1. An adult patient with capacity has just had a new antiepileptic medicine started on advice from the hospital specialist. The patient collects his new prescription from you and tells you that there was nothing wrong with his old treatment and he is not going to take the new one.

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

A advise the patient of the potential consequences of their decision and let the patient decide what to do

B argue with the patient that the new treatment has been recommended by an expert and they should do what they have been told to do

C disregard the comment, the patient has capacity and is entitled make their own choice

D immediately contact the patient’s GP to tell them what the patient intends to do

E immediately contact your manager to tell them what the patient intends to do

2 A patient attends your pharmacy to return 26 Methylphenidate XL 18mg tablets that her daughter no longer requires.

Which of the following would be the LEAST appropriate action to take?

A contact your authorised witness to attend to denature the tablets

B denature the tablets yourself prior to disposal

C have a colleague familiar with CDs witness the denaturing

D keep a record of receipt and destruction of the tablets separate to the CD register

E keep them under safe custody until they can be disposed of safely

3 A terminally ill patient is prescribed diamorphine 200mg, cyclizine 150mg and haloperidol 10mg to be given as a continuous subcutaneous infusion via a syringe driver over 24 hours. You are asked to recommend a stable infusion.

Which of the following would be the most appropriate for you to recommend?

A diamorphine 9mg/ml, cyclizine 6.8mg/ml plus haloperidol 0.5mg/ml in sodium chloride 0.9%

B diamorphine 11mg/ml, cyclizine 8.8mg/ml, haloperidol 0.06mg/ml in water for injections

C diamorphine 11mg/ml plus cyclizine 8.8mg/ml plus haloperidol 0.6mg/ml in sodium chloride 0.9%

D diamorphine 20mg/ml plus cyclizine 15mg/ml plus haloperidol 1mg/ml in water for injections

E diamorphine 20mg/ml plus cyclizine 15mg/ml plus haloperidol 1mg/ml in sodium chloride 0.9%

4 Mr R is 60 years of age and a regular patient at your community pharmacy. He picks up the following medication on a monthly basis using your managed repeat service.

Atenolol 100mg tablets, ONE dailyAmlodipine 10mg tablets, ONE dailyGlyceryl Trinitrate 400micrograms pump spray, ONE or TWO doses under the tongue when requiredAspirin 75mg tablets, ONE dailyAtorvastatin 20mg tablets, ONE daily

Today Mr R has entered the pharmacy looking particularly unwell. He is holding his chest and looks very anxious. You notice that he is very breathless as he tries to explain that he has ran up the steep bank from his home to get to the branch before closing.

What is the most appropriate first step in administering first aid to Mr R?

A encourage Mr R to get into the recovery position whilst you leave to call for help

B encourage Mr R to take a dose of his GTN spray followed by a second dose 15 minutes later if there is no improvement

C ring 111 to ask for the most appropriate advice

D ring 999 immediately for an ambulance

E sit Mr R down and make him comfortable whilst you assess his situation

5 You are the pharmacist on duty at Kettleton Pharmacy. You are conducting a MUR with a patient, Mr R who is 54 years of age. During the course of the consultation you gather from Mr R that he is a smoker and has been for 30 years.

What is the most appropriate action to take?

A immediately proceed to sell Mr R a smoking cessation product

B make a Health Promotion intervention

C refer Mr R to his GP

D stop the MUR consultation and spend the rest of the time informing Mr R of all the health risks associated with smoking

E take no further action as Mr R has not expressed a desire to stop

6 Mrs C, 42 years, comes in to buy an OTC medicine for heartburn that started yesterday, she has never experienced this before. On questioning she states that she had a big meal 4 days ago and blames this. Mrs C’s PMR is shown below:

What is the most appropriate advice for this patient?

A advise her to stop alendronic acid and see her GP immediately

B advise her to stop ibuprofen and see her GP immediately

C provide counselling on her new medicines

D sell her gaviscon as it is likely the meal caused the issue

E sell her omeprazole as it is likely the meal caused the issue

Drug Strength Quantity Issued

Times Issued

Last Issued

Alendronic Acid 70mg 4 2 One week ago

Calcichew D3 Forte

500mg/400units 56 2 One week ago

Amlodipine 5mg 28 57 one week ago

Ibuprofen 400mg 84 48 Two months ago

Paracetamol 500mg 100 48 Two months ago

Questions 7 to 9 relate to Mrs Clarke’s prescription. You can see from your patient medication record (PMR) that Mrs Clarke is prescribed the following drugs:

Aspirin 75mg dispersible tablets ONE tablet dailyAtorvastatin 20mg tablets (Lipitor) ONE tablet dailyCarbimazole 5mg tablets THREE tablets dailyDiltiazem 200mg (Tildiem LA) ONE dailyFluoxetine 20mg capsules ONE dailyGlyceryl trinitrate 400 micrograms sublingual spray. Spray ONE or TWO doses under the tongue when required.Isosorbide mononitrate SR (Monosorb XL) 60mg tablets ONE dailyLactulose oral solution 10ml TWICE each dayMesalazine 500mg tablets MR (Pentasa) ONE tablet THREE times each dayMorphine Sulfate SR 30mg capsules (Zomorph) ONE capsule TWICE each day Senna tablets TWO to be taken at nightSodium Valproate 500mg tablets (Epilim) ONE tablet TWICE each day for migraine prophylaxis

7 You receive a phone call from Mrs Clarke’s General Practitioner (GP) as he wishes to start her on a medicine compliance aid (MCA) and is enquiring about the suitability of her drugs for inclusion in a MCA. You consult the UKMI MCA database, see resource pack for the results.

Which of the following would be the most appropriate advice to give the GP?

A all of the patient’s solid dosage oral drugs are suitable to be delivered in a MCA if the tray is packaged weekly but not monthly

B aspirin 75mg dispersible tablets are not suitable to be delivered in a MCA as they disintegrate in the presence of a small amount of water

C atorvastatin 20mg tablets are not suitable to be delivered in a MCA as they degrade in the presence of light

D carbimazole 5mg tablets are not suitable to be delivered in a MCA as stability data indicates that it is not suitable

E fluoxetine 20mg capsules are not suitable to be delivered in a MCA as they are sensitive to light

8 Following an assessment, you are satisfied that Mrs Clarke meets the

Equality Act 2010 requirements and a MCA would be appropriate, Mrs Clarke agrees to the compliance aid.

What would be the most appropriate advice to give the Mrs Clarke when she collects her MCA?

A discolouration of the mesalazine (Pentasa) may occur as it has been removed from its original package, however this is harmless

B Mrs Clarke should ask the GP to issue 7 day prescriptions as the MCAs need to be dispensed weekly

C the MCA is child resistant and therefore she should not worry when her grandchildren visit.

D the morphine is supplied in a separate box because it is a controlled drug and therefore you are not legally allowed to put in a MCA

E there are no product information leaflets supplied with MCAs, however should she have any queries she should give you a call

9 Mrs Clarke’s GP Practice is switching patients from branded to generic drugs to try and cut their prescribing costs. Mrs Clarke is prescribed a number of branded items on her regular prescription. When you receive Mrs Clarke’s next prescription you notice that the atorvastatin, diltiazem, isosorbide mononitrate SR, morphine sulfate and sodium valproate no longer have the brand names detailed on the prescription. Your Pharmacy Technician has highlighted these changes to you and asks if she can continue to dispense these generically.

What would be the most appropriate answer?

A Mrs Clarke must continue on her Epilim as the generic product has a different release profile and this may affect her migraine control

B Mrs Clarke will be concerned if her medicines look different so please dispense the same brands as before

C there are different release profiles between the different brands of isosorbide mononitrate SR so please maintain Mrs Clarke on the Monosorb XL

D there are different release profiles between the different brands of modified release diltiazem so please maintain Mrs Clarke on Tildiem LA

E there is evidence that show switching between brands of morphine sulfate can affect pain control so please continue to dispense the Zomorph brand

10 Mr B, who is 58 years old, presents at the pharmacy with a prescription for

clarithromycin 500mg tablets. He is already being treated for hypertension,

hypercholesterolaemia and Type II diabetes. Upon checking his prescription,

you notice a possible serious interaction between the clarithromycin and one

of his other medications listed below:

Aspirin 75mg tablets

Gliclazide 80mg tablet

Metformin 500mg tablets

Ramipril 5mg capsules

Simvastatin 40mg tablets

Which of the following is most appropriate course of action?

A advise Mr B that he should not take the clarithromycin and to return to his GP

B advise Mr B to leave at least two hours between taking his aspirin and clarithromycin

C advise Mr B to stop taking his simvastatin for the duration of antibiotic treatment.

D contact Mr B’s GP and ask them to prescribe amoxicillin instead of clarithromycin

E contact Mr B’s GP and ask them to prescribe phenoxymethylpenicillin instead of clarithromycin.

11 Mrs R comes into your pharmacy to ask advice on feeding her daughter aged 9 months. She is currently feeding her formula milk but has been told by her mother that she should switch to cow’s milk.

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

A her daughter can be fed full fat cow’s milk from 6 months of age

B her daughter can be fed full fat cow’s milk from 12 months of age

C her daughter can be fed full fat cow’s milk from 2 years of age

D her daughter can be fed semi skimmed cow’s milk from 6 months of age

E her daughter can be fed semi skimmed cow’s milk from 12 months of age

12 You are conducting an NHS Health Check on Mrs P a 56-year old women on a Monday morning. During the Health Check you measure Mrs P’s BP three times, the readings are shown below:

Reading Blood Pressure1 185/1122 183/1113 184/113

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

A call an ambulance to come to the pharmacy for Mrs R

B explain to Mrs R that her BP is higher than it should be and ask her to visit her GP within 48 hours

C explain to Mrs R that her BP is higher than it should be and ask her to visit her GP within 1 week

D immediately refer Mrs R to her GP

E offer Mrs R lifestyle advice and ask her to come back for a repeat measurement in 1 week

13 Master A was diagnosed Type 1 diabetes two weeks ago. His mother phones you for advice as he has just developed vomiting and diarrhoea, she asks how she should manage him.

Which one of the following is the LEAST appropriate advice?

A he should continue to use his insulin and she should contact the diabetes team for information on how his insulin dose should be adjusted depending on the results of his monitoring

B he should try and eat even if he doesn’t feel like eating or is vomiting, as well as sip non-sugary fluids to prevent dehydration

C if he is unable to keep fluids down and/or cannot manage to reduce his blood glucose or ketone levels an urgent hospital assessment is required

D if his blood glucose falls below the normal range, he should sip sugary drinks such as fruit juice or Lucozade

E she should check his blood glucose at least 4 times a day and his ketones at least twice a day until the vomiting and diarrhoea resolves.

14 During a performance review, Tina a Dispensing Assistant discusses the possibility of undertaking development to become a registered Pharmacy Technician as she feels this is the next step in her career pathway

Which one of the following statements regarding training to become a registered Pharmacy Technician would be the most appropriate?

A a GPhC accredited competency based qualification and knowledge based qualification would be required to apply for registration as a Technician

B as a trainee Pharmacy Technician, Tina would NOT be required to abide by the GPhC’s Code of Conduct

C registration with the GPhC as a Technician could occur up to 5 years after completing the necessary training

D the training to become a Pharmacy Technician consists of 3 years’ consecutive work-based experience

E work based experience would need to occur under the supervision of a pharmacist directly accountable for Tina for not less than 20 hours per week

15 You are the pharmacist in a community pharmacy. A mother asks for some advice about her 5-year-old son. He has had a cough for 2 days. Upon further questioning, the mother tells you that her son has recently had a cold and has been coughing a little during waking hours. She states that the cough has improved since the previous day. She would like something just to ‘soothe his throat.’ He has no other symptoms.

The 5-year old has no previous medical history, no allergies and does not take any medicines.

Which is the most appropriate course of action?

A advise the mother that there is nothing available to purchase for her son

B advise the mother to see her son’s GP

C sell glycerin, honey and lemon linctus

D sell guaifenesin syrup

E sell pholcodine linctus

16 Mr DR, aged 45, comes into the pharmacy seeking advice about his right foot. He recently noticed that his whole toenail has started to discolour and feel very brittle. He reports no other symptoms. He has no medical conditions and is not on any regular medication.

As the pharmacist, you diagnose this as onychomycosis, which one of the following is the most suitable/appropriate action?

A sell amorolfine 5% nail lacquer

B sell miconazole 2% cream

C sell no treatment and advise the patient that this is a self-limiting condition which will resolve if left alone

D sell no treatment and advise the patient to see his GP

E sell terbinafine 1% cutaneous solution

17 With regard to the exemptions for pharmacists on wholesale dealing when engaging in non-commercial wholesaling.

Which of the following statements is NOT correct?

A the quantity supplied must be for the needs of an individual patient

B the supply must be made on a ‘not for profit’ basis

C the supply must take place on an occasional basis

D they apply to the exchange of stock between pharmacies that are part of the same company

E they apply to the supply of medicinal products to healthcare practitioners for use in their practice

18 You are the responsible pharmacist in branch and you take receipt of a prescription. You notice that the prescription is not legally valid.

Which one of the following statements relating to Veterinary prescription legal requirements explains the most appropriate reason why the prescription is NOT legally valid?

A a specific dose has not been prescribed

B it is missing the declaration “prescribed for an animal/herd under my care”

C the ID number of the dog is missing

D the owner’s phone number needs to be included on the prescription

E there is no dispense by date stated on the prescription

19 Miss T your newly registered Pharmacy Technician is involved in a near miss dispensing incident. As a result, you suggest that she uses the learning to complete a Continuing Professional Development (CPD) record. This is her first entry and she would like you to assist.

Which of the following statements is the LEAST appropriate information to provide Miss T?

A a minimum of five of your CPD entries each year should start at the reflection phase of the CPD cycle

B CPD records should cover the full scope of your practice

C it may be possible to make more than one CPD entry from the incident

D keeping a record of CPD enables you to demonstrate that you are maintaining your professional capability

E you should complete a minimum of nine CPD entries each year

20 Mr D is a 25 year old male, who weighs 85kg, has deliberately ingested an unknown number of paracetamol 500mg tablets about 3 hours ago (he thinks). He now regrets doing so and presents to the Emergency Department for treatment. The junior doctor on duty phones pharmacy to ask for advice.

Which one of the following is the most appropriate course of action in the first instance?

A advise the doctor to take a serum paracetamol level and decide whether to treat or not once the level is known

B advise the doctor to take a serum paracetamol level and immediately start an N-acetylcysteine infusion 4.4g in 500mls 5% Glucose over 4 hours

C advise the doctor to take a serum paracetamol level and immediately start an N-acetylcysteine infusion 8.6g in 1000mls 5% Glucose over 16 hours

D advise the doctor to take a serum paracetamol level and immediately start an N-acetylcysteine infusion 12.8g in 200mls 5% Glucose over 1 hour

E advise the doctor to take a serum paracetamol level and refer the patient to the local mental health service to have an assessment before deciding what treatment to offer

21 Mr L, aged 55 visited his GP for a repeat check up on 1.8.15. The patient is a heavy drinker and alcohol intake has been 72 units per week. However he has reported feeling reasonably well on his medication, initiated after his MI, 3 months previously. They were as follows:

aspirin 75mg once dailyatorvastatin 80mg at night bisoprolol 5mg once dailyclopidogrel once dailyramipril 10mg once daily

The following test results are found:Liver Function Tests (LFTs) andreference ranges 1

Test result 1.4.15 Test result 1.7.15 Test result 1.8.15

Alanine aminotransferase (ALT) 0-45 IU/L

30 IU/L 145 IU/L 160IU/L

Aspartate aminotransferase(AST) 0-50 IU/L

28 IU/L 162 IU/L 178 IU/L

Total Bilirubin3-20 micromol/L

10 micromol/L 19 micromol/L 18 micromol/L

Alkaline phosphatase30-130 IU/L

45 IU/L 50 IU/L 52 IU/L

Gamma glutamyl transferase0-70 IU/l

70 IU/L 110 IU/L 105 IU/L

Which of the following is the most appropriate action to take regarding the management of the patient’s drug therapy?

A change to simvastatin 40mg at night. Repeat the LFTs in another 4-6 weeks.

B continue all medication with caution. Repeat the LFTs in another 4-6 weeks

C reduce atorvastatin to 40mg at night. Repeat the LFTs in another 4-6 weeks.

D stop atorvastatin. Repeat the LFTs in another 4-6 weeks. Restart atorvastatin if the LFTs are in the normal range.

E stop atorvastatin. Repeat the LFTs in another 4-6 weeks. Seek specialist advice.

22 Mrs S, aged 78 has recently been prescribed tramadol following a total knee replacement. She has presented at A & E with symptoms of confusion, anxiety, tremors and shivering. Changes in blood pressure and tachycardia are also noted. Urgent management includes intravenous fluids, diazepam IV and close observation for the next 24 hours.

Her admission medication is:

lactulose 15ml twice daily ( started 5 days ago)paracetamol 1 gram four times daily (established)paroxetine 40mg daily (established)tramadol 100mg four times (started 5 days ago)

Which of the following is the most appropriate initial drug therapy advice for this patient?

A advise a change from paroxetine to amitriptyline

B advise a change from tramadol to codeine

C advise a dose reduction of paroxetine

D advise a dose reduction of tramadol

E advise withdrawal of paroxetine and tramadol

23 Mrs T asks for your advice regarding her 6 year old son who has been unwell for a few days. She describes his symptoms as cough accompanied with a fever which he has had for about four days. She has also noticed small white spots inside his mouth and the start of a rash on his face and neck.

What one of the following conditions is this child most likely to be suffering from?

A chicken pox

B measles

C meningitis

D rubella

E shingles

24 Mr S is due to be commenced on digoxin.

Which would be the most appropriate blood test to check before initiation?

A full blood count

B serum creatinine

C serum glycosylated haemoglobin (HbA1C)

D serum thyroid stimulating hormone

E serum vitamin D

25 Mr D comes into your pharmacy and asks for some advice. The previous day you supplied him with metformin 500mg tablets for the first time following several months of trying to control his diabetes by diet. After leaving the pharmacy, he explains, he spoke to a friend who took metformin in the past and told him it caused really bad diarrhoea and made him feel sick. After hearing this he feels very reluctant to take them and asks you what to do.

What is the most appropriate response to Mr D’s request?

A advise Mr D that metformin only causes these side effects when it is combined with another product called gliclazide.

B advise Mr D that these are potentially serious side effects and to inform the GP immediately if any diarrhoea occurs.

C advise him that these side effects are common but that they should only last about a week and to persevere with them if possible to see if they clear up.

D reassure Mr D that his friend is incorrect and that metformin does not cause gastrointestinal side effects.

E reassure him that these are possible side effects of metformin but that they are rare and as such are unlikely to occur except in 0.1-0.01% of people.

26 You are the Responsible Pharmacist at a rural community pharmacy when a power cut occurs. This affects all electronic equipment including computers and labellers. The power company explains that this will be the case for the rest of the day.

A patient presents with an antibiotic script for a 2 year old child. They explain that they have no car and are unable to reach another pharmacy that day. You decide to dispense the medication and ask your dispenser to hand write a label for it but she can’t quite remember what information legally needs to go on the label, she asks you to remind her.

What is the most appropriate reply to this question?

A name and address of the patient; name of prescriber; date of dispensing; name of the medicine; directions for use; precautions relating to the use of the medicine

B name of the patient; name and address of the supplying pharmacy; date of dispensing; name of the medicine; directions for use; keep out of the sight and reach of children

C name of the patient; name and address of the supplying pharmacy; date of dispensing; name of the medicine; directions for use; precautions relating to the use of the medicine

D name of the patient; name and address of the supplying pharmacy; date on the prescription; name of the medicine; directions for use; precautions relating to the use of the medicine

E name of the patient; name and telephone number of the supplying pharmacy; date of dispensing; name of the medicine; directions for use; precautions relating to the use of the medicine

27 You are concerned that your registered Technician, Mr A, has a health problem that he refuses to acknowledge but you believe is having a negative effect on his judgement and may be putting patients at risk.

Which of the following actions would be the LEAST appropriate to take?

A confide in a member of the team to see whether they share the same concerns about Mr A

B find out your organisation’s policy on raising concerns

C keep a record of the actions you have taken

D report without delay

E share your concerns with your line manager

28 You have been requested to join a meeting at the local health centre across the road from your pharmacy at lunchtime for one hour. You remain signed in to the responsible pharmacist register but note down the time you are leaving the premises. You have a registered accuracy checking technician, two dispensing assistants and a trained counter assistant in the pharmacy during your absence.

Which one of the following activities would it be most appropriate for the team to continue with in your absence?

A handing over of completed prescription items to the delivery driver for him to take out and deliver

B the sale of a box of 14 Nexium (esomeprazole) control tablets to a 20-year old woman

C the sale of a box of 32 co-codamol caplets to a 55-year old man

D the supervised consumption of methadone which has previously been checked by the responsible pharmacist clinically and for accuracy

E the supply of chloramphenicol 0.5% eye drops to a 2-year old child on a PGD

29 Mr K will be undertaking a long car journey at the weekend with his 8-year old daughter who is prone to travel sickness. He asks for your advice but would prefer to manage it without giving her any medication.

Which of the following statements would be most appropriate advice?

A do not encourage games that require her to look out of windows

B encourage her to read as this can help take her mind off the sickness

C encourage her to suck mints or glucose sweets

D give her a large meal before travelling

E sit her in the back of the car rather than the front

30 Miss L a 6-year old child with no long term medical conditions requires paracetamol for the treatment of pyrexia with flu-like symptoms.

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

A 60mg

B 120mg

C 180mg

D 240mg

E 300mg

31 Mr F wishes to make a complaint as he has received the wrong drugs in error. Your dispenser asks about your process for dealing with complaints.

Which of the following would be the LEAST appropriate response?

A the person making the complaint or expressing the concern should be asked to sign to declare the situation has been dealt with and won’t be taken any further

B there should be a set complaints procedure which should be followed

C you should make a record of the action taken

D you should make a record of the complaint, concern or incident

E you should review your records and findings and audit them regularly

32 Miss A, your second pharmacist, has made a number of errors over the last month. You decide to discuss how she can minimise the risk of a dispensing error in the future with her.

Which of the following would be the LEAST appropriate recommendation?

A all accuracy checks should be made against the original prescription re-reading the prescription first

B if you are a pharmacist working alone, once you have assembled the medicines, try to create a short mental break between the assembly and final check

C items should be selected from the shelf before dispensing labels are generated

D two people should be involved in the dispensing process where this is possible. A second competent person should carry out an accuracy check

E you should have systems in place to identify who was involved in the dispensing and checking process of each prescription item (e.g. dispensed by / checked by boxes)

33 You have a new member of staff who has never worked in a pharmacy before. You are explaining the Responsible Pharmacist Legislation to her today.

Which of the following statements is the most appropriate information to provide?

A a Responsible Pharmacist can be absent from the pharmacy for a maximum of 4 hours in any one working day

B in the absence of the responsible pharmacist prescriptions which have been previously checked and dispensed in the presence of the pharmacist can be supplied to patients

C P medicines can be sold whilst the Responsible Pharmacist is visiting a local hospital

D the dispensing process can be continued in the absence of the Responsible Pharmacist

E the responsible pharmacist notice must include the name and address of the pharmacist on duty

34 You are providing a presentation on veterinary medicines to your staff.

Which of the following statements would be the most appropriate information to include in your presentation?

A a pharmacist may sell chloramphenicol eye drops, as a P medicine over-the-counter, for a dog, under the verbal instructions from a veterinary surgeon

B a written prescription is required for the supply of NFA-VPS veterinary medicines

C if a veterinary medicine is dispensed in a pharmacy, the pharmacist should add Value-Added Tax (VAT) to the dispensing costs

D repeats are not allowed on veterinary prescriptions

E veterinary prescriptions are sent to the NHS Business Services Authority at the end of the month for pricing

35 You have been asked to provide a short teaching session on the legal supply of POMs at your local college for the BTEC level 3 diploma Pharmacy Technician students.

Which of the following would be the most appropriate information to include in your session?

A a prescription for tramadol is legally valid for a period of 6 months

B all the requested repeats on a private prescription must be made within 6 months of the prescription being issued

C an entry in the POM register upon supply of contraceptives against a private prescription is a legal requirement

D private prescriptions for tramadol must be issued on a FP10PCD form

E repeats can be requested by a prescriber on a NHS FP10 form

36 Mr DM is reviewed in the Pain Clinic. He takes morphine sulphate m/r tablets 30mg BD and 5mg morphine sulphate oral solution ‘when required’ every 2-4 hours for breakthrough pain. He has been taking 5 ‘when required’ doses per day in addition to the regular morphine m/r tablets. The doctor has contacted you to suggest a trial of buprenorphine patches.

Which one of the following is the most appropriate advice to give to the prescriber?

A a switch to Bu-Trans 20 patch applied once weekly

B a switch to Transtec-35 patch applied every 96 hours

C a switch to Transtec-52.5 patch applied every 96 hours

D an increase to oral morphine sulphate m/r tablets 40mg twice daily

E continuation with the current morphine regime

37 You receive a prescription for Miss Y who is 11 years old. The prescription is for norethisterone 5mg three times a day. The mother confirms that the drug had been prescribed to delay her daughter’s period when they go on holiday. You have not seen norethisterone prescribed in a child before so decide to consult the cBNF where you find that norethisterone is not licensed for use in children.

What would be the most appropriate action to take?

A dispense the prescription and inform the mother that it is not licensed in children

B dispense the prescription but remove the patient information leaflet so as the patient doesn’t get worried when she reads it should not be used in children

C inform the mother that it is not licensed in anyone under 18 and refuse to dispense it

D inform the prescriber that it is not licensed for use in children and you want them to sign a declaration that they are accepting full responsibility as you don’t want any blame if the patient is harmed

E liaise with the prescriber informing them that it is not licensed in children and in light of the available evidence decide if a supply should be made

38 Mr B, aged 55 presents with symptoms of an uncomfortable burning sensation behind his breastbone that worsens after eating and on lying down. He is also experiencing a burning sensation at the back of his throat accompanied with an unpleasant taste. He has no co-morbidities and is on no other medication.

Which of the following non-prescription medicines would be the most appropriate to treat the patient’s symptoms?

A Buscopan (hyoscine butylbromide) tablets

B Colpermin (peppermint oil) capsules

C Gaviscon advance (sodium alginate, potassium bicarbonate) suspension

D Imodium (loperamide) capsules

E Windeze (simeticone) capsules

39 Mr T, a 64-year old regular patient of yours who has type 2 diabetes visits you for an MUR. He is currently taking metformin 500mg three times a day, ramipril 5mg daily and gliclazide 80mg daily. He smokes 15 cigarettes each day, has a BMI of 28 and drinks 5 units of alcohol each evening. You calculate Mr T’s 10-year risk of cardiovascular disease using QRISK2 and get a score of 32%

Which one of the following is the LEAST appropriate recommendation to offer Mr T?

A he should visit his GP and discuss aspirin for primary prevention of cardiovascular disease

B he should visit his GP and discuss the initiation of a statin for primary prevention of cardiovascular disease

C offer brief advice on his alcohol consumption

D offer brief advice on smoking cessation

E provide lifestyle advice e.g. diet, exercise

Questions 40 and 41 concern Mr S who presents with the following prescription.

Omeprazole 20mg capsules 1 BD for one weekClarithromycin 250mg tablets 1 BDMetronidazole 400mg tablets 1 BD

40

What is most likely to be the condition that the patient is presenting with?

A fistulating crohns disease

B gastro-oesophageal reflux disease

C H.pylori infection

D NSAID-associated ulcer

E zollinger-ellison syndrome

41

Which of the following is NOT an appropriate counselling point for the metronidazole?

A do not drink alcohol whilst taking this medication

B space doses evenly through-out the day

C swallow the medication whole. Do not crush or chew

D take one hour before or two hours after food

E take with a full glass of water

Controlled Drugs

A buprenorphine

B diamorphine

C diazepam

D fentanyl

E lysergic acid diethylamide (LSD)

F nandrolone

G pholcodine

H tramadol

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

42 a patient has been involved in a road traffic accident which was not their fault. Which can the patient NOT raise a medical defence, even if low levels are found and the medicine has been taken in accordance with a healthcare professional.

43 may be requested by a registered midwife on a midwife supply order.

Infections

A amoxicillin

B cefalexin

C ciprofloxacin

D clarithromycin

E co-amoxiclav

F flucloxacillin

G nitrofurantoin

H trimethoprim

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

44 a 57-year old gentleman, who has a penicillin allergy, presents with low severity community acquired pneumonia.

45 a 27-year old lady who presents with a recurrent urinary tract infection a sample of urine has been sent for culture. She has recently completed a 3-day course of trimethoprim. She is allergic to penicillin but takes no other medication.

Topical skin preparations

A aqueous cream

B betamethasone ointment 0.1%

C calcipotriol ointment 50mcg/g

D clobetasol propionate cream 0.5%

E coal tar and salicylic acid ointment BP

F hydrocortisone cream 1%

G hydrocortisone 1%/ clotrimazole 1% cream

H tacrolimus ointment 0.1%

For the patients described, select the most appropriate product to be prescribed from the list above. Each option may be used once, more than once, or not at all.

46 Miss G, a 5-year old girl, with atopic eczema on her face and flexor surfaces of the body. There is NO evidence of bacterial or fungal infection.

47 Mr P, an adult male, with chronic, stable plaque psoriasis on the extensor surfaces of the trunk and limbs requiring long-term therapy. There are NO signs of inflammation.

48 Mrs T, aged 23 years, with lichenified eczema on the trunk and limbs.

Vitamins

A vitamin A

B vitamin B1

C vitamin B2

D vitamin B6

E vitamin C

F vitamin D

G vitamin E

H vitamin K

For the patients described, select the most suitable vitamin to be prescribed from the list above. Each option may be used once, more than once, or not at all.

49 a 7-year old boy who has been diagnosed as suffering from intestinal malabsorption and has presented with distortion of his bones.

50 a 42-year old woman who has been admitted to hospital with an INR of 8.0 with no bleeding