PSI Clinical Therapeutics 2

Question 1

A patient presents with symptoms of an uncomplicated urinary tract infection (UTI). What is the first-line recommended antibiotic treatment in Ireland?

Accepted Answer

Nitrofurantoin (modified release) for 3 days in non-pregnant women

Answer

Irish antibiotic prescribing guidelines recommend nitrofurantoin MR 100mg twice daily for 3 days as first-line treatment for uncomplicated UTIs in non-pregnant women. Trimethoprim is an alternative. Fluoroquinolones should be reserved for complicated infections due to resistance concerns.

Question 2

What are the key considerations when dispensing methotrexate for a patient?

Accepted Answer

Ensure the correct WEEKLY dose (not daily), counsel on folate supplementation, warn about teratogenicity, and advise on monitoring requirements (blood tests)

Answer

Methotrexate is a HIGH-RISK medication. The most critical safety point is ensuring it is taken WEEKLY (not daily — daily dosing has caused fatalities). Patients need folic acid supplementation, regular blood monitoring (FBC, LFTs, renal function), and pregnancy prevention counselling.

Question 3

What is the role of inhaler technique review in managing asthma and COPD?

Accepted Answer

Poor inhaler technique is a major cause of treatment failure; pharmacists should assess and correct technique at every opportunity, as up to 90% of patients use inhalers incorrectly

Answer

Studies show that 50-90% of patients use their inhalers incorrectly, leading to poor disease control. Pharmacists should review inhaler technique at every dispensing opportunity, demonstrate correct use, observe the patient's technique, and correct any errors. A change of device may be needed.

Question 4

What monitoring is required for a patient on Direct Oral Anticoagulants (DOACs) such as apixaban or rivarelbane?

Accepted Answer

Renal function (eGFR) should be monitored at least annually (more frequently if impaired), along with hepatic function and haemoglobin; no routine INR monitoring is needed

Answer

Unlike warfarin, DOACs do not require routine INR monitoring. However, renal function must be monitored (at least annually, more frequently if eGFR <60) as renal impairment affects drug clearance. Hepatic function and haemoglobin should also be checked. Dose adjustments may be needed based on renal function.

Question 5

A patient on an SSRI antidepressant wants to buy an OTC product containing ibuprofen. What should the pharmacist consider?

Accepted Answer

SSRIs increase the risk of GI bleeding, which is further increased by concurrent NSAID use; recommend paracetamol as an alternative or advise use of gastroprotection if an NSAID is essential

Answer

SSRIs affect platelet function by depleting serotonin in platelets, increasing bleeding risk. Combined with NSAIDs (which also impair platelet function and cause GI mucosal damage), the risk of GI bleeding is significantly increased. Paracetamol is a safer analgesic alternative.

PSI Pharmacy Practice Test

PSI Pharmacy Practice Test

PSI Clinical Therapeutics 2