- ProPharmace

• This assessment has been developed to support you with preparing for the GPhC registration assessment.
• You will score one mark for each correct answer, no marks will be deducted for incorrect answers or omissions.
• Answer the questions as though you were a pharmacist, not a Foundation trainee pharmacist
• For questions that show the resource logo, you can click on download the resource.
• Use the green accessibility tool on the right to adjust your learning experience according to your preference

Mr A is 55-years-old and is diagnosed with atrial fibrillation. The doctor has decided to initiate amiodarone as other medications have proven to be ineffective in managing his condition. Mr A is a non-smoker and drinks an average of 2 units of alcohol per day.

Which of the following clinical tests is the least likely to be conducted prior to the initiation of amiodarone?

Liver function test

Serum potassium

Ocular examination

Chest x-ray

Thyroid function test

Your comments:

Question 1 of 360

Mr B, a 40-year-old regular patient presents at the pharmacy complaining of pain in his right shoulder. He tells you that he thinks the pain was caused by lifting heavy boxes while he was helping his friend move house over the weekend. He asks you to recommend a suitable analgesic to ease his pain and tells you that he has not taken anything yet. His PMR shows that he is currently taking the following medication:

Ramipril 10mg
Amlodipine 5mg

Which of the following over the counter analgesics would be the most appropriate to recommend?

Soluble paracetamol tablets

Ibuprofen capsules

Naproxen tablets

Co-codamol tablets

Paracetamol caplets

Question 2 of 360

Mrs C is a 45-year-old woman who presents at your pharmacy with a prescription from her GP. She explains to you that the GP has recently prescribed a new medication for her to help reduce the risk of cardiovascular disease. Mrs C has type 1 diabetes which she was diagnosed with when she was 15 years old. She informs you that her blood sugar is well controlled with her current insulin regimen and she has no other medical problems.

Which of the following medications would Mrs C most likely have been recently prescribed?

Atorvastatin 20mg

Metformin 500mg

Simvastatin 20mg

Aspirin 75 mg

Ramipril 5mg

Your comments:

Question 3 of 360

Mr D, a 70-year-old, comes to the pharmacy seeking advice. He is upset that the Warfarin he has been using for a few years has now been stopped and a new medication, Apixaban, has been prescribed instead. He was used to taking the Warfarin and does not like changing medication because it confuses him. He also enjoyed attending the INR clinic for his appointments as it gave him a reason to leave the house, as well as making a number of friends there.

What is the most suitable advice you would give Mr D?

Inform Mr D that he will still need to attend a weekly clinic for blood testing

Inform Mr D that he will now be able to drink alcohol at his leisure

Inform Mr D that the doctor should not have stopped warfarin without gradually titrating down the dosage

Inform Mr D that there will be a lower risk of bleeding with apixaban compared to warfarin

Inform Mr D that apixaban has a lower ICER compared to warfarin

Your comments:

Question 4 of 360

Mr E, a 57-year-old man, presents in your pharmacy seeking advice on abnormal blood test results. He tells you that the medication he was taking for hypertension were not controlling his blood pressure sufficiently and the GP added Bendroflumethiazide 2.5mg two months ago. He recently had a blood test and was told that the results may be attributed to the Bendroflumethiazide.

Which of the following abnormal blood test results is least likely to be caused by Bendroflumethiazide?

Hyponatraemia

Hypomagnesaemia

Hypocalcaemia

Hypokalaemia

Hyperglycaemia

Your comments:

Question 5 of 360

Mrs F has been a regular patient at your pharmacy for 5 years. She presents in your pharmacy on a busy Friday afternoon requesting that you provide her with a copy of her PMR (patient medical record) that she requires for her personal use. All patient medication records in your pharmacy are completely held on computer.

Under the provisions of the Data Protection Act 1998, which of the following would be the best course of action for you to take?

Tell Mrs F that she has no right to access her PMR

Tell Mrs F that you are currently busy and ask her to return on Monday morning when it is quiet to obtain a copy of her PMR

Tell Mrs F that you will need the request in writing, after which you will provide her with a copy within 40 days upon the receipt of a £10 charge

Tell Mrs F that you cannot provide her with a copy of her PMR but she can arrange a time to come and view it in the pharmacy

Tell Mrs F that you will need the request in writing following which you will provide her with a copy within 40 days upon the receipt of a £50 charge

Question 6 of 360

Mrs G comes in to the pharmacy to speak to you about her 10-year-old son who was diagnosed with asthma a year ago. She tells you that she has noticed that her son is using his Salbutamol inhaler a lot more over the past two months, often up to six times a week and that his symptoms frequently disturb his sleep. Apart from the inhaler, her son takes no other medication.

According to the British Thoracic Society (BTS) guidelines, which of the following medications should her son be initiated on?

Beclometasone dipropionate inhaler 100mcg twice daily

Salmeterol 50mcg twice daily

Theophylline 175mg every 12 hours

Montelukast 5mg in the evening

Beclometasone dipropionate inhaler 400mcg twice daily

Your comments:

Question 7 of 360

Mrs H is a 55 year old woman who has Type 2 Diabetes for which she takes Metformin 500mg three times a day. She presents in the pharmacy complaining of painful lesions in her mouth that often bleed when she rubs them. She has had these symptoms for the past 10 days and has noticed that the number of lesions have increased and the pain has become progressively worse. Upon examination, you notice a number of white patches on her tongue.

Which of the following is the most appropriate action for you to take?

Advise Mrs H that this is a normal side effect of her medication and that she could use paracetamol to ease the pain

Sell her Bonjela oral gel and advise her to apply it to the lesions up to 8 times a day

Advise Mrs H that she is suffering from mouth ulcers and using an antibacterial mouthwash may help

Sell her Nystatin oral suspension and advise her to apply 1ml to the lesions four times a day for 7 days

Advise Mrs H to see her GP as her medication may need to be reviewed

Your comments:

Question 8 of 360

Mr I is a 65-year-old man with an ideal body weight of 72kg who has been hospitalised with septicaemia. The doctors decide to start him on gentamicin intravenous infusion at a dose of 7mg/kg. The infusion is started at 7am and a blood sample is taken at 5pm on the same day. The serum gentamicin concentration is found to be 6.5mg/L.

Which of the following statements would be most appropriate regarding the treatment of Mr I with gentamicin?

Mr I should be given a gentamicin dose of 252mg twice daily

Subsequent doses of gentamicin should be given every 36 hours

Blood samples for peak serum concentrations of multiple daily dose regimens of gentamicin should be taken two hours after a dose

Subsequent doses of gentamicin should be given every 24 hours

The serum gentamicin concentration is too high and no further doses should be administered until the serum concentration falls to below 1mg/L

Do you have any comments about this question? Let the team know below

Question 9 of 360

10.

A worried mother comes into the pharmacy with her 5-year-old son. The mother suspects a fever and you record a temperature of 37.8°C. The child appears distressed and the mother informs you he had developed a cold a few days ago. You recommend paracetamol for the fever.

Which of the following is the most appropriate dose of paracetamol to be administered every six hours?

2.5ml of 120mg/5ml oral suspension

5ml of 120mg/5ml oral suspension

7.5ml of 120mg/5ml oral suspension

10ml of 120mg/5ml oral suspension

15ml of 120mg/5ml oral suspension

Your comments:

Question 10 of 360

11.

Mr L, a 45-year-old man weighing 75kg, is rushed to hospital having taken an overdose. He was found in his house collapsed in the bathroom. After examination, the doctors determine that he had taken the overdose about 2 hours ago and decide that repeated doses of activated charcoal by mouth will be the best treatment for him.

Which of the following medication is Mr L most likely to have over dosed on?

Paracetamol

Lithium carbonate

Theophylline

Morphine

Aspirin

Your comments:

Question 11 of 360

12.

Mr M, who weighs 83kg, was initiated on lithium carbonate at a dose of 1.2g daily in two divided doses. His lithium levels have been monitored weekly for the past five weeks. Which of the following is the target serum-lithium concentration that should be achieved?

0.4-1 mmol/litre

0.2-1 mmol/litre

1-1.4 mmol/litre

0.4-1 mg/litre

0.2-1 mg/litre

Your comments:

Question 12 of 360

13.

Miss N has eczema and has been prescribed 3 x 500g of Balneum Plus Cream (Urea 5%, Lauromacrogols 3%) to use whilst she is away on holiday for two months.Which of the following provides the correct weight of active ingredients in the total amount of cream prescribed?

15g of Urea, 9g of Lauromacrogols

25g of Urea, 15g of Lauromacrogols

75g of Urea, 45g of Lauromacrogols

75g of Urea, 450g of Lauromacrogols

750g of Urea, 45g of Lauromacrogols

Your comments:

Question 13 of 360

14.

Ms O is a 34-year-old woman who comes into the pharmacy distressed and asks to speak to the pharmacist about the new medication for her rheumatoid arthritis, Methotrexate. She has been taking the Methotrexate weekly as directed for four weeks. She reports feeling sick for the past week. She is not sure if this is a side effect of the medication or if she might be pregnant as she is forgetful when taking her oral contraception.What is the best advice for Ms O regarding Methotrexate and pregnancy?

Methotrexate may harm the unborn child but is unlikely to cause a miscarriage. Women who become pregnant whilst on the treatment should continue their treatment as the benefit to the mother outweighs the risk to the unborn child

Methotrexate may harm the unborn child and cause a miscarriage. Women who become pregnant whilst on the treatment should continue their treatment as the benefit to the mother outweighs the risk to the unborn child

Methotrexate may harm the unborn child but is unlikely to cause a miscarriage. Women who become pregnant whilst on the treatment should continue their treatment and promptly speak to their doctor

Methotrexate may harm the unborn child but is unlikely to cause a miscarriage. Women who become pregnant whilst on the treatment should stop their treatment immediately and speak to their doctor

Methotrexate may harm the unborn child and cause a miscarriage. Women who become pregnant whilst on the treatment should stop their treatment immediately and speak to their doctor

Your comments:

Question 14 of 360

15.

Miss P, a 27-year-old presents in your pharmacy complaining of a rash. She shows you her arm which has round, red patches on it and she complains of itching.Which of the following would be the most suitable product to recommend, over the counter, for the treatment of Miss P’s rash?

Hydrocortisone 1% cream

Mepyramine Maleate cream

E45 itch relief cream

Clotrimazole 1% cream

Savlon cream

Do you have any comments about this question? Let the team know below

Question 15 of 360

16.

Mrs Q is a 49-year-old woman who presents at your pharmacy with a prescription for 28 x Perindopril erbumine 4mg tablets. She informs you that she has been recently diagnosed with hypertension that has not responded to lifestyle changes alone. She tells you that her GP has just measured her blood pressure to be 158/93mmHg. This is the first time she has been prescribed antihypertensive medication and she seems rather worried about taking it. You reassure Mrs Q and dispense the prescription for her.Which of the following should be added onto the dispensing label for Mrs Q’s medication?

Take at night

Do not stop taking this medicine unless your doctor tells you to stop

Total quantity

Take 30 to 60 minutes before food

Keep out of sight of children

Do you have any comments about this question? Let the team know below

Question 16 of 360

17.

Mrs R, a 34-year-old woman who is 2 months pregnant has been experiencing morning sickness. She has recently been experiencing new symptoms including a burning sensation upon urination and has a slightly elevated temperature. The doctor requests a urine specimen for culture and sensitivity testing and decides to start her on antibiotics while waiting for the results. Mrs R is otherwise healthy and takes no regular medication apart from Folic Acid 400mcg. Which of the following antibiotics would be the most suitable for Mrs R to start taking while the doctor awaits the results of the culture?

Trimethoprim

Ciprofloxacin

Cefalexin

Methenamine hippurate

Doxycycline

Your comments:

Question 17 of 360

18.

You are dispensing a prescription for Mr S, a 67-year-old man, who has just had cataract surgery on his right eye. The prescription includes:

Chloramphenicol 0.5% eye drops, one drop to be instilled into the affected eye(s) four times a day
Dexamethasone 0.1% eye drops, one or two drops should be applied topically to the eye up to six times a day

Mr S does not have any other health conditions and does not take any other medication.What is the most appropriate advice to give Mr S when dispensing his prescription?

If he is administering the eye drops at the same time, he should leave at least a five minute interval between instilling each one

He should administer the chloramphenicol eye drops after the Dexamethasone eye drop

He should not use the eye drops at the same time and should leave at least a two hour interval between using them

The Chloramphenicol eye drops do not need to be kept in the fridge once opened

Dexamethasone aids with the absorption of Chloramphenicol

Your comments:

Question 18 of 360

19.

Mrs T, a 56-year-old presents at your pharmacy with pain behind her right ankle. She is unable to weight bear on her right leg. She would like you to suggest some analgesics for her and you check her PMR (patient medical record) for any existing medication before proceeding. You notice that she was dispensed a course of Ciprofloxacin 500mg twice daily three days ago and she confirms that she has been taking them as prescribed since then. You suspect that she may have ruptured her tendon.Which of the following factors would increase the risk of tendon damage in Mrs T while taking Ciprofloxacin?

Taking oral prednisolone daily for the management of rheumatoid arthritis

A history of gout

Taking oral diclofenac daily for the management of osteoarthritis

Age over 55 years

A history of osteoporosis

Your comments:

Question 19 of 360

20.

Mrs U is on holiday in the UK from Germany. She cannot converse well in the English language and presents you with a prescription for herself. She also shows you a box of Ramipril that is labelled with her name and has one tablet remaining in there. You try to confirm the registration status of the prescriber by contacting the appropriate authorities in Germany but are unable to do so.What would be the most appropriate measures to take when handling Mrs U’s prescription?

Hand the prescription back to Mrs U and explain that you are unable to make the supply

Do not dispense the prescription but provide Mrs U with a five day emergency supply of Ramipril tablets

Dispense half the quantity prescribed and tell Mrs U to return to collect the remaining quantity once you have confirmed the registration status of the prescriber

Dispense the prescription as normal documenting the steps you have taken to confirm the registration status of the prescriber

Refer Mrs U to a UK based prescriber to obtain a new prescription

Do you have any comments about this question? Let the team know below

Question 20 of 360

21.

Mrs V, a 68-year-old woman has been admitted to hospital following a fall. She has been feeling very drowsy recently and appears to be confused. The doctor has sent her for further testing. She is currently taking the following medication:

- Diclofenac
- Omeprazole
- Amlodipine
- Fluoxetine
- Atorvastatin

Which one of Mrs V’s medication is the most likely cause of her fall?

Diclofenac

Omeprazole

Amlodipine

Fluoxetine

Atorvastatin

Do you have any comments about this question? Let the team know below

Question 21 of 360

22.

Mrs X is a 36-year-old regular customer at your pharmacy. Her husband rings the pharmacy and reports that she is very poorly with a fever and has developed a rash. You are aware from her PMR (patient medical record) that she started treatment with Carbamazepine a few weeks ago. He would like to know what recommendation you can make.What advice would you give to Mr X regarding his wife?

Mrs X is likely to have a virus and should not take any OTC medications due to the risk of drug interactions. She should rest and drink fluids to stay hydrated. If she is not better in a week, she should ring the GP for an appointment

Mrs X is likely to have a virus. It is safe for her to take paracetamol with carbamazepine. If she is not better in a week, she should ring the GP for an appointment

This may be due to her new medication. She should make an appointment with the GP to reduce the dose of carbamazepine

This may be due to her medication. She has signs of Antiepileptic Hypersensitivity Syndrome and should seek immediate medical attention

This may be due to her new medication. She has signs of carbamazepine toxicity and should seek immediate medical attention

Your comments:

Question 22 of 360

23.

You are the pharmacist at your local pharmacy and you receive a prescription from a new patient, Mr W. You do not have his item in stock. Which of the following is the most appropriate course of action to take?

Order the item and supply the medication to the patient when the order arrives

Contact the prescriber and ask them to make an indelible amendment to reduce the total quantity to 30 sachets, then dispense the prescription

Contact the prescriber and ask them to make an indelible amendment to reduce the total quantity to 28 sachets, then dispense the prescription

Amend the prescription indelibly to include the total quantity in words, then dispense the prescription

Do not dispense the prescription as it is not legally valid

Do you have any comments about this question? Let the team know below

Question 23 of 360

24.

Mrs Y, a 49-year-old woman has recently been diagnosed with a malignant tumour. It has been decided that she will commence chemotherapy following surgery to remove the tumour. Mrs Y is rather anxious about the side effects of chemotherapy and is worried that the nausea and vomiting may interfere with her daily activities.Which of the following cytotoxic medications is considered to be the least emetogenic treatment?

Cisplatin

Doxorubicin

Mitoxantrone

Vincristine

Cyclophosphamide

Your comments:

Question 24 of 360

25.

Mr Z, a 37-year-old man presents in the pharmacy and asks to speak to you in private. He tells you that he is very concerned about his father who is 72 years of age. On a number of recent visits to his father, he has noticed that he is eating an abnormally large amount of food in a short period of time and at a very rapid rate. He found him on a few occasions ‘binging’ on food in the kitchen shortly after they had a meal together. He asks you whether any of the medication that his father is taking could be making him hungry or causing him to binge eat.Which of the following medication that Mr Z’s father is taking could be the likely cause of his eating habits?

Co-careldopa

Simvastatin

Tamsulosin

Ramipril

Selegiline

Your comments:

Question 25 of 360

26.

Mrs A and her two children are regular customers at the pharmacy. Mrs A would like to speak to the pharmacist about her youngest daughter, who is 8 years old. You are aware her daughter started sodium valproate last year and is now on a maintenance dose. She has been seizure free for several months. Mrs A informs you her daughter is unwell with a tummy bug. She has pain in her stomach, feels sick and has been vomiting. Mrs A asks if you can recommend an OTC (over-the-counter) medication which would be suitable with her daughter’s medication for epilepsy. What advice would you give to Mrs A?

Do not give Mrs A’s daughter any OTC medication. There is too much risk of interactions with the sodium valproate

It is safe to give oral rehydration therapy. If her symptoms persist for more than 2 days, ring the GP for an appointment

It is safe to give paracetamol. If her symptoms persist for more than 2 days, ring the GP for an appointment

If she is vomiting, she may not be getting enough of the sodium valproate. Ring the GP for advice on her dose

Her symptoms may be due to the sodium valproate. Seek immediate medical attention

Your comments:

Question 26 of 360

27.

Miss B, a 36-year-old woman presents at your pharmacy and asks you for advice. She wishes to start using a contraceptive pill and wants to know which one would be the best option for her. She has read that combined contraceptive pills are associated with an increased risk of venous thromboembolic disease. She asks you whether there are any particular factors that may increase her risk of developing a venous thromboembolism.Which of the following is not a risk factor for developing venous thromboembolism for women taking a combined contraceptive pill?

A family history of venous thromboembolism

Migraine without aura

Smoking

Long term immobilisation

Age over 35 years

Your comments:

Question 27 of 360

28.

Mr C, a 24-year-old man is admitted to hospital with fluctuating levels of consciousness, excessive sweating, muscle rigidity and hyperthermia with a temperature of 39.1°C. Upon further examination, he is found to have tachycardia, tachypnea and labile blood pressure. On admission, Mr C is taking the following medication:- Simvastatin 20mg, one to be taken at night- Olanzapine 15mg, one to be taken in the evening- Procyclidine 5mg, one to be taken three times a day- Metformin 500mg, one to be taken twice a dayWhich of the following would be the most appropriate action to take in the management of Mr C’s condition?

Start an intravenous infusion of soluble insulin

Stop the olanzapine

Initiate an intravenous infusion of streptokinase 1,500,000 iu

Stop the procyclidine

Start amiodarone 100mg three times a day

Your comments:

Question 28 of 360

29.

You are the responsible pharmacist and need to leave the pharmacy to attend an urgent meeting in the GP surgery. Your meeting should not take longer than an hour and the pharmacy will remain open with a dispenser and counter assistant to attend to customers.Which of the following tasks can be conducted in your absence?

The sale of a 20g tube of clotrimazole 1% cream for the treatment of vaginal candidiasis

The sale of a pack of 32 paracetamol 500mg tablets to a man with a headache

The sale of a pack of 12 pseudoephedrine hydrochloride 60mg tablets to a man with nasal congestion

The sale of an 80ml bottle of paracetamol 250mg/5ml sugar free suspension to the parent of a 7-year-old child with fever

The sale of 30 Scholl Corn Removal salicyclic acid plasters to a 46-year-old woman who also takes metformin and sitagliptin

Your comments:

Question 29 of 360

30.

Mrs D visits her GP with her 4-year old-daughter. Mrs D is very worried as her daughter has been developing fluid filled blisters on her abdomen which quickly spread to her arms and legs. Some of the blisters on the abdomen have burst leaving a yellow crust. Mrs D’s daughter has said the blisters are painful and the skin surrounding them is quite itchy. Mrs D also mentions that her daughter has been suffering with a fever. The GP makes a diagnosis of bullous impetigo but does not suspect it is caused by streptococci and would like to prescribe antibiotics. Mrs D mentions that the last time her daughter took antibiotics for a chest infection she developed a rash on the back of her neck four days after starting the course. She explains that the rash was non-confluent and not itchy. The GP notes from Mrs D’s daughter’s records that the antibiotic prescribed was amoxicillin.Which of the following antibiotics would be the most appropriate for the treatment of Mrs D’s daughter’s impetigo?

Phenoxymethylpenicillin

Topical fusidic acid

Flucloxacillin

Clarithromycin

Topical mupirocin

Do you have any comments about this question? Let the team know below

Question 30 of 360

31.

You are on the committee appointed by your hospital that is responsible for writing the antibacterial policy to support ‘antimicrobial stewardship’.Which one of the following statements would be least likely to be included in the ‘antimicrobial stewardship’ policy?

a patient with a life-threatening condition due to a suspected bacterial infection should receive prompt antibiotic treatment without waiting for the results of investigations

a patient with a suspected infection should have samples taken for microbiology testing to help establish a diagnosis, preferably before starting antibiotic treatment

in general, broad-spectrum antibiotics are preferred to narrow-spectrum antibiotics unless there is a clear clinical indication (e.g. life-threatening sepsis)

when deciding whether or not to prescribe an antimicrobial, prescribers should take into account when prescribing antimicrobials, prescribers should follow local (where available) or national guidelines on prescribing the shortest effective course, the most appropriate dose, and the route of administration

Non-formulary antimicrobials must not be prescribed without authorisation from a consultant microbiologist

Your comments:

Question 31 of 360

32.

Mrs F, a 57-year-old woman with type 2 diabetes presents at your pharmacy asking for your advice. She tells you that she is interested in purchasing a glucose testing machine as her friend who is also diabetic has one and is able to monitor her blood glucose levels regularly. Mrs F would also like to be able to monitor her blood glucose levels but does not want a complicated machine and asks for your advice on which machine would be the best to buy. Which of the following is the least appropriate reason for a patient with type 2 diabetes to conduct self-monitoring of blood glucose?

The patient would like to check that the medication they are taking is providing adequate diabetic control

The patient is on insulin

The patient is taking oral medication that may increase their risk of hypoglycaemia while driving or operating machinery

The patient is pregnant or planning to become pregnant

There is evidence that the patient suffers from hypoglycaemic episodes

Your comments:

Question 32 of 360

33.

Mr G, a 38-year-old man, presents in the pharmacy with a prescription for 60g piroxicam 0.5% gel to be applied up to four times a day. He explains that his GP has prescribed this medication for him as he has severe back pain that did not respond to ibuprofen.Which of the following statements should you consider when dispensing Mr G’s prescription?

In adults the use of piroxicam should be limited to the symptomatic relief of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis

Treatment should be reviewed after four weeks

Mr G must take a gastro-protective agent concomitantly

Piroxicam should only be initiated by physicians experienced in treating inflammatory or degenerative rheumatic diseases

Piroxicam should not be used as first-line treatment

Your comments:

Question 33 of 360

34.

Mrs H, a 35-year-old woman, presents in the pharmacy asking for your advice. She has developed a small circle of thickened skin on the side of her big toe. Although it is not often painful, she is rather conscious of it and would like something to help remove it as the summer is approaching and she wants to wear sandals but is worried at how her feet may look in them.What is the most likely diagnosis of the lesion on Mrs H’s foot?

Corn

Plantar fasciitis

Callus

Hallux valgus

Verruca

Do you have any comments about this question? Let the team know below

Question 34 of 360

35.

Miss I, a 26-year-old woman, has recently been diagnosed with hypothyroidism. She presents at the pharmacy with a prescription for levothyroxine 50mcg daily.Which of the following is the least appropriate advice to give Miss I regarding taking the levothyroxine tablets?

Calcium salts can reduce the absorption of levothyroxine

If you are taking iron supplements, you should leave a 2 hour gap between taking iron and levothyroxine

You should wait at least 30 minutes after taking your levothyroxine tablets before you drink coffee or tea

Levothyroxine is best taken in the morning with breakfast

You should not take antacids at the same time as levothyroxine

Your comments:

Question 35 of 360

36.

Miss J, a 23-year old-woman presents you with a new prescription for Noriday (Norethisterone) 350mcg tablets. The doctor has prescribed them for her as a contraceptive and has told her to take one daily starting on day 1 of the menstrual cycle and then continuously.Which of the following is the most appropriate advice to give Miss J when dispensing her prescription?

Smoking increases some of the risks associated with progestogen-only pill

You should never take two pills in one day

If you are more than 3 hours late taking your pill, you should take the pill as soon as you remember and use an extra method of contraception for the next 7 days

You should wait at least a month after miscarriage or an abortion before taking Noriday

The risk of breast cancer associated with the use of progestogen-only pills is dependent on how long a woman takes the pill for

Do you have any comments about this question? Let the team know below

Question 36 of 360

37.

Mr L is a 57-year-old man who presents in the Urgent Care unit at his local hospital with a number of symptoms. Acute kidney injury is suspected.Which one of Mr L's symptoms is most likely to indicate acute kidney injury?

Ascites

Fever

Headache

Oliguria

Palpitations

Your comments:

Question 37 of 360

38.

Mr M, a 58-year-old, is starting treatment with Entresto for heart failure with reduced ejection fraction. He also takes the following medication:- metformin 500mg tablets, one to be taken three times daily- ramipril 10mg capsules, one to be taken daily- codeine 15mg tablets, one to be taken when required- paracetamol 500mg tablets when requiredHis eGFR is 90 mL/min/1.73m2. How much Sacubitril will Mr M receive if he takes the starting dose of Entresto recommended for him?

97mg twice daily

49 mg twice daily

51mg twice daily

26mg twice daily

24mg twice daily

Do you have any comments about this question? Let the team know below

Question 38 of 360

39.

Mrs N was started on amlodipine 5mg once daily but could not tolerate it. In accordance with the NICE Hypertension Treatment guidelines, the doctor decided to stop the amlodipine and initiate a diuretic.Which of the following diuretics would be the most appropriate for Mrs N to start taking?

Furosemide

Bendroflumethiazide

Spironolactone

Indapamide

Hydrochlorothiazide

Your comments:

Question 39 of 360

40.

This question is related to Mrs N, a 57-year-old woman who was recently diagnosed with stage 1 hypertension which did not respond to lifestyle interventions.

It is decided that Mrs N will use HBPM (home blood pressure monitoring) to monitor her response to the antihypertensive medication.

Which of the following is the most appropriate target average blood pressure that Mrs N should aim for?

Below 130/85mmHg

Below 135/85mmHg

Below 140/90mmHg

145/85mmHg

150/90mmHg

Your comments:

Question 40 of 360

41.

This question relates to Miss O, a 21-year-old woman who presents in the pharmacy with a prescription for ketoconazole 200mg tablets to be taken three times a day.

Which of the following conditions is Miss O most likely to be using the tablets for?

Aspergillosis

Acne

Cushing’s syndrome

Candidiasis

Tinea pedis

Your comments:

Question 41 of 360

42.

This question relates to Miss O, a 21-year-old woman who presents in the pharmacy with a prescription for ketoconazole 200mg tablets to be taken three times a day.

Which of the following assessments would least likely be conducted on Miss O while taking the ketoconazole tablets?

Serum alanine transaminase

Serum Cortisol

ECG

Serum aspartate transaminase

Thrombocyte count

Your comments:

Question 42 of 360

43.

This question relates to Mr P, a 56-year-old man with type 2 diabetes for over a year. He currently takes the following medication:

- Metformin 500mg three times a day
- Sitagliptin 100mg daily
- Gliclazide 80mg in the morning and afternoon, and 40mg at night.

Mr P has a BMI of 27kg/m2 and is of Scandinavian origin.

Despite taking his diabetic medication regularly as prescribed, Mr P continues to have raised blood sugar levels. His doctor decides to initiate him on insulin therapy.

Which of the following insulin preparations would be the most suitable for Mr P to begin taking?

Humalog Mix25 (25% insulin lispro solution and 75% insulin lispro protamine suspension)

NovoMix 30 (insulin aspart and protamine-crystallised insulin aspart)

Humulin I Isophane (insulin human)

NovoRapid (insulin aspart)

Lantus (insulin glargine)

Your comments:

Question 43 of 360

44.

This question relates to Mr P, a 56-year-old man with type 2 diabetes for over a year. He currently takes the following medication:

- Metformin 500mg three times a day
- Sitagliptin 100mg daily
- Gliclazide 80mg in the morning and afternoon, and 40mg at night.

Mr P has a BMI of 27kg/m2 and is of Scandinavian origin.

Despite taking his diabetic medication regularly as prescribed, Mr P continues to have raised blood sugar levels. His doctor decides to initiate him on insulin therapy.

One month later, Mr P returns to the pharmacy complaining that the insulin injections are proving to be quite painful.

When offering him advice on how to reduce the pain from the insulin injections, which of the following is the least appropriate recommendations to make?

Use a new needle for every injection

Use a shorter needle for injecting

Numb the injection site with ice for 15 seconds before injecting

Inject the insulin straight after showering

Do not use the insulin straight from the refrigerator

Your comments:

Question 44 of 360

45.

Mr Q, a 66-year-old man has been stabilised on Oramorph concentrated oral solution (morphine sulphate 100mg/5ml) for the past six months. The consultant doctor decides to switch him onto Durogesic DTrans (fentanyl) patches as his pain is under control. He currently takes 1.5mL every six hours.

Which of the following Durogesic DTrans patches should the doctor prescribe for use every 72 hours to provide an equivalent effect to Mr Q’s current daily dose from Oramorph concentrated oral solution?

fentanyl ‘12’ patch

fentanyl ‘25’ patch

fentanyl ‘50’ patch

fentanyl ‘75’ patch

fentanyl ‘100’ patch

Do you have any comments about this question? Let the team know below

Question 45 of 360

46.

You receive a prescription for Mrs R, a 75-year-old woman with terminal cancer. The prescription is for 5 x fentanyl 100mcg patches. You label and dispense the item in accordance with the instructions on the prescription and make a record of the supply in the CD register. While doing so, you notice that this is the final entry in the register. You also had some out of date fentanyl 100mcg patches in stock which were destroyed 2 weeks ago in the presence of an authorised witness. The destruction was recorded in the same register you used to enter Mrs R’s supply.

How long are you legally required to keep this completed CD register for?

1 year

2 years

3 years

5 years

7 years

Your comments:

Question 46 of 360

47.

Mr S, a 47-year-old who has been diagnosed with deep vein thrombosis, tells you that he regularly visits the anticoagulant clinic to have his INR measured and any dose adjustments to his warfarin are subsequently made.

Which of the following INR values would be considered as satisfactory for Mr S while receiving treatment with warfarin and would not require a dosage adjustment?

0.8

1.4

2.8

3.5

Your comments:

Question 47 of 360

48.

Drug X must be kept at a plasma concentration of above 50mcg/ml in order to maintain its therapeutic effect. If the initial plasma concentration achieved immediately after administration is 200mcg/ml and the half-life of Drug X is 2 hours, after how many hours post-administration will Drug X no longer be effective?

2 hours

3 hours

3.5 hours

4 hours

4.5 hours

Your comments:

Question 48 of 360

49.

This question relates to Mrs T, a 52-year-old woman, who presents to the GP surgery with symptoms and signs of lower respiratory tract infection. She reports a persistent cough with sputum production, chest pain, and fever for over a week. She has no history of respiratory illness. Upon examination her blood pressure is 119/78 and she has a respiratory rate of 20. Focal chest signs are present and in the absence of a chest X-ray, it is the GP’s opinion that Mrs T has community acquired pneumonia and should start oral antibiotic treatment today. She has a documented allergy to ciprofloxacin.

According to the CRB65 score, what is Mrs T’s risk of death?

0: Low Risk

1: Intermediate Risk

2: Intermediate Risk

3: High Risk

4: High Risk

Do you have any comments about this question? Let the team know below

Question 49 of 360

50.

[Get Hints]

cefalexin

amoxicillin

clarithromycin

erythromycin

dual antibiotic therapy with amoxicillin and clarithromycin

Your comments:

Question 50 of 360

51.

This question relates to Mr U, a 60-year-old man, who has developed diarrhoea after a course of broad spectrum antibiotics. A stool sample has confirmed an anaerobic Clostridium difficile infection. It is his first episode of C. difficile. His symptoms are mild, with less than three stools per day, and there is no increase in white cell count. Mr U has normal renal and hepatic function.

Which of the following doses of metronidazole would be the most appropriate to use when treating Mr U?

200mg every 6 hours

200mg every 8 hours

400mg every 6 hours

400mg every 8 hours

400mg every 12 hours

Your comments:

Question 51 of 360

52.

This question relates to Mr U, a 60-year-old man, who has developed diarrhoea after a course of broad spectrum antibiotics. A stool sample has confirmed an anaerobic Clostridium difficile infection. It is his first episode of C. difficile. His symptoms are mild, with less than three stools per day, and there is no increase in white cell count. Mr U has normal renal and hepatic function.

Which of the following antibiotics is least likely to have caused Mr U’s C.difficile infection?

co-amoxiclav

ciprofloxacin

amoxicillin

vancomycin

clindamycin

Your comments:

Question 52 of 360

53.

This question relate to Mr V, a 53-year-old Caucasian man presenting to the outpatient nephrology clinic at a hospital. He is being seen to review his renal function and if necessary adjust the doses of his current medication. He has a history of controlled type 2 diabetes, hypertension, hypercholesterolaemia, and osteoarthritis. His eGFR is 54mL/min/1.73m2. His medications are shown below.

Drug name	Dose	Route	Frequency
metformin	500mg	oral	twice daily
aspirin	75mg	oral	daily
simvastatin	20mg	oral	daily
ramipril	5mg	oral	daily
paracetamol	500mg	oral	four times daily

Which medication is at a maximum daily dose for Mr V’s renal function?

paracetamol

aspirin

metformin

ramipril

simvastatin

Your comments:

Question 53 of 360

54.

Drug name	Dose	Route	Frequency
metformin	500mg	oral	twice daily
aspirin	75mg	oral	daily
simvastatin	20mg	oral	daily
ramipril	5mg	oral	daily
paracetamol	500mg	oral	four times daily

Which medication may have an increased risk of hyperkalaemia due to Mr V’s renal function?

paracetamol

aspirin

metformin

ramipril

simvastatin

Your comments:

Question 54 of 360

55.

Drug name	Dose	Route	Frequency
metformin	500mg	oral	twice daily
aspirin	75mg	oral	daily
simvastatin	20mg	oral	daily
ramipril	5mg	oral	daily
paracetamol	500mg	oral	four times daily

Which of Mr V’s medications must be used with caution in renal impairment due to risk of lactic acidosis?

paracetamol

aspirin

metformin

ramipril

simvastatin

Your comments:

Question 55 of 360

56.

This question relates to Mr W, a 44-year-old man, who is admitted to hospital with a serious infection. Intravenous tobramycin is to be started at an appropriate dose and serum concentration levels have been ordered for therapeutic monitoring. His pre-treatment body weight is 60 kg, with a normal renal function.According to the SPC, which of the following is considered an appropriate usual dose of intravenous tobramycin for Mr W?

60mg every 8 hours

60mg every 12 hours

80mg every 8 hours

80mg every 12 hours

100mg every 8 hours

Do you have any comments about this question? Let the team know below

Question 56 of 360

57.

This question relates to Mr W, a 44-year-old man, who is admitted to hospital with a serious infection. Intravenous tobramycin is to be started at an appropriate dose and serum concentration levels have been ordered for therapeutic monitoring. His pre-treatment body weight is 60 kg, with a normal renal function. The hospital only holds 2ml vials in stock. How many 1mL vials of tobramycin are needed to make 24 hours supply of the usual dose?

3 vials

4 vials

5 vials

6 vials

2 vials

Do you have any comments about this question? Let the team know below

Question 57 of 360

58.

This question relates to Mr W, a 44-year-old man, who is admitted to hospital with a serious infection. Intravenous tobramycin is to be started at an appropriate dose and serum concentration levels have been ordered for therapeutic monitoring. His pre-treatment body weight is 60 kg, with a normal renal function.Which of the following medications is a correct dilution for a dose of tobramycin?

with 5% Dextrose Intravenous Infusion BP to 100mL

with 0.45% Sodium Chloride Intravenous Infusion BP to 100mL

with 0.9% Sodium Chloride Intravenous Infusion BP to 150mL

with 5% Dextrose Intravenous Infusion BP to 200mL

with 0.45% Sodium Chloride Intravenous Infusion BP to 200mL

Do you have any comments about this question? Let the team know below

Question 58 of 360

59.

Mrs X is a 45-year-old woman who was initiated on warfarin a year ago. She tells you that she has just seen her GP regarding an acute attack of gout and asks you to check whether the prescription she has been given will help to manage her pain. She also informs you that she has no known allergies.Which of the following medication would be the most suitable treatment for Mrs X’s acute attack of gout?

Allopurinol

Indometacin

Aspirin

Colchicine

Paracetamol

Your comments:

Question 59 of 360

60.

A 47-year-old comes into the pharmacy seeking advice about a symptom that he has experienced for the past 2 days. He has not yet attempted to take any treatment to relieve the symptom but he takes the following long-term prescribed medication:

Carbimazole 15mg once daily
Omeprazole 20mg once daily
Alendronic acid 70mg once weekly

Which of the following symptoms would most likely require an urgent referral to his doctor?

bilateral headache

constipation

diarrhoea

rosacea

sore throat

Your comments:

Question 60 of 360

61.

Mr Y, a 55-year-old man comes into your pharmacy with an open pack of Ralvo 700mg (Lidocaine) medicated plasters, which he was prescribed 10 days ago for his painful skin condition. The patient has come to seek your advice to ensure he is using the plaster correctly. He informs you that he cuts them to the right size then applies them in the morning after he showers and he leaves them on for 12 hours. He then removes them and folds them in half and throws them away. Sometimes when he forgets to apply them in the morning he uses them at night.What is the most suitable advice you can offer Mr Y regarding the use of his medicated plasters?

Mr Y should shave any hair from the painful area before applying the plaster

Mr Y should not cut the plaster into smaller pieces

Mr Y should not use his plasters at night

Mr Y should not drive or operate machinery whilst using the plasters

Mr Y should allow his skin to cool down after showering before applying the plasters

Do you have any comments about this question? Let the team know below

Question 61 of 360

62.

You are the GP practice pharmacist and you are conducting a review with 53-year-old Mrs Z who is taking Co-careldopa 25/100mg, one tablet three times daily. She explains to you that she has been feeling nauseous recently and would like a treatment for it. Which of the following antiemetics would you recommend to Mrs Z’s doctor to prescribe?

Metoclopramide

Domperidone

Chlorpromazine

Prochlorperazine

Trifluoperazine

Your comments:

Question 62 of 360

63.

Mr A, a new patient in the area, comes into your pharmacy with a prescription from the local GP for Methadone 5mg every eight hours. He tells you that he has been prescribed this as an analgesic for severe pain. Upon further questioning, you discover that Mr A has been previously prescribed morphine, and also regularly takes metformin for diabetes, fludrocortisone for postural hypotension and occasionally amitriptyline for pain.What is the best course of action you should take with Mr A?

Refuse to dispense the prescription as you suspect he is opioid dependant

Refer the patient back to their GP as methadone is cautioned in this patient

Refer the patient back to their GP as methadone is not used for this purpose

Check the dosage is appropriate then dispense the prescription

Dispense the prescription as there are no known issues

Your comments:

Question 63 of 360

64.

Mr B presents you with a veterinary prescription for his cat, Fluffy. He tells you that she has been quite poorly recently and not her usual self. The Vet doctor believes she has a respiratory tract infection.Which of the following would be the most appropriate course of action?

do not dispense as the prescription should include ‘FOR ANIMAL USE ONLY’

contact the prescriber and advise them to make an indelible amendment to include the number of times the prescription must be repeated

contact the prescriber and advise them to make an indelible amendment to include a statement that the medicine is prescribed under the veterinary cascade

contact the prescriber and request his RCVS registration number and amend the prescription indelibly to include this before dispensing the prescription

Do you have any comments about this question? Let the team know below

Question 64 of 360

65.

You are working as a locum pharmacist. A 16-year-old girl comes into the pharmacy requesting some strong painkillers. She appears to be distressed and looking around her. You ask her whether she would like to speak to you in the consultation room to which she agrees. In the consultation room she confides in you that she has had FGM (female genital mutilation) and would like some strong pain killers.What is the most appropriate course of action to take?

Inform her that she can speak to you in confidence and find out who encouraged her to have FGM

Refer her to the GP

Refer her to the local family planning clinic

Inform the superintendent pharmacist so that he can report the case to the police

Call the Police on (101) and report the case, and provide the girls name, DoB and address and your contact details

Your comments:

Question 65 of 360

66.

You are carrying out the flu vaccination service at your pharmacy. Mr D, a 42-year-old, comes to the pharmacy to have his flu vaccine. This is the first year Mr D has been eligible for the flu vaccine as he was diagnosed with diabetes earlier this year. His records show he is allergic to penicillin, has an egg allergy and also uses steroid creams for his psoriasis.What is the most appropriate action you should take regarding the administration of the flu vaccine to Mr D?

Administer the flu vaccination to Mr D as he is part of the high risk groups

Refer Mr D to his GP as you cannot administer the flu vaccination to him due to his penicillin allergy

Refer Mr D to his GP as you cannot administer the flu vaccination to him due to his egg allergy

Refer Mr D to his GP as you cannot administer the flu vaccination to him due to his use of steroid creams

Inform Mr D you could administer the flu vaccination privately as he needs to be 65 years or older to be eligible for a free vaccination

Your comments:

Question 66 of 360

67.

You notice a customer has been standing in the travel section of your pharmacy for a while now looking very confused. You approach them to ask if they need assistance. They inform you that they have noticed that all the repellents seem to share the same ingredient DEET, and they are interested in knowing what it is before purchasing as their children have sensitive skin and they need to ensure that they will not react to the product. Which of the following is the correct chemical name of DEET?

N,N-Diethyl-meta-toluamide

N,N-Diethyl-beta-toluamide

digoxy-ethyl-ethanolamide

dimethyl-meta-toluamide

diethanol-beta-ethanolamide

Your comments:

Question 67 of 360

68.

A 31-year-old woman visits her GP for dizzy spells she has been experiencing. The GP sends her for routine tests so that he is able to diagnose her condition correctly.Which of the following test results will most likely require further action to be taken?

total cholesterol - 5 mmol/L

fasting blood glucose - 5.5 mmol/L

Red Blood Cells (RBCs)- 3.5 x 10^12/L

ferritin -15mg/L

White Blood Cells (WBCs) – 5 x 10^9/L

Your comments:

Question 68 of 360

69.

You want to obtain information on the European Community guidelines on Good Manufacturing Practice. Which of the following is the most important reference source to consult for this information?

British Pharmacopoeia

British National Formulary

Martindale

NICE Guidelines

Orange Guide

Your comments:

Question 69 of 360

70.

This question relates to Mr G, a 61 year old man with mild renal impairment, who is to be admitted to hospital for total hip replacement surgery. He is medically fit for anaesthesia and surgery and has no uncontrolled comorbidities. He takes no regular medication and does not have any drug allergies. He weighs 65 kg and is of a normal body weight.

What is an appropriate dose of Clexane for Mr G for prophylaxis of venous thromboembolism?

20 mg (2,000 IU) daily by subcutaneous injection

40 mg (4,000 IU) daily by subcutaneous injection

60 mg (6,000 IU) daily by subcutaneous injection

80 mg (8,000 IU) daily by subcutaneous injection

100 mg (10,000 IU) daily by subcutaneous injection

Do you have any comments about this question? Let the team know below

Question 70 of 360

71.

approximately 24 hours before surgery

approximately 12 hours before surgery

approximately 6 hours before surgery

approximately 2 hours before surgery

the day after surgery

Do you have any comments about this question? Let the team know below

Question 71 of 360

72.

This question relates to Mr G, a 61 year old man with mild renal impairment, who is to be admitted to hospital for total hip replacement surgery. He is medically fit for anaesthesia and surgery and has no uncontrolled comorbidities. He takes no regular medication and does not have any drug allergies. He weighs 65 kg and is of a normal body weight.

How frequently was haemorrhage reported as a reaction when Clexane was used as prophylaxis in surgical patients?

very common (≥ 1/10)

common (≥ 1/100 to < 1/10)

uncommon (≥ 1/1000 to < 1/100)

rare (≥ 1/10,000 to <1/1,000)

very rare (< 1/10,000)

Do you have any comments about this question? Let the team know below

Question 72 of 360

73.

Mr H was diagnosed with type 2 diabetes a year ago, but has been struggling to control his insulin levels. The doctor has decided to start him on a sulfonylurea to help manage his diabetes. Mr H is a taxi driver and is concerned that this new medication will affect his ability to drive. You inform him that he should be able to drive with this new medicine but needs to be particularly careful to avoid hypoglycaemia.Which of the following medications has Mr H most likely been started on?

Canagliflozin

Tolbutamide

Pioglitazone

Metformin

Sitalgliptin

Your comments:

Question 73 of 360

74.

You wish to offer a chiropody service at your pharmacy and advertise for a suitable chiropodist to help you in conducting this service. One particular applicant stands out, as their CV mentions they are able to sell and/or supply certain prescription only medicines. You would like to check if the information on the CV is valid and that this chiropodist is able to sell and/or supply medicines.Which regulatory body will give you the information you require about this chiropodist?

Health and Care Professions Council

Allied Health and Care Council

Health and Support Professions Council

Chiropody Council of Great Britain

National Chiropody Association

Your comments:

Question 74 of 360

75.

Mrs I brings her 8-week old baby to your pharmacy. She shows you her baby’s scalp and asks you to recommend a suitable treatment.What is the most appropriate advice to treat this condition?

Ask the GP to prescribe a topical antibacterial cream for daily use for the scalp for 7-10 days

Ask the GP to prescribe a topical corticosteroid for daily use for the scalp for 7-10 days

Wash the baby’s head with coal tar solution every day for 7-10 days

Wash the baby’s head with an antifungal shampoo

Massage the baby’s head with baby oil followed by gentle brushing then wash the head with a mild shampoo.

Do you have any comments about this question? Let the team know below

Question 75 of 360

76.

You are conducting a medication review for Mr R, a 68-year-old man who has COPD, hypothyroidism and depression. During the review, you note that Mr R also taking omeprazole 20mg daily which he tells you was prescribed for gastro-oesophageal reflux disease (GORD) 6 months ago. Mr R further informs you that he has been using the omeprazole regularly as prescribed and that he is no longer experiencing any symptoms. As Mr R has been taking the omeprazole for longer than what is usually recommended for the treatment of GORD, you recommend that the GP reviews the need for it with the possibility of de-prescribing so as to avoid the risk of complications that may arise from long term use of proton pump inhibitors.Which of the following is not a risk factor of long term use of proton pump inhibitors?

Clostridium difficile infection

Fractures

Hypomagnesaemia

Constipation

Community acquired pneumonia

Your comments:

Question 76 of 360

77.

You are working as the Responsible Pharmacist at a community pharmacy and the superintendent pharmacist has asked you to dispose of some Controlled Drugs (CDs).For which of the following would it be most important to arrange for an authorised witness to be present whilst you denature the CDs?

10 expired oxycodone hydrochloride 5mg tablets returned by a patient

expired pharmacy stock of Suboxone (buprenorphine with naloxone) 2 mg/500 mg tablets

expired pharmacy stock of morphine sulphate 10 mg/5 mL oral solution

a full pack of 28 temazepam 20mg tablets and two buprenorphine 400 mcg tablets returned by a patient who no longer requires them; the tablets have not yet expired

expired pharmacy stock of diamorphine hydrochloride 10 mg tablets

Your comments:

Question 77 of 360

78.

You are preparing a presentation for your team on emergency contraception as you are aware that the Faculty of Sexual and Reproductive Healthcare (FSRH) has updated its guidelines. Which of the following would be least appropriate to include in the presentation?

A Cu-IUD can be inserted up to 5 days after the first instance of unprotected sexual intercourse in a natural menstrual cycle, or up to 5 days after the earliest date of ovulation

Ulipristal acetate has been demonstrated to be more effective than Levonorgestrel

If a woman is referred on for Cu-IUD, oral emergency contraception should be given at the time of referral in case the Cu-IUD cannot be inserted or the woman changes her mind

Ulipristal acetate has been demonstrated to be effective up to 130 hours after unprotected sexual intercourse

Ulipristal acetate for emergency contraception as the oral first-line for a woman who has had unprotected sexual intercourse within the last 5 days

Your comments:

Question 78 of 360

79.

A hospital inpatient has died from a drug over dosage due to a suspected dosing error. The chief pharmacist of the hospital has ordered the undertaking a Root Cause Analysis (RCA) on this incident.What is the most suitable type of investigation to be performed?

An independent investigation

An audit

A basic investigation

A comprehensive investigation

A concise investigation

Your comments:

Question 79 of 360

80.

Mr S, a 36-year-old man has been stopped by police on the motorway for dangerous driving. The police question Mr S and he denies taking any drugs that may have impaired his driving. The police decide to use a drug screening device to establish whether Mr S has taken any drugs by testing his saliva.

Which of the following licensed drugs can be identified on a roadside drug screening device?

Co-codamol

Flunitrazepam

Gabapentin

Zolpidem

Zopiclone

Your comments:

Question 80 of 360

81.

You are a hospital medicines information pharmacist who is responding to an enquiry by a paediatric consultant on whether a new medicine is suitable for a child. You view current literature available to you for evidence-based information to assess the risks for prescribing this medicine for an unlicensed indication for this child.

Which of the following is the most robust form of evidence?

case-control

case reports

cohort studies

cross sectional studies

randomised controlled trials

Your comments:

Question 81 of 360

82.

A patient comes into the pharmacy to get advice on treatment for his dry eyes. After further questioning you recommend hypromellose 0.3% eye drops. He agrees to buy the eye drops but wants to know why they contain they contain benzalkonium chloride.

Which one of the following is the most appropriate response to give this patient?

it kills microorganisms that may be introduced during manufacture 

it prevents degradation of the active ingredient by microorganisms 

it prevents growth of microorganisms that may be introduced during product use

it ensures that the product passes a sterility test

it prevents growth of microorganisms between manufacture and first use

Your comments:

Question 82 of 360

83.

This question relates to Ms Q, who visits your pharmacy often. She has several medical conditions and many allergies, including berries, potatoes, dairy and latex.

Ms Q comes into your pharmacy with a new prescription for Ilaxten 20mg tablets, for which she is to take one tablet daily on an empty stomach. The doctor has prescribed this for Ms Q to help control an itchy rash she has recently developed.

What would be the most appropriate advice you would give Ms Q?

[Get Hints]

Inform Ms Q you will contact the prescriber as the dose may need to be changed

Inform Ms Q that you will contact the prescriber, as she will be unable to take this medication since it contains sodium starch glycolate type A

Inform Ms Q that this medication will not affect her ability to drive

Inform Ms Q that she should take the medication 2 hours after eating

Inform Ms Q she should take this medication as prescribed

Do you have any comments about this question? Let the team know below

Question 83 of 360

84.

This question relates to Ms Q, who visits your pharmacy often. She has several medical conditions and many allergies, including berries, potatoes, dairy and latex.

Ms Q comes back to your pharmacy the next day saying she is unable to swallow tablets and requests your help on this matter.

What would be the most appropriate advice you would give Ms Q?

Inform Ms Q you can contact the prescriber for an alternative medication that has the same efficacy

Inform Ms Q that you can contact the prescriber to get a liquid formulation of this medication

Inform Ms Q that this medication can be crushed before taking

Inform Ms Q that the score line is there for her to half the tablet, making it easier to swallow

Inform Ms Q that she must try to swallow the tablet whole with a full glass of water to help

Do you have any comments about this question? Let the team know below

Question 84 of 360

85.

You decide to make a difference within your community by registering to become a 'dementia friend'. When you speak to your friends to encourage them to join, they ask you further questions about dementia.

Which of the following statements is the most accurate with regards to dementia?

Dementia occurs mostly in people over 75 years old

Dementia is rarely seen in younger people

Women have a greater risk of developing dementia during their lifetime

Dementia is a common cause of Alzheimers disease

Most types of dementia can be cured if caught early on

Your comments:

Question 85 of 360

86.

This question refers to 63 year-old Mrs R who regularly visits the hospital for her routine haemodialysis. She has now developed hyperphosphataemia and the specialist wants to initiate her on Renagel (Sevelamer) 800mg tablets to control her symptoms.

What would be the most appropriate starting dose of Renagel 800mg tablets for Mrs R?

1 tablet, three times per day if she has a serum phosphate level of 2.78mmol/L and is not on phosphate binders

2 tablets, twice a day if she has a serum phosphate level of 2.45mmol/L and is not phosphate binders

1 tablet three times a day if she has a serum phosphate level of 7.6mg/dl and is on phosphate binders

1 tablet, three times a day if she has a serum phosphate level of 1.93mmol/L and is not on phosphate binders

2 tablets, three times a day if she has a serum phosphate level of 5.9mg/dl and is not on phosphate binders

Do you have any comments about this question? Let the team know below

Question 86 of 360

87.

This question refers to 63 year-old Mrs R who regularly visits the hospital for her routine haemodialysis. She has now developed hyperphosphataemia and the specialist wants to initiate her on Renagel (Sevelamer) 800mg tablets to control her symptoms.

Mrs R takes regular medication which you dispense for her at your pharmacy.

Which of the following drugs need to be replaced before she starts taking Renagel 800mg tablets?

[Get Hints]

Warfarin

Digoxin

Ciprofloxacin

Paracetamol

Salbutamol

Question 87 of 360

88.

This question refers to 63 year old Mrs R who regularly visits the hospital for her routine haemodialysis. She has now developed hyperphosphataemia and the specialist wants to initiate her on Renagel (Sevelamer) 800mg tablets to control her symptoms.

After being discharged from hospital, Mrs R comes into your pharmacy and brings in a prescription for Renagel 800mg tablets. Your labeling machine has broken down since the morning and therefore you have been hand-writing all the labels for the drugs dispensed.

Which cautionary and advisory label should you write for the Renagel 800mg tablets?

Warning: Do not drink alcohol

Swallow this medicine whole. Do not chew or crush

Warning: Read the additional information given with this medicine

This medicine may colour your urine. This is harmless

Take 30 to 60 minutes before food

Do you have any comments about this question? Let the team know below

Question 88 of 360

89.

Mrs S is a 55-year-old woman who suffers with hyperthydroidism, osteoporosis and asthma for which she takes the following medications:

- Carbimazole 5mg od

- Alendronic acid 70mg weekly

- Calcichew D3, two tablets daily

- Salbutamol 100mcg inhaler, two puffs upto qds when required

- Seretide 125 evohaler, two puffs bd

Mrs S presents at the pharmacy with symptoms of heart burn and difficulty swallowing.

Which one of Mrs S’s medications is the most likely cause of her symptoms?

Carbimazole

Alendronic acid

Calcichew D3

Salbutamol 100mcg inhaler

Seretide 125 Evohaler

Your comments:

Question 89 of 360

90.

Cautionary and advisory labelsMrs T visits her doctor complaining of a severe sore throat and difficulty swallowing. Her doctor assesses her and can see she has red swollen tonsils and enlarged lymph nodes in her neck. He prescribes her phenoxymethylpenicillin 500mg every 6 hours.

Select the most suitable cautionary label from below that should be added to the dispensing label for the medication prescribed.

This medicine may cause harmless discoloration of your urine

Protect your skin from sunlight - even on a bright but cloudy day. Do not use sunbeds

Do not stop taking this medicine unless your doctor tells you to stop

Do not take milk, indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine

Take with or after food

Take 30 to 60 minutes before food

Swallow this medicine whole. Do not chew or crush

Take this medicine when your stomach is empty. This means an hour before food or 2 hours after food

Your comments:

Question 90 of 360

91.

Cautionary and advisory labelsMr U visits his urgent care centre with severe pains in his sides and whilst urinating. He also has a high temperature of 38°C. The doctor requests a urine sample, which indicates a urinary tract infection. He prescribes ciprofloxacin 500mg twice daily.

Select the most suitable cautionary label from below that should be added to the dispensing label for the medication prescribed.

This medicine may cause harmless discoloration of your urine

Protect your skin from sunlight - even on a bright but cloudy day. Do not use sunbeds

Do not stop taking this medicine unless your doctor tells you to stop

Do not take milk, indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine

Take with or after food

Take 30 to 60 minutes before food

Swallow this medicine whole. Do not chew or crush

Take this medicine when your stomach is empty. This means an hour before food or 2 hours after food

Your comments:

Question 91 of 360

92.

Cautionary and advisory labelsMr V was admitted into hospital following chest pain and light headedness. Further examination revealed that Mr V was suffering from atrial fibrillation and flutter, and was prescribed amiodarone 200mg daily for this.

Select the most suitable cautionary label from below that should be added to the dispensing label for the medication prescribed.

This medicine may cause harmless discoloration of your urine

Protect your skin from sunlight - even on a bright but cloudy day. Do not use sunbeds

Do not stop taking this medicine unless your doctor tells you to stop

Do not take milk, indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine

Take with or after food

Take 30 to 60 minutes before food

Swallow this medicine whole. Do not chew or crush

Take this medicine when your stomach is empty. This means an hour before food or 2 hours after food

Your comments:

Question 92 of 360

93.

VaccinesMiss W, a 17-year-old girl asks you for some advice. She tells you that she was watching a documentary on television last night about cervical cancer. She is rather concerned as her grandmother died of breast cancer and would like to know if there is anything that can help prevent the development of cervical cancer.

Select the most suitable vaccine

Rotavirus vaccine

Tetanus vaccine

Influenza vaccine

Measles, Mumps and Rubella vaccine

Hepatitis B vaccine

Varicella-zoster vaccine

BCG vaccine

Human papillomavirus vaccine

Your comments:

Question 93 of 360

94.

VaccinesMrs X has brought her 12-month-old daughter to the nurse for routine childhood vaccines. The nurse explains that one of the vaccines the baby will be receiving is the first dose of this vaccine and should be followed by a second pre-school dose between the ages of 3 years and 4 months.

Select the most suitable vaccine

Rotavirus vaccine

Tetanus vaccine

Influenza vaccine

Measles, Mumps and Rubella vaccine

Hepatitis B vaccine

Varicella-zoster vaccine

BCG vaccine

Human papillomavirus vaccine

Your comments:

Question 94 of 360

95.

VaccinesMr Y, a 46-year-old man with diabetes, is having a diabetic review with his GP. The GP advises Mr Y to make an appointment with the nurse to receive a vaccine and suggests that Mr Y has this vaccine annually as it is strongly recommended for people aged over 6 months with diabetes.

Select the most suitable vaccine

Rotavirus vaccine

Tetanus vaccine

Influenza vaccine

Measles, Mumps and Rubella vaccine

Hepatitis B vaccine

Varicella-zoster vaccine

BCG vaccine

Human papillomavirus vaccine

Your comments:

Question 95 of 360

96.

VaccinesMiss Z is a 24-year-old woman who is taking up a new position as a nurse in the hospital. Prior to starting her job, she has received a number of vaccines. She has been advised that one of the vaccines that have been administered to her contains the live virus, which could be transmitted from the vaccinated individual to people that come into close contact with them and that she should therefore, avoid contact with immunocompromised individuals if she develops a rash within 4-6 weeks of the first or second dose.

Select the most suitable vaccine

Rotavirus vaccine

Influenza vaccine

Measles, Mumps and Rubella vaccine

Hepatitis B vaccine

Varicella-zoster vaccine

BCG vaccine

Human papillomavirus vaccine

Your comments:

Question 96 of 360

97.

AnalgesicsMr W, a 67-year-old man is experiencing acute pain for which he has been prescribed morphine sulfate 20mg every 4 hours. He has found he cannot tolerate the morphine and the doctors decide to give him an alternative analgesic that provides the same level of pain relief.

Select the most appropriate Analgesics

Paracetamol 250mg/5ml oral suspension, 360mg every 4-6 hours

Diclofenac sodium tablets 50mg every 8 hours

Ibuprofen 100mg/5ml suspension, 150mg every 8 hours

Paracetamol 120mg/5ml oral suspension, 60mg immediately followed by another 60mg dose after 4-6 hours if required

Oxycodone modified release tablets 40mg every 12 hours

Ibuprofen 100mg/5ml oral suspension, 27mg every 6-8 hours

Paracetamol 250mg/5ml oral suspension, 480mg every 4-6 hours

Co-codamol 15/500mg tablets, two tablets four times a day

Your comments:

Question 97 of 360

98.

AnalgesicsMrs X presents in the pharmacy with her 2 month old daughter who had her first doses of DTP (diptheria tetanus pertussis), pneumococcal and rotavirus vaccines earlier today. Mrs X tells you that her daughter is feeling warmer to the touch than she usually does and would like medication to help with this.

Select the most appropriate Analgesics

Paracetamol 250mg/5ml oral suspension, 360mg every 4-6 hours

Diclofenac sodium tablets 50mg every 8 hours

Ibuprofen 100mg/5ml suspension, 150mg every 8 hours

Paracetamol 120mg/5ml oral suspension, 60mg immediately followed by another 60mg dose after 4-6 hours if required

Oxycodone modified release tablets 40mg every 12 hours

Ibuprofen 100mg/5ml oral suspension, 27mg every 6-8 hours

Paracetamol 250mg/5ml oral suspension, 480mg every 4-6 hours

Co-codamol 15/500mg tablets, two tablets four times a day

Your comments:

Question 98 of 360

99.

AnalgesicsMrs Y, a 65-year-old with an ideal body weight of 72kg presents in the pharmacy complaining that she finds her pain killers are not working for her. She tells you that she suffers with osteoarthritis and the doctor had advised her to take paracetamol 500mg but finds that it is not controlling her pain adequately despite taking them at the maximum recommended daily dose. Her records shows you that she is also on salbutamol and beclometasone inhalers.

Select the most appropriate Analgesics

Paracetamol 250mg/5ml oral suspension, 360mg every 4-6 hours

Diclofenac sodium tablets 50mg every 8 hours

Ibuprofen 100mg/5ml suspension, 150mg every 8 hours

Paracetamol 120mg/5ml oral suspension, 60mg immediately followed by another 60mg dose after 4-6 hours if required

Oxycodone modified release tablets 40mg every 12 hours

Ibuprofen 100mg/5ml oral suspension, 27mg every 6-8 hours

Paracetamol 250mg/5ml oral suspension, 480mg every 4-6 hours

Co-codamol 15/500mg tablets, two tablets four times a day

Your comments:

Question 99 of 360

100.

AnalgesicsMiss Z is an 8-year-old girl and has the flu accompanied by a temperature of 38°C.

Select the most appropriate Analgesics

Paracetamol 250mg/5ml oral suspension, 360mg every 4-6 hours

Diclofenac sodium tablets 50mg every 8 hours

Ibuprofen 100mg/5ml suspension, 150mg every 8 hours

Paracetamol 120mg/5ml oral suspension, 60mg immediately followed by another 60mg dose after 4-6 hours if required

Oxycodone modified release tablets 40mg every 12 hours

Ibuprofen 100mg/5ml oral suspension, 27mg every 6-8 hours

Paracetamol 250mg/5ml oral suspension, 480mg every 4-6 hours

Co-codamol 15/500mg tablets, two tablets four times a day

Your comments:

Question 100 of 360

101.

Key OrganisationsYou are a locum pharmacist and have noticed a significant difference in the health of patients in the different pharmacies you work in. In particular, you have noticed that in certain areas you have worked, the children tend to be more overweight than others and have attributed that to a possible variation in diet and activity. You are aware that overweight or obese children are likely to carry this problem into adulthood increasing the risk of other health diseases. You have read that levels of childhood obesity are higher in children from deprived background and would like to begin a campaign in the pharmacies in such areas.

Select the most relevant organisation implicated from the list below.

MHRA

ACBS

PSNC

CQC

CHM

GPhC

NICE

PHE

Your comments:

Question 101 of 360

102.

Key OrganisationsYou are a GP practice pharmacist conducting a review for Mr A, a 57-year-old with diabetes. He tells you that he is having difficulty using the Accu-Chek® Insight insulin pump system and has often noticed that some of the insulin leaks into the cartridge compartment. He is worried that he may not be receiving the required insulin dose. You identify that this could be a fault in the device.

Select the most relevant organisation implicated from the list below.

MHRA

ACBS

PSNC

CQC

CHM

GPhC

NICE

PHE

Your comments:

Question 102 of 360

103.

Drug interactionsAn 83-year-old elderly woman has been admitted to hospital following a fall. She has a history of congestive heart failure. She appears to be confused and has very dry skin. Her daughter informs you that she has not been drinking much for the past few days and has been passing very little urine. Her blood pressure is measured as 90/62 mmHg. The consultant doctor on the ward prescribes her naproxen 500mg bd for pain.

She is on the following medication:

Drug	Dose	Route	Frequency
ramipril	10 mg	orally	daily
bisoprolol	2.5 mg	orally	daily
furosemide	60 mg	orally	daily
losartan	100 mg	orally	daily
atorvastatin	20 mg	orally	daily
aspirin	75 mg	orally	daily

Select the most likely possible consequence of the drug interaction from the list below.

increased risk of acute kidney injury

increased risk of bleeding

increased risk of CNS toxicity

increased risk of convulsions

QT interval prolongation

thrombosis

hypertensive crisis

bradycardia

Question 103 of 360

104.

Drug interactionsA 41-year-old woman who takes citalopram 40mg daily visits her GP due to severe headaches. She explains to the doctor she also becomes nauseous and sensitive to light when these throbbing headaches occur. She has tried OTC paracetamol and ibuprofen which have helped only slightly. After further questioning the doctor prescribes sumatriptan 50mg tablets.

Select the most likely possible consequence of the drug interaction from the list below.

increased risk of acute kidney injury

increased risk of bleeding

increased risk of CNS toxicity

increased risk of convulsions

QT interval prolongation

thrombosis

hypertensive crisis

bradycardia

Your comments:

Question 104 of 360

105.

Infectious diseasesMr A presents with vesicular rash that has developed on the left side of his scalp and forehead and has extended to the eye. He explains that he experienced tingling sensations and pain in that area prior to the rash developing. He has no known allergies and is not taking any medication.

Select the most likely diagnosis from the list below.

Measles

Molluscum contagiosum

Herpes zoster

Herpes simplex

Tinea Cruris

Varicella zoster

Scarlet fever

Tinea corporis

Your comments:

Question 105 of 360

106.

Infectious diseasesMr B presents in the pharmacy with his 8-year-old daughter who has developed a rash. She shows you her arm which has a number of small, firm, flesh coloured dome shaped raised papules and tells you that she also noticed a few clusters behind her knees. She explains that they are not painful but sometimes itch.

Select the most likely diagnosis from the list below.

Measles

Molluscum contagiosum

Herpes zoster

Herpes simplex

Tinea Cruris

Varicella zoster

Scarlet fever

Tinea corporis

Do you have any comments about this question? Let the team know below

Question 106 of 360

107.

Infectious diseasesMrs C comes to the pharmacy seeking your advice about her 5-year-old son who has developed a rash. She tells you that her son had a fever yesterday morning and has developed a pink-red rash today. The rash has appeared on his chest and stomach and feels like sandpaper. She also tells you that her sons face is quite flushed and that he is not himself.

Select the most likely diagnosis from the list below.

Measles

Molluscum contagiosum

Herpes zoster

Herpes simplex

Tinea Cruris

Varicella zoster

Scarlet fever

Tinea corporis

Your comments:

Question 107 of 360

108.

DressingsMr D, a 27-year-old man presents in pharmacy requesting a plaster and antiseptic wipes for an injury he has sustained on his arm. On inspection you find that he has a red wound with moderate exudate. There are no signs or symptoms of infection.

Select the most suitable dressings for their wounds from the list below.

Soft polymer dressing

Alginate with silver dressing

Hydrocolloid dressing

Foam with silver dressing

Alginate dressing

Alginate with honey dressing

Hydrocolloid with silver dressing

Capillary-action dressing

Do you have any comments about this question? Let the team know below

Question 108 of 360

109.

DressingsMrs E, a 54-year-old woman cut her hand whilst gardening. She presents in the pharmacy requesting your advice on how to best care for the wound. The wound does not appear to be infected and is yellow with low exudate.

Select the most suitable dressings for their wounds from the list below.

Soft polymer dressing

Alginate with silver dressing

Hydrocolloid dressing

Foam with silver dressing

Alginate dressing

Alginate with honey dressing

Hydrocolloid with silver dressing

Capillary-action dressing

Do you have any comments about this question? Let the team know below

Question 109 of 360

110.

DressingsMr F, a 25-year-old man who works as a builder asks for your advice on a wound he has on his foot. He tells you that he stepped on an old plank of wood two days ago and a rusty nail pushed through his shoe and into his foot. Mr F informs you that the site has become increasingly painful and he is finding difficult to put pressure on that foot. He felt hot this morning and measured his temperature to be 38°C. On inspection, the wound appears to be red and inflamed with low exudate.

Select the most suitable dressings for their wounds from the list below.

Soft polymer dressing

Alginate with silver dressing

Hydrocolloid dressing

Foam with silver dressing

Alginate dressing

Alginate with honey dressing

Hydrocolloid with silver dressing

Capillary-action dressing

Do you have any comments about this question? Let the team know below

Question 110 of 360

111.

First aid techniquesMrs G presents in your pharmacy with her 8-year-old son who is sucking on a boiled sweet. While Mrs E is talking to you, you notice that he begins coughing and clutching his throat. Mrs G begins to panic.

Select the most appropriate initial first aid step from the list below.

Ensure they are comfortable

Think FAST

Call 999 immediately

Hit firmly on the back between the shoulder blades

Move the person to rest on their side with their head tilted back

Ensure their safety and take measures to prevent them from injury

If they become drowsy or vomit, call 999

Begin abdominal thrusts (Heimlich Maneuver)

Your comments:

Question 111 of 360

112.

First aid techniquesMr H, a 28-year-old comes to the pharmacy to collect his regular prescription for carbamazepine tablets. While in the pharmacy, Mr H begins to suffer uncontrollable muscle spasms and starts to froth at the mouth. You recognise that he is having a seizure.

Select the most appropriate initial first aid step from the list below.

Ensure they are comfortable

Think FAST

Call 999 immediately

Hit firmly on the back between the shoulder blades

Move the person to rest on their side with their head tilted back

Ensure their safety and take measures to prevent them from injury

If they become drowsy or vomit, call 999

Begin abdominal thrusts (Heimlich Maneuver)

Your comments:

Question 112 of 360

113.

First aid techniquesMr I, a 67-year-old r is in the pharmacy when you notice he begins to sweat while clutching his chest and arm. He also becomes short of breath and falls to the floor.

Select the most appropriate initial first aid step from the list below.

Ensure they are comfortable

Think FAST

Call 999 immediately

Hit firmly on the back between the shoulder blades

Move the person to rest on their side with their head tilted back

Ensure their safety and take measures to prevent them from injury

If they become drowsy or vomit, call 999

Begin abdominal thrusts (Heimlich Maneuver)

Your comments:

Question 113 of 360

114.

Health assessment toolsMr J has been diagnosed with non-valvular atrial fibrillation. He has been informed by his doctor that he is at a higher risk of developing stroke and would like to know what his risk is. He is 68 years of age and has no other underlying health conditions.

Select the most suitable tool from the list below that can be used when assessing the patient.

INR

CHA2DS2-VASc tool

QRisk3 tool

JBS3 risk calculator

ORBIT tool

HBA1c

CURB-65 calculator

PHQ-9

Your comments:

Question 114 of 360

115.

Health assessment toolsMrs K a 57-year-old woman was diagnosed with depression 6 months ago for which she was prescribed sertraline 50mg daily. Her doctor would like to establish whether she has responded to the treatment and how severe her condition is.

Select the most suitable tool from the list below that can be used when assessing the patient.

INR

CHA2DS2-VASc tool

QRisk3 tool

JBS3 risk calculator

ORBIT tool

HBA1c

CURB-65 calculator

PHQ-9

Your comments:

Question 115 of 360

116.

Health assessment toolsMr L is a 57-year-old man of Asian origin. During a health check, you measure his height to be 1.75m and his weight as 89kg. Mr L tells you he started smoking after his father passed away from a heart attack 5 years ago. Other than slightly elevated blood pressure, Mr L has no other health problems. He asks you whether he is at risk of a heart attack like his father.

Select the most suitable tool from the list below that can be used when assessing the patient.

INR

CHA2DS2-VASc tool

QRisk3 tool

JBS3 risk calculator

ORBIT tool

HBA1c

CURB-65 calculator

PHQ-9

Your comments:

Question 116 of 360

117.

Health assessment toolsMrs M was recently diagnosed with atrial fibrillation and warfarin therapy was initiated. She is rather anxious as she was told that a side effect of her medication was bleeding and she is worried about having a major bleed. She asks you whether there is a way of determining whether she is likely to bleed or not.

Select the most suitable tool from the list below that can be used when assessing the patient.

INR

CHA2DS2-VASc tool

QRisk3 tool

JBS3 risk calculator

ORBIT tool

HBA1c

CURB-65 calculator

PHQ-9

Your comments:

Question 117 of 360

118.

AntibioticsMr N was admitted to hospital two days ago and has now contracted hospital-acquired pneumonia. He has developed a cough with green phlegm and is also suffering with shortness of breath. His condition is not life-threatening and has no history of anti-bacterial treatment in the last three months.

Select the most appropriate antibiotic treatment from the options below.

Amoxicillin

Cefotaxime

Clarithromycin

Co-amoxiclav

Erythromycin

Flucloxacillin

Metronidazole

Tetracycline

Your comments:

Question 118 of 360

119.

AntibioticsMr O returned from a camping trip last week. During the trip an insect bit him on his leg. He has made an emergency appointment at his GP today as he is suffering with red, hot, swollen and painful legs. He has also developed a fever. Mr O has a penicillin allergy.

Select the most appropriate antibiotic treatment from the options below.

Amoxicillin

Cefotaxime

Clarithromycin

Co-amoxiclav

Erythromycin

Flucloxacillin

Metronidazole

Tetracycline

Your comments:

Question 119 of 360

120.

Mr A is 45-years-old. He smokes 15 cigarettes and drinks 2 to 3 units of alcohol per day. His BMI is 27 and he has an unhealthy diet. He has been prescribed atorvastatin 40 mg once daily for the treatment of familial hypercholesterolemia, which he has been taking for the past 3 months.

In addition to serum cholesterol, which of the following parameters is most important to monitor at this stage?

alanine transaminase

glycosylated haemoglobin

serum creatinine

serum potassium

white blood cell count

Your comments:

Question 120 of 360

121.

Mr B, a 52-year-old, comes into the pharmacy seeking advice about a symptom that he has experienced for the past 2 days. He has not yet attempted to take any treatment to relieve the symptom but he takes the following long-term prescribed medication:

carbimazole 15mg once daily
omeprazole 20mg once daily
alendronic acid 70mg once weekly

Which of the following symptoms would most likely require an urgent referral to his doctor?

bilateral headache

constipation

diarrhoea

rosacea

sore throat

Your comments:

Question 121 of 360

122.

This question relates to Mr C, a 62-year-old who has just been diagnosed with non-valvular atrial fibrillation. He does not take any regular medication and has no known allergies.Mr C asks for your advice on stroke prevention as he tells you his doctor had informed him that he is at a higher risk of developing a stroke.Which of the following assessment tools is most suitable for assessing stroke risk in patients with atrial fibrillation?

CHA2DS2VASc tool

ECG

ORBIT tool

INR

JBS3 risk calculator

Your comments:

Question 122 of 360

123.

This question relate to Mr C, a 62-year-old man who has just been diagnosed with non-valvular atrial fibrillation. He does not take any regular medication and has no known allergies.Which of the following drugs is least likely to be prescribed for stroke prevention for Mr C?

apixaban

aspirin

dabigatran

rivaroxaban

warfarin

Your comments:

Question 123 of 360

124.

Mr D is a 72-year-old man who presents with diffuse pain in his arms and legs. He is of South Asian origin and has been residing in the United Kingdom for 45 years. Upon questioning, he informs you that he rarely leaves the house for fear of falling and he eats a vegetarian diet. You have access to his most recent blood test results.With respect to Mr D’s blood test results, what is the best course of action?

consider starting vitamin D treatment at 40,000 units once weekly for 7 weeks, followed by daily maintenance 800 IU daily after

Mr D is at risk of developing osteoporosis, consider starting bisphosphonate treatment

take an over-the-counter paracetamol preparation for the pain, and increase his dietary intake of calcium

take an over-the-counter vitamin D preparation and advise safe sun exposure

these results are typical in older people; Mr D, should undertake some weight-bearing exercise to strengthen his bones

Do you have any comments about this question? Let the team know below

Question 124 of 360

125.

You have been appointed as the lead for pharmaceutical care within your hospital trust. You are preparing a training session for pharmacists as well as other health and social care professionals to raise awareness of pharmaceutical care. Which of the following descriptions would best describe the principles of pharmaceutical care?

a patient-focused approach to get the best from investment and in use of medicines

a system of processes and behaviours that determines how medicines are used by patients and by the NHS

a systematic process of establishing best practice by measuring against criteria and taking action to improve care

providing care that supports people to achieve the health outcomes that give them the best opportunity to lead the life that they want

the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve the patient’s quality of life

Your comments:

Question 125 of 360

126.

Mr E, a 65-year-old man with no history of alcohol misuse, was admitted to hospital with jaundice after feeling unwell for three weeks with nausea, vomiting, tiredness and abdominal pain. Three months before, his GP had changed his gliclazide to pioglitazone. He had also taken lercanidipine, metformin and bendroflumethiazide for some years, and recently a cephalosporin antibiotic for a few days. He developed encephalopathy 36 hours after admission and doctors transferred him to intensive care. Blood tests were conducted to assist in the diagnosis.

Which of the following drugs that Mr E has taken is most likely to have caused his abnormal laboratory results?

bendroflumethiazide

cefalexin

lercanidipine

metformin

pioglitazone

Do you have any comments about this question? Let the team know below

Question 126 of 360

127.

Mr F is a 38-year-old man who has been experiencing muscle cramps in his arms and a fine tremor in his hands for the past two weeks.

Below is a list of Mr F’s regular medication. Which one of these drugs is most likely to have caused Mr F’s symptoms?

[Get Hints]

beclometasone 100 mcg inhaler

bendroflumethiazide 2.5 mg tablets

ipratropium 20 mcg inhaler

salbutamol 100 mcg inhaler

simvastatin 20 mg tablets

Your comments:

Question 127 of 360

128.

Mrs G is a 45-year-old woman who takes the following regular medication:

ramipril 5 mg once daily
simvastatin 40 mg once daily at night

She has recently been to see her GP with symptoms of a severe chest infection and her doctor has issued a prescription for clarithromycin 500 mg twice daily for 2 weeks.

Which of the following would be the most appropriate course of action for you to take?

advise Mrs G to take all her medication as prescribed as there are no interactions between the drugs

advise Mrs G to take all her medication as prescribed as any interaction(s) between the drugs are not considered to be clinically significant

advise Mrs G to stop taking the ramipril whilst taking the course of clarithromycin and to resume once the course of clarithromycin is complete

advise Mrs G to stop taking the simvastatin whilst taking the course of clarithromycin and to resume once the course of clarithromycin is complete

advise Mrs G to take her evening dose of clarithromycin 2 hours before taking the simvastatin

Your comments:

Question 128 of 360

129.

Mrs H is a regular customer to your pharmacy. She has presented you with a new prescription for lansoprazole 15 mg gastro-resistant capsules. Mrs H explains that she has been prescribed a 4-week course of lansoprazole for the treatment of dyspepsia, which failed to respond to the antacids she was previously advised to take. Which of the following statements would be the most important factor for you to consider when dispensing Mrs H’s prescription?

[Get Hints]

Mrs H informs you that recent blood tests showed a slightly elevated serum creatinine

Mrs H occasionally drinks a glass of red wine

Mrs H occasionally takes paracetamol for headaches

Mrs H suffers with sucrose intolerance

patients with dyspepsia may benefit from weight reduction

Do you have any comments about this question? Let the team know below

Question 129 of 360

130.

Mr I has just attended his annual medication review with his GP. After completing the review and assessing Mr I’s blood pressure, the GP has decided to change Mr I’s current anti-hypertensive to Coversyl Arginine Plus (perindopril arginine 5 mg, indapamide 1.25 mg).

Which of the following cautionary and advisory labels would be most suitable for the new drug?

take 30 to 60 minutes before food

this medicine may colour your urine

protect your skin from sunlight – even on a bright but cloudy day; do not use sunbeds

warning: do not stop taking this medicine unless your doctor tells you to stop

warning: this medicine may make you sleepy; if this happens, do not drive or use tools or machines

Your comments:

Question 130 of 360

131.

Mrs J, a 70-year-old woman, has been admitted to hospital after having breathing problems. She has been feeling very weak and numb lately but is otherwise an active person. She takes the following medication:

bumetanide
fluoxetine
omeprazole
prednisolone
ramipril

Her most recent biochemistry test results are shown below.

Test	Result	Reference Range
Sodium (mmol/L)	140	137-145
Potassium (mmol/L)	6.0	3.5-5.1
Urea (mmol/L)	4.7	2.5-7.5
Creatinine (μmol/L)	75	50-120
Phosphate (mmol/L)	0.92	0.8-1.4

Which one of her drugs is the most likely cause of her abnormal test results?

bumetanide

fluoxetine

omeprazole

prednisolone

ramipril

Your comments:

Question 131 of 360

132.

Mr L is 67-years-old and has recently been initiated on isosorbide mononitrate 40 mg twice daily by his GP following recommendation by a hospital specialist. When Mr L comes to your pharmacy to collect his repeat prescription, he tells you that he takes the medicine as prescribed but has recently been experiencing occasional throbbing headaches.

What would be the most appropriate advice for you to give to Mr L?

advise Mr L that the symptom he has described is not known to be caused by isosorbide mononitrate

advise Mr L to see his GP as the dose of isosorbide mononitrate may need to be increased

advise Mr L to see his GP as the dose of isosorbide mononitrate may need to be reduced

advise Mr L that he is experiencing a side effect of isosorbide mononitrate; it is safe to continue taking it, but that he may wish to see his GP to be prescribed an alternative

advise Mr L to stop taking the medication straight away and to contact his hospital doctor

Your comments:

Question 132 of 360

133.

You are a regular locum at a community pharmacy. Lately, you have noticed that the superintendent pharmacist has been coming into work smelling of alcohol. He has also developed a bad temper, he frequently shouts at the rest of the pharmacy team and he has been making dispensing errors more frequently.

Which of the following would be the most appropriate course of action?

as he has not directly harmed staff members you do not have to report this concern

as he has not made any major dispensing errors you do not have enough evidence to raise a concern

as you are the locum pharmacist you are not required by law to raise this concern

contact the accountable officer and raise the concern with him in confidence

under the PIDA (Public Interest Disclosure Act) you should raise a concern about issues which have happened, or which you reasonably believe are likely to happen and involve a danger to the health or safety of an individual

Your comments:

Question 133 of 360

134.

Mrs M is a 57-year-old lady of South Asian origin who no longer has a menstrual bleed. She has been complaining of lethargy for the past 6 months despite not suffering from any sleep disturbance and despite eating a balanced vegetarian diet. She takes enalapril 5 mg once daily and furosemide 20 mg once daily for hypertension. Her GP recently sent her for a blood test to investigate a number of parameters.

In light of her symptoms and blood test results, which of the following points would it be most appropriate to inform Mrs M?

enalapril may increase the risk of hypocalcaemia

hypercalcaemia can precipitate renal damage

Mrs M’s calcium levels may be responsible for her symptoms

Mrs M should start taking ferrous sulphate 200mg tablets daily

raised TSH levels may suggest hyperthyroidism

Do you have any comments about this question? Let the team know below

Question 134 of 360

135.

Mrs N is a 50-year-old black South African lady who has just been diagnosed with stage 2 hypertension. Her blood pressure was last measured as 164/91 mmHg. She has no known drug or other allergies nor any other medical conditions. Which one of the following is the most appropriate first line antihypertensive for Mrs N?

atenolol

indapamide

lercanidipine hydrochloride

methyldopa

ramipril

Your comments:

Question 135 of 360

136.

Mrs O is an 80-year-old female with a history of Parkinson’s disease and osteoporosis. She takes her Parkinson’s medication in a ‘dosette box’ and takes the following:

- co-beneldopa (Madopar) 62.5 mg, one capsule once daily in the morning 9am
- co-careldopa 50/200 modified release (Sinemet CR), one tablet once daily at night at 8pm
- Stalevo 100/25/200 (levodopa 100 mg, carbidopa 25 mg, entacapone 200 mg), one tablet three times daily at 9am, 2pm and 8pm

She has been admitted to hospital for a fall. Her daughter is concerned as she feels her mother is not coping well at home. You inspect her ‘dosette box’ and can see that there are tablets which have not been taken by Mrs O. Which of the following counselling points is most appropriate for you give to Mrs O and her daughter?

encourage Mrs O to use a smart mobile phone medication reminder application to help her remember to take her tablets

if Mrs O and her daughter feel dissatisfied with the care they are receiving, they can make a complaint

if Mrs O stops taking the Madopar capsules suddenly, it can cause something called ‘neuroleptic malignant-like syndrome’ (NMLS); this is a very serious condition

Mrs O can open the contents of a Madopar capsule and mix it in water before taking dose

Mrs O must take her Parkinson’s medication on time to help with her ‘on’ and ‘off’ symptoms

Do you have any comments about this question? Let the team know below

Question 136 of 360

137.

Mr P is a 55-year-old man who presents at your pharmacy with the following prescription from his GP:

amlodipine 10 mg once daily
simvastatin 40 mg once daily at night

Mr P has not collected medicines from your pharmacy before but informs you that he has taken the prescribed medication for 2 months already.Which of the following would be the most appropriate course of action?

contact the GP and advise him/her to reduce the dose of amlodipine to 5mg

contact the GP and advise him/her to reduce the dose of simvastatin to 20mg or less

dispense the prescription exactly as prescribed and advise Mr P to contact his GP for a review of his medicines at his earliest convenience

dispense the prescription exactly as prescribed and advise Mr P to continue taking his medicines as prescribed and inform his GP straight away if he experiences any adverse effects

politely refuse to dispense the prescription and ask Mr P to return to the pharmacy he has used in the past

Your comments:

Question 137 of 360

138.

Miss Q is a 32-year-old accountant who was diagnosed with type 1 diabetes mellitus 12 years ago. She tests her glucose when she feels unwell and uses multiple injections of insulin. Her HbA1c is 64 mmol/mol (8.0%). She has a passion for rowing and every morning at 6:30 am she rows for up to one hour on the River Thames. She is planning to participate in a coastal race in the summer to raise funds for a campaign to increase awareness of the sport amongst the youth in her local community. She has a high-calorie diet to give her energy in the morning and help her get through the day.

What is the most suitable number of blood glucose tests Miss Q should be advised to take at this stage?

Once a day

Up to twice a day

Up to three times a day

Up to four times a day

Up to six times a day

Do you have any comments about this question? Let the team know below

Question 138 of 360

139.

Mr R is a 45-year-old man who does not take any regular medication and has no known allergies with the exception of being hypersensitive to NSAIDs. He tells you he has just seen his GP regarding an acute attack of gout and asks you to check if the prescription he has been given will help to treat his existing pain.Which one of the following would be the most suitable treatment for Mr R’s acute attack of gout?

aspirin

allopurinol

codeine

colchicine

indometacin

Your comments:

Question 139 of 360

140.

The doctor has ordered a culture sensitivity test for Miss S, but due to the severity of her infection he wants to start antibiotic treatment immediately. She has a mild cough, muscle ache and high temperature with chest tightening and breathlessness. Miss S is 8-years-old and has a documented penicillin allergy.Which of the following would be the most suitable empiric antibiotic treatment for her infection?

ampicillin

ciprofloxacin

clarithromycin

tetracycline

amoxicillin

Your comments:

Question 140 of 360

141.

Miss P, an 8-year-old girl has been admitted to the A&E unit at her hospital with moderate severity community-acquired pneumonia.

Which of the following microorganisms is the most likely causative agent of Miss P’s infection?

Candida albicans

pylobacter coliCam

Escherichia coli

Haemophilus influenzae

Neisseria meningitidis

Your comments:

Question 141 of 360

142.

Mr J is 17-years-old and has focal seizures for which he has been taking carbamazepine. He presents in your pharmacy with a new prescription for pregabalin ( Lyrica ) at a titrated dose to be used in addition to carbamazepine for the control of the seizures.Which of the following statements would be of most concern to you regarding Mr J’s treatment?

increased appetite is a common side effect of pregabalin

patients should refrain from drinking alcohol when taking pregabalin

pregabalin should not be used alone for the treatment of epilepsy

pregabalin should not be used in children and adolescents

women of childbearing age should use effective methods of contraception when taking pregabalin

Do you have any comments about this question? Let the team know below

Question 142 of 360

143.

You receive a private prescription for five fentanyl ‘75’ patches, one patch to be applied every 72 hours. Which of the following statements would be most appropriate regarding the legal supply of fentanyl patches against a private prescription?

an entry in the Controlled Drugs (CD) register is not legally required but it is a legal requirement to record the supply in the Prescription Only Medicines (POM) register

the prescription is valid for 13 weeks from the date on the prescription

all prescription details need to be handwritten 

it is illegal to dispense if not prescribed on a standardised form 

only a prescriber's request for an emergency supply is permitted

Your comments:

Question 143 of 360

144.

Mrs M is a 61-year-old receiving gentamicin by slow intravenous injection for gram-positive bacterial endocarditis at a dose of 1 mg/kg every 12 hours.

Target range for gentamicin: one-hour (‘peak’) serum concentration should be 3–5 mg/litre for endocarditis; pre-dose (‘trough’) concentration should be less than 1 mg/litre for endocarditis.

Three days later a peak gentamicin level of 4.9mg/L is reported with a trough concentration of 2.1mg/L. Mrs M’s renal function was unchanged.

Which of the following is an appropriate method of dose rationalisation in response to these results?

continue the current regimen

decrease the dose and decrease the dosing interval

increase the dose and increase the dosing interval

maintain the same dose and increase the dosing intervals

maintain the same dose and decrease the dosing interval

Your comments:

Question 144 of 360

145.

Mrs A, a 34-year-old woman presents at your pharmacy with a prescription for flucloxacillin 250mg qds for 10 days. She informs you that her GP prescribed the flucloxacillin for the treatment of mastitis but she is concerned about taking flucloxacillin whilst breastfeeding and asks for your advice. Mrs A takes no other medication and has no known drug allergies.

Which one of the following is the most appropriate course of action?

Reassure Mrs A that flucloxacillin is safe to take whilst breastfeeding

advise Mrs A to stop breastfeeding immediately and to start taking flucloxacillin 24 hours later

advise Mrs A that flucloxacillin is unsuitable, and recommend the use of simple analgesics and warm compress

advise Mrs A to take better care of her hygiene

contact Mrs A’s GP and advise them to prescribe erythromycin instead

Your comments:

Question 145 of 360

146.

Mr B is a 76-year-old weighing 65kg and requires treatment for a pulmonary embolism. You have been asked to provide advice on an appropriate dose of edoxaban to administer to Mr B.

Which of the following is the most appropriate dose to be administered to Mr B?

Edoxoban 30mg once daily

Edoxoban 30mg twice daily

Edoxoban 30mg three times daily

Edoxoban 60mg once daily

Edoxoban 60mg twice daily

Your comments:

Question 146 of 360

147.

This question concerns Mrs C, a 52-year-old woman who is a regular patient at your pharmacy and is being treated for deep vein thrombosis.

You receive a phone call from your local GP Dr T, informing you that Mrs C has been discharged from hospital after being treated with rivaroxaban for deep vein thrombosis. He tells you that Mrs C has received 7 days of rivaroxaban at the initial treatment dose of 15mg twice daily and he would like to know how many additional days of rivaroxaban he must prescribe for her at this dose.

How many additional days must you advise Dr T to prescribe for the initial treatment of deep vein thrombosis?

7 Days

14 Days

21 Days

28 days

56 Days

Your comments:

Question 147 of 360

148.

This question concerns Mrs C, a 52-year-old who is a regular patient at your pharmacy and is being treated for deep vein thrombosis.

Mrs C presents at your pharmacy with a prescription for rivaroxaban that the GP has prescribed for her.

Which of the following counselling points would be most appropriate for you to advise Mrs C when dispensing her prescription?

Remind Mrs C to attend the clinic for regular INR testing

She should not take two 15mg tablets at the same time, even if she forgets to take a dose

Rivaroxaban tablets should not be crushed

Mrs C should take the tablets with food

A common side effect of rivaroxaban is ‘purple toes’

Your comments:

Question 148 of 360

149.

You are working as a locum pharmacist on a busy Friday afternoon and are presented with a prescription for ciclosporin 50mg capsules. The patient requests that you provide him with the Capimune brand as this is what he was given previously. You do not have that brand in stock but do have the required strength and quantity of generic ciclosporin and the Neoral brand.

Which one of the following is the most appropriate course of action?

Dispense the generic ciclosporin as per the prescription

Contact the prescriber and request a prescription for the Capimune brand and order them in for the patient

Contact the prescriber and ask for a new prescription for Neoral and provide the patient with an immediate supply

Provide the patient with a 3 day supply of generic ciclosporin while placing an order for the required brand

Explain to the patient that he can take Neoral as it also contains ciclosporin which is the same active ingredient in Capimune

Your comments:

Question 149 of 360

150.

Mrs D is a 76-year-old woman who has atrial fibrillation and must be assessed for her risk of stroke using the CHA2 DS2 VASc scoring tool. Mrs D weighs 65 kg and has recently suffered a heart attack. She is currently on the following medication

• Tolbutamide 500mg od
• Ramipril 10mg od
• Donepezil 5mg nocte
• Atorvastatin 80mg od
• Bisoprolol 5mg od

Which of the following is Mrs D’s CHA2 DS2 VASc score?

Your comments:

Question 150 of 360

151.

You are preparing a pharmaceutical care plan for a paediatric cancer patient.

Which of the following is most likely to result in severe neurotoxicity if administered intrathecally?

Baclofen

Cytarabine

Hydrocortisone

Methotrexate

Vincristine

Your comments:

Question 151 of 360

152.

This question concerns Mrs E, a regular customer whose 7-year-old daughter takes desmopressin for bedwetting.

Mrs E informs you that she is travelling with her family next week. She tells you that they will be going to a beach and will be doing plenty of activities involving swimming. She asks for your advice regarding her daughter. She wants to know if there are any precautions she must take while on holiday.

Which of the following is the most appropriate advice to give Mrs E in regards to her daughter while on holiday?

Advise Mrs E that her daughter must ensure adequate hydration throughout the day especially if the weather is hot but should restrict drinking 5 hours after taking desmopressin

Advise Mrs E that her daughter must avoid swimming due to risk of retaining fluid

Advise Mrs E that her daughter must avoid drinking any fizzy drinks throughout the entire day

Advise Mrs E that her daughter can swim but must avoid swallowing large amounts of fluid due to risk of retaining fluid

Advise Mrs E that her daughter must shield her skin from sunlight and ensure adequate application of sun cream with an SPF of 50

Do you have any comments about this question? Let the team know below

Question 152 of 360

153.

This question concerns Mrs E, a regular customer whose 7-year-old daughter takes desmopressin for bedwetting.

Which of the following electrolyte imbalances would be of most concern if experienced by Mrs E’s daughter?

Hyponatraemia

Hypernatraemia

Hypokalaemia

Hyperkalaemia

Hypophosphatemia

Your comments:

Question 153 of 360

154.

This question concerns Mrs F, a 52-year-old woman who is a regular customer at your pharmacy.

Mrs F presents with a prescription for trimethoprim 200mg twice daily and she explains that the doctor has prescribed her antibiotics for a urinary tract infection. You are aware that she takes methotrexate tablets at a dose of 12.5mg weekly for rheumatoid arthritis and decide to contact the doctor to suggest an alternative antibiotic as there is an interaction between methotrexate and trimethoprim.

Which one of the following statements best describes the interaction between trimethoprim and methotrexate?

Methotrexate is an enzyme inducer and increases the metabolism of trimethoprim

Trimethoprim is an enzyme inhibitor and inhibits the metabolism of methotrexate causing toxicity

There is an increased risk of Stevens Johnson Syndrome if the drugs are co-administered

There is an increased risk of liver toxicity when methotrexate is administered with trimethoprim

Trimethoprim may increase the risk of side effects of methotrexate

Your comments:

Question 154 of 360

155.

Mrs H, a 35-year-old woman, presents in the pharmacy asking for your advice. She has developed a small circle of thickened skin on the side of her small toe. Although it is not often painful, she is rather conscious of it and would like something to help remove it as the summer is approaching and she wants to wear sandals but is worried at how her feet may look in them.

What is the most likely diagnosis of the lesion on Mrs H’s foot?

Corn

Plantar fasciitis

Callus

Hallux valgus

Verruca

Your comments:

Question 155 of 360

156.

Mr G, a 26-year-old man, comes into the pharmacy and asks if someone can have a look at his eye. He informs you that although his vision is not affected, his eye is causing him some irritation, is slightly watery and is sensitive to the touch.

Which of the following best describes the cause of Mr G’s condition and its management?

The cause is bacterial, chloramphenicol eye drops should be used at a dose of one drop every 2 hours for the first 48 hours, then four times a day for a total of 5 days

The cause is bacterial, chloramphenicol eye drops should be used at a dose of one drop every 4 hours for the first 48 hours, then four times a day for a total of 5 days

The cause is exposure to allergens, a mast cell stabiliser eye drop should be used, such as sodium cromoglicate at a dose of one or two drops four times a day

The cause is bacterial, but antibiotic therapy is not usually needed. A warm compress should be applied for 5-10 minutes three to four times a day to reduce swelling

The cause is viral, a cold compress should be applied for 5-10 minutes three to four times a day to reduce swelling

Do you have any comments about this question? Let the team know below

Question 156 of 360

157.

Mr H is 56-year-old man weighing 72 kg and is currently on the following medication
• Atorvastatin 20mg tablets
• Metformin 500mg tablets
• Sertraline 50mg tablets

You are a pharmacist in a GP surgery and need to give advice on the tests required for Mr H. You note from his records that atorvastatin was only started two months ago. Mr H has recently been complaining of tiredness and constipation. He has also noticed an increase in his weight, although he has not made any dietary changes and continues with his exercise regimen.

Which one of the following tests is most necessary for Mr H?

thyroid function tests

total cholesterol

blood glucose concentration

liver function tests

kidney function test

Your comments:

Question 157 of 360

158.

Mr I, a 57-year-old man visits your pharmacy and you hear him discussing a choice of suitable eye drops with the counter assistant. He explains that he has recently started to experience some blurred vision. You check the patient medication records and find that he is currently taking the following medication:

Allopurinol 100mg daily
Amiodarone 200mg daily
Salbutamol 100mcg inhaler 2 puffs when required

The counter assistant refers Mr I to you for your advice.

What is the most appropriate course of action?

Advise Mr I that this is a sign of the development of corneal microdeposits which is a side effect of amiodarone. He should take care when driving at night as he could be dazzled by headlights

Supply Mr I with chloramphenicol 1% eye drops to be used in both eyes every 2 hours in the first two days and every 4 hours for remaining three days. Continue for 48 hours after the infection has healed.

Advise Mr I that the blurred vision will settle and that he should not drive if affected

Advise Mr I that this is a common side effect of allopurinol and he should arrange for an eye test

Advise Mr I to see his GP as soon as possible

Your comments:

Question 158 of 360

159.

Miss J, a 27-year-old woman presents you with a prescription. You proceed to legally and clinically check the prescription and subsequently explain to her that you are unable to dispense the prescription. Today's date is 19 September 2024.

Which of the following is the most appropriate explanation to provide Miss J as to why you cannot dispense the prescription?

The total quantity for the roaccutane and erythromycin is missing

The dose of erythromycin is too high

The prescription has expired

The age of the patient is missing

There is a significant interaction between erythromycin and roaccutane

Your comments:

Question 159 of 360

160.

This question concerns Mrs K, a 54-year-old woman that is receiving treatment for breast cancer.

Mrs K has been receiving fluorouracil as part of her treatment plan but has now started to complain about a sore mouth.

Which of the following is the most appropriate advice to give Mrs K to help manage her symptoms?

Advise Mrs K to suck on ice chips during short infusions, rinse her mouth frequently and to brush her teeth 2-3 times daily with a soft brush

Advise Mrs K to chew gum in her mouth during short infusions, rinse her mouth frequently and to brush her teeth 2-3 times daily with a soft brush

Advise Mrs K to suck antibacterial lozenges throughout the day and to rinse her mouth with saline 2-3 times a day

Advise Mrs K to brush her teeth with a tooth paste that is formulated for sensitive teeth

Advise Mrs K to rinse her mouth frequently with chlorhexidine mouthwash

Your comments:

Question 160 of 360

161.

This question concerns Mrs K, a 54-year-old woman that is receiving treatment for breast cancer.

Mrs K has been receiving oral morphine at a dose of 30mg every 4 hours, but she has recently started to suffer with dysphagia. Consequently, the doctor has decided to change her from oral morphine to a 24-hourly subcutaneous infusion of morphine.

Which of the following is the most suitable daily dose of morphine that Mrs K should be given by subcutaneous infusion?

30 mg

90 mg

120 mg

180 mg

220 mg

Do you have any comments about this question? Let the team know below

Question 161 of 360

162.

This question concerns Mrs K, a 54-year-old woman that is receiving treatment for breast cancer.

Mrs K starts to suffer with constipation and the doctor decides that she will benefit from taking a laxative.

Which one of the following laxatives would be most suitable as initial treatment of constipation in palliative care?

Methylcellulose

Methlylnaltrexone bromide

Lactulose

Sterculia

Isphagula husk

Your comments:

Question 162 of 360

163.

You are working on a Saturday as a locum and the staff inform you about an error made by the regular pharmacist. You are aware that he is dealing with some personal issues at home, and the staff can smell alcohol when he works. On Friday a patient returned amlodipine 10mg tablets as she was prescribed amitriptyline 10mg tablets, two to be taken daily. She had realised the error before consuming any medication and has not come to harm from it. The staff are afraid to report their concerns as the pharmacist has had a short temper lately, however you deem it necessary to report this to the pharmacy manager.

Which of the following legislations will provide you with protection?

Misuse of Drugs Act 1971

Human Medicines Regulations 2012

Public Interest Disclosure Act 1998

Whistleblowing Act 2012

Data Protection Act 1998

Your comments:

Question 163 of 360

164.

Mrs L, a 67-year-old woman who is a regular patient at your pharmacy, asks for your advice. She has experienced nausea and diarrhoea and would like to purchase something to help with her symptoms. While talking to you, she compliments you on your “beautiful yellow top”. This raises concern as your top is in fact white and not yellow.

Which of the following medications is most likely be responsible for Mrs L’s symptoms?

Theophylline

Phenytoin

Digoxin

Salbutamol

Paracetamol

Your comments:

Question 164 of 360

165.

This question concerns Mr M, a 58-year-old man who is on warfarin.

Mr M has his INR checked on a regular basis. Usually his INR is within the normal range, however today it is found to be 6.5. There are no signs of bleeding.

Which one of the following is the most appropriate course of action?

Mr M should not take the following one or two doses of warfarin and subsequent maintenance doses should be reduced

Stop warfarin and give vitamin K orally using an intravenous preparation

Stop warfarin and give vitamin K by slow intravenous injection

Continue taking warfarin but at a reduced dose

Mr M’s medications should be reviewed with the possibility of switching him to a NOAC instead of warfarin

Your comments:

Question 165 of 360

166.

This question concerns Mr M, a 58-year-old man who is on warfarin.

Mr M informs you that he has been drinking a new juice lately, which you suspect could be the cause of the increased INR.

Which of the following juices is most likely responsible for Mr M’s increase in INR?

Grapefruit

Apple

Orange

Cranberry

Mango

Your comments:

Question 166 of 360

167.

Mrs N is a 65-year-old who is rushed into hospital. She presents with nausea, vomiting and abdominal pain and is severely dehydrated. She is also slightly confused and complains of a back ache, and tells the medical team that lately she has produced very little urine. She is taking the following medication on admission:

• Co-codamol 15/500mg
• Citalopram 20 mg
• Simvastatin 20mg
• Ramipril 5mg
• Amlodipine 5mg

Which of the following drugs is the most likely cause of Mrs N’s symptoms?

Co-codamol 15/500mg

Citalopram 20 mg

Simvastatin 20mg

Ramipril 5mg

Amlodipine 5mg

Your comments:

Question 167 of 360

168.

Mr P is a 52-year-old who takes medication for blood pressure and osteoporosis. Recently he has been feeling quite “light headed” but is otherwise fine. He asks if there is anything he can do to prevent this. He tells you that he has recently been started on Tamsulosin after he developed prostrate problems. His medication records show that he also takes the following medication:

• Amlodipine 5mg daily
• Ramipril 10mg daily
• Simvastatin 20mg at night
• Alendronic acid 10mg daily

What is the most appropriate course of action?

advise Mr P to take amlodipine in the morning and ramipril at bedtime

advise Mr P to visit his GP as soon as possible

advise Mr P that he should take all his medication at bedtime for a week and see if his symptoms improve

advise Mr P that his blood pressure may be high and the doctors may need to review his antihypertensive medication

advise Mr P that his simvastatin dose may need to be adjusted

Your comments:

Question 168 of 360

169.

Mrs Q is a 55-year-old weighing 72kg and presents to your pharmacy complaining of urinary problems. She complains of pain on urinating and feels the urge to go more frequently than usual, only to produce very little urine. Mrs Q would like to know if there is anything over the counter that can help. She does not suffer from any allergies and takes the following medications:

• Ramipril 5mg capsules
• Alendronic acid 70mg tablets
• Tiaprofenic acid 300mg tablets
• Salbutamol 100mcg inhaler

Which of the following is the best advice to give Mrs Q?

Supply Mrs Q with sodium citrate sachets and advise her to take one sachet three times a day for two days

Supply Mrs Q with clotrimazole 1% cream and advise her to apply it 2-3 times a day to the anogenital area

Supply Mrs Q with fluconazole 150mg capsule and tell her to take it with plenty of water

Advise Mrs Q to drink cranberry juice as it can help flush out any bacteria

Advise Mrs Q to see her GP promptly

Your comments:

Question 169 of 360

170.

This question relates to Mr R, who has mild renal impairment.

The nurse asks for your advice on whether Mr R’s medication requires adjusting.

Which one of the following serum creatinine levels would you most likely expect to see after Mr R’s eGFR has been measured?

15 ml/minute/1.73 m2

30 ml/minute/1.73 m2

40 ml/minute/1.73 m2

65 ml/minute/1.73 m2

90 ml/minute/1.73 m2

Your comments:

Question 170 of 360

171.

This question relates to Mr R, a patient who has mild renal impairment.

The nurse on the renal ward asks you for help. She informs you that she has been reading up about renal disease and asks what the acronym MDRD stands for.

Which one of the following options best describes what MDRD stands for?

Modification of diet in renal disease

Modification of dosage in renal disease

Malnutrition defines renal disease outcome

Monitoring of diet in renal disease

Monitoring of dosage in renal disease

Your comments:

Question 171 of 360

172.

Mrs S, a 53-year old woman who has type 2 diabetes and hypertension, presents you with a prescription for her regular medication. She explains that the GP has added on a new medication for hypertension as her blood pressure is still high despite taking ramipril 10mg daily.

Which of the following is the most appropriate action to take?

dispense the prescription and offer Mrs S appropriate lifestyle advice

contact the prescriber and suggest reducing the simvastatin dose to 20mg

inform Mrs S that she should not use the ibuprofen gel because she is hypertensive and takes ramipril

contact the prescriber and suggest that Mrs S should stop taking ramipril and that the dose of amlodipine should be increased to 10mg

contact the prescriber and suggest an alternative analgesic to co-codamol as that could be the cause of the uncontrolled hypertension

Do you have any comments about this question? Let the team know below

Question 172 of 360

173.

Miss T presents at your pharmacy after being bitten on her hand by a cat yesterday and asks for your advice. Her hand is rather tender and she is worried about the possibility of developing an infection. You are aware that cat bites have an increased risk of infection and suggest that Miss T visits her GP as she may need antibiotics.

Considering that Miss T is allergic to penicillin, which of the following antibiotics would be the most appropriate for her to take?

Co-amoxiclav

Doxycycline and metronidazole

Clarithromycin and metronidazole

Erythromycin and doxycycline

Clindamycin

Do you have any comments about this question? Let the team know below

Question 173 of 360

174.

You are working as a locum pharmacist. A 16-year-old girl comes into the pharmacy requesting some strong painkillers. She appears to be distressed and looking around her. You invite her to the consultation room to which she agrees. From the consultation you gather that she has had female genital mutilation (FGM) and would like some strong pain killers.

What is the most appropriate course of action to take?

Try and find out who encouraged her to have FGM

Refer her to the GP

Refer her to the local family planning clinic

Inform the superintendent pharmacist so that they can report the case to the police

Call the Police on (101) and report the case and provide the girls name, DoB, address and your contact details

Your comments:

Question 174 of 360

175.

Mr U is 21-years-old and was diagnosed with eczema 6 months ago. He has been struggling with looking after his skin as he leads quite a hectic lifestyle. He presents in the pharmacy asking you for advice concerning the spots on his face, which are increasingly becoming troublesome for him. He describes them as being red and itchy and also complains about his skin becoming painful. After examining his face you notice a few pustules. You ask him how he applies the E45 cream and he explains that he rubs it into his skin all over in circular motions. Prior to this he has had no skin issues apart from the eczema.

What is the most likely cause of Mr U’s spots on his face?

Cellulitis

Folliculitis

Acne vulgaris

Herpes zoster

Tinea faciei

Your comments:

Question 175 of 360

176.

Mr V is a 27-year-old who recently had an anaphylactic shock after eating a take-away, which he later discovered contained peanut oil. Consequently his GP recommended that he carries intramuscular adrenaline injection with him at all times.

Which of the following is the most appropriate dose of adrenaline that should be administered to Mr V in case of anaphylaxis?

100 mcg

150 mcg

200 mcg

300 mcg

500 mcg

Your comments:

Question 176 of 360

177.

This question concerns Miss W, a 22-year-old woman who has been newly prescribed Priadel 200mg prolonged release tablets for the treatment of bipolar disorder.

Miss W presents at the pharmacy to collect her prescription for Priadel 200mg tablets. She informs you that this is the first time she will be taking the tablets and asks whether there is any important information she should be aware of.

Which of the following advice is the most appropriate for you to give Miss W regarding the treatment?

When starting lithium therapy, patients may experience headaches. This effect is transient and can be managed with simple analgesics such as paracetamol or ibuprofen

Dose adjustments may be necessary during episodes of nausea, vomiting or diarrhoea

As part of the monitoring, serum lithium levels should be measured two weeks after starting treatment

The tablets should be taken at the same time every day. In case of a missed dose, a double dose should be taken to account for the missed dose

It may take between three to seven days of treatment for the full prophylactic effect of lithium to occur

Do you have any comments about this question? Let the team know below

Question 177 of 360

178.

This question concerns Miss W, a 22-year-old woman who has been newly prescribed Priadel 200mg prolonged release tablets for the treatment of bipolar disorder.

Miss W comes to the pharmacy with a dental prescription for metronidazole 400mg tablets. She informs you that the dentist has prescribed this for the treatment of acute gingivitis. She also asks if she can buy a bottle of chlorhexidine mouthwash.

Which of the following courses of action is the most appropriate for you to take?

[Get Hints]

dispense the metronidazole and counsel Miss W on the avoidance of alcohol during therapy and at least 48 hour afterwards due to the possibility of a disulfiram-like reaction. Provide her with alcohol free Corsodyl mouthwash

dispense the metronidazole and counsel Miss W that metronidazole tablets should be swallowed whole, without chewing, with half a glassful of water on an empty stomach

dispense the metronidazole and advise Miss W that she should not use mouthwash while taking metronidazole

dispense the metronidazole and advise Miss W to withhold taking the Priadel whilst on the short course of metronidazole to prevent lithium retention

contact the prescriber and suggest that amoxicillin is a suitable alternative to treat gingivitis instead of metronidazole for Miss W

Do you have any comments about this question? Let the team know below

Question 178 of 360

179.

This question concerns Miss W, a 22-year-old woman who was prescribed, a month ago, with Priadel 200mg prolonged release tablets for the treatment of bipolar disorder.

Miss W is admitted to A&E suffering with a suspected lithium overdose. Serum levels yield a lithium concentration of 3.0mmol/L. Further tests suggest Miss W has impaired renal function.

Which of the following methods is the most appropriate to manage Miss W’s lithium overdose?

treat by gastric lavage

repeated doses of activated charcoal

Miss W should be closely monitored and offered supportive treatment for a minimum of 24 hours and ECG should be monitored as there is no specific antidote to lithium

treat with haemodialysis which should be continued until there is no lithium in the serum or dialysis fluid

correct Miss W’s fluid and electrolyte balance and treat any other symptoms of lithium toxicity

Do you have any comments about this question? Let the team know below

Question 179 of 360

180.

Mr X is a 27-year-old man who has type 1 diabetes for which he uses NovoRapid (Insulin aspart) and Lantus (Insulin Glargine). You are having trouble obtaining Lantus devices and the doctor writes a prescription for Abasaglar (Insulin glargine) instead.

Which of the following statements regarding biosimilar medicines is the most appropriate?

pharmacists must record the brand name and batch number of any biologic medicine, including biosimilars supplied to a patient

the active substance of a biosimilar medicine is identical to the originator biological medicine

a biosimilar medicine is the same as a generic medicine

a biosimilar is a biologic medicine that is similar to an already licensed biologic medicine in terms of efficacy only

a biosimilar medicine can only be marketed after the patent protecting the originator product has expired

Your comments:

Question 180 of 360

181.

Mrs Y is a 68-year-old woman who with type 2 diabetes and hypertension for which she takes metformin, gliclazide and enalapril. She is admitted to hospital with generalised weakness, shortness of breath and vomiting. A blood and urine test is conducted upon admission and she is found to have an eGFR of 36ml/min/1.73m2 and an albumin:creatinine ratio of 18mg/mmol.

Which of the following is an appropriate chronic kidney disease classification for Mrs Y?

G3aA1

G3bA1

G4A3

G3bA2

G2A2

Do you have any comments about this question? Let the team know below

Question 181 of 360

182.

Mrs Z, a 72-year-old woman presents at your pharmacy seeking advice. She has been experiencing pain in her right ear and thinks it may be due to a build- up of ear wax. She asks if you can recommend something for her to use over the counter. Her records shows that she is currently taking the following medication:

• Amlodpine 10mg daily
• Alendronic acid 70mg weekly
• Atorvastatin 20mg daily

Which one of the following is the most appropriate course of action?

Advise Mrs Z to use olive oil drops and massage it into the affected ear

Advise Mrs Z to use Ear Calm spray three times a day

Advise Mrs Z to use Otomize ear spray three times a day

Advise/reassure Mrs Z that the condition will improve without any treatment

Advise Mrs Z to see her GP as soon as possible

Your comments:

Question 182 of 360

183.

Mr A visits your pharmacy and asks you to recommend a suitable analgesic to ease his headache that he has been experiencing over the last few days. When asked to describe the headache he tells you that it seems like a “tight band” around his head. You check the patient medication record system and see that he is currently taking:
• lithium carbonate 400mg tablets
• gliclazide 30mg tablets

Which of the following over the counter analgesics would be the most appropriate for Mr A?

Sumatriptan

Paracetamol and aspirin

Paracetamol

Ibuprofen

soluble paracetamol

Your comments:

Question 183 of 360

184.

Miss B is a 21-year-old woman who visits your pharmacy and requires emergency contraception, as she has had unprotected sexual intercourse two days ago. Upon further questioning you decide to provide her with EllaOne (ulipristal acetate). Miss B informs you that she has just completed a course of amoxicillin 250mg capsules and takes salbutamol, when required, for mild asthma. She also has a 6 month old baby whom she is breast feeding.

Which one of the following is the most suitable advise to give Miss B?

EllaOne is not suitable for Miss B as she suffers with mild asthma

Advise Miss B that emergency contraception is not suitable as she has just completed a course of antibiotics

Advise Miss B that she should express and discard breastmilk for one week after she has taken EllaOne

Advise Miss B that she should use a barrier method of contraception for the next three days

Advise Miss B that if she experiences vomiting within 2 hours of taking EllaOne she should take a replacement dose

Your comments:

Question 184 of 360

185.

This question concerns Master C, a 6 year old boy who has been taken to hospital after having ingested his mother’s iron tablets.

You are a hospital pharmacist working in the paediatric ward and have been asked by the doctor about iron poisoning. He informs you that Master C, who weighs 20 kg, has been rushed into hospital after ingesting his mother’s iron tablets which were in her handbag. Master C is showing signs of iron toxicity including vomiting and abdominal pain.

What is the minimum amount of elemental iron that the child could have ingested that could result in symptoms of toxicity?

100 mg

200 mg

300 mg

350 mg

400 mg

Question 185 of 360

186.

This question concerns Master C, a 6-year-old boy who has been taken to hospital after having ingested his mother’s iron tablets.

After initial assessment the doctors decide that treatment of iron overdose is necessary.

Which of the following is the most suitable approach to use when managing iron poisoning?

Repeated doses of activated charcoal

Intravenous infusion of desferrioxamine mesylate

Oral administration of ascorbic acid

Gastric lavage

Intravenous injection of methylthioninium chloride

Your comments:

Question 186 of 360

187.

Mr D, a 42-year-old man, presents at the pharmacy with a prescription for lansoprazole 30mg gastro resistant capsules. He explains that his GP has prescribed this to take alongside naproxen 250mg tablets which he is taking for tendinitis. The prescription is dispensed and you conduct a final check.

Which of the following information should be included on the dispensing label for lansoprazole 30mg gastro resistant capsules?

total quantity dispensed

do not take indigestion remedies 2 hours before or after you take this medicine

this medicine may colour your urine. This is harmless

take with or just after food

the form of the medicine

Do you have any comments about this question? Let the team know below

Question 187 of 360

188.

Mrs E is a 67-year-old woman who visits your pharmacy seeking advice about her hay fever. She explains that although she has suffered with mild hay fever symptoms in the past, she has not taken any medication for it previously. However, this year it is particularly bothersome, and she would like you to advise on the most appropriate medication to help manage her symptoms. Mrs E informs you that she is currently taking the following regular medication:

• Co-beneldopa 200/50mg twice a day
• Citalopram 20mg daily
• Metformin 500mg three times a day

Which of the following hay fever medications would be the least appropriate to supply Mrs E?

Acrivastine

Cetirizine

Fexofenadine

Chlorphenamine

Loratadine

Your comments:

Question 188 of 360

189.

Mrs F visits the pharmacy with her 3-year-old daughter weighing 14kg, who has had a high temperature recently. The GP has advised Mrs F to administer paracetamol every four to six hours, maximum 4 doses in 24 hours.

Which of the following doses should Mrs F administer to her child?

30 mg

60 mg

80 mg

100 mg

180 mg

Your comments:

Question 189 of 360

190.

Mr G is a 46-year-old who was admitted to hospital with meningitis. Following initial treatment with gentamicin, the doctors decided to switch to amikacin due to apparent resistance. Mr G was started on amikacin at a dose of 600mg twice daily. Following the administration of four doses, a serum amikacin concentration measurement yielded a pre-dose (‘trough’) amikacin level of 14mg/litre. Mr G has no known allergies.

Which of the following is the most appropriate action to take?

Increase the dosing interval

Reduce the amikacin dose being administered to Mr G

Reduce the dosing interval

Continue administering the amikacin at the prescribed dose and measure serum concentrations after two further doses are given

Withhold further doses until the pre-dose (trough) level falls to below 5mg/litre

Your comments:

Question 190 of 360

191.

Mrs H is a 46-year-old who has type 2 diabetes. Whilst discussing the medication with the patient you ascertain that over the last three days she has been experiencing nausea, fatigue, abdominal pain and she has also noticed that her urine is dark in colour. She informs you that, despite taking metformin 500mg three times a day regularly for the past four months, her HbA1c was found to be 68 mmol/mol and the doctor prescribed an additional oral anti-diabetic which she has been taking for the last 10 days.

Which of the following medications would the doctor have recently prescribed for Mrs H?

Exenatide

Pioglitazone

Canagliflozin

Sitagliptin

Acarbose

Your comments:

Question 191 of 360

192.

Mr I, a 35 year-old-man, presents at the pharmacy requesting to speak to the pharmacist. He explains that he has recently been experiencing shortness of breath and often finds himself wheezing. He notices the symptoms are worse after exercise and in cold weather. You measure his weight to be 72kg and height as 1.75m, concluding that he has a healthy BMI. He does not smoke and does not have any allergies.

Which of the following Peak Expiratory Flow Rate values would be considered normal for Mr I?

[Get Hints]

600 l/min

635 l/min

455 l/min

620 l/min

460 l/min

Do you have any comments about this question? Let the team know below

Question 192 of 360

193.

After attending a CPPE workshop on inhaler techniques, you decide to undertake an audit in the pharmacy to review the information and counselling provided to patients on how to effectively use their inhalers.

Which of the following statements regarding audits is true?

Confidential patient information cannot be collected

The audit can only be conducted by the pharmacist as it is their duty to ensure the safe and effective running of the registered pharmacy when it is operational

Audit is the only component of the clinical governance framework

Three audits must be conducted annually; this includes the National audit determined by NHS England, an NHS clinical audit and a GPhC standards adherence audit

The National Clinical Audit and Patient Outcomes Programme (NCAPOP) audits are commissioned and managed on behalf of NHS England by the Healthcare Quality Improvement Partnership (HQIP).

Your comments:

Question 193 of 360

194.

Both patients and healthcare professionals are encouraged to report all suspected adverse drug reactions via the yellow card scheme to the Medicines and Healthcare products Regulator Agency (MHRA).

Which of the following adverse drug reactions would need to be reported to the MHRA?

Mr J is 55 years old and develops a dry cough whilst taking Ramipril

Miss K is 36 years old who experiences constipation whilst taking Solpadeine (paracetamol, codeine) Max tablets

Mrs L who is 42 years old, has noticed a dry mouth since she started taking amitriptyline

Mr M is 25 years old and develops diarrhoea after taking clindamycin

Mr N is 56 years old and experiences dizziness whilst taking amlodipine

Your comments:

Question 194 of 360

195.

Mr O is a 26-year-old student who has recently visited the dentist and has been prescribed Colgate Duraphat (sodium fluoride) 5000ppm toothpaste. He has researched about the fluoride content in his area and is curious about fluoride tablets. Mr O would like to know what the fluoride content must be of drinking water in the area before fluoride tablets or drops are considered.

What is the most suitable advise to give Mr O?

Advise Mr O that when the fluoride content of drinking water is less than 0.7ppm, daily administration of fluoride tablets or drops provide suitable supplementation

Advise Mr O that when the fluoride content of drinking water is more than 0.7ppm, daily administration of fluoride tablets or drops provide suitable supplementation

Advise Mr O that when the fluoride content of drinking water is less than 650 micrograms per litre, daily administration of fluoride tablets or drops provide suitable supplementation

Advise Mr O that when the fluoride content of drinking water is less than 800 micrograms per litre, daily administration of fluoride tablets or drops provide suitable supplementation

Advise Mr O that fluoride supplementation is not required unless a person is at risk of developing dental caries

Your comments:

Question 195 of 360

196.

This question concerns Mr P, a 32-year-old man, who has depression.

Mr P presents in the pharmacy with a prescription for tranylcypromine 10mg twice daily and explains that this is a new medication that the doctor has prescribed for him.

Which of the following foods should you advise Mr P to avoid?

Nutella

Marmalade

Marmite

Fresh produce

Eggs

Your comments:

Question 196 of 360

197.

This question concerns Mr P, a 32-year-old man, who has depression.

Whilst counselling Mr P you highlight possible side effects of the Tranylcypromine.

Which one of the following symptoms would warrant urgent referral?

Constipation

Blurred vision

Throbbing headaches

Nausea

Diarrhoea

Your comments:

Question 197 of 360

198.

Mr Q, a 35-year-old man who is visiting the UK from Germany, presents you with a prescription for diazepam tablets. He explains that his doctor in Germany prescribed them for him for the management of muscle spasms. He further informs you that he was unable to obtain the medication in Germany due to his travels and asks whether you could dispense the prescription for him. You manage to confirm the registration status of the prescriber by checking their registration number online.

Which of the following is the most appropriate action for you to take?

inform Mr Q that you are unable to dispense the prescription and issue him with an emergency supply instead

inform Mr Q that you are unable to dispense prescriptions from Germany for diazepam and sign post him to a UK registered prescriber

dispense the medication in accordance with the instructions on the prescription making note of any steps taken to confirm the registration status of the prescriber

refuse to dispense the prescription until you have contacted and spoken to the doctor in Germany

dispense the prescription and inform Mr Q that prescriptions from Germany can be dispensed in the UK and are valid for 6 months from the date on the prescription

Do you have any comments about this question? Let the team know below

Question 198 of 360

199.

Mr R is a 56-year-old who visits your pharmacy for the first time and asks for Gaviscon (sodium alginate with calcium carbonate and sodium bicarbonate) as he thinks he may have indigestion after eating his lunch in a hurry. He explains that sometimes he has chest pain when he exerts himself but feels better after resting and taking the medication the GP prescribed him. Mr R has a BMI of 28 kg/m2 and you ask him to indicate where he feels the pain, to which he points towards his chest area. Mr R also complains of jaw pain and asks if you could look at his left arm since he is experiencing unexplainable pain.

What is the most appropriate course of action?

Supply Mr R with Gaviscon, and give him appropriate lifestyle advice

Ring 999 and place Mr R in the recovery position

Ring 999 and give Mr R aspirin 300mg tablet to chew followed by clopidogrel 75mg tablet

Ring 999 and give Mr R an aspirin 300mg tablet followed by glyceryl trinitrate 400mcg aerosol spray

Advise Mr R to see his GP immediately

Your comments:

Question 199 of 360

200.

Mr S is a 60-year-old man on the orthopaedic ward after having undergone hip replacement surgery. He has developed osteomyelitis and the doctors have prescribed fusidic acid at a dose of 500mg three times a day. You are screening his drug chart and notice that in addition to analgesics taken when required, he is also on the following regular medication:
• Enalapril 10mg
• Simvastatin 40mg

Which of the following advice is appropriate for you to provide to the medical team responsible for Mr S’s care?

Advise that Mr S should stop taking simvastatin whilst taking the fusidic acid tablets and resume taking them 7 days after the last fusidic acid dose

Advise that Mr S should reduce his simvastatin dose to 10mg whilst taking the fusidic acid

Advise that Mr S should take the fusidic acid tablets on an empty stomach 30 to 60 minutes before food

Advise that fusidic acid interacts with enalapril and suggest an alternative antibiotic

Advise that the metabolism of fusidic acid may be increased by simvastatin and a higher dose may be necessary for treatment

Your comments:

Question 200 of 360

201.

Mr T is a 32-year-old who visits your pharmacy seeking advice. He informs you that he had a tingling sensation in his lip yesterday and woke up this morning with a blister.

Which of the following situations would require you to refer MR T to the GP?

Lesion is still present after ten days

The blister begins to weep

Burning sensation around the mouth

Lesions that are filled with fluid

Blisters that scab after 48 hours

Do you have any comments about this question? Let the team know below

Question 201 of 360

202.

Mrs U has been visiting your pharmacy for 5 years. She presents in your pharmacy on a busy Friday afternoon requesting that you provide her with a copy of her patient medication record (PMR) that she requires for personal use. All patient medication records in your pharmacy are completely held on computer.

Under the provisions of the Data Protection Act 1998, which of the following would be the best course of action for you to take?

Tell Mrs U that she has no right to access her PMR

Tell Mrs U that you are currently busy and ask her to return on Monday morning when it is quiet to obtain a copy of her PMR

Tell Mrs U that you will need the request in writing, after which you will provide her with a copy within 40 days upon the receipt of a £10 charge

Tell Mrs U that you cannot provide her with a copy of her PMR but she can arrange a time to come and view it in the pharmacy

Tell Mrs U that you will need the request in writing following which you will provide her with a copy within 40 days upon the receipt of a £50 charge

Your comments:

Question 202 of 360

203.

Mrs V is a 28-year-old who presents at the pharmacy to collect her husband’s prescription for isotretinoin. She informs you that she is 3 weeks pregnant and would like to purchase folic acid tablets.

Which of the following advice is the most appropriate to give Mrs V?

Mrs V should take folic acid 400mcg daily to be continued until week 12 of the pregnancy

Mrs V should take folic acid 5mg daily to be continued until week 12 of the pregnancy

Mrs V should see her doctor immediately as her baby is at risk of congenital abnormalities

Confirm with Mrs V whether her husband takes folic acid and, if not, advise her to see her GP immediately

Advise Mrs V that she should have started taking folic acid 12 weeks before getting pregnant

Your comments:

Question 203 of 360

204.

You are training a new healthcare assistant and want to ensure she knows when it is appropriate to supply Maloff Protect 250mg/100mg tablets (atovaquone with proguanil hydrochloride) as a pharmacy only (P) medicine.

Which of the following patients would it be appropriate to supply with Maloff Protect tablets?

Mr W, a 50 year old male weighing 72kg and takes warfarin tablets

Miss X who is 21 years old weighing 50kg and is planning to travel for 6 months

Mrs Y a 25 year old female who is pregnant and is in her third trimester

Mr Z who is a 17 year old student and has recently been started on fluoxetine

Mr A who is 27 years old, weighing 60kg and planning to go on holiday for 8 weeks

Do you have any comments about this question? Let the team know below

Question 204 of 360

205.

This question concerns Mr B a 55-year-old with a BMI of 29 kg/m2 and is starting to feel concerned with his weight.

Mr B comes to the pharmacy seeking advice about how he can lose weight and explains that he was worried about developing further medical conditions if he does not. He currently takes the following medication:
• amlodipine 10mg
• atorvastatin 20mg at night

At which stage of the behavioural change cycle is Mr B currently at?

Action

Preparation

Contemplation

Pre-contemplation

Maintenance

Your comments:

Question 205 of 360

206.

This question concerns Mr B a 55-year-old with a BMI of 29 kg/m2 and is starting to feel concerned with his weight.

After visiting his GP Mr B returns with a prescription for orlistat 120mg, one to be taken three times a day. As he plans on dieting, the doctor has advised him to take vitamin supplements. He asks if you can recommend some multivitamins and seeks your assurance as to whether it would be suitable to take them whilst taking orlistat.

Which one of the following is the most appropriate course of action?

Advise Mr B that there is no interaction between vitamins and orlistat and that taking supplements may help to aid weight loss

Advise Mr B to take the multivitamin supplement at least 2 hours after orlistat or at bedtime

Advise Mr B that he may not need multivitamins but should consider taking iron supplements

Advise Mr B to take the multivitamin supplement at least 30 minutes before breakfast

Advise Mr B that orlistat affects the absorption of vitamins and there would be no point taking supplements

Your comments:

Question 206 of 360

207.

Mr C visits your pharmacy and presents you with a prescription for 7 tablets of temazepam 10mg once daily.

Using the table above, select the most appropriate option which reflects the correct legal procedures concerning temazepam.

Your comments:

Question 207 of 360

208.

This question concerns Mr D, a 57-year-old lorry driver weighing 69kg.

Mr D comes to the pharmacy to collect his repeat prescription and asks you to dispense a prescription for levofloxacin 500mg tablets that his GP has prescribed for the treatment of acute sinusitis.

Which of the following counselling points would be most appropriate for you to give Mr D when dispensing his prescription?

Mr D should avoid drinking milk two hours before or after taking levofloxacin

Mr D’s ability to drive may be affected by levofloxacin

Mr D should protect his skin from sunlight and avoid the use of sunbeds

Mr D should take the levofloxacin tablets 30 to 60 minutes before food

Mr D should avoid drinking alcohol while taking levofloxacin

Your comments:

Question 208 of 360

209.

This question concerns Mr D, a 57-year-old lorry driver weighing 69kg.

He collected a prescription for Levofloxacin 500mg tablets for sinusitis four days ago. Mr D returns to the pharmacy complaining of severe pain in his right shoulder and asks you to recommend a suitable pain killer. He explains that the pain started yesterday morning and is increasing in severity. He does not remember doing anything that may have caused injury to his shoulder and has not taken any pain killers for it.

Which of the following is the best course of action?

Advise Mr D to take paracetamol 500mg tablets, 2 tablets up to four times a day when required. He should seek medical attention if he continues to feel pain tomorrow

Advise Mr D to take ibuprofen 400mg tablets three times a day

Advise Mr D to apply Voltarol gel and a hot water bottle to the affected area and to seek medical attention if there is no improvement within 2 days

Advise Mr D to take co-codamol 8/500mg, 2 tablets up to four times a day when required. Warn him that codeine may make him feel drowsy and affect his ability to drive

Advise Mr D to seek immediate medical attention

Your comments:

Question 209 of 360

210.

Mr E, a 66-year-old man has been stabilised on Oramorph concentrated oral solution (morphine sulphate 100mg/5ml) for the past six months. The consultant doctor decides to switch him onto Durogesic DTrans (fentanyl) patches as his pain is under control. He currently takes 2mL every four hours.

Which of the following Durogesic DTrans patches should the doctor prescribe for use every 72 hours to provide an equivalent effect to Mr E’s current daily dose from Oramorph concentrated oral solution?

fentanyl ‘12’ patch

fentanyl ‘25’ patch

fentanyl ‘50’ patch

fentanyl ‘75’ patch

fentanyl ‘100’ patch

Do you have any comments about this question? Let the team know below

Question 210 of 360

211.

Mr F is a 44-year-old man who presents at the hospital with facial flushing, a throbbing headache, vomiting and a pulse rate of 115 beats per minute. Mr F smokes 3 cigarettes a day and has wine with his evening meals. He has no known allergies.

Which of the following drugs is the most likely cause of Mr F’s symptoms?

Paracetamol

Flucloxacillin

Metronidazole

Simvastatin

Amoxicillin

Your comments:

Question 211 of 360

212.

Mrs G is in the initial phase of treatment for tuberculosis and is currently being treated with the following medications:

• Isoniazid 300mg daily
• Rifampicin 600mg daily
• Pyrazinamide 2.5g three times a week
• Ethambutol 1.2g three times a week

Which one of the following can be administered to prevent isoniazid induced peripheral neuropathy?

Riboflavin

Duloxetine

Pyridoxine

Thiamine

Folic acid

Your comments:

Question 212 of 360

213.

Mr I presents at the pharmacy concerned about his 3-year-old daughter who has been suffering with perianal itching. After asking the relevant questions you decide to supply Mr I with mebendazole 100mg tablets. In addition to his daughter, Mr I also lives with his wife and his 7 year old son. He asks whether the condition his daughter has is contagious.

What is the most appropriate advice to give to Mr I?

Advise Mr I that only his daughter should be treated by taking two tablets 7 days apart

Advise Mr I that only his daughter must be treated by taking two tablets 14 days apart

Advise Mr I that all members of his family must be treated including himself, and if reinfection occurs a second treatment should be taken after 7 days

Advise Mr I that all members of his family must be treated including himself, and if reinfection occurs a second treatment should be taken after 14 days

Advise Mr I that both of his children must be treated and retreated after 14 days if reinfection occurs

Your comments:

Question 213 of 360

214.

You are working in the hospital pharmacy dispensary and a nurse from the mental health unit contacts you late on a Friday evening asking whether you have risperidone depot injection in stock as she requires it for Mr J. She informs you that he usually takes haloperidol tablets 5mg twice a day. The nurse confirms that the dose of haloperidol decanoate to be administered is 50mg every 4 weeks.

What would be the most likely reason behind Mr J’s change of formulation?

To lower the incidence of extrapyramidal side effects

To avoid first pass metabolism

To overcome any compliance issues with the oral regimen

To reduce the frequency of administration

To provide better control of symptoms

Your comments:

Question 214 of 360

215.

Miss N has eczema and has been prescribed 3 x 500g of Balneum Plus Cream (Urea 5%, Lauromacrogols 3%) to use whilst she is away on holiday for two months.

Which of the following provides the correct weight of active ingredients in the total amount of cream prescribed?

15g of Urea, 9g of Lauromacrogols

25g of Urea, 15g of Lauromacrogols

75g of Urea, 45g of Lauromacrogols

75g of Urea, 450g of Lauromacrogols

750g of Urea, 45g of Lauromacrogols

Your comments:

Question 215 of 360

216.

Ms L is a 42-year-old woman visiting the UK from France who presents at your pharmacy and asks if you can provide her with a supply of medication that she usually takes for Ménière's disease. She explains that she left France for the UK in a hurry to attend a conference and forgot her medication in the process. She further explains that she has enough to last her for two days but is staying for a week and will need more. The medication she is requesting is not one that you are familiar with and upon searching, you discover that it is used in countries in Europe but is not licensed in the UK.

Which of the following is the most appropriate action to take?

inform Ms L that you do not have the item in stock and sell her a pack of Buccastem M tablets and advise her to take two tablets twice a day

order the item in and make an emergency supply of a sufficient quantity to last her stay

explain to Ms L that you are unable to supply her with any POM medicines due to Brexit, and provide her with alternative items that she can purchase over the counter

refer Ms L to an appropriate UK based prescriber

contact Ms L’s doctor in France and request them to fax over a prescription for the medication which you can issue as long as the doctor agrees to send the original prescription to you within 72 hours

Your comments:

Question 216 of 360

217.

You are a locum pharmacist working in a busy pharmacy on a Friday evening. You are approached by a patient requesting an emergency supply of his medication. He explains that he has run out of his medicine and that he is in pain and needs his pain killers and sedatives.

Which of the following medications can be supplied in an emergency request on behalf of the patient?

Tramadol capsules

Morphine sulphate tablets

Buprenorphine patches

Diazepam tablets

Temazepam tablets

Your comments:

Question 217 of 360

218.

Mrs M is a 65-year-old woman who has developed a severe skin infection associated with methicillin resistant staphylococcus aureus (MRSA). She has been initiated on medication via the intravenous route in order to treat the infection, however she has now developed a temperature of 39.2oC and her torso, face and neck is of a prominent red colour. She also is experiencing a rash and itching.

Which of the following antibiotics is responsible for Mrs M’s symptoms?

Linezolid

Gentamicin

Teicoplanin

Vancomycin

Clindamycin

Your comments:

Question 218 of 360

219.

Miss N is 24 years old and has been admitted to hospital following a paracetamol overdose. She weighs 55kg and her mother informs you that she ingested the paracetamol six hours ago. She has no known allergies and has given up alcoholic beverages over a month ago. She has been vomiting over the last two hours. Miss N’s plasma-paracetamol concentration is 75mg/L.

Which of the following is the most appropriate course of action?

Miss N should be treated with acetylcysteine immediately

Miss N requires no treatment but should be monitored over the next 24 hours

Miss N should be treated with repeated doses of activated charcoal

Miss N should undergo a gastric lavage

Miss N should be treated with Intravenous administration flumazenil

Do you have any comments about this question? Let the team know below

Question 219 of 360

220.

Whilst working as a pharmacist in an inpatient hospital pharmacy, you receive a delivery of controlled drugs which you are required to store appropriately on the pharmacy premises.

Under the Misuse of Drugs (Safe Custody) Regulations 1973, which of the following medicines is exempt from being kept under safe custody?

buprenorphine 35 micrograms/hour patches

morphine sulfate 10 mg modified-release tablets

morphine sulfate 20 mg/mL oral solution

temazepam 10 mg tablets

quinalbarbitone (secobarbital) 100 mg capsules

Your comments:

Question 220 of 360

221.

Mrs O is a 27-year-old woman who recently gave birth and is currently breast-feeding. She presents you with a new prescription for phenytoin. You deem it pertinent to check her patient medication records which show that last week she collected a prescription for the following medication:
• Ferrous sulphate 200mg daily
• Co-codamol 8/500mg when required
• Sumatriptan 50mg when required
• Lactulose 15ml twice a day

Which of the following medications that Mrs O is taking would cause you the most concern?

Phenytoin

Ferrous sulphate

Co-codamol

Sumatriptan

Lactulose

Your comments:

Question 221 of 360

222.

Mr P is a 55-year-old who has been diagnosed with moderate rheumatoid arthritis. He has been started on prednisolone at an initial dose of 60mg daily which will be tapered to 7.5mg daily over 6 weeks and reviewed.

Which of the following is the most appropriate statement?

Mr P’s prednisolone should be gradually withdrawn as he has received more than 2 weeks’ treatment

Mr P’s prednisolone should be gradually withdrawn as his initial dose exceeds 30mg

If Mr P has not had chickenpox, he should avoid close contact with people with chickenpox but will not be affected by contact with people with shingles

Mr P should stop taking prednisolone immediately if he develops symptoms of confusion, irritability or delusions

Mr P is at risk of developing a fever and conjunctivitis if prednisolone is abruptly withdrawn

Your comments:

Question 222 of 360

223.

This question relates to Mr Q, a 64-year-old man who has been recently prescribed Trulicity (dulaglutide) 1.5 mg solution for injection as an add-on therapy for his diabetes at a dose of 1.5mg weekly, which he usually takes on Wednesdays. He is also on atorvastatin, metformin, gliclazide and ramipril. He has no known drug allergies and has a BMI of 28.2kg/m2.

Mr Q contacts you in the pharmacy on a Saturday morning. He explains that he has forgotten to take his regular dose this week and asks for your advice.

Which of the following is the most appropriate advice to give Mr Q regarding his missed dose?

Mr Q should take two doses next Wednesday and resume the once weekly dosing schedule thereafter

Mr Q should administer the next dose 3 days (72 hours) before the next scheduled dose then resume the once weekly dosing schedule

As there are less than 3 days (72 hours) before the next scheduled dose, Mr Q should skip the missed dose and resume dose administration on Wednesday

Mr Q should administer the dose as soon as possible and then resume the once weekly dosing schedule

Mr Q should visit an out of hours GP to assess his clinical condition as a matter of urgency

Do you have any comments about this question? Let the team know below

Question 223 of 360

224.

This question relates to Mr Q, a 64-year-old man who has been recently prescribed Trulicity (dulaglutide) 1.5 mg solution for injection as an add-on therapy for his diabetes at a dose of 1.5mg weekly, which he usually takes on Wednesdays. He is also on atorvastatin, metformin, gliclazide and ramipril. He has no known drug allergies and has a BMI of 28.2kg/m2.

Mr Q visits the pharmacy experiencing constipation and flatulence.

Constipation and flatulence are undesirable effects reported to occur in how many users of dulaglutide?

≥ 1/10

≥ 1/100 to < 1/10

≥ 1/1,000 to < 1/100

≥ 1/10,000 to < 1/1,000

< 1/10,000

Do you have any comments about this question? Let the team know below

Question 224 of 360

225.

This question relates to Mr Q, a 64-year-old man who has been recently prescribed Trulicity (dulaglutide) 1.5 mg solution for injection as an add-on therapy for his diabetes at a dose of 1.5mg weekly, which he usually takes on Wednesdays. He is also on atorvastatin, metformin, gliclazide and ramipril. He has no known drug allergies and has a BMI of 28.2kg/m2.

Mr Q is concerned about his weight and is attempting some lifestyle changes to help with weight loss. He asks whether dulaglutide will help reduce his weight.

Over a 52 week period, what change in Mr Q’s weight could be attributed to Trulicity?

-3.03kg

-2.29kg

-2.90kg

-1.33kg

-1.87kg

Do you have any comments about this question? Let the team know below

Question 225 of 360

226.

Mr R visits his GP and is diagnosed with type 2 diabetes mellitus. He is prescribed a biguanide.

Which of the following cautionary labels must be present on the dispensing label?

Take with or just after food, or a meal

Take 30 to 60 minutes before food

Take with a full glass of water

Do not drink alcohol

Space the doses evenly throughout the day. Keep taking this medicine until the course is finished, unless you are told to stop

Your comments:

Question 226 of 360

227.

Miss S, a 36-year-old comes to the pharmacy with a prescription for Norgeston (levonorgestrel) 30mcg, one to be taken daily. While dispensing the prescription, you notice from her Patient Medicine Records that she is also taking phenobarbital 30mg.

Which of the following is the best advice regarding Miss S’s medication?

Phenobarbital may reduce the effect of Norgeston and Miss S should take any combined oral contraceptive with standard dosing instead

Contact the prescriber and advise them that a contraceptive patch will be more suitable for Miss S

Inform Miss S that there is no suitable contraception while she is taking phenobarbital other than barrier methods, but she can use emergency hormonal contraception at the standard dose if she needs to

Contact the prescriber and suggest that Depo-Provera (medroxyprogesterone) 150mg/ml injection could be a more suitable contraception for Miss S

If Miss S needs to use emergency hormonal contraception she should ulipristal rather than levonorgestrel as it does not interact with phenobarbital

Your comments:

Question 227 of 360

228.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.Miss S is 16-years-old. She presents in the pharmacy requesting some pain relief as her dysmenorrhoea is becoming troublesome. Miss S explains that she takes paracetamol at the maximum recommended dose and the pain is usually alleviated, however now it doesn’t seem to be as effective and would like an alternative.

Methadone

Ibuprofen tablets

Tramadol

Co-codamol

Fentanyl patches

Morphine

Paracetamol

Naproxen

Your comments:

Question 228 of 360

229.

For each question in this section select one answer from the list of nine options. Miss T is a 26-year-old dance student who sprained her ankle yesterday and is suffering with mild-moderate pain. After being examined by the university nurse, Miss T is advised to purchase pain relief over the counter. Her ankle appears to be slightly swollen and she has informed you that she is not taking any medication.

Methadone

Ibuprofen tablets

Tramadol

Co-codamol

Fentanyl patches

Morphine

Paracetamol

Naproxen

Your comments:

Question 229 of 360

230.

For each question in this section select one answer from the list of nine options.Mr U is a 75-year old palliative patient with end stage lung cancer. He is currently taking modified release oxycodone at a dose of 80mg twice a day. Recently he has been suffering with a cough which makes it difficult for him to rest, and administration of oral medication has also become difficult. He requires treatment to alleviate his symptoms.

Methadone

Ibuprofen tablets

Tramadol

Co-codamol

Fentanyl patches

Morphine

Paracetamol

Naproxen

Your comments:

Question 230 of 360

231.

For each question in this section select one answer from the list of nine options.Mrs V is 55-years-old who slipped on ice while on her way to work and hit her head on the edge of the pavement. She also broke her nose in the process. She is suffering with moderate pain and has been brought to hospital for assessment. Apart from asthma, which is well managed with the inhalers she currently uses, Mrs V is otherwise well and has no known allergies.

Methadone

Ibuprofen tablets

Tramadol

Co-codamol

Fentanyl patches

Morphine

Paracetamol

Naproxen

Your comments:

Question 231 of 360

232.

For each question in this section select one answer from the list of nine options.Mr W is a 57-year-old who was diagnosed with type 2 diabetes a few years ago. His blood glucose is currently managed with metformin and pioglitazone. Despite appropriate lifestyle interventions, he now has raised blood pressure and continues to have an average blood pressure reading of 140/90 mmHg and the GP would like to initiate an appropriate antihypertensive.

Labetalol

Methyldopa

ABPM

Atenolol

Ramipril

Indapamide

Amlodipine

HBPM

Your comments:

Question 232 of 360

233.

For each question in this section select one answer from the list of nine options.Mrs X is a 42-year-old woman who has type 2 diabetes. After making a number of lifestyle changes, her blood pressure remains above the target recommended for type 2 diabetics. While discussing possible treatment measures with her GP, she mentions that she is currently trying to conceive.

Labetalol

Methyldopa

ABPM

Atenolol

Ramipril

Indapamide

Amlodipine

HBPM

Your comments:

Question 233 of 360

234.

For each question in this section select one answer from the list of nine options.Mr Y is a 42-year-old man who presents in the clinic complaining of recurrent headaches. Two consecutive blood pressure measurements taken in the clinic yield an average reading of 149/92mmHg. Mr Y explains that he has been under a considerable amount of stress lately exacerbated by the fact that his father has recently had a heart attack. You have been asked to select a suitable treatment for Mr Y.

Labetalol

Methyldopa

ABPM

Atenolol

Ramipril

Indapamide

Amlodipine

HBPM

Your comments:

Question 234 of 360

235.

For each question in this section select one answer from the list of nine options.Mrs Z visits your pharmacy worried about her 4-month-old daughter. She has noticed greasy yellow scaly patches on her daughter’s scalp. She has not tried anything yet and her daughter is otherwise well. Mrs Z has asked what condition her daughter has.

Varicella zoster

Herpes zoster

Tinea capitis

Neiserria meningitides

Colic

Headlice

Cradle cap

Scarlet fever

Your comments:

Question 235 of 360

236.

For each question in this section select one answer from the list of nine options.Miss A has brought her 6-year-old niece to the pharmacy seeking your advice. She tells you that her niece has had intense itching of the scalp, especially behind the ears and back of the neck. Miss A further informs you that she has looked at her scalp but did not see anything other than tiny brown specks. Miss A’s niece has no known allergies and uses a salbutamol inhaler when needed. Miss A would like to know what is causing these symptoms.

Varicella zoster

Herpes zoster

Tinea capitis

Neiserria meningitides

Colic

Headlice

Cradle cap

Scarlet fever

Your comments:

Question 236 of 360

237.

For each question in this section select one answer from the list of nine options.Mr B visits your pharmacy worried about his 3-month-old son who is crying and is noticeably red in the face. He explains that his son is usually quiet however, he has been crying constantly for several hours over the past few days. You notice that whilst the baby is crying, his back is arched and the knees are drawn up. Mr B is particularly worried as the baby is clenching his fists. Mr B would like to know what is causing these symptoms.

Varicella zoster

Herpes zoster

Tinea capitis

Neiserria meningitides

Colic

Headlice

Cradle cap

Scarlet fever

Your comments:

Question 237 of 360

238.

For each question in this section select one answer from the list of nine options.Mr C presents to your pharmacy with a prescription for his 12-year-old daughter for Penicillin V 250mg tablets at a dose of one tablet four times a day for 10 days. While waiting for the prescription, Mr C asks to purchase paracetamol tablets for his daughter. He explains that he took her to the GP this morning as she has had a sore throat and high temperature and developed a rash on her abdomen yesterday which was quite rough to the touch, like sand paper. Mr C would like to know what caused her symptoms.

Varicella zoster

Herpes zoster

Tinea capitis

Neiserria meningitides

Colic

Headlice

Cradle cap

Scarlet fever

Your comments:

Question 238 of 360

239.

For each question in this section select one answer from the list of nine options.Mr D is a 29-yea- old builder who recently broke his arm after falling off a ladder. He was prescribed codeine phosphate tablets to help with the pain and used them at the maximum recommended dose in addition to co-codamol. He is rushed into hospital with pinpoint pupils and is starting to suffer from respiratory depression where he is prescribed medication to reverse his symptoms. Which is the following is most suitable for Mr D?

Activated charcoal

Flumazenil

Acetylcysteine

100% oxygen

Adrenaline/epinephrine

Naloxone

Desferrioxamine mesilate

Gastric lavage

Your comments:

Question 239 of 360

240.

For each question in this section select one answer from the list of nine options.Mr E, a 34-year-old man, calls the ambulance and explains that he has come home to find his wife, who is 31-years-old, collapsed on the floor and breathing rapidly. After further questioning, the paramedics arrive at the house and find that Mrs E has a pulse rate of 127 beats per minute. Mr E explains that other than flu like symptoms and nausea that him and his wife have recently been suffering with, Mrs E is generally in good health. The paramedics suspect carbon monoxide poisoning and transfer Mrs E to the hospital. The hospital would like to initiate Mrs E on a suitable treatment.

Activated charcoal

Flumazenil

Acetylcysteine

100% oxygen

Adrenaline/epinephrine

Naloxone

Desferrioxamine mesilate

Gastric lavage

Your comments:

Question 240 of 360

241.

For each question in this section select one answer from the list of nine options.Miss G is 27-years-old and has been managed for epilepsy since the age of 15. She has discovered that she is pregnant and the doctor is considering reviewing her antiepileptic medication and would like to review its use.

Lamotrigine

Vigabitran

Ethosuximide

Sodium valproate

Phenobarbital

Carbamazepine

Zonisamide

Phenytoin

Your comments:

Question 241 of 360

242.

For each question in this section select one answer from the list of nine options.Mrs I is a 64-year-old who was recently diagnosed with valvular atrial fibrillation and initiated on warfarin. She presents at the pharmacy requesting to purchase Daktarin (miconazole) oral gel which she explains is to treat oral thrush caused by her beclometasone inhaler. She further informs you that she used the Daktarin oral gel 18 months ago when she had similar symptoms and it helped resolve the condition.

Increased risk of bleeding

Prolongation of the QT interval

Increased bleeding time

Hyponatraemia

Hypernatraemia

Hyperkalaemia

Reduced plasma concentration

Risk of neutropenia

Your comments:

Question 242 of 360

243.

For each question in this section select one answer from the list of nine options.Mr J is a 56-year-old who takes venlafaxine 75mg tablets once daily for social anxiety disorder. He visits your pharmacy today with a headache and requests to purchase Anadin Extra tablets (aspirin, paracetamol and caffeine) which have been recommended to him by a friend. Which of the following effects is Mr J most likely to experience?

Increased risk of bleeding

Prolongation of the QT interval

Increased bleeding time

Hyponatraemia

Hypernatraemia

Hyperkalaemia

Reduced plasma concentration

Risk of neutropenia

Your comments:

Question 243 of 360

244.

For each question in this section select one answer from the list of nine options.Mr L is a 55 year old taxi driver weighing 98kg, who has had a productive cough over the last 6 months. He stopped smoking 18 months ago after his father passed away from lung cancer; prior to which he smoked up to 30 cigarettes a day. Mr L visited his GP 2 months ago after noticing that he was becoming increasingly breathless whilst loading customer suitcases into the taxi and that the breathlessness had become more persistent causing him to use the salbutamol inhaler more frequently, nearly every day. During the consultation his FEV₁was measured to be 51% predicted. The GP is considering add-on therapy according to NICE guidelines.

Fostair 100/6 microgram inhalation solution (beclometasone dipropionate and formoterol)

Symbicort 400/12 turbohaler (budesonide and formoterol)

Clenil modulite 200mcg inhaler (beclomethasone dipropionate)

Singulair 5mg chewable tablets (Montelukast)

Serevent 50mcg accuhaler (salmeterol)

Atrovent 20mcg inhaler (ipratropium bromide)

Prednisolone 5mg tablets

Slo-Phyllin 250mg capsules (Theophylline)

Your comments:

Question 244 of 360

245.

For each question in this section select one answer from the list of nine options.You are conducting an asthma review for Master M, a 4 year old child, who has with asthma for which he uses Clenil modulite 50mcg inhaler (beclomethasone dipropionate) two puffs twice a day and salbutamol 100mcg inhaler two puffs when required. During the review, his mother explains that over the past three weeks, Master M has been using the salbutamol inhaler almost every day and she often notices that he wheezes at night. The GP is considering add-on therapy according to NICE guidelines.

Fostair 100/6 microgram inhalation solution (beclometasone dipropionate and formoterol)

Symbicort 400/12 turbohaler (budesonide and formoterol)

Clenil modulite 200mcg inhaler (beclomethasone dipropionate)

Singulair 5mg chewable tablets (Montelukast)

Serevent 50mcg accuhaler (salmeterol)

Atrovent 20mcg inhaler (ipratropium bromide)

Prednisolone 5mg tablets

Slo-Phyllin 250mg capsules (Theophylline)

Your comments:

Question 245 of 360

246.

For each question in this section select one answer from the list of nine options.Miss N is a 25 year old female who has chronic asthma. She visits her GP as she continues to use her salbutamol inhaler at least once a day despite using Clenil Modulite 100mcg inhaler (beclomethasone dipropionate) at a dose of two puffs twice a day for the past two months. The GP is considering add-on therapy according to NICE guidelines.

Fostair 100/6 microgram inhalation solution (beclometasone dipropionate and formoterol)

Symbicort 400/12 turbohaler (budesonide and formoterol)

Clenil modulite 200mcg inhaler (beclomethasone dipropionate)

Singulair 5mg chewable tablets (Montelukast)

Serevent 50mcg accuhaler (salmeterol)

Atrovent 20mcg inhaler (ipratropium bromide)

Prednisolone 5mg tablets

Slo-Phyllin 250mg capsules (Theophylline)

Your comments:

Question 246 of 360

247.

For each question in this section select one answer from the list of nine options.Mrs O is a 64-year-old woman who has asthma and osteoarthritis. Her son presents at the pharmacy with a prescription for his mother and explains that she has recently had a review with the GP who has made some changes to her medication.

Inappropriate drug dose

Inappropriate drug choice

Clinically significant drug interaction

Legally invalid prescription

Inappropriate drug formulation

Inappropriate quantity

Unnecessary drug therapy

Inappropriate drug directions

Do you have any comments about this question? Let the team know below

Question 247 of 360

248.

For each question in this section select one answer from the list of nine options.Mr P is a 59-year-old man who has type 2 diabetes, hypertension, angina and ischaemic heart disease. He visits the pharmacy informing you that a prescription should have been sent to you electronically from his GP for medication he has run out of.

Inappropriate drug dose

Inappropriate drug choice

Clinically significant drug interaction

Legally invalid prescription

Inappropriate drug formulation

Inappropriate quantity

Unnecessary drug therapy

Inappropriate drug directions

Do you have any comments about this question? Let the team know below

Question 248 of 360

249.

For each question in this section select one answer from the list of nine options.

Mrs Q is a 36-year-old who is 11 weeks pregnant. She explains that the doctor has prescribed some antibiotics as she has a urinary tract infection. She asks you for advice on any steps she can be taken to prevent her developing a urinary tract infection again as it is extremely painful and she would rather not take any medication whilst pregnant. Mrs Q further tells you that she has been taking Pregnacare (pregnancy vitamins) since she discovered she was pregnant.

Inappropriate drug dose

Inappropriate drug choice

Clinically significant drug interaction

Legally invalid prescription

Inappropriate drug formulation

Inappropriate quantity

Unnecessary drug therapy

Inappropriate drug directions

Do you have any comments about this question? Let the team know below

Question 249 of 360

250.

For each question in this section select one answer from the list of nine options.Mr R, an 80-year-old man, calls the pharmacy and asks if you could dispense and deliver his prescription that was collected from the GP surgery earlier today.

Inappropriate drug dose

Inappropriate drug choice

Clinically significant drug interaction

Legally invalid prescription

Inappropriate drug formulation

Inappropriate quantity

Unnecessary drug therapy

Inappropriate drug directions

Do you have any comments about this question? Let the team know below

Question 250 of 360

251.

For each question in this section select one answer from the list of nine options.Mr S presents at the pharmacy with a prescription for his 4-month-old son. He explains that the GP prescribed this gel for his son who has developed white patches on his tongue and inner cheeks. He asks you for instructions on how best to apply the gel.

Inappropriate drug dose

Inappropriate drug choice

Clinically significant drug interaction

Legally invalid prescription

Inappropriate drug formulation

Inappropriate quantity

Unnecessary drug therapy

Inappropriate drug directions

Do you have any comments about this question? Let the team know below

Question 251 of 360

252.

For each question in this section select one answer from the list of nine options.

Mrs T is a 46-year-old who has type 2 diabetes and hypertension. Recently her kidney function has started to deteriorate. She is currently taking metformin, pioglitazone and gliclazide in addition to Lantus Solostar (insulin glargine 100units/ml) at a dose of 28 units every morning. However, Mrs T is finding the Lantus painful and the endocrinologist decides to start her on Tresiba (insulin degludec).

[Get Hints]

18 units

12 units

30 units

28 units

24.8 units

14.4 units

22 units

10 units

Your comments:

Question 252 of 360

253.

For each question in this section select one answer from the list of nine options.

Mr U is a 36 year old man who has type 1 diabetes. Despite taking NovoRapid FlexPen (insulin aspart 100units/ml) at a dose of 8 units before meals and Levemir FlexPen (insulin detemir 100units/ml) at a dose of 15 units once daily, he continues to have raised glucose levels on waking. It is decided that Mr U should start using Tresiba (insulin degludec) as it has been shown to be longer acting and may provide him with better glycaemic control.

[Get Hints]

18 units

12 units

30 units

28 units

24.8 units

14.4 units

22 units

10 units

Your comments:

Question 253 of 360

254.

For each question in this section select one answer from the list of nine options.

Mr V is a 62-year-old man who has type 2 diabetes for which he takes metformin, pioglitazone and Tresiba (insulin degludec) at a dose of 18 units daily. However, despite taking his medication as prescribed, his diabetes continues to be uncontrolled. His doctor decides to initiate exenatide in addition to his existing medication.

18 units

12 units

30 units

28 units

24.8 units

14.4 units

22 units

10 units

Question 254 of 360

255.

For each question in this section select one answer from the list of nine options.Mr F is 73-years-old and has had epilepsy since childhood. He has recently visited his GP and has now been diagnosed with Parkinson’s disease.

Lamotrigine

Vigabitran

Ethosuximide

Sodium valproate

Phenobarbital

Carbamazepine

Zonisamide

Phenytoin

Question 255 of 360

256.

alanine transaminase

glycosylated haemoglobin

serum creatinine

serum potassium

white blood cell count

Your comments:

Question 256 of 360

257.

Mr B, a 52-year-old man, comes into the pharmacy seeking advice about a symptom that he has experienced for the past 2 days. He has not yet attempted to take any treatment to relieve the symptom but he takes the following long-term prescribed medication:

carbimazole 15mg once daily
omeprazole 20mg once daily
alendronic acid 70mg once weekly

Which of the following symptoms would most likely require an urgent referral to his doctor?

bilateral headache

constipation

diarrhoea

rosacea

sore throat

Your comments:

Question 257 of 360

258.

This question concerns Mr C, a 62-year-old man who has just been diagnosed with non-valvular atrial fibrillation. He does not take any regular medication and has no known allergies.

Mr C asks for your advice on stroke prevention as he tells you his doctor had informed him that he is at a higher risk of developing a stroke.

Which of the following assessment tools is most suitable for assessing stroke risk in patients with atrial fibrillation?

CHA2DS2VASc tool

ECG

ORBIT tool

INR

JBS3 risk calculator

Your comments:

Question 258 of 360

259.

apixaban

aspirin

dabigatran

rivaroxaban

warfarin

Question 259 of 360

260.

Whilst working as the Responsible Pharmacist at a community pharmacy premises you plan to dispose of some Controlled Drugs (CDs).

For which of the following would it be most important to arrange for an authorised witness to be present whilst you denature the CDs?

expired pharmacy stock of dipipanone hydrochloride 10 mg / cyclizine hydrochloride 30 mg tablets

expired pharmacy stock of suboxone 2 mg/500 mg tablets

expired pharmacy stock of morphine sulphate 10 mg/5 mL oral solution

five buprenorphine 400 mcg tablets returned by a patient who no longer requires them; the tablets have not yet expired

five expired diamorphine hydrochloride 10 mg tablets returned by a patient

Your comments:

Question 260 of 360

261.

bendroflumethiazide

cefalexin

lercanidipine

metformin

pioglitazone

Do you have any comments about this question? Let the team know below

Question 261 of 360

262.

beclometasone 100 mcg inhaler

bendroflumethiazide 2.5 mg tablets

ipratropium 20 mcg inhaler

salbutamol 100 mcg inhaler

simvastatin 20 mg tablets

Your comments:

Question 262 of 360

263.

Mrs G is a 45-year-old woman who takes the following regular medication:

ramipril 5 mg once daily
simvastatin 40 mg once daily at night

advise Mrs G to switch her statin to an alternative

advise Mrs G to take all her medication as prescribed as any interaction(s) between the drugs are not considered to be clinically significant

advise Mrs G to stop taking the ramipril whilst taking the course of clarithromycin and to resume once the course of clarithromycin is complete

advise Mrs G to stop taking the simvastatin whilst taking the course of clarithromycin and to resume once the course of clarithromycin is complete

advise Mrs G to take her evening dose of clarithromycin 2 hours before taking the simvastatin

Your comments:

Question 263 of 360

264.

take 30 to 60 minutes before food

this medicine may colour your urine

protect your skin from sunlight – even on a bright but cloudy day; do not use sunbeds

warning: do not stop taking this medicine unless your doctor tells you to stop

warning: this medicine may make you sleepy; if this happens, do not drive or use tools or machines

Your comments:

Question 264 of 360

265.

bumetanide
fluoxetine
omeprazole
prednisolone
ramipril

Her most recent biochemistry test results are shown below.

Test	Result	Reference Range
Sodium (mmol/L)	140	137-145
Potassium (mmol/L)	6.0	3.5-5.1
Urea (mmol/L)	4.7	2.5-7.5
Creatinine (μmol/L)	75	50-120
Phosphate (mmol/L)	0.92	0.8-1.4

Which one of her drugs is the most likely cause of her abnormal test results?

bumetanide

fluoxetine

omeprazole

prednisolone

ramipril

Your comments:

Question 265 of 360

266.

advise Mr L that the symptom he has described is not known to be caused by isosorbide mononitrate

advise Mr L to see his GP as the dose of isosorbide mononitrate may need to be increased

advise Mr L to see his GP as the dose of isosorbide mononitrate may need to be reduced

advise Mr L that he is experiencing a side effect of isosorbide mononitrate; it is safe to continue taking it, but that he may wish to see his GP to be prescribed an alternative

advise Mr L to stop taking the medication straight away and to contact his hospital doctor

Your comments:

Question 266 of 360

267.

Mrs M is a 57-year-old lady of South Asian origin who no longer has a menstrual bleed. She has been experiencing lethargy for the past 6 months despite not suffering from any sleep disturbance and despite eating a balanced vegetarian diet. She takes enalapril 5 mg once daily and furosemide 20 mg once daily for hypertension. Her GP recently sent her for a blood test to investigate a number of parameters.

In light of her symptoms and blood test results, which of the following points would it be most appropriate to inform Mrs M?

enalapril may increase the risk of hypocalcaemia

hypercalcaemia can precipitate renal damage

Mrs M’s calcium levels may be responsible for her symptoms

Mrs M should start taking ferrous sulphate 200mg tablets daily

raised TSH levels may suggest hyperthyroidism

Your comments:

Question 267 of 360

268.

A patient asks you why his multidose bottle of timolol eye drops contains benzalkonium chloride.

Which one of the following is the most appropriate response to give this patient?

it kills microorganisms that may be introduced during manufacture

it prevents degradation of the active ingredient by microorganisms 

it prevents growth of microorganisms that may be introduced during use

it ensures that the product passes a sterility test

it prevents growth of microorganisms between manufacture and first use

Your comments:

Question 268 of 360

269.

Mrs N is a 50-year-old black South African woman who has just been diagnosed with stage 2 hypertension. Her blood pressure was last measured as 164/91 mmHg. She has no known drug or other allergies nor any other medical conditions.

Which one of the following is the most appropriate first line antihypertensive for Mrs N?

atenolol

indapamide

lercanidipine hydrochloride

methyldopa

ramipril

Your comments:

Question 269 of 360

270.

Mrs O is an 80-year-old with a history of Parkinson’s disease and osteoporosis. She takes her Parkinson’s medication in a ‘dosette box’ and takes the following:

Co-beneldopa (Madopar) 62.5 mg, one capsule once daily in the morning 9am
Co-careldopa 50/200 modified release (Sinemet CR), one tablet once daily at night at 8pm
Stalevo 100/25/200 (levodopa 100 mg, carbidopa 25 mg, entacapone 200 mg), one tablet three times daily at 9am, 2pm and 8pm

She has been admitted to hospital for a fall. Her daughter is concerned as she feels her mother is not coping well at home. You inspect her ‘dosette box’ and can see that there are tablets which have not been taken by Mrs O.

Which of the following counselling points is most appropriate for you give to Mrs O and her daughter?

encourage Mrs O to use a smart mobile phone medication reminder application to help her remember to take her tablets

if Mrs O and her daughter feel dissatisfied with the care they are receiving, they can make a complaint

if Mrs O stops taking the Madopar capsules suddenly, it can cause something called ‘neuroleptic malignant-like syndrome’ (NMLS); this is a very serious condition

Mrs O can open the contents of a Madopar capsule and mix it in water before taking dose

Mrs O must take her Parkinson’s medication on time to help with her ‘on’ and ‘off’ symptoms

Do you have any comments about this question? Let the team know below

Question 270 of 360

271.

Mr P is a 55-year-old man who presents at your pharmacy with the following prescription from his GP:

amlodipine 10 mg once daily
simvastatin 40 mg once daily at night

Mr P has not collected medicines from your pharmacy before but informs you that he has taken the prescribed medication for 2 months already.

Which of the following would be the most appropriate course of action?

contact the GP and advise him/her to reduce the dose of amlodipine to 5mg

contact the GP and advise him/her to reduce the dose of simvastatin to 20mg or less

dispense the prescription exactly as prescribed and advise Mr P to contact his GP for a review of his medicines at his earliest convenience

dispense the prescription exactly as prescribed and advise Mr P to continue taking his medicines as prescribed and inform his GP straight away if he experiences any adverse effects

politely refuse to dispense the prescription and ask Mr P to return to the pharmacy he has used in the past

Your comments:

Question 271 of 360

272.

Miss Q is a 32-year-old accountant who was diagnosed with type 1 diabetes mellitus 12 years ago. She tests her glucose when she feels unwell and uses multiple injections of insulin. Her HbA_1c is 64 mmol/mol (8.0%).

She has a passion for rowing and every morning at 6:30 am she rows for up to one hour on the River Thames. She is planning to participate in a coastal race in the summer to raise funds for a campaign to increase awareness of the sport amongst the youth in her local community. She has a high-calorie diet to give her energy in the morning and help her get through the day.

What is the most suitable number of blood glucose tests Miss Q should be advised to take at this stage?

Once a day

Up to twice a day

Up to three times a day

Up to four times a day

Up to six times a day

Do you have any comments about this question? Let the team know below

Question 272 of 360

273.

Mr R is a 45-year-old man who does not take any regular medication and has no known allergies with the exception of being hypersensitive to NSAIDs. He tells you he has just seen his GP regarding an acute attack of gout and asks you to check if the prescription he has been given will help to treat his existing pain.

Which one of the following would be the most suitable treatment for Mr R’s acute attack of gout?

aspirin

allopurinol

codeine

colchicine

indometacin

Your comments:

Question 273 of 360

274.

This question relates to Miss S, an 8-year-old who has been admitted to the A&E unit at her hospital with moderate severity community-acquired pneumonia.

The doctor has ordered a culture sensitivity test, but due to the severity of her infection he wants to start antibiotic treatment immediately. Miss S has a documented penicillin allergy.

Which of the following would be the most suitable empiric antibiotic treatment for her infection?

ampicillin

cefalexin

ciprofloxacin

clarithromycin

tetracycline

Your comments:

Question 274 of 360

275.

This question relate to Miss S, an 8-year-old girl who has been admitted to the A&E unit at her hospital with moderate severity community-acquired pneumonia.

Which of the following microorganisms is the most likely causative agent of Miss S’s infection?

Candida albicans

Campylobacter coli

Escherichia coli

Haemophilus influenzae

Neisseria meningitidis

Your comments:

Question 275 of 360

276.

Mr J is 17 years old and suffers with focal seizures for which he has been taking carbamazepine. He presents in your pharmacy with a new prescription for pregabalin ( Lyrica ) at a titrated dose to be used in addition to carbamazepine for the control of the seizures.

Which of the following statements would be of most concern to you regarding Mr J’s treatment?

increased appetite is a common side effect of pregabalin

patients should refrain from drinking alcohol when taking pregabalin

pregabalin should not be used alone for the treatment of epilepsy

pregabalin should not be used in children and adolescents

women of childbearing age should use effective methods of contraception when taking pregabalin

Do you have any comments about this question? Let the team know below

Question 276 of 360

277.

You receive a private prescription for five fentanyl ‘75’ patches, one patch to be applied every 72 hours.

Which of the following statements would be most appropriate regarding the legal supply of fentanyl patches against a private prescription?

an entry in the Controlled Drugs (CD) register is not legally required but it is a legal requirement to record the supply in the Prescription Only Medicines (POM) register

the prescription is valid for 13 weeks from the date on the prescription

all prescription details need to be handwritten 

it is illegal to dispense if not prescribed on a standardised form 

only a prescriber's request for an emergency supply is permitted

Your comments:

Question 277 of 360

278.

Mrs M is a 61-year-old receiving gentamicin by slow intravenous injection for gram-positive bacterial endocarditis at a dose of 1 mg/kg every 12 hours.

Target range for gentamicin: one-hour (‘peak’) serum concentration should be 3–5 mg/litre for endocarditis; pre-dose (‘trough’) concentration should be less than 1 mg/litre for endocarditis.Three days later a peak gentamicin level of 5.3mg/L is reported with a trough concentration of 2.1mg/L. Mrs M’s renal function was unchanged.

Which of the following is an appropriate method of dose rationalisation in response to these results?

continue the current regimen

decrease the dose and decrease the dosing interval

increase the dose and increase the dosing interval

decrease the dose and increase the dosing interval

maintain the same dose and decrease the dosing interval

Your comments:

Question 278 of 360

279.

Mr K, a 27-year-old healthy young man, comes into the pharmacy to seek advice about a skin condition that has been bothering him. He explains to you that he has recently returned from a camping trip with his friends. He shows you his arms, between his fingers and toes and tells you that his skin is very itchy especially at night.

Which of the following is the most likely cause for Mr K’s skin condition?

hives

impetigo

measles

psoriasis

scabies

Do you have any comments about this question? Let the team know below

Question 279 of 360

280.

You are the Responsible Pharmacist working at a community pharmacy when you receive a veterinary prescription for ampicillin 100 mg/mL suspension for injection for Sheepy, a non-milk producing cow that is under the care of a veterinary surgeon. The prescription states a dose of 75 mL to be given stat, and the dose to be repeated once after 48 hours. In addition to a warning stating that there is a withdrawal period of 60 days, the prescription also includes “prescribed under the veterinary cascade”.

Which of the following best describes the “withdrawal period”?

how long it takes for withdrawal symptoms to commence

how long it takes for withdrawal symptoms to subside

the period of time during which the prescription is valid

the period of time that has to pass before using an animal for food

time frame during which the animal should not conceive an offspring

Your comments:

Question 280 of 360

281.

This question relates to Mrs L, a 53-year-old woman diagnosed with breast cancer.

Mrs L has been admitted into hospital for treatment of her breast cancer. An oncologist is preparing a treatment plan for Mrs L. Mrs L has no family history of cancer but was previously taking hormone replacement therapy for her menopausal symptoms. The oncologist wants to make sure that Mrs L’s treatment plan does not include a drug that causes bone marrow suppression.

Which of the following cytotoxic drugs would be the most suitable choice?

epirubicin

fluorouracil

treosulfan

vinblastine

vincristine

Your comments:

Question 281 of 360

282.

A 6-year-old child requires nutritional supplements containing less than 4g of protein in each 100 mL. The child cannot tolerate cow’s milk.

Which of the following would be the most appropriate supplement to recommend?

Fortijuce

Fresubin Original drink

Altrajuce

Elemental 028 Extra Liquid

Frebini Energy Drink

Do you have any comments about this question? Let the team know below

Question 282 of 360

283.

Mr M has been admitted to hospital for the treatment of high severity community-acquired pneumonia. Mr M takes the following regular medication:

amlodipine 5 mg once daily in the morning
aspirin 75 mg once daily
atorvastatin 20 mg once daily at night
bendroflumethazide 2.5 mg once daily
Epilim (sodium valproate) 500 mg e/c, two tablets twice daily

Which of the following is the most appropriate antibiotic combination to treat his infection?

benzylpenicillin + clarithromycin

benzylpenicillin + doxycycline

benzylpenicillin + co-trimoxazole + vancomycin

Co-amoxiclav + clarithromycin

benzylpenicillin + erythromycin + vancomycin

Your comments:

Question 283 of 360

284.

Mrs N has a family history of breast and ovarian cancer. She recently had an oophorectomy and would like to know if she can reduce her risk of developing breast cancer. She asks you for some advice.

Which one of the following would be considered as a non-modifiable risk factor for breast cancer?

adult attained height

adult weight gain

oestrogen-progestogen menopausal therapy

shift work involving circadian disruption

tobacco smoking

Your comments:

Question 284 of 360

285.

A 75-year-old retired pharmacist attended a memory clinic with his wife who reported that he has been experiencing memory difficulties and problems with activities of daily living such as needing help with dressing, misplacing items as well as displaying symptoms of aggression. After conducting a number of assessments as well as a CT scan, the specialist physician informed the patient and his wife that the likely diagnosis is mild Alzheimer’s disease.

According to this diagnosis, which of the following would be the most appropriate choice of drug treatment?

alprazolam

memantine

quetiapine

rivastigmine

sulpiride

Your comments:

Question 285 of 360

286.

This question relates to Mr O, a 30-year-old man, with type 1 diabetes mellitus and who is a regular patient at your pharmacy.

Mr O’s insulin regimen is as follows:

Mr O calls the pharmacy as he is not feeling well. He complains of some tummy (abdominal) pain, feeling thirsty all the time, tired, drowsy and sometimes out of breath. This morning he had some vomiting. He tested his blood glucose just prior to calling the pharmacy and the result was 28 mmol/litre.

Which of the following actions is most appropriate to take?

advise Mr O to rest and eat a healthy, well-balanced diet

inform Mr O that his symptoms are a side effect of insulin

Mr O likely has a medical emergency and needs to go to the A&E department at the nearest hospital

Mr O should increase his dose of Levemir by 10 units

Mr O should take his medication as normal and inform the diabetes specialist nurse or GP of these symptoms at the next routine check-up

Your comments:

Question 286 of 360

287.

This question relates to Mr O, a 30-year-old man, with type 1 diabetes mellitus and who is a regular patient at your pharmacy.

Lipodystrophy is an undesirable side effect reported to occur in how many users of Levemir?

[Get Hints]

greater than 1 in 10

1 in 100 to 1 in 10

1 in 1000 to 1 in 100

1 in 10,000 to 1 in 1000

less than 1 in 10,000

Your comments:

Question 287 of 360

288.

A patient returns to your pharmacy with a box of propranolol 10 mg tablets that were dispensed by a locum pharmacist in your pharmacy yesterday. The patient complains that they have been supplied with the wrong medication. Upon checking the prescription you realise that the prescription from the GP was for prednisolone 5 mg tablets. The patient has taken one tablet.

Which of the following would be the most appropriate action to take?

as the patient has only taken one tablet you do not need to inform the GP

as the patient looks well you do not need to inform the GP

check the patient’s blood pressure

inform the GP

inform the GP only if the patient has been harmed

Your comments:

Question 288 of 360

289.

Mr P is a 57-year-old man who presents in the Urgent Care unit at his local hospital complaining of a number of symptoms. Acute kidney injury is suspected.

Which one of the following symptoms is Mr P most likely to have presented with that would indicate acute kidney injury?

ascites

fever

headache

oliguria

palpitations

Your comments:

Question 289 of 360

290.

Mr Q is 35-years-old and HIV-positive. His latest CD4 T lymphocyte cell count was found to be significantly elevated and he has been advised to start antiretroviral treatment. You can see from his patient medication record that he has a metabolic disorder of haem synthesis known as hereditary coproporphyria.

Which of the following drugs prescribed for Mr Q is of most concern to you?

[Get Hints]

Combivir (Lamivudine and zidovudine) tablets, 1 tablet twice daily

ibuprofen 200 mg three times a day when required

pravastatin 10 mg once daily at night

salbutamol 100 mcg inhaler, 2 puffs when required

terbinafine 1% cream, apply to affected area(s) on foot twice daily for 7 days

Do you have any comments about this question? Let the team know below

Question 290 of 360

291.

You are the Responsible Pharmacist on duty in a community pharmacy. You are the only pharmacist working on the premises but you need to be absent for an hour to visit a patient at his home to conduct a medicines use review. You have made all the appropriate arrangements to ensure you are contactable.

Which of the following tasks would be most appropriate for your staff to undertake during your absence?

check and bag dispensed medicines when an Accredited Checking Technician (ACT) is present

hand previously checked medication over to the relevant patients

sell GSL medicines over-the-counter