Pharmacy Solved MCQs.

Questions 1–10
Directions: Each of the questions or incomplete statements is followed by
five suggested answers. Select the best answer in each case.
Q1 All the following products used in the treatment of glaucoma are applied
topically EXCEPT:
A ❏ Xalatan
B ❏ Diamox
C ❏ Trusopt
D ❏ Timoptol
E ❏ Betoptic
Q2 Which is an alternative preparation of Lipitor?
A ❏ Cozaar
B ❏ Lescol
C ❏ Zestril
D ❏ Cardura
E ❏ Trandate
Q3 Tambocor:
A ❏ may be of value in serious symptomatic ventricular arrhythmias
B ❏ is a beta-adrenoceptor blocker
C ❏ is available only for parenteral administration
D ❏ cannot be administered concurrently with antibacterial agents
E ❏ is a proprietary preparation for amiodarone
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Q4 Terazosin:
A ❏ constricts smooth muscle
B ❏ is a selective beta-blocker
C ❏ increases urinary flow rate
D ❏ may cause an increase in blood pressure
E ❏ is indicated in urinary frequency
Q5 Legionnaires’ disease:
A ❏ is caused by a Gram-positive coccus
B ❏ is a chronic infectious disease
C ❏ has an incubation period of 2 days to 3 years
D ❏ is characterised by the development of pneumonia
E ❏ may be prevented by vaccination
Q6 Trigger factors for migraine include all EXCEPT:
A ❏ use of caffeine
B ❏ exposure to sunlight
C ❏ missed meals
D ❏ lack of sleep
E ❏ air travel
Q7 All the following products contain a local anaesthetic EXCEPT:
A ❏ Dequacaine
B ❏ Merocaine
C ❏ BurnEze
D ❏ Anthisan
E ❏ Proctosedyl
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Q8 Good pharmacy practice guidelines:
A ❏ have been established by the International Pharmaceutical
Federation (FIP)
B ❏ comply with ISO 9000
C ❏ consist of an audit process
D ❏ relate to pharmaceutical marketing
E ❏ entail field observation studies
Q9 Anti-D immunoglobulin:
A ❏ is available as oral tablets
B ❏ is a vaccination for tetanus
C ❏ should be administered preferably within 72 h of a
sensitising episode
D ❏ is intended to protect the mother from haemolytic disease
E ❏ cannot be used for prophylaxis
Q10 Which of the following products is NOT indicated for the management
of peptic ulceration?
A ❏ Zantac
B ❏ Gaviscon
C ❏ Nexium
D ❏ Pariet
E ❏ Buscopan
Questions 11–34
Directions: Each group of questions below consists of five lettered
headings followed by a list of numbered questions. For each
numbered question select the one heading that is most closely
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related to it. Each heading may be used once, more than once
or not at all.
Questions 11–13 concern the following drugs:
A ❏ valaciclovir
B ❏ griseofulvin
C ❏ itraconazole
D ❏ famciclovir
E ❏ terbinafine
Select, from A to E, which one of the above corresponds to the brand name:
Q11 Famvir
Q12 Sporanox
Q13 Lamisil
Questions 14–17 concern the following drugs:
A ❏ nalidixic acid
B ❏ norfloxacin
C ❏ levofloxacin
D ❏ ofloxacin
E ❏ amphotericin
Select, from A to E, which one of the above:
Q14 can be used for intestinal candidiasis
Q15 has greater activity than ciprofloxacin against pneumococci
Q16 is marketed as Tavanic
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Q17 is only indicated in urinary tract infection
Questions 18–20 concern the following drugs:
A ❏ atenolol
B ❏ folic acid
C ❏ imipramine
D ❏ carbamazepine
E ❏ co-trimoxazole
Select, from A to E, during pregnancy which one of the above:
Q18 may cause intrauterine growth restriction
Q19 may increase the risk of neural tube defects
Q20 may increase the risk of tachycardia in neonate
Questions 21–23 concern the following maximum oral daily doses:
A ❏ 200 mg daily
B ❏ 150 mg daily
C ❏ 100 mg daily
D ❏ 50 mg daily
E ❏ 300 mg daily
Select, from A to E, which one of the above corresponds to:
Q21 diclofenac
Q22 sildenafil
Q23 sumatriptan
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Questions 24–26 concern the following cautionary labels:
A ❏ To be sucked or chewed.
B ❏ With or after food.
C ❏ Follow the printed instructions you have been given with this
medicine.
D ❏ Avoid exposure of skin to direct sunlight or sun lamps.
E ❏ Do not stop taking this medicine except on your doctor’s
advice.
Select, from A to E, which one of the above corresponds to the drugs:
Q24 chlorpromazine
Q25 dapsone
Q26 warfarin
Questions 27–30 concern the following products:
A ❏ AeroChamber
B ❏ Nuelin
C ❏ Atrovent
D ❏ Beconase
E ❏ Alupent
Select, from A to E, which one of the above corresponds to the following presentations:
Q27 syrup
Q28 aerosol for inhalation
Q29 spacer device
Q30 nasal spray
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Questions 31–34 concern the following tablet descriptions:
A ❏ yellow 40 mg
B ❏ brown 1 mg
C ❏ yellow 250 mg
D ❏ red-brown 100 mg
E ❏ yellow 2.5 mg
Select, from A to E, which one of the above corresponds to the following preparations:
Q31 Klaricid
Q32 Diovan
Q33 warfarin
Q34 Zomig
Questions 35–60
Directions: For each of the questions below, ONE or MORE of the
responses is (are) correct. Decide which of the responses is
(are) correct. Then choose:
A ❏ if 1, 2 and 3 are correct
B ❏ if 1 and 2 only are correct
C ❏ if 2 and 3 only are correct
D ❏ if 1 only is correct
E ❏ if 3 only is correct
Directions summarised
A B C D E
1, 2, 3 1, 2 only 2, 3 only 1 only 3 only
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Q35 When administering cisplatin powder for injection:
1 ❏ it should be reconstituted with water for injection
2 ❏ it should be given over 6–8 h
3 ❏ the infusion fluid used is Ringer’s solution
Q36 Ceftazidime:
1 ❏ is a ‘third-generation’ cephalosporin antibacterial
2 ❏ is more active than cefuroxime against Gram-positive bacteria
3 ❏ is available as tablets and injections
Q37 Potentially hazardous interactions could occur between:
1 ❏ ergotamine and zolmitriptan
2 ❏ warfarin and gliclazide
3 ❏ combined oral contraceptives and clindamycin
Q38 Examples of enzyme inducers include:
1 ❏ griseofulvin
2 ❏ rifampicin
3 ❏ warfarin
Q39 Which of the following drugs may be used in patients with liver disease
but require a dose reduction?
1 ❏ Natrilix
2 ❏ Nizoral
3 ❏ Zyloric
Q40 Capsulitis:
1 ❏ is a disorder affecting the shoulder
2 ❏ may be caused by unaccustomed movement
3 ❏ is an inflammatory process
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Q41 Presentations of a facial lesion that warrant referral include:
1 ❏ swollen lymph glands in the neck
2 ❏ butterfly distribution of a rash over the nose and cheeks
3 ❏ a scaly rash with mild erythema affecting the forehead and
eyebrows
Q42 Antacid preparations containing sodium bicarbonate include:
1 ❏ Gaviscon liquid
2 ❏ Bisodol Heartburn Relief tablets
3 ❏ Maalox Plus tablets
Q43 The agents associated with pain and inflammation of a bee sting include:
1 ❏ histamine
2 ❏ apamin
3 ❏ hyaluronidase
Q44 Antispasmodics that could be recommended for irritable bowel
syndrome include:
1 ❏ Colofac
2 ❏ Spasmonal
3 ❏ Fybogel
Q45 Paradichlorobenzene:
1 ❏ has antifungal properties
2 ❏ is used as a disinfectant
3 ❏ is present in Cerumol drops
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Q46 Aspirin:
1 ❏ potentiates the anticoagulant effect of warfarin
2 ❏ inhibits platelet aggregation
3 ❏ promotes vitamin K synthesis
Q47 Male pattern baldness:
1 ❏ is androgenetic alopecia
2 ❏ is caused by the release of prostaglandins
3 ❏ may be precipitated by chemical hair preparations
Q48 Finasteride:
1 ❏ is an enzyme inhibitor
2 ❏ is an anti-androgen
3 ❏ could be used in male-pattern baldness
Q49 Diamorphine:
1 ❏ is a controlled drug
2 ❏ is more lipid soluble than morphine
3 ❏ may be administered intramuscularly
Q50 Drugs that could be used in nausea and vomiting caused by palliative
cancer treatment include:
1 ❏ metoclopramide
2 ❏ haloperidol
3 ❏ prochlorperazine
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Q51 Bacterial conjunctivitis:
1 ❏ is an infectious condition
2 ❏ affects both eyes
3 ❏ is associated with pain
Q52 Wet skin lesions:
1 ❏ indicate presence of a fungal infection
2 ❏ always require referral
3 ❏ potassium permanganate soaks may be recommended
Q53 Infant formula milk preparations:
1 ❏ may be based on cow’s milk
2 ❏ contain no fat
3 ❏ are presented as separate components to be reconstituted
before use
Q54 Staphylococcal napkin dermatitis:
1 ❏ occurs when the patient also has oral thrush
2 ❏ presents as a pustular rash
3 ❏ should be referred
Q55 Sialolithiasis:
1 ❏ is the inflammation of a salivary gland
2 ❏ presents with facial pain and swelling
3 ❏ is associated with eating
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Q56 Accompanying conditions that require referral when patients present
with ear problems include:
1 ❏ history of perforated ear drum
2 ❏ discharge
3 ❏ pain
Q57 When patients present with complaints related to indigestion the pharmacist should enquire whether:
1 ❏ symptoms are related to food intake patterns
2 ❏ accompanying symptoms include vomiting or constipation
3 ❏ the patient is wheezing
Q58 Kaolin and Morphine Mixture:
1 ❏ is not recommended for acute diarrhoea
2 ❏ contains a low concentration of morphine
3 ❏ contains kaolin, which may reduce bioavailability of morphine
Q59 Meggezones pastilles:
1 ❏ contain pseudoephedrine
2 ❏ provide a soothing effect through the promotion of saliva
production
3 ❏ should not be recommended to diabetic patients
Q60 In migraine:
1 ❏ a soluble oral drug formulation is preferred to a solid oral
dosage form
2 ❏ an analgesic should be taken at the first sign of an attack
3 ❏ Syndol may be recommended
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Questions 61–80
Directions: The following questions consist of a first statement followed
by a second statement. Decide whether the first statement is
true or false. Decide whether the second statement is true or
false. Then choose:
A ❏ if both statements are true and the second statement is a
correct explanation of the first statement
B ❏ if both statements are true but the second statement is NOT
a correct explanation of the first statement
C ❏ if the first statement is true but the second statement is false
D ❏ if the first statement is false but the second statement is true
E ❏ if both statements are false
Q61 Hydroxychloroquine is used to treat rheumatoid arthritis. Hydroxychloroquine is better tolerated than gold.
Q62 Acute attacks of porphyria may be precipitated by drug administration.
Progestogen-containing preparations should be avoided in patients with
porphyria.
Q63 Goserelin may be used in prostrate cancer. Goserelin may result in a
tumour ‘flare’.
Directions summarised
First statement Second statement
A True True Second statement is a correct
explanation of the first
B True True Second statement is NOT a correct
explanation of the first
C True False
D False True
E False False
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Q64 Tacrolimus is chemically similar to ciclosporin. Tacrolimus has a similar
mode of action to ciclosporin.
Q65 In older patients, imipramine may cause hyponatraemia. Hyponatraemia occurs because of increased sodium re-uptake in the loop of
Henle.
Q66 Inflammation of the larynx requires the administration of atropine.
Atropine is a sympathomimetic agent.
Q67 Lidocaine is used in ventricular arrhythmias. Lidocaine suppresses
ventricular tachycardia and reduces the risk of ventricular fibrillation
following myocardial infarction.
Q68 Propranolol is preferred to atenolol in hypertensive patients with
moderate kidney damage. Propranolol is not water soluble and is not
excreted by the kidneys.
Q69 Filgrastim is used for neutropenia induced by cytotoxic chemotherapy.
Filgrastim is an example of a recombinant human erythropoietin.
Q70 Intake of drugs at therapeutic doses in mothers who are breast-feeding
are not likely to cause toxicity in the infant. Toxicity in the infant always
occurs when the drug enters the milk.
Q71 Pemphigus is an autoimmune reaction. Immunosuppressants such as
ciclosporin are the first line of treatment in pemphigus.
Q72 Ear pain during air travel occurs because of a problem in the external
ear. Nasal decongestants may be used to prevent this condition.
Q73 Agranulocytosis could occur as a result of Stelazine therapy. Stelazine
is trimipramine.
Q74 Tinnitus may be an adverse effect of furosemide. All diuretics may cause
tinnitus.
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Q75 Concomitant use of St John’s wort and sertraline should be avoided. St
John’s wort is used for mild depression.
Q76 Co-codamol preparations that can be sold over-the-counter contain
codeine 60 mg. Co-codamol is a combination of codeine and dextropropoxyphene.
Q77 Varicella is a highly contagious disease. Prophylaxis for varicella is not
available.
Q78 Graduated compression hosiery should not be used during pregnancy.
Graduated compression hosiery prevents oedema.
Q79 First-line treatment of nocturnal enuresis is drug treatment. Amitriptyline
may be used in nocturnal enuresis.
Q80 Betahistine is indicated for motion sickness. Betahistine may be associated with headache.
Questions 81–100
Directions: These questions involve prescriptions or patient requests.
Read the prescription or patient request and answer the
questions.
Questions 81–85: Use the prescription below:
Patient’s name .........................................................................
Premarin 0.625 mg tablets
1 od m 28
Doctor’s signature .........................................................................
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Q81 Premarin contains
A ❏ conjugated oestrogens 625 μg
B ❏ conjugated oestrogens 62.5 μg
C ❏ conjugated oestrogens 0.625 μg
D ❏ conjugated oestrogens 625 μg and levonorgestrel 75 μg
E ❏ conjugated oestrogens 0.625 μg and levonorgestrel 75 μg
Q82 Premarin is also available as:
1 ❏ a nasal spray
2 ❏ patches
3 ❏ tablets in a different strength
A ❏ 1, 2, 3
B ❏ 1, 2 only
C ❏ 2, 3 only
D ❏ 1 only
E ❏ 3 only
Q83 Premarin:
1 ❏ is indicated in women with an intact uterus
2 ❏ may be used for prophylaxis of osteoporosis
3 ❏ is marketed by Wyeth
A ❏ 1, 2, 3
B ❏ 1, 2 only
C ❏ 2, 3 only
D ❏ 1 only
E ❏ 3 only
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Q84 An equivalent product to Premarin is:
A ❏ Nuvelle
B ❏ Progynova
C ❏ Trisequens
D ❏ Prempak-C
E ❏ Femoston
Q85 The patient should:
1 ❏ take one Premarin tablet daily
2 ❏ take tablets for 28 days followed by a 7-day break before
starting the next pack
3 ❏ undertake regular visits to a general practitioner every 15
days
A ❏ 1, 2, 3
B ❏ 1, 2 only
C ❏ 2, 3 only
D ❏ 1 only
E ❏ 3 only
Questions 86–87: Use the prescription below:
Patient’s name .........................................................................
Fosamax tablets
70 mg once per week
Doctor’s signature .........................................................................
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Q86 Fosamax:
A ❏ contains disodium etidronate
B ❏ increases rate of bone turnover
C ❏ may cause dysphagia
D ❏ can impair bone mineralisation
E ❏ acts as a posterior pituitary hormone antagonist
Q87 Fosamax:
1 ❏ a weekly treatment costs about £6
2 ❏ is available only as 5 mg tablets
3 ❏ the patient has to take three tablets weekly
A ❏ 1, 2, 3
B ❏ 1, 2 only
C ❏ 2, 3 only
D ❏ 1 only
E ❏ 3 only
Questions 88–90: Use the prescription below:
Patient’s name .........................................................................
Combivent
2 puffs qds
Doctor’s signature .........................................................................
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Q88 Combivent consists of:
1 ❏ ipratropium
2 ❏ salbutamol
3 ❏ salmeterol
A ❏ 1, 2, 3
B ❏ 1, 2 only
C ❏ 2, 3 only
D ❏ 1 only
E ❏ 3 only
Q89 Combivent is available as:
1 ❏ dry powder for inhalation
2 ❏ a nebuliser solution
3 ❏ an aerosol inhalation
A ❏ 1, 2, 3
B ❏ 1, 2 only
C ❏ 2, 3 only
D ❏ 1 only
E ❏ 3 only
Q90 Combivent is not available. Which of the following products could be
recommended to replace Combivent?
1 ❏ Ventolin
2 ❏ Atrovent
3 ❏ Becotide
A ❏ 1, 2, 3
B ❏ 1, 2 only
C ❏ 2, 3 only
D ❏ 1 only
E ❏ 3 only
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Questions 91–92: Use the prescription below:
Q91 Depo-Medrone:
1 ❏ consists of methylprednisolone
2 ❏ is used to suppress an allergic reaction
3 ❏ may be used in rheumatic disease
A ❏ 1, 2, 3
B ❏ 1, 2 only
C ❏ 2, 3 only
D ❏ 1 only
E ❏ 3 only
Q92 Depo-Medrone:
1 ❏ is administered parenterally
2 ❏ may be administered twice daily
3 ❏ is highly likely to cause cerebral oedema
A ❏ 1, 2, 3
B ❏ 1, 2 only
C ❏ 2, 3 only
D ❏ 1 only
E ❏ 3 only
Patient’s name .........................................................................
Depo-Medrone
m 1
Doctor’s signature .........................................................................
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Questions 93–96: Use the prescription below:
Q93 Persantin Retard is an:
A ❏ anticoagulant
B ❏ antiplatelet
C ❏ analgesic
D ❏ antihypertensive
E ❏ anti-arrhythmic drug
Q94 The side-effects that could occur with Persantin Retard include:
1 ❏ gastrointestinal effects
2 ❏ worsening of symptoms of coronary heart disease
3 ❏ hot flushes
A ❏ 1, 2, 3
B ❏ 1, 2 only
C ❏ 2, 3 only
D ❏ 1 only
E ❏ 3 only
Patient’s name .........................................................................
Persantin Retard
1 bd m 60
Aspirin 75 mg
1 daily m 60
Doctor’s signature .........................................................................
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Q95 The pharmacist should dispense Persantin Retard in its original container
because:
A ❏ the pack also includes aspirin
B ❏ the original pack is better labelled
C ❏ such dispensing saves time in counting capsules
D ❏ the original pack contains a dessicant
E ❏ it is a controlled drug
Q96 Regarding the Persantin Retard, the patient is instructed to:
A ❏ take two capsules together at breakfast
B ❏ discard any capsules remaining 6 weeks after opening
C ❏ double the dose before undergoing surgery
D ❏ abstain from driving when taking these medications
E ❏ keep the medicines prescribed in a refrigerator
Questions 97–100: For each question read the patient request:
Q97 A parent requests a multivitamin preparation for a 6-year-old child.
Which product could be recommended?
A ❏ Forceval
B ❏ Vivioptal
C ❏ Maxepa
D ❏ En-De-Kay
E ❏ Calcium-Sandoz
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Q98 A mother requests a preparation for her 5-year-old son for a chesty
cough. Which of the following products is the most appropriate?
A ❏ Benylin with Codeine syrup
B ❏ Alupent syrup
C ❏ Actifed Chesty Coughs syrup
D ❏ Vicks Medinite syrup
E ❏ Neoclarityn syrup
Q99 A patient asks for ibuprofen gel. The pharmacist may dispense:
A ❏ Oruvail
B ❏ Voltarol
C ❏ Dubam
D ❏ Brufen
E ❏ Ibutop
Q100 A patient asks for a preparation as a vaginal cream for candidiasis.
Which product is the most appropriate?
A ❏ Canesten
B ❏ Ortho-Gynest
C ❏ Eurax
D ❏ Bactroban
E ❏ Dermovate
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Test 1
Answers
A1 B
Diamox contains acetazolamide, which is a carbonic anhydrase inhibitor
administered orally or by the parenteral route. Xalatan contains latanoprost,
a prostaglandin analogue, and Trusopt contains dorzolamide, a carbonic
anhydrase inhibitor. Timoptol and Betoptic both consist of beta-blockers
containing timolol and betaxolol respectively.
A2 B
Lipitor contains atorvastatin. An alternative preparation is Lescol, which
contains another statin, fluvastatin. Cozaar contains losartan, an angiotensinII receptor antagonist, Zestril contains lisinopril, an angiotensin-converting
enzyme inhibitor, Cardura contains doxazosin, an alpha-adrenoceptor
blocking drug, and Trandate contains labetalol, a beta-adrenoceptor blocking
drug.
A3 A
Tambocor contains flecainide, which may be of value in serious symptomatic
ventricular arrhythmias. It is also indicated for junctional re-entry tachycardias
and for paroxysmal atrial fibrillation. It is available as tablets or injections for
intravenous administration. Hazardous interactions may be expected when
flecainide is administered concurrently with drugs such as amiodarone,
tricyclic antidepressants, terfenadine, ritonavir, dolasetron, clozapine, verapamil, and with beta-blockers. Amiodarone is a drug that is also indicated in
the treatment of arrhythmias. An example of a proprietary name for amiodarone is Cordarone X.
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A4 C
Terazosin is a selective alpha-blocker that relaxes smooth muscle and is indicated in benign prostatic hyperplasia because it increases urinary flow rate
and improves obstructive symptoms. Terazosin is also indicated in the management of mild-to-moderate hypertension. After the first dose a rapid reduction
in blood pressure may occur.
A5 D
Legionnaires’ disease is an acute respiratory tract infection caused by a
Gram-negative bacillus of the Legionella species. It is characterised by the
development of pneumonia. The incubation period is from 2 to 10 days. The
condition is attributed to the inhalation of water droplets, such as from water
generated in air-conditioning cooling systems and in hot-water systems, that
are contaminated with the microorganism. Prevention techniques are based
on the maintenance of air-conditioning filters and water systems.
A6 D
Trigger factors for migraine include intake of specific food such as caffeine,
chocolate, cheese and alcoholic drinks, exposure to light, hunger and missed
meals, and air travel.
A7 D
Anthisan contains mepyramine, an antihistamine. Dequacaine contains benzocaine and dequalinium, Merocaine contains benzocaine and cetylpyridinium,
BurnEze contains benzocaine, and Proctosedyl contains cinchocaine and
hydrocortisone. Benzocaine and cinchocaine are anaesthetics.
A8 A
During the FIP congress in Japan in 1993 the international guidelines for Good
Pharmacy Practice (GPP) were adopted. A revised version of these guidelines,
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Standards for Quality of Pharmacy Services, was endorsed during the 35th
meeting of the World Health Organization’s Expert Committee on Specifications for Pharmaceutical Preparations in April 1997 and this was approved
by the FIP Congress in Vancouver in 1997.
A9 C
Anti-D(Rh0) immunoglobulin should be administered immediately or within
72 h of any sensitising episode during abortion, miscarriage or giving birth
to a rhesus-positive foetus. It prevents a rhesus-negative mother from forming
antibodies to rhesus-positive cells that may pass into the maternal circulation.
It is intended to protect any subsequent child from haemolytic disease. It is
available as an injection.
A10 E
Buscopan contains hyoscine, which is a quaternary ammonium compound
having antimuscarinic activity. It is indicated for symptomatic relief of gastrointestinal or genitourinary disorders characterised by smooth muscle spasm.
Zantac contains ranitidine, which is an H2-receptor antagonist that promotes
healing of peptic ulcers by reducing gastric output as a result of histamine H2-
receptor blockade. Nexium contains esomeprazole and Pariet contains
rabeprazole, both of which are proton pump inhibitors. The proton pump
inhibitors inhibit gastric acid output by blocking the hydrogen–potassium–
adenosine triphosphatase enzyme system of the gastric parietal cells. Gaviscon
is an antacid preparation that can be used for the management of symptoms
of peptic ulceration. The constitution of Gaviscon preparations varies according to dosage forms. Gaviscon tablets contain alginic acid, dried aluminium
hydroxide, magnesium trisilicate and sodium bicarbonate, whereas Gaviscon
liquid contains sodium alginate, sodium bicarbonate and calcium carbonate.
A11 D
Famvir is a proprietary preparation of famciclovir (used for the treatment of
herpes virus infections).
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A12 C
Sporanox is a proprietary preparation of itraconazole (triazole antifungal).
A13 E
Lamisil is a proprietary preparation of terbinafine (antifungal).
A14 E
Amphotericin is active against most fungi and yeasts. It can be used for intestinal candidiasis.
A15 C
Both levofloxacin and ciprofloxacin are quinolones. Levofloxacin has greater
activity against pneumococci than ciprofloxacin.
A16 C
Tavanic is a proprietary preparation of levofloxacin.
A17 A
Nalidixic acid is a quinolone that is indicated only for urinary tract infections.
A18 A
Atenolol is a beta-adrenoceptor blocker that, when administered during
pregnancy, may cause intrauterine growth restriction, neonatal hypoglycaemia
and bradycardia.
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A19 D
Carbamazepine is an anti-epileptic drug that, when administered during the
first trimester of pregnancy, increases the risk of teratogenesis, including an
increased risk of neural tube defects. To counteract the risk of neural tube
defects, adequate folate supplements are advised before and during
pregnancy. Administration of carbamazepine during the third trimester may
cause vitamin K deficiency and increase the risk of neonatal bleeding.
A20 C
Imipramine is a tricyclic antidepressant that, when administered during the
third trimester, may cause tachycardia, irritability and muscle spasms in the
neonate.
A21 B
The maximum daily dose for diclofenac, a non-steroidal anti-inflammatory
drug, is 150 mg.
A22 C
The maximum daily dose for sildenafil, a phosphodiesterase type-5 inhibitor,
is 100 mg.
A23 E
The maximum daily dose for sumatriptan, a 5HT1-agonist, is 300 mg.
A24 D
Chlorpromazine is an antipsychotic drug, specifically a phenothiazine derivative, that is characterised by pronounced sedative effects. Cautionary labels
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recommended are to avoid exposure of skin to direct sunlight or sun lamps
and a warning that it may cause drowsiness and, if affected, not to drive or
operate machinery and to avoid alcoholic drinks.
A25 E
Dapsone is an anti-leprotic drug. It is also used in malaria prophylaxis and in
dermatitis herpetiformis. The cautionary label ‘Do not stop taking this medicine
except on your doctor’s advice’ is recommended. This label is recommended
for use on preparations that contain a drug which has to be taken over long
periods without the patient perceiving any benefit, or for a drug where withdrawal is likely to present a particular hazard. In the management of leprosy,
dapsone may be used in combination with other drugs and treatment is usually
for a few months. Withdrawal of dapsone therapy in skin conditions may be
associated with sudden flare-ups.
A26 C
Warfarin is an oral anticoagulant. The cautionary label ‘Follow the printed
instructions you have been given with this medicine’ is recommended. An
appropriate treatment card should be given to the patient where advice on
anticoagulant therapy, necessity of monitoring and precautions are presented.
A27 E
Alupent, which contains orciprenaline, an adrenoceptor agonist, is available
as a syrup.
A28 C
Atrovent, which contains ipratropium, an antimuscarinic bronchodilator, is
available as an aerosol for inhalation, as a nebuliser solution, and as dry
powder for inhalation.
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A29 A
AeroChamber is a proprietary name for a spacer device. It is a large spacer
with a one-way valve. Spacer devices eliminate the disadvantage associated
with metered-dose inhalers, where drug administration may be compromised
due to lack of coordination between actuation of the inhaler and inhalation.
A30 D
Beconase, which contains beclometasone, a corticosteroid, is available as a
nasal spray.
A31 C
Klaricid, which contains clarithromycin, a macrolide antibacterial agent, is
available as yellow tablets in 250 mg and 500 mg strengths.
A32 A
Diovan, which contains valsartan, an angiotensin-II receptor antagonist, is
available as yellow tablets 40 mg.
A33 B
Warfarin, an oral anticoagulant, is available as brown tablets at 1 mg
strength. Warfarin is also available as tablets in other colours in the 0.5 mg,
3 mg and 5 mg strengths.
A34 E
Zomig, which contains zolmitriptan, a 5HT1-agonist, is available as yellow
tablets of 2.5 mg.
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A35 B
Cisplatin is a platinum compound that is used alone or in combination therapy
for the treatment of testicular, lung, cervical, bladder, head and neck and
ovarian cancer. It is administered intravenously and is available as powder
for injection. The powder formulation should be reconstituted with water for
injections to produce a 1 mg/mL solution. Subsequently it is diluted into 2 L
sodium chloride 0.9% or sodium chloride and glucose solution. The infusion
is given over 6–8 h.
A36 D
Ceftazidime is a ‘third-generation’ cephalosporin antibacterial agent. It has
greater activity than cefuroxime against certain Gram-negative bacteria and
less activity against Gram-positive bacteria. Ceftazidime is administered by
deep intramuscular injection or intravenous injection or infusion. It is not available as tablets.
A37 B
Both ergotamine and zolmitriptan are indicated for migraine attacks. When
ergotamine and zolmitriptan are administered concurrently there is an
increased risk of vasospasm. Use of ergotamine should be avoided for 6 h
after administration of zolmitriptan, and use of zolmitriptan should be avoided
for 24 h after administration of ergotamine. This reaction could be potentially
hazardous. When warfarin is administered to a patient receiving a sulphonylurea such as gliclazide, this could enhance the hypoglycaemic effect and may
also result in changes in the anticoagulant effect. There is no evidence of a
potentially hazardous interaction when clindamycin is administered to patients
receiving combined oral contraceptives.
A38 B
Griseofulvin and rifampicin are enzyme inducers. They can increase the rate
of synthesis of cytochrome P450 enzymes, resulting in enhanced clearance of
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other drugs. When enzyme inducers are administered to patients receiving
warfarin, a decreased effect of warfarin results. However, warfarin itself is not
known to be an enzyme inducer.
A39 E
Zyloric contains allopurinol, which requires dose-reduction in patients with liver
disease. Natrilix contains indapamide, a thiazide diuretic that should be
avoided in severe liver disease. Nizoral contains ketoconazole, an antifungal
agent that should be avoided in liver disease.
A40 A
Capsulitis is a disorder affecting the shoulder joint. It may be caused by unaccustomed movement or overuse. The condition is characterised by inflammation of the fibrous tissue surrounding the shoulder joint.
A41 B
Any facial lesion that is accompanied by swollen lymph glands in the neck
requires referral as this suggests systemic disease or an infection. A rash that
presents as a butterfly distribution over the nose and cheeks requires referral
as this could be caused by systemic lupus erythematosus. This is a rare
condition that is associated with auto-antibody formation. A butterfly rash
covering the nose and cheeks is a very characteristic symptom. A scaly rash
with mild erythema affecting the forehead and eyebrows indicates seborrhoeic
eczema. This condition can extend to the nose and pinna of ears. Emollient
creams and ointments are useful in the management of this condition as they
hydrate the skin.
A42 B
Gaviscon liquid and Bisodol Heartburn Relief tablets contain sodium bicarbonate. Gaviscon liquid also contains sodium alginate and calcium carbonate.
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Bisodol Heartburn Relief tablets contain alginic acid and magaldrate in
addition to the sodium bicarbonate. Maalox Plus tablets contain aluminium
hydroxide, magnesium hydroxide and simeticone.
A43 A
The pain and inflammation associated with a bee sting are caused by agents
that include histamine, apamin, which is neurotoxic, and the enzyme
hyaluronidase, which breaks down the intercellular tissue structure, promoting
the penetration of the venom into the human tissues.
A44 B
Colofac (mebeverine) and Spasmonal (alverine) contain an antispasmodic
agent, whereas Fybogel (ispaghula husk) presents a bulk-forming laxative.
Alverine and mebeverine are direct relaxants of intestinal smooth muscle,
which may relieve pain in irritable bowel syndrome.
A45 E
Paradichlorobenzene is an organic compound that is included in products,
such as Cerumol drops, which are intended for ear wax removal. The rationale
for its inclusion is based on the ability of paradichlorobenzene to penetrate
the ear wax plugs. In Cerumol it is available with chlorobutanol and arachis
oil.
A46 B
Because of its antiplatelet effect, the administration of aspirin to patients receiving warfarin is associated with a potentiated anticoagulant effect leading to
an increased risk of bleeding. Aspirin decreases platelet aggregation by
inactivating cyclo-oxygenase, an enzyme involved in the platelet aggregation
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pathway through the interference with thromboxane A2. Vitamin K is required
for the procoagulation activity. Aspirin does not interfere with vitamin K synthesis. However warfarin, which is an oral anticoagulant, acts as a vitamin K
antagonist.
A47 D
Male-pattern baldness is also referred to as androgenetic alopecia. It occurs
when genetically predisposed hair follicles in the scalp respond to stimulation
by circulating androgens.
A48 A
Finasteride is an inhibitor of the enzyme 5 -reductase, which is responsible
for the metabolism of testosterone into the androgen dihydrotestosterone.
Finasteride is used in benign prostatic hyperplasia and at a lower dose in
male-pattern baldness.
A49 A
Diamorphine is an opioid drug, which in many countries is classified as a
‘controlled drug’, indicating that special prescription and dispensing requirements are necessary. Diamorphine is more lipid soluble than morphine and
this allows for effective doses to be injected in smaller volumes. Diamorphine
may be administered by mouth, subcutaneously, intramuscularly or by intravenous injection.
A50 A
The three drugs are used in the management of nausea and vomiting caused
by palliative cancer treatment, which commonly features cytotoxics and opioid
drugs. The three drugs are useful in counteracting nausea and vomiting
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induced by opioids and cytotoxic agents. Haloperidol is also used in palliative care to counteract nausea and vomiting attributable to chemical causes
such as hypercalcaemia and renal failure.
A51 D
Bacterial conjunctivitis is an eye disorder characterised by inflammation of the
conjunctiva caused by a bacterial infection. A common microorganism associated with this condition is Staphylococcus aureus. The condition does not
necessarily affect both eyes. However, infection can be spread from one eye
to the other. The patient complains of itchiness or grittiness on the surface of
the eye but this is differentiated from pain.
A52 E
Wet skin lesions or weeping lesions may or may not be infected. Referral is
not always warranted. It is recommended to refer when the lesion is presenting purulent discharge, which indicates an infective component. When the
exudate is clear and watery, the patient may be advised to undertake potassium permanganate soaks to cleanse the lesion.
A53 D
Infant formula milk preparations are manufactured to mimic as much as
possible the composition of the mother’s milk. Most preparations are based
on cow’s milk, and modifications, such as the addition of carbohydrates, are
made to achieve the formula. The fat content of infant formula milk is adjusted
to be similar to mother’s milk. Some preparations may substitute cow’s milk fat
with vegetable and animal fats that are more easily digested. Infant formula
milk preparations may be presented as ready-to-use preparations or as
powders for reconstitution. Dried milk formulations should be reconstituted
according to the manufacturer’s instructions and involve adding water to the
powder formulation.
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A54 C
Staphylococcal napkin dermatitis is a condition where a rash develops in the
napkin area. A rash that has a pustular appearance, as opposed to a confluent red rash, which is associated with napkin dermatitis, indicates a
bacterial infection caused by the Staphylococcus species. A patient presenting such symptoms should be referred as antibacterial treatment may be indicated. Candidal napkin dermatitis, where infection of the napkin area with
Candida species occurs, is associated with oral thrush (candidiasis).
A55 C
Sialolithiasis is a condition characterised by the formation of calculi (salivary
stones) in the salivary ducts or salivary glands. This leads to obstruction and
hence accumulation of saliva within the gland especially when eating. The
patient presents with facial pain and swelling, which may last for a few hours.
A56 A
A history or suspicion of a perforated ear drum requires referral for assessment of the damage and treatment of the condition through systemic drug
administration. Discharge may reflect an infective component such as in otitis
media and infective dermatitis. Earache generally occurs with otitis media and
requires referral for diagnosis.
A57 B
Enquiry whether the symptoms are related to food intake patterns confirms that
the origin of discomfort is in the gastrointestinal tract. Vomiting or constipation
with indigestion warrant referral because the clinical presentation may
indicate obstruction in the gastrointestinal tract.
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A58 A
Products containing adsorbents such as kaolin are not recommended for acute
diarrhoea. Adsorption may interfere with the absorption of other drugs from
the intestine. Oral rehydration therapy should be considered to be the first-line
treatment in acute diarrhoea. Kaolin and Morphine Mixture is an oral suspension that contains 4% chloroform and morphine tincture. Absorption of
morphine after oral administration of Kaolin and Morphine may be reduced
because it may become adsorbed to the kaolin.
A59 C
Meggezones pastilles contain menthol. They provide a soothing effect for sore
throats through the promotion of saliva secretion. The preparation contains
glucose as excipients and therefore should not be recommended to diabetic
patients.
A60 A
In migraine gastric motility is reduced and this may compromise drug absorption. Soluble oral drug formulations are preferred to solid oral dosage forms
because absorption is faster. Analgesics should be taken at the first sign of
an attack. Syndol contains paracetamol (non-opioid drug), caffeine, codeine
(opioid drug) and doxylamine (antihistamine). Syndol presents a compound
analgesic that also contains caffeine, which is a weak stimulant claimed to
enhance the analgesic effect, and a sedating antihistamine that confers antiemetic activity.
A61 B
Hydroxychloroquine and gold are examples of disease-modifying
antirheumatic drugs that can be used in the management of rheumatoid arthritis. Hydroxychloroquine is better tolerated than gold. Gold is associated with
severe skin reactions and blood disorders, which could be sudden and fatal.
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A62 B
Porphyrias are a group of rare disorders that are characterised by a disturbed
metabolism of porphyrin, which contributes to the formation of the ironcontaining complex, haem. Attacks may be precipitated by drug administration. Progestogens are porphyrinogenic and should be avoided in patients
with porphyria.
A63 B
Goserelin is a gonadorelin analogue that can be used in prostate cancer.
During the initial weeks of treatment with gonadorelin analogues, increased
production of testosterone may result in the progression of prostate cancer
(tumour ‘flare’). This stage may present with increased bone pain, back pain
caused by spinal cord compression, and ureteric obstruction.
A64 D
Tacrolimus and ciclosporin are immunosuppressants. Tacrolimus is a fungal
macrolide and has a different chemical structure to ciclosporin. However, it
has a similar mode of action.
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A65 C
Imipramine is a tricylic antidepressant and, as with all types of antidepressants, hyponatraemia may occur in older people. This is possibly due to
inappropriate secretion of antidiuretic hormone.
A66 E
Inflammation of the larynx (laryngitis) is usually due to a bacterial or viral infection and is a very common condition after a common cold. When the cause
of laryngitis is a bacterial infection, an antibacterial agent may be appropriate. Atropine is an antimuscarinic drug that can be used in the symptomatic
relief of gastrointestinal disorders characterised by smooth muscle spasm, in
mydriasis and cycloplegia, for the reversal of bradycardia, and in cardiopulmonary resuscitation.
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A67 A
Lidocaine is indicated for ventricular arrhythmias, especially after myocardial
infarction, because it suppresses ventricular tachycardia and reduces the risk
of ventricular fibrillation.
A68 A
In moderate kidney damage, the dose of atenolol should be reduced. Atenolol
is a highly water-soluble drug that is excreted by the kidneys. Hence it may
accumulate in the body to a greater extent than propranolol, which is predominantly excreted by the liver.
A69 C
Filgrastim is indicated for the reduction in duration of neutropenia as a result
of cytotoxic chemotherapy. Filgrastim is a recombinant human granulocytecolony stimulating factor (G-CSF).
A70 E
When drugs are administered to breast-feeding mothers, the concentration of
some drugs in milk may exceed the concentration in maternal plasma. Therapeutic doses in the mother may result in toxic doses in the milk. Toxicity in the
infant depends on the drug and on the amount of drug in the milk.
A71 C
Pemphigus is a skin condition characterised by severe and chronic blistering,
which is attributed to an autoimmune reaction. Oral corticosteroids are the
first-line treatment. Immunosuppressants are considered either when optimum
management is not achieved with oral corticosteroids or when corticosteroids
are not tolerated or the dose has to be decreased.
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A72 D
Ear pain during air travel when the aircraft is descending occurs when the
eustachian tube, which normally equalises the pressure, is blocked and
pressure inside the middle ear is less than on the outside (barotrauma). The
tympanic membrane is sucked and may rupture. Nasal decongestants may be
used to prevent eustachian tube blockage hence preventing barotrauma.
A73 C
Stelazine contains trifluoperazine, a phenothiazine. It may cause pancytopenia, which includes agranulocytosis. Agranulocytosis is a condition resulting in a marked decrease in the number of granulocytes.
A74 C
Tinnitus is an adverse effect of furosemide, especially when it is administered
in large parenteral doses, as a rapid administration and in renal impairment.
Not all diuretics are associated with tinnitus.
A75 B
Increased serotonergic effects have been reported when St John’s wort is given
with selective serotonin re-uptake inhibitors (SSRIs). Concomitant use should
be avoided. Sertraline is an SSRI. St John’s wort is a herbal remedy that can
be used for mild depression.
A76 E
Co-codamol preparations, which may be sold to the public as over-the-counter
medicines, contain codeine 8 mg. Co-codamol is a combination of codeine
(opioid drug) and paracetamol.
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A77 C
Varicella (chickenpox) is an infection caused by the varicella zoster virus,
which in the acute phase is highly contagious. It is transmitted via airborne
droplets or by contact with active lesions. Varicella zoster immunoglobulin is
available for prophylaxis for individuals who are at increased risk of severe
varicella or who have significant exposure to chickenpox or herpes zoster.
A78 D
Graduated compression hosiery is in some cases recommended during pregnancy against the varicosis that may result. Compression with graduated
hosiery allows haemostasis to occur and therefore reduces oedema and
swelling.
A79 D
Nocturnal enuresis is persistent involuntary urination during sleep and it is a
common condition in young children. Drug treatment is not appropriate in
children under 5 years of age and it is usually not needed in those under 7
years. Psychotherapy and enuresis alarms may be used. Enuresis alarms
should be first-line treatment for well-motivated children aged over 7 years
because their use may achieve a more sustained reduction of enuresis than
the use of drugs. Tricyclic antidepressants such as amitriptyline, imipramine
and less often, nortriptyline may be used in nocturnal enuresis. However,
relapse is common after drug withdrawal.
A80 D
Betahistine is an analogue of histamine and is indicated for vertigo, tinnitus
and hearing loss associated with Ménière’s disease. Side-effects of betahistine
include gastrointestinal disturbances, headache, rashes and pruritus.
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A81 A
Premarin is an example of a product that presents hormone replacement
therapy and contains conjugated oestrogens 625 μg.
A82 E
Premarin is also available as tablets of 1.25 mg conjugated oestrogens and
as a vaginal cream, which contains 625 μg/g conjugated oestrogens.
A83 C
Premarin is not indicated in women with intact uterus because it does not
present cyclical or continuous administration of progestogen. In women with
intact uterus, the administration of progestogen for at least 12 days per month
reduces the risk of endometrial cancer. Hormone replacement therapy (HRT)
is an option for the prophylaxis of osteoporosis and Premarin may be used
for this purpose. However, guidelines in a number of countries advise that HRT
should not be considered as first-line therapy for the long-term prevention of
osteoporosis in women over 50 years of age. Premarin is marketed by Wyeth.
A84 B
Progynova is another product that presents an oestrogen component only and
therefore is indicated in women without intact uterus. It contains estradiol
valerate. Nuvelle, Trisequens and Femoston are examples of products containing estradiol with progestogen, whereas Prempak-C is an example of a
product that contains conjugated oestrogens with progestogen.
A85 D
Patient should take one Premarin tablet daily and start a new pack once the
28-day pack has finished. The therapy is continuous and there is no 7-day
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break. Patient should be advised to maintain regular visits to a general
practitioner every 12 months but should be advised to seek advice from the
pharmacist or the general practitioner should any symptoms that warrant withdrawal of the HRT occur. Such symptoms include sudden, severe chest pain,
sudden breathlessness or cough with blood-stained sputum, unexplained
severe pain in the calf of one leg, severe stomach pain, serious neurological
effects including unusually severe, prolonged headache and blood pressure
above systolic 160 mmHg and diastolic 100 mmHg.
A86 C
Fosamax contains alendronic acid, a biphosphonate that is adsorbed onto
hydroxyapatite crystals in the bone resulting in a deceleration in the rate of
growth and dissolution of the bone. Use of alendronic acid therefore results
in a decreased rate of bone turnover. Alendronic acid may cause oesophageal
reactions and patients should be advised to seek advice if they develop
symptoms of oesophageal irritation such as dysphagia.
A87 D
Fosamax Once Weekly is available as a pack containing four tablets of 70 mg
strength at a price of £22.80. At this dosage regimen, weekly treatment costs
about £6. Fosamax tablets are available in 5 mg, 10 mg and 70 mg
strengths. The patient has been prescribed one 70 mg tablet once a week.
A88 B
Combivent contains ipratropium (antimuscarinic bronchodilator) and salbutamol (selective beta2 agonist).
A89 C
Combivent is available as an aerosol inhalation and as a nebuliser solution.
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A90 B
Ventolin contains salbutamol and Atrovent contains ipratropium. The two
products can be used together to replace the combination product Combivent.
Becotide contains beclometasone (corticosteroid).
A91 A
Depo-Medrone consists of methylprednisolone (corticosteroid), which is used
for the suppression of inflammatory and allergic disorders and in rheumatic
disease.
A92 D
Depo-Medrone is presented as an aqueous suspension that can be administered either by deep intramuscular injection into the gluteal muscle or by intraarticular or intrasynovial injection for rheumatic disease. Administration can
be repeated after 2–3 weeks or, for rheumatic disease, at intervals of 7–35
days. Corticosteroids, including methylprednisolone, can be used in the
management of raised intracranial pressure or in cerebral oedema resulting
from malignancy.
A93 B
Persantin Retard contains dipyridamole which, like aspirin, is an antiplatelet
drug.
A94 A
Side-effects of dipyridamole include gastrointestinal effects, worsening of
symptoms of coronary heart disease and hot flushes.
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A95 D
The original pack of Persantin Retard contains a dessicant that protects the
modified-release capsules.
A96 B
The patient should be advised to take one capsule of Persantin Retard twice
daily with food and to take one tablet of aspirin daily. Persantin Retard
capsules are unstable in humid conditions, so the patient should be advised
to open one pack and to use the capsules before opening another pack. If
any capsules remain 6 weeks after opening a pack, they should be discarded.
A97 A
Forceval is a multivitamin preparation, which is available as adult and paediatric formulations (Forceval Junior capsules). Vivioptal is also a multivitamin
preparation. It is presented for children over 12 years of age and for adults.
Maxepa consists of a fish-oil preparation rich in omega-3-marine triglycerides,
En-De-Kay presents a fluoride supplement whereas Calcium-Sandoz contains
calcium salts.
A98 C
Actifed Chesty Coughs syrup contains guaifenesin (expectorant), pseudoephedrine (decongestant) and triprolidine (antihistamine). Benylin with
Codeine syrup contains codeine (antitussive), diphenhydramine (antihistamine)
and menthol. Alupent syrup contains orciprenaline, an adrenoceptor agonist
indicated for reversible airways obstruction. Vicks Medinite syrup contains
dextromethorphan (antitussive), doxylamine (antihistamine), ephedrine (decongestant) and paracetamol (analgesic and anti-pyretic). Vicks Medinite is not
recommended for children under 10 years of age. Neoclarityn syrup contains
desloratidine, a non-sedating antihistamine.
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A99 E
Ibutop gel contains ibuprofen. Brufen contains ibuprofen but the dosage forms
available are tablets, syrup and effervescent granules. Voltarol (diclofenac)
and Oruvail (ketoprofen) present other non-steroidal anti-inflammatory drugs
in the form of gels. Dubam products contain rubefacients.
A100 A
Canesten is presented as a vaginal cream, which contains clotrimazole, an
imidazole antifungal agent that is indicated in vaginal candidiasis. OrthoGynest is presented as an intravaginal cream that contains estriol and which
is indicated as a topical hormone replacement therapy. Eurax contains crotamiton, an anti-pruritic, Bactroban contains mupirocin, an antibacterial agent, and
Dermovate contains clobetasol, a corticosteroid