GPhC Patient Safety & Clinical Pharmacy 2 — Questions and Answers
Question 1: What is the STOPP/START tool used for in geriatric pharmacy?
- Identifying potentially inappropriate prescribing in older patients and medicines that should be started (Correct answer)
- Scoring pain levels in elderly patients
- A tool for assessing falls risk
- A medication administration system for care homes
Correct answer: Identifying potentially inappropriate prescribing in older patients and medicines that should be started
STOPP (Screening Tool of Older Persons' Prescriptions) and START (Screening Tool to Alert to Right Treatment) help identify inappropriate medicines in the elderly and treatments that should be initiated.
Question 2: A patient taking phenytoin complains of dizziness and double vision after a dosage increase. What is the most likely cause?
- Phenytoin toxicity — dose-related adverse effects at high plasma concentrations (Correct answer)
- A new eye condition
- Dehydration
- New cardiac arrhythmia
Correct answer: Phenytoin toxicity — dose-related adverse effects at high plasma concentrations
Phenytoin has a narrow therapeutic index and non-linear (zero-order) kinetics. Nystagmus, diplopia, and ataxia are classic signs of toxicity at elevated plasma concentrations.
Question 3: Which drug is used to treat acute anaphylaxis as the first-line emergency treatment?
- Intramuscular adrenaline (epinephrine) 0.5 mg (1:1000) (Correct answer)
- Intravenous hydrocortisone
- Oral antihistamine
- Intravenous salbutamol
Correct answer: Intramuscular adrenaline (epinephrine) 0.5 mg (1:1000)
IM adrenaline 0.5 mg (0.5 mL of 1:1000 solution) into the anterolateral thigh is the first-line treatment for anaphylaxis, reversing bronchospasm, vasodilation, and angioedema.
Question 4: The Beers Criteria is a list of:
- Medications potentially inappropriate for use in older adults (Correct answer)
- Approved generic medicines in the USA
- Medicines suitable for use in pregnancy
- High-cost medicines requiring NICE approval
Correct answer: Medications potentially inappropriate for use in older adults
The Beers Criteria (American Geriatrics Society) identifies medicines that may be inappropriate or harmful in older adults (≥65) due to adverse effects, drug interactions, or reduced clearance.
Question 5: What is meant by 'medication reconciliation' at hospital discharge?
- Ensuring the discharge prescription reflects intended changes to pre-admission medication, clearly communicating to GP and patient (Correct answer)
- Only listing all medicines given during admission
- Cancelling all hospital medications
- Transferring the hospital drug chart to the GP unchanged
Correct answer: Ensuring the discharge prescription reflects intended changes to pre-admission medication, clearly communicating to GP and patient
Discharge medicines reconciliation ensures intentional medication changes (stopped, started, dose changes) are documented, communicated to GP, and explained to the patient to prevent post-discharge errors.
Question 6: Which clinical sign is associated with digoxin toxicity?
- Bradycardia, nausea, and yellow-green visual disturbance (Correct answer)
- Tachycardia and hypertension
- Respiratory depression only
- Severe hyponatraemia
Correct answer: Bradycardia, nausea, and yellow-green visual disturbance
Digoxin toxicity classically presents with nausea, vomiting, bradycardia, and the characteristic yellow-green visual disturbances (xanthopsia). Arrhythmias may also occur.
GPhC Patient Safety & Clinical Pharmacy 2
What is the STOPP/START tool used for in geriatric pharmacy?