GPhC Patient Safety & Clinical Pharmacy 3 — Questions and Answers
Question 1: What is the purpose of a 'medication use evaluation' (MUE) or drug use review in clinical pharmacy?
- To systematically assess prescribing patterns to identify areas for improvement in drug therapy (Correct answer)
- To count stock levels
- To evaluate drug acquisition costs only
- To discharge patients sooner
Correct answer: To systematically assess prescribing patterns to identify areas for improvement in drug therapy
MUE/drug use review is a structured, ongoing programme assessing whether medicines are being prescribed, dispensed, and administered appropriately, safely, and cost-effectively.
Question 2: A patient on spironolactone and an ACE inhibitor develops muscle weakness. What electrolyte abnormality is most likely?
- Hyperkalaemia (Correct answer)
- Hypokalaemia
- Hyponatraemia
- Hypercalcaemia
Correct answer: Hyperkalaemia
Both spironolactone (potassium-sparing diuretic) and ACE inhibitors increase serum potassium. Combination therapy can cause dangerous hyperkalaemia, manifesting as muscle weakness or arrhythmias.
Question 3: Which antibiotic class should be avoided in children under 12 years due to effects on developing joints?
- Fluoroquinolones (e.g., ciprofloxacin) (Correct answer)
- Penicillins
- Macrolides
- Cephalosporins
Correct answer: Fluoroquinolones (e.g., ciprofloxacin)
Fluoroquinolones can damage developing cartilage in children and adolescents, causing arthropathy. They are generally avoided in children under 18 unless no safer alternative exists.
Question 4: What is the primary concern when prescribing NSAIDs to an elderly patient with chronic kidney disease?
- Worsening renal function due to prostaglandin inhibition reducing renal blood flow (Correct answer)
- Increased bleeding time only
- Reduced analgesic effect
- Increased sodium retention only
Correct answer: Worsening renal function due to prostaglandin inhibition reducing renal blood flow
NSAIDs inhibit prostaglandins that maintain renal vasodilation in patients with CKD. This can precipitate acute-on-chronic kidney injury, especially in elderly patients with reduced renal reserve.
Question 5: What is a 'high-alert medication' in patient safety terms?
- A medicine that bears a heightened risk of causing significant patient harm when used in error (Correct answer)
- A medicine sold at a high price
- A medicine requiring refrigerated storage
- A controlled drug only
Correct answer: A medicine that bears a heightened risk of causing significant patient harm when used in error
High-alert medications (e.g., insulin, anticoagulants, concentrated electrolytes) require special safeguards because errors in their use are more likely to cause serious or fatal patient harm.
Question 6: Which drug is associated with QT interval prolongation and increased risk of torsades de pointes?
- Amiodarone (Correct answer)
- Atenolol
- Amlodipine
- Metformin
Correct answer: Amiodarone
Amiodarone prolongs the cardiac action potential and QT interval, increasing risk of torsades de pointes — a potentially fatal polymorphic ventricular tachycardia.
GPhC Patient Safety & Clinical Pharmacy 3
What is the purpose of a 'medication use evaluation' (MUE) or drug use review in clinical pharmacy?