Things I Got Wrong In Exams

Front 1

Drugs that affect renal function (SADMAN)

Back 1

Sglt-2 inhibitors (e.g. empagliflozin), ACE inhibitors (e.g. ramipril), Diuretics (e.g. furosemide), Metformin, ARBs (e.g. losartan), NSAIDs (e.g. naproxen)

Front 2

What is the licensed dose of paracetamol OTC for children (pain)?

Back 2

3-5 months: 60mg QDS

6-23 months: 120mg QDS

2-3 years: 180mg QDS

4-5: 240mg QDS

6-7: 240-250mg QDS

8-9: 360-375mg QDS

10-11: 480-500mg QDS

12-15: 480-750mg QDS

16-17: 500mg-1g QDS

Front 3

ACE inhibitors and Lithium interaction:

Back 3

ACE inhibitors increase the concentration of lithium, resulting in toxicity. (Monitor and adjust dose - severe anecdotal)

Front 4

What are symptoms of hypernatremia (>145)? Too much water retention causing water in brain

Back 4

Confusion, coma, headache, irritability, seizures, muscle cramps, weakness, nausea, vomiting, tiredness, lack of energy

Front 5

What are symptoms of hyponatremia (<135)? Too little water retention causing brain cells to shrink

Back 5

Thirst, irritability, restlessness, muscle twitching, feeling tired/lack of energy, confusion, seizures, coma

Front 6

Which opioid is used for mild to moderate pain?

Back 6

Codeine

Front 7

Which drugs are used for moderate to severe pain?

Back 7

Oxycodone and morphine

Front 8

According to NPSA guidance, which of the following does a patient need written information on when taking oral cytotoxic medicines?

Back 8

Details of the intended oral anti-cancer regimen, the treatment plan, and arrangements for monitoring, taken from the original protocol from the initiating hospital.

Front 9

What is the recommended compression-ventilation ratio for CPR on this patient (18 year old)?

Back 9

30 chest compressions followed by two rescue breaths for as long as

Front 10

______ can cause urine to be coloured pink or orange

Back 10

Phenindione (vitamin K antagonist)

Front 11

Taking which medicine concomitantly with quinolones could also induce convulsions?

Back 11

The CSM has warned that quinolones may induce convulsions in patients with or without a history of convulsions; taking NSAIDs at the same time may also induce them.

Front 12

Is Guernsey in the UK?

Back 12

No

Front 13

You want to obtain guidance on prescribing restrictions for podiatrist independent prescribers. Which of the following is the most appropriate reference source to use to find this information?

Back 13

Restrictions by prescriber types are legal requirements and can be found in the MEP.

Front 14

What is a common side effect of amiodarone?

Back 14

Bradycardia, hyper/hypothyroidism, jaundice, nausea, persistent slate grey skin discoloration, phototoxicity, pulmonary toxicity (pneumonitis and fibrosis), raised serum transaminases, sleep disorder, taste disturbance, tremor, vomiting, reversible corneal microdeposits

Front 15

What is licensed for the treatment of acute life-threatening hypertension?

Back 15

IV nicardipine

Front 16

Which beta-blocker is LESS suitable for a once daily regime?

Back 16

Propanolol. Some beta blockers, such as atenolol, bisoprolol fumarate, celiprolol hydrochloride, and nadolol, have an intrinsically longer duration of action and need to be given only once daily.

Front 17

Which direct-acting oral anticoagulant should be taken with food?

Back 17

Rivaroxaban should be taken with food due to lack of efficacy on an empty stomach.

Front 18

For which of the following antiepileptic drugs should you consult the prescriber to establish if the same brand is to be dispensed each time?

Back 18

Category 2 drugs: Clobazam, Clonazepam, Eslicarbazepine, Lamotrigine, Oxcarbazepine, Perampanel, Retigabine, Rufinamide, Topiramate, Valproate, Zonisamide

Front 19

She wants to purchase a nasal drop containing xylometazoline. What is the maximum length of time the child should use it for?

Back 19

Xylometazoline should not be used for more than 5 days in a 7 year old.

Front 20

Mrs A presents to the pharmacy complaining of dysuria, fever and flank pain.Which condition is this symptom cluster most indicative of?

Back 20

Pyelonephritis is associated with fever and flank pain, compared to trichomoniasis whose predominant feature is discharge.

Front 21

Which of the following medicines must be cautioned in diabetes due to affects on blood glucose?

Back 21

Pseudoephedrine must be used in caution in patients with diabetes. Pseudoephedrine may increase blood glucose levels.

Front 22

Mrs R is a patient who has AIDS. She has been diagnosed with mild pneumocystis pneumonia. She is unable to tolerate trimethoprim.Which single medication is the most likely treatment option for her pneumonia?

Back 22

Atovaquone is licensed for the treatment of mild to moderate pneumocystis infection in patients who cannot tolerate co-trimoxazole

Front 23

Which of the following is NOT a symptom of hay fever?

Back 23

Patients experience itchy, red or watery eyes not dry eyes.

Front 24

Which of the following does NOT have to be recorded when making an entry into the controlled drugs register in respect to the supply of a controlled drug?

Back 24

It is NOT a requirement for prescriber's address to be recorded in the CD register.

Front 25

What is the maximum TOTAL daily dose of Ibuprofen in an adult when used as a GSL product?

Back 25

Adults can take 200 mg-400 mg every FOUR hours if required, however, they must not exceed 1.2 g in 24 hours when taking over-the-counter. The BNF doses are much higher as they are usually prescription only and patient should be under the care of a physician.

Front 26

The patients blood glucose level is reading as 3.5 mmol/L.What would the best advice to give the junior doctor regarding treatment for the patient?

Back 26

Recommend that the ward nursing staff give the patient a glucogel STAT. Initially 10-20 grams of glucose is given by mouth for treatment of a mild hypo. This can be in the form of a glucogel.

Front 27

Which is NOT a symptom of opioid toxicity?

Back 27

Pupil narrowing or 'miosis' is an effect of opiate toxicity; pupil dilation is not. Opioids stimulate the parasympathetic nerve system which causes pinpoint pupils

Front 28

Which of the following medications is the most suitable to treat her migraine? She has a history of ischaemic heart disease.

Back 28

Aspirin and metoclopramide could be used to relieve the symptoms of a migraine: pain and vomiting, respectively. Serotonin 5HT1 agonists (i.e. the 'triptans') are contraindicated in patients with ischaemic heart disease.

Front 29

Which of the following medications is most likely to be the causative factor of the brown staining?

Back 29

Brown staining of the teeth frequently follows the use of chlorhexidine mouthwash, spray or gel, but can readily be removed by polishing.

Front 30

These prescribers are restricted to prescribing dressings, appliances and licensed medicines which are listed in the Nurse Prescribers' Formulary.

Back 30

Community Practitioner Nurses must only prescribe dressings, appliances and licensed medicines which are listed in the Nurse Prescribers' Formulary.

Front 31

Mr Q, a 21-year-old student, has a mild headache following a sports injury. He presents with no other signs or symptoms.

Back 31

Paracetamol is suitable for mild-to-moderate pain.

Front 32

Mr K is a 61-year-old office worker. He has successfully completed an alcohol detoxification programme but was admitted to hospital after a drink-driving incident. He does not want to go back to the alcohol detoxification programme but admits developing strong cravings for alcohol.

Back 32

Acamprosate is indicated as therapy to maintain abstinence in alcohol-dependent patients. It should be combined with counselling. Disulfiram could be used, however, it acts by causing an acute sensitivity when Mr K drinks alcohol instead of resolving the alcohol cravings.

Front 33

If prescribing cocaine for the purpose of treating addiction this prescriber requires a Home Office license.

Back 33

Doctors registered in the UK require a Home Office license to prescribe this controlled drug.

Front 34

This drug, when prescribed, should be withdrawn gradually if used for more than 2 weeks.

Back 34

Benzodiazepines can be prescribed for an array of conditions, however, they should not be prescribed for any longer than 2 to 4 weeks. This is due to the addictive nature of this drug class.

Front 35

Treatment of this drug may cause visual field defects.

Back 35

Vigabatrin - Patients using this drug must have regular eye checks as the use of this drug may cause visual field defects.

Front 36

Which ONE the following is most likely to cause dry mouth?

Back 36

Ipratropium is an antimuscarinic drug and therefore can cause dry mouth.

Front 37

She is breastfeeding her four week old baby and the baby has oral thrush. She has been prescribed miconazole cream for herself but she is unsure what to do with it. What is the best advice to give to the lady?

Back 37

The cream should be applied after feeding the baby.

Front 38

Which one of the following allied healthcare professionals is the most suitable to assess and support Mr G with his discomfort and could provide the patient with the support aids to assist him?[arthritis]

Back 38

Orthotists provide support aids to correct problems or deformities in people's nerves, muscles or bones. Examples include splints, braces and special footwear (orthotics).

Front 39

A 34-year-old woman has come in with her prescription for carbamazepine 200 mg three times daily. She asks you what the likely reason is for her maintenance dose to be higher than the dose she was started on, as her symptoms have not worsened since the start of treatment. What is the most appropriate explanation to give to this patient?

Back 39

Carbamazepine is an enzyme autoinducer and thus a lower loading dose is required. Carbamazepine induces its own metabolism and so the maintenance dose is higher than the initial doses

Front 40

She calls the pharmacy to state she is stopping her methotrexate treatment to try for a baby. She would like to know how long she needs to continue to use contraception for.

Back 40

Women must not get pregnantduring methotrexate therapy, and effective contraception must be used duringtreatment with methotrexate and at least 6 months thereafter.

Front 41

He calls the pharmacy to state he is stopping his methotrexate treatment to try for a baby. He would like to know how long he needs to continue to use contraception for.

Back 41

Sexually active male patients or their female partners are recommended to use reliable contraception during treatment of the male patient and for at least 6 months after cessation of methotrexate. Men should not donate semen during therapy or for 6 months following discontinuation of methotrexate.

Front 42

A terminally ill patient is very constipated and a doctor asks you to recommend a suitable laxative. Which one of the following is licensed for use in this situation?

Back 42

Co-danthramer is licensed for use 'only in constipation in terminally patients of all ages'.

Front 43

This medication can be used at a dose of up to 500 mg daily in divided doses in adult patients suffering with chronic constipation.

Back 43

Docusate sodium can be used up to 500 mg daily in divided doses for those adult patients suffering with chronic constipation.

Front 44

You are running a workshop training healthcare professionals in medicines and some side effects to look out for. One of the attendees questions you on which laxatives can colour the urine.

Back 44

Co-danthramer may colour urine red.

Front 45

Whilst delivering a revision session to a set of pharmacy students, you are asked which of the listed laxatives is an osmotic laxative.

Back 45

Lactulose is an osmotic laxative which exerts its action by increasing the amount of water in the large bowel.

Front 46

Use of this drug may cause the urine of the patient to turn reddish-brown in colour.

Back 46

Use of this drug may cause the urine of the patient to turn reddish-brown in colour.

Front 47

One of your patients has recently been diagnosed with gout. Clinical conditions often have associated risk factors. Which of the following increases the risk of developing gout?

Back 47

Risk factors for gout include: meat, seafood, alcohol (10 or more grams per day), diuretics, obesity, hypertension, coronary heart disease, diabetes mellitus, chronic kidney disease, high triglycerides, heart failure and male gender.

Front 48

You are working a Sunday morning shift in a high street pharmacy in England. A mother approaches you and asks for a spacer for her five year old son because his has broken. What would be the most appropriate course of action?

Back 48

A spacer is a medical device not a medicine. Therefore there are no restrictions on the sale of the spacer. As the medicaldevice can be sold to the patient, there is no need for the pharmacy tocomplete emergency supply record keeping and apply any applicableadministrative charges.

Front 49

What can a rubella infection cause in pregnant patients who DON'T have immunity to rubella?

Back 49

The mother passes the virus on the foetus and it damages their organs as they develop. This is known as congenital rubella syndrome (CRS). This includes the eyes (e.g. cataracts), ears (hearing loss), heart and brain. This could affect the child throughout their life.

Front 50

Which one of the following pieces of information relating to a patient's medication is NOT normally required when completing a medication history?

Back 50

Medication history should include medicines that have recently stopped or changed and although the MEP does not define how recent it would have to be, it is unlikely that medicines taken 6 months ago would be relevant to a current medication history.

Front 51

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?

Back 51

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

Front 52

Which of the following are monitored under the clozapine patient monitoring service?

Back 52

The UK Clozaril Patient Monitoring Service (CPMS) was developed in order to manage the risk of agranulocytosis associated with clozapine. Patients are centrally monitored for their leucocyte and neutrophil counts.

Front 53

Which of the following classifications require no licence to import or export the controlled drug?

Back 53

Schedule 5 Controlled Drugs require no special license for either exportation or importation.

Front 54

Which of the following medications may be the causative factor in the QT prolongation?

Back 54

Quinolones including ciprofloxacin may prolong the QT interval.

Front 55

Given that Mr K has tinea corporis, which one of the following treatments is the most suitable to treat his lesion?

Back 55

Dermatophyte infections such as tinea corporis may be exacerbated by prolonged use of topical steroids such as hydrocortisone as these exhibit immunosuppressive properties. Terbinafine is indicated in the treatment of tinea corporis.

Front 56

Over the past couple of days she has found it painful to urinate. She describes it as being a burning, stinging type of pain. She feels like she needs to urinate frequently but is only passing small amounts of urine. She says that her urine is quite dark and smells strongly.Which one of the following is Ms J most likely to be suffering from?

Back 56

Symptoms described are indicative of cystitis. Other conditions are associated with accompanying symptoms e.g. fever, discharge.

Front 57

A patient has been prescribed a cream to treat their condition. You need to counsel them that this cream may stain their clothing.Which of the following creams/ointments could stain clothing?

Back 57

Stains clothing. Patients or carers should be counselled on application of betamethasone with clioquinol preparations.

Front 58

Mrs T comes into your pharmacy. She tells you that her 15-year-old child has had diarrhoea for 6 days.Which of the following is NOT a red flag symptom of a more serious underlying cause for the acute diarrhoea?

Back 58

Prompt investigation is required to identify or exclude any serious underlying cause if the child has any red flag symptoms such as unexplained weight loss, rectal bleeding, persistent diarrhoea, a systemic illness.

Front 59

You are teaching a summer placement student about side effects. Which of the following symptoms is most likely to be attributed to prednisolone?

Back 59

Increased appetite is a pronounced side-effect of Prednisolone. Myositis reflects inflammation in the muscle possibly resulting from muscle damage. That is distinct from degradation of the muscle through chronic steroid use and is therefore not the correct answer.

Front 60

Which ONE of the following is NOT a reason to STOP the combined oral contraceptive pill?

Back 60

Only blood pressure above systolic 160 mmHg or diastolic 100 mmHg is a reason to stop the combined oral contraceptive pill.

Front 61

She has just turned 17 and would like to give blood. She has seen on the NHS website that when people are on certain medicines they may not be able to give blood. She asks you about her medicine, isotretinoin. What is the most appropriate advice?

Back 61

Patients should not donate blood during therapy and for 1 month following discontinuation of isotretinoin because of the potential risk to the foetus of a pregnant transfusion recipient.

Front 62

A patient is initiated on a medication for which they will need to take extra precautions to protect their skin from sunlight whilst taking it. Which of the following drugs when given at higher doses does this advice apply to?

Back 62

Promazine makes the skin more susceptible to the UV rays from the sun. As such, a patient on promazine therapy is more susceptible to burning/sun burn and must take precaution in sunlight. The BNF entry for promazine lists a specific advice warning on photosenitivity whereas the BNF entry for indapamide does not, and that is why it was chosen in this instance.

Front 63

Miss WQ is a regular patient of your pharmacy and comes to collect her weekly instalment of methadone. She returns, an hour later, asking for another to be dispensed as she dropped the bottle containing methadone. She shows you pieces of the broken bottle. Which of the following is the most appropriate response?

Back 63

Methadone is a schedule 2 Controlled Drug which is used to treat opioid misusers and can only be legally prescribed and dispensed against a valid instalment prescription. Pharmacists must be aware of the abuse potential of any Controlled Drug.

Front 64

It is mid-March and a patient presents to you in the pharmacy displaying cold-like symptoms. On questioning she says she remembers having a really bad cold last year at the same time.On questioning the patient, you suspect she might have an allergy rather than a cold. What is the likely cause of her allergy?

Back 64

In March, the responsible allergen is most likely to be tree pollen. The summer months would be grass pollen

Front 65

Morphine is a Schedule 2 controlled drug and is subject to strict regulations, including making records in the controlled drug register. Which of the following is NOT true regarding entries in the controlled drug register?

Back 65

When making an entry into the controlled drugs register the entry must be made on the day of transaction or the FOLLOWING DAY, no later.