PSI Pharmacy Registration Assessment Ireland — Questions and Answers

Question 1: The 'tall man lettering' convention (e.g., hydrOXYzine vs hydrALAzine) is used to prevent:

CD misuse
Look-alike/sound-alike (LASA) drug name errors (Correct answer)
Labelling omissions
Generic substitution errors

Correct answer: Look-alike/sound-alike (LASA) drug name errors

Tall man lettering highlights the differing portions of LASA drug names to reduce visual confusion during dispensing. It is endorsed by ISMP and international patient safety organisations.

Question 2: What measures should a pharmacy implement to prevent dispensing errors?

Separate LASA products, use barcode scanning, implement independent double-checking, maintain adequate staffing, reduce interruptions during dispensing, and report all near misses (Correct answer)
Only rely on the pharmacist's memory and experience
Remove all safety checks to improve efficiency
Speed up dispensing to reduce waiting times

Correct answer: Separate LASA products, use barcode scanning, implement independent double-checking, maintain adequate staffing, reduce interruptions during dispensing, and report all near misses

Error prevention requires multiple strategies: physical separation of similar products, barcode verification technology, mandatory independent final checks, appropriate staffing levels, a quiet dispensing environment, standard operating procedures, near-miss reporting, and a positive safety culture.

Question 3: What is antimicrobial stewardship and why is it important for pharmacists?

Only prescribing the newest antibiotics available
Selling as many antibiotics as possible
A systematic approach to optimising antibiotic use by ensuring the right drug, dose, and duration to improve outcomes and reduce antimicrobial resistance (Correct answer)
Keeping antibiotics in stock at all times

Correct answer: A systematic approach to optimising antibiotic use by ensuring the right drug, dose, and duration to improve outcomes and reduce antimicrobial resistance

Antimicrobial stewardship involves selecting the optimal antibiotic, dose, and duration of therapy to maximise clinical cure while minimising side effects and the development of antimicrobial resistance. Pharmacists play a key role in reviewing prescriptions, advising prescribers, and educating patients.

Question 4: Under Irish law, who can own and operate a pharmacy?

Only the HSE can operate pharmacies
Anyone can own a pharmacy without qualifications
Only doctors can own pharmacies
A registered pharmacist, a partnership where all partners are registered pharmacists, or a company where the superintendent pharmacist is responsible for the professional aspects (Correct answer)

Correct answer: A registered pharmacist, a partnership where all partners are registered pharmacists, or a company where the superintendent pharmacist is responsible for the professional aspects

The Pharmacy Act 2007 permits pharmacy ownership by registered pharmacists, partnerships of pharmacists, or registered pharmacy businesses. Every pharmacy must have a superintendent pharmacist who takes professional responsibility, and a supervising pharmacist must be present during opening hours.

Question 5: What is the correct sequence of steps in the dispensing process?

Label first → clinical check → dispense
Receive prescription → clinical check → label → dispense → accuracy check → counsel patient (Correct answer)
Clinical check → label → dispense → skip counselling
Dispense immediately → check → label

Correct answer: Receive prescription → clinical check → label → dispense → accuracy check → counsel patient

The standard dispensing process: receive and validate the prescription, perform a clinical check, generate a label, select and dispense the product, accuracy check, then counsel the patient on proper use.

Question 6: A pharmacy receives a medicine at the wrong storage temperature during delivery. The pharmacist should:

Quarantine the product, refuse acceptance and raise a deviation report with the supplier/HPRA if needed (Correct answer)
Return to manufacturer later without reporting
Store in fridge immediately and dispense
Dispense as normal if it looks unchanged

Correct answer: Quarantine the product, refuse acceptance and raise a deviation report with the supplier/HPRA if needed

Cold-chain breaks compromise product quality. The pharmacist must quarantine the affected stock, refuse or document the deviation, contact the supplier and report significant cold-chain failures to the HPRA.

Question 7: A patient presents a forged prescription. The pharmacist's immediate obligation is to:

Retain the prescription, refuse to dispense and notify the relevant authorities (Correct answer)
Dispense but note the forgery
Return the prescription to the patient
Only document the incident internally

Correct answer: Retain the prescription, refuse to dispense and notify the relevant authorities

Prescription fraud is a criminal offence. The pharmacist should retain the prescription (do not return it), refuse to dispense, and report to Garda and the prescribing practice if appropriate.

Question 8: What counselling points should a pharmacist provide to a patient starting a statin (e.g., atorvastatin)?

No counselling is needed for statins
Take at the recommended time, report unexplained muscle pain, have liver function monitored, avoid grapefruit juice in large quantities, and understand it is for long-term use (Correct answer)
Only tell them to take it with food
Tell them to stop taking it if they feel fine after a month

Correct answer: Take at the recommended time, report unexplained muscle pain, have liver function monitored, avoid grapefruit juice in large quantities, and understand it is for long-term use

Key counselling points include: take consistently (some statins are best taken at night), report muscle pain/weakness (risk of rhabdomyolysis), baseline and follow-up liver function tests, avoid excessive grapefruit juice (CYP3A4 interaction with some statins), and emphasise long-term adherence.

Question 9: Which interaction between alcohol and benzodiazepines is clinically important?

Alcohol prevents benzodiazepine absorption
Alcohol reduces benzodiazepine effectiveness
No clinically relevant interaction
Additive CNS depression — combination causes excessive sedation and respiratory depression risk (Correct answer)

Correct answer: Additive CNS depression — combination causes excessive sedation and respiratory depression risk

Both alcohol and benzodiazepines are CNS depressants. Combined, they produce additive sedation, impaired coordination, and potentially fatal respiratory depression. Patients must avoid alcohol during benzodiazepine treatment.

Question 10: What is the pharmacist's role in smoking cessation in Ireland?

Only selling nicotine patches without advice
Providing advice, support, and nicotine replacement therapy (NRT) to patients who wish to quit smoking, including behavioural counselling and follow-up (Correct answer)
Referring all smokers to their GP without any intervention
Pharmacists have no role in smoking cessation

Correct answer: Providing advice, support, and nicotine replacement therapy (NRT) to patients who wish to quit smoking, including behavioural counselling and follow-up

Pharmacists are ideally placed for smoking cessation support through brief interventions, motivational counselling, supply of NRT products (patches, gum, lozenges, inhalers), and follow-up. The HSE QUIT programme works with community pharmacies to provide structured cessation services.

Question 11: Which OTC product is recommended for treating head lice in children?

Permethrin 1% cream rinse only
Lindane shampoo
Dimeticone 4% lotion (physical insecticide) applied for 8 hours (Correct answer)
Oral ivermectin OTC

Correct answer: Dimeticone 4% lotion (physical insecticide) applied for 8 hours

Dimeticone is a physical agent that coats and suffocates lice — resistance does not develop. It is preferred first-line in Ireland and the UK. Two applications 7 days apart are needed to kill newly hatched lice.

Question 12: Which parameter best describes the rate of drug elimination from the body?

Half-life (t½) (Correct answer)
Bioavailability
Protein binding
Volume of distribution

Correct answer: Half-life (t½)

Half-life is the time taken for plasma drug concentration to fall by 50%. It directly reflects the rate of elimination and determines dosing intervals.

Question 13: A mother asks for cough medicine for her 18-month-old child with a wet cough. The pharmacist should advise:

Antihistamine cough preparation is appropriate
Codeine linctus is safe for toddlers
OTC cough medicines should not be used in children under 6 years — advise honey (over 12 months) and fluids instead (Correct answer)
Give adult cough linctus at a reduced dose

Correct answer: OTC cough medicines should not be used in children under 6 years — advise honey (over 12 months) and fluids instead

In Ireland/UK, OTC cough and cold medicines are not recommended for children under 6 (some say under 12). Honey (not before 12 months) and adequate hydration are safe, evidence-supported alternatives.

Question 14: What ethical principle requires pharmacists to act in the best interest of the patient?

Autonomy — the right to make decisions independently
Beneficence — the duty to act in the patient's best interest and promote their welfare (Correct answer)
Justice — the fair distribution of resources
Non-maleficence — the duty to do no harm

Correct answer: Beneficence — the duty to act in the patient's best interest and promote their welfare

Beneficence is the ethical principle requiring healthcare professionals to act in the patient's best interest. For pharmacists, this means providing optimal pharmaceutical care, advocating for patients, and always prioritising patient welfare over commercial interests.

Question 15: Which ethical principle requires pharmacists to act in the best interest of the patient?

Beneficence (Correct answer)
Non-maleficence
Autonomy
Justice

Correct answer: Beneficence

Beneficence means actively doing good for the patient — the duty to promote health and wellbeing. It forms a core pillar of pharmacy ethics alongside non-maleficence, autonomy and justice.

Question 16: What is the mechanism of action of proton pump inhibitors (PPIs) such as omeprazole?

They speed up gastric emptying
They neutralise existing stomach acid
They coat the stomach lining to protect it
They irreversibly inhibit the hydrogen-potassium ATPase enzyme (proton pump) in gastric parietal cells, reducing gastric acid secretion (Correct answer)

Correct answer: They irreversibly inhibit the hydrogen-potassium ATPase enzyme (proton pump) in gastric parietal cells, reducing gastric acid secretion

PPIs work by irreversibly binding to the H+/K+-ATPase enzyme system (the proton pump) on the surface of gastric parietal cells. This blocks the final step of acid production, providing potent and long-lasting suppression of gastric acid secretion.

Question 17: Which drug is a direct oral anticoagulant (DOAC) that inhibits thrombin (factor IIa)?

Apixaban
Dabigatran (Correct answer)
Edoxaban
Rivaroxaban

Correct answer: Dabigatran

Dabigatran is a direct thrombin inhibitor. Its antidote is idarucizumab. The other DOACs listed inhibit factor Xa.

Question 18: How can pharmacists contribute to reducing health inequalities in Ireland?

Only by offering discounts on medicines
By only serving patients with medical cards
Health inequalities are not a pharmacy concern
By providing accessible healthcare services in all communities, offering health literacy support, promoting uptake of screening and vaccination, and adapting services for disadvantaged groups (Correct answer)

Correct answer: By providing accessible healthcare services in all communities, offering health literacy support, promoting uptake of screening and vaccination, and adapting services for disadvantaged groups

Pharmacies are often the most accessible healthcare setting in communities, particularly in disadvantaged areas. Pharmacists can reduce health inequalities through accessible services, culturally sensitive care, health literacy support, targeted health promotion, and advocacy for equitable healthcare access.

Question 19: What is the pharmacist's duty of confidentiality regarding patient information?

Confidentiality only applies to medical records, not verbal information
To protect all patient information and only disclose it with consent or when legally required, in accordance with GDPR and professional standards (Correct answer)
Patient information can be discussed freely with anyone
Confidentiality does not apply in community pharmacies

Correct answer: To protect all patient information and only disclose it with consent or when legally required, in accordance with GDPR and professional standards

Pharmacists have both a professional and legal duty to maintain patient confidentiality. Under GDPR and the Data Protection Act 2018, patient data must be processed lawfully, stored securely, and only shared with authorised persons for legitimate purposes. Breaches have serious professional and legal consequences.

Question 20: What is the role of inhaler technique review in managing asthma and COPD?

Inhaler technique does not affect treatment outcomes
Technique review is only needed when first prescribed
Poor inhaler technique is a major cause of treatment failure; pharmacists should assess and correct technique at every opportunity, as up to 90% of patients use inhalers incorrectly (Correct answer)
Only doctors should review inhaler technique

Correct answer: Poor inhaler technique is a major cause of treatment failure; pharmacists should assess and correct technique at every opportunity, as up to 90% of patients use inhalers incorrectly

Studies show that 50-90% of patients use their inhalers incorrectly, leading to poor disease control. Pharmacists should review inhaler technique at every dispensing opportunity, demonstrate correct use, observe the patient's technique, and correct any errors. A change of device may be needed.

Question 21: Which clinical question is most important when counselling a patient purchasing OTC omeprazole?

Have you had these symptoms before and have you seen your GP if they are new or persisting? (Correct answer)
Do you have a preference for capsule or tablet?
Are you vegetarian?
Are you over 18?

Correct answer: Have you had these symptoms before and have you seen your GP if they are new or persisting?

New or persistent dyspeptic symptoms — especially in patients over 55 — may indicate serious pathology (gastric cancer, oesophageal cancer). Pharmacists must screen for alarm features before recommending OTC PPIs.

Question 22: Digoxin toxicity is worsened by hypokalaemia because:

Low potassium increases renal digoxin excretion
Hypokalaemia reduces digoxin protein binding
Potassium competes with digoxin for the same binding site on Na+/K+ ATPase (Correct answer)
Digoxin shifts potassium out of cells

Correct answer: Potassium competes with digoxin for the same binding site on Na+/K+ ATPase

Potassium and digoxin bind competitively to Na+/K+ ATPase. When potassium is low, more binding sites are available for digoxin, increasing its inhibitory effect and risk of toxicity.

Question 23: Which drug interaction mechanism underlies the interaction between antacids and fluoroquinolone antibiotics?

Fluoroquinolones inhibit antacid neutralisation
Competition for protein binding
Antacids induce CYP enzymes
Chelation — antacid cations (Al3+, Mg2+) complex with fluoroquinolones reducing oral absorption (Correct answer)

Correct answer: Chelation — antacid cations (Al3+, Mg2+) complex with fluoroquinolones reducing oral absorption

Divalent and trivalent metal cations form insoluble chelates with fluoroquinolones (and tetracyclines), preventing absorption. Fluoroquinolones should be taken 2 hours before or 6 hours after antacids.

Question 24: A patient presents with symptoms of an uncomplicated urinary tract infection (UTI). What is the first-line recommended antibiotic treatment in Ireland?

Nitrofurantoin (modified release) for 3 days in non-pregnant women (Correct answer)
Ciprofloxacin for 7 days
Amoxicillin for 5 days
Co-amoxiclav for 14 days

Correct answer: Nitrofurantoin (modified release) for 3 days in non-pregnant women

Irish antibiotic prescribing guidelines recommend nitrofurantoin MR 100mg twice daily for 3 days as first-line treatment for uncomplicated UTIs in non-pregnant women. Trimethoprim is an alternative. Fluoroquinolones should be reserved for complicated infections due to resistance concerns.

Question 25: The 'three-way check' in dispensing refers to checking the label against the:

Three components of the prescription only
Three pharmacist signatures
Prescription, product and patient record — at three points in the dispensing process (Correct answer)
Label checked three times only

Correct answer: Prescription, product and patient record — at three points in the dispensing process

The three-way dispensing check verifies the prescription against the product retrieved, and the label — performed at: (1) product selection, (2) labelling, (3) final accuracy check before dispensing.

Question 26: Heparin is prescribed at 1000 units/hour. The infusion bag contains 25,000 units in 50 mL. At what rate should the infusion pump be set?

10 mL/hr
1 mL/hr
5 mL/hr
2 mL/hr (Correct answer)

Correct answer: 2 mL/hr

25,000 units ÷ 50 mL = 500 units/mL; 1000 units/hr ÷ 500 units/mL = 2 mL/hr.

Question 27: What is the pharmacist's role in pharmacovigilance?

It only applies during clinical trials
Pharmacovigilance is only the manufacturer's responsibility
To monitor the safety of medicines in everyday use, detect new or changing safety signals, report adverse events, and contribute to the ongoing assessment of medicine benefit-risk profiles (Correct answer)
Pharmacists have no role in pharmacovigilance

Correct answer: To monitor the safety of medicines in everyday use, detect new or changing safety signals, report adverse events, and contribute to the ongoing assessment of medicine benefit-risk profiles

Pharmacovigilance (the science of monitoring drug safety) is a responsibility shared by all healthcare professionals. Pharmacists contribute by reporting ADRs to the HPRA, monitoring patients for drug safety issues, educating patients about potential adverse effects, and staying informed about drug safety alerts.

Question 28: What is a medication error and how should it be managed in a pharmacy?

Medication errors should be hidden to protect the pharmacy's reputation
Any preventable event that may cause or lead to inappropriate medication use or patient harm; it should be documented, reported, the patient assessed, and a root cause analysis conducted (Correct answer)
An error only counts if the patient is harmed
Only dispensing the wrong drug counts as a medication error

Correct answer: Any preventable event that may cause or lead to inappropriate medication use or patient harm; it should be documented, reported, the patient assessed, and a root cause analysis conducted

Medication errors include any preventable event at any stage: prescribing, dispensing, administration, or monitoring. When discovered, the patient must be assessed for harm, the prescriber informed, an incident report completed, the error documented, and a root cause analysis conducted to prevent recurrence.

Question 29: Proton pump inhibitors (PPIs) like omeprazole work by:

Neutralising gastric acid
Irreversibly inhibiting H+/K+ ATPase in gastric parietal cells (Correct answer)
Blocking H2 histamine receptors
Coating the stomach lining

Correct answer: Irreversibly inhibiting H+/K+ ATPase in gastric parietal cells

PPIs are prodrugs activated in the acidic canaliculi of parietal cells. Active drug covalently binds and irreversibly inhibits H+/K+ ATPase (the proton pump), suppressing acid secretion.

Question 30: Which scheme allows pharmacists in Ireland to dispense a generic medicine instead of the branded product prescribed?

GMS scheme rules only
Generic substitution under the Health (Pricing and Supply of Medical Goods) Act 2013 (Correct answer)
Prescriber authorisation each time
There is no substitution allowed in Ireland

Correct answer: Generic substitution under the Health (Pricing and Supply of Medical Goods) Act 2013

The Health (Pricing and Supply of Medical Goods) Act 2013 allows pharmacists to substitute with a listed generic unless the prescriber has handwritten 'do not substitute' on the prescription.

Question 31: A patient on warfarin asks about taking cranberry juice. The pharmacist should advise:

A small glass is a safe daily limit
Avoid large amounts — cranberry juice may inhibit CYP2C9, raising warfarin levels and INR (Correct answer)
Cranberry is completely safe in any amount with warfarin
Cranberry reduces warfarin efficacy

Correct answer: Avoid large amounts — cranberry juice may inhibit CYP2C9, raising warfarin levels and INR

Cranberry juice, especially in large quantities, may inhibit CYP2C9 (warfarin's main metabolic pathway), increasing INR and bleeding risk. Case reports and pharmacovigilance data support caution with regular large intakes.

Question 32: What ethical principles should guide a pharmacist when dealing with a patient's request for information about their medication that may cause anxiety?

Withhold negative information to avoid causing distress
Provide truthful, balanced information about benefits and risks, using appropriate language, while being sensitive to the patient's emotional state and level of understanding (Correct answer)
Give all information regardless of the patient's emotional state
Refuse to provide any information and refer to the prescriber

Correct answer: Provide truthful, balanced information about benefits and risks, using appropriate language, while being sensitive to the patient's emotional state and level of understanding

The ethical principles of veracity (truthfulness), beneficence, and autonomy require pharmacists to provide honest, complete information while being sensitive to the patient's needs. Information should be tailored to the patient's level of understanding, delivered with empathy, and balanced between risks and benefits.

Question 33: What should a pharmacist do if they identify a drug recall notice?

Only act if a patient complains
Wait until the stock runs out
Immediately quarantine the affected stock, check dispensing records for patients who received the recalled product, notify affected patients and their prescribers, and arrange returns (Correct answer)
Continue dispensing the product until a replacement is available

Correct answer: Immediately quarantine the affected stock, check dispensing records for patients who received the recalled product, notify affected patients and their prescribers, and arrange returns

Upon receiving a drug recall notice from the HPRA, the pharmacist must immediately quarantine affected stock, check records to identify patients who received the product, contact those patients and their prescribers, arrange for returns to the supplier, and document all actions taken.

Question 34: What is the pharmacist's duty under the Criminal Justice (Psychoactive Substances) Act 2010?

To ensure no psychoactive substances (other than legitimate medicines, alcohol, tobacco, and food) are sold from the pharmacy premises, and to be aware of substances that may be used for psychoactive purposes (Correct answer)
The Act only applies to head shops
Only Gardaí need to know about this Act
This Act has no relevance to pharmacy practice

Correct answer: To ensure no psychoactive substances (other than legitimate medicines, alcohol, tobacco, and food) are sold from the pharmacy premises, and to be aware of substances that may be used for psychoactive purposes

The Criminal Justice (Psychoactive Substances) Act 2010 criminalised the sale of psychoactive substances (formerly sold in 'head shops'). Pharmacists must ensure no such substances are sold from their premises and be vigilant about products that may be marketed as legitimate but are actually psychoactive substances.

Question 35: Under the Falsified Medicines Directive (EU 2011/62/EU), pharmacies must use which system to verify medicines?

A manual serial number log
Contacting the manufacturer by telephone
HPRA database lookup only
The European Medicines Verification System (EMVS) — scanning 2D barcodes at point of dispensing (Correct answer)

Correct answer: The European Medicines Verification System (EMVS) — scanning 2D barcodes at point of dispensing

The Falsified Medicines Directive requires pharmacies to scan the 2D data matrix barcode on medicine packs before dispensing, verifying authenticity and decommissioning the pack via the EMVS/Irish MVO.

Question 36: Which process converts a prodrug to its active form?

Bioactivation (Correct answer)
Glucuronidation
Protein binding
Renal filtration

Correct answer: Bioactivation

Bioactivation is metabolic conversion of an inactive prodrug to its pharmacologically active metabolite. Example: enalapril → enalaprilat; codeine → morphine (via CYP2D6).

Question 37: Which antiepileptic is contraindicated in pregnancy due to neural tube defect risk?

Levetiracetam
Sodium valproate (Correct answer)
Lamotrigine
Gabapentin

Correct answer: Sodium valproate

Sodium valproate is a potent teratogen — it causes neural tube defects, neurodevelopmental disorders and other congenital malformations. It must be used with pregnancy prevention programme (PREVENT) in women of childbearing age.

Question 38: Which mineral supplement is recommended in pregnancy to prevent neural tube defects?

Calcium tablets
Iron only
Folic acid 400 mcg daily (started before conception and continued to 12 weeks) (Correct answer)
Vitamin D only

Correct answer: Folic acid 400 mcg daily (started before conception and continued to 12 weeks)

Folic acid supplementation starting pre-conception and continuing until 12 weeks gestation reduces neural tube defect (spina bifida, anencephaly) risk by up to 70%. High-risk women need 5 mg daily.

Question 39: What safety checks should a pharmacist perform when dispensing a new prescription for a patient already on other medications?

Only check the expiry date of the medicine
Only check the patient's name matches the prescription
Check for drug-drug interactions, therapeutic duplication, contraindications based on the patient's medical history, appropriate dose for age/weight/renal function, and allergies (Correct answer)
No additional checks are needed

Correct answer: Check for drug-drug interactions, therapeutic duplication, contraindications based on the patient's medical history, appropriate dose for age/weight/renal function, and allergies

A comprehensive clinical check includes: drug-drug interactions with current medications, therapeutic duplication, contraindications (medical history, pregnancy), dose appropriateness (age, weight, renal/hepatic function), allergy status, and whether the new medicine is consistent with the patient's conditions.

Question 40: What ethical considerations apply when a pharmacist suspects a patient is being abused or neglected?

The pharmacist has an ethical duty to safeguard vulnerable patients, which may require breaking confidentiality to report concerns to appropriate authorities such as the HSE or Tusla (Correct answer)
Patient confidentiality prevents any reporting
Abuse is a matter only for the Gardaí, not pharmacists
Pharmacists should only act if the patient explicitly asks for help

Correct answer: The pharmacist has an ethical duty to safeguard vulnerable patients, which may require breaking confidentiality to report concerns to appropriate authorities such as the HSE or Tusla

Pharmacists have a duty of care that extends to safeguarding vulnerable patients. When abuse or neglect is suspected, confidentiality may be broken to protect the patient. The pharmacist should document concerns, report to appropriate authorities (HSE, Tusla for children), and follow safeguarding protocols.

Question 41: What is the first-line treatment for mild-to-moderate community-acquired pneumonia in adults in Ireland?

Metronidazole
Ciprofloxacin
Flucloxacillin
Amoxicillin (Correct answer)

Correct answer: Amoxicillin

According to Irish antibiotic prescribing guidelines, amoxicillin is the first-line treatment for community-acquired pneumonia in adults. For penicillin-allergic patients, doxycycline or clarithromycin are alternatives. This follows antimicrobial stewardship principles.

Question 42: A Monitored Dosage System (MDS) such as a Dosette box is most appropriate for:

Patients with poor adherence or cognitive impairment taking multiple medicines (Correct answer)
Children under 5 years
All patients as standard
Patients who only take one medicine

Correct answer: Patients with poor adherence or cognitive impairment taking multiple medicines

MDS organises medicines by time of day and day of week. They are indicated for patients struggling with complex regimens due to cognitive impairment, polypharmacy or disability.

Question 43: Which drug is used to reverse opioid overdose?

Flumazenil
Protamine
Naloxone (Correct answer)
Neostigmine

Correct answer: Naloxone

Naloxone is a competitive opioid receptor antagonist with high affinity for mu-receptors. IV/IM/intranasal naloxone rapidly reverses respiratory depression, sedation and miosis of opioid overdose.

Question 44: Which counselling point is most important for a patient starting a new SSRI for depression?

Stop the medication if side effects occur in week 1
SSRIs work immediately
Antidepressant effect takes 2–4 weeks — continue even if no immediate improvement (Correct answer)
Take double dose if you miss a day

Correct answer: Antidepressant effect takes 2–4 weeks — continue even if no immediate improvement

SSRIs take 2–4 weeks for full antidepressant effect. Early discontinuation is a major cause of treatment failure. Patients must be counselled to persist through initial side effects and not expect immediate results.

Question 45: MUPS (Medicines Use Points System) in Ireland — in which OTC recommendation should pharmacists ALWAYS refer to a GP without treating?

Red flag symptoms such as unexplained weight loss, dysphagia or blood in stool with indigestion (Correct answer)
Mild bloating in an adult with no other symptoms
Occasional acid reflux only
Simple heartburn after a large meal in an otherwise healthy adult

Correct answer: Red flag symptoms such as unexplained weight loss, dysphagia or blood in stool with indigestion

Red flags such as unexplained weight loss, dysphagia, rectal bleeding or persistent indigestion in patients over 55 may indicate oesophageal or gastric cancer — these require urgent GP/hospital referral.

Question 46: Which piece of information is NOT required on a controlled drug prescription under Irish Misuse of Drugs Regulations?

Prescriber's signature
Total quantity in words and figures
Patient's full name and address
The patient's occupation (Correct answer)

Correct answer: The patient's occupation

Irish CD prescription requirements include patient name/address, drug/strength/form, dose instructions, total quantity in words AND figures, date, and prescriber's signature and address. Occupation is not required.

Question 47: Which interaction should a pharmacist counsel a patient about when dispensing sildenafil for erectile dysfunction?

Do not take with antacids
Avoid with statins
Absolute contraindication with organic nitrates (GTN, isosorbide) — risk of fatal hypotension (Correct answer)
Avoid with paracetamol

Correct answer: Absolute contraindication with organic nitrates (GTN, isosorbide) — risk of fatal hypotension

Both sildenafil (PDE-5 inhibition) and nitrates (cGMP elevation via guanylate cyclase) cause vasodilation. Combined, they produce profound, potentially fatal hypotension. Nitrates are an absolute contraindication.

Question 48: Ibuprofen is contraindicated OTC in patients with:

Active peptic ulcer, third trimester of pregnancy, or severe renal impairment (Correct answer)
Age over 60 with no other issues
Mild seasonal allergy
Controlled hypertension only

Correct answer: Active peptic ulcer, third trimester of pregnancy, or severe renal impairment

NSAIDs including ibuprofen are contraindicated in active GI ulceration (risk of bleeding), third trimester pregnancy (premature ductus arteriosus closure), and severe renal impairment (risk of acute kidney injury).

Question 49: The ABCDE approach in responding to a medical emergency in a pharmacy stands for:

Assess, Blood pressure, Call, Drugs, Emergency
Airway, Baseline, Compressions, Drugs, ECG
Airway, Breathing, Circulation, Disability, Exposure (Correct answer)
Alert, Breathe, Compress, Defibrillate, Evaluate

Correct answer: Airway, Breathing, Circulation, Disability, Exposure

The ABCDE framework is a systematic approach to medical emergencies: Airway (patent?), Breathing (rate, effort), Circulation (pulse, BP), Disability (consciousness, glucose), Exposure (full assessment). Used in BLS and advanced life support.

Question 50: What is the 'high alert medications' concept and which medicines fall into this category?

Only medicines administered by injection
Medicines that have been recalled
Medicines that bear a heightened risk of causing significant patient harm when used in error, including anticoagulants, insulin, opioids, and chemotherapy agents (Correct answer)
Any medicine that costs over €100

Correct answer: Medicines that bear a heightened risk of causing significant patient harm when used in error, including anticoagulants, insulin, opioids, and chemotherapy agents

High-alert medications carry an elevated risk of harm when errors occur. The ISMP (Institute for Safe Medication Practices) list includes anticoagulants, insulin, opioids, neuromuscular blocking agents, and concentrated electrolytes. Extra safeguards (independent double-checks, dose limits) should be applied.

Question 51: What is the pharmacist's ethical responsibility regarding counterfeit medicines?

Check medicines only if a patient complains
Only customs officials deal with counterfeit medicines
To source medicines only from authorised suppliers, be vigilant for counterfeit products, report any suspicious products to the HPRA, and protect patients from potentially dangerous fake medicines (Correct answer)
Counterfeit medicines are not a concern in Ireland

Correct answer: To source medicines only from authorised suppliers, be vigilant for counterfeit products, report any suspicious products to the HPRA, and protect patients from potentially dangerous fake medicines

Pharmacists have an ethical and legal responsibility to maintain the integrity of the medicine supply chain. This includes sourcing only from authorised wholesalers, checking deliveries for signs of counterfeiting, using the FMD (Falsified Medicines Directive) verification system, and reporting any suspicious products.

Question 52: Which counselling point is essential for a patient starting bisphosphonate therapy for osteoporosis?

Take on an empty stomach with a full glass of water, remain upright for 30 minutes, and take calcium/vitamin D at a different time (Correct answer)
No specific timing requirements
Take at bedtime for best absorption
Can be taken with milk for GI comfort

Correct answer: Take on an empty stomach with a full glass of water, remain upright for 30 minutes, and take calcium/vitamin D at a different time

Bisphosphonates are poorly absorbed and inactivated by food/calcium/dairy. They must be taken on an empty stomach, with plain water only, with 30 minutes upright to prevent oesophageal damage.

Question 53: What is the pharmacist's role in managing chronic disease conditions like diabetes or hypertension?

Referring all queries to the GP without comment
Only dispensing medications without any further input
Pharmacists have no role in chronic disease management
Providing medication counselling, monitoring adherence, reviewing medication appropriateness, conducting health screenings, and supporting self-management education (Correct answer)

Correct answer: Providing medication counselling, monitoring adherence, reviewing medication appropriateness, conducting health screenings, and supporting self-management education

Pharmacists play an increasingly important role in chronic disease management through medication therapy reviews, adherence support, health screenings (blood pressure, blood glucose), lifestyle counselling, identifying drug-related problems, and working collaboratively with GPs and other healthcare professionals.

Question 54: A drug with a narrow therapeutic index requires:

No dose adjustments
Less frequent dosing
Higher loading doses
Therapeutic drug monitoring (Correct answer)

Correct answer: Therapeutic drug monitoring

Narrow therapeutic index drugs (e.g., digoxin, warfarin, lithium) have small differences between effective and toxic concentrations, necessitating regular plasma level monitoring.

Question 55: A patient receiving intramuscular methotrexate for psoriasis asks about taking folic acid supplements. The pharmacist advises:

No — folic acid completely blocks methotrexate
Only if mouth ulcers develop
Folic acid is irrelevant with IM methotrexate
Yes — folic acid 5 mg once weekly (on a different day) is routinely co-prescribed to reduce methotrexate side effects without reducing efficacy (Correct answer)

Correct answer: Yes — folic acid 5 mg once weekly (on a different day) is routinely co-prescribed to reduce methotrexate side effects without reducing efficacy

Folic acid supplementation with methotrexate reduces toxicity (mouth ulcers, GI side effects, liver toxicity, cytopenias) without significantly compromising its anti-inflammatory effect. It is routinely co-prescribed.

Question 56: What are the key considerations when dispensing methotrexate for a patient?

Methotrexate can be taken daily without concern
Ensure the correct WEEKLY dose (not daily), counsel on folate supplementation, warn about teratogenicity, and advise on monitoring requirements (blood tests) (Correct answer)
Methotrexate has no serious side effects
No special counselling is needed

Correct answer: Ensure the correct WEEKLY dose (not daily), counsel on folate supplementation, warn about teratogenicity, and advise on monitoring requirements (blood tests)

Methotrexate is a HIGH-RISK medication. The most critical safety point is ensuring it is taken WEEKLY (not daily — daily dosing has caused fatalities). Patients need folic acid supplementation, regular blood monitoring (FBC, LFTs, renal function), and pregnancy prevention counselling.

Question 57: A patient reports they missed their dose of levothyroxine this morning. They should be advised to:

Stop and restart from tomorrow
Take both doses at once
Take the missed dose as soon as they remember, unless it is almost time for the next dose — then skip the missed dose (Correct answer)
Double the next dose to compensate

Correct answer: Take the missed dose as soon as they remember, unless it is almost time for the next dose — then skip the missed dose

Standard missed dose guidance for levothyroxine: take as soon as remembered unless within a few hours of the next scheduled dose. Doubling doses is not recommended as it can cause symptoms of hyperthyroidism.

Question 58: Which solid dosage form release mechanism uses an osmotic pump?

Immediate release capsule
Enteric coating
Matrix tablet
OROS (Osmotic Release Oral System) (Correct answer)

Correct answer: OROS (Osmotic Release Oral System)

OROS uses osmotic pressure to drive water into a core compartment, pushing drug through a laser-drilled orifice at a controlled, constant rate.

Question 59: What monitoring is required for a patient on Direct Oral Anticoagulants (DOACs) such as apixaban or rivarelbane?

Only blood pressure monitoring is required
Renal function (eGFR) should be monitored at least annually (more frequently if impaired), along with hepatic function and haemoglobin; no routine INR monitoring is needed (Correct answer)
DOACs require weekly INR monitoring like warfarin
No monitoring is needed for DOACs

Correct answer: Renal function (eGFR) should be monitored at least annually (more frequently if impaired), along with hepatic function and haemoglobin; no routine INR monitoring is needed

Unlike warfarin, DOACs do not require routine INR monitoring. However, renal function must be monitored (at least annually, more frequently if eGFR <60) as renal impairment affects drug clearance. Hepatic function and haemoglobin should also be checked. Dose adjustments may be needed based on renal function.

Question 60: What is the importance of patient counselling at the point of dispensing?

Written labels are sufficient — no verbal counselling is needed
It improves medication adherence, helps patients understand their treatment, reduces errors in self-administration, and identifies potential problems before they cause harm (Correct answer)
Counselling should only be provided if the patient asks for it
Patient counselling is a waste of time

Correct answer: It improves medication adherence, helps patients understand their treatment, reduces errors in self-administration, and identifies potential problems before they cause harm

Patient counselling is a core pharmacy activity that significantly impacts treatment outcomes. It should cover: how to take the medicine, expected effects, potential side effects, storage, what to do if a dose is missed, and when to seek medical attention. Counselling improves adherence by up to 50%.

Question 61: Reconstitution of an oral antibiotic suspension requires adding which liquid?

Orange juice to improve taste
Tap water directly to the bottle mark
Saline solution
Freshly boiled and cooled water to the specified volume (Correct answer)

Correct answer: Freshly boiled and cooled water to the specified volume

Oral antibiotic suspensions (e.g., amoxicillin) are reconstituted with freshly boiled and cooled water to the volume indicated on the bottle label, then shaken well. Tap water may contain bacteria.

Question 62: Which document establishes the PSI's Standards of Conduct, Ethics and Performance for pharmacists?

European Pharmacopoeia
National Drug Strategy
PSI Code of Conduct (Conduct and Discipline Rules) (Correct answer)
Health Act 1970

Correct answer: PSI Code of Conduct (Conduct and Discipline Rules)

The PSI Code of Conduct sets out the ethical and professional standards expected of registered pharmacists in Ireland, underpinning fitness to practise proceedings.

Question 63: What is the National Immunisation Programme in Ireland and what is the pharmacist's role?

Pharmacists only store vaccines but never administer them
A publicly funded programme providing vaccines to protect against infectious diseases; pharmacists can administer certain vaccines (flu, COVID-19) and provide vaccine information to the public (Correct answer)
Pharmacists have no involvement in vaccination
The programme only operates in hospitals

Correct answer: A publicly funded programme providing vaccines to protect against infectious diseases; pharmacists can administer certain vaccines (flu, COVID-19) and provide vaccine information to the public

Ireland's National Immunisation Programme provides free vaccines through a schedule covering childhood, adolescent, and adult vaccinations. Since 2011, trained pharmacists can administer seasonal flu vaccines, and this role expanded to include COVID-19 vaccination. Pharmacists also play a key role in public education about vaccination.

Question 64: What does the term 'polymorphism' refer to in pharmaceutical sciences?

Variation in patient metabolism
Multiple dosage forms of one drug
Different salts of the same drug
Different crystal structures of the same compound (Correct answer)

Correct answer: Different crystal structures of the same compound

Polymorphism describes the ability of a solid material to exist in more than one crystal form. Different polymorphs can have different solubility and bioavailability.

Question 65: Under PSI guidance, the minimum period for retaining prescription records in a pharmacy in Ireland is:

2 years
10 years
1 year
6 years (Correct answer)

Correct answer: 6 years

PSI requires pharmacy prescription records (including GMS/DPS claims) to be retained for a minimum of 6 years. This aligns with general healthcare record retention policy in Ireland.

Question 66: Which vitamin supplement is recommended by Irish health authorities for all adults during autumn and winter?

Zinc 15 mg daily
Vitamin D 400–1000 IU daily (Correct answer)
Vitamin C 1000 mg daily
Vitamin B12 daily

Correct answer: Vitamin D 400–1000 IU daily

Due to Ireland's northern latitude, sunlight is insufficient for cutaneous vitamin D synthesis from October to March. HSE and FSAI recommend vitamin D supplementation for all adults during this period.

Question 67: What is the importance of medication reconciliation when a patient is discharged from hospital?

It is the hospital's sole responsibility
To ensure continuity of care by comparing the discharge prescription with the patient's pre-admission medications, identifying any intentional changes, and preventing unintended omissions or duplications (Correct answer)
Medication reconciliation is only needed on admission
The community pharmacist has no role in discharge reconciliation

Correct answer: To ensure continuity of care by comparing the discharge prescription with the patient's pre-admission medications, identifying any intentional changes, and preventing unintended omissions or duplications

Community pharmacists play a vital role in discharge reconciliation. They should compare the discharge prescription with the patient's previous medication record, identify any changes (new medicines, stopped medicines, dose changes), verify these changes were intentional, and counsel the patient on the updated regimen.

Question 68: What is the pharmacist's responsibility regarding cold chain management for medicines requiring refrigeration?

Only the wholesaler is responsible for cold chain
Medicines can be returned to the fridge after being left out overnight
To maintain the cold chain (2-8°C) throughout storage and supply, monitor and record temperatures daily, investigate any breaches, and not supply medicines that have been compromised (Correct answer)
Temperature monitoring is optional

Correct answer: To maintain the cold chain (2-8°C) throughout storage and supply, monitor and record temperatures daily, investigate any breaches, and not supply medicines that have been compromised

Cold chain management ensures temperature-sensitive medicines (vaccines, insulin, biologics) remain within 2-8°C from receipt to supply. Daily temperature monitoring, calibrated equipment, breach protocols, and patient counselling on home storage are all pharmacist responsibilities.

Question 69: When handing out a new inhaler, the minimum counselling should include:

Only the dose and frequency
Correct inhaler technique with a demonstrated step-by-step guide (Correct answer)
Advising the patient to read the PIL
Noting side effects only

Correct answer: Correct inhaler technique with a demonstrated step-by-step guide

Incorrect inhaler technique is a leading cause of poor asthma/COPD control. The pharmacist must demonstrate correct technique, have the patient practise and check — not merely hand over with verbal advice.

Question 70: Emergency supply of prescription-only medicines without a prescription is permitted in Ireland when:

The patient has a repeat prescription from abroad only
A CD is requested for a known patient
A pharmacist is satisfied immediate treatment is necessary and the patient has previously been prescribed the medicine (Correct answer)
The patient requests any prescription medicine urgently

Correct answer: A pharmacist is satisfied immediate treatment is necessary and the patient has previously been prescribed the medicine

Irish pharmacy law allows pharmacist-initiated emergency supply for POMs (not Schedule 1/2 CDs) when the pharmacist judges it is immediately necessary, the patient has had it prescribed before, and a follow-up prescription will be obtained.

Question 71: What is the pharmacist's ethical obligation regarding pharmaceutical company interactions?

Pharmacists have no restrictions on interactions with pharmaceutical companies
To maintain professional independence, not allow commercial relationships to influence clinical decisions, and be transparent about any conflicts of interest (Correct answer)
To promote whatever products pharmaceutical companies recommend
To only stock products from companies that offer the best incentives

Correct answer: To maintain professional independence, not allow commercial relationships to influence clinical decisions, and be transparent about any conflicts of interest

Pharmacists must maintain clinical independence from pharmaceutical industry influence. They should not accept gifts or inducements that could influence prescribing or recommendations, must make clinical decisions based on evidence and patient need, and should declare any potential conflicts of interest.

Question 72: When dispensing warfarin, which additional monitoring information should the pharmacist check?

Recent INR result and current INR target range (Correct answer)
Serum creatinine only
Blood pressure only
HbA1c

Correct answer: Recent INR result and current INR target range

Warfarin is a narrow therapeutic index drug monitored by INR. The pharmacist should check that the INR is within the patient's target range and that the dose dispensed aligns with the INR result and clinic instructions.

Question 73: Which scoring system guides pharmacists in advising on head injury referral after a bump to the head?

NICE Head Injury Guidelines criteria (loss of consciousness, amnesia, vomiting, age, mechanism) (Correct answer)
CURB-65
GCS alone
Ottawa Rules only

Correct answer: NICE Head Injury Guidelines criteria (loss of consciousness, amnesia, vomiting, age, mechanism)

NICE head injury guidelines identify criteria for urgent CT scan and hospital referral including loss of consciousness, amnesia, vomiting (>1 episode), GCS <15, seizure, or high-risk mechanism (high fall, RTA).

Question 74: What is the difference between a generic medicine and a branded medicine?

Generic medicines are less effective than branded medicines
A generic contains the same active ingredient, dose, and dosage form as the brand but is marketed under the non-proprietary (generic) name, usually at a lower cost (Correct answer)
Generic medicines contain different active ingredients
There is no difference — the terms are interchangeable

Correct answer: A generic contains the same active ingredient, dose, and dosage form as the brand but is marketed under the non-proprietary (generic) name, usually at a lower cost

Generic medicines must contain the same active ingredient in the same dose and dosage form as the reference (branded) product and must demonstrate bioequivalence. They are approved by the HPRA and meet the same quality standards but are typically less expensive as they do not carry development costs.

Question 75: A child weighing 25 kg requires ibuprofen 10 mg/kg. The suspension is 100 mg/5 mL. What volume should be administered?

10 mL
25 mL
12.5 mL (Correct answer)
5 mL

Correct answer: 12.5 mL

Dose = 10 mg/kg × 25 kg = 250 mg; volume = 250 mg ÷ 20 mg/mL = 12.5 mL.

Question 76: Which international quality standard covers pharmaceutical Good Manufacturing Practice in the EU?

ISO 9001
EU GMP Guidelines (EudraLex Volume 4) (Correct answer)
ICH Q10 alone
USP <1> General Notices

Correct answer: EU GMP Guidelines (EudraLex Volume 4)

EU GMP is published in EudraLex Volume 4 and sets legally binding standards for manufacture of medicinal products in the EU/EEA, including Ireland.

Question 77: Which drug class inhibits neuraminidase and is used to treat influenza?

Oseltamivir (Tamiflu) (Correct answer)
Aciclovir
Interferon alfa
Amantadine

Correct answer: Oseltamivir (Tamiflu)

Oseltamivir inhibits viral neuraminidase, preventing release of new viral particles from infected cells and limiting spread of influenza A and B.

Question 78: What is a 'near miss' in the pharmacy context?

A patient who nearly missed collecting their prescription
A delivery of medicines that nearly arrived late
A prescription that was nearly written incorrectly
A dispensing error that is detected and corrected before the medicine reaches the patient (Correct answer)

Correct answer: A dispensing error that is detected and corrected before the medicine reaches the patient

A pharmacy near miss is an error caught during the checking process before the medicine is handed to the patient. Recording and analysing near misses is crucial for patient safety as they reveal system weaknesses that could lead to actual errors reaching patients.

Question 79: Lithium toxicity risk increases with concurrent use of which drug?

ACE inhibitors only slightly affect lithium
Antacids have no effect
Thiazide diuretics reduce lithium only (this option is wrong placement)
NSAIDs (reduce renal lithium excretion) (Correct answer)

Correct answer: NSAIDs (reduce renal lithium excretion)

NSAIDs inhibit prostaglandin-mediated renal blood flow, reducing GFR and lithium excretion. This can rapidly elevate lithium plasma levels into the toxic range.

Question 80: What is the principle of patient autonomy and how does it apply to pharmacy practice?

Autonomy only applies to patients in hospitals
Patients must always follow the pharmacist's recommendations
The pharmacist always knows what is best for the patient
The right of a competent patient to make informed decisions about their own healthcare, including the right to refuse treatment; pharmacists must respect these decisions while providing full information (Correct answer)

Correct answer: The right of a competent patient to make informed decisions about their own healthcare, including the right to refuse treatment; pharmacists must respect these decisions while providing full information

Patient autonomy is a fundamental ethical principle. Pharmacists must provide patients with the information they need to make informed decisions, respect their right to refuse or choose treatments, and support shared decision-making. Pharmacists should advise but never coerce.

Question 81: Which diuretic is potassium-sparing and acts by blocking aldosterone receptors?

Acetazolamide
Bendroflumethiazide
Furosemide
Spironolactone (Correct answer)

Correct answer: Spironolactone

Spironolactone competitively antagonises aldosterone receptors in the collecting duct, reducing sodium reabsorption and potassium excretion. It is used in heart failure and hyperaldosteronism.

Question 82: Which drug interaction causes 'serotonin syndrome' when tramadol is co-prescribed with an SSRI?

Reduced tramadol absorption by SSRIs
Additive serotonergic effect — tramadol inhibits serotonin reuptake in addition to opioid activity (Correct answer)
Tramadol induces CYP2D6 raising SSRI levels
Physical precipitation in the GI tract

Correct answer: Additive serotonergic effect — tramadol inhibits serotonin reuptake in addition to opioid activity

Tramadol is both a mu-opioid agonist and a serotonin/noradrenaline reuptake inhibitor. Combined with SSRIs, the serotonergic burden increases risk of serotonin syndrome (hyperthermia, clonus, agitation, autonomic instability).

Question 83: What is 'conscientious objection' in pharmacy practice?

The right to refuse to stock any product the pharmacist disagrees with
The right to refuse to serve any customer for any reason
An objection to working on certain days of the week
A pharmacist's right to decline providing certain services based on personal moral or religious beliefs, provided the patient is referred to another provider without delay (Correct answer)

Correct answer: A pharmacist's right to decline providing certain services based on personal moral or religious beliefs, provided the patient is referred to another provider without delay

Pharmacists may exercise conscientious objection to certain services (e.g., emergency contraception) based on genuine moral or religious beliefs. However, they must not impose their beliefs on patients, must inform the patient and refer them to another pharmacist who can provide the service without delay.

Question 84: A patient demands their repeat prescription before the due date, claiming they are going on holiday. The pharmacist should:

Always dispense early without question to ensure continuity
Contact the prescriber only if a CD is involved
Refuse entirely regardless of circumstances
Use professional judgement, verify the reason and consider a partial early supply if clinically appropriate (Correct answer)

Correct answer: Use professional judgement, verify the reason and consider a partial early supply if clinically appropriate

Professional judgement is required. Early supply may be justified for holidays — the pharmacist may dispense a limited early quantity. For CDs, contact with the prescriber and extra caution is needed.

Question 85: Which device is used to measure liquid medicines accurately for paediatric doses?

Standard kitchen teaspoon
Oral syringe (Correct answer)
Dropper alone for all volumes
Measuring jug

Correct answer: Oral syringe

Oral syringes are the most accurate method for measuring small paediatric liquid doses. Kitchen spoons are inaccurate (may hold 3–7 mL) and should never be recommended for medicine measurement.

Question 86: A patient on phenytoin is started on fluconazole. Which outcome should the pharmacist anticipate?

Increased phenytoin levels (risk of toxicity) — fluconazole inhibits CYP2C9 (Correct answer)
No interaction — phenytoin levels unchanged
Decreased phenytoin levels
Fluconazole levels increase only

Correct answer: Increased phenytoin levels (risk of toxicity) — fluconazole inhibits CYP2C9

Fluconazole is a potent CYP2C9 inhibitor. Phenytoin is primarily metabolised by CYP2C9. Combination leads to significantly elevated phenytoin levels, risking ataxia, nystagmus and diplopia.

Question 87: Which storage temperature range is considered 'refrigerated' for medicinal products?

2°C to 8°C (Correct answer)
-20°C to -10°C
15°C to 25°C
8°C to 15°C

Correct answer: 2°C to 8°C

Refrigerated storage (2–8°C) is required for vaccines, insulin, some eye drops and many biologics. Temperatures outside this range can irreversibly damage the product.

Question 88: The General Medical Services (GMS) scheme in Ireland provides medicines free of charge to which patient group?

Medical card holders (Correct answer)
All EU citizens in Ireland
All patients under 70
Private patients only

Correct answer: Medical card holders

Medical card holders (means-tested) receive prescription medicines dispensed under the GMS scheme free of charge. Pharmacies claim reimbursement from the HSE at agreed reference prices.

Question 89: What is the LASA (Look-Alike, Sound-Alike) issue in pharmacy?

A patient classification system
A quality assessment tool for pharmacy labels
The risk of medication errors caused by medicines with similar names, similar packaging, or both, leading to potential selection errors during dispensing (Correct answer)
An inventory management system

Correct answer: The risk of medication errors caused by medicines with similar names, similar packaging, or both, leading to potential selection errors during dispensing

LASA medicines pose a significant safety risk because their similar names (e.g., hydroxyzine/hydralazine) or packaging can lead to wrong drug selection errors. Pharmacies should implement strategies such as tall-man lettering, physical separation of LASA products, and electronic alerts.

Question 90: What is the pharmacist's role in managing substance misuse in Ireland?

Only dispensing methadone without any supervision
Supervising methadone consumption for opioid-dependent patients, providing needle exchange services, supplying naloxone, and supporting patients in recovery (Correct answer)
Pharmacists have no role in substance misuse services
Refusing to serve patients with addiction issues

Correct answer: Supervising methadone consumption for opioid-dependent patients, providing needle exchange services, supplying naloxone, and supporting patients in recovery

Community pharmacists are central to substance misuse services in Ireland through the Methadone Treatment Protocol Scheme (supervised consumption), needle and syringe programmes, naloxone (Nyxoid) provision for opioid overdose reversal, and providing accessible, non-judgemental healthcare to this vulnerable population.

Question 91: You need to prepare 200 mL of a 0.9% NaCl solution from a 20% NaCl stock. What volume of stock solution is required?

4.5 mL
1.8 mL
9.0 mL (Correct answer)
18.0 mL

Correct answer: 9.0 mL

Using C1V1 = C2V2: 20% × V1 = 0.9% × 200 mL; V1 = 9 mL.

Question 92: What is the pharmacist's role in adverse drug reaction (ADR) reporting in Ireland?

Only report ADRs that cause hospitalisation
ADR reporting is only the doctor's responsibility
To identify, document, and report suspected ADRs to the HPRA through the national ADR reporting system, especially for new medicines and serious reactions (Correct answer)
ADRs do not need to be reported

Correct answer: To identify, document, and report suspected ADRs to the HPRA through the national ADR reporting system, especially for new medicines and serious reactions

Pharmacists have a professional duty to report suspected ADRs to the HPRA (Health Products Regulatory Authority). Reports should be made for all suspected ADRs to medicines, vaccines, herbal products, and devices, particularly for new medicines (marked with a black triangle ▼) and serious reactions.

Question 93: What is the 'Healthy Ireland' framework and how does it relate to pharmacy practice?

A health insurance scheme
A food labelling system
A gym membership programme
The national framework for improved health and wellbeing, which pharmacists support through health promotion, screening, lifestyle advice, and preventive healthcare services (Correct answer)

Correct answer: The national framework for improved health and wellbeing, which pharmacists support through health promotion, screening, lifestyle advice, and preventive healthcare services

Healthy Ireland is the government framework aimed at improving health and wellbeing and reducing health inequalities. Pharmacists contribute through health promotion activities, smoking cessation, weight management advice, physical activity encouragement, alcohol awareness, and providing accessible preventive healthcare.

Question 94: A patient is prescribed warfarin. Which of the following interactions should the pharmacist be most concerned about?

Drinking water with the medication
Taking the warfarin with food
Taking warfarin in the morning versus evening
Concurrent use of NSAIDs such as ibuprofen, which increases the risk of bleeding (Correct answer)

Correct answer: Concurrent use of NSAIDs such as ibuprofen, which increases the risk of bleeding

NSAIDs increase bleeding risk with warfarin through multiple mechanisms: they inhibit platelet function, can cause GI erosion, and some (like fluconazole) inhibit CYP2C9, which metabolises warfarin. Pharmacists should counsel patients about avoiding OTC NSAIDs and reporting any signs of bleeding.

Question 95: Which medication used for OTC heartburn works by neutralising gastric acid?

Aluminium/magnesium hydroxide antacids (Correct answer)
Ranitidine
Omeprazole
Domperidone

Correct answer: Aluminium/magnesium hydroxide antacids

Antacids (aluminium and magnesium salts, calcium carbonate) act quickly to neutralise existing stomach acid, providing rapid but short-lived relief. They do not reduce acid production.

Question 96: Adsorption onto packaging components is a stability concern particularly for which type of drug?

Protein biologics and low-dose drugs (Correct answer)
Immediate-release tablets
Drugs with large particle size
Highly water-soluble drugs

Correct answer: Protein biologics and low-dose drugs

Proteins and peptides, and drugs present in very small amounts, can adsorb onto glass or plastic container surfaces, reducing the available dose and causing potency loss.

Question 97: Serotonin syndrome is most likely when combining an SSRI with which other drug?

Atenolol
Metformin
Amlodipine
Linezolid (MAO inhibitor) (Correct answer)

Correct answer: Linezolid (MAO inhibitor)

Linezolid inhibits monoamine oxidase (MAO), reducing serotonin breakdown. Combined with an SSRI, serotonin accumulates, causing hyperthermia, clonus, agitation and autonomic instability.

Question 98: Which class of antihypertensives is the first-line treatment in patients with heart failure with reduced ejection fraction (HFrEF)?

Calcium channel blockers
ACE inhibitors (Correct answer)
Alpha-1 blockers
Direct vasodilators

Correct answer: ACE inhibitors

ACE inhibitors (e.g., ramipril, lisinopril) reduce mortality and morbidity in HFrEF by blocking angiotensin II production, reducing cardiac afterload and preload.

Question 99: Which counselling point is essential for a patient using transdermal hormone patches?

Apply over hairy areas for better absorption
Rotate application sites, apply to clean dry skin and press firmly for 30 seconds — avoid same site for at least one week (Correct answer)
Remove and reapply if sweating
Change every day regardless of the prescribed schedule

Correct answer: Rotate application sites, apply to clean dry skin and press firmly for 30 seconds — avoid same site for at least one week

Site rotation prevents skin irritation and maintains consistent drug absorption. Clean, dry, non-hairy skin (e.g., lower abdomen, upper arm) maximises adhesion. Intervals between uses of the same site allow skin recovery.

Question 100: Hygroscopic drug substances require which type of packaging?

Strip foil only
PET containers
Amber glass bottles
Moisture-barrier packaging (Correct answer)

Correct answer: Moisture-barrier packaging

Hygroscopic substances absorb moisture from the environment, leading to degradation. Moisture-barrier packaging (e.g., blister with aluminium foil) protects product stability.

Question 101: Digoxin tablets are available as 62.5 micrograms. A patient requires 125 micrograms per dose. How many tablets should be given?

1 tablet
2 tablets (Correct answer)
4 tablets
3 tablets

Correct answer: 2 tablets

125 micrograms ÷ 62.5 micrograms = 2 tablets per dose.

Question 102: A patient on an SSRI antidepressant wants to buy an OTC product containing ibuprofen. What should the pharmacist consider?

SSRIs increase the risk of GI bleeding, which is further increased by concurrent NSAID use; recommend paracetamol as an alternative or advise use of gastroprotection if an NSAID is essential (Correct answer)
SSRIs make NSAIDs more effective
There is no interaction between SSRIs and NSAIDs
Recommend a higher dose of ibuprofen

Correct answer: SSRIs increase the risk of GI bleeding, which is further increased by concurrent NSAID use; recommend paracetamol as an alternative or advise use of gastroprotection if an NSAID is essential

SSRIs affect platelet function by depleting serotonin in platelets, increasing bleeding risk. Combined with NSAIDs (which also impair platelet function and cause GI mucosal damage), the risk of GI bleeding is significantly increased. Paracetamol is a safer analgesic alternative.

Question 103: Which important counselling point applies to all patients using topical corticosteroids long-term on the face?

Avoid prolonged use — risk of skin atrophy, telangiectasia, perioral dermatitis and steroid-induced rosacea (Correct answer)
Moisturisers should not be used on the face with topical steroids
Stronger is better for faster results on the face
Face application is always safe regardless of duration

Correct answer: Avoid prolonged use — risk of skin atrophy, telangiectasia, perioral dermatitis and steroid-induced rosacea

Facial skin is thin and absorbs corticosteroids more readily. Prolonged use causes skin thinning (atrophy), visible blood vessels (telangiectasia), and steroid rosacea/perioral dermatitis — all difficult to reverse.

Question 104: What are the key principles of health promotion that pharmacists should apply?

Empowerment, accessibility, evidence-based practice, equity, and a whole-population approach combining individual and community health interventions (Correct answer)
Focusing exclusively on medication-related issues
Only providing information to patients who ask for it
Only promoting health during specific awareness weeks

Correct answer: Empowerment, accessibility, evidence-based practice, equity, and a whole-population approach combining individual and community health interventions

Health promotion in pharmacy involves empowering patients with knowledge and skills, ensuring accessibility of services, using evidence-based approaches, addressing health inequalities, and taking opportunities for brief interventions during every patient interaction — not just during awareness campaigns.

Question 105: Which type of drug interaction at receptor level is reversible and competitive?

Irreversible antagonism
Physiological antagonism
Non-competitive antagonism
Competitive antagonism (Correct answer)

Correct answer: Competitive antagonism

Competitive antagonists bind reversibly to the same receptor site as the agonist. Increasing agonist concentration can overcome the antagonism, shifting the dose-response curve to the right.

Question 106: Which preservative is commonly used in multi-dose eye drop formulations?

Benzalkonium chloride (Correct answer)
Chlorhexidine
Benzyl alcohol
Phenol

Correct answer: Benzalkonium chloride

Benzalkonium chloride (BAK) is the most widely used preservative in ophthalmic preparations. It disrupts bacterial cell membranes but can cause ocular surface toxicity with prolonged use.

Question 107: How should a pharmacist handle a conflict of interest between commercial pressures and patient care?

Patient care and safety must always take priority over commercial or business interests (Correct answer)
Balance equally between commercial and patient interests
Let the pharmacy owner decide which takes priority
Commercial success should be the primary priority

Correct answer: Patient care and safety must always take priority over commercial or business interests

The PSI Code of Conduct is clear: patient care must always come first. Pharmacists must not allow commercial pressures to compromise the quality of care, recommend unnecessary products, or dispense inappropriately. Professional judgement must prioritise patient safety above business interests.

Question 108: A patient requires amoxicillin 250 mg. The available suspension contains 125 mg/5 mL. What volume should be dispensed per dose?

5 mL
20 mL
10 mL (Correct answer)
15 mL

Correct answer: 10 mL

250 mg ÷ (125 mg/5 mL) = 10 mL per dose.

Question 109: Which packaging component directly contacts the dosage form?

Transit packaging
Secondary packaging
Primary packaging (Correct answer)
Tertiary packaging

Correct answer: Primary packaging

Primary packaging is in direct contact with the product (e.g., blister foil, ampoule, bottle). It must be compatible with the formulation and protect against degradation.

Question 110: Emergency hormonal contraception (morning-after pill) available OTC in Ireland works primarily by:

Preventing implantation primarily
Acting as an abortifacient
Preventing fertilisation of an egg already ovulated
Delaying or preventing ovulation (Correct answer)

Correct answer: Delaying or preventing ovulation

Levonorgestrel (e.g., Levonelle, NorLevo) primarily prevents or delays ovulation when taken before the LH surge. It is most effective within 72 hours. It does not terminate an established pregnancy.

Question 111: What is the pharmacist's obligation regarding the notification of infectious diseases in Ireland?

Pharmacists must directly report all infectious diseases
Infectious disease notification has nothing to do with pharmacy
Pharmacists should be aware of notifiable diseases and facilitate the notification process, though the primary reporting obligation lies with the attending medical practitioner (Correct answer)
Only hospital pharmacists need to know about notifiable diseases

Correct answer: Pharmacists should be aware of notifiable diseases and facilitate the notification process, though the primary reporting obligation lies with the attending medical practitioner

While the legal obligation to notify lies primarily with the medical practitioner, pharmacists play a supporting role by being aware of notifiable diseases, recognising unusual patterns in OTC sales that might indicate outbreaks, and facilitating the public health response through medicine supply and public information.

Question 112: Which drug class is used as first-line for acute migraine attacks?

Beta-blockers
Triptans (5-HT1B/1D agonists) (Correct answer)
Sodium valproate
Opioids

Correct answer: Triptans (5-HT1B/1D agonists)

Triptans (e.g., sumatriptan) selectively activate 5-HT1B/1D receptors causing cerebral vasoconstriction and inhibiting neuropeptide release, aborting migraine attacks.

Question 113: Which calculation gives the number of tablets required for a prescription reading 'take 2 tablets THREE times a day for 7 days'?

42 tablets (2 × 3 × 7) (Correct answer)
14 tablets
21 tablets
6 tablets

Correct answer: 42 tablets (2 × 3 × 7)

2 tablets per dose × 3 doses per day = 6 tablets/day × 7 days = 42 tablets total. Accurate calculation prevents under or over-supply.

Question 114: What is the ethical importance of continuing professional development (CPD) for pharmacists?

CPD is the employer's responsibility, not the individual pharmacist's
CPD is optional and only for career advancement
CPD is an ethical obligation to maintain and develop competence throughout a pharmacist's career, ensuring patients receive care based on current knowledge and best practice (Correct answer)
CPD is only required for the first five years after qualification

Correct answer: CPD is an ethical obligation to maintain and develop competence throughout a pharmacist's career, ensuring patients receive care based on current knowledge and best practice

CPD is both a regulatory requirement and an ethical imperative. The rapid pace of pharmaceutical science means knowledge quickly becomes outdated. Pharmacists have an ethical duty to maintain competence through lifelong learning, ensuring their practice reflects current evidence and best practice.

Question 115: How should a pharmacist approach end-of-life care and palliative pharmacy services?

Only hospital pharmacists are involved in palliative care
End-of-life care is not relevant to pharmacy practice
Refer all palliative patients to their GP without providing any service
With compassion and respect, ensuring timely access to palliative medications, providing advice on symptom management, supporting the patient's wishes, and collaborating with the palliative care team (Correct answer)

Correct answer: With compassion and respect, ensuring timely access to palliative medications, providing advice on symptom management, supporting the patient's wishes, and collaborating with the palliative care team

Community pharmacists play an important role in end-of-life care: ensuring palliative medications (especially controlled drugs for pain management) are readily available, advising on administration and dosing, supporting carers, maintaining dignity and respect, and collaborating with the palliative care team.

Question 116: Medicines reconciliation at hospital discharge involves:

Only supplying 28-day TTOs
Comparing the patient's pre-admission medicines with discharge medicines to identify unintended discrepancies (Correct answer)
Having the patient bring in their medicines
Checking allergies only

Correct answer: Comparing the patient's pre-admission medicines with discharge medicines to identify unintended discrepancies

Medicines reconciliation compares the complete pre-admission medication list with newly prescribed medicines at each care transition, identifying omissions, duplications and changes requiring communication.

Question 117: Which antiplatelet drug requires hepatic activation by CYP2C19 to exert its effect?

Clopidogrel (Correct answer)
Ticagrelor
Dipyridamole
Aspirin

Correct answer: Clopidogrel

Clopidogrel is a prodrug requiring CYP2C19-mediated activation. Poor metabolisers of CYP2C19 have reduced antiplatelet effect, increasing cardiovascular risk.

Question 118: What is the pharmacist's role in managing minor ailments in the community?

Diagnosing diseases and prescribing medications
Only selling products without any assessment
Assessing symptoms, recommending appropriate OTC treatments, providing self-care advice, and referring to a GP when symptoms suggest a more serious condition (Correct answer)
Telling all patients to see their GP

Correct answer: Assessing symptoms, recommending appropriate OTC treatments, providing self-care advice, and referring to a GP when symptoms suggest a more serious condition

Pharmacists manage common minor ailments (colds, headaches, hayfever, mild skin conditions) by assessing symptoms, recommending appropriate OTC treatments, providing lifestyle and self-care advice, and making appropriate referrals. This reduces pressure on GP services and provides convenient healthcare access.

Question 119: Which inhaler technique is most important for pressurised metered dose inhalers (pMDIs)?

Slow, deep inhalation coordinated with actuation (Correct answer)
No breath-hold required
Fast, forceful inhalation
Holding the inhaler vertically downwards

Correct answer: Slow, deep inhalation coordinated with actuation

Slow, deep inhalation coordinated with actuation maximises drug deposition in the lower airways. Fast inhalation causes impaction in the oropharynx, and a 10-second breath-hold improves deposition.

Question 120: Michaelis-Menten kinetics apply when enzyme-mediated metabolism is:

Only seen with CYP3A4
Independent of substrate concentration
Linear at all concentrations
Saturated at high drug concentrations (Correct answer)

Correct answer: Saturated at high drug concentrations

At high concentrations, metabolic enzymes become saturated and elimination shifts from first-order to zero-order kinetics — described by Michaelis-Menten equations.

PSI Pharmacy Registration Assessment Ireland

The PSI (Pharmaceutical Society of Ireland) Registration Assessment is the qualifying exam for pharmacists seeking registration in Ireland. It covers Irish pharmacy law and ethics, clinical therapeutics, dispensing practice, patient safety, public health, pharmaceutical sciences, pharmacology, and patient counselling. Candidates must demonstrate competency in both clinical and legal aspects of pharmacy practice in Ireland.

120

Questions

180 min

Time Limit

65%

To Pass

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

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