam? Select one: A running balance of temazepam must be recorded in the Controlled Drugs register Invoices for temazepam do not need to be retained Invoices for temazepam need to be retained for five years Invoices for temazepam need to be retained for two years The receipt of temazepam must be recorded in the Controlled Drugs register

Answer 70

Invoices for temazepam need to be retained for two years Temazepam is a Schedule 3 drug therefore is exempt from certain record keeping requirements required for other schedules of controlled drugs. Some hospitals will record temazepam in their CD register, but this is not a legal requirement.

Question 71

An 84-year-old man is initiated on co-careldopa after being referred to a specialist hospital outpatient clinic, presenting with hypokinesia and rigidity. Which of the following drugs is most appropriate to be prescribed for the management of nausea or vomiting, associated with co-careldopa use? Select one: Domperidone Haloperidol Levomepromazine Metoclopramide Prochlorperazine

Answer 71

Domperidone All others are CI or cautioned in Parkinson as they can exacerbate symptoms

Question 72

A 3-year-old girl is prescribed aspirin as an antiplatelet following cardiac surgery to prevent thrombus formation. You check the BNF, and confirm the dose is correct and it is listed as appropriate to prescribe. Which of the following is statements regarding aspirin in paediatric patients is most accurate? Select one: Aspirin is licensed for use in under 16-year olds Aspirin is safe to prescribe in previous history of hypersensitivity to NSAID Aspirin is safe to use in asthmatic patients Manufacturer states avoid aspirin in under 16-year olds due to risk of Kawasaki disease Manufacturer states avoid aspirin in under 16-year olds due to risk of Reyes syndrome

Answer 72

Manufacturer states avoid aspirin in under 16-year olds due to risk of Reyes syndrome

Question 73

A 34-year-old man visits the pharmacy for advice on his symptoms. He has just eaten at a new restaurant and now feels wheezy, lightheaded with clammy skin and a fast heartbeat. Upon questioning him about his medical conditions, you find out he has a nut allergy. Which of the following actions is the most appropriate to take? Select one: Administer adrenaline to the patient immediately Advise the patient that you need a prescription to supply adrenaline Advise the patient to attend accident and emergency immediately Call 999 for an ambulance immediately Call NHS 111 for advice on what action to take

Answer 73

Administer adrenaline to the patient immediately P125 MEP- Regulation 238 of the Human Medicines Regulations 2012 allows adrenaline to be administered by anyone for the purpose of saving life in an emergency. Therefore pharmacists using their professional and clinical judgement can administer adrenaline in an emergency to persons presenting with symptoms of anaphylaxis. If a pharmacist administers adrenaline they must also ensure that an ambulance is called by dialling 999 and reporting that there is a case of suspected anaphylaxis

Question 74

An 18-year-old man is started on phenytoin 300 mg capsules daily, for tonic-clonic seizures. Which one of the following is the most appropriate plasma phenytoin concentration for an optimum response? Select one: 1 – 2 mg/L 10 – 20 mg/L 40 – 80 mg/L 100 – 200 mg/L 400 – 800 mg/L

Answer 74

10-20

Question 75

A 6-year-old boy presents to the GP clinic with worsening asthma symptoms. He uses beclometasone 100 micrograms inhaler and salbutamol 100 micrograms inhaler. He presents with the following observations: Breathless when talking SpO2 < 92% Peak flow 45% best Heart rate 130 bpm Respiratory rate 28 breaths /min Which one of the following is the most appropriate course of action? Select one: Ask the patient to wait in the patient waiting area for 30 minutes and then recheck his observations Ask the patient to wait in patient waiting area for one hour whilst administering salbutamol nebules and then recheck his observations Recommend a prescription for salbutamol 100 micrograms inhaler, 10 puffs to be used every two hours Refer the patient to accident and emergency Step up the beclometasone treatment as his peak flow is 45 % be

Answer 75

Refer to A + E. Potentially severe acute asthma

Question 76

A new patient brings in a private prescription for codeine 30 mg tablets. It appears that all legal requirements have been met. You have been made aware that two local pharmacies have recently received forged prescriptions. The patient appears to be agitated and nervous which also makes you suspect that the prescription may not be genuine. Which of the following is most likely to suggest that the prescription is fraudulent? Select one: The prescription is for 90 tablets The prescription is handwritten The prescription is not on letter headed paper The prescription is signed by a local GP The prescription specifies Dr before the signature

Answer 76

The insertion of title ‘Dr’ before the signature could suggest a fraudulent prescription. Prescribers would not usually use their title next to their signature

Question 77

You are a checking the accuracy of some dispensed medication within your pharmacy to ensure it contains all the necessary legal requirements. Which of the following is most likely to be a legal requirement required on dispensed medication labels? Select one: The brand and generic name of the product The date the item was dispensed The expiry date of the product The formulation of the product The warning ‘Keep out of the reach and sight of children’

Answer 77

The date the item was dispense It should be noted that the RPS recommends the following also appears on the dispensing label, ‘Keep out of the reach and sight of children’, however this is not a legal requirement. An additional note is that keep out of reach part is a legal requirement but not and sight

Question 78

A 38-year-old woman presents to an endocrinology ward where she is being treated for primary hyperparathyroidism. Blood tests have been ordered. Which of the following is most likely to be monitored regularly and potentially supplemented? Select one: Vitamin A Vitamin B12 Vitamin C Vitamin D Vitamin E

Answer 78

For people with a probable diagnosis of primary hyperparathyroidism, measure vitamin D and offer vitamin D supplements if needed.- as stated in NICE guidance.

Question 79

A 62-year-old man informs you he has been prescribed a new medicine for his overactive bladder that requires close blood pressure monitoring. Which of the following medicines has most likely been prescribed for the patient? Select one: Finasteride Mirabegron Oxybutynin Propiverine Solifenacin

Answer 79

Blood pressure should be monitored before starting treatment and regularly during treatment, especially in patients with pre-existing hypertension with mirabegron All licensed for overactive bladder apart from A but no specific requirement regarding BP

Question 80

A 65-year-old woman is admitted to hospital with an exacerbation of chronic obstructive pulmonary disease (COPD). She has had five exacerbations in the last 12 months. Her current inhaler therapy is Trimbow (beclometasone dipropionate, formoterol fumarate dihydrate, glycopyrronium) and salbutamol. The respiratory specialist decides to initiate azithromycin as a prophylactic antibiotic. Which of the following monitoring requirements is most appropriate for this patient? Select one: Baseline ECG and LFT’s Baseline ECG and U and E’s Baseline chest x-ray and LFT’s Baseline chest x-ray and U and E’s U and E’s and LFT’s

Answer 80

Baseline ECG and LFT’s ECG needed to rule out prolonged QT and LFT’s also required (CT scan and sputum cultures also actioned)

Question 81

A 32-year-old woman with has a known history of childhood asthma presents for a medication review with you in general practice. You decide to change her treatment from her Clenil inhaler (beclometasone dipropionate) to Fostair inhaler (beclometasone dipropionate and formoterol fumarate dihydrate). Which one of the following statements regarding Fostair inhaler is correct? Select one: Fostair can be used as maintenance and reliever therapy in response to COPD symptoms Fostair has extra fine particle size distribution which can produce a more potent effect Fostair is a dry powder inhaler Fostair is unlicensed for use in asthma Fostair is unlicensed for use in COPD

Answer 81

Fostair has extra fine particle size distribution which can produce a more potent effect Not A as this is for asthma Not C as the Fostair NEXThaler device is a dry powder inhaler Not D or E as licensed in both B – comparing to other beclomethasone inhalers with particles not as fine