rpsE222120 Flashcards by Simon Evans

A 72-year-old man comes into your pharmacy complaining of pain in his mouth. Upon observation you
notice that there are white patches on his throat and tongue. He is currently taking warfarin.
Which of the anti-infective agents indicated for this infection would interact with warfarin?
a. aciclovir
b. amoxicillin
c. ciprofloxacin
d. clarithromycin
e. ethambutol
f. miconazole
g. rifampicin
h. terbinafine

Miconazole greatly increases the anticoagulant effect of Warfarin. Miconazole can be purchased OTC. MHRA
advises avoid unless INR can be monitored closely; monitor for signs of bleeding.
Oral thrush is a fungal infection. F and H are antifungals however terbinafine is not licensed for oral thrush.

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A 42-year-old woman who regularly takes simvastatin 20 mg tablets requires antibiotics for a chest
infection.
Which of the anti-infective agents is least likely to be prescribed given her history?
a. aciclovir
b. amoxicillin
c. ciprofloxacin
d. clarithromycin
e. ethambutol
f. miconazole
g. rifampicin
h. terbinafine

Amoxicillin and clarithromycin are licensed first line for chest infection however there is an interaction
between clarithromycin and simvastatin - clarithromycin is predicted to increase the exposure to
simvastatin. Manufacturer advises avoid. If clarithromycin was indicated, the patient would need to stop
taking simvastatin for the duration of the course.

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A 31-year-old woman is taking desogestrel as hormonal contraception.
Which anti-infective is most likely to reduce the efficacy of her contraception?
a. aciclovir
b. amoxicillin
c. ciprofloxacin
d. clarithromycin
e. ethambutol
f. miconazole
g. rifampicin
h. terbinafine

Rifampicin is an enzyme inducer and therefore is predicted to decrease the efficacy of desogestrel.
Concomitant administration of strong (e.g., ketoconazole, itraconazole, clarithromycin) or moderate (e.g.
fluconazole, diltiazem, erythromycin) CYP3A4 inhibitors may increase the serum concentrations of
progestins, including etonogestrel, the active metabolite of desogestrel

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A 4-year-old boy and his mother come to you in distress. His face is pale, and skin is cold to touch. He is
holding his throat and wheezing.
Which of the medicines would be most appropriate to administer?
a. adrenaline 150 mcg by intramuscular injection
b. adrenaline 300 mcg by intramuscular injection
c. adrenaline 500 mcg by intramuscular injection
d. glucagon
e. glucose 10% intravenous infusion
f. glucose 40% gel
g. intravenous insulin
h. subcutaneous insuli

The boy is showing signs of an anaphylactic reaction and A is the appropriate strength for a 6-month to 6
year old child.

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A 13-year-old girl who has type 1 diabetes has a blood glucose reading of 3.7mmol/l and is starting to feel
lightheaded.
Which of the medicines would be most appropriate to administer?
a. adrenaline 150 mcg by intramuscular injection
b. adrenaline 300 mcg by intramuscular injection
c. adrenaline 500 mcg by intramuscular injection
d. glucagon
e. glucose 10% intravenous infusion
f. glucose 40% gel
g. intravenous insulin
h. subcutaneous insulin

Any patient with a blood-glucose concentration less than 4 mmol/litre, with or without symptoms, and who
is conscious and able to swallow, should be treated with a fast-acting carbohydrate by mouth. Glucose 40%
gel is an example.

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A 42-year-old woman brings in a prescription for a new medication for high blood pressure. She tells you
the doctor has switched her to this as she is pregnant.
Which of the anti-hypertensives would be most appropriate to prescribe?
a. amlodipine 5 mg tablets once daily
b. amlodipine 10 mg tablets once daily
c. bendroflumethiazide 2.5 mg tablets once daily
d. bendroflumethiazide 5 mg tablets once daily
e. labetalol 100 mg tablets twice daily
f. labetalol 200 mg tablets twice daily
g. ramipril 1.25 mg tablet tablets once daily
h. ramipril 2.5 mg tablet tablets once daily

Labetalol is used first line for hypertension in pregnant women. The dose is initially 100 mg twice daily
increased to 200 mg twice daily.

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An 82-year-old woman with a creatinine clearance of 27 mL/min had recently been switched to a new
antihypertensive which caused a dry cough for two weeks.
Which of the anti-hypertensives was most likely prescribed?
a. amlodipine 5 mg tablets once daily
b. amlodipine 10 mg tablets once daily
c. bendroflumethiazide 2.5 mg tablets once daily
d. bendroflumethiazide 5 mg tablets once daily
e. labetalol 100 mg tablets twice daily
f. labetalol 200 mg tablets twice daily
g. ramipril 1.25 mg tablet tablets once daily
h. ramipril 2.5 mg tablet tablets once daily

Max. initial dose 1.25 mg once daily (do not exceed 5 mg daily) if creatinine clearance less than 30
mL/minute.

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A 26-year-old woman, who is being treated for iron deficiency anaemia, has been prescribed ferrous
gluconate 300 mg tablets twice daily. She was previously taking ferrous sulfate (dried) 200 mg tablets once
daily. She asks you how much more elemental iron she consumed per day with her new tablets.
Information about anaemia iron deficiency has been provided below:
https://bnf.nice.org.uk/treatment-summaries/anaemia-iron-deficiency/
Which of the following would be most appropriate to advise?
a. 10 mcg
b. 25 mcg
c. 400 mcg
d. 5 mg
e. 35 mg
f. 60 mg
g. 65 mg
h. 70 mg

200 mg of ferrous sulfate (dried) = 65 mg elemental iron
300 mg x 2 (600 mg) ferrous gluconate = 70 mg elemental iron
70 mg – 65 mg = 5 mg

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A mother of a 6-month-old baby comes into the pharmacy and tells you that she read somewhere that her
baby should be taking vitamin D. She asks you what strength you would recommend for her baby as she is
breastfeeding.
Which of the following would be most appropriate to advice?
a. 10 mcg
b. 25 mcg
c. 400 mcg
d. 5 mg
e. 35 mg
f. 60 mg
g. 65 mg
h. 70 mg

Babies from birth to 1 year of age who are being breastfed should be given a daily supplement of 8.5-10 mcg
of vitamin D.

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A 31-year-old woman has recently been diagnosed with focal seizures without secondary generalisation.
The decision has been made to commence treatment.
The NICE treatment summary for epilepsy has been provided below:
https://bnf.nice.org.uk/treatment-summaries/epilepsy/
Which of the options would be the most appropriate first-line treatment option?
a. arbamazepine
b. ethosuximide
c. gabapentin
d. lacosamide
e. lamotrigine
f. phenytoin
g. sodium valproate
h. topiramate

Lamotrigine or Levetiracetam are considered as first-line options for treating focal seizures with or without
secondary generalisation.

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A 29-year-old woman of childbearing potential has recently been diagnosed with tonic-clonic seizures. The
decision has been made to commence treatment.
The NICE treatment summary for epilepsy has been provided below:
https://bnf.nice.org.uk/treatment-summaries/epilepsy/
Which of the options would be the most appropriate first-line treatment option?
a. arbamazepine
b. ethosuximide
c. gabapentin
d. lacosamide
e. lamotrigine
f. phenytoin
g. sodium valproate
h. topiramate

Sodium valproate is considered as first-line monotherapy for generalised tonic-clonic seizures in males,
and females unable to have children. For females who can have children, lamotrigine or levetiracetam
[unlicensed use] are considered as first-line.

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A mother brings her son to the pharmacy for his first dose of MenB vaccine.
Information about vaccinations has been provided below.
https://www.nhs.uk/conditions/vaccinations/nhs-vaccinations-and-when-to-have-them/
At which of the ages is the vaccine most likely to be administered?
a. 8 weeks
b. 12 weeks
c. 16 weeks
d. 1 year
e. 3 years and 4 months
f. 12 years
g. 13 years
h. 14 years

MenB vaccine is taken at 8 weeks, 16 weeks and 1 year.

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A father brings his daughter into the pharmacy for her second dose of MMR vaccine.
Information about vaccinations has been provided below.
https://www.nhs.uk/conditions/vaccinations/nhs-vaccinations-and-when-to-have-them/
Which age is the vaccine most likely to be administered?
a. 8 weeks
b. 12 weeks
c. 16 weeks
d. 1 year
e. 3 years and 4 months
f. 12 years
g. 13 years
h. 14 years

MMR vaccine is administered at 1 year and again at 3 years 4 months.

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A 42-year-old woman has been prescribed folic acid to reduce the risk of mucosal and gastrointestinal side
effects and hepatotoxicity.
Which of the following immunosuppressants has the patient most likely been prescribed?
a. azathioprine
b. ciclosporin
c. mercaptopurine
d. methotrexate
e. mycophenolate mofetil
f. prednisolone
g. sirolimus
h. tacrolimus

Methotrexate is a folate antagonist. Methotrexate inhibits dihydrofolate reductase (DHFR), the enzyme that
reduces folic acid to tetrahydrofolic acid.

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A 62-year-old woman has been asked to undergo an assessment for the risk of osteoporosis.
Which of the following immunosuppressants has the patient most likely been prescribed?
a. azathioprine
b. ciclosporin
c. mercaptopurine
d. methotrexate
e. mycophenolate mofetil
f. prednisolone
g. sirolimus
h. tacrolimus

Osteoporosis is a common/very common side effect of prednisolone

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A pregnant woman has had constipation since the start of her pregnancy. She has tried increasing her fibre
intake and altered her exercise routine. She is now in her third trimester and hasn’t opened her bowels for 5
days. She would prefer not to take medicines during her pregnancy.
Which one of the following options is the most appropriate laxative?
a. bisacodyl
b. co-danthramer
c. docusate sodium
d. glycerol suppository
e. isphagula husk
f. lactulose
g. macrogol
h. naloxegol

Glycerol suppository is the only non-oral option.

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A patient is now under the palliative care team; the team would like to know which laxative is licensed for
use in palliative care.
Which one of the following options is the most appropriate laxative?
a. bisacodyl
b. co-danthramer
c. docusate sodium
d. glycerol suppository
e. isphagula husk
f. lactulose
g. macrogol
h. naloxegol

Co-danthramer is licensed for constipation in palliative care patients, all the other options are not.

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A patient has had a hip replacement and has had a difficult time with pain management; they have trialled
multiple opioids and are now taking morphine sulphate slow-release tablets regularly.
Which one of the following options is the most appropriate licensed option for this scenario?
a. bisacodyl
b. co-danthramer
c. docusate sodium
d. glycerol suppository
e. isphagula husk
f. lactulose
g. macrogol
h. naloxegol

Opioids are commonly known to cause constipation, naloxegol is licensed to treat opioid induced
constipation.

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A patient has been started on finasteride 1 mg tablets once daily for male-pattern hair loss. They take
amlodipine 10 mg once daily, famotidine 40 mg tablets once daily and metformin 500 mg tablets twice a
day.
Which of the following is the adverse effect the patient is most likely to experience?
a. constipation
b. depression
c. epistaxis
d. hypertension
e. nausea
f. sexual dysfunction
g. skin reaction
h. vision disorders

A common/very common side effect of finasteride is sexual dysfunction; thus, option F is correct. It’s
important to note that depression is a side effect that is reported in those taking finasteride for male pattern
hair loss – MHRA / CHM report, though there have been rare reports. The question here, though, asks for likely
adverse effects.

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A 55-year-old male attends your clinic for a medication review and you note that he has been recently
started on tamsulosin hydrochloride 400 mcg modified release capsules. He is currently taking citalopram
10 mg tablets and simvastatin 40 mg tablets.
Which one of the following options best describes the adverse effect the patient is likely to experience?
a. constipation
b. depression
c. epistaxis
d. hypertension
e. nausea
f. sexual dysfunction
g. skin reaction
h. vision disorders

Sexual dysfunction is a common side effect of tamsulosin

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A 72-year-old patient with newly diagnosed atrial fibrillation requires anticoagulation therapy for
prophylaxis against stroke and systemic embolism. They have a past medical history of hypertension for
which they are prescribed amlodipine 5 mg once daily and atorvastatin 20 mg once daily.
Which of the following medicines is most suitable for this patient?
a. aspirin
b. clopidogrel
c. enoxaparin
d. fondaparinux
e. heparin
f. rivaroxaban
g. ticagrelor
h. warfarin

NICE AF guidelines indicate a DOAC should be offered as first line treatment for prevention of stroke in AF,
rivaroxaban is an example of a DOAC

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A 28-year-old woman is admitted to hospital following a fall and has a suspected broken ankle. She has no
past medical history but requires venous thromboembolism prophylaxis. She follows a vegan diet and
avoids animal derived products.
Which of the following medicines is most suitable for this patient?
a. aspirin
b. clopidogrel
c. enoxaparin
d. fondaparinux
e. heparin
f. rivaroxaban
g. ticagrelor
h. warfarin

Low molecular weight heparin is the agent of choice for VTE prophylaxis, but enoxaparin is derived from
porcine intestinal mucosa. Fondaparinux is a synthetic product and is licensed for VTE prophylaxis so can be
used as an alternative

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A 36-year-old man enters your pharmacy. He explains that he has been suffering from a cough for the past
week. On further questioning he tells you it is productive with no other symptoms present. He takes losartan
25 mg once a day.
Which of the following medicines is most suitable for this patient?
a. beclometasone nasal spray (Beconase hayfever®)
b. cetirizine 5 mg/5mL liquid
c. dextromethorphan 7.5 mg/5 mL liquid (Robitussin dry cough sugar free®)
d. glycerol liquid (Covonia, Dry and Tickly Cough Linctus®)
e. guaifenesin 100 mg/5 mL liquid (Robitussin chesty cough sugar free®)
f. pholcodine 5 mg/5 mL linctus
g. prochlorperazine 3 mg buccal tablets (Buccastem M®)
h. pseudoephedrine 60 mg tablets (Sudafed®)

Guaifenesin – expectorant and is safe for patients with high blood pressure

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An 11-year-old girl visits your pharmacy with her mother. The mother tells you her daughter is suffering from
a dry cough. She mentions it is unproductive and very irritating. She has had it for 3 days and no other
symptoms present. She takes no other medication and has not yet tried anything.
Which of the following medicines is most suitable for this patient?
a. beclometasone nasal spray (Beconase hayfever®)
b. cetirizine 5 mg/5mL liquid
c. dextromethorphan 7.5 mg/5 mL liquid (Robitussin dry cough sugar free®)
d. glycerol liquid (Covonia, Dry and Tickly Cough Linctus®)
e. guaifenesin 100 mg/5 mL liquid (Robitussin chesty cough sugar free®)
f. pholcodine 5 mg/5 mL linctus
g. prochlorperazine 3 mg buccal tablets (Buccastem M®)
h. pseudoephedrine 60 mg tablets (Sudafed®)

Cough suppressants such as pholcodine 5 mg/5 mL and dextromethorphan should not be used for under
the age of 12. Covonia ® is a soothing preparation for relief of the symptoms of coughs and sore throats and
is suitable for children over the age of 1. Pholcodine can be used from 6 years of age at concentration of 2
mg/5 mL - Galenphol Paediatric Linctus, (CHM/MHRA advises that pholcodine should not be given to
children under the age of 6).

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A patient presents at your community pharmacy with a prescription written in English from a doctor in France for co-codamol 30/500 mg tablets. You are satisfied that the prescription is genuine, and you have enough information to determine that the medicine is safe for the patient. Which of the following options is the most appropriate course of action? a. advise the patient that, although you are able to dispense prescriptions from this country, you cannot legally dispense this item and refer them to a UK registered prescriber b. advise the patient that, since this medication does not have a UK marketing authorisation, you cannot dispense the prescription and refer them to a UK registered prescriber c. advise the patient that you are unable to dispense prescriptions from this country and offer to sell them an alternative P medication d. advise the patient that you are unable to dispense prescriptions from this country and refer them to a UK registered prescriber e. advise the patient that you are unable to dispense prescriptions from this country but provide an emergency supply of the medication and make an entry in the POM register f. advise the patient that you are unable to dispense the prescription immediately since you are legally required to confirm the registration status of the prescriber before dispensing g. ask the patient to provide you with their covering letter from their prescriber before you can dispense the item h. supply the prescription and counsel the patient on the medication as appropriate

France is an EEA country therefore the prescription can be dispensed. Co-codamol 30/500 mg tablets are a schedule 5 controlled drug which can legally be dispensed. Although it is preferable to confirm the registration status of the prescriber, it is not a legal requirement and if it is not possible after taking all reasonable steps then you can still make a safe and legal supply

A patient presents at your community pharmacy with a prescription written in English from a prescriber in the USA. The prescription is for their regular medication of tamsulosin capsules. The patient has some medication with them but will run out in the next few days. Which of the following options is the most appropriate course of action? a. advise the patient that, although you are able to dispense prescriptions from this country, you cannot legally dispense this item and refer them to a UK registered prescriber b. advise the patient that, since this medication does not have a UK marketing authorisation, you cannot dispense the prescription and refer them to a UK registered prescriber c. advise the patient that you are unable to dispense prescriptions from this country and offer to sell them an alternative P medication d. advise the patient that you are unable to dispense prescriptions from this country and refer them to a UK registered prescriber e. advise the patient that you are unable to dispense prescriptions from this country but provide an emergency supply of the medication and make an entry in the POM register  f. advise the patient that you are unable to dispense the prescription immediately since you are legally required to confirm the registration status of the prescriber before dispensing g. ask the patient to provide you with their covering letter from their prescriber before you can dispense the item h. supply the prescription and counsel the patient on the medication as appropriate

advise the patient that you are unable to dispense prescriptions from this country and refer them to a UK registered prescriber

A 72-year-old man with a three-day history of diarrhoea develops acute kidney injury and hypokalaemia. He subsequently demonstrates symptoms of nausea, vomiting, confusion, and visual disturbances, including yellow vision. Which of the following medicines has most likely caused the symptoms? a. amiodarone b. ciclosporin c. digoxin d. gentamicin e. methotrexate f. phenytoin g. theophylline h. warfarin

Typical early symptoms of digoxin toxicity are nausea and vomiting with confusion, which can be exacerbated by hypokalaemia that can result from diarrhoea. A characteristic symptom is visual disturbances with yellow vision.

A 32-year-old woman comes into your pharmacy to show you her lower leg which appears red, swollen, painful and warm to touch. She tells you that she thinks she may have been bitten whilst gardening a few days ago and that the rash seems to be getting bigger. She thinks she has an infection but explains that she has an allergy to penicillin. Which of the following antibiotics would be most appropriate to administer? a. amoxicillin 500 mg tablets b. clarithromycin 500 mg tablets c. co-amoxiclav 500/125 tablets d. flucloxacillin 500 mg tablets e. fusidic acid 2% cream f. metronidazole tablets g. mupirocin 2% ointment h. trimethoprim 200 mg tablets

Clarithromycin is first line for patients being treated for cellulitis who are allergic to penicillin. Flucloxacillin would be first line if the patient was not allergic to penicillin.

A 52-year-old woman was recently started on levothyroxine 25 micrograms once daily following a presentation to her GP with symptoms of unexplained weight gain, cold intolerance and fatigue. Thyroid function tests indicated the development of hypothyroidism. Which of the following medicines has most likely caused the symptoms? a. amiodarone b. ciclosporin c. digoxin d. gentamicin e. methotrexate f. phenytoin g. theophylline h. warfarin

Hypothyroidism is a known side-effect of amiodarone, with a requirement for thyroid function test monitoring before treatment and then every 6 months

A mother brings her 3-year-old boy to you and tells you that he has developed cornflake-like patches around the mouth and nose. They appear to also be on his hands and feel itchy. Which of the following antibiotics would be most appropriate to administer? a. amoxicillin 500 mg tablets b. clarithromycin 500 mg tablets c. co-amoxiclav 500/125 tablets d. flucloxacillin 500 mg tablets e. fusidic acid 2% cream f. metronidazole tablets g. mupirocin 2% ointment h. trimethoprim 200 mg tablet

The child seems to have impetigo and topical fusidic acid is the first line antibiotic. Mupirocin can be used if resistance to fusidic acid is suspected.

You are a paediatric pharmacist and a student midwife seeks your advice in the maternity ward. She would like to know what is given to prevent haemorrhagic disease of the newborn. Select from the list of options the most appropriate vitamin for the patient. Select one: Ascorbic acid (Vitamin C) Cholecalciferol (Vitamin D ) Folic acid Pantothenic acid (Vitamin B ) Phytomenadione (Vitamin K) Pyroxidine (Vitamin B ) Retinol (Vitamin A) Tocopherols (Vitamin E)

The Chief Medical Officer and the Chief Nursing Officer have recommended that all newborn babies should receive vitamin K to prevent vitamin K deficiency bleeding (previously termed haemorrhagic disease of the newborn)

A 48-year-old man takes isoniazid as part of his treatment regimen for tuberculosis. As he is diabetic, he is at higher risk of developing peripheral neuropathy. He hands in a new prescription to help reduce the effects of peripheral neuropathy. Select from the list of options the most appropriate vitamin for the patient. Select one: Ascorbic acid (Vitamin C) Cholecalciferol (Vitamin D ) Folic acid Pantothenic acid (Vitamin B ) Phytomenadione (Vitamin K) Pyroxidine (Vitamin B ) Retinol (Vitamin A) Tocopherols (Vitamin E)

Adverse effects of isoniazid can cause peripheral neuropathy which is prevented by the prophylactic use of pyridoxine

A 56-year-old man who has been newly diagnosed with heart failure and started on spironolactone. He has been admitted to hospital with an adverse drug reaction, the consequence of which is visible on an ECG. Select from the list of options the most likely adverse drug reaction. Select one: Constipation Diarrhoea Hyperkalaemia Hypernatremia Hypokalaemia Hyponatraemia QTc prolongation Rash

Caution and contra-indications of spironolactone = hyperkalemia. This would cause an admission to hospital.

An 84-year-old man recently started on citalopram, who has been admitted to hospital with symptoms of confusion and seizures. Select from the list of options the most likely adverse drug reaction. Select one: Constipation Diarrhoea Hyperkalaemia Hypernatremia Hypokalaemia Hyponatraemia QTc prolongation Rash

Citalopram causes hyponatraemia in elderly, and symptoms of low sodium are confusion and seizures

A 45-year-old woman who has been diagnosed with schizophrenia and is having regular dose increases of quetiapine. Select from the list of options the most likely adverse drug reaction. Select one: Constipation Diarrhoea Hyperkalaemia Hypernatremia Hypokalaemia Hyponatraemia QTc prolongation Rash

Antipsychotics are higher risk of causing QTC prolongation

A 7-year-old girl having regular salbutamol nebules for an exacerbation of asthma. An ECG has been performed due to a potential adverse reaction that salbutamol has caused. Select from the list of options the most likely adverse drug reaction. Select one: Constipation Diarrhoea Hyperkalaemia Hypernatremia Hypokalaemia Hyponatraemia QTc prolongation Rash

Salbutamol can cause hypokalaemia, which can cause arrythmias.

A mother of a 6-year-old boy has attended your pharmacy asking for advice on a reaction after having cefalexin for an infection. You think this reaction is an immune response. Select from the list of options the most likely adverse drug reaction. Select one: Constipation Diarrhoea Hyperkalaemia Hypernatremia Hypokalaemia Hyponatraemia QTc prolongation Rash

A rash can appear as an immune mediated response, especially with penicillins

A 6-year-old child has been diagnosed with faecal impaction (first presentation), they have been referred to the specialist but treatment has been initiated until the specialist can review them (two week wait). Select from the list of options the most appropriate constipation medicine for the patient. Select one: Bisacodyl 10 mg suppositories Co-danthramer 25 mg capsules Docusate 100 mg capsules Lactulose 10 g/15 mL liquid Movicol 13.8 g sachets Movicol paediatric 6.9 g sachets Naloxegol 25 mg tablets Senna 7.5 mg tablets

Movicol paed can be used for treatment or prevention

A 46-year-old patient requires treatment for opioid induced constipation. Previous treatment has been trialled and found to be inadequate. Select from the list of options the most appropriate constipation medicine for the patient. Select one: Bisacodyl 10 mg suppositories Co-danthramer 25 mg capsules Docusate 100 mg capsules Lactulose 10 g/15 mL liquid Movicol 13.8 g sachets Movicol paediatric 6.9 g sachets Naloxegol 25 mg tablets Senna 7.5 mg tablets

Licensed for use in OIC, recommended for the treatment of opioid-induced constipation when response to other laxatives is inadequate

A 35-year-old woman presents to her GP with constipation. She would prefer to be prescribed a quick acting agent. Select from the list of options the most appropriate constipation medicine for the patient. Select one: Bisacodyl 10 mg suppositories Co-danthramer 25 mg capsules Docusate 100 mg capsules Lactulose 10 g/15 mL liquid Movicol 13.8 g sachets Movicol paediatric 6.9 g sachets Naloxegol 25 mg tablets Senna 7.5 mg tablets

Bisacodyl 10 mg suppositories Suppositories can work within 45 minutes

A 25-year-old pregnant patient who has developed constipation in her third trimester. She has not previously taken anything and would like to be prescribed medication that is safe in pregnancy. Select from the list of options the most appropriate constipation medicine for the patient. Select one: Bisacodyl 10 mg suppositories Co-danthramer 25 mg capsules Docusate 100 mg capsules Lactulose 10 g/15 mL liquid Movicol 13.8 g sachets Movicol paediatric 6.9 g sachets Naloxegol 25 mg tablets Senna 7.5 mg tablets

Lactulose not known to be harmful in pregnancy and is prescribed first line for constipation in pregnancy.

The maximum treatment of phenobarbital tablets that can be supplied in an emergency at the request of a patient. Select from the list of options the most appropriate value that relates to this scenario. Select one: 3 days 5 days 7 days 28 days 30 days 3 months 6 months 12 months

If the emergency supply is for a CD (i.e. phenobarbital or Schedule 4 or 5 CD), the maximum quantity that can be supplied is for five days’ treatment.

The maximum treatment that can be provided for an emergency supply of simvastatin tablets at the request of a patient. Select from the list of options the most appropriate value that relates to this scenario. Select one: 3 days 5 days 7 days 28 days 30 days 3 months 6 months 12 months

For any other POM (non CD), no more than 30 days can be supplied

The validity of an NHS prescription for furosemide tablets for a new patient. Select from the list of options the most appropriate value that relates to this scenario. Select one: 3 days 5 days 7 days 28 days 30 days 3 months 6 months 12 months

6 months

The validity of an NHS prescription for fentanyl patches for a regular patient. Select from the list of options the most appropriate value that relates to this scenario. Select one: 3 days 5 days 7 days 28 days 30 days 3 months 6 months 12 months

28 days

The validity of an NHS prescription for isotretonin capsules for use under the Pregnancy Prevention Programme. Select from the list of options the most appropriate value that relates to this scenario. Select one: 3 days 5 days 7 days 28 days 30 days 3 months 6 months 12 months

Under the PPP, prescriptions are valid only for seven days and ideally should be dispensed on the date the prescription is written.

A 78-year-old woman with chronic obstructive pulmonary disease (COPD) is complaining of dry mouth. Select from the list of options the most appropriate respiratory medicine for the patient. Select one: Budesonide inhaler Formoterol inhaler Montelukast tablets Prednisolone tablets Salbutamol inhaler Sodium cromoglicate inhaler Theophylline tablets Tiotropium inhaler

Common side effect of antimuscarinic drugs is dry mouth - tiotropium is the only antimuscarinic drug

An 80-year-old man with chronic asthma is complaining of a white furry coating on his tongue. Select from the list of options the most appropriate respiratory medicine for the patient. Select one: Budesonide inhaler Formoterol inhaler Montelukast tablets Prednisolone tablets Salbutamol inhaler Sodium cromoglicate inhaler Theophylline tablets Tiotropium inhaler

White furry coating sign of oral candidiasis. This is common with steroid inhalers Budesonide is a steroid inhaler

A 67-year-old woman, with an acute exacerbation of asthma, is complaining of stomach pains and cramps. Select from the list of options the most appropriate respiratory medicine for the patient. Select one: Budesonide inhaler Formoterol inhaler Montelukast tablets Prednisolone tablets Salbutamol inhaler Sodium cromoglicate inhaler Theophylline tablets Tiotropium inhaler

Common side of steroid tablets (prednisolone) GI discomfort

A 56-year-old man who has been diagnosed with atrial fibrillation and needs to start a medicine for the prevention of stroke in atrial fibrillation, with effectiveness measured by monitoring INR. Select from the list of options the most appropriate prescribed medicine for the patient. Select one: Aspirin Amiodarone Bisoprolol Clopidogrel Digoxin Lisinopril Rivaroxaban Warfarin

Warfarin and rivaroxaban both licensed – rivaroxaban does not need monitoring

An active 45-year-old woman with no known allergies and no previous medical history who has been diagnosed with atrial fibrillation and needs to start a medication for treatment Select from the list of options the most appropriate prescribed medicine for the patient. Select one: Aspirin Amiodarone Bisoprolol Clopidogrel Digoxin Lisinopril Rivaroxaban Warfarin

Beta-blockers first line. Digoxin only indicated if a patient is sedentary

A 50-year-old woman taking a medication for the treatment of atrial fibrillation and has been advised they will need regular thyroid stimulating hormone (TSH) and thyroxine (T4) monitoring to ensure no side effects. Select from the list of options the most appropriate prescribed medicine for the patient. Select one: Aspirin Amiodarone Bisoprolol Clopidogrel Digoxin Lisinopril Rivaroxaban Warfarin

Side effects of amiodarone – hyper/hypothyroid

68-year-old man who has completed two weeks of 300 mg aspirin and is now needs to start a medication for the ongoing prevention of stroke. Select from the list of options the most appropriate prescribed medicine for the patient Select one: Aspirin Amiodarone Bisoprolol Clopidogrel Digoxin Lisinopril Rivaroxaban Warfarin

Clopidogrel – lifelong treatment for prophylaxis of stroke after 2 weeks of aspirin 300 mg.

A 43-year-old man who has attended accident and emergency with a potassium of 6.5 mmol/L, attributed to one of their cardiac medicines which they have been taking for two weeks. Select from the list of options the most appropriate prescribed medicine for the patient. Select one: Aspirin Amiodarone Bisoprolol Clopidogrel Digoxin Lisinopril Rivaroxaban Warfarin

Lisinopril Only medication above that would cause hyperkalaemia.

A neonate at risk of tuberculosis receives a vaccine is a live attenuated strain derived from Mycobacterium bovis which stimulates the development of immunity to M. tuberculosis. Select from the list of options the most appropriate vaccine for the patient. Select one: Bacillus Calmette-Guérin (BCG) Vaccine Cholera Vaccine Influenza Vaccine Infanrix Hexa ® Measles, Mumps, Rubella (MMR) Vaccine Rotavirus Vaccine Tetanus Vaccine Varicella Zoster Vaccine

Bacillus Calmette-Guérin (BCG) Vaccine BCG vaccine is given at birth to babies that are at risk only.

A 75-year-old male receives a vaccine to prevent a painful skin disease. Select from the list of options the most appropriate vaccine for the patient. Select one: Bacillus Calmette-Guérin (BCG) Vaccine Cholera Vaccine Influenza Vaccine Infanrix Hexa ® Measles, Mumps, Rubella (MMR) Vaccine Rotavirus Vaccine Tetanus Vaccine Varicella Zoster Vaccine

Varicella Zoster Vaccine - A shingles vaccination programme was introduced for selected people aged between 70 and 79 years in September 2013 with the aim of reducing the incidence and severity of shingles in older people.

A 25-year-old humanitarian relief worker is prescribed an oral vaccine before her travels. As the pharmacist you advise her to mix the vaccination with water, and avoid eating, drinking or taking oral medication for an hour before and after having the vaccination. Select from the list of options the most appropriate vaccine for the patient. Select one: Bacillus Calmette-Guérin (BCG) Vaccine Cholera Vaccine Influenza Vaccine Infanrix Hexa ® Measles, Mumps, Rubella (MMR) Vaccine Rotavirus Vaccine Tetanus Vaccine Varicella Zoster Vaccine

The cholera vaccine is available to patients while travelling, although most people won't need it because food and water hygiene precautions are usually enough to prevent infection.

The first dose of this live, oral vaccine is delivered at two months to protect young children against gastro-enteritis. Select from the list of options the most appropriate vaccine for the patient. Select one: Bacillus Calmette-Guérin (BCG) Vaccine Cholera Vaccine Influenza Vaccine Infanrix Hexa ® Measles, Mumps, Rubella (MMR) Vaccine Rotavirus Vaccine Tetanus Vaccine Varicella Zoster Vaccine

Rotavirus is the most common cause of infantile gastroenteritis. Almost every child in the UK will have an infection before their fifth birthday. Infection in adults is uncommon because immunity is long lasting. An oral rotavirus vaccine, is currently offered as part of the UK national childhood immunization programme

A 12-month-old child receives their first dose of this vaccine, with a second booster dose scheduled between 3 – 5 years. This vaccine should not be administered on the same day as yellow fever vaccine and there should be a 4-week minimum interval between the vaccines. Select from the list of options the most appropriate vaccine for the patient. Select one: Bacillus Calmette-Guérin (BCG) Vaccine Cholera Vaccine Influenza Vaccine Infanrix Hexa ® Measles, Mumps, Rubella (MMR) Vaccine Rotavirus Vaccine Tetanus Vaccine Varicella Zoster Vaccine

MMR vaccine is administered at 12 months and between the ages of 3 – 5 according the immunization schedule. It should not be administered on the same day as yellow fever vaccine; there should be a 4-week minimum interval between the vaccines. When protection is rapidly required, the vaccines can be given at any interval and an additional dose of MMR may be considered.

A 31-year-old male patient who presents at the pharmacy to collect his prescription for propranolol to help with his anxiety symptoms. Select one: A. Abdominal pain B. Fatigue C. Fungal overgrowth D. Haemorrhage E. Heat intolerance F. Myalgia G. Photosensitivity H. Tachycardia

Fatigue

A 32-year-old male patient who has been prescribed clindamycin to treat a staphylococcal bone and joint infection Select one: A. Abdominal pain B. Fatigue C. Fungal overgrowth D. Haemorrhage E. Heat intolerance F. Myalgia G. Photosensitivity H. Tachycardia

Abdominal pain

A 32-year-old male patient who is travelling to India and has been prescribed doxycycline as malaria prophylaxis. Select one: A. Abdominal pain B. Fatigue C. Fungal overgrowth D. Haemorrhage E. Heat intolerance F. Pancreatitis G. Photosensitivity H. Tachycardia

Photosensitivity

A 66-year-old female patient has been prescribed glyceryl trinitrate sublingual spray for the prophylaxis and treatment of angina. You counsel her on the most common side effects associated with nitrates. Select one: A. Abdominal pain B. Fatigue C. Fungal overgrowth D. Haemorrhage E. Heat intolerance F. Myalgia G. Photosensitivity H. Tachycardia

Tahycardia - Side effects of GTN include postural hypotension, tachycardia (but paradoxical bradycardia also reported); throbbing headache, dizziness; less commonly nausea, vomiting, heartburn, flushing, syncope, temporary hypoxaemia.

An 81-year-old woman has been prescribed Trimethoprim 100mg once a day at night for the prophylaxis of recurrent urinary tract infections. Select one: A. Abdominal pain B. Fatigue C. Fungal overgrowth D. Haemorrhage E. Heat intolerance F. Myalgia G. Photosensitivity H. Tachycardia

fUngal overgrowth

A 45-year-old male patient has schizophrenia and has been prescribed olanzapine to prevent the recurrence of his bipolar disorder. He has no other significant past medical history. Identify the parameters that must be reviewed and recorded before commencing treatment. Select one: A. Blood pressure B. Chest X-ray C. Electrocardiogram (ECG) D. Fasting blood glucose E. Heart rate F. Plasma urea G. Serum alanine transaminase (ALT) H. Urinalysis

Fasting blood glucose – patients taking antipsychotics, particularly olanzapine are susceptible to hyperglycaemia and diabetes therefore fasting BG must be tested at baseline and at regular intervals thereafter.

A 23-year-old female patient has been taking an oral contraceptive pill (containing ethinylestradiol and levonorgestrel) for the past 4 years. She is not taking any other medicines and has no significant past medical history. She is due a review with the prescriber. Identify the parameter which should be measured before prescribing a repeat prescription. Select one: A. Blood pressure B. Chest X-ray C. Electrocardiogram (ECG) D. Fasting blood glucose E. Heart rate F. Plasma urea G. Serum alanine transaminase (ALT) H. Urinalysis

Blood pressure should be measured as hypertension is a known risk factor that increases the risk of arterial disease associated with oral contraceptives.

A 60-year-old female patient comes into the pharmacy for an NHS health check. Following the assessment, you discover that she has 10-year cardiovascular risk of 25.5 %. You refer her to the GP who prescribes simvastatin 20 mg to be taken at night. Identify the parameter that should be measured before commencing treatment with simvastatin. Select one: A. Blood pressure B. Chest X-ray C. Electrocardiogram (ECG) D. Fasting blood glucose E. Heart rate F. Plasma urea G. Serum alanine transaminase (ALT) H. Urinalysis

(Transaminases (ALT/AST) should be checked 3 and 12 months after commencing treatment by requesting LFTS. Statins should be used with caution in patients with a history of liver disease as they are metabolized by the liver, so hepatic impairment will increase their levels and thus the risk of myopathy. Simvaststin is contraindicated in active liver disease or if transaminases ALT & AST are raised more than 3 times the normal range.

A 67-year-old male patient has been diagnosed with persistent stage 2 hypertension despite attempting to change their lifestyle. A decision is made with the patient to start antihypertensive drug treatment. He is started on ramipril 1.25 mg once daily. Identify the parameter that should be monitored at regular intervals. Select one: A. Blood pressure B. Chest X-ray C. Electrocardiogram (ECG) D. Fasting blood glucose E. Heart rate F. Plasma urea G. Serum alanine transaminase (ALT) H. Urinalysis

Blood pressure

A 55-year-old male patient suffers from generalised seizures. He has been prescribed sodium valproate and also uses a salbutamol inhaler once or twice a year. Identify the parameter that should be measured before commencing treatment. Select one: A. Blood pressure B. Chest X-ray C. Electrocardiogram (ECG) D. Fasting blood glucose E. Heart rate F. Plasma urea G. Serum alanine transaminase (ALT) H. Urinalysis

ALT SV is associated with hepatotoxicity therefore LFT should be measured at baseline and at regular intervals throughout therapy

A 50-year-old man takes folic acid 5 mg once weekly, methotrexate 10 mg once weekly. He has been newly prescribed amoxicillin 500 mg three times a day for seven days. Select one: A. Bradycardia B. Hypertensive crisis C. Increased eGFR D. Increased risk of bleeding E. QT interval prolongation F. Reduced eGFR G. Tachycardia H. Toxicity of either or both drugs

H Amoxicillin is predicted to increase the risk of toxicity when given with MTX manufacture advises monitor

A 63-year-old man takes lisinopril 10 mg daily, amlodipine 10 mg daily. He has been newly prescribed simvastatin 40 mg at night. Select one: A. Bradycardia B. Hypertensive crisis C. Increased eGFR D. Increased risk of bleeding E. QT interval prolongation F. Reduced eGFR G. Tachycardia H. Toxicity of either or both drugs

H Amlodipine slightly increases exposure of simvastatin. manufacture advises to adjust simvastatin dose to a max 20mg when using with amlodipine

Which analgesic would be most suitable for the effective treatment of neuropathic pain in an 82-year-old man with diabetes? Select one: A. Aspirin 300 mg tablets B. Fentanyl 25 microgram patches C. Gabapentin 300 mg capsules D. Ketamine 10 mg/mL vial E. Morphine sulphate 10 mg tablets F. Naproxen 250 mg tablets G. Tapentadol 50 mg tablets H. Tramadol 50 mg capsules

Which analgesic can be sold to a 24-year-old for the treatment of primary dysmenorrhea? Select one: A. Aspirin 300 mg tablets B. Fentanyl 25 microgram patches C. Gabapentin 300 mg capsules D. Ketamine 10 mg/mL vial E. Morphine sulphate 10 mg tablets F. Naproxen 250 mg tablets G. Tapentadol 50 mg tablets H. Tramadol 50 mg capsules

Which analgesic is contraindicated for a 42-year-old with uncontrolled epilepsy? Select one: A. Aspirin 300 mg tablets B. Fentanyl 25 microgram patches C. Gabapentin 300 mg capsules D. Ketamine 10 mg/mL vial E. Morphine sulphate 10 mg tablets F. Naproxen 250 mg tablets G. Tapentadol 50 mg tablets H. Tramadol 50 mg capsules

A 5-years-old boy, presents with exanthema behind the ears which spread to the face and later to the trunks and extremities and after three days, it begins to fade. Select one: A. Chickenpox B. Colic C. Conjunctivitis D. Cradle cap E. Croup F. Hand foot and mouth disease G. Meningitis H. Rubella

Rubella rash tends to start behind ears and on face before spreading to the rest of the body

A 18-month-old girl, presents with general malaise, loss of appetite. She has small erythematous macules on her stomach and arms, and a few some pustules. Select one: A. Chickenpox B. Colic C. Conjunctivitis D. Cradle cap E. Croup F. Hand foot and mouth disease G. Meningitis H. Rubella

Chickenpox

A 6-month-old boy, presents with sudden onset of a seal-like barking cough with stridor and sternal recession at rest. Select one: A. Chickenpox B. Colic C. Conjunctivitis D. Cradle cap E. Croup F. Hand foot and mouth disease G. Meningitis H. Rubella

Croup is characterised by the sudden onset of a seal-like barking cough, often accompanied by stridor, voice hoarseness, and respiratory distress.

A 4–year-old girl, presents with sore throat, low-grade fever and tender lesions in the mouth and papulovesicular lesions of the distal limbs. Select one: A. Chickenpox B. Colic C. Conjunctivitis D. Cradle cap E. Croup F. Hand foot and mouth disease G. Meningitis H. Rubel

A 2-week-old baby, presents with excessive crying, inconsolable crying which occurs in late afternoon or evening and draws its knees up to abdomen when crying. Select one: A. Chickenpox B. Colic C. Conjunctivitis D. Cradle cap E. Croup F. Hand foot and mouth disease G. Meningitis H. Rubella