GPhC Clinical Therapeutics & BNF Guidelines 2 — Questions and Answers
Question 1: Which inhaler technique error is most common with a pressurised metered-dose inhaler (pMDI)?
- Inhaling too fast (Correct answer)
- Not removing the cap
- Shaking too vigorously
- Using it in cold weather
Correct answer: Inhaling too fast
Inhaling too fast is the most common critical error with pMDIs. The aerosol requires a slow, steady inhalation to ensure deep lung deposition.
Question 2: According to BNF, which medication should be avoided in patients with eGFR <30 mL/min/1.73m²?
- Metformin (Correct answer)
- Atorvastatin
- Amlodipine
- Omeprazole
Correct answer: Metformin
Metformin is contraindicated when eGFR <30 due to the risk of lactic acidosis from drug accumulation in renal impairment.
Question 3: What is the recommended duration of dual antiplatelet therapy after a drug-eluting coronary stent?
- 12 months (Correct answer)
- 1 month
- 3 months
- Indefinitely
Correct answer: 12 months
NICE and cardiology guidelines recommend 12 months of dual antiplatelet therapy (aspirin + P2Y12 inhibitor) following drug-eluting stent insertion to prevent stent thrombosis.
Question 4: Which opioid analgesic has the highest oral bioavailability?
- Methadone (Correct answer)
- Morphine
- Codeine
- Tramadol
Correct answer: Methadone
Methadone has oral bioavailability of approximately 80–95%, significantly higher than morphine (~35%), making it effective orally. It also has a long half-life.
Question 5: A patient with atrial fibrillation and a CHAâ‚‚DSâ‚‚-VASc score of 2 (male) should receive:
- Anticoagulation with apixaban or warfarin (Correct answer)
- Aspirin alone
- No treatment needed
- Rate control only
Correct answer: Anticoagulation with apixaban or warfarin
NICE recommends anticoagulation for males with CHA₂DS₂-VASc ≥2. A score of 2 warrants anticoagulation with a DOAC (e.g., apixaban) or warfarin.
Question 6: Which drug class is first-line for preventing recurrent gout attacks?
- Xanthine oxidase inhibitors (allopurinol) (Correct answer)
- NSAIDs
- Colchicine
- Corticosteroids
Correct answer: Xanthine oxidase inhibitors (allopurinol)
Allopurinol (xanthine oxidase inhibitor) lowers uric acid production and is the mainstay of long-term urate-lowering therapy to prevent recurrent gout.
GPhC Clinical Therapeutics & BNF Guidelines 2
Which inhaler technique error is most common with a pressurised metered-dose inhaler (pMDI)?