GPhC Patient Safety & Clinical Pharmacy 4

Question 1

According to NICE, what is the first-line pharmacological treatment for osteoporosis in post-menopausal women?

Accepted Answer

Alendronic acid (bisphosphonate) plus vitamin D and calcium

Answer

NICE recommends alendronic acid as first-line bisphosphonate for post-menopausal osteoporosis, with calcium/vitamin D supplementation if dietary intake is inadequate.

Question 2

A patient on ciclosporin is started on clarithromycin. What is the clinical concern?

Accepted Answer

Ciclosporin toxicity — clarithromycin inhibits CYP3A4, raising ciclosporin levels

Answer

Clarithromycin is a potent CYP3A4 inhibitor. Ciclosporin is extensively metabolised by CYP3A4. Co-administration can lead to significantly elevated ciclosporin levels, risking nephrotoxicity.

Question 3

Which monitoring should be performed in a patient started on clozapine?

Accepted Answer

Full blood count (FBC) — monitoring for agranulocytosis

Answer

Clozapine monitoring requires regular FBC because the drug causes agranulocytosis in up to 1% of patients, which can be fatal if undetected. Monitoring frequency decreases as treatment duration increases.

Question 4

What is the mechanism by which NSAIDs can worsen heart failure?

Accepted Answer

Sodium and water retention due to prostaglandin inhibition and reduced renal perfusion

Answer

NSAIDs inhibit prostaglandins involved in renal sodium excretion and vascular regulation, leading to fluid retention, increased preload and afterload, potentially precipitating or worsening heart failure.

Question 5

A patient requires gentamicin therapy. Which monitoring is essential?

Accepted Answer

Serum gentamicin levels, renal function, and signs of ototoxicity

Answer

Gentamicin is an aminoglycoside with a narrow therapeutic index. Monitoring trough and peak levels, renal function, and symptoms of ototoxicity (hearing loss, tinnitus) is essential to prevent toxicity.

GPhC Registration Practice Test

GPhC Registration Practice Test

GPhC Patient Safety & Clinical Pharmacy 4