Single Best Answer Set 5 Flashcards
Master U 3-years-old has been confirmed to have severe allergies to peanuts. His paediatrician has asked the GP if they can ensure Master U has access to a suitable strength adrenaline pen. He weights 14kg.
From below which would be the most suitable to prescribe for Master U?
A. EpiPen 300mcg
B. Jext 150mcg
C. Emerade 500mcg
D. Jext 300mcg
B. Jext 150 mcg
Child 1 month–5 years; 150 micrograms
0.15 mL1 in 1000(1 mg/mL) adrenaline
Use suitable syringe for measuring small volume
Child 6–11 years; 300 micrograms
0.3 mL1 in 1000(1 mg/mL) adrenaline
Child 12–17 years; 500 micrograms
0.5 mL1 in 1000(1 mg/mL) adrenaline
300 micrograms (0.3 mL) if child is small or prepubertal
Adult; 500 micrograms
0.5 mL1 in 1000(1 mg/mL) adrenaline
Which of the following statements below best describes when a course of oral prednisolone, for a minimum duration of 5 days, should usually be given to someone who has experienced an acute asthma attack?
A. Anyone who has had an acute asthma attack regardless of severity
B. Only those have had a moderate acute asthma attack
C. Only those who have had a severe acute asthma attack
D. Only those who had had a life-threatening acute asthma attack
Anyone who has had an acute asthma attack regardless of severity
Can oral and inhaled corticosteroids be used as normal in pregnant women for asthma management?
Yes
No
Yes
SABAs, LABAs, oral and inhaled corticosteroids, sodium Cromoglicate and nedocromil sodium, and oral and intravenous theophylline (with appropriate monitoring) can be used s normal during pregnancy.
What medication is not an example of Inhaled Corticosteroids?
A. Budesonide B. Vilanterol C Beclometasone D. Fluticasone E. Mometasone
B. Vilanterol
What is not a side effect of selective beta 2 agonist?
A. Hand tremors B. Wheezing C. Tachycardia D. Hypokalaemia E. Hyperglycaemia
B. Wheezing
What is NOT a side effect of inhaled corticosteroids?
A. Sore throat B. Bronchospasm C. Restlessness D. Hoarse voice E. Oral candidiasis
Restlessness
When taking theophylline, which medication can interact and cause a risk of hypokalaemia?
A. Montelukast B. Bumetanide C. Warfarin D. Rifampicin E. Metoclopramide
When taking theophylline, which medication can interact and cause a risk of hypokalaemia?
Montelukast Bumetanide !! Warfarin Rifampicin Metoclopramide
There is an increased risk of hypokalaemia when theophylline is taken with loop (bumetanide, furosemide, torasemide)/thiazide (bendroflumethiazide) diuretics, corticosteroids and b2 agonists.
* SICKFACES.COM grapefruit juice can raise theophylline levels and increase toxicity
The dose of an inhaled corticosteroid (ICS) should be prescribed at an appropriate dose. Which of the following is recommended when prescribing an ICS?
A. ICS should initially be used twice daily (except ciclesonide)
B. Lower doses must be given to smokers
C. Introduction of an ICS should start with a once daily dose
D. Dose adjusting of an ICS over time should aim for the highest dose for effective asthma control
A. ICS should initially be used twice daily (except ciclesonide)
Which of the following does not interact with Azithromycin?
A. Colchicine
B. Statins
C. Digoxin
D. Ramipril
Which of the following does not interact with Azithromycin?
Colchicine - Azithromycin is predicted to increase the exposure to colchicine.
Statins - Azithromycin (macrolide) increases exposure
Digoxin - Azithromycin increases digoxin concentration
Ramipril - no interaction
Mr INR is a 62-year-old man who has been prescribed warfarin to treat myocardial infarction. He has been admitted into hospital with an INR of 10.4 with minor bleeding.
Which of the following is the most appropriate course of action?
A. Stop warfarin; give phytomenadione (vitamin K1) by slow IV injection; give dried prothrombin 25-50 units/kg
B. Stop warfarin; give phytomenadione (vitamin K1) by slow IV injection; repeat dose of phytomenadione if INR still too high after 24 hours; restart warfarin when INR <5.0
C. Stop warfarin; give phytomenadione (vitamin K1) by mouth using the IV preparation orally; repeat dose of phytomenadione if INR still too high after24 hours; restart warfarin when INR <5.0
D. Stop warfarin; give phytomenadione (vitamin K1) by slow IV injection; restart warfarin when INR <5.0
E. Withhold 1 or 2 doses of warfarin and reduce subsequent maintenance
B.
A. Stop warfarin; give phytomenadione (vitamin K1) by slow IV injection; give dried prothrombin 25-50 units/kg
●Emergency Major bleeding
B. Stop warfarin; give phytomenadione (vitamin K1) by slow IV injection; repeat dose of phytomenadione if INR still too high after 24 hours; restart warfarin when INR <5.0
● INR >8 with minor bleeding
C. Stop warfarin; give phytomenadione (vitamin K1) by mouth using the IV preparation orally; repeat dose of phytomenadione if INR still too high after24 hours; restart warfarin when INR <5.0
● INR > 8 with no bleeding
D. Stop warfarin; give phytomenadione (vitamin K1) by slow IV injection; restart warfarin when INR <5.0
● INR 5 - 8
E. Withhold 1 or 2 doses of warfarin and reduce subsequent maintenance
● INR between 5 and 8
*if the anticoagulant is stopped but not reversed, the INR should be measured 2–3 days later to ensure that it is falling
Mrs P comes into the pharmacy to speak to you about her warfarin. She states she is trying to have a baby. She confirms she is not pregnant yet.
What is the most appropriate advice for Mrs P regarding her warfarin and pregnancy?
A. She should speak to the anticoagulant clinic so they can monitor her INR closely during pregnancy
B. She should speak to the anticoagulant clinic as soon as possible to let them know she is trying for a baby so her treatment can be reviewed
C. She must stop taking the warfarin straight away if she becomes pregnant, as it is unsafe
D. She should carry on taking warfarin as it does no harm to a baby
E. She does not need further advice and should continue to take her warfarin as directed
A. She should speak to the anticoagulant clinic as soon as possible to let them know she is trying for a baby so her treatment can be reviewed
Warfarin should not be given during the first trimester of pregnancy. Warfarin, acenacoumarol, and phenidione cross the placenta with risk of congenital malformations, and placental, fetal, or neonatal haemorrhage, especially during the last few weeks of pregnancy and at delivery. Therefore, if at all possible, they should be avoided in pregnancy, especially in the first and third trimesters.
Mr GTN has been complaining of chest pain and has been diagnosed with angina. He has a previous diagnosis of type 2 diabetes mellitus. Mr GTN has been complaining of severe headaches, which he has not experienced before.
Which one of the following medicines is most likely to be causing the headaches?
A. Aspirin B. Enalapril C. Rosuvastatin D. Gliclazide E. Isosorbide mononitrate
E. Isosorbide mononitrate
Common side effects of nitrates include dizziness; postural hypotension; tachycardia; throbbing headache.
Mr Y is a 54-year-old man who was admitted to hospital 3 days ago with a diagnosis of heart failure. The medical team decide to start him on digoxin and after an oral loading dose he is maintained on 125 micrograms daily. Mr Y requires a blood test to assess his plasma digoxin concentration.
When is the most appropriate time to sample Mr Y’s blood to monitor his digoxin levels?
A. At least 8 hours after an oral dose has been administered
B. Between 2-3 hours after an oral dose has been administered
C. At least 6 hours after an oral dose has been administered
D. Immediately after an oral dose has been administered
E. Thirty minutes after an oral dose has been administered
BNF states that for plasma-digoxin concentration assay, blood should be taken at least 6 hours after a dose. Monitor serum electrolytes and renal function. Toxicity increased by electrolyte disturbances.
Mrs SF who suffers from heart failure has recently been admitted to hospital due to poor symptom control. Her recent U&Es are as follows:
Potassium 3.6 mmol/L (3.5-5.3)
Urea 9.2 mmol/L (2.5-7.8)
Creatinine 150 mmol/L (44-80)
Sodium 145 mmol/L (133-146)
On the ward, she complains to you of nausea and her vision is a little blurred. Looking at the observation chart you note her BP is 120/68 and pulse rate of 54.
Which of the following drugs she is prescribed is the most likely to be contributing to this clinical picture?
A. Bumetanide 2mg OM B. Bisoprolol 1.25mg OD C. Digoxin 125mcg OD D. Ramipril 5mg OD E. Spironolactone 12.5mg OD
Digoxin overdose: Common GI symptoms: nausea, vomiting, diarrhoea, abdominal pain or anorexia. CNS symptoms: lethargy, weakness and confusion. Visual symptoms: disturbances of colour vision with a tendency to perceive yellow halos around objects (xanthopsia), blurred vision. Cardiovascular symptoms: palpitations, bradycardia. arrhythmias, dyspnoea.
Mr VF has been commenced on amiodarone in hospital for ventricular fibrillation. He comes to your community pharmacy 2 weeks after discharge to get a further supply. He complains that he is feeling tired and that his stools have changed from a dark brown to clay-coloured and wonders if this could be caused by the amiodarone.
What is the most appropriate advice for this patient?
A. The symptoms described are not known to be caused by amiodarone
B. Stop taking the amiodarone immediately and see the GP as soon as possible
C. He should see the GP as the dose of amiodarone may need to be increased
D. He should see the GP as the dose of amiodarone may need to be decreased
E. He is experiencing a side effect of amiodarone but may want to speak to the GP about an alternative but keep taking the amiodarone until then
B. stop medicine and see GP
Hepatotoxicity may occur while you are using this medicine. Stop using this medicine and check with your doctor right away if you are having more than one of these symptoms: abdominal pain or tenderness; clay-coloured stools; dark urine; decreased appetite; fever; headache; itching loss of appetite; nausea and vomiting; skin rash; swelling of the feet or lower legs; unusual tiredness or weakness; or yellow eyes or skin.
A 10-year-old weighing 32kg is prescribed heparin 250 units/kg BD SC adjusted according to their APTT.
Which of the following statements regarding the above prescription is incorrect?
A. The specified dose is a licensed/indication for the treatment of thromboembolic disorders in children
B. The actions of heparin can be reversed by protamine sulphate
C. The child should be monitored for heparin induced thrombocytopenia
D. The increase in clotting time will last for approximately 8 hours after administration
E. Heparin can be administered by intramuscular, intravenous and subcutaneous injection
E. Heparin can be administered by intramuscular, intravenous and subcutaneous injection
False. Only IV and subcutaneous not IM
Mrs W is an 81-year-old lady who is being treated for chronic heart failure. She has recently been prescribed new medication following a medication review with her heart failure nurse at the hospital. She tells you that ever since starting the medication, her hands and feet are feeling very cold, especially her fingers and toes. This happens especially at night and she can’t seem to keep them warm.
Which of the following medication could be causing these symptoms?
A. Carvedilol B. Verapamil C. Diltiazem D. Amlodipine E. Bendroflumethiazide
Beta-blockers are associated with fatigue, coldness of the extremities (may be less common with those with ISA), and sleep disturbances with nightmares (may be less common with the water-soluble beta-blockers)
Carvedilol
Mrs H is a 65-year-old lady who suffers from hypertension. She asks you to check her blood pressure, as she is concerned that it may be too high. She suffers from kidney disease also. She is on the following medication: Ramipril 10mg capsules Amlodipine 5mg tablets Metformin 500mg tablets Aspirin 75mg tablets Gliclazide 80mg tablets
What the guideline aims for her blood pressure?
140/90 mmHg
140/80 mmHg
120/80 mmHg
130/80 mmHg
130/90 mmHg
130/80
For patients with diabetes, a target clinic blood pressure below 140/80 mmHg is suggested (below 130/80 mmHg is advised if kidney, eye, or cerebrovascular disease are also present).
A 67-year-old is currently taking Ramipril 10mg once daily. Following a recent review by the GP practice pharmacist, her renal function test showed his eGFR to be 43mL/minute/1.73m2. The pharmacist wants to alter the dose.
Taking into account the patient’s eGFR, which of the following would be the most appropriate dose of Ramipril?
2.5mg daily
5mg daily
7.5mg daily
10mg daily
Ramipril is contraindicated
5mg
According to the monograph for Ramipril, if eGFR is between 30-60mL/minute/1.73m2 the maximum daily dose of Ramipril is 5mg.
Mr U has a prescription for Bumetanide 2mg BD. He states that he’s been taking Bumetanide 2mg OM for the past 4 months.
Which of the following is the most appropriate action to take?
Counsel Mr U to take the doses at 8am and 8pm
Counsel Mr U to take the doses at 8am and 2pm
Contact the prescriber as this is a prescribing error
Contact the prescriber as bumetanide should be given once daily
Ask Mr U to go back to his GP for a new prescription
Diuretic - Bumetanide used in oedema related to HF. Dose normally BD in morning and after 6-8 hours. Counsel to take it at 8am and 2pm. Furosemide and bumetanide are similar in activity; both act within 1 hour of administration and diuresis complete within 6 hours so that, if necessary, they can be given BD without interfering with sleep.
Mr K 89 yo, has been admitted to the ward. He was admitted due to experiencing n+v, being very confused and irritable. Some blood tests have been conducted, and the results have come back showing a reduction in sodium levels.
Which of the following medications below is likely to have caused a reduction in sodium levels?
Citalopram
Olanzapine
Temazepam
Zopiclone
Citalopram
Miss P, a 17-year-old girl has been referred to CAMHS to help with her ongoing persistent sadness and low mood. The specialist has decided to offer pharmacological therapy alongside the psychological therapy which Miss P is undertaking.
Which of the following is most appropriate to offer as first line drug treatment to Miss P? A. Sertraline B. Clozapine C. Fluoxetine D. Venlafaxine
C. fluoxetine
SSRIs are better tolerated / safer in overdose than other antidepressants classes. Fluoxetine 1st line considered for children and adolescents: best evidence base available, licensed 8 yrs+ age.
Elderly best SSRIs: citalopram,escitalopram, andsertraline.
Extra bnf
Review every 1–2 weeks at the start. Continue at least 4 weeks (6 weeks in elderly) before switch. In partial response, further 2–4 weeks (elderly may take longer).
Following remission, treatment continued at same dose for at least 6 months (12 months elderly), or for at least 12 months in generalised anxiety disorder (high likelihood of relapse). History of recurrent depression maintenance treatment for at least 2 years.
Which of the following antipsychotics has the lowest risk of Diabetes?
A. Haloperidol
B. Clozapine
C. Olanzapine
D. Quetiapine
Haloperidol
Antipsychotic drugs, formerly called ‘major tranquillisers’, are also known as neuroleptics.
Schizophrenia is associated with insulin resistance and DB; the risk of DB is probably increased in all patients with schizophrenia who take antipsychotic drugs. Some evidence suggests 1st gen antipsychotic drugs are less likely to cause DB than 2nd-gen, and of the 1st gen drugs,fluphenazine decanoateandhaloperidolhave the lowest risk.
Amisulprideandaripiprazolehave the lowest risk of diabetes of the second-generation antipsychotic drugs.
Mr S has had Parkinson’s disease for 3 years now and is on Co-Beneldopa to help manage his symptoms. Unfortunately, today he has also been diagnosed with Dementia.
Which of the following drugs would be the most appropriate for him to be put on?
A. Donepezil
B. Galantamine
C. Rivastigmine
D. Memantine
C. Rivastigmine
In July 2017, rivastigmine capsules are the only treatment with a UK marketing authorisation for this indication. Use of donepezil, galantamine and rivastigmine patches was off-label.
3 acetylcholinesterase (AChE) inhibitors donepezil, galantamine and rivastigmine as monotherapies for managing mild - mod Alzheimer’s disease
■ Offer donepezil or rivastigmine to people with mild to moderate dementia with Lewy bodies.
■ Only consider galantamine for people with mild to moderate dementia with Lewy bodies if donepezil and rivastigmine are not tolerated.
■ Donepezil or rivastigmine for pt with severe dementia with Lewy bodies.
■ Consider memantine for dementia with Lewy bodies if AChE inhibitors not tolerated/ contraindicated.
■ Only consider AChE inhibitors or memantine for people with vascular dementia if they have suspected comorbid Alzheimer’s disease, Parkinson’s disease dementia or dementia with Lewy bodies.
○ Do not offer AChE inhibitors or memantine to people with frontotemporal dementia
○ Do not offer AChE inhibitors / memantine to people with cognitive impairment due to multiple sclerosis.
Memantine monotherapy for Alzheimer’s disease:
moderate Alzheimer’s disease who are intolerant of or have a contraindication to AChE inhibitorsor
severe Alzheimer’s disease.
•people with an established of Alzheimer’s disease who are already taking an AChE inhibitor: consider memantine + AChE inhibitor if mod - sev disease
Entacapone can colour your urine what colour?
A. Red/Yellow
B. Orange/Yellow
C. Orange/Brown
D. Red/Brown
Red/brown
Mrs R brings in a prescription for Duloxetine. Your pre-reg student asks you what drug class this belongs to, what answer do you give? A. SSRI B. TCA C. SNRI D. MAOI’s E. Atypical
C. SNRI
Antidepressants
SSRI - citalopram, escitalopram, fluoxetine, paroxetine
SNRI - duloxetine, Venlafaxine
TCA- Amitriptyline, clomipramine, nortriptyline, imipramine
MAOI’s- Phenelzine, moclobemide, selegiline
Atypical- mirtazepine, trazodone, buproprion
Antipsychotics 1st gen - chlorpromazine, haloperidol, flupentixol 2nd gen - Quetiapine, risperidone
Which of the following drugs below has both opioid agonist and antagonist properties?
A. Methadone
B. Gabapentin
C. Topiramate
D. Buprenorphine
D. Buprenorphine
Which of the following antidepressants drugs can increase the risk of bleeding?
A. Venlafaxine
B. Amitriptyline
C. Imipramine
D. Sertraline
D. Sertraline
How many weeks can it take for Buspirone to work?
A. Up to one week
B. Up to two weeks
C. Up to three weeks
D. Up to four weeks
B Up to 2 weeks
