1. Mr A is a 45-year-old ex-smoker with a history of chronic asthma. He is a regular patient at your pharmacy. Today he brings in a prescription for erythromycin 500 mg tablets, one to be taken every 6 hours for 5 days. He explains that he has developed a bad chest infection. His patient medication record shows that he is allergic to penicillin and that he is taking the following medication:
    • Salbutamol 100 mcg/dose inhaler, two puffs four times daily when required
    • Seretide 250 Evohaler (fluticasone propionate 250 mcg, salmeterol xinafoate 25 mcg/metered inhalation), two puffs twice daily
    • Uniphyllin Continus (theophylline) 300 mg modified release tablets, one tablet every 12 hours
You decide to contact his GP to discuss your concerns.

Which of the following points would be most important to discuss with Mr A’s GP?

Module-5-Developing-as-a-Practice-Supervisor (1)

2. Mrs B, a 50-year-old woman who recently had the flu, which worsened and developed into low severity community acquired pneumonia of bacterial origin. She has been prescribed a 14-day course of amoxicillin 250 mg capsules and flucloxacillin 250 mg capsules. She takes no other medication and has no known allergies.

Which of the following is the most likely organism implicated in Mrs B’s pneumonia infection?

3. Mrs B, a 50-year-old woman who recently had the flu, which worsened and developed into low severity community acquired pneumonia of bacterial origin. She has been prescribed a 14-day course of amoxicillin 250 mg capsules and flucloxacillin 250 mg capsules. She takes no other medication and has no known allergies.

Mrs B asks you how she should take her flucloxacillin

Which of the following is the most appropriate counselling advice to give to Mrs B regarding this medication?

4. Mr C is a 67-year-old He has type 2 diabetes mellitus, angina and hypertension. At his most recent medication review, he complains of severe throbbing headaches that seem to be more frequent. You suspect that he could be experiencing an adverse drug reaction.

Which one of Mr C’s medicines is most likely to be implicated?

5. You arrive at a community pharmacy in the afternoon to start your shift as the Responsible pharmacist. You are due to attend an important 2-hour meeting at your local GP practice but your Medicines Counter Assistant informs you that the Responsible Pharmacist on duty before you was absent from the pharmacy for 2 hours that morning.

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

6. The extravasation of chemotherapy drugs must be managed according to the extravasation risk of each drug and the local extravasation policy using the extravasation kit.

Which of the following techniques is least likely to be used to prevent extravasation injury?

7. Mr D, a 57-year-old accountant who collects his monthly Byetta (exenatide) injection prescriptions from your hospital outpatient pharmacy. He brings in a new outpatient prescription today and you can see that his dose has been increased to 10 mcg twice daily. Mr D is also taking metformin 500 mg three times daily. He has a BMI of 34 kg/m2.

Which of the following statements is most applicable regarding the correct use of Byetta prefilled pen for injection?

8. Mr D, a 57-year-old accountant who collects his monthly Byetta (exenatide) injection prescriptions from your hospital outpatient pharmacy. He brings in a new outpatient prescription today and you can see that his dose has been increased to 10 mcg twice daily. Mr D is also taking metformin 500 mg three times daily. He has a BMI of 34 kg/m2.

Excessive sweating is an undesirable side effect reported to occur in how many users of Byetta prefilled pen for injection?

9. 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?

10. Mrs E who is receiving treatment for chronic pain.

You receive a prescription from Mrs E for Fentalis Reservoir 25 mcg/hr transdermal patches, one patch to be applied every 72 hours, to supply four patches. From her patient medication record, you can see that Mrs E is also taking Oramorph (morphine sulphate) 10 mg/5 mL oral solution, 5 mL every 4 hours when required.

Which of the following counselling points would be most inappropriate to give to Mrs E regarding Fentalis Reservoir 25 mcg/hr transdermal patch?

11. Mrs E who is receiving treatment for chronic pain.

You receive a prescription from Mrs E for Fentalis Reservoir 25 mcg/hr transdermal patches, one patch to be applied every 72 hours, to supply four patches. From her patient medication record, you can see that Mrs E is also taking Oramorph (morphine sulphate) 10 mg/5 mL oral solution, 5 mL every 4 hours when required.

Which of the following medication that Mrs E is also taking is most likely to cause an increase in the plasma fentanyl concentration?

12. Mrs F who is 45 years old and has rheumatoid arthritis. Since her diagnosis she has tried a number of anti-inflammatory drugs, which have been unsuccessful in controlling her condition. As a result, she now takes oral prednisolone 7.5 mg once daily and naproxen 500 mg twice daily, which control her condition well.

Mrs F’s GP asks for your advice. He wants to start Mrs F on treatment to prevent NSAID-associated ulceration as she is considered to be at a high risk of developing gastro-intestinal complications whilst taking an NSAID.

Which of the following puts Mrs F at a greater risk of developing gastro-intestinal complications while taking an NSAID?

13. Mrs F who is 45 years old and has rheumatoid arthritis. Since her diagnosis she has tried a number of anti-inflammatory drugs, which have been unsuccessful in controlling her condition. As a result, she now takes oral prednisolone 7.5 mg once daily and naproxen 500 mg twice daily, which control her condition well.

Two months later Mrs F is admitted to hospital for major surgery under general Her dose of prednisolone was increased 4 weeks earlier due to a flare up in her rheumatoid arthritis, and on admission is 12.5 mg daily.

Which one of the following is the most suitable regimen for corticosteroid replacement for Mrs F during surgery?

14. Mrs F who is 45 years old and has rheumatoid arthritis. Since her diagnosis she has tried a number of anti-inflammatory drugs, which have been unsuccessful in controlling her condition. As a result, she now takes oral prednisolone 7.5 mg once daily and naproxen 500 mg twice daily, which control her condition well.

Six months later, Mrs F’s GP has decided to stop her prednisolone, and asks for your advice on the current recommendations.

A gradual withdrawal of systemic corticosteroids should be considered in those patients whose disease is unlikely to relapse as well as which of the following?

15. You are a hospital pharmacist and you receive a prescription for a 7-year-old child weighing 23kg who has been prescribed alfacalcidol at the maximum recommended dose for the prevention of vitamin D deficiency in liver disease.

Which of the following is the correct number of alfacalcidol 250ng capsules would this child have received after three months of treatment? Assume no dose adjustment has occurred.

16. A 40-year-old man who is a regular patient at your pharmacy requests for your advice on a suitable treatment for his mouth On further questioning, he informs you that he also has a sore throat. You view his patient medication record and see that he currently takes the following medication:
  • Ipocol (mesalazine) 400 mg enteric coated tablets
  • lansoprazole 30 mg capsules
  • Gaviscon oral suspension

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

17. Mrs B is 6 months pregnant and comes into the pharmacy seeking your advice on what she can take to help with her constipation. She explains that she is aware that constipation is common in pregnancy but tells you that it is becoming increasingly problematic and has started to cause her much Mrs B further explains that she has tried to increase her fluid intake and the fibre in her diet, but this has not helped.

Which of the following is the most suitable for you to recommend to Mrs B?

18. A 6-year-old child has been diagnosed with attention deficit hyperactivity disorder (ADHD) by a specialist doctor and has been initiated on methylphenidate hydrochloride (Concerta XL) tablets 18 mg once daily in the morning. The mother is quite concerned and asks you several questions about her child’s new medication.
Which of the following would be the best advice to give to the mother?
19. Mr G, a 67 year old man, presents at the pharmacy with a prescription for Oxybutynin 2.5mg tablets. He explains that this is a new medicine the doctor has prescribed for him as he has been experiencing urinary symptoms. He asks you whether there is any information he should be aware of regarding this medication.
Which of the following would be the most appropriate advice to give Mr G?
20. You are a locum pharmacist in a local pharmacy and you have had a busy morning supervising patients take their methadone.

Which of the following is the most appropriate method to dispose spent methadone bottles?

21. Mrs H and her 7-year-old daughter Miss H visit your pharmacy requesting for advice about a skin rash that has developed recently on Miss H. Mrs H explains that the rash initially appeared as red itchy spots which have now developed into fluid-filled intensely itchy blisters that crust over and scab. They have appeared on her face, on the chest and abdomen, and on the arms and legs. She has no other symptoms and does not have any other medical conditions.

Which of the following is the most likely cause of Miss H’s symptoms?
22. A GP orders some routine tests for a 46-year-old female patient following a consultation.
Which of the following test results will most likely require further action to be taken?
23. 23. Mr I visits your pharmacy and asks you about a leaflet that he saw at his local GP surgery advertising your smoking cessation service. You invite him to the consultation room and counsel him on the service, explaining to him the benefits of quitting smoking. By the end of your consultation he informs you that after he celebrates his 40th birthday the following week, he will return to the pharmacy and sign up to the service.
At which stage of the ‘Stages-of-Change Model’ is Mr I at?
24. Mr J is a 65-year-old man who underwent an elective knee replacement surgery two weeks ago. He has a history of hypertension, which is treated with amlodipine 5mg once daily and lisinopril 10mg once daily. There have been complications due to an infection and Mr J has been readmitted to hospital.
Which of the following drugs started in hospital is most likely to have caused Mr J’s abnormal laboratory results?
25. Mr K visits your pharmacy for a cardiovascular health check. You check his blood pressure, cholesterol and calculate his BMI.

Which of the following is most important to highlight to Mr K as a risk factor for developing coronary heart disease?
26. Mrs L has been prescribed sodium valproate (to be taken alongside her lamotrigine) for tonic-clonic seizures. Whilst handing in her prescription for sodium valproate, Mrs L enquires about suitable dietary supplements to boost her nutritional intake as she is hoping to start a family in the near future. Mrs L has no known allergies and does not take any other medication.

Which of the following would be the most appropriate course of action?
27. Mr M is a 47 year old man who takes ramipril 10mg for hypertension. He has a BMI of 28kg/m2 and a calculated Q-Risk of 13.5%. He was recently started on atorvastatin 20 mg once daily as primary prevention for cardiovascular disease. He manages a small vineyard in the countryside and enjoys drinking wine as well as locally produced spirits. He drinks a glass of fresh fruit or vegetable juice every morning and eats a balanced vegetarian diet. He has no known allergies and does not take any other medication.

Which of the following is the most appropriate counselling advice to give to Mr M regarding atorvastatin?
28. A 1-year-old child is prescribed domperidone liquid 400 micrograms/kg four times a day for the treatment of gastro-oesophageal reflux disease.

Which of the following is the most appropriate course of action?
29. Mrs MA is a 67 year old woman who has hypertension, osteoporosis and asthma for which she takes the following medication:

• Lisinopril 30mg od
• Amlodipine 10mg 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 MA presents at the pharmacy requesting medication for diarrhoea. She informs you that this is the second day that she has had diarrhoea and vomiting and that she vomited three times yesterday and has lost count of the number of times she has been to the toilet with very loose stools.

Which one of Mrs MA’s medication should be temporarily held until Mrs MA recovers from the diarrhoea and vomiting?
30. Mr N is a 37-year-old asthmatic who has been regularly prescribed the following medication:
• Flixotide Accuhaler (fluticasone propionate) 100 mcg/blister, 100 mcg twice daily
• Ventolin Accuhaler (salbutamol sulfate) 200 mcg/blister, 200 mcg up to four times daily when required

Whilst discussing the medicines with Mr N, you discover that he is regularly needing to use his Ventolin Accuhaler 3 to 4 times a week to relieve bouts of breathlessness. You confirm that Mr N uses his Flixotide Accuhaler as prescribed. Since you have come to the conclusion that Mr N’s condition does not appear to be under control, you recommend to his GP to review his treatment and consider stepping it up to the next stage in the management of his chronic asthma.

According to the BTS Guidelines on the management of asthma, which of the following treatment regimens would best correspond to a step up in treatment from Mr N’s current medication?
31. A 10-year-old boy has type 1 diabetes mellitus. Previous attempts to achieve optimal glycaemic control with multiple-injection regimens for him have failed and resulted in repeated hypoglycaemic episodes. Multiple injection regimens have proven to be impractical as there is not always a suitably trained member of staff to administer the insulin to him whilst he is at school. He is of average body weight for his age and has no known allergies.
Which of the following would be the most suitable treatment option for him?
32. Mrs O, a 55-year-old regular patient at your pharmacy, presents with a prescription for erythromycin tablets. After viewing her patient medication record you decide to contact the prescriber.
Which of Mrs O’s medicines listed below would be of most concern to you?
33. You are the Responsible Pharmacist working at a community pharmacy when you receive a veterinary prescription for phenobarbital 30 mg tablets for Dolly, a cat that is under the care of a veterinary surgeon.

Which of the following would be the most appropriate course of action?
34. Mr Q 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 Q 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?
35. 35. You are the superintendent pharmacist of several pharmacy premises’ in a local area. The Responsible Pharmacist at one pharmacy is preparing for a GPhC inspection and wants to train his team on confidentiality.

To which of the following scenarios would you agree to provide the information requested?
36. Mr R is a 40 year old man with type 1 diabetes mellitus. He is using a basal-bolus insulin regimen to control his blood glucose and monitors his blood glucose regularly.

He has recently changed occupation and started working as a part-time lorry driver for a transport company. Each job usually involves long distance travel. On an average day, he completes two jobs and travels up to 350 miles a day. He usually has a rest stop every 70 miles at a minimum.

What is the most suitable number of blood glucose tests Mr R should be advised to take at this stage?
37. You have been unable to source Fresubin 1000 Complete to supply to your local care homes for the past week. You receive a call from the matron at one of the care homes asking for your recommendation of the most similar product to Fresubin 1000 Complete so that they can ask the doctor to prescribe this alternative product.
Which of the following would be the closest substitute?
38. 38. A 35-year-old male diabetic patient presented to A&E with vomiting and abdominal pain. He had a 2-week history of polyuria and polydipsia, accompanied by a 10 kg weight loss. His medical history shows he is also being treated for hypertension with amlodipine 10 mg daily. His blood pressure on admission was 130/80 mmHg. His initial blood glucose level was 30 mmol/L and a diagnosis of diabetic ketoacidosis was made.

What would be the most appropriate treatment for this condition?
39.  

Mrs S visits your pharmacy seeking advice for her 2-year-old son Master S. She explains that his left eye was sticky in the morning and now appears red. Master S has no other medical conditions and is not on any regular medication.

Which of the following would be the most appropriate advice to give Mrs S?
40. Mr T presents a prescription for oxycodone 5 mg/5 mL oral solution.

Which of the following is the maximum recommended duration of supply on a single prescription for this medicine?
41. Mr U has been taking morphine sulfate oral solution 10 mg/5 mL, 6 mL every six hours for the past 7 days. Now that his pain is controlled on this dose, his doctor would like to switch him to buprenorphine patches.

Which of the following patches would provide an approximate equivalent daily dose of morphine sulfate?
42. You are a pharmacist at a mental health clinic. Mr V’s most recent prescription is for haloperidol depot injection. Mr V’s patient medication record shows that he usually takes haloperidol tablets.
Which of the following is the most likely reason that the haloperidol has been changed from tablets to a depot injection?
43. Which term best describes the following ‘is the process of withdrawal of an inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy and improving outcomes’?
44. This question relate to a new member of staff who is receiving emergency first aid.

The superintendent pharmacist is running a training course for a few new members of staff at the pharmacy. One of the staff members has bought some nuts to snack on during the training. A member of the team starts to become increasingly unwell and you suspect an anaphylactic reaction. The superintendent is qualified to deliver emergency first aid, and reaches for the First Aid kit in the room.

Which of the following is the recommended dosage of adrenaline to be administered by intramuscular injection? 
45. This question relate to a new member of staff who is receiving emergency first aid.

The superintendent pharmacist is unsure about whether to call an ambulance and asks for your advice.

Which of the following responses would be most appropriate for you to give? 
46.

Cardiovascular drugs

For the patients described, select the most suitable cardiovascular drug from the list. Each option may be used once, more than once, or not at all.

A 45-year-old Afro-Caribbean male has recently been diagnosed with hypertension. His most recent blood pressure was measured as 160/90 mmHg. He has no other medical conditions and no known allergies.
47.

Cardiovascular drugs

For the patients described, select the most suitable cardiovascular drug from the list. Each option may be used once, more than once, or not at all.

A 62-year-old white female who has had hypertension for the past 10 years. Her most recent blood pressure was measured as 145/100 mmHg. She is currently taking ramipril 10 mg once daily and amlodipine 10 mg once daily to control the condition. She also has type 2 diabetes which is controlled by a strict diet. She has no known allergies.
48.

Vitamins

For the patients described, select the most likely vitamin deficiency from the list. Each option may be used once, more than once, or not at all.

Mr X is a type 2 diabetic who has been taking metformin for the past 5 years. He has recently been experiencing a lack of energy, and complains of a sore tongue and regular mouth ulcers.
49.

Vitamins

For the patients described, select the most likely vitamin deficiency from the list. Each option may be used once, more than once, or not at all.

Mr Y is a chronic alcoholic and is showing signs of ataxia, confusion and ophthalmoplegia.
50.

Electrolyte abnormalities

For the patients described, select from the list, the single most likely cause of the patient’s symptoms. Each option may be used once, more than once or not at all.

A 66-year-old woman is examined in A&E following a two-day history of confusion, diarrhoea, vomiting and lethargy. The junior doctor has ordered blood tests. The patient was commenced on lithium carbonate at an initial dose of 400 mg daily for the management of bipolar disorder two weeks ago.
51.

Electrolyte abnormalities

For the patients described, select from the list, the single most likely cause of the patient’s symptoms. Each option may be used once, more than once or not at all.

A 68-year-old man with a history of heart failure has been admitted to hospital with suspected deterioration in his condition. Following treatment with spironolactone, his symptoms improve but he now develops fatigue, nausea and vomiting.

His current medication is shown below:
DrugDoseRouteFrequency
ramipril10 mgorallyonce daily
bisoprolol5 mgorallyonce daily
aspirin75 mgorallyonce daily
52.

Effects of drug-drug interactions

For the patients described, select the single most likely possible consequence the drug interaction from the list. Each option may be used once, more than once or not at all.

Miss F is a 19-year-old woman who was admitted to A&E following a seizure. She also has a bad chest infection. The junior doctor on the ward prescribes ciprofloxacin 500 mg every 12 hours for 7 day to treat the infection. The neurologist prescribes lamotrigine 25 mg once daily, increasing to 50 mg once daily after 14 days for juvenile myoclonic epilepsy.
53.

Effects of drug-drug interactions

For the patients described, select the single most likely possible consequence the drug interaction from the list. Each option may be used once, more than once or not at all.

A 75-year-old woman has been admitted to hospital following a fall. She has a history of congestive heart failure. She appears confused and her son informs you that she has not been drinking much over the past few days. Her blood pressure is measured as 95/60 mmHg. The junior doctor on the ward prescribes ibuprofen 400 mg three times daily for the pain.

The patient is on the following medication:

 
DrugDoseRouteFrequency
ramipril5 mgorallydaily
bisoprolol2.5 mgorallydaily
furosemide80 mgorallydaily
atorvastatin20 mgorallydaily
aspirin75 mgorallydaily
54.

Effects of drug-drug interactions

For the patients described, select the single most likely possible consequence the drug interaction from the list. Each option may be used once, more than once or not at all.

A 55-year-old patient comes in with a prescription for metronidazole 400mg tablets. He currently takes warfarin 5 mg daily for atrial fibrillation.
55.

Antibiotics

For each of the patients described, select from the list, the most appropriate antibiotic treatment. Each option may be used once, more than once or not at all.

A 54 year old man with no long-term medical conditions visits his GP complaining of fever. He has also developed a rash on the face and cheeks that is red, swollen, painful and warm to the touch. He has just completed a 7 day course of Metronidazole 400mg that was prescribed by his dentist for an abscess. He is allergic to penicillin.
56.

Antibiotics

For each of the patients described, select from the list, the most appropriate antibiotic treatment. Each option may be used once, more than once or not at all.

A 4 year old boy has recently developed small fluid filled blisters on the upper abdomen and neck. His parents have noticed that the blisters have spread to other parts of the body including the arms and legs and the child is complaining of pain and itching. Upon examination, you notice that the child has a slight fever and swollen glands and that some of the blisters on his abdomen appear to have burst leaving behind a yellow crust. The child has no penicillin allergies
57.

Antibiotics

For each of the patients described, select from the list, the most appropriate antibiotic treatment. Each option may be used once, more than once or not at all.

A 31-year-old mother who has given birth one month ago visits her GP complaining of an extremely burning pain in her right breast when breastfeeding. Her breast appears to be swollen and red and the lady has a fever. She explains that the symptoms developed yesterday and she has tried applying a warm flannel to the area and expressing the extra milk after feeds but has found that the symptoms have not improved. The doctor requests a small sample of her breast milk for a culture and decides to initiate treatment with an antibiotic in the meantime. The mother has no known allergies.
58.

Paracetamol dosages

For the patients described, select the most suitable dosage of paracetamol from the list. Each option may be used once, more than once, or not at all.

A mother brings in her 3-year-old child who has Chickenpox. You recommend Piriton but she also informs you that he has a high temperature.
59.

Paracetamol dosages

For the patients described, select the most suitable dosage of paracetamol from the list. Each option may be used once, more than once, or not at all.

A 11-year-old boy has injured his elbow whilst playing rugby. The arm appears red and swollen and he is experiencing mild pain. A cold compress was used immediately after the injury.
60.

Paracetamol dosages

For the patients described, select the most suitable dosage of paracetamol from the list. Each option may be used once, more than once, or not at all.

A worried mother comes into the pharmacy with her 2-month-old child who has just been immunised that morning and has developed a high temperature.

 

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