1️⃣Mock Exams - Questions I got wrong

What are the legal requirements required on dispensed medication labels?

• Name of the patient

• Name and address of supplying pharmacy

• Date of dispensing

• Name of medicine

• Directions for use

• Precautions relating to the use of the medicine

(RPS 2022 - Q31)

What details are recorded in the POM register?

• Date of supply

• Prescription date

• Medicine details (name, quantity, formulation and strength)

• Prescriber details

• Patient details

(RPS 2022 - Q33)

What antimetabolite used for an autoimmune condition, is advised for the patient to use effective contraception during and at least 6 months after treatment - both men & women?

Methotrexate

Contraception advice: Mycophenolate

• Women - should be used at least 6 weeks after stopping treatment

• Men - 90 days (for their partners too)

Suitable anticoagulant for patients with prosthetic value replacements e.g. metal heart value?

Warfarin

(RPS 2022 - Q43)

What are the symptoms of an anal fissure?

Anal pain which always occurs with passing a stool, pain is severe and sharp (like a tearing sensation, followed by a deep burning pain that can persist for some hours, bleeding may also occur

(RPS 2022 - Q44)

What is medicine is used for hyperkalaemia?

Patiromer calcium

What is medicine is used for hypokalaemia?

Potassium chloride

What is medicine is used for hypomagnesaemia?

Magnesium aspartate

What is medicine is used for hypophosphatemia?

Sevelamer & Calcium acetate

What are the signs of Diabetic Ketoacidosis?

• Increased thirst & urination

• Stomach pain

• Nausea & vomiting

• Feeling tired or sleepy

• Fruity-smelling breath

What are some clinical signs of euglycaemic DKA?

• Increased anion gap metabolic acidosis

• Ketonemia or ketouria (large amounts of ketos in blood or urine)

• Normal blood glucose levels (<200 mg/dL)

Signs of a blood disorders

• Unexpected bleeding

• Sore throat

• Bruising

• Purpura (Red or purple spots or patches on the skin)

• Fever

• Malaise

What specific wording has been approved by the Home office when supplying methadone for an upcoming bank holiday?

“ Please dispense instalments due on pharmacy closed days on prior suitable day.”

(Also note that “If an instalment collection day has been missed, please still dispense the amount due for any remaining day(s) of that instalment.”)

What are the symptoms of neutropenic sepsis? And what to do if they appear?

Dysuria (painful urination), diarrhoea, a productive cough, chills, shivers, rigors, a temp greater than 38C

✏ Rigors - intense, involuntary shaking or shivering, often accompanied by a rapid rise in body temperature

(RPS 2022 - Q67)

Combined hormone contraceptives & Surgery: when should it be discontinued before an elective surgery

4 weeks before

Contraindications for Sildenafil: Cardio

• Unstable angina

• Severe cardiac failure

• Heart attack/acute myocardial infarction or stroke within the last 6 months

• Not fit enough for physical or sexual activity

(RPS 2022 - Q79)

Symptoms of hypomagnesaemia

N&V, pins & needles, fatigue & muscle twitches

(RPS 2022 - Q101)

What interactions occur when Orlistat is co-administered with Levothyroxine?

Hypothyroidism and/or reduced control of hypothyroidism

(RPS 2022 - Q119)

Interaction: Orlistat and Oral contraceptives

Reduced availability of oral contraceptives and may lead to unexpected pregnancies = use of additional contraceptive method is recommended

(RPS 2022 - Q119)

What laxatives are recommended for opioid-induced constipation?

An osmotic laxative and a stimulant laxative

(Propharmace 2024 - Q2)

Laxatives to avoid in opioid-induced constipation

Bulk-forming laxatives

(Examples: Ispaghula husk, Methylcellulose)

Methylphenidate: Side effects

Appetite suppression, increased the alertness and increases in blood pressure, heart rate and respiration.

(Propharmace 2024 - Q10)

Monitoring requirements: Methylphenidate

Pulse, blood pressure, psychiatric symptoms, appetite, weight and height

(Propharmace 2024 - Q10)

Methylphenidate monitoring: when to monitor

• Initiation of therapy

• Following each dose adjustments

• At every 6 months after

Interactions: CHC & Enzyme-inducing drugs

Contraceptive effectiveness could be reduced. Use is not advised during AND 28 days after stopping inducer

(Propharmace 2024 - Q31)

Contraception that is not affected by enzyme-inducing drugs

• LNG-IUS = Levonorgestrel Intrauterine System

• Copper IUD (Cu-IUD)

• Depot Medroxyprogesterone Acetate Injection (DMPA)

(Propharmace 2024 - Q31)

Symptoms of Mastitis

• One of the breasts becoming swollen, hot to touch, painful

• Red

• Lump or hard area on the breast

• Burning pain - can be constant or when breastfeeding

• Nipple discharge - can be white in colour or contain streaks of blood

• Flu like symptoms

Can be caused by blocked milk ducts, very common in breastfeeding women and does not usually need any urgent medical treatment.

Mastitis: Advice to give

• If you’re breastfeeding, continue to breastfeed

• Take paracetamol or ibuprofen to reduce any pain or high temperature

• Make sure the baby is positioned and attached properly

• Breast pain can be soothed with a cold compress (Cloth soaked in cold water)

• Rest and drink lots of fluids

(Propharmace 2024 - Q38)

What NOT to do: Mastitis

• Do not take Aspirin

• Do not wear tight fitting clothing or bras

• Do not apply firm pressure to the breast

• Do not stop breastfeeding suddenly

• Do not apply oils, soaks or creams to your breast

(Propharmace 2024 - Q38)

Common side effect: Rivastigmine

GI disturbances - appetite decrease, diarrhoea, GI discomfort, nausea & vomiting

(Propharmace 2024 - Q39)

Monitoring: Clozapine

• WBC - weekly for 18 weeks, then fortnightly for up to 1 year and then monthly as part of the clozapine patient monitoring service

• Bloods lipids & weight - before treatment starts, at 3 months, then yearly

• Prolactin - before treatment starts, 6 monthly for 1 year and then yearly

• Fasting blood glucose - baseline, at 4-6 months and then yearly

(Propharmace 2024 - Q45)

Medications that cause Hyponatremia

Carbamazepine, Diuretics (loop & thiazide), Desmopressin, SSRI’s, Trimethoprim

(Remember as: Certain Drugs Ditch Salt Temporarily)

[Propharmace 2024 - Q92]

Symptoms of Hyponatremia

• Lack or loss of appetite (anorexia)

• Headache

• Nausea & vomiting

• Lack of energy

• Confusion

• Drowsiness

Remember as NHS ABCDE

(Propharmace 2024 - Q92)

Electrolyte imbalances that increase the risk of Digoxin toxicity

Hypomagnesaemia, Hypokalaemia and Hypercalcemia

(Propharmace 2024 - Q93)

Treatment: Hyponatremia

• Sodium chloride (Usually given IV)

• Oral sodium e.g. Sodium chloride/Sodium bicarbonate (mild-moderate sodium depletion)

Medications that cause Hypomagnesemia

• Digoxin (increases the risk of toxicity)

• Aminoglycosides

• Diuretics

• PPIs

• Tacrolimus

Remember DAD PT

(Propharmace 2024 - Q93)

Signs & Symptoms: Hypomagnesemia

• ECG changes (prolonged cutie interval, wide QRS, ST depression and T – wave inversion)

• Nystagmus

• Confusion

• Seizure

(ProPharmace 2024 - Q93)

Treatment of Hypomagnesemia

Magnesium sulphate

Causes of Hypomagnesemia

Alcohol, diarrhoea, stoma, fistula, Crohn’s disease, hypokalaemia & hypocalcemisma

(Propharmace 2024 - Q93)

What deficiency are vegans mainly prone to?

Vitamin B12 (Cyanocobalamin)

First line for Pyelonephritis

Cefalexin

(Propharmace 2024 - Q119)

HbA1c targets: Diet and diet combined with Metformin or single drug not associated with hypoglycaemia

48 mmol/mol (6.5%)

(Propharmace 2024 - Q47)

HbA1c targets: Adults on drug associated with hypoglycaemia

53 mmol/mol (7%)

HbA1c targets: Adults with type 2 diabetes, if HbA1c levels are not adequately controlled by a single drug and rise to 58 mmol/mol (7.5%) or higher

53 mmol/mol (7%)

Warfarin: factors that require a dose reduction⬇

Weight loss, Smoking cessation and Acute illness (e.g, COVID)

(Propharmace 2024 - Q49)

Warfarin: factors that require a dose increase⬆

Weight gain, Diarrhoea and Vomiting

(Propharmace 2024 - Q49)

What age is Migraleve contradictaed in?

<12 years

What is in Migraleve? And What do the colours represent?

• Pink tablet = paracetamol, codeine and buclizine

• Yellow tablet = paracetamol and codeine

(Propharmace 2024 - Q51)

Migraleve:

1. Max daily dose for 12-15yrs

2. Max daily dose for adults and children >16yrs

1. Don’t take more than 4 tablets (1 pink and 3 yellow) in 24hrs

2. Don’t take more than 8 tablets (2 pink and 6 yellow) in 24hrs

Antidiabetic medicine that has both cardio and reno-protective effects and can be used as an add-on to standard care treatment for CKD

SGLT-2 inhibitors (e.g. Empagliflozin)

(Standard care for CKD: lifestyle and diet changes with ACEI or ARBs ➡ Propharmace 2024 - Q58)

Activities that can take place with RP physically present

• Professional check – Clinical and legal

• Sale and supply of P medicines

• Sale and supply of POMs

• Supply of medicines under a PGD

• Wholesale of medicines

• Emergency supply of medicines at the request of a patient or healthcare professional

Activities that can take place with RP absence

Contraception: <16 years old

• Sexual activity under the age of 16 is an offence even if consensual, offences are considered more serious (statutory rape) when the person is younger than 13

(Propharmace 2024 - Q60)

Treatment: Acute Gout attack

• Colchicine 500mcg 2-4 times a day, max 6mg per course (Do not repeat the course within 3 days) OR

• High dose NSAIDs (not aspirin) e.g. Diclofenac or Naproxen

• Short course of Corticosteroid

• PPI can be considered for those on NSAIDs

Allopurinol itself is not a treatment for acute gout, but BNF states that if a patient is already receiving Allopurinol, to continue using it and treat attack separately.

(Propharmace 2024 - Q61)

Treatment: Prohylaxis of Gout

Allopurinol or Febuxostat

(Usually in patients who have had two or more gout attacks in the previous year)

MenB vaccine: prevent or treat high temp

3 doses of paracetamol

• Give 1 dose as soon as possible after being vaccinated

• Give 2nd dose 4-6 hrs after being vaccinated

• 3rd dose 4-6 hrs after that

(Propharmace 2024 - Q63)

What is red man syndrome & what drug can cause it?

• Red man syndrome: An adverse reaction caused by a rapid infusion rate

• Vancomycin

(Propharmace 2024 - Q75/6)

Symptoms of red man syndrome

Flushing (redness), rash on a behalf of the body, Hypotension, Bronchospasms and pruritus.

⚠MHRA warning: Finasteride

Risk of psychiatric and sexual side effects ➡ look out for signs of depression, suicidal thoughts and sexual dysfunction

(Propharmace 2024 - Q80)

⚠MHRA Warning: Montelukast

Insomnia: What drugs would you use for patients that have difficulty maintaining sleep?

Long-acting benzos e.g. Diazepam, Nitrazepam and Flurazepam

(Propharmace 2024 - Q83)

Insomnia: What drugs would you use for patients that have difficulty initiating sleep?

• Z drugs e.g. Zolpidem or Zopiclone

• Short-acting benzodiazepines e.g. Loprazolam, Lormetazepam, Temazepam

Diabetes & Driving: Blood glucose <4 mmol/L

• If driving, stop in safe place & stop engine

• Remove keys and move from driver’s seat

• Wait for 45 mins after your good glucose has returned to normal before continuing the journey

(Propharmace 2024 - Q85)

When should alendronic acid be stopped and patient should seek medical advice from their doctor?

If oesophageal reactions occur e.g. heartburn, dysphasia

(Pioneer May 2024- Q82)

Doses of Bisoprolol: Hypertension & Angina

• Initially 5mg OD

• Maintenance dose = 10mg OD

• Increased if necessary up to 20mg OD

(Pioneer May 2024 - Q77)

Characteristic features of Type 1 Diabetes in children

• Polyuria

• Polydipsia

• Weight loss

• Excessive tiredness (malaise)

(Pioneer May 2024 - Q66)

⚠MHRA Warning: Nitrofurantoin

Risks of pulmonary and hepatic (damage) adverse drug reactions

Appropriate first line emergency medical treatment for a patient with diabetes suffering forom hypoglycaemia

15-20g glucose or sucrose

What should be ensured for people with disabling ischaemic stroke who are in atrial fibrillation?

Treat with Aspirin 300mg for 2 weeks before anticoagulation is considered

(Greenlight 2021 - Q37)

When should a loading dose of Clopidogrel 300mg be given?

(cardio)

For patients with STEMI or NSTEMI

Sodium valproate & pregnancy: contraindications

• Sod. Val is contraindicated for management of bipolar disorder in pregnant women

• Sod. Val contraindicated as treatment for epilepsy during pregnancy (unless there are no suitable alternative to treat epilepsy)

(Greenlight 2021 - Q19)

EHC: EllaOne & Breastfeeding

If Ulipristal is taken during breastfeeding = recommended to avoid breastfeeding for the next 7 days

(Greenlight 2021 - Q7)

What antibiotic commonly causes maculopapular rushes that is associated in patients with glandular fever?

Amoxicillin

(UEA 2018 R2 - Q60)

What agent can be used to correct acidosis created by the kidneys decreased function?

Sodium bicarbonate

(UEA 2018 R2 - Q9)

Why is it that less phenytoin (on a mg/kg basis) is needed to treat seizures in neonates compared to babies older than three months old?

Neonates have lower albumin levels leading to increased ‘free’ Phenytoin

(UEA 2018 R2 - Q33)