Single Best Answer Set 4

Question 1

An 11-year-old boy is admitted to hospital with an infective exacerbating of asthma. He has a past medical history of asthma, which has been well controlled until the development of infection. He is penicillin allergic. His current medication is as follow:

Salbutamol 100mcg MDI 2 puffs PRN

Seretide accuhaler 100 1 puff BD

Which of the following would be the most appropriate treatment option?

A. Amoxicillin
B. Cefalexin
C. Clindamycin
D. Erythromycin
E. Tetracycline

Answer 1

Erythromycin

Amoxicillin would be the MOST appropriate treatment however the patient is penicillin allergic and therefore erythromycin is a suitable alternative. Macrolides have a similar spectrum of activity and are commonly used when patients are penicillin allergic.

Question 2

A patient comes into your pharmacy to speak to you. They have recently started taking theophylline a few weeks and think they are experiencing a side effect due to the drug.

Which of the following could be caused by theophylline?

A. Constipation
B. Tremor
C. Increased appetite
D. Diarrhoea
E. Dizziness

Answer 2

D. Diarrhoea

Theophylline side effects include: Arrhythmias; CNS stimulation; convulsions; diarrhoea; gastric irritation; headache; insomnia; nausea; palpitation; tachycardia; vomiting.

Question 3

Mrs B comes into the pharmacy complaining of a sore mouth that she has developed over the past 24 hours. You notice on examination that she has red and raw cheeks and tongue. Upon questioning you find that she has newly started Clenil Modulite inhaler (beclomethasone dipropionate) 2 weeks ago. You send Mrs B to the GP. The GP contacts you and asks what would be the most appropriate initial treatment for Mrs B?

Which of the following would be the most appropriate initial treatment?

A. Co-amoxiclav 500/125ng TDS
B. Strepsil lozenges
C. Itraconazole 100mg BD
D. Fluconazole 50mg OD
E. Nystatin (100,000 units/mL) 1mL QDS

Answer 3

Nystatin
Mrs B has oral thrush due to her newly prescribed Clenil Modulite inhaler (beclomethasone). Initial treatment should be with nystatin or miconazole. Fluconazole is effective for unresponsive infections or if a topical anti-fungal cannot be used or if the patient has dry mouth.

Question 4

A patient on your ward asks you to explain how to use his inhaler. You check his medication locker and find Symbicort® (Budesonide/Formoterol).

Which of the following instructions would you give regarding Symbicort® (Budesonide/Formoterol)?

A. Inhale slowly and gently
B. Inhale slowly and deeply
C. Inhale quickly and deeply
D. Inhale quickly and shallowly
E. Inhale slowly and shallowly

Answer 4

Symbicort® (budesonide/formoterol) is a dry powder inhaler and should be inhaled quickly and deeply to ensure adequate delivery to the lungs.

Question 5

A patient comes with his 4 yo daughter with a prescription for Seretide 50 Evohaler (salmeterol and fluticasone). The dose states TWO puffs TWICE a day with a spacer. Which of the following actions would be the most appropriate;

A. Return prescription to prescriber for alternative brand
B. Contact prescriber to discuss supply of unlicensed medicines
C. Contact prescriber to reduce dose to ONE puff TWICE a day
D. Contact prescriber to reduce dose to TWO puffs ONCE a day
E. Return prescription to prescriber alternative inhalation device

Answer 5

B

Salmeterol unlicensed in <5 yo

Question 6

Mr C is rushed to his local hospital emergency department as he is having a severe asthma attack. On arrival, the doctor tries to take a medication history but it is unable to gather much information as Mr C is unable to complete his sentences. You find from his previous admission notes for a recent operation that he regularly takes theophylline and smokes 20 a day.

Identify the most appropriate initial treatment:

A. Serevent Accuhaler (salmeterol) 50mcg per blister, 1 puff PRN
B. Ventolin Evohaler (salbutamol) 100mcg, 2-10 puffs via spacer immediately
C. Prednisolone 5mg tablets, 4 tablets immediately
D. Salamol Easi-breathe (salbutamol) 100mcg, 2-10 puffs immediately
E. Atrovent (ipratropium bromide) 250mcg/mL nebuliser solution, 500mcg nebuliser every 6 hours

Answer 6

Ventolin Evohaler (salbutamol) 100mcg, 2-10 puffs via spacer immediately
Pmdi

Serevent Accuhaler = DPI
Salamol Easi-breathe = breath actuated MDI
Atrovent = pMDI

First-line treatment for acute asthma is a high-dose inhaled short-acting beta-2 agonist given as soon as possible. A pressurised metered dose inhaler with spacer device is preferred in patients with non-life-threatening acute asthma. Whereas, in patients with life-threatening acute asthma, a beta-2 agonist administered by an oxygen-driven nebuliser is recommended. If the response to an initial dose of short-acting beta-2 agonist is poor, consider continuous nebulisation with an appropriate nebuliser.

Question 7

When using Peak Expiratory Flow (PEF) as one of the measures to categorise the severity of an acute asthma.

What PEF (best/predicted) would you expect to find for an adult who is defined as having a moderate asthma attack?

A. <33%
B. 50-75%
C. 33-50%
D. >75%
E. 25-33%

Answer 7

PEF;
Moderate; 50 - 75%
Severe; 33-55%
Life threatening; <33%

Moderate; normal speech, no features of severe/Life threatening asthma
Severe; resp rate at least 25bpm, >1 breath to complete sentences, pulse rate at least 110 bpm
Life threatening; o2 sat <92%, exhaustion, hypotension, silent chest, cardiac arrhythmia, cyanosis, poor resp effort

Question 8

Which of the following statements is false regarding asthma?

A. Symptoms can be worse at night
B. Sometimes cause limitations on activities including exercise
C. Inflammation is mostly caused by eosinophils
D. Uncommon in over 40 year olds

Answer 8

D. Uncommon in over 40 year olds

Question 9

Which of the following oral antihistamines is the most sedating?

A. Chlorphenamine
B. Alimemazine
C. Cetirizine
D. Acrivastine

Answer 9

Alimemazine

Sedating antihistamines: lipid soluble Cross BBB
Alimemazine
Chlorphenamine
Clemastine
Hydroxyzine
Ketotifen
Promethazine
⚠️used with caution in patients with prostatic hypertrophy, urinary retention and angle-closure glaucoma

Non sedating;
Acrivastine
Cetirizine
Desloratadine
Fexofenadine
Loratadine
Mizolastine
Rupatadine

Preg/BF: loratadine and Cetirizine preferred
⚠️ Loratadine caution with liver impairment
⚠️ cetirizine caution with kidney impairment

Question 10

Mrs B 52 years old, has just been prescribed her 4th course of Prednisolone, within a year, due to another asthma exacerbation. As this is her 4th course of steroid tablets additional monitoring should take place.

Which of the following is not something which would require monitoring due to the frequent courses of oral steroids?

A. Vision
B. Cholesterol
C. eGFR
D. HbA1c

Answer 10

Egfr

Question 11

The severity of an acute exacerbation of asthma can be classed into ‘moderate acute asthma’, ‘severe acute asthma’ and ‘life-threatening acute asthma’. A child experiences confusion during an acute exacerbation.

What class does this fall into?

A. Moderate acute asthma
B. Severe acute asthma
C. Life-threatening acute asthma

Answer 11

Life-threatening acute asthma

Question 12

Mr C Utee has visited the practice 
- ongoing widespread itch affecting sleep
- nurse prescribes sedating antihistamine short term
Mr C Utee’s list of medication is below:
Aspirin 75mg 1 OD
Atorvastatin 80mg 1 OD
Ramipril 10mg 1 OD
Bisoprolol 10mg 1 OD
Amiodarone 200mg 1 OD

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

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

Answer 12

Hydroxyzine

BNF and MHRA alert
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 13

Post-op, Mr C is returned to the ward with an epidural catheter in situ for his pain relief. In the evening, as Mr C is eating and drinking, he is prescribed all of his usual meds and post-op meds. Which ONE of the following drugs should be omitted in order to have the greatest reduction in risk of complications associated with the insertion of an epidural catheter?

A. Candesartan

B. Levothyroxine

C. Dabigatran

D. Gliclazide

E. Dalteparin

Answer 13

Dabigatran

NOACs carry a risk of causing epidural haematoma (collection of blood in between skull and dura matter). No evidence of a risk with LMWH.

Question 14

Mr ARB is a 47-year-old, Afro-Caribbean man who has just had his blood pressure measured. The machine read 177/97 mmHg. He has no other medical conditions and takes no medication.
Which of the following lifestyle advice is the most appropriate to be given to Mr ARB to help reduce his blood pressure?
A . Stop smoking, as there is a direct link between smoking and hypertension
B. Restrict salt intake to no more than 9g per day
C. Partake in aerobic exercise every day for 50 mins
D. Alcohol consumption should be more than 4 units each day
E. Encourage a healthy diet consisting of an intake of at least five fruit or vegetables per day

Answer 14

Encourage a healthy diet consisting of an intake of at least five fruit or vegetables per day

The answer comes through the process of elimination. There is no direct link between smoking and hypertension. Salt intake should be restricted to 6g a day. It is recommended to partake in 30mins of moderate aerobic exercise 5 times a week. The recommended alcohol intake is 14 units a week for both men and women.

Question 15

Mr ARB is a 47-year-old, Afro-Caribbean man who has had ambulatory blood pressure monitoring with an average of 155/95 mmHg.

Which of the following medicine should be initiated for the treatment of his hypertension.

A. Losartan 50mg daily
B. Nifedipine 60mg daily
C. Amlodipine 10mg daily
D. Perindopril 8mg daily

Answer 15

Losartan 50mg daily - ARB
Nifedipine 60mg daily - CCB
Amlodipine 10mg daily - CCB
Perindopril 8mg daily - ACEi

The CCB is the appropriate treatment for Mr ARB because he is of Afro-Caribbean origin and they are first line for this ethnic group. Nifedipine can be used but not at a dose of 60mg daily. There are multiple brands of Nifedipine indicated for hypertension. Amlodipine 10mg daily is indicated for hypertension at this dose

Question 16

Mrs Jones has been prescribed a parenteral anti-coagulant for prevention of venous thromboembolism. The doctor has decided to prescribe the LMWH, tinzaparin.
What is the rationale for prescribing a low molecular weight heparin (LMWH) in preference to unfractionated heparin?

A. LMWH have a lower risk of heparin-induced thrombocytopenia
B. LMWH allow people to have regular INR monitoring to ensure safety
C. LMWH are more effective at preventing thromboembolism
D. LMWH have a higher risk of heparin-induced thrombocytopenia

Answer 16

A. LMWH have a lower risk of heparin-induced thrombocytopenia
To induce thrombocytopenia, a specific saccharide sequence needs to be present in the heparin formulation. This sequence is more commonly found in unfractionated heparin compared low molecular weight heparin.

Question 17

Mrs D comes into the pharmacy asking about her sore leg. You ask her if you can take a look in the consultation room. You see that it is inflamed and red. Mrs D states that it is stiff and hot to touch she also states she has recently been to Malaysia for a holiday. She also takes the combined oral contraceptive pill.

Which of the following is the most appropriate advice to give?

A. Mrs D should take aspirin 300mg

B. Mrs D should take a regular anti-inflammatory such as ibuprofen 400mg to help with the inflammation

C. Mrs D should make a non-urgent GP appointment

D. Mrs D should rest and keep her leg elevated to help reduce the inflammation

Mrs D should seek immediate medical attention

Answer 17

Mrs D should seek immediate medical attention

These symptoms are indicative of a DVT. Taking the combined oral contraceptive pill increases the risk of VTE. For initial treatment of DVT, a low molecular weight heparin is used.

Question 18

Mr S is a 71-year-old patient with hypertension and chronic heart failure. His current medication is as follows:

Digoxin 125mcg daily

Ramipril 5mg daily

Bisoprolol 2.5mg daily

Bumetanide 2mg daily

Atorvastatin 80mg at NIGHT

Vitamin D3 1000 units daily

Which of his medications listed above is most likely to predispose Mr S to digoxin toxicity?

A. Ramipril 10mg

B. Bumetanide 2mg

C. Bisoprolol 2.5mg

D. Atorvastatin 40mg

E. Vitamin D3 1000 units

Answer 18

Bumetanide is a loop diuretic, loop and thiazide diuretics can cause hypokalaemia which predisposes to digoxin toxicity.

Question 19

Which class of drugs does cimetidine belong to?

A. H1 receptor agonist

B. H2 receptor agonist

C. H2 receptor antagonist

D. H1 receptor antagonist

Answer 19

H2 receptor antagonist

Question 20

Antidepressant medication review with Mr PL who is 79 yo. 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 is he can come off this medication.

How long should antidepressant treatment be continued in Mr PL following remission?

A. At least 1 week

B. At least 4 weeks

C. At least 6 months

D. At least 12 months

Answer 20

D. At least 12 months

Question 21

Mr Wilkins is a 20yo man who comes into your pharmacy for advice. He has a headache initially and then developed a burning, tingling rash that is moderately painful. He has no other medical conditions.

What is the best drug treatment option for Mr Wilkins?

A. Vanciclovir cream 
B. Hydrocortisone tablets 
C. Amitriptyline tablets 
D. Gabapentin tablets 
E. Fusidic acid cream

Answer 21

A.

Shingles treatment

Question 22

A patient was admitted as an emergency for gastrointestinal surgery. The patient was stable on warfarin prior to the accident. His INR target was 2.5 and he was always within target range. Enoxaparin was given during the hospital stay. The patient is due to be discharged back after 2 days in hospital and warfarin is to be restarted.

Which of the following is the most suitable way of restarting the warfarin?

A. Enoxaparin can be given on discharge and the GP can restart the warfarin
B. Enoxaparin should be stopped and then warfarin started the following day
C. Warfarin should be restarted at the original dose and then enoxaparin stopped once the INR is over 2
D. Warfarin should be started at the original dose and then enoxaparin stopped the day afterwards
E. Enoxaparin should be stopped and the warfarin should be prescribed as if the patient is taking for the first time.

Answer 22

C. Warfarin should be restarted at the original dose and then enoxaparin stopped once the INR is over 2

If the patient’s INR is not in range, a clot can occur. Enoxaparin could possibly be given on discharge however it may be difficult to liaise with the GP and handover. The easiest way is to bridge the low molecular weight heparin and warfarin until the INR is suitable.

Question 23

Mr AF has just been commenced on a new medication from his cardiologist. He has been informed that he will need to attend his GP every 6 months so that his TFTs can be checked.

Which drug below is this monitoring requirement most likely be applicable too?

A. Digoxin

B. Sotalol

C. Valsartan

D. Amiodarone

Answer 23

D. Amiodarone

Question 24

Mr BP 45-years-old, brings in a prescription for a new medication. This medication has been prescribed to help control Mr BPs blood pressure. Upon handing out this medication, you advise Mr BP that he should take the first dose of this drug at night-time, as it may cause “first-dose hypotension”.

Which of the drugs below would this advice be most suitable for?

A. Doxazosin
B. Amlodipine
C. Verapamil
D. Bendroflumethiazide

Answer 24

A. Doxazosin

A “first dose phenomenon” similar to that described with α1-antagonists following initiation of treatment can result in lightheadedness, dizziness, and syncope.

1st dose phenomenon

• ramipril
• tamsulosin

Question 25

Mrs O Mron 42-years-old, has recently had an antenatal appointment, as she has found out she is pregnant. The midwife believes that Mrs O Mron is at high risk of developing pre-eclampsia and writes to the GP advising if they can prescribe Aspirin 150mg to be taken.

From what week during the pregnancy would you expect Mrs O Mron to commence a daily dose of 150mg Aspirin?

A. Week 1

B. Week 9

C. Week 12

D. Week 36

Answer 25

C. Week 12

Question 26

Which of the drugs below, used for the treatment of stable angina can cause serious skin, mucosal and eye ulceration, including gastrointestinal ulcers?

A. Atenolol
B. Bisoprolol
C. Nicorandil
D. Verapamil

Answer 26

C. Nicorandil but it’s rare SE

The usual dose is one tablet (either 10 mg or 20 mg) twice daily. K channel activator works by relaxing (widening) your blood vessels. This increases the supply of blood and oxygen to your heart and helps to reduce the number of angina attacks you have. It can also reduce the risk of further heart conditions.
The most common side-effects are headache and feeling dizzy. These should settle as you get used to the tablets.

Question 27

What electrolyte disturbance would be most likely to occur with co-administration of Ramipril and Spironolactone?

A. Hypokalaemia

B. Hyperkalaemia

C. Hyponatraemia

D. Hypermagnesia

Answer 27

ACEi and Diuretic.
B. Hyperkalaemia

Not Hypokalaemia as its only loop/thiazide and spironolactone is K sparing so it’s hyperkalaemia

A.Hypokalaemia -
The Insulin Pen caused Theos Gentle Muscles to Quit the Beta Plates And Echoed in Dire pain in the Court

B. Hyperkalaemia - He SAID 2 ACE the 2K cycle Track, wAldo Trimmed and Digged

C. Hyponatraemia -
Lillith Aced her depression and psychosis at desmopressin school by driving a Car and cycle HerSelf

D. Hypermagnesia

Question 28

Which one of the following diuretics is associated with gynecomastia?

A. Furosemide
B. Bumetanide
C. Bendroflumethiazide
D. Eplerenone

Answer 28

D. Eplerenone??

Gynecomastiais an enlargement or swelling of breast tissue in males. It is most commonly caused by male estrogen levels that are too high or are out of balance with testosterone levels

• furosemide; doesn’t say in BNF
• spironolactone; BNF freq not known
• bumetanide; BNF frequently not known

Spironolactone can cause gynecomastia (enlargement of glandular tissue in the male breast) due to effects on estrogen steroid receptors. Due to its greater selectivity for mineralocorticoid receptors, eplerenone has not been associated with this side effect

Question 29

Mr Q has been admitted to hospital due to having blackouts and heart palpitations. An ECG was conducted, and Mr Q was found to have a prolonged QT interval. Upon reviewing his medication, you see that he is taking Sotalol.

Which of the following drugs below can cause an increased risk of QT prolongation when taken alongside Sotalol?

A. Haloperidol
B. Naproxen
C. Digoxin
D. Methotrexate

Answer 29

A. Haloperidol
■ Antipsychotics(all have some risk)
Risperidone, Fluphenazine, Haloperidol, Chlorpromazine
Quetiapine, Clozapine
■ Antimicrobials
Erythromycin Clarithromycin, Moxifloxacin ,
Fluconazole Ketoconazole

■Antiarrhythmics  
Dronedarone  Sotalol
 Antidepressants 
Quinidine Citalopram/escitalopram 
Amiodarone Amitriptyline 
Flecainide Clomipramine 
Dosulepin 
Others Doxepin 
Methadone Imipramine 
Protein kinase inhibitors e.g. sunitinib Lofepramine 
Some antimalarials Antiemetics
Some antiretrovirals Domperidone
Telaprevir Droperidol 
Boceprevir Ondansetron/Granisetron

Question 29

Mr Q has been admitted to hospital due to having blackouts and heart palpitations. An ECG was conducted, and Mr Q was found to have a prolonged QT interval. Upon reviewing his medication, you see that he is taking Sotalol.

Which of the following drugs below can cause an increased risk of QT prolongation when taken alongside Sotalol?

A. Haloperidol
B. Naproxen
C. Digoxin
D. Methotrexate

Answer 29

A. Haloperidol
■ Antipsychotics(all have some risk)
Risperidone, Fluphenazine, Haloperidol, Chlorpromazine
Quetiapine, Clozapine
■ Antimicrobials
Erythromycin Clarithromycin, Moxifloxacin ,
Fluconazole Ketoconazole

■Antiarrhythmics  
Dronedarone  Sotalol
 Antidepressants 
Quinidine Citalopram/escitalopram 
Amiodarone Amitriptyline 
Flecainide Clomipramine 
Dosulepin 
Others Doxepin 
Methadone Imipramine 
Protein kinase inhibitors e.g. sunitinib Lofepramine 
Some antimalarials Antiemetics
Some antiretrovirals Domperidone
Telaprevir Droperidol 
Boceprevir Ondansetron/Granisetron

Question 29

Mr Q has been admitted to hospital due to having blackouts and heart palpitations. An ECG was conducted, and Mr Q was found to have a prolonged QT interval. Upon reviewing his medication, you see that he is taking Sotalol.
Which of the following drugs below can cause an increased risk of QT prolongation when taken alongside Sotalol?

A. Haloperidol
B. Naproxen
C. Digoxin
D. Methotrexate

Answer 29

A. Haloperidol

QT interval drugs
■ Antipsychotics(all have some risk)
Risperidone, Fluphenazine, Haloperidol, Chlorpromazine
Quetiapine, Clozapine
■ Antimicrobials
Erythromycin Clarithromycin, Moxifloxacin, Fluconazole Ketoconazole
■Antiarrhythmics
Dronedarone Sotalol, Quinidine, Amiodarone, Flecainide
■ Antidepressants
Citalopram/escitalopram, Amitriptyline, Clomipramine,
Dosulepin, Doxepin, Imipramin, Lofepramine
■ Antiemetics
Domperidone, Droperidol, Ondansetron/Granisetron
■ Others
Methadone, Protein kinase inhibitors e.g. sunitinib, Some antimalarials, some antiretrovirals, Telaprevir, Boceprevir

Question 30

Mr H a 47-year-old patient has recently been diagnosed with GORD. He is currently taking Aspirin 75mg OD, Atorvastatin 80mg OD, Ramipril 5mg OD, Bisoprolol 5mg OD and Clopidogrel 75mg OD. Which of the drugs below would be least suitable for Mr H?

A. Omeprazole
B. Rabeprazole
C. Pantoprazole
D. Ranitidine

Answer 30

I would say omeprazole.

Combining these medications may increase the blood levels and effects ofatorvastatin. This can increase the risk of side effects such as liver damage and a rare but serious condition called rhabdomyolysis that involves the breakdown of skeletal muscle tissue.

Many important interactions for simvastatin (Zocor) and atorvastatin relate to drugs that inhibit or induce metabolism via the cytochrome P450 (CYP3A4) enzyme, or that affect transport proteins.

Question 31

What electrolyte disturbance would be most likely to occur with co-administration of Candesartan and Spironolactone?

A. Hypokalaemia

B. Hyperkalaemia

C. Hyponatraemia

D. Hypermagnesia

Answer 31

Candesartan = angiotensin II Receptor antagonist 
Spironolactone = k sparing diuretic

Hyperkalaemia
He SAID 2 ACE/ARB thr Cycle Track 2k waldo Dig Trimmed

Drugs that cause hyperKalaemia >5mmol/L
He SAID 2 ACE the 2K cycle Track, wAldo Trimmed and Digged

[ ] Heparin
[ ] NSAIDS* mefenamic acid
[ ] ARB, ACEI*
[ ] K sparing diuretics e.g. Amiloride*
[ ] K supplements
[ ] Tacrolimus*
[ ] Ciclosporin
[ ] Aldosterone antagonist e.g. eplerenone*
[ ] Trimethoprim+ Cotrimoxazole*
[ ] Digoxin @ toxic levels*

Question 32

Which of the drugs below is associated with causing gynecomastia?

A. Spironolactone
B. Bendroflumethiazide
C. Furosemide
D. Chlortalidone

Answer 32

A. Spironolactone

Medications Known to Cause Gynecomastia:

■Aldosterone Antagonists
Eplerenone (Inspra) [up to 1%]
Spironolactone (Aldactone)
■Antipsychotics
Typical or First Generation
Chlorpromazine (Thorazine)
Fluphenazine (Prolixin)
Haloperidol (Haldol)
Perphenazine (Trilafon)
Trifluoperazine (Stelazine)
■Atypical or Second Generation
Aripiprazole (Abilify; Abilify Discmelt)
Asenapine sublingual tablets (Saphris)
Clozapine (Clozaril; Fazaclo)
Finasteride (Propecia; Proscar)
Olanzapine (Zyprexa; Zydis, Zyprexa Relprevv)
Paliperidone (Invega; Invega Sustenna)
Quetiapine (Seroquel; Seroquel XR)
Cimetidine (Tagamet) [1-4%]
Digoxin (Lanoxin) [<1%]
Efavirenz (Sustiva)
Estrogen use
Ethanol (Alcohol)
Ketoconazole (Nizoral) [<1%]
Methadone

Question 33

Symptoms at early stages: tingling/itchy/numb sensation on lip, red fluid filled vessels then appear which can burst and crust over then
• Recovery can take 10-14 days

A. Angular cheilitis
B. Wart
C. Herpes Simplex infection
D. Impetigo

Answer 33

Herpes simplex

Cause HSV type1 = cold sore, type 2 = genetalia herpes
• Virus remains dormant and can be reactivated by triggers such as sun, stress, cold & menstruation
• Symptoms at early stages: tingling/itchy/numb sensation on lip, red fluid filled vessels then appear which can burst and crust over then
• Recovery can take 10-14 days
• Refer if immunocompromised & if pustules are weeping
• Self limiting but can treat Aciclovir (5 times a day for
5 days) or penciclovir cream (every 2 hours for 4 days)
• Void oral sex and sharing towels, use lip balm
• They are highly infections

Question 34

When a topical steroid has been prescribed alongside an emollient, what do you advise the patient to apply first and why?

A. Apply steroid first so that inflammation is first reduced then skin soothed by emollient after 30 mins
B. Apply emollient first, then leave for about 30 minutes before applying corticosteroid
C. Apply steroid first, then wait 4 hours before applying emollient so it acts as barrier protection
D. Apply emollient first so that skin is primed to absorb steroid preferably at night

Answer 34

B. Apply emollient first, then leave for about 30 minutes before applying corticosteroid (NICE, CKS recommendation)

Question 35

Which topical preparation is NOT used for the treatment of Rosacea?
A. Ivermectin
B. Metronidazole gel
C. Rozex cream
D. Azelaic acid
E. Fusidic acid

Answer 35

E. Fusidic acid used for impetigo not rosacea

Question 36

You receive a prescription for phenytoin injection 250 mg/5 mL, 100 mg three times daily for one of your patients. The trainee dispensing technician comments that she has never seen phenytoin prescribed in injection form before and asks you why this is.
What is the best explanation to give her?
A. Injectable phenytoin decreases adherence
B. Injectable phenytoin increases the risk of adverse events
C. Injectable phenytoin is more error-prone with a risk of death
D. Injectable phenytoin provides a slower response
E. Injectable phenytoin reduces efficacy

Answer 36

The correct answer was Injectable phenytoin is more error-prone with a risk of death

Although the other points may be factually correct, in a practice the reason for phenytoin not being prescribed as an injection is primarily that it is more error-prone than in oral form and this can lead to an increased risk of patient deaths.

Question 37

You are working as the RP. A patient presents you with a prescription for oxycodone. The patient’s address and the prescriber’s address is in Geurnsey.
What is the best course of action with this prescription?
A. Advise the patient to see a local prescriber to get a new prescription
B. Call a local prescriber to ask if they will write a prescription and send it to you
C. Confirm the prescriber’s details and that the prescription meets prescription requirements and dispense
D. Do not dispense the prescription as it is not a valid prescription in the UK
E. Speak to the prescriber in Guernsey and make an emergency supply at their request

Answer 37

The correct answer was Advise the patient to see a local prescriber to get a new prescription

Prescriptions for CDs should be written by a prescriber with an address in the UK. The GMC advises that Guernsey is not in the UK. The patient should be advised to see a local prescriber to get a prescription so that they are not left in pain.

Question 38

You are completing some CPD on the use of anticoagulant medicines.
Which of the following is most likely to interact with warfarin and increase the INR?
A. Pomegranate juice
B. Apple juice
C. Grapefruit juice
D. Pineapple juice
E. Tomato juice

Answer 38

The correct answer was Pomegranate juice

Pomegranate juice increases the INR in response to warfarin.

Question 39

Mr and Mrs A are travelling to India for 2 weeks in one month’s time and require malaria prophylaxis medication. Both Mr and Mrs A are not taking any other medication and do not have any medical conditions. The community pharmacist recommends they take Proguanil and Chloroquine.
How many tablets will the couple take in total between them for the full prophylaxis regimen?
The SPC is provided here: https://www.medicines.org.uk/emc/medicine/2294
A. 6 Chloroquine tablets plus 42 Proguanil tablets
B. 7 Chloroquine tablets plus 49 Proguanil tablets
C. 12 Chloroquine tablet plus 84 Proguanil tablets
D. 14 Chloroquine tablets plus 98 Proguanil tablets
E. 28 Chloroquine tablets plus 196 Proguanil tablets

Answer 39

The correct answer was 28 Chloroquine tablets plus 196 Proguanil tablets

Length of prophylaxis = 1 week prior to travel + 2 week holiday + 4 weeks on return = 7 weeks total. Chloroquine base dose = 310 mg once weekly therefore 2 tablets of 155 mg = 2 x 7 weeks = 14 tablets x 2 = 28 tablets. Proguanil dose = 200 mg daily therefore 2 tablets of 100 mg = 2 x 7 days x 7 weeks = 98 tablets x 2 = 196 tablets.

Question 40

NSAIDs are commonly used for both their analgesic and anti-inflammatory properties.
Which of the following NSAIDs has a maximum daily dose of 600 mg?
A. Dexketoprofen
B. Etodolac
C. Etoricoxib
D. Felbinac
E. Ibuprofen

Answer 40

B. Etodolac

Question 41

A patient presents in your pharmacy with a prescription.
She is breastfeeding her four week old baby and the baby has oral thrush. Her and her baby are being treated for the condition. She asks you about expressing milk. What is the best advice to give the lady?
A. Advise her that expressing milk is not advised when treating oral thrush
B. Advise her to freeze the expressed milk before using it
C. Advise her to refrigerate the expressed milk before using it
E. Advise her to use the expressed milk only while she and the baby are undergoing treatment
E. Refer her to her health visitor

Answer 41

The correct answer was Advise her to use the expressed milk only while she and the baby are undergoing treatment

Expressed milk should be taken and used while the mother and baby are undergoing treatment to prevent re-infection.

Question 42

Mrs K is a 62-year-old computer analyst who has been initiated on hormone replacement therapy (HRT). She has heard many rumours from her friends and is concerned about any serious effects which her new medication may cause. During your discussion, you mention that there are some instances when HRT should be stopped immediately.
Which one of the following is a reason for Mrs K to stop her HRT immediately?

A.	Alopecia
B.	Exfoliative dermatitis
C.	Nausea
D.	Severe stomach pain
E.	Severe unexplained sore throat, fever or malaise

Answer 42

The correct answer was Severe stomach pain

Hormone replacement therapy should be stopped (pending investigation and treatment), if severe stomach pains occur.

Question 43

Steroid creams are routinely sold over the counter.
In which of the following situations can hydrocortisone 1% cream be recommended over the counter?
A. In a 9-year-old child with an insect bite on the arm
B. For contact dermatitis on the neck line of a post-menopausal female
C. For acne on the back of a 14-year-old male
D. For the external treatment of chicken pox in an adult
E. For a patient who has tried it for 7 days and would like to continue for a further 7 days

Answer 43

The correct answer was For contact dermatitis on the neck line of a post-menopausal female

This question refers to OTC supply - not prescription. It can be sold to treat allergic contact dermatitis, irritant dermatitis, insect bite reactions and mild to moderate eczema. However it may not be sold to children under 10 or in pregnancy except under medical advice. Contraindications include use on eye or face, anogenital region, broken or infected skin, acne or athletes foot. Use is restricted to a max. of 1 week.

Question 44

You are the Responsible Pharmacist and you are helping your pre-registration pharmacist to revise about Controlled Drugs.
Which of the following Controlled Drugs is most likely to require a licence for import/export as well as the need to retain the invoice for 2 years?
A. Diazepam tablets 2 mg
B. Morphine sulfate Oral Solution 10 mg/5 mL
C. Morphine sulfate Oral Solution 100 mg/5 mL
D. Morphine sulfate tablets 10 mg
E. Temazepam 10 mg tablets

Answer 44

The correct answer was Temazepam 10 mg tablets

Schedule 3 CD requires imp/exp licence and invoice retention.

Diazepam is Sched 4 BZD

Question 45

QRISK is a tool used to assess a patient’s cardiovascular disease (CVD) risk.
Which of the following patients would be most likely to have their CVD risk assessed using this tool?
A, A 45-year-old man with familial hypercholesterolaemia
B. A 47-year-old woman who is a smoker
C. A 55-year-old man who is recovering from a myocardial infarction (MI)
D. A 77-year-old woman with angina
E. An 85-year-old man with no previous CVD

Answer 45

A 47-year-old woman who is a smoker is the only suitable option based on patient age and medical conditions. CHD risk assessment tools should not be used to guide management of people with familial hypercholesterolaemia because they are already at a high risk of premature CHD.

• up to and including 84 years of age
• 10 yr risk score in people who do not have heart disease (inc angina/heart attack)

Question 46

You are making a record of the destruction of expired schedule 2 controlled drugs that you have in your pharmacy controlled drugs cabinet.
What is the minimum period of time that this individual record of destruction has to be kept?
A. 1 year
B. 2 years
C. 5 years
D. 7 years
E. 10 years

Answer 46

The correct answer was 2 years

Records of CD drugs destroyed that are stock items must be kept for 2 years from the date of destruction. For patient return medicines the minimum recommended duration is 7 years from the date of destruction.

Question 47

If a patient presents with recurrent aphthous ulcers, which vitamin defiency is this suggestive of?
A. Vitamin B12
B. Vitamin C
C. Vitamin E
D. Vitamin D

Answer 47

B12

Question 48

The Misuse of Drugs Regulations 2001 (as amended) classify controlled drugs into 5 schedules according to the different levels of control attributed to each.
Which schedule includes midazolam?
Schedule 1
Schedule 2
Schedule 3
Schedule 4
Schedule 5

Answer 48

Midazolam is a Schedule 3 CD.

Question 49

47 yo Mr A has come into your pharmacy talking about his ongoing depression. He has undergone psychological therapy but this has not helped. The GP is looking for pharmacological treatment options. Mr A is at low risk of self harm and has no other medical problems.

Which is most appropriate
A. Citalopram 
B. Amitriptyline 
C. Clozapine 
D. Phenelzine

Answer 49

SSRIs are better tolerated and are safer in overdose than other classes of antidepressants and should be considered first-line for treating depression. In patients with unstable angina or who have had a recent myocardial infarction,sertralinehas been shown to be safe.