Single Best Answer Set 2

Question 1

Mr BS has been prescribed colestyramine from the GP. He calls to ask you when he should take his other medicines in relation to the colestyramine.
When should she take her other medicines?

A. 1 hour before or 1 hour after
B. 1 hour before or 4 hours after
C. 2 hours before or 4 hours after
D. 30 minutes before or 1 hour after
E. 30 minutes before or 4 hours after

Answer 1

1 hour before or 4 hours after – To reduce possible interference with absorption

Question 2

What advice is incorrect when a pregnant lady is constipated?

A. A bulk-forming laxative is the first choice during pregnancy if fibre supplements fail.
B. An osmotic laxative, such as lactulose, can also be used.
C. Bisacodyl or Senna may not be suitable if a stimulant effect is necessary.
D. Docusate sodium and glycerol suppositories can also be used.

Answer 2

Bisacodyl or Senna may not be suitable if a stimulant effect is necessary.

Bisacodyl and Senna MAY be suitable if a stimulant effect is necessary, but use of Senna should be avoided near term or if there is a history of unstable pregnancy.

Question 3

Which of the following is not recommended in diverticular disease?

Paracetamol
Bulk forming laxatives
Fibre in diet
Antispasmodics
Non-steroidal anti-inflammatory drugs and opioid analgesics

Answer 3

Nsaids

NSAIDs and opioid analgesics are not recommended as their use may increase the risk of diverticular perforation.

Question 4

Which of the following is false regarding Ranitidine’s exception to its legal status for sale to the public?

A. Ranitidine can be sold to the public for adults and children over 12 years
B. Packs being sold must not contain more than 1 weeks’ supply
C. Max. daily dose 300mg
D. Max. single dose 150mg

Answer 4

Packs being sold must not contain more than 2 weeks’ supply

B

• as of Oct 2020 Ranitidineis not currently available in theUK. There is an ongoing investigation into whether some ingredients can increase the risk of cancer. All supplies have been stopped until the medicine is shown to be safe.

Question 5

Which of the following is false regarding antacids?

A. Aluminium- and magnesium-containing antacids, being relatively insoluble in water, are long-acting if retained in the stomach
B. Magnesium-containing antacids tend to be laxative
C. Aluminium-containing antacids may be constipating
D. Antacids containing both magnesium and aluminium may increase these colonic side-effects

Answer 5

Antacids containing both magnesium and aluminium may increase these colonic side-effects FALSE

Antacids containing both magnesium and aluminium may REDUCE these colonic side-effects.

Question 6

Which of the following is false when taking proton pump inhibitors?

Very low risk of subacute cutaneous lupus erythematosus when taking a PPI
Can increase the risk of fractures
May reduce the risk of gastro-intestinal infections
May mask the symptoms of gastric cancer

Answer 6

May reduce the risk of gastro-intestinal infections FALSE

Proton pump inhibitors can INCREASE the risk of gastro-intestinal infections.

Question 7

Which of the following is true for orlistat and weight loss?

A. An anti-obesity drug should be considered only for those with a BMI of ≥ 30 kg/m2
B. A vitamin and mineral supplement may also be considered if there is concern about inadequate micronutrient intake when taking orlistat
C. Treatment with orlistat shouldn’t be used to maintain weight loss. Discontinuation of treatment with orlistat should be considered after 12 weeks if weight loss has not exceeded 10% since the start of treatment.
D. Discontinuation of treatment with orlistat should be considered after 12 weeks if weight loss has not exceeded 10% since the start of treatment

Answer 7

A vitamin and mineral supplement may also be considered if there is concern about inadequate micronutrient intake when taking orlistat

A => An anti-obesity drug should be considered only for those with a BMI of ≥ 28 kg/m2

Question 8

Master KP, 7 years old, has been diagnosed with having pneumonia. The doctor wishes to start antibiotic therapy for Master P.

Which of the following antibiotics below would be contraindicated for Master P? Master P has no allergies to any medication.

Doxycycline
Amoxicillin
Phenoxymethylpenicillin
Co-amoxiclav

Answer 8

Doxycycline only 12+

Question 9

One of your GP colleagues has asked for your advice regarding stopping certain medications in a patient. The patient is approaching end of life and the GP wishes to only continue essential medications. They are aware that certain medications cannot be stopped abruptly.

Which one of the following drugs below should not be stopped abruptly?

Naproxen
Baclofen
Methocarbamol
Pyridostigamine Bromide

Answer 9

Baclofen

Avoid abrupt withdrawal (risk of hyperactive state, may exacerbate spasticity, and precipitate autonomic dysfunction including hyperthermia, psychiatric reactions and convulsions; to minimise risk, discontinue by gradual dose reduction over at least 1–2 weeks (longer if symptoms occur)).

Question 10

Which of the following drugs below is associated with causing arrow-angle glaucoma?

Vilanterol
Beclometasone diproprionate
Tiotropium
Formoterol

Any advice?

Answer 10

Tiotropium
ADR of antimuscarinics:
- Cardiac; arrhythmias and - palpitations.
- Respiratory; paradoxical bronchospasm, throat irritation, and cough.
- GI; dry mouth, abnormal taste, n+v, constipation and diarrhoea.
- ENT; nasal congestion, dry nasal mucosa, and epistaxis.
- Nervous system; headache and dizziness.
- Urinary; bladder outflow obstruction and prostatic hyperplasia.
- Visual disorders: acute angle-closure glaucoma — reported in pt on nebulized ipratropium, particularly when given with nebulised salbutamol.

To reduce the risk:

1. Use mouthpiece instead of mask with nebulizer; minimize eye exposure to drug.
2. On correct administration of DPI and aerosol inhalers avoid accidental release of contents into eye.
3. With angle-closure glaucoma who are using SAMA/LAMA to stop and consult a specialist immediately if they experience eye pain or discomfort, visual halos or coloured images, or temporary blurring of vision.

Question 11

What dose of prednisolone would you expect to see for the treatment of an acute asthma attack for an adult?

30-40mg for 5 days

40-50mg for 5 days

30-40mg for 3 days

40-50mg for 3 days

Answer 11

40 to 50 mg 5 days

Question 12

Which electrolyte disturbance is most likely to occur with Beta2 Agonist therapy?

Hyponatraemia
Hypernatraemia
Hypokalaemia
Hyperkalaemia

Answer 12

HYPOKALAEMIA

Salbutamol hypo K

All b2 selective agonists; BNF
Arrhythmias;cardiovascular disease;diabetes (risk of hyperglycaemia and ketoacidosis, especially with intravenous use);hypertension;hyperthyroidism;hypokalaemia;susceptibility to QT-interval prolongation

Question 13

Mr P has visited the practice to see the advanced nurse practitioner about his ongoing widespread itch. It has been affecting Mr P’s sleep, and as well as self-care advice the nurse decides to prescribe a sedating antihistamine short term, to help with the symptoms. Mr P’s list of medication is below:

Aspirin 75mg 1OD
Atorvastatin 80mg 1OD
Ramipril 10mg 1OD
Bisoprolol 10mg 1OD
Citalopram 20mg 1OD

Which would be the least suitable sedating antihistamine to prescribe for Mr P?

A. Clemastine
B. Chlorphenamine
C. Hydroxyzine
D. Promethazine

Answer 13

C. Hydroxazine X Citalopram

hydroxyzine is associated with a small risk of QT-interval prolongation and torsade de pointes; these events are most likely to occur in patients who have risk factors for QT prolongation, e.g. concomitant use of drugs that prolong the QT-interval, cardiovascular disease, family history of sudden cardiac death, significant electrolyte imbalance (low plasma-potassium or plasma-magnesium concentrations), or significant bradycardia.

Question 14

Which of the following beta-blockers has a long duration of action?

Sotalol
Metoprolol
Acebutol
Nadolol

Answer 14

Nadolol

Beta-blockers with a relatively short duration of action have to be given bd or tds. Many of these are, however, available in MR formulations so that administration od is adequate for HTN. For angina bd treatment may sometimes be needed even with a MR formulation.
Atenolol,bisoprolol,celiprolol, andnadolol, have an intrinsically longer duration of action and need to be given only once daily.

Question 15

Which of the following is an example of a thiazide-like diuretic?

Bendroflumethiazide
Bumetanide
Metolazone
Triamterene

Answer 15

Metolazone

thiazide-like diuretic is a sulfonamide diuretic that has similar physiological properties to a thiazide diuretic, but does not have the chemical properties of a thiazide, lacking the benzothiadiazine molecular structure.

Thiazides
Bendroflumethiazide
Cyclopenthiazide
Hydrochlorothiazide

Thiazide-like
Chlortalidone
Metolazone
Indapamide

Question 16

Mr P just been discharged after a successful hip replacement operation. He has been discharged with Rivaroxaban 10mg 1 OD for prophylaxis of VTE.

How long would you expect Mr P to take the Rivaroxaban for?

14 days
21 days
28 days
35 days

Answer 16

35 days bnf

Prophylaxis of VTE following knee replacement surgery
■ 10 mg od for 2 weeks, started 6–10 hrs after surgery.

Prophylaxis of VTE following hip replacement surgery
■10 mg od for 5 weeks, started 6–10 hrs after surgery.

Treatment of DVT, PE
■ Initially 15 mg bd for 21 days, then maintenance 20 mg od, to be taken with food, for duration of treatment, consult product literature.

Question 17

Upon asking Ms O when she last used her GTN tablets, she informed you it was about 1 month ago when she overdone it in the garden but didn’t think they worked as well as when she first opened the bottle and used some 3 months ago. She proudly tells you that she carries them around with her all the time and shows you. Looking at the label on the opened bottle you can see that this was dispensed on the 19/12/19. You take this opportunity to remind Ms O how important it is to discard GTN SL after a period of time once they have been opened.

When should the GTN SL tablets be discarded once they are in use?

A. 1 week
B. 2 weeks
C. 4 weeks
D. 6 weeks
E. 8 weeks

Answer 17

8 weeks

Question 18

Mr P has come into the pharmacy to hand in a prescription for Isosorbide Mononitrate 40mg 1 BD. He mentions that he was a bit confused as when best to take them. The doctor advised that they should be taken a little differently to normal twice daily medications and asks if you could clarify on when best to take them.

When should the second dose of Isosorbide Mononitrate be taken?

After 4 hours
After 6 hours
After 8 hours
After 12 hours

Answer 18

After 8 hrs

Question 19

Skin condition

• burning
• redness
• butterfly 🦋 shape
• flushing
• > 30 yo

A. Acne
B. Pityriasis versicolor
C. Dermatitis
D. Rosacea

Answer 19

Rosacea

Question 20

What is treatment for rosacea?

A. Refer
B. Acyclovir cream
C. Clotrimazole 1% cream
D. Emollient

Answer 20

A. Refer

Treatment for rosacea from a GP. Rosacea cannot be cured but treatment from a GP can help control the symptoms. It can get worse if it’s not treated.

Question 21

Following an NHS health check 52yo male found to have high LDL
Pt mentions they are not concerned as they ‘haven’t had a stroke and have never been ill before’
Pt mentions his partner tried to encourage dietary change but he did not stick to it
What is the stage pt is in regards to behavioural change model?
A. Precontemplation
B. Contemplation
C. Action
D. Relapse

Answer 21

Precontemplation: no intention to change behaviour
Contemplation: aware problem exists but no commitment to action
Preparation: intent on taking action to address problem
Action: active modification of behaviour
Maintenance: sustained change new behaviour replaces old
Relapse: fall back into old patient behaviour

Correct ans: A precontemplation

Question 22

Which is more sedating than others?
Which one is also used via IV for anaphylactic reactions?
A. promethazine
B. chlorphenamine
C. fexofenadine
D. acrivastine

Answer 22

more sedating than others: chlorphenamine

IV for anaphylactic reactions: chlorphenamine

Question 23

Most likely to be issued for trigeminal neuralgia
A. amitriptyline
B. carbamazepine 
C. duloxetine
D. gabapentin

Answer 23

B. carbamazepine 
amitryptyline - SSRI
carbamazepine - AED
duloxetine - SNRI
gabapentin - anticonvulsant

Neuropathic pain is generally managed with TCA or with certain AED. Amitriptyline and pregabalin are effective tx. They can be used in combo if patient has an inadequate response to either drug at the maximum tolerated dose.

Carbamazepine taken during the acute stages of trigeminal neuralgia, reduces frequency and severity of attacks. It is very effective for the severe pain and (less commonly) glossopharyngeal neuralgia. Blood counts and electrolytes should be monitored with high doses. Small doses should be used initially to reduce SE e.g. dizziness. Some cases respond to phenytoin; the drug may be given by intravenous infusion (possibly as fosphenytoin sodium) in a crisis (specialist use only).