SJT Flashcards
You work in a community pharmacy. One morning, Mrs. Kennedy presents in your pharmacy with the symptom shown in the picture. She explains that she first noticed it this morning. Besides the bloodshot eye, she has no other symptoms, and her vision is not impaired. She only takes atorvastatin 20mg once daily. She would like you to advise her on the next step of action to take ?
A. Give self-limiting advice.
B. Sell chloramphenicol OTC.
C. Refer to the GP
D. Refer to A & E immediately.
E. Ask her to stop taking atorvastatin for 7 days.
A. Give self-limiting advice.
> bloodshot eye: without symptoms, with symptoms could indicate SCH
Regarding Private Controlled drug prescriptions. You are asked during an audit which of the following controlled drugs does not need to be written on a standardized form for private prescriptions? Select one answer from five possible options.
A. Tramadol 50mg capsules (CD 3)
B. Morphine 10mg tablets (CD 2)
C. Alprazolam 0.5mg tablets (CD4Pt1)
D. Phenobarbital 50mg tablets (CD3)
E. Pethidine 50mg tablets (CD2)
F. Buprenorphine 0.4mg tablets (CD3)
G. Gabapentin 100mg capsules (CD3)
C. Alprazolam 0.5mg tablets (CD4Pt1)
Private Rx, Sch. 2 and 3: standardised form
Sch. 4 and 5: do not need to be on a form
Vet CD to be on a standardised form: none
Pink FP20PCD: Sch. 2 and 3
You work as a community pharmacy when a patient of south Asian origin presents to enquire about vitamin D supplements. Which of the following statements is true in this scenario as regards patients living in the UK ?
A. Patients with dark skin tend to have a higher Vitamin D level than patients with light skin complexion.
B. Patients with dark skin do not need vitamin D supplementation.
C. Patients with dark skin tend to have a lower vitamin D level and need
vitamin D supplementation throughout the year.
D. Patients with dark skin need vitamin D supplantation in winter but not in summer.
E. Patients with dark skin need vitamin D supplantation in summer but not in winter.
C. Patients with dark skin tend to have a lower vitamin D level and need
vitamin D supplementation throughout the year.
Darker skin advice: need vitamin D supplementation throughout the year (African, Indian, Bangladesh, Pakistan, Sri Lanka, South Asia)
Maintenance: *min: 800u-1000u daily
Treatment: 20000-40000 p/week for 7 weeks (20k twice a week every week M, Th), have it with food
Children Vitamin D: 400u
You work as a hospital pharmacist. Mr. J a 60-year-old patient presents in your ward. The chart above shows four drugs he is currently taking. You decide to make an intervention as you have spotted an issue with his medication. Which of the following options is the most likely reason to make an intervention ?
A. Dosage of a medication
B. Quantity of a medication C. Drug interaction
D. Timing of a medication
E. A drug is contraindicated
C. Drug interaction
Bendroflumethazide 2.5mg @8
Amoxicillin 500mg TDS
Methotrexate 7.5mg Once Weekly @8
Digoxin 250mcg @8
Methotrexate and Amox interaction: amox reduces exertion of methotrexate via the kidneys, increasing methotrexate in the bloodstream=>toxicity; give cephalosporin instead
Digoxin interacts with Bendro: electrolyte imbalance (4 kinds)=>digoxin toxicity
You work as a pharmacist in a hospital pharmacy. You are presented with the drug chart shown which belongs to a 75-year-old patient. The doctor on duty has stopped one of the patient’s drugs. Which of the following is the most appropriate reason why the drug was stopped? Choose an option below.
A. Increased risk of serotonin syndrome
B. Increased risk of myopathy
C. Reduced eGFR
D. Coldness of the extremities
E. Increased risk of QT prolongation
Ramipril (can cause electrolyte imbalance, high potassium, affects kidneys and liver, SE=>dry cough, known side effect, if dry cough is affecting day to day activity, speak with GP to discuss alternative ie ARB): has been stopped.
C. Reduced eGFR
When a patient isn’t diabetic, ramipril is nephrotoxic reducing kidney function, reducing eGFR. Only nephroprotective when diabetic.
On methotrexate with liver problems, stop taking medicine and go to A/E.
Ramipril with hepatic dysfunction, send to A/E.
You work in a community pharmacy. One morning, Miss. Brown presents in your pharmacy with the symptom shown in the picture. She tells you that she has noticed it for a month, and it has not changed in size or colour since. She currently takes bisoprolol, amlodipine, hydrochlorothiazide, isosorbide mononitrate and atorvastatin She would you to advise her on the best action to take.
A. Give self-limiting advice.
B. Sell bazuka gel OTC.
C. Refer to the GP
D. Refer to A & E immediately.
E. Ask her to remove it with a tweezer.
Risk if cancer linked to hydrochlorothiazide (under MHRA monitoring for possible skin cancer)
C. Refer to the GP
A patient presents her symptoms to your pharmacy and asks for your advice. What is the most appropriate advice you would give?
A. Sell her Canesten cream
B. Refer her to A and E
C. Refer her to her GP
D. Sell her Amorolfine lacquer
E. Tell her that her symptoms are self-limiting.
C. Refer her to her GP
Curanail=Amorolfine (POM to P, 18 yrs min, use for 6 months, not sold to diabetic pts, can sell to pts on warfarin): More than two affected toenails, cannot treat in pharmacy, send to GP
A mother calls your pharmacy via telephone and sounds very worried . She explains that her 14-year-old son is having an anaphylactic reaction after being stung by a wasp in the garden. She explains that although he is struggling, he is conscious and breathing okay. Based on your judgment of the situation, what would your next line of advice be in this situation ?
A. Ask the mother to call 999 only.
B. Ask the mother to dial 999 and also perform CPR on her son.
C. Ask the mother to give up to five back blows: hit him firmly on his back between the shoulder blades.
D. Ask the mother to dial 999, administer epipen and keep him in an upright position.
E. Ask the mother to dial 999, administer epipen and keep him in a recovery position.
D. Ask the mother to dial 999, administer epipen and keep him in an upright position.
**upright, still conscious
**recovery, unconscious
Mark is a 37-year-old diabetic patient who is also one of your regular
patients in your community pharmacy. His wife phones your pharmacy
deeply concerned and states that she does not understand what’s happening to Mark of late. Upon further questioning, she explains that Mark has been feeling poorly, confused, pearl smell breath, feeling very thirsty, fast and deep breaths, needing to pee more than usual and also feeling extremely lethargic. What would you advice Mark’s wife to do and why?
A. Advice his wife to bring Mark to the pharmacy for a chat.
B. Refer Mark to his GP immediately.
C. Tell Mark’s wife not to worry as his symptoms will resolve on their own.
D. Record the symptoms on your computer and report it via the yellow card scheme.
E. Ask Mark’s wife to call the ambulance immediately so that Mark can be taken to the hospital.
E. Ask Mark’s wife to call the ambulance immediately so that Mark can be taken to the hospital.
**showing signs of diabetic ketoacidosis=>medical emergency
**causes of diabetic ketoacidosis: infection=>insulin need goes up, but pt isnt increasing dose=insufficient insulin dosing
**hospital treatment for DKA: check BP (DKA reduces BP)=>fluids (normal saline if have hypotension=>increases sodium to rise BP)=>soluble insulin=>potassium chloride IV solution (if low levels present), no KCl when pt is struggling to urinate (anuria)
A transgender man visits your pharmacy and asks to speak to you in the consultation room following an episode of unprotected sexual intercourse with their male partner 2 days ago. They tell you that they are worried that they will become pregnant. The patient also feels very embarrassed about this situation and does not wish to see another healthcare professional. The patient is overweight and weighs 85kg according to the last health check record.
What is the most appropriate further action in this situation?
A) Refer to a sexual health clinic for a IUD device as it is the most effective emergency
contraception.
B) Make a supply of levonelle tablet (less than 70 for 1 pill, BMI less than 26, if over needs 2 tablets but must get rx=>give ellaone)
C) Make a supply of ella-one tablet
D) Explain to the man that it is impossible for them to get pregnant and that they should not worry about getting pregnant.
E) Refer to the GP for consultation
C) Make a supply of ella-one tablet
Mr. A.B is a patient who picks up methadone everyday on a supervised instalment prescription. He comes in on a Sunday to collect his dose but spills it on the floor by mistake as he was about to open the bottle. Mr. A.B starts shaking, sweating and panicking immediately. Which of the following is the most appropriate course of action to take ?
A. Ask Mr. A.B to go home and come back tomorrow for tomorrow’s dose .
B. Replace the spilled methadone for Mr . A.B as it was an unexpected
accident.
C. Ask Mr. A.B to drive his car to A& E to obtain a new prescription.
D. Call NHS 111 explain the situation and get Mr. A.B to request a replacement prescription.
E. Provide an emergency supply of methadone for Mr. A.B as it’s a Sunday and the specialist prescriber’s clinic is closed and that is the only place he can get a replacement prescription.
Methadone cannot be given as an emergency supply, sch. 2.
D. Call NHS 111 explain the situation and get Mr. A.B to request a replacement prescription.
**if you spilled it, it must be witnessed by authorised person
A young couple walk into your pharmacy to enquire about treatment
for morning sickness. The female partner explains that they are expecting their first child and wonders if there is a suitable medicine to take over-the- counter for mild morning sickness? What is the most appropriate course of action?
A. Refer her to her doctor as this is her first pregnancy.
B. Sell her some prochlorperazine over the counter to help alleviate
her symptoms.
C. Tell her the symptoms come with first pregnancies, so she should get on with it.
D. Sell her some ginger tablets as they reduce symptoms of nausea.
E. Sell her nothing. Give lifestyle advice only.
E. Sell her nothing. Give lifestyle advice only.
**mild morning sickness: 1st line, self-limiting measures
**severe morning sickness (Pamper My Pregnancy: prochlorperazine, metoclopramide, promethazine, cylizine, odansetron, promethazine teoclate, xonvea): lethargic, unwell, unable to keep anything down=>refer
CHOOSE AN INCORRECT STATEMENT from A - E
A. Hana or lovima is suitable for women over 35 years who are smokers. (not a COC which has age and smoker, Hana/lovima can be sold to smoker and of childbearing age bc PO)
B. Do not supply Hana or lovima to patients with kidney function impairment.
C. Do not supply Hana if vaginal bleeding has an unexplained cause; refer to doctor to exclude underlying pathology.
D. If a woman is under 18 years of age, do not supply more than 3 months of Hana.
E. Do not supply Hana if the woman has: * breast cancer or other known or suspected sex-steroid sensitive cancers (e.g. ovarian or uterine cancer) (PO worsens: breast)
B. Do not supply Hana or lovima to patients with kidney function impairment.
**main concern is liver
One morning you get a phone call from the police asking you for personal information regarding one of your regular patient who has been involved in a robbery. The police tells you they would like you to provide his Date of birth and address to enable them complete their investigation. What would your next line of action be ?
A. Refuse to continue the conversation and put the phone down.
B. Legally , you must call the patient and ask for his permission to enable you give out his personal
details.
C. Ask the police for their registration I.D and then give the information they want over the phone as face to face meeting is unnecessary.
D. Refer the police to the patient’s GP surgery instead.
E. Ask the police to come to your pharmacy in person, with an ID and written letter of request.
E. Ask the police to come to your pharmacy in person, with an ID and written letter of request.
**cases that can give info without pt consent: when public safety is at risk, court order
Miss T has been taking azathioprine for the last 4 months. She is in the pharmacy collecting her mother’s repeat medication and mentions that she has a bruise on her left leg which seems to be taking a while to go down. The bruising has also started spreading up her leg. The bruise first appeared around 3 weeks ago.
Which of the following options would be the most appropriate advice to give Miss T?
A. Advise Miss T that the symptoms she is describing are unlikely to be due to her
medication.
B. Miss T should contact her GP straight away and explain that she has unexplained bruising.
C. Miss T should buy arnica cream and see if that resolves the bruising.
D. Miss T should call 999 as she requires an ambulance immediately.
E. Miss T should stop taking the azathioprine straight away and call her consultant for an appointment in the next 2 weeks.
azathioprine=>causes bone marrow suppression which causes similar SE as blood disorder=>unexplained bruising
B. Miss T should contact her GP straight away and explain that she has unexplained bruising.
