GPhC Registration Assessment — Questions and Answers

Question 1: Zeta potential is used to assess:

Microbial contamination
Dissolution rate
Physical stability of colloidal dispersions (Correct answer)
Chemical stability of solutions

Correct answer: Physical stability of colloidal dispersions

Zeta potential measures the electrostatic charge on colloidal particles. A high absolute zeta potential (>±30 mV) indicates good electrostatic repulsion and physical stability.

Question 2: A patient requires anticoagulation but has heparin-induced thrombocytopenia (HIT). Which anticoagulant is appropriate?

Unfractionated heparin
Warfarin alone acutely
Low molecular weight heparin
Argatroban or fondaparinux (Correct answer)

Correct answer: Argatroban or fondaparinux

In HIT, all heparin products (including LMWH) are contraindicated due to cross-reactivity with anti-platelet factor 4 antibodies. Argatroban (direct thrombin inhibitor) or fondaparinux are used instead.

Question 3: According to BNF, what is the first-line treatment for Helicobacter pylori eradication?

Triple therapy: PPI + amoxicillin + clarithromycin for 7 days (Correct answer)
Metronidazole monotherapy
PPI alone for 4 weeks
Bismuth quadruple therapy

Correct answer: Triple therapy: PPI + amoxicillin + clarithromycin for 7 days

UK first-line H. pylori eradication is triple therapy: a PPI + amoxicillin + clarithromycin for 7 days. Clarithromycin resistance affects choice in some areas.

Question 4: The STOPP/START criteria are primarily used to:

Screen for drug interactions in patients on polypharmacy
Assess patient adherence to long-term medication regimens
Identify potentially inappropriate medications and omissions in older patients (Correct answer)
Calculate renal dose adjustments for commonly prescribed drugs

Correct answer: Identify potentially inappropriate medications and omissions in older patients

STOPP (Screening Tool of Older People's Prescriptions) identifies potentially inappropriate medicines and START (Screening Tool to Alert to Right Treatment) identifies treatment omissions in older patients.

Question 5: What is the 'medication adherence' concept and why is it clinically important?

Whether medicines are stored correctly
How quickly patients refill prescriptions
How often patients visit their pharmacy
Whether patients take medicines as prescribed; poor adherence reduces therapeutic efficacy and increases disease complications (Correct answer)

Correct answer: Whether patients take medicines as prescribed; poor adherence reduces therapeutic efficacy and increases disease complications

Medication adherence refers to how consistently a patient takes medicines as prescribed. Poor adherence is a major cause of treatment failure, disease progression, and preventable hospital admissions.

Question 6: A patient weighing 70 kg requires a drug at 5 mg/kg/day in two divided doses. What is each dose?

140 mg
175 mg (Correct answer)
87.5 mg
350 mg

Correct answer: 175 mg

Total daily dose = 70 × 5 = 350 mg. Divided into 2 doses: 350 ÷ 2 = 175 mg per dose.

Question 7: Which of the following is a legal requirement on a private prescription for a Schedule 2 CD?

Only the prescriber's name and date
A GP surgery stamp only
The prescriber's address, signature, date, and full name and address of the patient (Correct answer)
Only the patient's name and drug dose

Correct answer: The prescriber's address, signature, date, and full name and address of the patient

CD prescriptions (Schedule 2 and 3) must include: prescriber name, address, and signature; patient name and address; drug, dose, form, total quantity; and date — all legally required.

Question 8: Parenteral preparations must be:

Isotonic only
Preservative-free only
Water-soluble only
Sterile and pyrogen-free (Correct answer)

Correct answer: Sterile and pyrogen-free

Parenteral (injectable) preparations must be sterile and free from pyrogens (bacterial endotoxins) as these can cause fever and serious reactions when injected.

Question 9: What is the percentage concentration (w/v) of a solution containing 2 g of drug in 250 mL?

0.8% w/v (Correct answer)
0.4% w/v
2% w/v
1% w/v

Correct answer: 0.8% w/v

2 g in 250 mL = 2/250 × 100 = 0.8% w/v. Percentage w/v = grams per 100 mL.

Question 10: According to the Misuse of Drugs Act 1971, Class A drugs include:

Anabolic steroids
Heroin, cocaine, and LSD (Correct answer)
Benzodiazepines only
Cannabis and amphetamines

Correct answer: Heroin, cocaine, and LSD

Class A drugs carry the most severe penalties under the MDA 1971. They include heroin (diamorphine), cocaine, crack cocaine, MDMA (ecstasy), and LSD.

Question 11: A patient on warfarin starts a course of amiodarone. What monitoring is required?

INR monitoring can be stopped
Increased INR monitoring; warfarin dose likely needs to be reduced (Correct answer)
Amiodarone and warfarin cannot be co-prescribed
No change needed

Correct answer: Increased INR monitoring; warfarin dose likely needs to be reduced

Amiodarone inhibits CYP2C9, reducing warfarin metabolism and significantly increasing INR. Warfarin dose often needs to be halved. Enhanced INR monitoring is essential when starting amiodarone.

Question 12: According to NICE, which antidepressant class should be avoided in patients with a recent MI?

SNRIs
Mirtazapine
SSRIs
Tricyclic antidepressants (TCAs) (Correct answer)

Correct answer: Tricyclic antidepressants (TCAs)

TCAs have cardiotoxic effects including QT prolongation and arrhythmia risk, making them contraindicated post-MI. SSRIs are preferred for depression post-MI.

Question 13: What is the responsible pharmacist's legal obligation regarding the pharmacy's standard operating procedures (SOPs)?

SOPs are only required for controlled drug dispensing
SOPs only need to be reviewed annually by the superintendent pharmacist
The responsible pharmacist must ensure SOPs are in place and are followed during their period of responsibility (Correct answer)
SOPs are optional guidelines that may be followed at discretion

Correct answer: The responsible pharmacist must ensure SOPs are in place and are followed during their period of responsibility

Under the Medicines (Pharmacies) (Responsible Pharmacist) Regulations 2008, the responsible pharmacist must ensure that appropriate SOPs are in place and are being followed during the period they are the responsible pharmacist. This is a legal, not merely professional, requirement.

Question 14: What is the mechanism of action of selective serotonin reuptake inhibitors (SSRIs)?

Stimulate postsynaptic serotonin receptors directly
Block serotonin reuptake at the presynaptic terminal (Correct answer)
Inhibit MAO enzymes
Increase serotonin synthesis

Correct answer: Block serotonin reuptake at the presynaptic terminal

SSRIs inhibit the serotonin transporter (SERT), preventing reuptake of serotonin into the presynaptic neuron, increasing serotonin availability in the synapse.

Question 15: What is the recommended duration of dual antiplatelet therapy after a drug-eluting coronary stent?

12 months (Correct answer)
Indefinitely
3 months
1 month

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 16: A dispensary receives a FP10MDA prescription for supervised methadone consumption. What does 'MDA' indicate?

Multi-drug administration
Standard FP10 for any medication
Instalment dispensing prescription for controlled drugs (Correct answer)
Medical Device Authority approval

Correct answer: Instalment dispensing prescription for controlled drugs

FP10MDA prescriptions are used for instalment dispensing of controlled drugs (typically methadone or buprenorphine in addiction treatment), specifying how frequently doses should be dispensed.

Question 17: What is the purpose of a disintegrant in a tablet formulation?

To promote tablet breakup in GI fluids (Correct answer)
To mask bitter taste
To bind particles together
To improve flow during manufacture

Correct answer: To promote tablet breakup in GI fluids

Disintegrants (e.g., sodium starch glycolate, croscarmellose sodium) absorb water and swell or create channels that cause tablets to break apart in GI fluid.

Question 18: The Yellow Card Scheme is used to report suspected adverse drug reactions (ADRs) to which UK organisation?

General Pharmaceutical Council (GPhC)
National Institute for Health and Care Excellence (NICE)
Medicines and Healthcare products Regulatory Agency (MHRA) (Correct answer)
NHS England

Correct answer: Medicines and Healthcare products Regulatory Agency (MHRA)

The Yellow Card Scheme is operated by the MHRA and is the UK system for collecting information on suspected adverse drug reactions. Healthcare professionals and patients can report via yellow cards, online, or through the Yellow Card app. It is vital for post-marketing surveillance.

Question 19: A solution has a pH of 3. What does this indicate?

Alkaline solution
Acidic solution (Correct answer)
Buffered solution
Neutral solution

Correct answer: Acidic solution

pH below 7 indicates an acidic solution. pH 7 is neutral; above 7 is alkaline. pH 3 is strongly acidic.

Question 20: A patient with newly diagnosed type 2 diabetes declines to start metformin, citing concerns about gastrointestinal side effects. The most appropriate medicines optimisation response is to:

Prescribe metformin regardless, as it is first-line and has a strong evidence base
Explore the patient's concerns, provide accurate information about side effects, and collaboratively agree a management plan (Correct answer)
Respect the patient's decision and take no further action at this appointment
Refer the patient back to the GP and document that they have refused treatment

Correct answer: Explore the patient's concerns, provide accurate information about side effects, and collaboratively agree a management plan

Medicines optimisation requires exploring and addressing patient concerns through shared decision making, supporting informed choices and finding solutions such as dose titration or alternative formulations.

Question 21: Which formulation type is designed to release drug over an extended period to reduce dosing frequency?

Enteric-coated tablet
Modified-release tablet (Correct answer)
Dispersible tablet
Effervescent tablet

Correct answer: Modified-release tablet

Modified-release (MR) formulations control the rate of drug release to maintain therapeutic levels over a longer period, reducing dosing frequency.

Question 22: Which antiepileptic drug is a potent inducer of hepatic CYP enzymes?

Sodium valproate
Lamotrigine
Carbamazepine (Correct answer)
Levetiracetam

Correct answer: Carbamazepine

Carbamazepine is a potent CYP3A4 and CYP2C9 inducer, accelerating metabolism of many co-administered drugs including warfarin, OCP, and other antiepileptics.

Question 23: A dispensing error results in a patient receiving the wrong dose. What immediate steps must be taken?

Recall the dispensed medicine, inform the patient and assess for harm, report through incident system, and document (Correct answer)
Only document the error internally
Wait to see if the patient reports symptoms
Inform only the prescriber

Correct answer: Recall the dispensed medicine, inform the patient and assess for harm, report through incident system, and document

Immediate steps include: recalling the incorrect item, contacting and informing the patient, assessing for harm, appropriate clinical management if needed, and internal/external incident reporting.

Question 24: What action is required if a community pharmacist identifies a prescription that appears to be forged?

Retain the prescription, contact the prescriber to verify, and report to police/NHS Controlled Drugs team if confirmed forgery (Correct answer)
Call the GPhC immediately
Return it to the patient and ask them to get a new one
Dispense and report later

Correct answer: Retain the prescription, contact the prescriber to verify, and report to police/NHS Controlled Drugs team if confirmed forgery

A forged CD prescription should not be dispensed. The pharmacist should retain it (it is evidence), verify with the prescriber, and report to police/NHS CD Accountable Officer if forgery is confirmed.

Question 25: The GPhC principle 'Act with Professionalism and Integrity' includes which behaviour?

Avoiding documentation of errors
Being honest even when mistakes occur (Correct answer)
Prioritising business interests over patient safety
Only acting professionally when being observed

Correct answer: Being honest even when mistakes occur

Acting with integrity requires honesty and transparency at all times, including when things go wrong. This underpins patient trust and the open culture needed for safety learning.

Question 26: A prescription asks for coal tar solution 5% in aqueous cream to make 100g. The coal tar solution BP contains coal tar 20% w/w. How much coal tar solution BP is required?

10g
25g (Correct answer)
5g
20g

Correct answer: 25g

The final product needs 5% coal tar solution, i.e., 5g of coal tar solution in 100g. But the coal tar solution BP is 20% w/w coal tar. The prescription asks for 'coal tar solution 5%' — meaning 5g of coal tar solution BP per 100g total. Therefore 25g of coal tar solution BP is needed to provide 5g of actual coal tar (25g × 20% = 5g coal tar).

Question 27: A pharmacist discovers a dispensing error before the patient has received the medication. What must happen?

Cover it up to avoid criticism
Just correct the error and say nothing
Contact the prescriber and blame them
Correct the error, document it, tell the patient if relevant, and report through the pharmacy's error reporting system (Correct answer)

Correct answer: Correct the error, document it, tell the patient if relevant, and report through the pharmacy's error reporting system

GPhC standards require duty of candour: pharmacists must be open about errors, correct them, inform patients if harm occurred, and report through governance systems to enable learning.

Question 28: Which piece of legislation governs the safe management and use of controlled drugs in the UK, including requirements for record-keeping in controlled drug registers?

Health Act 2006
Medicines Act 1968
Misuse of Drugs Act 1971
Misuse of Drugs Regulations 2001 (Correct answer)

Correct answer: Misuse of Drugs Regulations 2001

The Misuse of Drugs Regulations 2001 provides the detailed framework for the practical management of controlled drugs, including prescribing, supply, administration, record-keeping in CD registers, and safe custody requirements. The Misuse of Drugs Act 1971 sets out the classification and offences.

Question 29: Which NICE guideline specifically addresses medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes?

NG15
NG76
NG28
NG5 (Correct answer)

Correct answer: NG5

NICE guideline NG5, published in 2015, sets out the key principles and recommendations for medicines optimisation in the NHS.

Question 30: A patient presents with a prescription for co-trimoxazole. They mention they are also taking warfarin. What is the key safety concern?

There is no clinically significant interaction
Co-trimoxazole reduces warfarin absorption
Warfarin reduces the antibacterial efficacy of co-trimoxazole
Co-trimoxazole enhances the anticoagulant effect of warfarin, increasing bleeding risk (Correct answer)

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

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 31: Which type of interaction occurs when two drugs compete for the same plasma protein binding site?

Synergistic interaction
Additive interaction
Pharmacodynamic interaction
Pharmacokinetic displacement interaction (Correct answer)

Correct answer: Pharmacokinetic displacement interaction

Protein binding displacement is a pharmacokinetic interaction where one drug displaces another from albumin or other proteins, increasing free drug concentration.

Question 32: A pharmacist needs to dilute a 95% v/v ethanol solution to produce 500mL of 70% v/v ethanol. What volume of the 95% solution is required?

263mL
368mL (Correct answer)
475mL
432mL

Correct answer: 368mL

Using C₁V₁ = C₂V₂: 95% × V₁ = 70% × 500mL. V₁ = (70 × 500) ÷ 95 = 35,000 ÷ 95 = 368.4mL. Therefore approximately 368mL of the 95% solution is needed, made up to 500mL with purified water.

Question 33: A drug with a narrow therapeutic index requires:

Therapeutic drug monitoring (Correct answer)
Wider dosing intervals
Increased dosing frequency
Lower protein binding

Correct answer: Therapeutic drug monitoring

Narrow therapeutic index drugs have a small margin between therapeutic and toxic doses, necessitating regular therapeutic drug monitoring (TDM) to ensure safety.

Question 34: What is a 'prescribing cascade' in patient safety?

When electronic prescribing replaces paper
When a new drug is prescribed to treat a side effect of a previous drug, leading to further prescribing (Correct answer)
When multiple prescribers prescribe for the same patient
When a pharmacist queries every prescription

Correct answer: When a new drug is prescribed to treat a side effect of a previous drug, leading to further prescribing

A prescribing cascade occurs when a drug side effect is misidentified as a new disease and treated with another drug, creating unnecessary polypharmacy and compounding adverse effects.

Question 35: Which OTC product is used for the treatment of scabies?

Clotrimazole cream
Hydrocortisone 1% cream
Fusidic acid cream
Permethrin 5% cream (Correct answer)

Correct answer: Permethrin 5% cream

Permethrin 5% cream (Lyclear Cream) is first-line OTC treatment for scabies. The whole body (excluding face) must be treated and all household contacts treated simultaneously.

Question 36: What is the Electronic Prescription Service (EPS) Release 2?

A digital patient medication record
A real-time drug interaction checker
A system allowing electronic transfer of prescriptions from prescriber to pharmacy with electronic signatures (Correct answer)
An updated paper prescription format

Correct answer: A system allowing electronic transfer of prescriptions from prescriber to pharmacy with electronic signatures

EPS Release 2 enables the full electronic prescription workflow: the prescriber signs digitally, the prescription is sent electronically to the patient's nominated pharmacy, and the dispense is transmitted back to the NHS BSA.

Question 37: A 78-year-old patient is taking a long-term NSAID for joint pain alongside a PPI for gastric protection. Which medicines optimisation approach is most appropriate during their review?

Increase the PPI dose to provide enhanced gastric mucosal protection
Switch from an oral to topical NSAID without further clinical review
Consider whether the NSAID is still necessary given the patient's age and risk profile, and explore safer alternatives (Correct answer)
Add an H2 antagonist alongside the PPI for dual gastric protection

Correct answer: Consider whether the NSAID is still necessary given the patient's age and risk profile, and explore safer alternatives

In an older patient, the continued need for an NSAID should be critically reviewed given increasing risks of GI bleeding, renal impairment, and cardiovascular events with age — adding medicines to manage NSAID side effects is not the preferred approach.

Question 38: Which OTC analgesic is recommended for a patient with chronic renal impairment experiencing mild pain?

Ibuprofen
Paracetamol at lowest effective dose (Correct answer)
Codeine
Naproxen

Correct answer: Paracetamol at lowest effective dose

Paracetamol is the safest OTC analgesic in renal impairment (used at lowest effective dose). NSAIDs reduce renal perfusion and worsen CKD. Codeine may accumulate with renally-cleared active metabolites.

Question 39: A patient states they regularly forget to take their once-daily antihypertensive because of a busy routine. This is an example of:

Intentional non-adherence
Unintentional non-adherence (Correct answer)
Medicines management failure
Therapeutic non-compliance

Correct answer: Unintentional non-adherence

Unintentional non-adherence occurs when patients want to take their medication but face practical barriers such as forgetfulness, rather than making a deliberate decision not to take it.

Question 40: A patient with a documented penicillin allergy (anaphylaxis) is prescribed cefalexin. What should the pharmacist do?

Substitute with a different cephalosporin without consulting the prescriber
Contact the prescriber — patients with penicillin anaphylaxis have a higher risk of cross-reactivity with cephalosporins (Correct answer)
Tell the patient cefalexin is completely safe despite their allergy
Dispense cefalexin as it is not a penicillin

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

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 41: Which OTC antihistamine is least sedating and therefore preferred for daytime use?

Chlorphenamine (Piriton)
Promethazine
Loratadine or cetirizine (second-generation antihistamines) (Correct answer)
Diphenhydramine

Correct answer: Loratadine or cetirizine (second-generation antihistamines)

Second-generation antihistamines (loratadine, cetirizine, fexofenadine) have poor CNS penetration and minimal sedating effects, making them suitable for daytime use without impairment.

Question 42: A patient asks about using Gaviscon Advance for heartburn. What is its mechanism?

It neutralises stomach acid directly like antacids
It reduces acid production like omeprazole
It forms a raft on top of stomach contents, reducing acid reflux into the oesophagus (Correct answer)
It coats the oesophageal lining permanently

Correct answer: It forms a raft on top of stomach contents, reducing acid reflux into the oesophagus

Gaviscon Advance contains sodium alginate and potassium bicarbonate, forming a viscous gel raft on top of gastric contents, acting as a physical barrier against reflux into the oesophagus.

Question 43: In a first-order elimination process, when plasma concentration doubles, the elimination rate:

Halves
Stays the same
Quadruples
Doubles (Correct answer)

Correct answer: Doubles

In first-order kinetics, the rate of elimination is proportional to the drug concentration. If concentration doubles, so does the elimination rate.

Question 44: What is the OTC age restriction for selling aspirin in the UK?

Not recommended under 16 years due to Reye's syndrome risk (Correct answer)
Not recommended under 12 years only
No age restriction applies
Not recommended under 6 years

Correct answer: Not recommended under 16 years due to Reye's syndrome risk

Aspirin is contraindicated in children under 16 years (under 18 in some guidelines) due to the risk of Reye's syndrome — a rare but potentially fatal condition causing liver and brain damage.

Question 45: A 70-year-old patient requests a sleep aid OTC. Which is the most appropriate recommendation?

Melatonin OTC in high doses
Diphenhydramine 50 mg nightly indefinitely
Sleep hygiene advice and referral if persistent; avoid sedating antihistamines in elderly (Correct answer)
Temazepam (prescription only)

Correct answer: Sleep hygiene advice and referral if persistent; avoid sedating antihistamines in elderly

Sedating antihistamines (diphenhydramine, promethazine) are on the Beers Criteria as inappropriate for the elderly due to risks of falls, confusion, urinary retention, and next-day sedation. Sleep hygiene and GP referral are preferred.

Question 46: The NO TEARS tool is used to structure medication reviews. What does the letter 'T' represent in this mnemonic?

Toxicity risk assessment
Tests and monitoring (Correct answer)
Therapeutic outcome targets
Tolerability of side effects

Correct answer: Tests and monitoring

In the NO TEARS medication review tool, T stands for 'Tests and monitoring', prompting the reviewer to check whether appropriate safety monitoring is in place for the patient's current medicines.

Question 47: What is the maximum period of validity for an NHS prescription for a Schedule 2 controlled drug?

6 months
14 days
3 months
28 days (Correct answer)

Correct answer: 28 days

NHS prescriptions for Schedule 2 controlled drugs are valid for 28 days from the appropriate date on the prescription. This restriction was introduced to reduce the risk of diversion and misuse of controlled substances.

Question 48: Which property of a drug most influences its ability to cross the blood-brain barrier?

Renal clearance
Protein binding
Lipophilicity (Correct answer)
Molecular weight only

Correct answer: Lipophilicity

Lipophilic (fat-soluble) drugs cross the blood-brain barrier more readily because the barrier is composed mainly of lipid bilayer membranes.

Question 49: A patient is found to be taking 12 different regular medications concurrently. This situation is best described as:

Complex prescribing syndrome
Multimorbidity pharmacotherapy
Polypharmacy (Correct answer)
Hyperpharmacy

Correct answer: Polypharmacy

Polypharmacy refers to the concurrent use of multiple medications; complex or problematic polypharmacy is typically defined as 10 or more medicines.

Question 50: Which drug interaction should be identified when a patient on ramipril is prescribed potassium supplementation?

Hyperkalaemia risk — ACE inhibitors reduce aldosterone, raising potassium levels (Correct answer)
Reduced ramipril efficacy
No significant interaction
Hypokalaemia risk

Correct answer: Hyperkalaemia risk — ACE inhibitors reduce aldosterone, raising potassium levels

ACE inhibitors reduce angiotensin II-mediated aldosterone secretion, decreasing urinary potassium excretion. Adding potassium supplements increases hyperkalaemia risk, potentially causing dangerous arrhythmias.

Question 51: Which of the following best describes the concept of medicines optimisation as defined by NICE?

A person-centred approach to safe and effective medicines use to achieve the best possible outcomes (Correct answer)
Ensuring patients take all prescribed medications at the correct dose
Minimising the total number of medications a patient takes
Ensuring prescribers adhere strictly to national formulary guidelines

Correct answer: A person-centred approach to safe and effective medicines use to achieve the best possible outcomes

NICE defines medicines optimisation as a person-centred approach to safe and effective medicines use to help patients achieve the best possible outcomes.

Question 52: Which sterilisation method is preferred for heat-labile products?

Autoclaving
Gamma irradiation
Filtration through 0.22 µm membrane (Correct answer)
Dry heat sterilisation

Correct answer: Filtration through 0.22 µm membrane

Membrane filtration (0.22 µm) physically removes microorganisms without heat, making it suitable for thermolabile solutions such as proteins or certain injectables.

Question 53: 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)
A tool for assessing falls risk
A medication administration system for care homes
Scoring pain levels in elderly patients

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 54: Which proton pump inhibitor has the most significant interaction with clopidogrel?

Esomeprazole
Omeprazole (Correct answer)
Lansoprazole
Pantoprazole

Correct answer: Omeprazole

Omeprazole and esomeprazole are potent CYP2C19 inhibitors, reducing conversion of clopidogrel to its active metabolite. Pantoprazole has the least effect.

Question 55: According to NICE, what is the first-line pharmacological treatment for osteoporosis in post-menopausal women?

Alendronic acid (bisphosphonate) plus vitamin D and calcium (Correct answer)
Raloxifene alone
Strontium ranelate
HRT alone

Correct answer: Alendronic acid (bisphosphonate) plus vitamin D and calcium

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

Question 56: Under the Medicines Act 1968, which category of medicines can only be sold or supplied from a registered pharmacy by or under the supervision of a pharmacist?

Controlled drugs only
Pharmacy (P) medicines (Correct answer)
General Sale List (GSL) medicines
Prescription Only Medicines (POMs)

Correct answer: Pharmacy (P) medicines

Pharmacy (P) medicines must be sold from a registered pharmacy under the supervision of a pharmacist. POMs require a prescription, GSL medicines can be sold from any retail outlet, and controlled drugs are a subset of POMs with additional restrictions.

Question 57: During the final accuracy check of a dispensed prescription, the pharmacist notices the tablets are the correct generic medicine but a different brand from what the patient usually receives. The prescription is written generically. What is the correct action?

Contact the prescriber to change to a branded prescription
The prescription is written generically so any brand is acceptable — proceed with the accuracy check and counsel the patient about the different appearance (Correct answer)
Tell the patient to return the tablets if they experience any problems
Reject the dispensed item and reorder the patient's usual brand

Correct answer: The prescription is written generically so any brand is acceptable — proceed with the accuracy check and counsel the patient about the different appearance

When a prescription is written generically, any brand of that generic medicine meeting the required specification can be dispensed. The pharmacist should proceed with the accuracy check and proactively inform the patient that the tablets may look different but contain the same medicine. This prevents confusion and supports adherence.

Question 58: A patient taking ibuprofen OTC also takes warfarin. What advice should the pharmacist give?

Avoid ibuprofen — recommend paracetamol instead; ibuprofen increases bleeding risk (Correct answer)
Ibuprofen is safe with warfarin
Take ibuprofen at a different time to warfarin
Use a reduced dose of ibuprofen

Correct answer: Avoid ibuprofen — recommend paracetamol instead; ibuprofen increases bleeding risk

NSAIDs including ibuprofen displace warfarin from protein binding and inhibit platelet function, significantly increasing bleeding risk. Paracetamol is the safer OTC analgesic choice for anticoagulated patients.

Question 59: What is the purpose of 'therapeutic drug monitoring' (TDM)?

To assess drug costs
To measure drug plasma concentrations to optimise dosing for efficacy and safety (Correct answer)
To monitor patient compliance only
To evaluate prescriber performance

Correct answer: To measure drug plasma concentrations to optimise dosing for efficacy and safety

TDM involves measuring drug concentrations in blood to ensure levels are within the therapeutic window — high enough for efficacy, low enough to avoid toxicity. Used for drugs with narrow therapeutic indices.

Question 60: Which body investigates concerns about fitness to practise for registered pharmacists?

The GPhC Fitness to Practise Committee (Correct answer)
NHS England
The Royal Pharmaceutical Society
The Coroner

Correct answer: The GPhC Fitness to Practise Committee

The GPhC's Fitness to Practise Committee investigates allegations of impairment through misconduct, poor performance, health issues, or criminal convictions affecting a pharmacist's registration.

Question 61: Under the NHS community pharmacy contractual framework in England, which public health service involves pharmacies providing advice and supplying nicotine replacement therapy without a prescription?

Flu vaccination service
Medicines Use Review (MUR)
Minor Ailments Scheme
NHS Stop Smoking Service (Correct answer)

Correct answer: NHS Stop Smoking Service

The NHS Stop Smoking Service is a public health service commissioned through community pharmacies. Pharmacists can provide behavioural support and supply NRT (nicotine replacement therapy) products through a PGD or locally commissioned service without requiring a prescription. This is one of the key public health roles of community pharmacy.

Question 62: Which route of administration avoids first-pass metabolism most effectively?

Sublingual
Oral
Rectal
Intravenous (Correct answer)

Correct answer: Intravenous

Intravenous administration delivers drug directly into systemic circulation, completely bypassing first-pass hepatic metabolism.

Question 63: An insulin pen delivers 100 units/mL. A patient is prescribed 36 units twice daily. How many days will a 3mL cartridge last?

4 days (Correct answer)
2 days
8 days
10 days

Correct answer: 4 days

Total units in cartridge = 100 units/mL × 3mL = 300 units. Daily dose = 36 units × 2 = 72 units/day. Days supply = 300 ÷ 72 = 4.17 days, so the cartridge will last 4 complete days.

Question 64: Which antibiotic class acts by inhibiting cell wall synthesis by binding penicillin-binding proteins?

Fluoroquinolones
Macrolides
Aminoglycosides
Beta-lactams (penicillins, cephalosporins) (Correct answer)

Correct answer: Beta-lactams (penicillins, cephalosporins)

Beta-lactam antibiotics (penicillins, cephalosporins, carbapenems) inhibit transpeptidase enzymes (penicillin-binding proteins) that cross-link peptidoglycan in bacterial cell walls.

Question 65: According to BNF, which medication should be avoided in patients with eGFR <30 mL/min/1.73m²?

Atorvastatin
Omeprazole
Amlodipine
Metformin (Correct answer)

Correct answer: Metformin

Metformin is contraindicated when eGFR <30 due to the risk of lactic acidosis from drug accumulation in renal impairment.

Question 66: What is 'off-label' prescribing?

Prescribing a medicine outside its licensed indications, age, dose, or route (Correct answer)
Prescribing a generic medicine
Prescribing a controlled drug
Dispensing without a prescription

Correct answer: Prescribing a medicine outside its licensed indications, age, dose, or route

Off-label use means a licensed medicine is used in a way not covered by its marketing authorisation (e.g., different indication, age group, or dose). The prescriber takes clinical responsibility.

Question 67: Which legislation governs the safe and secure handling of controlled drugs in England?

Medicines Act 1968
Misuse of Drugs Act 1971 only
Health Act 2006 and Controlled Drugs (Supervision of Management and Use) Regulations 2013 (Correct answer)
Human Medicines Regulations 2012

Correct answer: Health Act 2006 and Controlled Drugs (Supervision of Management and Use) Regulations 2013

The Health Act 2006 and CD Supervision Regulations 2013 established the Controlled Drugs Accountable Officer (CDAO) system for oversight and safe management of CDs in England.

Question 68: A patient is taking warfarin and reports they have started taking aspirin for joint pain. What is the key concern?

Reduced warfarin efficacy
No interaction — both are safe together
Increased bleeding risk due to antiplatelet + anticoagulant combination and aspirin-induced gastric bleeding (Correct answer)
Reduced aspirin efficacy

Correct answer: Increased bleeding risk due to antiplatelet + anticoagulant combination and aspirin-induced gastric bleeding

Aspirin combined with warfarin significantly increases bleeding risk through two mechanisms: synergistic anticoagulant/antiplatelet effect and aspirin-induced GI erosions. This combination should be avoided unless clinically indicated.

Question 69: Which of the following medicines requires therapeutic drug monitoring (TDM) due to its narrow therapeutic index?

Omeprazole
Amoxicillin
Metformin
Lithium (Correct answer)

Correct answer: Lithium

Lithium has a very narrow therapeutic index — the difference between a therapeutic dose and a toxic dose is small. Regular serum lithium monitoring is essential (target range 0.4-1.0 mmol/L for maintenance). Toxicity can cause renal failure, seizures, and cardiac arrhythmias.

Question 70: Which validated tool is commonly used in clinical practice to measure a patient's self-reported adherence to long-term medication regimens?

PHQ-9 questionnaire
Morisky Medication Adherence Scale (MMAS) (Correct answer)
FRAX score
AUDIT-C questionnaire

Correct answer: Morisky Medication Adherence Scale (MMAS)

The Morisky Medication Adherence Scale (MMAS) is a validated self-report questionnaire specifically designed to identify patterns of adherence and barriers to taking medicines.

Question 71: The GPhC Pharmacist Independent Prescriber qualification allows prescribing:

Any medicine within their competence, including Schedule 2 and 3 CDs (except diamorphine for addiction) (Correct answer)
Only in hospital settings
Only from a limited formulary
Only GSL medicines

Correct answer: Any medicine within their competence, including Schedule 2 and 3 CDs (except diamorphine for addiction)

GPhC-qualified pharmacist independent prescribers can prescribe any licensed medicine within their competence, including CDs (except diamorphine and cocaine for addiction treatment).

Question 72: A patient taking warfarin is prescribed clarithromycin. What interaction should you counsel about?

Increased INR and bleeding risk (Correct answer)
No clinically significant interaction
Reduced warfarin absorption
Decreased INR

Correct answer: Increased INR and bleeding risk

Clarithromycin inhibits CYP3A4 and CYP2C9, reducing warfarin metabolism and increasing anticoagulant effect, raising INR and bleeding risk.

Question 73: A patient with atrial fibrillation and a CHA₂DS₂-VASc score of 2 (male) should receive:

Rate control only
Aspirin alone
Anticoagulation with apixaban or warfarin (Correct answer)
No treatment needed

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 74: What is the significance of a drug's pKa?

It predicts renal clearance directly
It measures lipid solubility
It determines the degree of ionisation at a given pH (Correct answer)
It indicates the drug's protein binding affinity

Correct answer: It determines the degree of ionisation at a given pH

pKa is the pH at which 50% of the drug is ionised. It helps predict ionisation state at physiological pH, influencing absorption and distribution.

Question 75: A pharmacist discovers that a dispensing error has been made after the patient has left the pharmacy. Under the GPhC duty of candour, what must the pharmacist do?

Document the error internally and wait for the patient to return
Report only to the superintendent pharmacist
Contact the patient promptly, explain what happened, and apologise (Correct answer)
Notify the MHRA before contacting the patient

Correct answer: Contact the patient promptly, explain what happened, and apologise

The duty of candour requires pharmacy professionals to be open and honest with patients when things go wrong. This includes promptly contacting the patient, explaining what happened, apologising, and taking steps to remedy the situation. Delay could cause patient harm.

Question 76: At which transition of care is medicines reconciliation most critical for preventing medication errors?

When a patient changes their registered community pharmacy
When a patient collects a repeat prescription from the pharmacy
On admission to or discharge from hospital (Correct answer)
When a patient requests a new OTC product from the pharmacist

Correct answer: On admission to or discharge from hospital

Medicines reconciliation is most important at hospital admission and discharge, where care transitions create the highest risk of medication omissions, unintended changes, and prescribing errors.

Question 77: A patient on atorvastatin is prescribed a course of fluconazole by their GP. What patient safety concern should the pharmacist raise?

There is no significant interaction between these drugs
Fluconazole inhibits CYP3A4, increasing atorvastatin levels and the risk of myopathy/rhabdomyolysis (Correct answer)
Atorvastatin reduces the antifungal effect of fluconazole
Fluconazole reduces the effectiveness of atorvastatin

Correct answer: Fluconazole inhibits CYP3A4, increasing atorvastatin levels and the risk of myopathy/rhabdomyolysis

Fluconazole is a potent inhibitor of CYP3A4 and CYP2C9. Atorvastatin is metabolised by CYP3A4. Co-administration can significantly increase atorvastatin plasma concentrations, raising the risk of statin-related myopathy and rhabdomyolysis. The pharmacist should contact the prescriber to discuss alternatives or temporary statin suspension.

Question 78: A prodrug is:

A drug with no side effects
An inactive compound converted to active drug in the body (Correct answer)
An immediate-release formulation
A drug that bypasses renal clearance

Correct answer: An inactive compound converted to active drug in the body

Prodrugs are pharmacologically inactive compounds that undergo biotransformation in vivo to release the active drug, often improving absorption or reducing toxicity.

Question 79: A pharmacist needs to prepare 200mL of a 5% w/v solution from a 20% w/v stock solution and water. What volumes of stock solution and water are needed?

25mL stock + 175mL water
100mL stock + 100mL water
50mL stock + 150mL water (Correct answer)
40mL stock + 160mL water

Correct answer: 50mL stock + 150mL water

Using C₁V₁ = C₂V₂: 20% × V₁ = 5% × 200mL. V₁ = (5 × 200) ÷ 20 = 50mL of stock solution. Water needed = 200mL - 50mL = 150mL.

Question 80: A patient presents with a prescription for diazepam 10 mg tablets, 56 tablets. What consideration applies?

It can be dispensed without a prescription in an emergency
It requires full Schedule 2 CD register entry
It cannot be legally prescribed for more than 14 days
Diazepam is Schedule 4 Part 1 CD — it requires a valid prescription but not a CD register entry or safe custody (Correct answer)

Correct answer: Diazepam is Schedule 4 Part 1 CD — it requires a valid prescription but not a CD register entry or safe custody

Diazepam is Schedule 4 Part 1 (benzodiazepines). It requires a valid prescription but not a CD register entry, CD requisition, or mandatory safe custody, though safe storage is recommended.

Question 81: Which monitoring should be performed in a patient started on clozapine?

Full blood count (FBC) — monitoring for agranulocytosis (Correct answer)
Liver function tests only
Blood glucose only
Serum creatinine only

Correct answer: Full blood count (FBC) — monitoring for agranulocytosis

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 82: Shared decision making in the context of medicines optimisation requires that:

The clinician and patient work together using evidence alongside the patient's preferences and values (Correct answer)
The patient selects their preferred medicine from a clinician-generated list
Agreement is reached between the GP and pharmacist before informing the patient
The clinician makes the final decision based on the strongest clinical evidence

Correct answer: The clinician and patient work together using evidence alongside the patient's preferences and values

Shared decision making is a collaborative process where clinical evidence is combined with the patient's individual values, preferences, and circumstances to reach a jointly agreed decision.

Question 83: What is serotonin syndrome and which combination most commonly causes it?

Opioid toxicity; tramadol + morphine
Antibiotic resistance; macrolide + SSRI
Dangerous serotonergic excess; SSRI + tramadol (Correct answer)
Hypertensive crisis; MAOI + paracetamol

Correct answer: Dangerous serotonergic excess; SSRI + tramadol

Serotonin syndrome is life-threatening excess serotonin activity causing hyperthermia, clonus, and agitation. SSRI combined with tramadol (also serotonergic) is a common precipitant.

Question 84: A 70-year-old patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. Which of the following is the most appropriate anticoagulation strategy according to NICE?

A direct oral anticoagulant (DOAC) such as apixaban or edoxaban (Correct answer)
Clopidogrel 75mg daily
Aspirin 75mg daily
No anticoagulation needed at this score

Correct answer: A direct oral anticoagulant (DOAC) such as apixaban or edoxaban

NICE recommends offering anticoagulation to patients with a CHA₂DS₂-VASc score of 2 or above. DOACs (apixaban, dabigatran, edoxaban, rivaroxaban) are recommended as options. Aspirin monotherapy is no longer recommended for stroke prevention in atrial fibrillation.

Question 85: A mother asks for something to treat her 4-year-old child's fever. Which product is most appropriate?

Codeine-containing liquid
Adult paracetamol 500 mg tablets
Paracetamol suspension (120 mg/5 mL) or ibuprofen suspension (Correct answer)
Adult aspirin tablets

Correct answer: Paracetamol suspension (120 mg/5 mL) or ibuprofen suspension

Paracetamol (120 mg/5 mL) and ibuprofen suspensions are appropriate for children aged ≥3 months. Aspirin is contraindicated under 16 (Reye's syndrome risk). Adult formulations are inappropriate doses.

Question 86: A pharmacist dispenses methotrexate 2.5 mg tablets. What is the critical safety counselling point?

Methotrexate is taken ONCE weekly — daily dosing can be fatal (Correct answer)
It cannot be taken with water
It should be stored in the freezer
It must be taken with food only

Correct answer: Methotrexate is taken ONCE weekly — daily dosing can be fatal

Methotrexate must only be taken once weekly for inflammatory conditions (not daily). Inadvertent daily dosing has caused severe toxicity and deaths. This must be explicitly counselled.

Question 87: Which solubility enhancing technique involves forming a complex between drug and cyclodextrin?

Salt formation
Micronisation
Complexation (Correct answer)
Co-solvency

Correct answer: Complexation

Cyclodextrins form inclusion complexes with poorly water-soluble drugs, enhancing their solubility and bioavailability without chemical modification.

Question 88: A patient weighing 70kg requires gentamicin at 5mg/kg/day administered in two divided doses. Gentamicin injection is available as 80mg/2mL. What volume is needed per dose?

2.19mL
8.75mL
3.5mL
4.38mL (Correct answer)

Correct answer: 4.38mL

Daily dose = 5mg/kg × 70kg = 350mg. Per dose = 350 ÷ 2 = 175mg. Concentration = 80mg/2mL = 40mg/mL. Volume = 175mg ÷ 40mg/mL = 4.375mL, approximately 4.38mL.

Question 89: Which Schedule of the Misuse of Drugs Regulations 2001 includes morphine and diamorphine?

Schedule 1
Schedule 3
Schedule 5
Schedule 2 (Correct answer)

Correct answer: Schedule 2

Schedule 2 includes drugs with accepted medical use but high misuse potential (e.g., morphine, diamorphine, fentanyl, pethidine), subject to full CD controls.

Question 90: Under the public health agenda, what is the pharmacist's responsibility regarding antimicrobial stewardship?

Antibiotics stewardship is solely the responsibility of hospital pharmacists
Prescribe antibiotics for self-limiting conditions to prevent complications
Supply antibiotics over the counter to reduce GP workload
Promote appropriate antibiotic use, advise patients on self-limiting infections, and support national campaigns to reduce antimicrobial resistance (Correct answer)

Correct answer: Promote appropriate antibiotic use, advise patients on self-limiting infections, and support national campaigns to reduce antimicrobial resistance

Community pharmacists play a key role in antimicrobial stewardship by advising patients that many infections are self-limiting, recommending symptomatic relief, supporting the TARGET toolkit and Antibiotic Awareness campaigns, and ensuring appropriate antibiotic supply. This helps combat antimicrobial resistance, which the WHO identifies as a major global health threat.

Question 91: 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 controlled drug only
A medicine requiring refrigerated storage

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 92: According to NICE guidelines, what is the first-line treatment for newly diagnosed type 2 diabetes alongside lifestyle advice?

Gliclazide
Metformin (Correct answer)
Sitagliptin
Insulin glargine

Correct answer: Metformin

NICE recommends metformin as first-line pharmacotherapy for type 2 diabetes, provided renal function is adequate (eGFR ≥30 mL/min/1.73m²).

Question 93: A pharmacist prepares 500mL of an oral solution. The displacement value of the suspended powder is 0.8mL/g, and 25g of powder is used. What volume of vehicle is needed?

480mL (Correct answer)
475mL
500mL
520mL

Correct answer: 480mL

Displacement volume of powder = 25g × 0.8mL/g = 20mL. The powder displaces 20mL when suspended. Therefore, vehicle needed = 500mL - 20mL = 480mL to give a final volume of 500mL.

Question 94: Which of the following is an example of a 'clinical governance' activity in community pharmacy?

Only ordering stock efficiently
Setting promotional pricing
Decorating the pharmacy premises
Regular audit of dispensing errors and near misses (Correct answer)

Correct answer: Regular audit of dispensing errors and near misses

Clinical governance encompasses activities that improve quality and safety of patient care: clinical audit, error reporting, CPD, risk assessment, and patient feedback mechanisms.

Question 95: A patient's prescription specifies 'metformin 500mg tablets — 56 tablets'. The pharmacy has both standard and modified-release metformin 500mg in stock. Which should be dispensed?

Either formulation can be dispensed as the dose is the same
Whichever is cheaper for the pharmacy
The modified-release formulation as it has better compliance
Only the standard-release formulation, as modified-release would need to be specified on the prescription (Correct answer)

Correct answer: Only the standard-release formulation, as modified-release would need to be specified on the prescription

Standard-release and modified-release formulations are not interchangeable. If the prescription simply states 'metformin 500mg tablets' without specifying MR or SR, the standard-release formulation should be dispensed. Modified-release formulations have different pharmacokinetic profiles, dosing schedules, and are prescribed specifically when intended.

Question 96: Which schedule of the Misuse of Drugs Regulations exempts certain preparations from CD safe custody requirements?

Schedule 5 (Correct answer)
Schedule 2
Schedule 1
Schedule 3

Correct answer: Schedule 5

Schedule 5 preparations (e.g., low-strength codeine linctus, dihydrocodeine preparations) are exempt from most CD controls including safe custody, requisitions, and registers.

Question 97: What is an 'unlicensed medicine'?

A medicine without a UK marketing authorisation, used on prescriber responsibility (Correct answer)
A controlled drug
A medicine that has been withdrawn from sale
A medicine that has failed NICE appraisal

Correct answer: A medicine without a UK marketing authorisation, used on prescriber responsibility

Unlicensed medicines have no UK marketing authorisation (MA). Their use is legal but places full clinical responsibility on the prescriber. They include specials, imports, and investigational drugs.

Question 98: A patient prescribed warfarin reports eating large amounts of leafy green vegetables. What effect might this have?

Increased INR
Reduced INR due to increased vitamin K intake (Correct answer)
Reduced warfarin absorption
No effect on warfarin

Correct answer: Reduced INR due to increased vitamin K intake

Leafy greens (e.g., spinach, kale) are rich in vitamin K, which antagonises warfarin's anticoagulant effect, reducing INR. Consistent dietary intake is advised.

Question 99: What is the maximum quantity of codeine linctus a pharmacist may sell to one customer over the counter under current guidelines?

Any amount up to 500 mL
Unlimited if the patient insists
One 100 mL bottle (limiting to small quantities) (Correct answer)
Only on prescription

Correct answer: One 100 mL bottle (limiting to small quantities)

Sales of codeine-containing preparations should be limited to small quantities (typically one pack/bottle). Pharmacists must use professional judgment to prevent misuse and dependence.

Question 100: What is the first-line treatment for Clostridium difficile infection according to UK guidelines?

Oral amoxicillin
Intravenous metronidazole
Oral vancomycin or fidaxomicin (Correct answer)
Oral ciprofloxacin

Correct answer: Oral vancomycin or fidaxomicin

UK guidelines (PHE/NICE) recommend oral vancomycin or fidaxomicin as first-line treatment for C. difficile infection. Oral metronidazole is no longer first-line.

Question 101: What does 'bioavailability' refer to?

The rate of renal excretion
The fraction of administered drug that reaches systemic circulation (Correct answer)
The speed at which a drug is metabolised
The volume in which a drug distributes

Correct answer: The fraction of administered drug that reaches systemic circulation

Bioavailability (F) is the proportion of an administered dose that reaches the systemic circulation unchanged. IV administration gives 100% bioavailability.

Question 102: Which professional obligation requires a pharmacist to act in their patient's best interest even when it conflicts with commercial pressures?

Duty of care and patient-centredness (GPhC Standard 1) (Correct answer)
Employer instructions always override professional duty
Commercial compliance
Only applies to NHS pharmacists

Correct answer: Duty of care and patient-centredness (GPhC Standard 1)

GPhC Standard 1 (Provide person-centred care) and the duty of care require pharmacists to prioritise patient wellbeing even when this conflicts with employer or commercial interests.

Question 103: Which of the following is NOT permitted on a Schedule 2 CD prescription?

A nurse independent prescriber's signature
Total quantity expressed as words only without figures (Correct answer)
Computer-generated text with handwritten signature
Both words and figures for the total quantity

Correct answer: Total quantity expressed as words only without figures

CD prescriptions must state the total quantity in both words AND figures (e.g., thirty (30) tablets). Words alone are not sufficient; both are legally required.

Question 104: A newly diagnosed asthma patient is prescribed a salbutamol inhaler. They are using it four times per week. According to the BTS/SIGN stepwise approach, what should happen next?

Continue with salbutamol alone as needed
Start a long-acting beta-agonist (LABA) without ICS
Prescribe oral montelukast as monotherapy
Add a regular low-dose inhaled corticosteroid (ICS) (Correct answer)

Correct answer: Add a regular low-dose inhaled corticosteroid (ICS)

Using a reliever inhaler three or more times per week indicates uncontrolled asthma. BTS/SIGN guidelines recommend stepping up to a regular low-dose ICS (e.g., beclometasone 200-400 micrograms/day) at Step 2. A LABA should never be used without an ICS in asthma.

Question 105: A prescription reads: 'Hydrocortisone cream 1% diluted 1 in 4 with aqueous cream. Supply 100g.' How much hydrocortisone 1% cream is needed?

25g (Correct answer)
33g
75g
4g

Correct answer: 25g

'Diluted 1 in 4' means 1 part hydrocortisone cream in 4 parts total (i.e., 1 part cream + 3 parts diluent). For 100g total: hydrocortisone cream = 100g ÷ 4 = 25g. Aqueous cream = 100g - 25g = 75g.

Question 106: What is the correct way to store morphine sulphate tablets in a community pharmacy?

In the pharmacy fridge
In a locked, fixed Schedule 2 CD cabinet (Correct answer)
In a separate room away from the dispensary
On open shelves if labelled clearly

Correct answer: In a locked, fixed Schedule 2 CD cabinet

Schedule 2 CDs must be stored in a locked, fixed-to-structure cabinet that meets the Misuse of Drugs (Safe Custody) Regulations 1973 specifications.

Question 107: What is a 'specials' medicine in the context of UK pharmacy?

A particularly expensive medicine
An unlicensed medicine manufactured to meet a specific clinical need not met by licensed products (Correct answer)
A hospital-only formulary medicine
A medicine on shortage

Correct answer: An unlicensed medicine manufactured to meet a specific clinical need not met by licensed products

Specials are unlicensed medicines manufactured under a Manufacturer's Specials Licence (MS) when no licensed product is suitable for a patient's individual clinical need (e.g., specific dose, formulation, or excipient-free version).

Question 108: Which inhaler technique error is most common with a pressurised metered-dose inhaler (pMDI)?

Inhaling too fast (Correct answer)
Using it in cold weather
Not removing the cap
Shaking too vigorously

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 109: A prescription requires 150mL of a 1 in 10,000 solution of potassium permanganate. How many milligrams of potassium permanganate are needed?

0.015mg
150mg
15mg (Correct answer)
1.5mg

Correct answer: 15mg

A '1 in 10,000' solution means 1g in 10,000mL. For 150mL: (1g ÷ 10,000mL) × 150mL = 0.015g = 15mg. Remember that 'x in y' concentrations express grams per millilitres.

Question 110: Which process describes drug movement from blood into tissues?

Elimination
Metabolism
Distribution (Correct answer)
Absorption

Correct answer: Distribution

Distribution refers to the reversible transfer of a drug from the systemic circulation into tissues and organs throughout the body.

Question 111: What is the legal basis for a pharmacist to make an emergency supply of a POM without a prescription?

Emergency supply is always illegal without a prescription
The Medicines Act 1968 allows unlimited emergency supply
The Human Medicines Regulations 2012 allow emergency supply at patient or prescriber request under defined conditions (Correct answer)
Only doctors can authorise emergency supply

Correct answer: The Human Medicines Regulations 2012 allow emergency supply at patient or prescriber request under defined conditions

Pharmacists can make an emergency supply under the Human Medicines Regulations 2012 when a prescriber cannot be contacted or the patient urgently needs continuation of chronic therapy, subject to conditions.

Question 112: What is the purpose of an enteric coating on a tablet?

To mask unpleasant taste
To speed up drug release
To improve appearance
To prevent dissolution in gastric acid (Correct answer)

Correct answer: To prevent dissolution in gastric acid

Enteric coatings resist gastric acid and dissolve in the higher pH of the small intestine, protecting acid-labile drugs or preventing gastric irritation.

Question 113: A suppository base that melts at body temperature is described as:

Glycerin base
Macrogol base
Theobroma oil base (Correct answer)
Hydrophilic base

Correct answer: Theobroma oil base

Theobroma oil (cocoa butter) melts at approximately 34–35°C, close to body temperature, making it suitable for rectal suppositories.

Question 114: A medication review that involves the patient in a detailed discussion of all their medicines and aims to optimise therapy through shared decision making is classified as which level of review?

Repeat dispensing review
Prescription review
Clinical medication review (Correct answer)
Adherence review

Correct answer: Clinical medication review

A clinical medication review is the highest level of medication review, conducted with the patient present, covering all aspects of therapy with the aim of optimising outcomes.

Question 115: A patient is prescribed lithium. Which monitoring parameter is most critical?

Blood glucose only
Liver enzymes only
Full blood count only
Serum lithium levels, renal function, and thyroid function (Correct answer)

Correct answer: Serum lithium levels, renal function, and thyroid function

Lithium has a narrow therapeutic index. Regular monitoring of serum lithium (0.4–1.0 mmol/L), renal function (lithium is renally cleared), and thyroid function is essential.

Question 116: Which of the following best describes medication adherence?

The extent to which a patient's behaviour corresponds with agreed recommendations from a healthcare provider (Correct answer)
The patient's written agreement to take medication as prescribed
The ability of a patient to obtain and correctly fill their prescription
The extent to which a patient follows their prescriber's instructions without question

Correct answer: The extent to which a patient's behaviour corresponds with agreed recommendations from a healthcare provider

Adherence describes correspondence between a patient's behaviour and agreed recommendations from a healthcare provider, reflecting a collaborative rather than prescriber-directed relationship.

Question 117: A prescription for 'MST Continus 30mg tablets' is presented. What does 'MST Continus' indicate?

A brand name for methadone
Codeine phosphate tablets
Immediate-release morphine
Modified-release morphine sulfate tablets (Correct answer)

Correct answer: Modified-release morphine sulfate tablets

MST Continus is a brand of modified-release morphine sulfate tablets, providing 12-hourly controlled release. This is a Schedule 2 CD requiring full CD prescription requirements.

Question 118: What is the correct procedure for endorsing an NHS prescription that has been dispensed with a broken bulk (part of an original pack)?

Write 'part pack' on the prescription
Endorse with the total quantity in the original pack
No endorsement is required for broken bulk
Endorse the prescription with 'BB' followed by the pack size and quantity supplied (Correct answer)

Correct answer: Endorse the prescription with 'BB' followed by the pack size and quantity supplied

When a full original pack is not supplied (broken bulk), the pharmacist must endorse the prescription with 'BB' and include details of the pack size used and the quantity supplied. This ensures correct reimbursement from the NHS and creates an accurate dispensing record.

Question 119: What is the Henderson-Hasselbalch equation used for in pharmacy?

Calculating degree of drug ionisation (Correct answer)
Determining drug potency
Calculating infusion rates
Measuring osmolality

Correct answer: Calculating degree of drug ionisation

The Henderson-Hasselbalch equation relates pH, pKa, and the ratio of ionised to unionised drug, enabling prediction of ionisation state in body fluids.

Question 120: A patient taking SSRIs asks about taking St John's Wort for additional mood support. What is the critical interaction?

No interaction with modern SSRIs
Serotonin syndrome risk — both increase serotonin, a potentially life-threatening combination (Correct answer)
St John's Wort reduces SSRI absorption only
Beneficial combination that can replace one SSRI

Correct answer: Serotonin syndrome risk — both increase serotonin, a potentially life-threatening combination

St John's Wort has serotonergic activity. Combined with an SSRI, it can precipitate serotonin syndrome (hyperthermia, clonus, agitation, tachycardia), which can be life-threatening.

Question 121: A patient requires 250 mg of amoxicillin. The suspension available is 125 mg/5 mL. What volume should be dispensed?

10 mL (Correct answer)
5 mL
15 mL
2.5 mL

Correct answer: 10 mL

250 mg ÷ 125 mg × 5 mL = 10 mL. This is a standard concentration calculation.

Question 122: What is the role of a surfactant in pharmaceutical formulations?

Acts as a colouring agent
Reduces surface tension to improve wetting and emulsification (Correct answer)
Provides antimicrobial activity
Increases viscosity

Correct answer: Reduces surface tension to improve wetting and emulsification

Surfactants (surface-active agents) reduce surface tension at interfaces, aiding wetting, emulsification, solubilisation, and dispersion of poorly soluble drugs.

Question 123: For how long must a pharmacist retain a Schedule 2 controlled drug register entry?

1 year
2 years from date of entry (Correct answer)
5 years
6 months

Correct answer: 2 years from date of entry

Under the Misuse of Drugs Regulations 2001, Schedule 2 CD register entries must be kept for at least 2 years from the date of the last entry.

Question 124: A pharmacist suspects a prescription has been forged. What is the most appropriate initial action?

Dispense half the quantity as a compromise
Return the prescription to the patient and ask them to get a new one
Refuse to dispense, retain the prescription, and contact the prescriber to verify its authenticity (Correct answer)
Dispense the prescription but alert the police afterwards

Correct answer: Refuse to dispense, retain the prescription, and contact the prescriber to verify its authenticity

If a pharmacist suspects forgery, they should not dispense the prescription. The prescription should be retained and the prescriber contacted to verify authenticity. If forgery is confirmed, the police should be informed. Dispensing a suspected forged prescription could facilitate drug misuse and is a breach of professional duty.

Question 125: Which type of emulsion is most suitable for intravenous administration?

Microemulsion
Oil-in-water (O/W) (Correct answer)
Multiple emulsion
Water-in-oil (W/O)

Correct answer: Oil-in-water (O/W)

O/W emulsions are miscible with blood (which is aqueous-based), making them suitable for IV use. W/O emulsions are not compatible with blood.

Question 126: An infusion of 500 mg in 250 mL is running at 50 mL/hour. What is the rate in mg/hour?

50 mg/hour
25 mg/hour
200 mg/hour
100 mg/hour (Correct answer)

Correct answer: 100 mg/hour

Concentration = 500/250 = 2 mg/mL. Rate = 2 mg/mL × 50 mL/hour = 100 mg/hour.

Question 127: What is the pharmacist's role in needle and syringe exchange programmes (NSP) as part of harm reduction for injecting drug users?

Pharmacists should refuse to participate as it encourages drug use
Provide clean needles/syringes, sharps bins, and advice on safer injecting practices to reduce blood-borne virus transmission (Correct answer)
Refer all clients to their GP without providing any equipment
Only provide needles if the person agrees to enter a treatment programme

Correct answer: Provide clean needles/syringes, sharps bins, and advice on safer injecting practices to reduce blood-borne virus transmission

Needle and syringe programmes are evidence-based harm reduction interventions that significantly reduce transmission of blood-borne viruses (HIV, hepatitis B and C) among injecting drug users. Community pharmacies provide clean equipment, sharps disposal, and health advice without requiring engagement in treatment as a precondition.

Question 128: Which of the following conditions can a pharmacist supply treatment for under the NHS Pharmacy First service in England?

Chest pain radiating to the left arm
Uncomplicated urinary tract infection in women aged 16-64 (Correct answer)
Type 2 diabetes management
Suspected appendicitis

Correct answer: Uncomplicated urinary tract infection in women aged 16-64

The NHS Pharmacy First service (launched January 2024) allows community pharmacists to assess and supply prescription-only medicines for seven common conditions via clinical pathways, including uncomplicated UTIs in women aged 16-64. Other conditions include sinusitis, sore throat, earache, infected insect bites, impetigo, and shingles.

Question 129: What is the target INR range for a patient with atrial fibrillation on warfarin?

2.0–3.0 (Correct answer)
3.0–4.5
1.5–2.0
1.0–1.5

Correct answer: 2.0–3.0

The target INR for AF anticoagulation with warfarin is 2.0–3.0. Higher ranges (3.0–4.5) are used for mechanical heart valves.

Question 130: A pharmacist reviewing a patient's medication record identifies that ramipril and candesartan are both prescribed concurrently. What is the most appropriate action?

Dispense both medications but counsel the patient to monitor their blood pressure at home
Continue both medications as dual renin-angiotensin system blockade is endorsed in heart failure management
Withhold both medications immediately and arrange an urgent GP appointment
Contact the prescriber to discuss the combination, as dual RAAS blockade increases the risk of renal failure, hyperkalaemia, and hypotension (Correct answer)

Correct answer: Contact the prescriber to discuss the combination, as dual RAAS blockade increases the risk of renal failure, hyperkalaemia, and hypotension

Dual RAAS blockade combining an ACE inhibitor and ARB is not recommended in guidelines due to significantly increased risks of acute kidney injury, hyperkalaemia, and hypotension; the prescriber should be alerted.

Question 131: Which excipient acts as a preservative in multi-dose eye drops?

Sodium chloride
Povidone
Hydroxypropyl methylcellulose
Benzalkonium chloride (Correct answer)

Correct answer: Benzalkonium chloride

Benzalkonium chloride (BAC) is the most commonly used preservative in multi-dose ophthalmic preparations. It prevents microbial contamination.

Question 132: A community pharmacist is providing the NHS seasonal influenza vaccination service. Which of the following patient groups is eligible for a free NHS flu vaccination?

Only healthcare workers in hospital settings
Children under 5 only
Adults aged 65 and over (Correct answer)
All adults aged 18-64 with no health conditions

Correct answer: Adults aged 65 and over

Adults aged 65 and over are routinely eligible for free NHS flu vaccination. Other eligible groups include those with chronic conditions (asthma, diabetes, heart disease), pregnant women, carers, and frontline health/social care workers. Pharmacists can administer the vaccine under a national PGD or NHS service specification.

Question 133: A cream contains 0.025% w/w of betamethasone valerate. How many micrograms of betamethasone valerate are in 30g of the cream?

7,500 micrograms (Correct answer)
750,000 micrograms
750 micrograms
75,000 micrograms

Correct answer: 7,500 micrograms

0.025% w/w = 0.025g per 100g. In 30g: (0.025g ÷ 100g) × 30g = 0.0075g = 7.5mg = 7,500 micrograms.

Question 134: In pharmaceutical compounding, a 'tincture' is defined as:

A sterile injectable solution
An oil-based cream
An alcoholic extract of plant material (Correct answer)
A water-based suspension

Correct answer: An alcoholic extract of plant material

Tinctures are alcoholic or hydroalcoholic extracts prepared from plant materials or animal drugs, typically at a 1:5 or 1:10 ratio.

Question 135: A patient with chronic heart failure is being managed with ramipril and bisoprolol. Despite optimal doses, they remain symptomatic (NYHA class III). According to NICE, which additional medication should be considered?

Digoxin as first add-on
Furosemide dose increase only
Amlodipine
Spironolactone (or eplerenone) (Correct answer)

Correct answer: Spironolactone (or eplerenone)

NICE recommends adding a mineralocorticoid receptor antagonist (MRA) such as spironolactone or eplerenone for patients with heart failure with reduced ejection fraction who remain symptomatic despite optimal ACE inhibitor and beta-blocker therapy. This is established step 3 in the heart failure treatment pathway.

Question 136: What must a pharmacist do if they have a conscientious objection to dispensing a legal prescription?

Refer the patient to another provider who can dispense it (Correct answer)
Dispense it regardless of personal beliefs
Refuse without providing any alternative
Contact the prescriber to cancel the prescription

Correct answer: Refer the patient to another provider who can dispense it

GPhC standards require that even if a pharmacist exercises a conscientious objection, they must ensure the patient receives the care they need by referring them to another provider promptly.

Question 137: A pharmacist dispenses the wrong drug to a patient who then takes it. What regulatory reporting obligation may exist?

Only tell the patient's GP
Report as a patient safety incident via NHS reporting systems; serious harm may require reporting to GPhC and coroner (Correct answer)
No reporting needed if patient recovers
Only document in the dispensary error log

Correct answer: Report as a patient safety incident via NHS reporting systems; serious harm may require reporting to GPhC and coroner

A dispensing error causing patient harm must be reported through NHS incident reporting. Serious harm or death may necessitate reporting to the GPhC (fitness to practise) and the coroner if death occurs.

Question 138: How many millimoles of sodium are in 500mL of sodium chloride 0.9% infusion? (Molecular weight of NaCl = 58.5, Na = 23, Cl = 35.5)

154 mmol
77 mmol (Correct answer)
38.5 mmol
308 mmol

Correct answer: 77 mmol

NaCl 0.9% = 0.9g per 100mL = 4.5g per 500mL. Moles of NaCl = 4.5g ÷ 58.5g/mol = 0.0769 mol = 76.9 mmol. Since each NaCl molecule gives one Na⁺ ion, sodium content = 77 mmol. (Note: 154 mmol would be per litre.)

Question 139: Which body administers the NHS Business Services Authority (NHS BSA) Prescription Pricing Division?

NHS BSA (Correct answer)
GPhC
NICE
NHS England

Correct answer: NHS BSA

The NHS BSA Prescription Pricing Division processes NHS prescription claims from dispensing contractors, calculates reimbursements, and monitors dispensing activity nationally.

Question 140: A customer with hypertension asks about using an OTC decongestant nasal spray. What advice should be given?

Oral decongestants should be avoided; short-term nasal decongestant sprays may be considered but use with caution (Correct answer)
No OTC options exist for hypertensive patients
Use pseudoephedrine tablets — safer than nasal sprays
All decongestants are safe in hypertension

Correct answer: Oral decongestants should be avoided; short-term nasal decongestant sprays may be considered but use with caution

Oral sympathomimetic decongestants (pseudoephedrine, phenylephrine) raise blood pressure and are contraindicated in hypertension. Topical nasal sprays have less systemic absorption but short-term use with caution is generally preferred.

Question 141: Which of the following is NOT a legal requirement on an NHS FP10 prescription form?

Date of prescribing
Prescriber's signature
Patient's name and address
The patient's NHS number (Correct answer)

Correct answer: The patient's NHS number

The NHS number is not a legal prescription requirement, though it is increasingly used for identification. Legal requirements include patient name/address, drug, dose, quantity, prescriber signature, and date.

Question 142: A pharmacist identifies that a patient has been prescribed methotrexate 10mg daily instead of 10mg weekly. What is the most critical immediate action?

Refer the patient to A&E as a precaution
Dispense as written and advise the patient to take it weekly
Contact the prescriber immediately to clarify the dosing frequency before dispensing (Correct answer)
Dispense a reduced quantity to limit potential harm

Correct answer: Contact the prescriber immediately to clarify the dosing frequency before dispensing

Daily methotrexate dosing (instead of weekly) is a well-known fatal prescribing error that has caused multiple patient deaths. The pharmacist must contact the prescriber immediately to clarify and correct the prescription. This is a never-event in the NHS. Dispensing as written, even with verbal advice, is not acceptable.

Question 143: Which strength of naloxone is carried as an emergency medicine in community pharmacies under some NHS England schemes?

Naloxone 100 mg infusion only
Naloxone is not available in community pharmacies
Naloxone 10 mg tablets
Naloxone 400 micrograms/mL injection and/or 1.8 mg intranasal spray (Correct answer)

Correct answer: Naloxone 400 micrograms/mL injection and/or 1.8 mg intranasal spray

Under take-home naloxone schemes, pharmacies supply naloxone 400 mcg/mL injection or Nyxoid 1.8 mg nasal spray for opioid overdose reversal in community settings.

Question 144: What is the molecular basis of drug tolerance?

Enhanced gut absorption
Receptor downregulation (Correct answer)
Reduced protein binding
Increased renal excretion

Correct answer: Receptor downregulation

Tolerance often develops due to receptor downregulation — the number or sensitivity of receptors decreases with repeated drug exposure, reducing effect.

Question 145: 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 sodium retention only
Increased bleeding time only
Reduced analgesic effect

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 146: Which NSAID is associated with the lowest cardiovascular risk according to current evidence?

Ibuprofen high-dose
Diclofenac
Celecoxib
Naproxen (Correct answer)

Correct answer: Naproxen

Naproxen is generally considered to have the lowest cardiovascular risk among NSAIDs due to its platelet inhibitory effects resembling aspirin, though GI risk remains.

Question 147: Which antihypertensive is recommended as first-line for a 55-year-old Caucasian patient without diabetes?

Lisinopril (ACE inhibitor)
Spironolactone
Amlodipine (calcium channel blocker) (Correct answer)
Atenolol (beta-blocker)

Correct answer: Amlodipine (calcium channel blocker)

NICE step 1 for patients aged ≥55 or of black African/Caribbean origin: calcium channel blocker (e.g., amlodipine). ACE inhibitors are first-line for under 55s.

Question 148: What action should a pharmacist take if they receive a prescription they believe is for excessive quantities intended for misuse?

Dispense all prescriptions regardless of quantity
Use professional judgement, potentially contact the prescriber, and decline to dispense if misuse is suspected (Correct answer)
Only dispense half the quantity
Report to police without contacting the prescriber first

Correct answer: Use professional judgement, potentially contact the prescriber, and decline to dispense if misuse is suspected

Pharmacists have a professional duty to exercise judgement. Contacting the prescriber, assessing context, and refusing if misuse is suspected are all appropriate professional responses.

Question 149: Which drug class is first-line for preventing recurrent gout attacks?

Colchicine
Corticosteroids
Xanthine oxidase inhibitors (allopurinol) (Correct answer)
NSAIDs

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.

Question 150: According to NICE, which drug is first-line for treating acute migraine attacks?

Preventive beta-blockers
Opioid analgesics
Sodium valproate
Triptans (e.g., sumatriptan) or analgesics + antiemetic (Correct answer)

Correct answer: Triptans (e.g., sumatriptan) or analgesics + antiemetic

NICE recommends a triptan combined with an NSAID or paracetamol plus an antiemetic for acute migraine. Opioids are not recommended due to risk of medication overuse headache.

Question 151: A child weighing 22kg requires amoxicillin at a dose of 25mg/kg/day in three divided doses. The suspension available is 250mg/5mL. What volume should be given per dose?

22mL
11mL
3.7mL
7.3mL (Correct answer)

Correct answer: 7.3mL

Total daily dose = 25mg/kg × 22kg = 550mg/day. Per dose = 550mg ÷ 3 = 183.3mg. Volume = (183.3mg ÷ 250mg) × 5mL = 3.67mL, rounded to 3.7mL per dose.

Question 152: A pharmacist is asked by police for patient medication records. What is the correct response?

Disclose only with a court order, patient consent, or under a statutory gateway; refuse informal requests (Correct answer)
Refuse all police requests without exception
Ask the GP to decide
Always comply with any police request

Correct answer: Disclose only with a court order, patient consent, or under a statutory gateway; refuse informal requests

Patient information is confidential under UK GDPR/DPA 2018. Pharmacists may disclose to police under statutory gateways (e.g., prevention of serious crime), court orders, or with patient consent — but not on informal request alone.

Question 153: A dispensary technician checks a dispensed item. What is the legal limitation of this role?

Technicians can only count tablets, not check labels
Accuracy checking by technicians is legally permitted for certain accredited technicians, but the final clinical check must be by a pharmacist (Correct answer)
Technicians cannot check anything legally
Technicians can perform all checks independently

Correct answer: Accuracy checking by technicians is legally permitted for certain accredited technicians, but the final clinical check must be by a pharmacist

Accredited checking technicians (ACTs) can perform accuracy checks in some settings, but the clinical appropriateness check — ensuring the prescription is medically safe — must be performed by a pharmacist.

Question 154: During dispensing, a pharmacist notices a prescription for amoxicillin 250mg/5mL suspension with directions 'take 5mL three times a day for 7 days' but the quantity prescribed is only 50mL. What should the pharmacist do?

Dispense 50mL as written on the prescription
Dispense 50mL and tell the patient to return for more
Contact the prescriber to clarify — the dose and duration require 105mL, not 50mL (Correct answer)
Dispense 100mL as the nearest available pack size

Correct answer: Contact the prescriber to clarify — the dose and duration require 105mL, not 50mL

The required quantity is 5mL × 3 times daily × 7 days = 105mL, but only 50mL has been prescribed. This discrepancy between dose/duration and quantity could mean the course will be incomplete. The pharmacist should contact the prescriber to clarify whether the quantity, dose, or duration needs correcting to ensure the patient receives a complete course.

Question 155: Which pharmacist-initiated service involves reviewing all medicines for an older patient with multiple long-term conditions?

Medicines Use Review (MUR) / Structured Medication Review (SMR) (Correct answer)
Minor Ailments Scheme
New Medicines Service
Flu vaccination service

Correct answer: Medicines Use Review (MUR) / Structured Medication Review (SMR)

Structured Medication Reviews (in PCNs) and previously MURs involve pharmacists reviewing the complete medicines regimen of patients on multiple medications to optimise therapy and reduce harm.

Question 156: A pharmacist suspects a prescription may be forged. What is the correct first action?

Ask the patient to return with a new prescription
Refuse dispensing and call the police immediately
Contact the prescriber to verify the prescription (Correct answer)
Dispense the prescription and report later

Correct answer: Contact the prescriber to verify the prescription

The first step is to verify authenticity by contacting the prescriber directly using a verified number (not one on the prescription). Dispensing a forged prescription is a criminal offence.

Question 157: Which factor does NOT affect drug absorption from an oral solid dosage form?

Dissolution rate
Hair colour of the patient (Correct answer)
Particle size of drug
Gastric emptying rate

Correct answer: Hair colour of the patient

Hair colour has no pharmacological relevance. Particle size, dissolution rate, and gastric emptying rate all significantly influence oral drug absorption.

Question 158: What is the significance of a Yellow Card report submitted to the MHRA?

It authorises a new medicine for use
It reports a suspected adverse drug reaction to support pharmacovigilance (Correct answer)
It records a controlled drug transaction
It logs a prescription error internally

Correct answer: It reports a suspected adverse drug reaction to support pharmacovigilance

The MHRA Yellow Card scheme collects reports of suspected adverse drug reactions from healthcare professionals and patients, enabling ongoing pharmacovigilance and drug safety monitoring.

Question 159: A customer requests treatment for oral thrush. Which OTC product is first-line?

Hydrocortisone pellets
Chlorhexidine mouthwash
Amoxicillin
Miconazole oral gel (Daktarin) or nystatin suspension (Correct answer)

Correct answer: Miconazole oral gel (Daktarin) or nystatin suspension

Miconazole oral gel (Daktarin 2%) is the first-line OTC antifungal for oral thrush (candidiasis). Nystatin suspension is also used but is prescription-only in some formulations.

Question 160: When dispensing an owing (incomplete supply), what must the pharmacist ensure?

Record the quantity owed, mark the prescription, inform the patient, and supply the balance from the same prescription within a reasonable timeframe (Correct answer)
Only complete owings for controlled drugs
Issue a new prescription for the remaining quantity
Nothing special is required — just give the rest when stock arrives

Correct answer: Record the quantity owed, mark the prescription, inform the patient, and supply the balance from the same prescription within a reasonable timeframe

When a full quantity cannot be supplied, the pharmacist should record the owing, endorse the prescription with the quantity supplied and quantity owed, inform the patient when to collect the balance, and ensure the remaining quantity is supplied within a reasonable time from the same prescription. Good practice includes maintaining an owings register.

GPhC Registration Assessment

The GPhC Registration Assessment is the UK national examination for trainee pharmacists seeking registration with the General Pharmaceutical Council. It comprises a calculations paper (Part 1) and a clinical and pharmaceutical knowledge paper (Part 2), covering pharmacy law, clinical therapeutics, dispensing practice, pharmaceutical sciences, and public health.

160

Questions

270 min

Time Limit

70%

To Pass

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