SUNDERLAND Flashcards
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
E
QRISK >10%
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
Lorazepam
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
B
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
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.
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
Levofloxacin
Signs of tendinitis - painful swelling
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
C
https://bnf.nice.org.uk/medicines-guidance/adverse-reactions-to-drugs/
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
B - Midazolam
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 [Patient on Edoxaban]
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
But also co-prescribed with biphosphonates
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
B - Sell paracetamol
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
D
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
C - Take regular paracetamol
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
Take 30- 60 minutes before
It is safe to take Gaviscon + PPI
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
C
Savitex is required to be entered in the CD register
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
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
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
D) A 28-year-old female who was admitted to hospital with a provoked deep vein thrombosis when she was 22 years old
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
[E] Risedronate sodium
[C] Hypocalcaemia - ALSO FOR ALENDRONIC ACID