Single Best Answer Flashcards
HB, a 76-year old, 40 kg patient wishes to purchase the following herbal products. Which would you NOT sell based on the following patient record information? Current medications: Warfarin (Coumadin) 2.5mg daily x 2 years. Donepezil (Aricept) 5 mg daily x 2 months I-Ginkgo biloba II-Evening primrose oil III-Vitamin B complex a. I only b.III only side effects c.II and III d.All of these options e.I and II
A gingko biloba risk of bleeding
A child has ingested an unknown substance and has evidence of respiratory depression. This symptom is usually found with poisoning due to:
a. Amphetamines
b. Atropine
c. Mushrooms
d. Kerosene
e. Opioids
The correct answer is e.The main toxic side effect of opioids is respiratory depression.
Joan Linscombe approaches you confidentially stating that she has a problem, every month for the last 5 months and has tried Miconazole and Clotrimazole ovules, 3 day therapy as per her prescribers guidance. Both were effective, but the problem recurs frequently. This time her symptoms include frequent urination and thirst. She had her menstrual period ten days ago, but it is unpredictable. She has not been to her doctor for almost a year. Based on this information, you would be MOST concerned that she could be which of the following options?
a. Using the incorrect product. Recurrent infections respond better to 6-day therapy
b. Overusing non-prescription antifungals and the subsequent bacterial overgrowth is contributing to her recurrent bacterial infections
c. Diabetic and the sugar spilling into her urine may be causing the recurrent yeast infections
d. Undergoing pre-menopausal symptoms and the fluctuation in vaginal pH is contributing to her recurrent yeast infections
e. Diabetic, but the yeast infections could not be associated with the sugar in her urine
The correct answer is c. The polydipsia and polyuria are the most worrying symptoms here, diabetics are more prone to all types of infection including those of the urinary tract. She is not overusing the antifungals as she is following her prescribers guidance which seems not to be excessive. Dependent on the services available at the pharmacy a dipstick urinalysis for pathogenic or hyperglycaemic markers could be performed, which may aid in further diagnosis by a suitably qualified healthcare professional.
A patient complains of headache and his blood pressure is 120/80. His medications include hydrochlorothiazide and hydralazine. Which of the following would seem most likely?
a. The headaches are secondary to thiazide-induced hypokalemia
b. The headaches are secondary to hydralazine therapy
c. The headaches are probably unrelated to drug therapy
d. The headaches are related to hydralazine-induced agranulocytosis
e. The headaches are caused by an temporary increased blood pressure
B headaches are secondary to hydralazine therapy
Hydralazine = vasodilator works by relaxing blood vessels. It produces a fall in peripheral resistance and a decrease in arterial BP, effects which induce reflex sympathetic cardiovascular responses. The concomitant use of a beta-blocker will reduce these reflex effects and enhance the anti-hypertensive effect. The use of hydralazine can result in sodium and fluid retention, producing oedema and reduced urinary volume. These effects can be prevented by concomitant administration of a diuretic.
Se: tachycardia, palpitations, headache,
Which of the following statements is FALSE about blood drug monitoring?
a. Carbamazepine often requires monitoring
b. Sodium valproate often requires monitoring
c. Digoxin often requires monitoring
d. Drugs which have significant pharmacokinetic variability often need monitoring
e. Monitoring should be performed immediately after the first dose
The correct answer is e.The main drugs which require therapeutic monitoring include those with:
- narrow target range
significant pharmacokinetic variability - a reasonable relationship between plasma concentrations and clinical effects
- established target concentration range
- availability of cost-effective drug assay.
MD, a 17 year old, presents with a purpuric skin rash. She wonders if she is having another flare-up of her eczema, but this rash looks different to previous presentations. Her patient medical record reveals the following: Allergies: penicillin History: eczema x 2.5 years epilepsy x 1 month Current medications: Betamethasone Cr 0.05% bid prn x 2.5 years Ethinyl estradiol/ levonorgestrel x 10 months Phenytoin 200mg qhs x 1 month. What is the most probable cause of her skin rash?
a. An acute flare-up of her eczema
b. A reaction to phenytoin
c. A reaction to oral contraceptives
d. An interaction between ethinyl estradiol with levonorgestrel and phenytoin
e. A reaction to the steroid
The correct answer is b.Phenytoin is a highly effective and widely prescribed anticonvulsant agent. Phenytoin is however, associated with both dose related side effects and hypersensitivity reactions. 5-10% of patients using phenytoin have a skin reaction.
The best definition for “Phlebotomy” is which of the following?
a. The act or practice of opening a vein for letting or drawing blood as a therapeutic or diagnostic measure
b. The act or practice of opening a artery for letting or drawing blood as a therapeutic or diagnostic measure
c. The branch of medicine and biology concerned with immunity
d. The branch of medicine and biology concerned with arthritic conditions
e. The branch of medicine and biology concerned with respiratory secretions
The correct answer is a. 1. The removal of blood from a vein, usually with a needle and syringe or other container, for diagnostic or therapeutic purposes, as in the treatment of hemochomatosis. 2. The removal of blood from a vein with a cutting instrument, formerly done to reduce blood volume as a treatment of disease. In both senses also called venesection.
Which of the following is a cause of hyperkalemia?
a. Acidosis
b. Crush injury
c. ACE inhibitor
d. Hypoaldosteronism
e. All of these options
The correct answer is e.Medication that interferes with urinary excretion:
ACE inhibitors and angiotensin receptor blockers
Potassium-sparing diuretics (e.g. amiloride and spironolactone)
NSAIDs such as ibuprofen, naproxen, or celecoxib
The calcineurin inhibitor immunosuppressants ciclosporin and tacrolimus
The antibiotic trimethoprim
The antiparasitic drug pentamidine
Mineralocorticoid deficiency or resistance, such as: Addison’s disease Aldosterone deficiency
Some forms of congenital adrenal hyperplasia Type IV renal tubular acidosis (resistance of renal tubules to aldosterone)
Regarding cholesterol therapy, the goal is to achieve which of the following?
a. Reduce LDL and raise triglycerides
b. Reduce LDL and raise HDL
c. Raise LDL and raise HDL
d. Raise LDL and reduce triglycerides
e. None of these options
The correct answer is b.Total cholesterol LDL (low-density lipoprotein cholesterol, also called “bad” cholesterol) HDL (high-density lipoprotein cholesterol, also called “good” cholesterol)Triglycerides (fats carried in the blood from the food we eat. Excess calories, alcohol, or sugar in the body are converted into triglycerides and stored in fat cells throughout the body.)
Mr. H is seeking advice about this wife, Mrs. H (aged 30). They have just returned from their holiday in Australia and Mrs. H is complaining of a stiff inflamed lower leg. He says it is quite red and hot. She is not taking any medication except her usual combined oral contraceptive pill, What is the most appropriate advice?
a. Seek medical help immediately
b. Sell ibuprofen 400mg and tell her to take it regularly for five days
c. Recommend that she follows the RICE approach and seek further advice if no improvement after seven days
d. Sell aspirin for DVT prophylaxis
e. Make an appointment to see her GP
The correct answer is a. The patient has been on a long haul flight (above 6 hours). The symptoms he is describing could be a potential DVT which requires urgent medical referral. Management of this condition if often sough from a hospital where low molecular weight heparin (LMWH) is usually given. It is an important part of a pharmacists daily job to look out for these types of “red flag” warning signs that a patients life may be in danger and then be able to sign post correctly.
Which of the following tests will give a decreased test result in patient suffering from renal failure?
a. Serum Creatinine
b. Blood Urea Nitrogen
c. Creatinin clearance
d. Urea breath Test
e. All of these options
C
Which of the following medicines will increase Theophylline serum levels if combined with Theophylline?
a. Carbamazepine
b. Tobacco smoking
c. Phenytoin
d. Ciprofloxacin HCl
e. All of these options
The correct answer is d.
Patient name: DA Age: 60 years old Gender: male Allergies: No known allergies Medical conditions: Type 2 Diabetes, Hypercholesterolemia, Occasional angina Other: Half-marathon walker, eats grapefruit Medications:
Atorvastatin (Lipitor) 20 mg qhs - start 2 yrs ago
Metformin (Glucophage) 500 mg TID - start 2 yrs ago
Sildenafil (Viagra) 100 mg hs prn - start 2 months ago Nitroglycerin (Nitrolingual) 0.4 mg Spray 1-2 sprays sl prn -initiate-start 3 weeks ago
DA requests a repeat of his sildenafil (Viagra) prescription.
You would be concerned about all of the following EXCEPT:
a. Atorvastatin with grapefruit
b. Sildenafil with nitroglycerin
c. Metformin with atorvastatin
d. Heart conditions and marathons
e. Sildenafil with grapefruit
correct answer is c.As the patient has angina the marathon running may be an issue, the others and standard interactions.
Which one of the following is least likely to cause a significantly elevated level of ALT (SGPT)?
a. Viral hepatitis
b. Diabetes
c. Congestive heart failure
d. Liver damage
e. Transient ischaemic event
The correct answer is e.
Significantly elevated levels of ALT (SGPT) often suggest the existence of other medical problems such as viral hepatitis, diabetes, congestive heart failure, liver damage, bile duct problems, infectious mononucleosis, or myopathy, so ALT is commonly used as a way of screening for liver problems. Elevated ALT may also be caused by dietary choline deficiency. However, elevated levels of ALT do not automatically mean that medical problems exist. Fluctuation of ALT levels is normal over the course of the day, and they can also increase in response to strenuous physical exercise.
Patient Name: FJ Age: 40 years old Allergies: No known allergies History: Smoker Current medications: Zopiclone 7.5 mg qhs prn x 30
FJ presents the following new prescription:
Clarithromycin 500mg bid x 7 days
Metronidazole 500 mg bid x 7 days
Bismuth subsalicylate (Pepto Bismol) ii tabs qid x 7 days
What is the most likely diagnosis according to this new prescription drug regimen?
a. Helicobacter pylori infection induced peptic ulcer
b. Salmonella intestinal infection
c. Intestinal amoebiasis
d. Escherichia coli intestinal infection
e. Gardnerella vaginitis
The correct answer is a
ALT is commonly measured clinically as a part of a diagnostic evaluation of hepatocellular injury, to determine liver health. When used in diagnostics, it is almost always measured in international units/liter (IU/L). Significantly elevated levels of ALT (SGPT) often suggest the existence of other medical problems such as viral hepatitis, diabetes, congestive heart failure, liver damage, bile duct problems, infectious mononucleosis, or myopathy, so ALT is commonly used as a way of screening for liver problems.
Which of the following is an example of an enzyme inhibitor?
a. Grisoefulvin
b. Phenytoin
c. Phenobarbitone
d. Fluconazole
e. Smoking cigarettes
The correct answer is d.
Patient Name: HR, Age: 79 yo, Allergies: Allopurinol
Current medications:
Zopiclone 7.5 mg hs prn
Hydrochlorothiazide 25 mg daily
Potassium chloride 600 mg (slow K) ii bid
Digoxin 0.25 mg daily
HR has a prescription for: Verapamil SR 240 mg daily
Upon reviewing the patient record, you would:
a. Call the doctor regarding a possible hydrochlorothiazide interaction
b. Call the doctor to decrease the dose of verapamil
c. Dispense as written; warn the patient to notify you of any new gastrointestinal symptoms
d. Call the doctor regarding a potential digoxin interaction
e. Call the doctor regarding a potential verapamil hypersensitivity
The correct answer is e. Serum digoxin concentration rise by 60-75% due to decreased renal tubular secretion and nonrenal clearance mechanisms. Additionally, there appears to be a synergistic effect of slowing impulse conduction and muscle contractility, leading to bradycardia and possible heart block.
ALT is most commonly measured clinically as a part of a diagnostic evaluation of which of the following?
a. Hepatocellular injury
b. Brain injury
c. Cardiac injury
d. Respiratory injury
e. Ocular nerve degradation
The correct answer is a.
ALT is commonly measured clinically as a part of a diagnostic evaluation of hepatocellular injury, to determine liver health. When used in diagnostics, it is almost always measured in international units/liter (IU/L). Significantly elevated levels of ALT (SGPT) often suggest the existence of other medical problems such as viral hepatitis, diabetes, congestive heart failure, liver damage, bile duct problems, infectious mononucleosis, or myopathy, so ALT is commonly used as a way of screening for liver problems.
Which of the following options would be considered the most common cause of HYPOcalcemia?
a. Rickets
b. Osteomalacia
c. Renal failure
d. Massive blood transfusion
e. Idiopathic hypoparathyroidism
The correct answer is c
Which of the following white blood cells is capable of phagocytosis?
a. Basophil
b. Eosinophil
c. Lymphocyte
d. Neutrophil
e. Platelets
The correct answer is d.Phagocytosis is the process by which a cell can ingest and digest other cells. The two WBCs that are phagocytic in nature are neutrophils and monocytes.
Torsade de pointes is a lethal complication of ventricular tachycardia.
It can be caused by drugs such as sotalol and hypokalaemia.
What is the treatment for Torsades de Pointes?
A. IV Mg Sulfate
B. IV amiodarone
C. IV sodium chloride
D. IV flumenazil
A iv mg sulfate
Mrs L comes into the pharmacy complaining of congestion and productive cough. She takes lisinopril 5mg regularly for her BP.
Which product can you sell her?
A. Robitussin chesty cough
B. Sudafed
C. Lemsip max sinus and flu
D. Day and night nurse caps
A correct. Guaifenesin expectorajt. If you’re taking medicines for highblood pressureyou shouldn’t takeRobitussinmucus cough and congestion relief as well, because the pseudoephedrine may make yourblood pressuremedicine less effective.
B. Sudafed has pseudoephedrine
C. Lemsipproducts contain decongestants (paracetamol and phenylephrine) which constrictbloodvessels; this may worsen raisedBP. ThereforeLemsip, which contains decongestant, should not be taken.
D. Day; paracetamol, pseudoephedrine, pholcodine
Night; paracetamol, promethazine, dextromethorphan
Match the antidotes to the drug
- Protamine sulfate
- Pyridoxine
- Physostigmine
- IV Flumenazil
- Naloxone
- Glucagon
- Activated charcoal
- N- acetylcysteine
- Phytomenadione
A. Isoniazid B. Benzodiazepines C. Beta blockers D. Acetaminophen E. Many toxins F. Heparin G. Anticholinergics H. Warfarin I. Opioids
Naloxone = opioids Physostigmine = anticholinergics Protamine sulfate = heparin Pyridoxine = isoniazid Glucagon = beta blockers N- acetylcysteine = acetaminophen Phytomenadione = warfarin Flumenazil = benzodiazepines Activated charcoal = many toxins
Match the vitamin to the following statements.
Vitamin A, B, C, D, E, K
- Helps with the common cold
- Deficiency can cause scurvy
- Contraindicated pregnancy
- Deficiency can cause rickets
- Tocopherol
- Green leafy veg
- Given to all newborns to prevent neonatal haemorrhage
- Deficiency petechiae
- Warfarin + vitamin => enhanced anticoagulation
- Antioxidant effect
- Deficiency beriberi
- Thiamine
- Helps with the common cold - C
- Deficiency can cause scurvy - C
- Contraindicated pregnancy - A
- Deficiency can cause rickets - D
- Tocopherol - E
- Green leafy veg - K
- Given to all newborns to prevent neonatal haemorrhage - K
- Deficiency petechiae - B3 (niacin) and C
- Warfarin + vitamin => enhanced anticoagulation - K
- Antioxidant effect - C
- Deficiency beriberi - B1
- Thiamine - B1
Max sumatriptan you can take in 24 hrs? A. 4 tabs B. 6 tabs C. 2 tabs D. 1 tabs E. No restrictions on maximum dose
Max dose 300mg in 24 hrs
Comes in 50mg or 100mg
B
What dose of prednisolone would you expect for an acute asthma attack? A. 30 - 40mg for 5 days B. 30 - 40mg for 3 days C. 40 - 50mg for 5 days D. 40 - 50mg for 3 days
C. 40 - 50mg for at least 5 days
The MHRA released advice regarding Domperidone, in particularly the duration of its use. The advice restricts the dose, indication and duration of use, due to the risk of serious cardiac side-effects.
How many days should Domperidone be prescribed for?
A) Up to 3 days
B) Up to 4 days
C) Up to 5 days
D) Up to 7 days
D 7 days
Domperidone is no longer indicated for the relief of n+v in children < 12 yrs or those weighing < 35 kg. A European review concluded that domperidone is not as effective in this population as previously thought and alternative treatments should be considered. Healthcare professionals are to use the lowest effective dose for the shortest possible duration (max. treatment duration should not usually exceed 1 week).
You are currently conducting a medication history for Mr N who was admitted to the ward this morning.
You gather that he is currently on:
Tegretol® Prolonged Release 200mg: 1 BD
Sertraline 50mg: 1 OD
Ramipril 10mg: 1 OD
Paracetamol 500mg: 1-2 QDS PRN
He presented being confused, lethargic and generally fatigued. You review his blood results and find that there is an electrolyte disturbance.
Based on the medication Mr N is taking, and the clinical presentation he presented with, which electrolyte disturbance is most likely to have occured? A) Hypokalaemia B) Hyponatremia C) Hypernatremia D) Hypocalcemia
Carbamazepine => hyponatraemia
Sertraline => hyponatraemia
B
You are conducting an anti-depressant medication review with 79 yo Mr PL. You have been seeing Mr PL who was commenced on Sertraline 50mg 1 OD a year and a half ago since the passing of his wife. Today Mr PL informs you he feels as though he does not need this medication anymore and is informing you, he is in a much better place. He has, over the last week or so started to wonder if he can come off this medication.
How long should antidepressant treatment be continued in Mr PL following
remission?
A) 1 week
B) 4 weeks
C) 6 months
D) 12 months
C
The dose should preferably be reduced gradually over about 4 weeks, or longer if withdrawal symptoms emerge (6 months in patients who have been on long-term maintenance treatment).
Mr A, 47 years old, has been coming into the practice to talk about their ongoing depression. Mr A has been undergoing psychological and psychosocial interventions, however this has not seemed to help. The GP is looking at possible pharmacological treatment options. Mr A is at very low risk of self-harm and has no other medical problems. Which of the following treatments below would be most appropriate? A) Citalopram B) Amitriptyline C) Clozapine D) Phenelzine
A. SSRIs are better tolerated and are safer in overdose than other classes of antidepressants and should be considered first-line for treating depression.
Citalopram = SSRI Amitriptyline = TCA Clozapine = antipsychotic Phenelzine = moai
Miss R, has been diagnosed with epilepsy. She has come into the practice to see the GP after having a seizure yesterday. Whilst having a seizure, she injured herself resulting in being in severe pain. What would be the least appropriate analgesic to prescribe to Miss R? A) Paracetamol B) Tramadol C) Codeine D) Naproxen
B
Seizuresare a rare side effect of tramadol. Tramadol-relatedseizuresare short, tonic-clonic seizuresthat, like other drug- related seizures, are self-limiting. Thisoccurs at both low and high doses.
Mr I has presented a prescription for some Matrifen® (Fentanyl) patches. You are counselling Mr I on these patches, as this is the first time he has had them.
Which of the following statements is most appropriate regarding counselling for these patches?
A) Remove and change patch every 72 hours, place replacement patch on the same area.
B) Remove and change patch every 48 hours, place replacement patch on a different area.
C) Remove and change patch every week, place replacement patch on a different area.
D) Remove and change patch every 72 hours, place replacement patch on a different area.
D
The MHRA released advice regarding Metoclopramide, in
particularly the duration of its use. The advice reinforces the fact, that prolonged use can possibly cause serious neurological adverse
effects.
How many days should Metoclopramide be prescribed for?
A) Up to 3 days
B) Up to 4 days
C) Up to 5 days
D) Up to 7 days
C
In adults > 18 yrs, metoclopramide should only be used for prevention of postop, radiotherapy-induced, delayed (but not acute) chemotherapy-induced, and symptomatic treatment of n+v, including that associated with acute migraine (where it may also be used to improve absorption of oral analgesics ~gastric stasis);
Only be prescribed for short-term use (up to 5 days);
Usually 10 mg, up to tds; max. daily dose 500mcg/kg;
IV doses be given as slow bolus over at least 3 min;
Oral liquid formulations be given via an appropriately designed, graduated oral syringe to ensure dose accuracy.
This advice does not apply to unlicensed uses of metoclopramide (e.g. palliative care).
You are carrying out a polypharmacy medication review with Mr N.C. As part of the review you check his adherence and compliance to his medication regime.
Mr N.C informs you that on the whole he is happy with his medications, apart from one.
This particular medication which is part of Mr N.C treatment regime is causing him a dry mouth which does not like, and therefore does not take it regularly as he should.
Which of the medications below is likely to be the cause for Mr N.C dry mouth?
A) Salbutamol
B) Salmeterol
C) Beclometasone Dipropinate
D) Tiotropium
D
Tiotropium is an antimuscarinic bronchodilator. It works by relaxing and opening the air passages to the lungs to make breathing easier.Tiotropium acts mainly on M3 muscarinic receptors located in the airways to produce smooth muscle relaxation and bronchodilation. Most common adverse effect is dry mouth 👄
Mr L, 58 years old has come into the practice today to see his regular GP. Mr L has recently been experiencing pain in his back.
Below is the list of medication Mr Lis currently taking.
Priadel 400mg Tablets
Levothyroxine 100mcg Tablets
Olanzapine 10mg Tablets
What would be the least suitable analgesic to prescribe, considering Mr L’s medication?
A) Naproxen
B) Paracetamol
C) Codeine
D) Meptazinol
A
Taking lithium along with NSAIDs might increase the risk of lithium side effects. Avoid taking lithium supplements and NSAIDs at the same time. Some NSAIDs include ibuprofen, indomethacin, naproxen, piroxicam, aspirin, and others.
Miss U, 73 years old is new to the practice. You are currently conducting a meds reconciliation from her previous practice notes.
From the notes you can see that she has been stabilised on a brand of Lithium Citrate for 20 years, and her bloods from the last 3 years all show Lithium being in range.
She also has her annual secondary care mental health review with the psychiatry team.
How often should Miss U come in for monitoring for her Lithium?
A) 2 weekly
B) Monthly
C) 3 monthly
D) 6 monthly
D
Routine serum-lithium monitoring should be performed weekly after initiation and after each dose change until concentrations are stable, then every 3 months for the first year, and every 6 months thereafter. Patients who are 65 years and older, taking drugs that interact with lithium, at risk of impaired renal or thyroid function, raised calcium levels or other complications, have poor symptom control or poor adherence, or whose last serum-lithium concentration was 0.8 mmol/litre or higher, should be monitored every 3 months. Additional serum-lithium measurements should be made if a patient develops significant intercurrent disease or if there is a significant change in a patient’s sodium or fluid intake.
Which of the following treatments for gout do not induce fluid retention and can be co-administered with anticoagulants? A. Febuxistat B. Naproxen C. Allopurinol D. Canakinumab E. Omeprazole
The use ofcolchicineis limited by the development of toxicity at higher doses. However unlike NSAIDs, it does not induce fluid retention; moreover, it can be co-administered with anticoagulants.
A pt of yours suffers from gout and standard treatment has not been effective. He has recently had his gouty arthritis attack making it the 4th one this year. What drug can be initiated at this stage? A. methotrexate B. benzodiazepine C. xanthine oxidase inhibitor D. interleukin-1 inhibitor E. corticosteroid
An interleukin-1 inhibitor, such ascanakinumab, can be considered for treatment of frequent gouty arthritis attacks (at least 3 in the previous 12 months) in patients who have an inadequate response to standard treatment.
A pt has been started on allopurinol which has been titrated up to a higher dose every four weeks to reach <300micromol/L serum uric acid.
He has recently had an acute gout attack fir which he was given colchicine in hospital. For how long should he continue to take colchicine for?
A. 7 days
B. 30 days
C. 28 days
D. 3 months
E. 6 months
Bonus: if the patient were contraindicated to the use of colchicine what is the alternative?
E
The initiation or up-titration of urate-lowering therapy may precipitate an acute attack, and thereforecolchicineshould be considered as prophylaxis and continued for up to 6 months.
A low-dose NSAID with gastro-protection is an alternative in patients who have contra-indications tocolchicine. If an acute attack develops during treatment, the urate-lowering therapy should continue at the same dosage and the acute attack treated separately.
Pityriasis rosea is a relatively common skin condition that causes a temporary rash of raised red scaly patches on the body. What is the name of the rash that appears in the first 2-3 days?
A. Widespread rash
B. Heralds patch
C. Vitiligo
B
Mr. P attends your pharmacy based travel clinic with his 9-year old son. He asks for advice about malaria tablets for their upcoming trip to Ghana. Mr. P is currently taking citalopram 10 mg and amlodipine 10 mg. His son does
not take any regular medication. Neither Mr P nor his son have any known allergies.
You check the appropriate website and confirm that there is a high risk of malaria in Ghana and the
recommended anti-malarials are atovaquone with proguanil hydrochloride or doxycycline or mefloquine.
Considering Mr P would prefer for both him and his son to take the same anti-malarial tablets, which of the
following would be the most appropriate?
A. Atovaquone alone
B. Atovaquone combined with proguanil
C. Doxycycline
D. Mefloquine
E. Proguanil alone
Answer: B - Atovaquone/Proguanil
- Doxycycline not suitable for children <12 years.
- Mefloquine not suitable for Mr P due to history of depression.
- Atovaquone/proguanil suitable for both
Miss J, aged 16-years, comes into the pharmacy asking to speak to the pharmacist privately. Miss J explains that she is experiencing very heavy periods and often bleeds through her bedding at night. She also needs to change
her sanitary protection every two hours throughout the day which is preventing her from doing her normal
everyday activities. She read online that there are medicines she can buy to help with this. She is currently not taking any other medicines and has no allergies.
What would be the most appropriate response to Miss J?
A. No action required, condition is self-limiting
B. Refer to GP
C. Supply ibuprofen tablets
D. Supply paracetamol tablets
E. Supply tranexamic acid tablets
B
patient has symptoms of menorrhagia, this can be treated OTC with tranexamic acid however as patient is
16 years old, we cannot supply (women aged 18-45 years), therefore must refer patient to GP to get prescription.
Paracetamol, ibuprofen would not be sufficient for treatment.
Mrs G, a 39-year-old woman, comes into your pharmacy asking to purchase Alli© (orlistat) to aid weight loss.
Which of the following statement is INCORRECT?
A. Alli© may potentially impair the absorption of fat-soluble vitamins
B. Alli© should be taken in conjunction with high fat, mildly hypocaloric diet
C. Alli© should only be sold to overweight adults with a BMI >28kg/m²
D. Maximum daily dose of 180mg in divided doses.
E. Treatment with OTC Alli© should not exceed 6 months
B
Statement should say low fat, mildly hypocaloric diet.
Mr O, a 47-year-old man, requests to buy OTC Pantoloc Control© (Pantoprazole)for the treatment of heartburn.
He is not taking any other medicines and has no allergies.
Which of the following signs/symptoms would make the supply unsuitable?
A. Acidic taste in mouth after meals
B. Burning sensation in middle of the chest
C. Family history of colon cancer
D. Increased appetite
E. Unintentional weight loss
E
Mr. K, a 65-year-old man, comes into the pharmacy asking to speak to the pharmacist regarding the purchase of Viagra Connect® (sildenafil 50mg tabs). You speak to Mr K in the consultation room and ask questions to determine whether you can make a supply. After questioning, you decide to refer Mr. K to his GP as you are unable to supply the medicine as a Pharmacy medicine.
Which of the following is the most likely reason that the supply for Mr. K was NOT appropriate?
A. He drinks alcohol
B. He is 65 years old
C. He is currently taking doxazosin
D. He is currently taking lansoprazole
E. He is a smoker
C Interaction between sildenafil and alpha blockers. Doxazosin causes significant hypotensive effects when
given with sildenafil.
Master M, an 8-year-old child, has been diagnosed with scarlet fever. He is known to be allergic to penicillin.
Which of the following would be the most appropriate option for Master M to treat his condition?
A. Azithromycin 300 mg once daily for 5 days
B. Doxycycline 200 mg daily for 7 days
C. No treatment, the condition is self-limiting.
D. Phenoxymethylpenicillin 250 mg qds for 10 days
E. Treatment with paracetamol alone
A, Azithromycin.
- not B & D, due to child’s age and history of penicillin allergy
- not C & E. Paracetamol can be given alongside the antibiotics.
Scarlet fever should be treated promptly with antibiotics to prevent complications, regardless of the severity. Azithromycin is recommended for ppl with penicillin allergy.
1st line is Phenoxymethylpenicillin qds for 10 days, however, this is unsuitable due to history of allergy.
Doxycycline is unsuitable as it is not a recommended antibiotic for this condition, plus it should not be prescribed for children <12 years.
Miss V, a 10-year-old child, has been experiencing fever, runny nose, and a red rash for the past 72 hours. Her mother took her to see the GP who recommended paracetamol and plenty of fluids and said the child does not need to stay off school. The GP found no other symptoms, including no signs of photophobia, stiff neck or vomiting.
Which of the following conditions is the most likely diagnosis for Miss V’s condition?
A. Chickenpox
B. Impetigo
C. Meningitis
D. Scarlet fever
E. Slapped cheek syndrome
E
Once diagnosed with slapped cheek syndrome, you do not need to keep your child off school because once the rash appears, they are no longer infectious. It is usually a mild, self-limiting illness.
For children and adults (not pregnant) with suspected parvovirus B19 infection, management includes
advice on:
• Symptom relief, such as fluids, analgesia, and rest.
• The need for exclusion from school, nursery, or work (if appropriate). Note: this is not usually necessary as the
person is no longer infectious one day after any rash or symptoms develop.
Scarlet fever, impetigo and meningitis would all require antibiotic treatment. If your child has chickenpox, they need to be kept off school until all the spots have crusted over.
Mrs G, aged 73 years, has recently been discharged from hospital following a stroke. The hospital has started Mrs G on clopidogrel, however the consultant is concerned about the risk of gastrointestinal bleeding and would like to co-prescribe gastrointestinal protection.
Which of the following medicines would be the least appropriate to co-prescribe?
A. Lansoprazole
B. Omeprazole
C. Pantoprazole
D. Rabeprazole
E. Ranitidine
B
Interaction between clopidogrel and proton pump inhibitors. Proton pump inhibitors are inhibitors of CYP2C19 with varying degrees of potency. Therefore,PPIsmay inhibit activation ofclopidogrelto its active metabolite via CYP2C19 leading to decreased serum concentrations of the active metabolite and potentially reducing the antiplatelet effect ofclopidogrel.
FDA, MHRA and EMA discourage use of omeprazole and esomeprazole in patients taking clopidogrel (this is also
shown in BNF appendix 1).
Pantoprazole is the least likely to interact and lansoprazole and rabeprazole are also suitable alternatives.
A GP practice based pharmacist is carrying out a medication review for Mrs L, aged 67 years. The pharmacist is considering the appropriateness of a statin for Mrs L, given her myocardial infarction 2 years ago. According to her current and past medication lists, Mrs L has never been prescribed a statin. You cannot see from her notes any clinical reason why a statin would not be appropriate and so decide to initiate one.
Which statin would be considered first line for Mrs L?
A. Atorvastatin 20 mg o.d.
B. Atorvastatin 80 mg o.d.
C. Rosuvastatin 20 mg o.d.
D. Simvastatin 20 mg o.d.
E. Simvastatin 80 mg o.d.
B: atorvastatin 80 mg.
NICE - Atorvastatin 80mg od 1st line for 2ndary prevention of CVD.
https://cks.nice.org.uk/topics/lipid-modification-cvd-prevention/management/lipid-therapy-secondary-prevention-of-cvd/
Prescribe a lower dose if:
There aredrug interactions.
There is an increased risk ofadverse events.
The person requests to start at a lower dose.
High intensity statin treatment is the most clinically effective option for the prevention of CVD. However, statins at any intensity reduce CVD risk compared with no treatment.
