GPhC Patient Safety 2

Question 1

A patient presents with a prescription for co-trimoxazole. They mention they are also taking warfarin. What is the key safety concern?

Accepted Answer

Co-trimoxazole enhances the anticoagulant effect of warfarin, increasing bleeding risk

Answer

Co-trimoxazole significantly potentiates the anticoagulant effect of warfarin through multiple mechanisms: the trimethoprim component inhibits CYP2C9 (the main enzyme metabolising S-warfarin), and the sulfamethoxazole component may displace warfarin from protein binding. This can cause dangerously elevated INR and serious bleeding.

Question 2

When performing a medicines use review (MUR) or the New Medicine Service (NMS), the pharmacist identifies that an elderly patient is taking a benzodiazepine long-term. What patient safety advice should be prioritised?

Accepted Answer

Discuss the increased risk of falls, cognitive impairment, and dependence, and suggest a GP review for a planned gradual withdrawal

Answer

Long-term benzodiazepine use in elderly patients significantly increases the risk of falls, fractures, cognitive impairment, and dependence. NICE recommends planned gradual withdrawal. Abrupt cessation is dangerous and can cause seizures. The pharmacist should advise a GP review for a structured dose reduction plan.

Question 3

A patient with a documented penicillin allergy (anaphylaxis) is prescribed cefalexin. What should the pharmacist do?

Accepted Answer

Contact the prescriber — patients with penicillin anaphylaxis have a higher risk of cross-reactivity with cephalosporins

Answer

While the overall cross-reactivity between penicillins and cephalosporins is low (1-2%), patients with a history of penicillin anaphylaxis have a higher risk and should generally avoid cephalosporins, particularly first-generation ones like cefalexin. The pharmacist should contact the prescriber to discuss alternative antibiotics.

Question 4

Which of the following scenarios would require the pharmacist to intervene under the NHS safeguarding framework?

Accepted Answer

An elderly patient with unexplained bruising who appears fearful and is accompanied by an aggressive relative

Answer

Pharmacists have a duty of care under safeguarding legislation to recognise and report concerns about vulnerable adults and children. Unexplained bruising combined with fearful behaviour and an aggressive companion are recognised indicators of potential abuse or coercion. The pharmacist should follow local safeguarding procedures.

Question 5

A prescription for a child specifies a dose that exceeds the maximum recommended in the BNF for Children. The prescriber states this is intentional for the patient's specific condition. What should the pharmacist do?

Accepted Answer

Request the prescriber endorse the prescription to confirm the higher dose is intended, document the conversation, and dispense with appropriate counselling

Answer

When a prescriber intentionally prescribes above BNF-recommended doses, the pharmacist should request written confirmation (endorsement) that the dose is intentional, document the clinical conversation, and then dispense with appropriate patient/carer counselling. This creates an audit trail and ensures patient safety without blocking appropriate clinical decisions.

GPhC Registration Practice Test

GPhC Registration Practice Test

GPhC Patient Safety 2