settler 05 Flashcards by Simon Evans

An 11-month-old girl has moderate symptoms of pyrexia and requires medication. Paracetamol is the most appropriate option.
Which of these would be the correct dose to give the child, every 4-6 hours?
60mg
90mg
120mg
160mg
180mg

120mg

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man who complains to the doctor regarding his symptoms of bloating, nausea, and abdominal pain. He
recently had a course of flucloxacillin for a skin infection. The man mentions he has not responded to OTC medication. The doctor has
advised the patient to take a week’s course of the following:
omeprazole 20mg BD
amoxicillin 1g BD
clarithromycin 500mg BD
Which condition does this patient have?
Gastro-oesophageal reflux disease
Helicobacter pylori infection
Inflammatory bowel syndrome
NSAID-induced ulcer
Ulcerative colitis

H pylori

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man who complains to the doctor regarding his symptoms of bloating, nausea, and abdominal pain. He
recently had a course of flucloxacillin for a skin infection. The man mentions he has not responded to OTC medication.
Considering a retest is required, how long does the man have to wait after having finished his course of flucloxacillin, before taking
the test again to prevent getting a false negative result?
1 week
2 weeks
3 weeks
4 weeks
5 weeks

4 weeks

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A 22-year-old man has presented to the doctor after having unusual bowel movements for two weeks and is now starting to become
anxious. He has tried but has not responded to increasing fibre in his diet.
What is the recommended first-line treatment for this patient?
docusate sodium capsules
ispaghula husk sachets
loperamide capsules
macrogol sachets
senna tablets

Ispaghula husk - first like is bulk forming laxatives

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A patient presents with xerostomia and asks what she could use to reduce its severity. She says she recently started taking a new medication
and ever since then she has had this problem.
Which of her medications is most likely to have caused the xerostomia?
amitriptyline
aspirin
bisoprolol
gliclazide
metformin

xerostomia is a dry mouth- TCA common side effects include dry mouth - Amitriptyline

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75-year-old man who attends the pharmacy after being discharged from the hospital a few days ago. There have
been some changes to his medications and a medicines reconciliation is yet to be done at the pharmacy. His medications are listed below.
-apixaban 5mg twice daily
-bisoprolol 10mg once daily
-digoxin 125micrograms once daily
-GTN 400micrograms spray as directed
-ramipril 5mg once daily
-spironolactone 25mg once daily
verapamil 80mg once daily
What is the most appropriate course of action in this scenario?
advise the patient to continue taking these medicines, the hospital would have informed him of any changes
contact the prescriber immediately, a serious drug interaction exists between bisoprolol and verapamil
contact the prescriber immediately, a serious drug reaction exists between digoxin and spironolactone
contact the prescriber immediately, the apixaban dose needs reducing
contact the prescriber immediately, the digoxin dose needs reducing

Bisoprolol. Verapamil increases the risk of cardiovascular adverse effects when given with Bisoprolol. Manufacturer advises use with caution or avoid. Both Verapamil and Bisoprolol can increase the risk of bradycardia.

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75-year-old man who attends the pharmacy after being discharged from the hospital a few days ago. He has never
used a GTN spray before and is unsure about how to use this in response to an angina attack.
What is the correct advice to provide him?
Use 1-2 sprays under the tongue when required
Use 1-2 sprays under the tongue up to four times a day
Use 1-2 sprays under the tongue, if the chest pain does not reside after 5 minutes, call 999
Use 1-2 sprays under the tongue, repeat after five minute intervals if required. If chest pain persists five minutes after second dose, call
999
Call 999 as soon as you have used this spray

Use 1-2 sprays under the tongue, repeat after five minute intervals if required. If chest pain persists five minutes after
second dose, call 999

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A 52-year-old Caucasian man with poorly controlled hypertension has a BP of 167/98mmHg. He is already taking losartan and amlodipine.
Which would be the most appropriate next treatment option for this patient?
bisoprolol
furosemide
indapamide
labetalol
spironolactone

For a 52-year-old man with poorly controlled hypertension (BP 167/98 mmHg) already taking losartan and amlodipine, the most appropriate next treatment option would be to add indapamide, a thiazide-like diuretic, to the regimen.

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Gina (estradiol) 10microgram vaginal tablet is a P medicine indicated for the treatment of vaginal atrophy in postmenopausal women.
Which of the following is contraindicated with the use of Gina and will require referral to the GP?
acute liver disease
patient has amenorrhoea
patient who takes warfarin for a non-mechanical heart valve
symptoms of vaginal soreness, burning and painful intercourse
Women aged above 50

Acute liver disease

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A 7-year-old boy with type I diabetes mellitus is suffering with a fever and is feeling nauseous. His mother is seeking advice on how to
manage her son’s condition while he is ill.
In relation to ‘sick day’ rules for type I diabetes mellitus, which is the correct piece of advice?
avoid unhealthy foods such as sugary drinks or ice cream
drink only clear fluids such as water
do not adjust your insulin doses
do not continue taking insulin if you are not eating
measure your ketones

Measure your ketones
- sick day rules in diabetes melluilits

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A 48-year-old man is experiencing side effects from taking his metformin to treat his diabetes mellitus.
Which of the following side effects are common in patients taking metformin?
Anaemia
Hepatitis
Lactic acidosis
Skin reactions
Vitamin B12 deficiency

Vitamin B12 deficiency

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A 63-year-old man enters the pharmacy and wishes to purchase sildenafil tablets OTC. The man takes quite a few different medications.
-isosorbide mononitrate
-lansoprazole
-mirtazapine
-sumatriptan
-tiotropium
Which of the following medications would warrant you to refer the patient to his GP?
isosorbide mononitrate
lansoprazole
mirtazapine
sumatriptan
tiotropium

Isosorbide mononitrate -
Sildenafil (Viagra) and nitrates should never be taken together because their combination can cause dangerously low blood pressure, potentially leading to serious health complications or even death

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A 65-year-old woman takes methotrexate 10mg weekly for rheumatoid arthritis. She has been maintained on this dose for over a year and
her condition is stable.
How often does she need to have her full blood count monitored?
at least fortnightly
at least monthly
at least every twelve weeks
at least every six months
at least every year

At least every 12 weeks

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A mother presents in the pharmacy with her anxious 14-year-old daughter who is going into a private hospital for a minor procedure. The
mother has been advised to purchase a numbing cream OTC. Emla cream is available to buy.
What does Emla cream contain?
lidocaine with adrenaline
lidocaine with cetrimide
lidocaine with prilocaine
lidocaine with phenylephrine
lidocaine only

Learning point(s): lidocaine is available on it’s own OTC as a cream (e.g. Vagisil) ointment and spray. Lidocaine with adrenaline, with
cetrimide and with phenylephrine are all used for different reasons or are POMs. Lidocaine with prilocaine has been available OTC for many
years and is generally purchased by people before having tatoos done Lidocaine and prilocaine are both anaesthetics.
The correct answers are: lidocaine with adrenaline, lidocaine with prilocaine

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A 42-year-old woman has been diagnosed with cellulitis. On her record, it mentions she had an allergic skin reaction to amoxicillin when she
was prescribed it for a chest infection 7 years ago. Last year she had a course of trimethoprim for a UTI which caused no such problems.
What is the most suitable antibiotic to treat this patient’s cellulitis?
clarithromycin
clindamycin
co-amoxiclav
flucloxacillin
nitrofurantoin

Claritromycin

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A local dentist emails across a prescription for metronidazole 400mg tablets for a 24-year-old woman. The practice has assured you they
will have the original script delivered by end of the day. The prescription has been prepared off the emailed script and will only be handed
out after the original is received.
Which of the following counselling points would be INCORRECT to tell the patient?
avoid alcohol during the course and for 48 hours after stopping the treatment
metronidazole is safe to use in pregnancy
metronidazole may cause taste disturbances
metronidazole should be taken with or just after food
metronidazole works against both anaerobic bacteria and protozoa

metronidazole is not safe in pregnancy and manufacturer advises avoid

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A man currently takes morphine for his cancer pain. He takes MST Continus 60mg every 12 hours and morphine sulfate 10mg/5mL oral
solution for breakthrough pain, 10mL three times a day. He is now being switched to an equivalent dose of fentanyl.
What is the most appropriate dose of a 72-hour fentanyl patch the man should be switched to?
Fentanyl ‘12’ Patch
Fentanyl ‘25’ Patch
Fentanyl ‘50’ Patch
Fentanyl ‘75’ Patch
Fentanyl ‘100’ Patch

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A 35-year-old woman, weighing 55kg, is admitted to the hospital following a paracetamol overdose. She had consumed a total of 18
paracetamol 500mg tablets over 9 hours ago.
View resource
Using the resource provided, which of the following statements is correct regarding the management of this patient?
give acetylcysteine immediately
give activated charcoal immediately
treat only if ALT is 2 times the upper limit of normal
treat the patient with flumazenil
wait for blood results before considering treatment

Give acetylcysetine

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A man enters your community pharmacy and asks to speak to the pharmacist. He reports that he is worried that his 5-year-old son’s asthma
is worsening.
Which of the following symptoms is a sign that this child’s asthma may be poorly controlled?
doesn’t use their spacer device each time they use their salbutamol inhaler
missed a dose of their montelukast treatment
needs to use their salbutamol inhaler before exercising
states they can’t taste anything in their mouth when they use their inhaler
asthma symptoms have caused them to wake up at night on three occasions this week

Asthma symptoms causing them to wake up at night on three occasions this week

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A 67-year-old man is admitted to hospital with an infective exacerbation of COPD. Pre-admission he was taking salmeterol 100micrograms
(Serevent), one dose twice daily and a salbutamol 100micrograms inhaler to be used when required for his COPD. The patient has asthmatic
features.
Which inhaler is the most suitable to add on to the treatment plan for this patient?
Clenil (beclometasone dipropionate)
Relvar Ellipta 92/22 (fluticasone furoate, vilanterol trifenatate)
Seretide 50 (fluticasone propionate and salmeterol xinafoate)
Trimbow (beclometasone dipropionate, formoterol fumarate dihydrate, glycopyrronium bromide)
Ultibro Breezhaler (glycopyrronium bromide, indacterol)

Clenil

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A 4-year-old boy is prescribed salbutamol and Clenil (beclometasone CFC free) metered dose inhalers from the pharmacist independent
prescriber at the GP practice. He is also prescribed a spacer device. His father presents the prescription to your community pharmacy. You
are counselling the parent and child on how to use both inhalers and the spacer.
What is the maximum duration that a spacer device should be used before replacing?
weekly
monthly
6 monthly
yearly
2 yearly

You should replace your spacer at least every year, especially if you use it daily, but some may need to be replaced
sooner.
If it’s a new spacer, clean it before you use it for the first time, then once a month afterwards.
Take your spacer apart and gently clean it with warm water and a detergent, such as washing-up liquid.
Only a small number of brands of spacer are dishwasher safe, so check the instructions on the label.
Use warm water instead of boiling water, as boiling water may damage the spacer.
Be careful not to scrub the inside of your spacer as this might affect the way it works.
Leave it to air-dry as this helps to reduce static (an electrical charge that builds up) and prevent the medicine sticking to the inside of the
spacer.
When it’s completely dry, put your spacer back together ready for use.
Wipe the mouthpiece or mask clean before you use it again.
The correct answer is: yearly

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A woman presents into your pharmacy with her 3-year-old daughter. She wants to speak to the pharmacist regarding a skin rash around her
daughter’s mouth. On closer inspection you can see fluid filled blisters around her lips. From the symptoms you have confirmed this to be
bullous impetigo. The daughter has a penicillin allergy
Which of the following is the most appropriate to recommend?
See GP for clarithromycin
See GP for flucloxacillin
See GP for fusidic acid 2% cream
See GP for tetracycline
Sell hydrogen peroxide cream

See GP for clarithromycin

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2-year-old child that is diagnosed with chronic lymphocytic leukaemia and is currently on a course of
weekly vincristine injections.
Select the INCORRECT statement regarding storage and handling requirements for vincristine.
vincristine has a shelf life of 18 months
vincristine is a cytotoxic medication and requires careful handling
vincristine should be stored at a temperature of 2°C - 8°C
vincristine should not be handled by anyone that is pregnant
vincristine should only be handled and administered by a consultant

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relate to a woman who has severe anaemia as a result of inflammatory bowel disease. She is due to receive iron via
intravenous infusion.
Which statement regarding intravenous iron is INCORRECT?
intravenous desferrioxamine can be given to manage iron overdose
intravenous iron can cause a serious hypersensitivity reaction
intravenous iron should be avoided in the second and third trimester of pregnancy
Patients should be monitored for signs of hypersensitivity for at least 30mins after every dose of intravenous iron
Patients with asthma are at an increased risk of hypersensitivity reactions associated with intravenous iron therapy

intravenous iron should be avoided in the second and third trimester of pregnancy
Explanation:
This statement is incorrect because intravenous iron can be used in the second and third trimesters of pregnancy if the benefits outweigh the risks. In fact, it’s often used during these stages if oral iron is not tolerated or effective. Caution is advised, but it’s not avoided outright.

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On discharge, the GP has advised the woman to continue taking oral iron tablets. Which of the following statements regarding oral iron treatment is true? A common side effect of oral iron is tooth discolouration Iron salts differ marginally in their efficiency of absorption of elemental iron m/r preparations of iron are superior to immediate release preparations oral iron is only available on prescription oral iron and folic acid should be prescribed together to aid absorption of elemental iron

Iron salts may differ marginally in their efficiency of absorption of elemental iron

An 82-year-old man is newly diagnosed with heart failure and started on ramipril and bisoprolol by his cardiologist. In light of his diagnosis which one of the patient’s other medications should now be stopped? Adcal D3 (calcium carbonate and colecalciferol) alogliptin dapagliflozin gliclazide pioglitazone

Pioglitazone is CI in HF

A 55-year-old woman is prescribed several medications for a variety of conditions. She has recently developed AF Which of her medicines most likely contributed to her AF? ascorbic acid colecalciferol with calcium carbonate Ketovite Liquid (choline chloride, cyanocobalamin, ergocalciferol, vitamin A) omega-3-acid ethyl esters vitamin B compound strong

MHRA Drug Safety Update Learning point(s): Omega-3-acid ethyl ester medicines (Omacor/Teromeg 1000mg capsules): dose-dependent increased risk of atrial fibrillation in patients with established cardiovascular diseases or cardiovascular risk factors

A 54-year-old man presents at the pharmacy and asks for advice about erectile function. He wants to know how often he can use Cialis Together (tadalafil) OTC without having to get it on prescription. Which of the following is the recommended maximum use of Cialis Together? once a day twice a day thrice a week twice a week once a week

The recommended dose is one 10mg tablet taken at least 30 minutes prior to anticipated sexual activity. It is not recommended for continuous daily use. Men who use this product frequently (i.e.at least twice weekly) should consult their physician to discuss whether a once daily regimen with the lowest doses of tadalafil would be more suitable. Cialis Together may be taken with or without food. The maximum dosing frequency is once per day. The correct answer is: once a week

A 38-year-old woman presents at the community pharmacy and asks to speak to you in private. She is having to take time off work due to her period. She needs to change her tampon every two hours and her periods last more than 7 days. She has NKDA and does not take any other medication. You decide to sell her tranexamic acid OTC. What age ranges is it licensed? 15-50 16-60 18-45 18-60 18-65

18-45. The recommended dosage is 2 tablets 3 times daily as long as needed but for a maximum of 4 days. If there is very heavy menstrual bleeding, the dosage may be increased. A total dose of 4g daily (8 tablets) should not be exceeded.

A 4-year-old girl is admitted to hospital. She is diagnosed with non-severe hospital-acquired pneumonia that is treatable with antibiotics. She has NKDA and takes no other medication. Which of the following is the most appropriate antibiotic for her to take for a 5-day course? amoxicillin 250mg/5mL suspension- 10mL BD clarithromycin 250mg/5mL suspension- 10mL BD co-amoxiclav 125mg/31mg/5mL suspension- 10mL TDS doxycycline 100mg capsules – 1 BD erythromycin 125mg/5mL suspension- 5mL QDS

co-amoxiclav 125mg/31mg/5mL suspension – 10mL TDS Here's why: Hospital-acquired pneumonia (HAP) often involves organisms that are more resistant than those causing community-acquired pneumonia (CAP), so broader spectrum coverage is required. Co-amoxiclav (amoxicillin + clavulanic acid) provides broad-spectrum coverage, including beta-lactamase-producing organisms, making it suitable for non-severe HAP. The BNF for Children recommends oral co-amoxiclav for non-severe HAP when IV treatment isn’t required and the child is stable.

Which antibiotic does the MHRA remind healthcare professionals to be vigilant for signs and symptoms of pulmonary and hepatic damage? amoxicillin doxycycline nitrofurantoin trimethoprim vancomycin

The MHRA (Medicines and Healthcare products Regulatory Agency) has issued safety warnings reminding healthcare professionals to be vigilant for signs of pulmonary and hepatic damage associated with nitrofurantoin, especially with long-term use.

A 28-year-old man has come into the pharmacy complaining about a burning sensation in his mouth. On closer inspection, you can see small white patches on the tongue. The patient has asthma which is controlled using a Clenil (beclometasone) and salbutamol inhaler. What is the most suitable course of action? ask the patient if he has drunk any milk this morning, this may be the cause of the white patches recommend the use of a spacer to the patient which will help prevent such symptoms Sell miconazole oral gel to the patient and check if the patient rinses his mouth after using his Clenil inhaler sell miconazole oral gel to the patient and use this opportunity to assess his inhaler technique white patches are an indication of a serious infection and the patient will need to be referred to the GP

Sell miconazole oral gel and check if the patient rinses his mouth after using the inhaler

A father is scheduling his annual leave in line with his newborn’s immunisation schedule. He has requested his manager to allow him to take his days off so he can take his child to the clinic for vaccination. When is the first dose of the rotavirus vaccine given? at birth at 8 weeks at 12 weeks at 16 weeks at 1 year

8 weeks

Pneumococcal polysaccharide vaccine is an inactivated, 23-valent vaccine that protects against pneumococcal disease caused by Streptococcus pneumoniae. At what age and over is this vaccine recommended to be given? 25 years 35 years 50 years 60 years 65 years

relate to a 60-year-old woman who is reviewed by her GP and is having her antidepressant medication altered. She will now be taking sertraline 50mg once daily. She also takes the following: aspirin 75mg - OD paracetamol 500mg- 2 QDS phenelzine 15mg - TDS bisoprolol 10mg - OD hypromellose 0.5% eye drops - PRN After stopping phenelzine, how long does this woman have to wait before she can start taking sertraline? She can take it straight away 10 days 2 weeks 3 weeks 4 weeks

Phenelzine is a non-selective monoamine oxidase inhibitor (MAOI). When switching from a MAOI (like phenelzine) to a selective serotonin reuptake inhibitor (SSRI) like sertraline, there is a risk of serotonin syndrome, which can be life-threatening. To reduce this risk, a washout period of at least 14 days (2 weeks) is recommended after stopping phenelzine before starting sertraline.

Which of the following is a more significant side effect of phenelzine in comparison to sertraline? GI disturbances Muscle ache Nausea Postural hypotension Skin reactions

Postural hypotension

There are four main drugs used in the treatment of Alzheimer’s dementia. Which of the following statements regarding Alzheimer's disease treatment is INCORRECT? donepezil is started at the lowest dose of 10mg initially and increased to 20mg if needed galantamine can cause severe cutaneous skin reactions and are advised to stop taking galantamine at the first signs of a rash memantine is licensed for the treatment of moderate or severe Alzheimer’s disease rivastigmine is an acetylcholinesterase inhibitor rivastigmine patches should be used with caution in patients weighing under 50kg

Doneprizil

What is the target phenytoin plasma concentration, (in mg/L) for optimum response? 5-25 10-20 20-30 40-70 40-80

10-20

28-year-old woman who experiences tonic-clonic seizures. Treatment with phenytoin 25mg capsules has been initiated. She is of childbearing age and is currently not planning on having any children. For this reason, she takes Microgynon 30 (ethinylestradiol with levonorgestrel) daily. Her record confirms that she has been taking this regularly, a requirement set by the pregnancy prevention programme (PPP). What is the cause for concern when seeing both of these on her record? Both medications need to be taken at the same time Microgynon 30 might not be effective when taken with phenytoin Phenytoin might not be effective when taken with Microgynon 30 Taking Microgynon 30 and phenytoin together may cause increased likelihood of heartburn Taking Microgynon 30 and phenytoin together will increase the chances of seizures occurring

Contraceptive may not be as effective when taken with phenytoin

28-year-old woman who experiences tonic-clonic seizures. Treatment with phenytoin 25mg capsules has been initiated. If the level of phenytoin is above the optimum range, which of these side effects is she most likely to experience? acid reflux dizziness hypoglycaemia nausea slurred speech

slurred speech

Sulfasalazine, an aminosalicylate, is an option in patients where conventional corticosteroids are unsuitable for the treatment of Crohn’s disease. Which of the following statements regarding sulfasalazine is true? aminosalicylates are the primary option for maintaining remission in Crohn’s disease patients on sulfasalazine therapy should report signs of unexplained bleeding or bruising Renal function should be monitored every week at the beginning of sulfasalazine therapy Severe cutaneous adverse reactions (SCARs) are common with aminosalicylate therapy The maintenance dose of sulfasalazine is greater than the treatment dose for an acute attack in ulcerative colitis

patients on sulfasalazine therapy should report signs of unexplained bleeding or bruising

Liver function tests are necessary to monitor in patients taking sulfasalazine. After initial testing, at what interval does this parameter need to be tested during the first 3 months? weekly fortnightly monthly every 6 weeks at 3 months

Monthly

A 52-year-old woman who takes theophylline m/r 200mg twice daily for her asthma begins to develop symptoms of nausea, vomiting and tremor. She is admitted to hospital and following some blood tests is diagnosed with acute theophylline toxicity. Which of these following medications may have contributed to her admission to hospital? amlodipine clarithromycin diazepam doxycycline Ramipril

Clarithromycin is a macrolide antibiotic that inhibits cytochrome P450 3A4 (CYP3A4) — the enzyme responsible for metabolising theophylline. When clarithromycin is taken with theophylline, it can increase theophylline levels, leading to toxicity.

Which of these medications commonly used for sedation and/or anaesthesia in the critical care setting, is a schedule 2 controlled drug? isoflurane 1mg/mL inhalation solution ketamine 500mg/10mL solution for injection midazolam 10mg/2mL injections propofol 200mg/20mL emulsion for injection vials thiopental 500mg powder for solution

ketamine

Prescriptions for controlled drugs are subject to more specific requirements than regular prescriptions, the quantity must be in words and figures and the dose must be clearly defined. Which of the below instructions is NOT an example of a legal dose for a schedule 2 controlled drug prescription? administer four-hourly as directed in end of life chart take one every 12 hours Take one tablet when required Take one to two tablets as directed Take one up to three times daily

administer four-hourly as directed in end of life chart

What is the maximum amount of pseudoephedrine that can be sold in one transaction? 180mg 300mg 420mg 720mg 980mg

720mg

Which of the below is a NOT legal requirement for a veterinary prescription for a prescription-only-medicine? Identification and species of the animal Name and address of animal owner Name, address, telephone number and qualification of prescriber Written words stating ‘prescribed under the veterinary cascade’ Written words stating ‘prescribed under the care of the veterinarian

the not legal requirement from the list was written words stating "prescribed under the care of the vet"

A 62-year-old woman broke her wrist in May 2024 and was started on bisphosphonate therapy. The patient takes zoledronic acid. When should this patient's bisphosphonate treatment be reviewed? May 2025 May 2026 May 2027 May 2028 October 2026

According to NICE and UK guidelines: IV zoledronic acid is usually given once yearly. The treatment should typically be reviewed after 3 years of use. In this case: The patient started zoledronic acid in May 2024. Therefore, the review should be due in May 2027

A 56-year-old man who weighs 118kg and is 6ft tall has recently been diagnosed with type 2 diabetes after his Hba1C result. He is a bit unsure how one blood test can diagnose diabetes as his brother-in-law has to check his blood several times a day. His medications are listed below. clopidogrel 75mg tablets- take OD bisoprolol 3.75mg tablets- take OD simvastatin 40mg tablets- take ON metformin 500mg tablets- Take ONE with breakfast for a week then ONE twice daily if tolerated What is the target HbA1c concentration (mmol/L) for this patient? 42 45 48 50 53

A 36-year-old man takes levothyroxine for an underactive thyroid. He believes his medication dose needs increasing. Which of the following symptoms is NOT typical for someone with an underactive thyroid? bradycardia brittle nails constipation heat intolerance weight gain

Heat intolerance is more of a hyperthyroidism symptom

Denosumab 60mg (Prolia) is a monoclonal antibody used for the treatment of osteoporosis in postmenopausal women. Denosumab is associated with a risk of osteonecrosis of the jaw and risk of electrolyte imbalance. Which electrolyte imbalance can Prolia effect? hyperkalaemia hypernatremia hyperphosphataemia hypocalcaemia hyponatraemia

Hypocalceamia

A 13-year-old girl saw her GP a few weeks ago displaying an array of symptoms suspecting type I diabetes. Following further tests, the patient is consequently diagnosed with type I diabetes. Which of the below symptoms is NOT a characteristic feature of type 1 diabetes in children? blurred vision constant malaise polydipsia polyuria weight loss

Blurred vision

While working in a community pharmacy you receive a prescription for a prednisolone reducing dose. A patient is taking 40mg daily and the prescription stipulates he should reduce his dose by 5mg every 4 days until he is taking nothing. How many 5mg prednisolone tablets are required for this prescription? 112 128 136 144 156

144

Pregnant women or women who wish to conceive should be advised to take folic acid. Which of the following groups does NOT require a higher daily dose of folic acid? women who are taking anti-epileptic medication women who are taking thyroid medication women who previously had an infant with a neural tube defect women with diabetes women with sickle-cell disease

Thyroid

Vitamins have soluble properties, where some are soluble in water and others are soluble in fat. Which of the following vitamins is water-soluble? A C D E K

A 5-year-old boy has asthma and uses a beclomethasone inhaler daily. He is also prescribed a spacer. His mother has come into the pharmacy to collect his prescription and ask the pharmacist for some information regarding any monitoring requirements she should be aware of. What is the most important monitoring requirement for a child using inhaled corticosteroids? heart rate height and weight peak flow test regular blood tests respiratory rate

👉 Height and weight Why? Inhaled corticosteroids, even at standard doses, can affect growth in children. Monitoring height and weight over time helps detect any growth suppression early. Growth should be tracked regularly, usually at least once a year, in line with asthma management guidelines (e.g. NICE, BTS/SIGN).

A 46-year-old patient takes warfarin sodium for her atrial fibrillation. On her most recent appointment at the warfarin clinic an INR of 6.7 was measured with no signs of active bleeding or bruising. What is the most appropriate course of action to take? stop warfarin sodium and give phytomenadione by slow intravenous injection plus give dried prothrombin complex stop warfarin sodium and give phytomenadione by slow intravenous injection; repeat dose of phytomenadione if INR still too high after 24 hours stop warfarin sodium and give phytomenadione by mouth using the intravenous preparation orally; repeat dose of phytomenadione if INR still too high after 24 hours take no course of action and wait till the INR drops below 5, then restart warfarin withhold 1 or 2 doses of warfarin sodium and reduce subsequent maintenance dose

Here's the rationale (based on NICE and BNF guidance): For INR >6 but <8 with no bleeding: ✅ Withhold 1 or 2 doses of warfarin. ✅ Consider reducing the maintenance dose. ✅ Monitor INR more frequently. Phytomenadione (vitamin K) is reserved for: Higher INR values (e.g. >8) with no bleeding. INR >6 with minor bleeding. Or any INR with serious bleeding, where IV vitamin K ± prothrombin complex is indicated.

A dose of medicine is made by diluting one part of concentrate to four parts of water. How much concentrate will there be in a 20mL dose? 1mL 2mL 3mL 4mL 5mL

4ml

74-year-old woman who is admitted to the hospital following a fall. She complains of pain in her pelvis. She has a previous diagnosis of high blood pressure, stable angina, and glaucoma. Blood pressure on admission: 90/61 mmHg Medication on admission: aspirin 75mg tablets - 1OD amlodipine 10mg tablets - 1OD GTN 400mcg SL spray - PRN bisoprolol 5mg tablets - 1OD atorvastatin 40mg tablets - 1ON latanoprost eye drops - MDU timolol eye drops – MDU ramipril 10mg capsules (started a week ago) – 1OD During her admission, she explains that recently she has had more episodes of chest pain than usual and has been taking her GTN spray a few times each day. She explains that over the past few days she has been feeling weak, dizzy and nauseous. Which of the following is UNLIKELY to have contributed to this patient's fall? her blood pressure her age low compliance of eye drop medications taking atorvastatin in the daytime instead of the evening overuse of GTN spray

The only reason which would not of contributed to the fall is taking her statin in the day

74-year-old woman who is admitted to the hospital following a fall. She complains of pain in her pelvis. She has a previous diagnosis of high blood pressure, stable angina, and glaucoma. Blood pressure on admission: 90/61 mmHg Medication on admission: aspirin 75mg tablets - 1OD amlodipine 10mg tablets - 1OD GTN 400mcg SL spray - PRN bisoprolol 5mg tablets - 1OD atorvastatin 40mg tablets - 1ON latanoprost eye drops - MDU timolol eye drops – MDU ramipril 10mg capsules (started a week ago) – 1OD During her admission, she explains that recently she has had more episodes of chest pain than usual and has been taking her GTN spray a few times each day. She explains that over the past few days she has been feeling weak, dizzy and nauseous. Which of the following medications is most important to withdraw temporarily? aspirin atorvastatin latanoprost eye drops ramipril timolol eye drops

The patient is hypotensive (BP 90/61 mmHg) and symptomatic (dizzy, weak, nauseous, recent fall). Ramipril is an ACE inhibitor that lowers blood pressure. It was started only a week ago, increasing the risk of first-dose hypotension, especially in the elderly. Continuing ramipril in this situation could worsen her hypotension and increase fall risk. Temporarily withholding it allows her blood pressure to stabilise.

74-year-old woman who is admitted to hospital following a fall. She complains of pain in her pelvis. She has a previous diagnosis of high blood pressure, stable angina, and glaucoma. Blood pressure on admission: 90/61 mmHg Medication on admission: Aspirin 75mg tablets - 1OD Amlodipine 10mg tablets - 1OD GTN 400mcg SL spray - PRN Bisoprolol 5mg tablets - 1OD Atorvastatin 40mg tablets - 1ON Latanoprost eye drops - MDU Timolol eye drops – MDU Ramipril 10mg capsules (started a week ago) – 1OD During her admission, she explains that recently she has had more episodes of chest pain than usual and has been taking her GTN spray a few times each day. She explains that over the past few days she has been feeling weak, dizzy and nauseous. In light of the current situation, which of the following can be done to help get this patient’s angina back under control? increase the dose of ramipril to 10mg BD; reducing her blood pressure will alleviate angina symptoms increase the frequency of use of her GTN SL spray 400mcg introduce clopidogrel; this will help to clear any arterial blockages causing the chest pain once her blood pressure is back to normal, consider increasing the bisoprolol dose as she has not yet reached the maximum use a long-acting nitrate in replacement for her GTN spray

Once her blood pressure is back to normal, consider increasing the bisoprolol dose as she has not yet reached the maximum

74-year-old woman who is admitted to hospital following a fall. She complains of pain in her pelvis. She has a previous diagnosis of high blood pressure, stable angina, and glaucoma. Blood pressure on admission: 90/61 mmHg Medication on admission: Aspirin 75mg tablets - 1OD Amlodipine 10mg tablets - 1OD GTN 400mcg SL spray - PRN Bisoprolol 5mg tablets - 1OD Atorvastatin 40mg tablets - 1ON Latanoprost eye drops - MDU Timolol eye drops – MDU Ramipril 10mg capsules (started a week ago) – 1OD During her admission, she explains that recently she has had more episodes of chest pain than usual and has been taking her GTN spray a few times each day. She explains that over the past few days she has been feeling weak, dizzy and nauseous. The patient is transferred to a surgical ward for surgery. She may require prophylaxis treatment for DVT. Which statement regarding prophylaxis for DVT is true? prophylaxis of DVT can be achieved using compression hosiery only prophylaxis of DVT is best achieved by a single dose of Clexane (enoxaparin) before surgery prophylaxis of DVT will only be required if the surgery is carried out under general anaesthetic prophylaxis of DVT is best achieved by giving a dose of Clexane before surgery and each day afterwards until she is mobile again prophylaxis medication is contraindicated as she is on aspirin

Prophylaxis of DVT is achieved by giving a dose of clean before and each day afterwards until mobile

A woman has the following symptoms: pain on urination, cloudy urine, and lower abdomen pain. A UTI is suspected, and you decide to provide her with empirical antibiotics as you wait for her urine culture sample to come back. She is currently 3 weeks pregnant. What is the best antibiotic to treat this woman? amoxicillin cefalexin metronidazole nitrofurantoin trimethoprim

Nitrofuratoinin

A 59-year-old man has been diagnosed with a chest infection. He is prescribed a short course of amoxicillin to treat his infection and currently also takes ramipril and omeprazole for blood pressure and occasional reflux episodes. He breaks out in a rash after starting the amoxicillin, and rings the pharmacy and wants to speak to the pharmacist. What is the best course of action to take for him? advise patient to continue taking the amoxicillin and to seek urgent medical attention advise patient to stop taking amoxicillin immediately and seek urgent medical attention advise patient to stop using the ramipril as it interacts with amoxicillin causing a rash advise patient that the rash is transient and will disappear after a day or two of the course Reassure the patient that this is a common occurrence and he should continue taking amoxicillin and only seek urgent medical attention if he has any gastrointestinal side effects

Advise the patient to stop taking amoxicillin and immediately seek urgent medical attention

A 78-year-old woman comes into your pharmacy complaining of heartburn. She brings a copy of her hospital discharge letter with her. This contains the following information: Reason for admission: Hip surgery on fractured neck of femur Newly started medications: Adcal D3 chewable tablets, alendronic acid tablets, codeine tablets, paracetamol tablets and macrogol sachets. Which is the most appropriate course of action to take given her symptoms and history? explain that the symptoms could be as a result of her new medication and sell her some Pyrocalm Control (omeprazole) explain that the symptoms could be as a result of her new medication and sell her some Gaviscon liquid explain that the symptoms could be as a result of her new medication and refer her to her GP explain that the symptoms will settle in a few weeks and offer her diet and lifestyle advice to help reduce her symptoms send her back to the hospital pharmacy to discuss her discharge medications

The patient was recently started on alendronic acid, which can cause heartburn and oesophageal irritation. If not taken properly (e.g. without water or not staying upright), it can lead to serious GI side effects. Referral to the GP is safest to assess symptoms and decide whether to stop, switch, or add gastroprotection. OTC treatments like omeprazole or Gaviscon may mask symptoms but won't address the underlying cause. ✅ Referring her to the GP ensures safe management and avoids complication

Your local GP calls for advice regarding a patient who has forgotten to stop his methotrexate therapy whilst on a course of antibiotics for community-acquired pneumonia (CAP). The patient’s usual dose of methotrexate is 15mg once a week. The patient takes amoxicillin 500mg TDS for his CAP. What is the most likely outcome of the patient taking both amoxicillin and methotrexate concurrently? no interaction exists between amoxicillin and methotrexate will occur the patient will be more susceptible to methotrexate toxicity the patient will be more susceptible to a flare-up of their rheumatoid arthritis the concentration of amoxicillin is reduced and therefore the patient will have a sub-therapeutic response to his infection the patient is at an increased risk of experiencing side effects from the amoxicillin

Amoxicillin can reduce the renal clearance of methotrexate, especially at higher doses or in patients with impaired renal function. This leads to increased plasma levels of methotrexate, raising the risk of toxicity.

A 45-year-old man takes Priadel tablets (lithium carbonate modified release) 400mg ON for mania and simvastatin 20mg ON for primary prevention of cardiovascular disease. When should samples be taken after a dose and what target serum-lithium concentration is recommended for acute episodes of mania? 2 hours and 0.4–1 mmol/litre 6 hours and 0.4–1 mmol/litre 6 hours and 0.8–1 mmol/litre 12 hours and 0.4–1 mmol/litre 12 hours and 0.8–1 mmol/litr

Samples should be taken 12 hours after the dose to achieve a serum-lithium concentration of 0.4–1 mmol/litre (lower end of the range for maintenance therapy and elderly patients). A target serum-lithium concentration of 0.8–1 mmol/litre is recommended for acute episodes of mania, and for patients who have previously relapsed or have sub-syndromal symptoms. It is important to determine the optimum range for each individual patient. The correct answer is: 12 hours and 0.8–1 mmol/litre

A 14-year-old girl calls the pharmacy for advice. She had unprotected sex last night and is worried that she could become pregnant. She wants to know whether she could get an emergency hormonal contraception (EHC) pill from the pharmacy. Which of the following statements is most appropriate in this situation? An EHC pill may be available, but the patient would have to pay for it Children under the age of 16 cannot take an EHC pill and must be referred to a sexual health clinic for coil-fitting Due to the patient’s age, her parents must be involved in the decision making process EHC could be supplied under a PGD by an accredited pharmacist providing that the Fraser Guidelines are met It is unlikely that a child of this age could become pregnant

EHC could be supplied under a PGD by an accredited pharmacist providing that the Fraser guidelines are met

Which of the following medications is likely to be the cause of the patient’s abnormal test results?- low potassium carbamazepine furosemide lercanidipine olanzapine phenytoin

Furosemide

A 6-year-old boy has ADHD. He has no other medical conditions or NKDA. What would be the first-line treatment for this patient? atomoxetine bupropion dexamfetamine lisdexamfetamine modafinil

Lisdexamfetamine

A 24-year-old man is started on sodium valproate therapy for migraine prophylaxis. He has had his bloods taken prior to starting treatment. Which blood tests are important to take in the first 6 months of sodium valproate therapy? full blood count kidney function tests liver function tests sodium valproate plasma concentrations thyroid function test

LFT

A 52-year-old man presents at the GP practice for a routine appointment. His wife is also present. The man appears hesitant and his wife discloses that her husband cannot stop gambling. His medications include: -allopurinol -alverine -amlodipine -atorvastatin -aripiprazole Which of his medications is the most likely cause? allopurinol alverine amlodipine atorvastatin aripiprazole

Aripiprazole is an atypical antipsychotic that is sometimes used to treat schizophrenia, bipolar disorder, and as an adjunct in depression. One of the rare but significant side effects of aripiprazole is impulse control disorders, including: Pathological gambling Compulsive shopping Hypersexuality The development of these impulse control problems is a known side effect of aripiprazole and has been documented in the literature. The patient’s gambling problem is most likely linked to the medication he is taking, as it is a known issue for some patients on dopamine-modulating drugs like aripiprazole.

The trainee pharmacist is revising the pain ladder. He asks you when would you refer a patient for further investigation. Which of these back pain symptoms would NOT require referral to a GP? loss of bladder control numbness or tingling in the buttocks pain lasting for more than one week pain that is not relieved on resting pain that is worse at night or affecting sleep

Pain lasting for more than a week

A 65-year-old man is prescribed flucloxacillin 1g QDS to treat his UTI increased risk of QT interval prolongation increased risk of myopathy increased risk of tendonitis increased bleeding risk overdose risk of clostridium difficile infection reduced seizure threshold treatment failure

Treatment failure - not used for UTI

A 75-year-old man with hypertension, COPD, and angina is treated with levofloxacin 500mg OD and prednisolone 30mg OD for an infective exacerbation of COPD. increased risk of QT interval prolongation increased risk of myopathy increased risk of tendonitis increased bleeding risk overdose risk of clostridium difficile infection reduced seizure threshold treatment failure

Increased risk of QT and also increased risk of tendonitis

A 52-year-old woman with bipolar disorder and type II diabetes is prescribed clarithromycin 500mg BD for community acquired pneumonia (CAP). She also takes bisoprolol 5mg OD, metformin 1g BD, citalopram 40mg OM, and lithium 400mg ON. increased risk of QT interval prolongation increased risk of myopathy increased risk of tendonitis increased bleeding risk overdose risk of clostridium difficile infection reduced seizure threshold treatment failure

Increased risk of QT prolongation

A 25-year-old woman with depression and epilepsy takes IV levofloxacin 500mg OD to treat hospital acquired pneumonia. She also takes sertraline 100mg OM and lamotrigine 100mg BD. increased risk of QT interval prolongation increased risk of myopathy increased risk of tendonitis increased bleeding risk overdose risk of clostridium difficile infection reduced seizure threshold treatment failure

Reduced seizure threshold.

A 38-year-old man who regularly visits your pharmacy to collect his weekly methadone prescriptions has been prescribed an alternate antidepressant medication. He is now starting with citalopram 10mg tablets OD increased risk of QT interval prolongation increased risk of myopathy increased risk of tendonitis increased bleeding risk overdose risk of clostridium difficile infection reduced seizure threshold treatment failur

Increased risk of QT interval prolongation

A 33-year-old woman who is 18 weeks pregnant is diagnosed with gestational diabetes. She currently takes sertraline 100mg OD and omeprazole 20mg OD. Which of the medications would be most appropriate first line treatment? canagliflozin empagliflozin exenatide gliclazide insulin metformin pioglitazone sitagliptin

Metformin

A 68-year-old man with type II diabetes is undergoing a review of his medications. As part of his medication review, he has highlighted to the diabetes nurse that he has a lump under the skin of his abdomen. canagliflozin empagliflozin exenatide gliclazide insulin metformin pioglitazone sitagliptin

Insulin is typically administered subcutaneously, often in the abdomen, and long-term use can lead to: Lipohypertrophy – fatty lumps or thickened skin at injection sites Caused by repeated injections into the same area Can affect insulin absorption and glycaemic control

A 21-year-old man with type II diabetes was started on metformin initially, but after his last HbA1c result he was commenced on another medication. He has come back to his GP complaining of regular episodes of hypoglycaemia. Which medication was she commenced on? canagliflozin empagliflozin exenatide gliclazide insulin metformin pioglitazone sitagliptin

Glicazide

This medication blocks a particular receptor that effectively increases the levels of incretin and thus insulin. The medication is not associated with any weight gain but may cause hypoglycaemia. canagliflozin empagliflozin exenatide gliclazide insulin metformin pioglitazone sitagliptin

Sitagliptin is a DPP-4 inhibitor. It inhibits the breakdown of incretin hormones (GLP-1, GIP), increasing their levels. This boosts insulin secretion (glucose-dependent). Weight-neutral. Low risk of hypoglycaemia, but can occur if used with sulfonylureas or insulin.

A 40-year-old man with type 2 diabetes and hypertension presented to his GP with a foot ulcer. canagliflozin empagliflozin exenatide gliclazide insulin metformin pioglitazone sitagliptin

Canna

The following schedule may also be referred to as CD INV POM. Schedule 2 Schedule 3 Schedule 4 Schedule 5 2 years 3 years 5 years 6 years

Sch 5

It would be considered good practice to destroy an out-of-date controlled drug of this schedule in the presence of another staff member. Schedule 2 Schedule 3 Schedule 4 Schedule 5 2 years 3 years 5 years 6 years

Sch 3

Veterinary CD prescriptions are not submitted to the relevant NHS agency. How long should veterinary prescriptions be retained? Schedule 2 Schedule 3 Schedule 4 Schedule 5 2 years 3 years 5 years 6 year

5 years

How long are you legally required to keep a requisition made for a controlled drug between hospital wards? Schedule 2 Schedule 3 Schedule 4 Schedule 5 2 years 3 years 5 years 6 years

2 years

For how long must the controlled drug register legally be kept for from the date of the last entry? Schedule 2 Schedule 3 Schedule 4 Schedule 5 2 years 3 years 5 years 6 years

2 years

A woman with Raynaud’s syndrome is on first-line therapy to treat her condition. bendroflumethiazide diltiazem doxazosin labetalol lisinopril losartan nicorandil nifedipine

Nifedipine

A patient has failed to respond to a combination of a beta blocker and calcium channel blocker to treat their angina and thus has been commenced on the next suitable option. bendroflumethiazide diltiazem doxazosin labetalol lisinopril losartan nicorandil nifedipin

When angina is not controlled with a beta blocker and calcium channel blocker, third-line anti-anginal agents include: Nicorandil Ivabradine Ranolazine Long-acting nitrates (e.g. isosorbide mononitrate) Among the list provided, the only one that fits is: ✅ Nicorandil Why? Nicorandil acts as a potassium channel opener with nitrate-like properties Relieves angina by: Vasodilation (arterial and venous) ↓ Preload and afterload Improved coronary blood flow Often added as third-line when first-line treatments (beta blockers & calcium channel blockers) are inadequate

A patient started on an ACE inhibitor has been switched to a suitable alternative due to having developed a cough. bendroflumethiazide diltiazem doxazosin labetalol lisinopril losartan nicorandil nifedipine

Lorsartan

First line treatment for a 33-year-old pregnant patient with gestational hypertension. Her BP reading is 146/93mmHg. bendroflumethiazide diltiazem doxazosin labetalol lisinopril losartan nicorandil nifedipine

Labetalol

A woman who is 8 weeks pregnant has been feeling very nauseous lately which is preventing her from eating properly. Her concerned husband took her to her GP who has advised her to take the following medication, to be taken three times daily when required. azelastine betahistine cetirizine chlorphenamine cyclizine diphenhydramine fexofenadine loratadine

Cyclizine is an antihistamine with antiemetic properties Commonly used for nausea and vomiting in pregnancy (NVP) Recommended in guidelines (e.g. NICE, RCOG) as a first-line option for moderate NVP Safe in pregnancy Typical dose: 50mg up to three times daily when needed

A nurse is looking for something to help her sleep due to her night shifts sleeping patterns. azelastine betahistine cetirizine chlorphenamine cyclizine diphenhydramine fexofenadine loratadine

Diphenhydramine

A 45-year-old patient on carbimazole and amlodipine has reported sore throat with fever. Chest x-ray ESR Faecal calprotectin FBC LFTs N-terminal pro-B-type natriuretic peptide level TFT U&E

FBC

A 63-year-old patient presented with heart failure symptoms including breathlessness, fluid retention and fatigue. Chest x-ray ESR Faecal calprotectin FBC LFTs N-terminal pro-B-type natriuretic peptide level TFT U&E

NT-proBNP is released by the heart in response to ventricular stretch and pressure overload Elevated levels are a strong marker for heart failure It is recommended as a first-line investigation in patients with suspected heart failure by NICE and ESC guidelines A raised NT-proBNP prompts referral for echocardiography and cardiology assessment

A patient is admitted to hospital urgently following a presentation of a severe headache and stiff neck, and is subsequently administered a dose of IV benzylpenicillin. Acute otitis media Clostridium difficile Community acquired pneumonia Helicobacter pylori Leg ulcer infection Meningitis Septicaemia UTI

Meningitis

A patient is diagnosed with pyelonephritis which if left untreated can result in which of the following infections. Acute otitis media Clostridium difficile Community acquired pneumonia Helicobacter pylori Leg ulcer infection Meningitis Septicaemia UTI

Septicaemia

A patient is assessed by his GP using a CRB-65 scoring system. Acute otitis media Clostridium difficile Community acquired pneumonia Helicobacter pylori Leg ulcer infection Meningitis Septicaemia UTI

CAP