SUNDERLAND Flashcards

1
Q

You are performing a cardiovascular risk assessment on a 68-years old woman with hypertension and rheumatoid arthritis. During your assessment, her clinic blood pressure is found to be 140/92mmHg,
subsequent ambulatory blood pressure 133/87mmHg, total cholesterol of 4.8 and BMI of 34kg/m . You calculate her QRISK score to be 18.9%. What is the most appropriate recommendation for her care?
A) No recommendations are required
B) Start simvastatin 40mg once daily
C) Start amlodipine 5mg once daily
D) Start ramipril 5mg once daily
E) Start atorvastatin 20mg once daily

A

E
QRISK >10%

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2
Q

An 85-year-old care home patient has been admitted to hospital with increasing confusion and dizziness following a fall. The patient has advanced dementia and had become increasingly agitated in the
care home so the GP decided to prescribe a medication to manage this agitation. Which medication is most likely to be associated with
the patient’s fall?
A) Amlodipine
B) Mirtazapine
C) Metformin
D) Lorazepam
E) Codeine phosphate

A

Lorazepam

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3
Q

With regards to veterinary prescribing ‘under the cascade’, which of the following is the preferred treatment choice for an animal where a
licensed veterinary product for the species does not exist?
A) A veterinary medicine imported from outside Europe via the Special Import Scheme
B) A veterinary medicine authorised in the UK for a different indication in the same species
C) A veterinary medicine prescribed by the vet responsible for treating the animal and prepared especially on this occasion by a vet, a pharmacist or a person holding an appropriate manufacturer’s
authorisation
D) A veterinary medicine not authorised in the UK, but authorised in another EU member state for use in any animal species in accordance with the Special Import Scheme
E) A medicine authorised in the UK for human use

A

B

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4
Q

A 32-year-old male has brought his 1-year-old daughter into the pharmacy who appears to be teething. She has become increasingly agitated over the past few days and has been dribbling excessively
and chewing on objects around the house. He is looking for a product that will relieve the symptoms. Which product would be most appropriate to sell?
A) Ashton and Parson’s teething sachets
B) Paracetamol 120mg/5mL oral suspension
C) Bonjela baby soothing teething gel
D) Anbesol liquid
E) Sell no product, the condition is self-limiting

A

C
Advise that topical oral lidocaine-containing products for infant teething (such as Bonjela® and Dentinox® teething gels) are only available under the supervision of a pharmacist. Bonjela® is not licensed for children under the age of 5 months.

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5
Q

A 47-year-old woman has presented to her GP with acute symptoms of dysuria, frequency, urgency, and lower back pain. She has a past medical history of giant cell arteritis and bronchiectasis. She currently
takes the following medications:
Prednisolone 1mg tablets: 7mg once daily
Carbocisteine 375mg capsules: 2 TDS
Salbutamol 100mcg/puff evohaler: 2 puffs to be inhaled when required.
Her GP diagnosed her with a severe UTI and has prescribed her a course of antibiotics. Four days later, she attends A&E with severe ankle pain which occurred abruptly when she woke up that morning.
Which antibiotic is likely to have been associated with her new onset symptoms?
A) Nitrofurantoin
B) Rifampicin
C) Levofloxacin
D) Trimethoprim
E) Erythromycin

A

Levofloxacin
Signs of tendinitis - painful swelling

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6
Q

The Medicines and Healthcare products Regulatory Agency (MHRA) asks for which one of the following to be reported via the yellow card scheme?
A) A 42-year-old male patient who has taken 8mg of ondansetron twice a day for two days following chemotherapy and now complains of constipation
B) A 52-year-old male patient taking propranolol 10mg TDS who develops shortness of breath
C) A 41-year-old female patient who develops neutropenia following initiation of carbimazole for hyperthyroidism
D) An 8-year-old male patient taking amoxicillin 250mg/5ml liquid, 10ml three times a day, who develops diarrhoea
E) A 60-year-old male patient who presents at an urgent care centre with dysuria. She is prescribed dapagliflozin 10mg tablets

A

C
https://bnf.nice.org.uk/medicines-guidance/adverse-reactions-to-drugs/

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7
Q

You have been asked to recommend an appropriate anxiolytic for a palliative patient with end-stage COPD who has medication given via a syringe driver. What would be the most appropriate anxiolytic for anticipatory medication use?
A) Tempazepam
B) Midazolam
C) Diazepam
D) Lorazepam
E) Clonazepam

A

B - Midazolam

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8
Q

A 65-year-old woman is admitted to hospital following a severe neck of femur fracture. Her past medical history includes atrial fibrillation and hypertension. She is prescribed the following medication:
Amlodipine 10mg tablets, 1OD
Atorvastatin 80mg tablets, 1OM
Edoxaban 60mg capsules, 1OD
Sotalol 80mg tablets, 1 BD
Her eGFR is 97mL/min/1.73m and blood pressure is 132/87mmHg. The patient has her leg immobilised whilst awaiting surgery. She is initially prescribed the following medication:
Enoxaparin SC injection, 20mg two hours before surgery and then once daily
Morphine sulphate IV injection, 5mg prn and adjust according to response
Paracetamol 500mg tablets, 1g QDS prn
You decide to contact the prescriber because:

A) Enoxaparin is contra-indicated for this patient
B) Morphine is not suitable for this patient due to their renal function
C) The morphine dose prescribed is too high for an opioid naive patient
D) Enoxaparin should not be administered before surgery
E) The patient should be prescribed a bisphosphonate and calcium supplementation

A

A [Patient on Edoxaban]

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9
Q

You are working on the gastro-enterology ward and have been asked to review the medications of a 70-year-old male patient who has been admitted to hospital with a gastric bleed. On endoscopy, this
was identified to be a peptic ulcer. Which of the following medications is most likely to have contributed to this?
A) Diclofenac
B) Codeine phosphate
C) Alendronic acid
D) Allopurinol
E) Erythromycin

A

A
But also co-prescribed with biphosphonates

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10
Q

A 56-year-old patient has asked for your advice on a headache that has been present for the past two days. He describes the headache as a dull feeling that is worse when he bends over. You assess his temperature in the pharmacy and obtain a reading of 37.3°C. He currently takes amlodipine for hypertension and clenil modulite for
asthma. What would be the most appropriate management?
A) Sell ibuprofen
B) Sell paracetamol
C) Provide self-care advice only
D) Sell beclomethasone nasal spray
E) Refer to GP

A

B - Sell paracetamol

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11
Q

A patient would like to know how many millilitres of ibuprofen100mg/5ml she should give to her three-year-old son for fever associated with a cold. What would be the most appropriate answer?
A) 2.5mL
B) 15mL
C) 10mL
D) 7.5mL
E) 5mL

A

D

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12
Q

A 33-year-old patient has presented to your pharmacy for advice on a burn they have sustained on their wrist from their hair tongs. Their wrist is red but there are no noticeable blisters that have appeared.
What would be the most appropriate advice?
A) Cover the burn in an occlusive dressing
B) Use calamine lotion to cool the burn
C) Take regular paracetamol
D) Use hydrocortisone 1% cream
E) Place ice on burnt area

A

C - Take regular paracetamol

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13
Q

What counselling would be most appropriate to provide to this patient about their new prescription for lansoprazole?
A) Do not stop taking abruptly
B) Protect your skin from sunlight
C) Take 30-60 minutes before food
D) Do not take indigestion remedies 2 hours either side of this medication
E) The medication may make your drowzy

A

Take 30- 60 minutes before
It is safe to take Gaviscon + PPI

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14
Q

Which of the following statements relating to the supply of Sativex oromucosal spray (27 mg delta-9-tetrahydrocannabinol and 25 mg
cannabidiol) is true?
A) Sativex prescriptions are valid for 30 days
B) On a prescription for Sativex, the quantity must be written in words and figures
C) Sativex is required to be entered in the CD register D) Sativex must be stored in the CD cupboard upon receipt from the wholesaler
E) Upon destruction of Sativex, a CD register entry needs to be made and kept for 7 years

A

C
Savitex is required to be entered in the CD register

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15
Q

You are running a public health campaign as your CCG has the highest trends of current smokers in the country. In your campaign you advertise the use of various therapies to support smoking cessation. Which of the following is not true regarding the available
treatment options?
A) NRT gums should be chewed until the taste becomes strong before resting the gum in between gum and cheek
B) Varenicline should be discontinued in the presence of depressive disorders
C) NRT mouth sprays are a widely used adjuvant therapy due to their rapid onset of action
D) Patients should be advised to take caution when driving due to risks of dizziness when taking bupropion
E) Smokers who have an urge for a cigarette as soon as they wake up would be suitable for a 16 hour NRT patch

A

E) Smokers who have an urge for a cigarette as soon as they wake up would be suitable for a 16 hour NRT patch

Nicotine transdermal patches are generally applied for 16 hours, with the patch removed overnight; if individuals experience strong nicotine cravings upon waking, a 24-hour patch can be used instead

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16
Q

In which of the following patients would it be suitable to supply Hana (Desogestrel) to from your pharmacy?
A) A 17-year-old female who has used contraceptives in the past on prescription and is requesting six months’ treatment
B) A 25-year-old female who is currently taking carbamazepine for epilepsy
C) A 19-year-old female with type 1 diabetes mellitus
D) A 28-year-old female who was admitted to hospital with a provoked deep vein thrombosis when she was 22 years old
E) A 33-year-old female who has intermittent vaginal bleeding

A

D) A 28-year-old female who was admitted to hospital with a provoked deep vein thrombosis when she was 22 years old

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17
Q

Questions 57 and 58 relate to the following patient:
You are a pharmacist working in general practice and have been asked to provide treatment advice for a 72-year-old woman. You have received the results of her DEXA scan (T score of -2.9). She has chronic kidney disease and a current eGFR of 34ml/min. What
would be the most appropriate treatment recommendation?
A) Strontium ranelate
B) Alendronic acid
C) Zoledronic acid
D) Denosumab
E) Risedronate sodium

Which of the following electrolyte disturbances would contra indicate
the use of your chosen therapeutic agent for your patient?
A) Hyperkalaemia
B) Hypophosphataemia
C) Hyponatraemia
D) Hypocalcaemia
E) Hypermagnaesaemia

A

[E] Risedronate sodium

[C] Hypocalcaemia - ALSO FOR ALENDRONIC ACID

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18
Q

You are reviewing a 44-year-old patient with depression who is currently prescribed fluoxetine 20mg capsules once daily. She currently has poor control, and the GP would like to switch her to
duloxetine as she could not tolerate other SSRIs or higher doses of fluoxetine. What advice would you provide to the GP about switching
from fluoxetine?
A) The patient will experience withdrawal effects when switching antidepressants
B) Fluoxetine can be immediately stopped, and duloxetine started
C) Fluoxetine has a long half-life compared to other SSRIs so this should be stopped for one week before starting duloxetine.
D) Starting duloxetine after fluoxetine severely increases the risk of serotonin syndrome
E) Duloxetine would be an inappropriate option to switch to

A

C) Fluoxetine has a long half-life compared to other SSRIs so this should be stopped for one week before starting duloxetine.

19
Q

A 68-year-old man who is currently staying in a local rehab unit following a stroke has swallowing difficulties. The SALT team have advised that his medication is crushed or opened prior to
administration. Which one of the following medications should not be administered in this way by female staff?
A) Finasteride
B) Pravastatin
C) Carbimazole
D) Clopidogrel
E) Indapamide

A

A - Finasteride

20
Q

A 72 year old woman has been initiated on alendronic acid 70mg tablets, one to be taken every week for osteoporosis. She has also been prescribed Evacal 1500mg/400units chewable tablets. What would be the most time to administer Evacal on the day this patient takes her alendronic acid given she takes this at 8am on a Monday morning?
A) 5pm and 10pm
B) 10am and 4pm
C) 10am and 8pm
D) 8am and 8pm
E) 8am and 12pm

A

A

21
Q

A 63 year old patient has recently had elective surgery. During his recovery period in hospital, he is diagnosed with severe hospital-acquired pneumonia and is treated with co-amoxiclav as an IV infusion. What is the minimum interval at which you would advise to
convert his antibiotics to oral administration provided the patient is making an expected recovery?
A) 24 hours
B) 72 hours
C) 36 hours
D) 48 hours
E) 12 hours

A

48 hours

22
Q

A 67-year old patient has been feeling increasingly short of breath over the last six months especially when lying down in bed. He also has evident ankle oedema despite the use of furosemide. His
natriuretic peptides (NT pro-BNP) is 2500ng/L (<400ng/L) and you have referred him to cardiology for further assessment. What treatment would you expect this patient to be initiated on?
A) Increased dose of furosemide
B) Ramipril and bisoprolol
C) Spironolactone
D) Ivabradine
E) Digoxin

A

Ramipril and Bisoprolol

23
Q

A 77-year-old male has obsolete stock of his fentanyl 12mcg/hour patches as his pain is currently poorly controlled and his GP has increased him to 25mcg/hour. He brings his old fentanyl stock to the
pharmacy for advice on destruction. Which of the following statements is correct relating to the correct disposal of his fentanyl 12mcg/hour patches?
A) Fentanyl patches that have been used should be folded in half and placed into household waste
B) Fentanyl patches do not contain any residual active drug after 72 hours so can be placed straight into household waste
C) Once returned to the pharmacy, fentanyl patches should be immediately placed into the medicines returns bin.
D) Fentanyl patches should be cut in half prior to disposal
E) A record needs to be made in the CD returns register and kept for two
years

A

A) Fentanyl patches that have been used should be folded in half and placed into household waste

24
Q

A 23 year old female has presented to your pharmacy at 4pm asking for advice. She currently takes Cerazette tablets (desogestrel) but has forgotten to take her tablet at 9am this morning. She had
unprotected intercourse last night and is asking for EHC. What would be the most appropriate advice for her?
A) Supply Ullipristal 30mg tablets using a PGD
B) Refer to her local GUM clinic for insertion of an IUD
C) Use extra precautions such as barrier methods for the next 48 hours
D) Advise her to take her next tablet as soon as possible and continue taking the next tablet at her usual time
E) Supply Levonelle 1500mg using a PGD

A

Advise her to take her next tablet as soon as possible and continue taking the next tablet at her usual time

25
Q

A 73 year old male was initiated on repeat dispensing by his GP seven months ago. He comes into your pharmacy today to collect his medications and asks you to dispense azithromycin 250mg capsules, one to be taken three times per week for prophylaxis of COPD exacerbations. He has previously declined this medication on previous batches but now feels he should be taking this. Which of the following is the most appropriate course of action?
A) Contact the GP as antibiotics should not be on repeat dispensing
B) Contact the GP because this prescription is now out of date
C) Inform the patient he must wait till his next batch is due to collect
D) Contact the GP as the patient needs a COPD review before you supply this
E) Dispense the medication to the patient

A

Contact the GP because this prescription is now out of date

26
Q

A 66 year old male patient will be travelling to Kenya for charity work next month for three weeks. He has been advised by his GP to visit your pharmacy as you offer a local travel health clinic. He needs to purchase malaria prophylaxis and you agree with him that
Malarone (proguanil/atovaquone) is most suitable. What is the maximum number tablets will he need for his holiday?
A) 29
B) 21
C) 28
D) 22
E) 30

A

30

27
Q

Which of the following is not true in relation to the human papillomavirus vaccine?
A) The HPV vaccine is offered as part of the standard NHS vaccination programme
B) In females receiving the two-dose schedule, the second dose must be completed within 12 months
C) In females receiving the three-dose schedule, the doses must all be completed within 12 months
D) Females receiving their first dose after the age of 15 years require three doses in total
E) Two doses in total are provided as part of the vaccination schedule if the first dose is provided to a female under the age of 15 year

A

The HPV vaccine is offered as part of the standard NHS vaccination programme

28
Q

As part of your current role, you have been asked by your superintendent pharmacist to perform a clinical audit to help improve medicines safety in your pharmacy. Which of the following would not
be an appropriate example of clinical audit?
A) Assessing the dispensed frequency of salbutamol inhalers in asthmatics over the past 12 months.
B) Screening the prescribing trends of sodium valproate in women of childbearing potential
C) Running a data search to identify which of your patients have enrolled onto your new travel vaccination service to ask for their feedback.
D) Determining which patients in your pharmacy have been using bisphosphonates for longer than five years to flag for potential review by their GP.
E) Identifying which medications that should be prescribed by brand are dispensed from the pharmacy generically.

A

Running a data search to identify which of your patients have enrolled onto your new travel vaccination service to ask for their feedback.

29
Q

A 56-year-old man has recently started this antibiotic for high severity community acquired pneumonia. He presents complaining of abdominal pain and nausea. Upon further investigation, you notice the whites of his eyes are slightly yellow. His liver biochemistry
results are as follows:
Total bilirubin 121umol/L (≤ 19umol/L)
A) Doxycycline
B) Co-amoxiclav
C) Rifampicin
D) Nitrofurantoin
E) Erythromycin
F) Amoxicillin
G) Gentamicin
H) Isoniazid

A

B- Co-amoxiclav

30
Q

A 32-year-old man has recently returned from holiday in Africa and has been diagnosed with tuberculosis. Following initiation of this antibiotic, he has started to develop tingling and numbness in his left leg, radiating to his foot
A) Co-amoxiclav
B) Rifampicin
C) Gentamcin
D) Erythromycin
E) Amoxicillin
F) Nitrofurantoin
G) Isoniazid
H) Doxycycline

A

Isoniazid

31
Q

A 44-year-old woman has been initiated on this antibiotic as part of a
treatment regime for infective endocarditis. She was not informed to
stop wearing contact lenses with this medication and the use of this
medication has stained her lenses red.
A) Co-amoxiclav
B) Rifampicin
C) Gentamcin
D) Erythromycin
E) Amoxicillin
F) Nitrofurantoin
G) Isoniazid
H) Doxycycline

A

Nitrofurantoin

32
Q

A 10-year-old male patient has been started on this antibiotic for the treatment of a chest infection. His mother has asked for advice as she has read about tooth discolouration associated with this antibiotic.
Rifampicin
Doxycycline
Erythromycin
Gentamicin
Amoxicillin
Nitrofurantoin
Co-amoxiclav
Isoniazid

A

Doxycycline

33
Q

A 29-year-old pregnant woman has presented to her GP practice with increased thirst, urination, and hunger. You assess her fasting blood
glucose levels and obtain a value of 7.2mmol/L. A diagnosis of gestational diabetes is made
Metformin
Lifestyle modification
Glibencamide
Dapagliflozin
Abasaglar (insulin glargine)
Semeglutide
Apidra (insulin glulisine)
Linagliptin

A

Metformin

34
Q

A 72-year-old male with chronic kidney disease has come in for his 6 monthly bloods today. He has returned an eGFR of 29mL/min and the GP has asked you for advice on an appropriate treatment for his
diabetes.
A. Apidra (insuline glulisine)
B. Linagliptin
C. Glibencamide
D. Dapagliflozin
E. Metformin
F. Semeglutide
G. Abasaglar (insuline glargine)
H. Lfestyle modifications

A

Linagliptin

35
Q

You have been asked to provide advice for an 11-year-old male who has been playing in his garden this morning. He has developed a rash on his hand and has been itching at this all morning. There are
no current signs of infection.
Miconazole 2% / hydrocortisone 1% cream
Hydrogren peroxide
Clotrimazole 1% cream
Hydromol emollient
Clobetasone 0.05% cream
Refer to prescriber
Hydrocortisone 1% cream
Terbinafine 1% cream

A

Hydrocortisone cream

36
Q

A 43-year-old male with type 2 diabetes has come to ask for your advice for a rash on his right foot. He is overweight and has been putting a lot of effort into exercising recently to improve his diabetes control. The rash is moist and and the skin has started to peel in between his toes
Hydrocortisone 1% cream
Hydrogen peroxide
Refer to prescriber
Clobetasone 0.05% cream
Terbinafine 1% cream
Hydromol emollient
Miconazole 2% / hydrocortisone 1% cream
Clotrimazole 1% cream

A

Refer to prescriber

37
Q

A mother has brought her 6-month-old daughter into the pharmacy to ask for advice relating to a rash around her daughter’s nappy area. The child is normally well but has finished a course of
phenoxymethylpenicillin for scarlet fever. The rash is red and inflamed and her daughter is clearly distressed.
Terbinafine 1% cream
Refer to prescriber
Hydromol emollient
Hydrocortisone 1% cream
Miconazole 2% / hydrocortisone 1% cream
Hydrogen peroxide
Clotrimazole 1% cream
Clobetasone 0.05% cream

A

Clotrimazole 1% cream

38
Q

You are performing an asthma review on a 34-year-old male who currently takes QVAR 100mcg/dose 1 puff twice daily as monotherapy but is continuing to experience symptoms of breathlessness, wheeze, and a frequent dry cough daily. He has ordered six salbutamol inhalers in the past six months and states he feels he relies on this to relieve his symptoms. You determine he has poor control of his asthma and has demonstrated appropriate inhaler
technique.
Ultibro breezehaler (glycopyrronium/indacaterol)
Clenil modulite 100mcg/puff evohaler (beclomethasone dipropionate)
Amoxicillin 500mg TDS for 5 days
Prednisolone 30mg daily for 5 days
Trelegy Ellipta (umeclidinium/vilanterol/fluticasone)
Sereflo 125/25mcg evohaler (salmeterol/fluticasone)
prednisolone 40mg daily for 5 days
Fostair 100/6mcg evohaler MART regime (formoterol/beclomethasone dipropionate)

A

Fostair 100/6mcg evohaler MART regime (formoterol/beclomethasone dipropionate)

39
Q

You are working in a community pharmacy and a patient has
returned their stock of pregabalin 50mg capsules to you as they have
now completed a successful withdrawal schedule and no longer take
this medication.
1 year
28 days
30 days
7 years
No records required
5 years
2 years
10 years

A

No records required

40
Q

A local veterinarian has prescribed lamotrigine 25mg tablets for a dog under their care. Their owner brings this prescription to your pharmacy for dispensing and supply. You are satisfied this prescription meets all legal requirements.
7 years
30 days
28 days
10 years
1 year
No records required
2 years
5 years

A

5 years

41
Q

You have been presented with a prescription for co-amoxiclav 625mg
tablets for low severity community acquired pneumonia at a dose of 1
to be taken three times per day for five days. You decide to discuss
your concerns with the GP. A list of the patient’s regular medications
is as follows:
Sulfasalazine 500mg EC tablets 2 to be taken twice a day
Atorvastatin 20mg tablets 1 to be taken once a day
Sertraline 50mg tablets 1 to be taken once a day
Contra-indication
Dose too low
Duplication of therapy
Dose too high
Wrong drug
Clinically significant drug interaction
Incorrect dosage frequency
Wrong duration of treatment

A

Wrong drug

42
Q

You have been asked to review the use of prednisolone in a 66-yearold patient with polymyalgia rheumatica. The patient has been taking
prednisolone at a dose of 10mg once per day for the last two years and the GP now has asked you to discuss a withdrawal of his prednisolone. Prior to discussing withdrawal, the patient needs blood tests to assess for inflammatory control.
Full blood count
Liver function tests
Thyroid function tests
Renal function
Serum drug concentration
Erythrocyte sedimentation rate
C-reactive protein
DEXA scan

A

Erythrocyte sedimentation rate (ESR)
Shows if you have inflammation in your body

43
Q

A 61-year-old male who has atrial fibrillation has just been discharged from hospital following acute decompensation in heart failure. He currently takes the following medications:
Apixaban 5mg tablets 1 to be taken twice a day
Atorvastatin 80mg tablets 1 to be taken daily
Bisoprolol 7.5mg tablets 1 to be taken daily
Digoxin 125mcg tablets 1 to be taken daily
Upon discharge, the patient receives furosemide 20mg tablets 1 to
be taken in the morning and 1 to be taken at lunchtime. Three days
later he presents with visual disturbances and nausea.
C-reactive protein
Erythrocyte sedimentation rate
Renal function
Liver function tests
DEXA scan
Thyroid function tests
Serum drug monitoring
Full blood count

A

Serum drug monitoring

44
Q

You are working in a community pharmacy and have been asked to speak with a 54-year-old woman. She has been experiencing recent onset confusion, increased urination, and a coarse tremor over the
past four days. Her GP recently prescribed diclofenac 75mg modified release tablets for arthritis. She currently takes the following regular
medications:
Fluoxetine 20mg capsules 1 to be taken daily
Priadel (lithium carbonate) 400mg tablets 1 to be taken daily
Sulfasalazine 500mg GR tablets 2 to be taken twice daily.
Serum drug concentration
DEXA scan
Thyroid function tests
Full blood count
Liver function tests
Erythrocyte sedimentation rate
Renal function
C-reactive protein

A

Serum drug concentration