Mixed Deck — All GPHC Topics Flashcards

Which drug is used as prophylaxis against Pneumocystis jirovecii pneumonia (PCP) in immunosuppressed patients?

Answer: Co-trimoxazole (trimethoprim + sulfamethoxazole)

Co-trimoxazole is first-line PCP prophylaxis in HIV patients with CD4 <200 cells/µL and other immunosuppressed patients (e.g., on high-dose corticosteroids, post-transplant).

When dispensing a prescription for a Schedule 2 controlled drug, what specific record must be made in the controlled drug register?

Answer: Date of supply, name and address of the patient, prescriber details, quantity supplied, and the running balance

The Misuse of Drugs Regulations 2001 require comprehensive entries in the CD register for Schedule 2 drugs including: date of supply, drug name/form/strength, quantity supplied, person collecting, prescriber name and address, and (good practice) a running balance. Entries must be made on the day of supply or the next day.

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?

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.

What is the osmolarity of normal saline (0.9% NaCl) approximately?

Answer: 308 mOsm/L

0.9% NaCl dissociates into Na+ and Cl−, each at 154 mmol/L, giving approximately 308 mOsm/L, which is isotonic with blood.

What is meant by 'medication reconciliation' at hospital discharge?

Answer: Ensuring the discharge prescription reflects intended changes to pre-admission medication, clearly communicating to GP and patient

Discharge medicines reconciliation ensures intentional medication changes (stopped, started, dose changes) are documented, communicated to GP, and explained to the patient to prevent post-discharge errors.

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

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.

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

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.

A customer who is 8 weeks pregnant asks for advice on safe pain relief. What should be recommended?

Answer: Paracetamol at lowest effective dose — avoid NSAIDs, especially in third trimester

Paracetamol is the safest OTC analgesic in pregnancy. NSAIDs (including ibuprofen) are contraindicated in the third trimester (risk of premature ductus arteriosus closure) and avoided in early pregnancy if possible.

A patient requests a repeat dispensing of their regular atorvastatin. The repeat dispensing authorisation has expired. What should the pharmacist do?

Answer: Make an emergency supply to cover the patient while they obtain a new prescription or repeat dispensing authorisation from their GP

An expired repeat dispensing authorisation cannot be used. However, to ensure continuity of treatment for a long-term medicine, the pharmacist can consider making an emergency supply at the patient's request (under Human Medicines Regulations 2012) while advising them to obtain a new authorisation from their GP promptly.

Which of the following interventions has the strongest evidence base for improving long-term medication adherence?

Answer: Simplifying the medication regimen by reducing dose frequency where possible

Simplifying medication regimens — for example by using once-daily formulations or combination products — consistently improves adherence across a wide range of conditions and patient populations.

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?

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.

What is the 'five rights' framework in medication safety?

Answer: Right patient, right drug, right dose, right route, right time

The five rights are a widely used medication safety framework: right patient, right drug, right dose, right route, and right time — all must be confirmed to prevent medication errors.

A patient is discharged with new amlodipine after a hospital admission. What patient counselling is essential?

Answer: Ankle swelling is a common side effect; avoid grapefruit juice as it inhibits metabolism; take at same time daily

Amlodipine commonly causes peripheral oedema (ankle swelling). Grapefruit juice inhibits CYP3A4, increasing amlodipine levels. Consistent timing helps maintain steady plasma concentrations.

What is the pharmacist's role in medicines reconciliation on hospital admission?

Answer: Accurately determine the patient's complete pre-admission medication list and reconcile it with hospital prescriptions

Medicines reconciliation at admission involves verifying what medicines the patient was actually taking (using GP records, patient history, pharmacy records) and ensuring the inpatient prescription accurately reflects this.

A prescriber telephones a pharmacy to request an emergency supply of a Prescription Only Medicine. Under what condition can the pharmacist legally make this supply?

Answer: The prescriber must undertake to furnish a prescription within 72 hours, and the drug must not be a Schedule 1, 2, or 3 controlled drug

Under the Human Medicines Regulations 2012, a pharmacist can make an emergency supply at the request of a prescriber provided the prescriber undertakes to furnish a prescription within 72 hours. Schedule 1, 2, and 3 controlled drugs (except phenobarbital for epilepsy) cannot be supplied this way.

Which body is responsible for regulating pharmacists in Great Britain?

Answer: General Pharmaceutical Council (GPhC)

The GPhC is the statutory regulator for pharmacists, pharmacy technicians, and pharmacy premises in Great Britain. The PSNI regulates in Northern Ireland.

A patient taking clarithromycin is also prescribed simvastatin. What is the major concern?

Answer: Myopathy and rhabdomyolysis due to raised statin levels

Clarithromycin inhibits CYP3A4, significantly increasing simvastatin levels. This dramatically raises the risk of myopathy and rhabdomyolysis. Simvastatin should be suspended during clarithromycin treatment.

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?

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.

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

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.

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

Answer: Intravenous

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