PSI Pharmacy Registration Assessment Ireland — Questions and Answers

Question 1: Which antibiotic class acts by inhibiting bacterial protein synthesis at the 30S ribosomal subunit?

Aminoglycosides (Correct answer)
Chloramphenicol
Macrolides
Linezolid

Correct answer: Aminoglycosides

Aminoglycosides (e.g., gentamicin) bind the 30S ribosomal subunit, causing misreading of mRNA and production of aberrant proteins, leading to bacterial cell death.

Question 2: How should a pharmacist handle a conflict of interest between commercial pressures and patient care?

Balance equally between commercial and patient interests
Let the pharmacy owner decide which takes priority
Commercial success should be the primary priority
Patient care and safety must always take priority over commercial or business interests (Correct answer)

Correct answer: Patient care and safety must always take priority over commercial or business interests

The PSI Code of Conduct is clear: patient care must always come first. Pharmacists must not allow commercial pressures to compromise the quality of care, recommend unnecessary products, or dispense inappropriately. Professional judgement must prioritise patient safety above business interests.

Question 3: What monitoring is required for a patient on Direct Oral Anticoagulants (DOACs) such as apixaban or rivarelbane?

No monitoring is needed for DOACs
DOACs require weekly INR monitoring like warfarin
Only blood pressure monitoring is required
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 (Correct answer)

Correct 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

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 4: The 'yellow card' equivalent for adverse drug reaction reporting in Ireland is submitted to:

The HPRA (Correct answer)
The patient's GP
The PSI
The manufacturer directly

Correct answer: The HPRA

ADRs in Ireland are reported to the HPRA (Health Products Regulatory Authority) via the online reporting system. Healthcare professionals and patients can both report. The HPRA feeds data to EudraVigilance.

Question 5: A prescription states 'paracetamol 0.5 g'. Tablets available are 500 mg. How many tablets should be dispensed per dose?

2 tablets
0.5 tablet
5 tablets
1 tablet (Correct answer)

Correct answer: 1 tablet

0.5 g equals 500 mg, which is exactly one 500 mg tablet.

Question 6: What should a pharmacist do if they identify a drug recall notice?

Immediately quarantine the affected stock, check dispensing records for patients who received the recalled product, notify affected patients and their prescribers, and arrange returns (Correct answer)
Only act if a patient complains
Continue dispensing the product until a replacement is available
Wait until the stock runs out

Correct answer: Immediately quarantine the affected stock, check dispensing records for patients who received the recalled product, notify affected patients and their prescribers, and arrange returns

Upon receiving a drug recall notice from the HPRA, the pharmacist must immediately quarantine affected stock, check records to identify patients who received the product, contact those patients and their prescribers, arrange for returns to the supplier, and document all actions taken.

Question 7: Which type of isomerism involves non-superimposable mirror image molecules?

Diastereomerism
Geometric isomerism
Structural isomerism
Enantiomerism (Correct answer)

Correct answer: Enantiomerism

Enantiomers are mirror images that cannot be superimposed. They have identical physical properties but can differ in pharmacological activity, toxicity and metabolism.

Question 8: Which patient group should always be asked about allergies before dispensing amoxicillin?

Only patients over 65
Only inpatients
Only patients with asthma
All patients — particularly those with known penicillin or cephalosporin allergy (Correct answer)

Correct answer: All patients — particularly those with known penicillin or cephalosporin allergy

Penicillin allergy affects 8–10% of patients; ~1% cross-react with cephalosporins. Asking about penicillin, amoxicillin and related antibiotic allergy before dispensing is mandatory to prevent potentially fatal anaphylaxis.

Question 9: What measures should a pharmacy implement to prevent dispensing errors?

Remove all safety checks to improve efficiency
Speed up dispensing to reduce waiting times
Only rely on the pharmacist's memory and experience
Separate LASA products, use barcode scanning, implement independent double-checking, maintain adequate staffing, reduce interruptions during dispensing, and report all near misses (Correct answer)

Correct answer: Separate LASA products, use barcode scanning, implement independent double-checking, maintain adequate staffing, reduce interruptions during dispensing, and report all near misses

Error prevention requires multiple strategies: physical separation of similar products, barcode verification technology, mandatory independent final checks, appropriate staffing levels, a quiet dispensing environment, standard operating procedures, near-miss reporting, and a positive safety culture.

Question 10: What is the first-line treatment for mild-to-moderate community-acquired pneumonia in adults in Ireland?

Flucloxacillin
Metronidazole
Ciprofloxacin
Amoxicillin (Correct answer)

Correct answer: Amoxicillin

According to Irish antibiotic prescribing guidelines, amoxicillin is the first-line treatment for community-acquired pneumonia in adults. For penicillin-allergic patients, doxycycline or clarithromycin are alternatives. This follows antimicrobial stewardship principles.

Question 11: Blister packaging for dispensed medicines is preferable to loose tablets in a bottle for which reason?

Bottles are legally prohibited
Blisters are cheaper to produce
Each tablet is individually protected from moisture, air and light — improving stability and aiding compliance (Correct answer)
Loose tablets improve dose accuracy

Correct answer: Each tablet is individually protected from moisture, air and light — improving stability and aiding compliance

Blister packs protect each unit individually and the date-sequencing aids patient adherence (knowing which tablet to take each day). Bottles expose all tablets to humidity and air each time they are opened.

Question 12: What are the key considerations when dispensing methotrexate for a patient?

Methotrexate has no serious side effects
Ensure the correct WEEKLY dose (not daily), counsel on folate supplementation, warn about teratogenicity, and advise on monitoring requirements (blood tests) (Correct answer)
No special counselling is needed
Methotrexate can be taken daily without concern

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

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 13: Which property does the partition coefficient (log P) measure?

Degree of ionisation
Lipophilicity of a drug (Correct answer)
Solubility in water
Molecular weight

Correct answer: Lipophilicity of a drug

Log P is the ratio of drug concentration in octanol vs water, indicating how lipophilic a molecule is. High log P means good membrane permeability but poor aqueous solubility.

Question 14: What is the PSI Code of Conduct for Pharmacists?

A code that only applies during inspections
An optional guideline with no legal standing
A code only for newly qualified pharmacists
A set of principles and standards published by the PSI that outline the ethical and professional conduct expected of all registered pharmacists in Ireland (Correct answer)

Correct answer: A set of principles and standards published by the PSI that outline the ethical and professional conduct expected of all registered pharmacists in Ireland

The PSI Code of Conduct sets out mandatory principles of professional conduct that all registered pharmacists must follow. It covers patient care, professional competence, communication, trust, and autonomy. Breaches can lead to fitness to practise proceedings.

Question 15: Calcium gluconate is urgently required in hyperkalaemia to:

Stabilise cardiac membrane potential (Correct answer)
Lower potassium levels directly
Enhance renal potassium excretion
Shift potassium into cells

Correct answer: Stabilise cardiac membrane potential

Calcium gluconate rapidly antagonises the effect of high potassium on cardiac membrane excitability, preventing arrhythmias. It works within minutes but does not lower potassium.

Question 16: Aspirin's antiplatelet effect is due to irreversible inhibition of which enzyme?

Phosphodiesterase
COX-1 (cyclooxygenase-1) (Correct answer)
Thrombin
COX-2

Correct answer: COX-1 (cyclooxygenase-1)

Aspirin irreversibly acetylates COX-1 in platelets, blocking thromboxane A2 synthesis. Because platelets lack nuclei, they cannot regenerate COX-1, so the effect lasts the platelet's 7–10 day lifespan.

Question 17: Which drug class is used as first-line for acute migraine attacks?

Sodium valproate
Triptans (5-HT1B/1D agonists) (Correct answer)
Opioids
Beta-blockers

Correct answer: Triptans (5-HT1B/1D agonists)

Triptans (e.g., sumatriptan) selectively activate 5-HT1B/1D receptors causing cerebral vasoconstriction and inhibiting neuropeptide release, aborting migraine attacks.

Question 18: What is the pharmacist's role in adverse drug reaction (ADR) reporting in Ireland?

ADR reporting is only the doctor's responsibility
To identify, document, and report suspected ADRs to the HPRA through the national ADR reporting system, especially for new medicines and serious reactions (Correct answer)
Only report ADRs that cause hospitalisation
ADRs do not need to be reported

Correct answer: To identify, document, and report suspected ADRs to the HPRA through the national ADR reporting system, especially for new medicines and serious reactions

Pharmacists have a professional duty to report suspected ADRs to the HPRA (Health Products Regulatory Authority). Reports should be made for all suspected ADRs to medicines, vaccines, herbal products, and devices, particularly for new medicines (marked with a black triangle ▼) and serious reactions.

Question 19: When dispensing warfarin, which additional monitoring information should the pharmacist check?

Serum creatinine only
Recent INR result and current INR target range (Correct answer)
HbA1c
Blood pressure only

Correct answer: Recent INR result and current INR target range

Warfarin is a narrow therapeutic index drug monitored by INR. The pharmacist should check that the INR is within the patient's target range and that the dose dispensed aligns with the INR result and clinic instructions.

Question 20: A patient requests an OTC decongestant (xylometazoline nasal spray). What is the maximum recommended duration of use?

5–7 days (Correct answer)
3 months
28 days
No limit

Correct answer: 5–7 days

Nasal decongestant sprays (alpha-agonists: xylometazoline, oxymetazoline) should not be used for more than 5–7 days to avoid rhinitis medicamentosa (rebound congestion from nasal blood vessel supersensitisation).

Question 21: What is the LASA (Look-Alike, Sound-Alike) issue in pharmacy?

An inventory management system
The risk of medication errors caused by medicines with similar names, similar packaging, or both, leading to potential selection errors during dispensing (Correct answer)
A quality assessment tool for pharmacy labels
A patient classification system

Correct answer: The risk of medication errors caused by medicines with similar names, similar packaging, or both, leading to potential selection errors during dispensing

LASA medicines pose a significant safety risk because their similar names (e.g., hydroxyzine/hydralazine) or packaging can lead to wrong drug selection errors. Pharmacies should implement strategies such as tall-man lettering, physical separation of LASA products, and electronic alerts.

Question 22: Emergency supply of prescription-only medicines without a prescription is permitted in Ireland when:

The patient has a repeat prescription from abroad only
A CD is requested for a known patient
The patient requests any prescription medicine urgently
A pharmacist is satisfied immediate treatment is necessary and the patient has previously been prescribed the medicine (Correct answer)

Correct answer: A pharmacist is satisfied immediate treatment is necessary and the patient has previously been prescribed the medicine

Irish pharmacy law allows pharmacist-initiated emergency supply for POMs (not Schedule 1/2 CDs) when the pharmacist judges it is immediately necessary, the patient has had it prescribed before, and a follow-up prescription will be obtained.

Question 23: Which Irish legislation governs data protection in healthcare, including patient medication records?

General Data Protection Regulation (GDPR) and Data Protection Acts 1988–2018 (Correct answer)
Pharmacy Act 2007 alone
Health Information Bill
Freedom of Information Act 2014

Correct answer: General Data Protection Regulation (GDPR) and Data Protection Acts 1988–2018

GDPR (as enacted in Ireland via the Data Protection Acts) governs all processing of personal data including health data. Pharmacies must have lawful basis for processing, maintain records and comply with subject access rights.

Question 24: What is the pharmacist's role in smoking cessation in Ireland?

Referring all smokers to their GP without any intervention
Providing advice, support, and nicotine replacement therapy (NRT) to patients who wish to quit smoking, including behavioural counselling and follow-up (Correct answer)
Pharmacists have no role in smoking cessation
Only selling nicotine patches without advice

Correct answer: Providing advice, support, and nicotine replacement therapy (NRT) to patients who wish to quit smoking, including behavioural counselling and follow-up

Pharmacists are ideally placed for smoking cessation support through brief interventions, motivational counselling, supply of NRT products (patches, gum, lozenges, inhalers), and follow-up. The HSE QUIT programme works with community pharmacies to provide structured cessation services.

Question 25: The Noyes-Whitney equation describes the rate of:

Drug absorption
Drug dissolution (Correct answer)
Drug distribution
Drug excretion

Correct answer: Drug dissolution

The Noyes-Whitney equation describes how dissolution rate depends on surface area, diffusion coefficient, solubility, and boundary layer thickness.

Question 26: What are the requirements for a valid prescription under the Medicinal Products (Prescription and Control of Supply) Regulations 2003?

No specific format is required
It must include the prescriber's name, address, and qualification; the patient's name and address; the drug name, form, strength, dose, quantity; the date; and the prescriber's signature (Correct answer)
Prescriptions can be verbal only
Only the drug name and patient name are required

Correct answer: It must include the prescriber's name, address, and qualification; the patient's name and address; the drug name, form, strength, dose, quantity; the date; and the prescriber's signature

A valid prescription must contain: prescriber details (name, address, qualification), patient details (name and address), the medicinal product (name, form, strength), directions for use, quantity to be supplied, date, and the prescriber's signature (or electronic equivalent).

Question 27: When should a patient using a reliever inhaler (salbutamol) be advised to seek urgent medical review?

If using reliever more than 3 times per week — indicates poor asthma control requiring step-up therapy (Correct answer)
Only if symptoms last more than 2 weeks
If using it once a month
After every use regardless of frequency

Correct answer: If using reliever more than 3 times per week — indicates poor asthma control requiring step-up therapy

Reliever use >3 times/week signals inadequately controlled asthma. This requires review of preventer therapy (ICS) and adherence. Dependence on reliever without preventer increases severe attack risk.

Question 28: What ethical principle requires pharmacists to act in the best interest of the patient?

Autonomy — the right to make decisions independently
Non-maleficence — the duty to do no harm
Justice — the fair distribution of resources
Beneficence — the duty to act in the patient's best interest and promote their welfare (Correct answer)

Correct answer: Beneficence — the duty to act in the patient's best interest and promote their welfare

Beneficence is the ethical principle requiring healthcare professionals to act in the patient's best interest. For pharmacists, this means providing optimal pharmaceutical care, advocating for patients, and always prioritising patient welfare over commercial interests.

Question 29: Under the Drug Payment Scheme (DPS), what is the monthly out-of-pocket cap per family in Ireland (as of 2024)?

€80 (Correct answer)
€50
€144
€20

Correct answer: €80

As of 2024, the DPS monthly threshold is €80 per individual or family. Once this amount is reached in a calendar month, further approved medicines are free. (The threshold was reduced from €144 in recent years.)

Question 30: Which drug is used to reverse opioid overdose?

Protamine
Neostigmine
Flumazenil
Naloxone (Correct answer)

Correct answer: Naloxone

Naloxone is a competitive opioid receptor antagonist with high affinity for mu-receptors. IV/IM/intranasal naloxone rapidly reverses respiratory depression, sedation and miosis of opioid overdose.

Question 31: What is the recommended action if a patient presents requesting a supply of naloxone for take-home use?

Dispense and counsel on administration — naloxone is available without prescription in Ireland for at-risk individuals (Correct answer)
Only supply to family members of opioid users, not to users themselves
Decline — naloxone is a prescription-only CD
Refer only to a specialist drug service

Correct answer: Dispense and counsel on administration — naloxone is available without prescription in Ireland for at-risk individuals

Take-home naloxone is available in Irish community pharmacies without a prescription to at-risk individuals and those around them. Counselling on IM/intranasal administration and calling emergency services is essential.

Question 32: What counselling points should a pharmacist provide to a patient starting a statin (e.g., atorvastatin)?

Take at the recommended time, report unexplained muscle pain, have liver function monitored, avoid grapefruit juice in large quantities, and understand it is for long-term use (Correct answer)
Only tell them to take it with food
No counselling is needed for statins
Tell them to stop taking it if they feel fine after a month

Correct answer: Take at the recommended time, report unexplained muscle pain, have liver function monitored, avoid grapefruit juice in large quantities, and understand it is for long-term use

Key counselling points include: take consistently (some statins are best taken at night), report muscle pain/weakness (risk of rhabdomyolysis), baseline and follow-up liver function tests, avoid excessive grapefruit juice (CYP3A4 interaction with some statins), and emphasise long-term adherence.

Question 33: Which drug interaction mechanism underlies the interaction between antacids and fluoroquinolone antibiotics?

Competition for protein binding
Fluoroquinolones inhibit antacid neutralisation
Chelation — antacid cations (Al3+, Mg2+) complex with fluoroquinolones reducing oral absorption (Correct answer)
Antacids induce CYP enzymes

Correct answer: Chelation — antacid cations (Al3+, Mg2+) complex with fluoroquinolones reducing oral absorption

Divalent and trivalent metal cations form insoluble chelates with fluoroquinolones (and tetracyclines), preventing absorption. Fluoroquinolones should be taken 2 hours before or 6 hours after antacids.

Question 34: Probenecid, used for gout, inhibits renal tubular secretion. Which antibiotic interaction is clinically significant?

No interaction with antibiotics
Probenecid reduces penicillin absorption
Probenecid blocks penicillin/amoxicillin secretion, raising antibiotic levels (formerly used therapeutically) (Correct answer)
Probenecid increases penicillin metabolism

Correct answer: Probenecid blocks penicillin/amoxicillin secretion, raising antibiotic levels (formerly used therapeutically)

Probenecid competitively inhibits OAT transporters in the renal tubule, blocking active secretion of penicillins and raising their plasma levels. This was historically exploited to prolong penicillin action (e.g., during wartime antibiotic shortages).

Question 35: What is the principle of patient autonomy and how does it apply to pharmacy practice?

Patients must always follow the pharmacist's recommendations
The right of a competent patient to make informed decisions about their own healthcare, including the right to refuse treatment; pharmacists must respect these decisions while providing full information (Correct answer)
The pharmacist always knows what is best for the patient
Autonomy only applies to patients in hospitals

Correct answer: The right of a competent patient to make informed decisions about their own healthcare, including the right to refuse treatment; pharmacists must respect these decisions while providing full information

Patient autonomy is a fundamental ethical principle. Pharmacists must provide patients with the information they need to make informed decisions, respect their right to refuse or choose treatments, and support shared decision-making. Pharmacists should advise but never coerce.

Question 36: Which diuretic is potassium-sparing and acts by blocking aldosterone receptors?

Spironolactone (Correct answer)
Furosemide
Acetazolamide
Bendroflumethiazide

Correct answer: Spironolactone

Spironolactone competitively antagonises aldosterone receptors in the collecting duct, reducing sodium reabsorption and potassium excretion. It is used in heart failure and hyperaldosteronism.

Question 37: Which statement is correct regarding generic medicines vs branded medicines when counselling a patient?

Branded medicines always work better
Generics are inferior and less effective
Generic medicines contain the same active ingredient, dose and are bioequivalent — they are equally safe and effective (Correct answer)
Generics contain different active ingredients

Correct answer: Generic medicines contain the same active ingredient, dose and are bioequivalent — they are equally safe and effective

Generic medicines must demonstrate bioequivalence (within 80–125% of brand AUC/Cmax) before regulatory approval. They contain the same active ingredient and are equally safe and effective.

Question 38: Under PSI guidance, the minimum period for retaining prescription records in a pharmacy in Ireland is:

6 years (Correct answer)
10 years
2 years
1 year

Correct answer: 6 years

PSI requires pharmacy prescription records (including GMS/DPS claims) to be retained for a minimum of 6 years. This aligns with general healthcare record retention policy in Ireland.

Question 39: What is the National Immunisation Programme in Ireland and what is the pharmacist's role?

The programme only operates in hospitals
A publicly funded programme providing vaccines to protect against infectious diseases; pharmacists can administer certain vaccines (flu, COVID-19) and provide vaccine information to the public (Correct answer)
Pharmacists have no involvement in vaccination
Pharmacists only store vaccines but never administer them

Correct answer: A publicly funded programme providing vaccines to protect against infectious diseases; pharmacists can administer certain vaccines (flu, COVID-19) and provide vaccine information to the public

Ireland's National Immunisation Programme provides free vaccines through a schedule covering childhood, adolescent, and adult vaccinations. Since 2011, trained pharmacists can administer seasonal flu vaccines, and this role expanded to include COVID-19 vaccination. Pharmacists also play a key role in public education about vaccination.

Question 40: Medicines reconciliation at hospital discharge involves:

Only supplying 28-day TTOs
Comparing the patient's pre-admission medicines with discharge medicines to identify unintended discrepancies (Correct answer)
Having the patient bring in their medicines
Checking allergies only

Correct answer: Comparing the patient's pre-admission medicines with discharge medicines to identify unintended discrepancies

Medicines reconciliation compares the complete pre-admission medication list with newly prescribed medicines at each care transition, identifying omissions, duplications and changes requiring communication.

Question 41: When handing out a new inhaler, the minimum counselling should include:

Correct inhaler technique with a demonstrated step-by-step guide (Correct answer)
Noting side effects only
Advising the patient to read the PIL
Only the dose and frequency

Correct answer: Correct inhaler technique with a demonstrated step-by-step guide

Incorrect inhaler technique is a leading cause of poor asthma/COPD control. The pharmacist must demonstrate correct technique, have the patient practise and check — not merely hand over with verbal advice.

Question 42: What is the mechanism of action of proton pump inhibitors (PPIs) such as omeprazole?

They irreversibly inhibit the hydrogen-potassium ATPase enzyme (proton pump) in gastric parietal cells, reducing gastric acid secretion (Correct answer)
They neutralise existing stomach acid
They speed up gastric emptying
They coat the stomach lining to protect it

Correct answer: They irreversibly inhibit the hydrogen-potassium ATPase enzyme (proton pump) in gastric parietal cells, reducing gastric acid secretion

PPIs work by irreversibly binding to the H+/K+-ATPase enzyme system (the proton pump) on the surface of gastric parietal cells. This blocks the final step of acid production, providing potent and long-lasting suppression of gastric acid secretion.

Question 43: Which international quality standard covers pharmaceutical Good Manufacturing Practice in the EU?

ICH Q10 alone
EU GMP Guidelines (EudraLex Volume 4) (Correct answer)
USP <1> General Notices
ISO 9001

Correct answer: EU GMP Guidelines (EudraLex Volume 4)

EU GMP is published in EudraLex Volume 4 and sets legally binding standards for manufacture of medicinal products in the EU/EEA, including Ireland.

Question 44: Warfarin's anticoagulant effect is reversed most quickly by administering:

Idarucizumab
Protamine sulphate
Fresh frozen plasma alone
Vitamin K and prothrombin complex concentrate (PCC) (Correct answer)

Correct answer: Vitamin K and prothrombin complex concentrate (PCC)

For urgent reversal of warfarin, IV vitamin K plus PCC (containing factors II, VII, IX, X) restores clotting factors immediately. Vitamin K alone takes 6–12 hours to work.

Question 45: What is the importance of medication reconciliation when a patient is discharged from hospital?

It is the hospital's sole responsibility
The community pharmacist has no role in discharge reconciliation
To ensure continuity of care by comparing the discharge prescription with the patient's pre-admission medications, identifying any intentional changes, and preventing unintended omissions or duplications (Correct answer)
Medication reconciliation is only needed on admission

Correct answer: To ensure continuity of care by comparing the discharge prescription with the patient's pre-admission medications, identifying any intentional changes, and preventing unintended omissions or duplications

Community pharmacists play a vital role in discharge reconciliation. They should compare the discharge prescription with the patient's previous medication record, identify any changes (new medicines, stopped medicines, dose changes), verify these changes were intentional, and counsel the patient on the updated regimen.

Question 46: Which antiepileptic is contraindicated in pregnancy due to neural tube defect risk?

Lamotrigine
Levetiracetam
Sodium valproate (Correct answer)
Gabapentin

Correct answer: Sodium valproate

Sodium valproate is a potent teratogen — it causes neural tube defects, neurodevelopmental disorders and other congenital malformations. It must be used with pregnancy prevention programme (PREVENT) in women of childbearing age.

Question 47: The STOPP/START criteria in Ireland are used to:

Score pain severity in older patients
Guide antibiotic selection in elderly patients
Assess cognitive function in dementia
Identify potentially inappropriate prescribing and prescribing omissions in older adults (Correct answer)

Correct answer: Identify potentially inappropriate prescribing and prescribing omissions in older adults

STOPP (Screening Tool of Older Persons' Prescriptions) and START (Screening Tool to Alert to Right Treatment) help identify potentially harmful medicines and missing beneficial ones in older patients.

Question 48: Methadone dispensing in Irish pharmacies for opioid dependence is governed by which protocol?

HSE Methadone Treatment Protocol (Correct answer)
Misuse of Drugs Act alone
GP Contract requirements only
PSI CD guidelines only

Correct answer: HSE Methadone Treatment Protocol

The HSE Methadone Treatment Protocol regulates supervised daily dispensing of methadone in community pharmacies in Ireland. Pharmacies must be approved under the protocol and comply with supervised consumption requirements.

Question 49: What is antimicrobial resistance (AMR) and why should pharmacists be concerned?

AMR is only a hospital problem
The ability of microorganisms to resist the effects of antimicrobial drugs; pharmacists play a key role in combating AMR through antimicrobial stewardship and patient education (Correct answer)
AMR only affects antibiotics, not other antimicrobials
Pharmacists cannot influence AMR

Correct answer: The ability of microorganisms to resist the effects of antimicrobial drugs; pharmacists play a key role in combating AMR through antimicrobial stewardship and patient education

AMR is a global public health emergency. Pharmacists combat AMR by: ensuring antibiotics are only used when appropriate, counselling patients on completing courses, advising on self-care for viral infections (not antibiotics), promoting appropriate OTC alternatives, and supporting national AMR action plans.

Question 50: What is a 'near miss' in the pharmacy context?

A patient who nearly missed collecting their prescription
A delivery of medicines that nearly arrived late
A prescription that was nearly written incorrectly
A dispensing error that is detected and corrected before the medicine reaches the patient (Correct answer)

Correct answer: A dispensing error that is detected and corrected before the medicine reaches the patient

A pharmacy near miss is an error caught during the checking process before the medicine is handed to the patient. Recording and analysing near misses is crucial for patient safety as they reveal system weaknesses that could lead to actual errors reaching patients.

Question 51: Which parameter best describes the rate of drug elimination from the body?

Half-life (t½) (Correct answer)
Volume of distribution
Bioavailability
Protein binding

Correct answer: Half-life (t½)

Half-life is the time taken for plasma drug concentration to fall by 50%. It directly reflects the rate of elimination and determines dosing intervals.

Question 52: Which antibiotic should not be prescribed with warfarin without close INR monitoring?

Nitrofurantoin — no CYP interaction
Ciprofloxacin — inhibits CYP1A2 and CYP2C9, raising warfarin levels significantly (Correct answer)
Amoxicillin — no significant CYP interaction
Cefalexin — no CYP interaction

Correct answer: Ciprofloxacin — inhibits CYP1A2 and CYP2C9, raising warfarin levels significantly

Ciprofloxacin inhibits multiple CYP enzymes that metabolise warfarin, reducing its clearance. INR can rise substantially, increasing bleeding risk. Enhanced INR monitoring is required.

Question 53: Which body adjudicates fitness to practise complaints against pharmacists in Ireland at the initial stage?

The Department of Health
The District Court
The Medical Council
PSI Preliminary Proceedings Committee (Correct answer)

Correct answer: PSI Preliminary Proceedings Committee

Complaints are first assessed by the PSI Preliminary Proceedings Committee, which determines if there is a prima facie case. If so, the matter proceeds to the Fitness to Practise Committee or is resolved via consent.

Question 54: Under the Falsified Medicines Directive (EU 2011/62/EU), pharmacies must use which system to verify medicines?

The European Medicines Verification System (EMVS) — scanning 2D barcodes at point of dispensing (Correct answer)
HPRA database lookup only
Contacting the manufacturer by telephone
A manual serial number log

Correct answer: The European Medicines Verification System (EMVS) — scanning 2D barcodes at point of dispensing

The Falsified Medicines Directive requires pharmacies to scan the 2D data matrix barcode on medicine packs before dispensing, verifying authenticity and decommissioning the pack via the EMVS/Irish MVO.

Question 55: Which vitamin supplement is recommended by Irish health authorities for all adults during autumn and winter?

Zinc 15 mg daily
Vitamin D 400–1000 IU daily (Correct answer)
Vitamin C 1000 mg daily
Vitamin B12 daily

Correct answer: Vitamin D 400–1000 IU daily

Due to Ireland's northern latitude, sunlight is insufficient for cutaneous vitamin D synthesis from October to March. HSE and FSAI recommend vitamin D supplementation for all adults during this period.

Question 56: Which approach best supports medication adherence in an elderly patient with multiple daily medicines?

Reduce follow-up appointments
Prescribe all medicines at the same time of day only
Simplify regimen, use once-daily formulations where possible, provide clear labelled blister packs, and arrange regular medicine reviews (Correct answer)
Give more medicines to compensate for missed doses

Correct answer: Simplify regimen, use once-daily formulations where possible, provide clear labelled blister packs, and arrange regular medicine reviews

Regimen simplification, modified-release formulations, compliance aids, and regular review all improve adherence in older patients. Complexity is the biggest adherence barrier — reducing the number of daily doses helps significantly.

Question 57: A patient is prescribed ACE inhibitor ramipril and potassium-sparing diuretic spironolactone together. The risk is:

No significant interaction
Hyperkalaemia — both drugs increase serum potassium (Correct answer)
Hyponatraemia only
Hypokalaemia

Correct answer: Hyperkalaemia — both drugs increase serum potassium

Both ACE inhibitors (reduce aldosterone-driven potassium excretion) and spironolactone (block aldosterone receptors) raise serum potassium. Combination increases hyperkalaemia risk — monitor electrolytes closely.

Question 58: Which drug is a direct oral anticoagulant (DOAC) that inhibits thrombin (factor IIa)?

Rivaroxaban
Edoxaban
Dabigatran (Correct answer)
Apixaban

Correct answer: Dabigatran

Dabigatran is a direct thrombin inhibitor. Its antidote is idarucizumab. The other DOACs listed inhibit factor Xa.

Question 59: Which antibacterial mechanism does penicillin use?

DNA gyrase inhibition
Cell membrane disruption
Inhibition of bacterial cell wall synthesis (Correct answer)
Inhibition of protein synthesis

Correct answer: Inhibition of bacterial cell wall synthesis

Penicillin irreversibly binds penicillin-binding proteins (PBPs), inhibiting cross-linking of peptidoglycan in the bacterial cell wall, leading to osmotic lysis of the bacterium.

Question 60: What is the pharmacist's role in addressing the opioid crisis and promoting safe use of pain medications?

Pharmacists should simply dispense whatever is prescribed without question
Pharmacists should refuse to dispense opioids entirely
Screening for opioid misuse risk, counselling on safe use and storage, promoting non-opioid alternatives, dispensing naloxone for overdose reversal, and supporting patients transitioning off opioids (Correct answer)
Opioid management is entirely the prescriber's responsibility

Correct answer: Screening for opioid misuse risk, counselling on safe use and storage, promoting non-opioid alternatives, dispensing naloxone for overdose reversal, and supporting patients transitioning off opioids

Pharmacists play a critical role in the opioid crisis by assessing prescriptions for appropriateness, counselling patients on safe use/storage/disposal, promoting non-opioid and non-pharmacological pain management, providing naloxone, identifying signs of misuse or diversion, and supporting patients in opioid tapering programmes.

Question 61: What is a medication error and how should it be managed in a pharmacy?

Any preventable event that may cause or lead to inappropriate medication use or patient harm; it should be documented, reported, the patient assessed, and a root cause analysis conducted (Correct answer)
Medication errors should be hidden to protect the pharmacy's reputation
An error only counts if the patient is harmed
Only dispensing the wrong drug counts as a medication error

Correct answer: Any preventable event that may cause or lead to inappropriate medication use or patient harm; it should be documented, reported, the patient assessed, and a root cause analysis conducted

Medication errors include any preventable event at any stage: prescribing, dispensing, administration, or monitoring. When discovered, the patient must be assessed for harm, the prescriber informed, an incident report completed, the error documented, and a root cause analysis conducted to prevent recurrence.

Question 62: What is the pharmacist's role in managing chronic disease conditions like diabetes or hypertension?

Pharmacists have no role in chronic disease management
Only dispensing medications without any further input
Providing medication counselling, monitoring adherence, reviewing medication appropriateness, conducting health screenings, and supporting self-management education (Correct answer)
Referring all queries to the GP without comment

Correct answer: Providing medication counselling, monitoring adherence, reviewing medication appropriateness, conducting health screenings, and supporting self-management education

Pharmacists play an increasingly important role in chronic disease management through medication therapy reviews, adherence support, health screenings (blood pressure, blood glucose), lifestyle counselling, identifying drug-related problems, and working collaboratively with GPs and other healthcare professionals.

Question 63: What is the role of inhaler technique review in managing asthma and COPD?

Inhaler technique does not affect treatment outcomes
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 (Correct answer)
Technique review is only needed when first prescribed
Only doctors should review inhaler technique

Correct 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

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 64: An isotonic solution has the same osmolarity as:

5% glucose only
Blood plasma (~285–310 mOsm/kg) (Correct answer)
Normal saline only
Distilled water

Correct answer: Blood plasma (~285–310 mOsm/kg)

Isotonic solutions match the osmolarity of blood plasma (~285–310 mOsm/kg), preventing osmotic shift across cell membranes. Both normal saline (0.9%) and 5% glucose are isotonic examples.

Question 65: When conducting a clinical check on a prescription, the pharmacist should assess:

Dose only
Whether the prescriber's handwriting is legible only
Drug, dose, frequency, route, duration, interactions, allergies and patient appropriateness (Correct answer)
Price and availability only

Correct answer: Drug, dose, frequency, route, duration, interactions, allergies and patient appropriateness

A comprehensive clinical check covers the 'seven rights': right patient, drug, dose, route, frequency, duration and documentation — plus interactions and contraindications.

Question 66: The 'right drug, right patient, right dose, right route, right time' is known as the:

Five Rights of Medicines Administration (Correct answer)
WHO Surgical Safety Checklist
Seven Rights of Dispensing
PSI Dispensing Protocol

Correct answer: Five Rights of Medicines Administration

The Five Rights (or expanded Seven Rights) is a fundamental patient safety framework for medicines administration and dispensing, minimising errors across prescribing, dispensing and administration.

Question 67: A liquid medicine with a measured dose of 5 mL BID for 10 days — what total volume should be dispensed?

100 mL (5 mL × 2 × 10) (Correct answer)
150 mL
200 mL
50 mL

Correct answer: 100 mL (5 mL × 2 × 10)

5 mL per dose × 2 doses per day (BID) = 10 mL/day × 10 days = 100 mL total. Accurate volume calculation ensures the correct supply with no shortfall during the treatment course.

Question 68: Which term describes the legal category of medicines that may be sold without a prescription from a pharmacy or general retail outlet in Ireland?

General Sale List (GSL) medicines (Correct answer)
Prescription-Only Medicines (POM)
Controlled drugs Schedule 5
Pharmacy-Only medicines (P)

Correct answer: General Sale List (GSL) medicines

General Sale List medicines may be sold from any general retail outlet without pharmacy supervision. In contrast, Pharmacy-only (P) medicines require sale from a registered pharmacy under pharmacist supervision.

Question 69: The Poisons (Ireland) Regulations 2008 classify certain non-medicinal poisons. A pharmacy selling a Poisons List substance must:

Notify the Garda Síochána of every sale
Enter the sale in the Poisons Register and confirm the purchaser's identity and purpose (Correct answer)
Simply sell freely as they are non-medicinal
Require a prescription for all poison sales

Correct answer: Enter the sale in the Poisons Register and confirm the purchaser's identity and purpose

Schedule 1 Poisons require the purchaser to be known to the pharmacist or properly introduced, provide a reason for purchase, and the transaction must be recorded in the Poisons Register.

Question 70: Adsorption onto packaging components is a stability concern particularly for which type of drug?

Protein biologics and low-dose drugs (Correct answer)
Immediate-release tablets
Highly water-soluble drugs
Drugs with large particle size

Correct answer: Protein biologics and low-dose drugs

Proteins and peptides, and drugs present in very small amounts, can adsorb onto glass or plastic container surfaces, reducing the available dose and causing potency loss.

Question 71: What safety checks should a pharmacist perform when dispensing a new prescription for a patient already on other medications?

Only check the patient's name matches the prescription
No additional checks are needed
Only check the expiry date of the medicine
Check for drug-drug interactions, therapeutic duplication, contraindications based on the patient's medical history, appropriate dose for age/weight/renal function, and allergies (Correct answer)

Correct answer: Check for drug-drug interactions, therapeutic duplication, contraindications based on the patient's medical history, appropriate dose for age/weight/renal function, and allergies

A comprehensive clinical check includes: drug-drug interactions with current medications, therapeutic duplication, contraindications (medical history, pregnancy), dose appropriateness (age, weight, renal/hepatic function), allergy status, and whether the new medicine is consistent with the patient's conditions.

Question 72: Which OTC product is recommended for the management of mild allergic contact dermatitis on the skin?

Antifungal cream
Betamethasone 0.1% cream OTC
Antihistamine cream (topical diphenhydramine)
Hydrocortisone 1% cream applied sparingly for up to 7 days (Correct answer)

Correct answer: Hydrocortisone 1% cream applied sparingly for up to 7 days

Hydrocortisone 1% is the only topical corticosteroid available OTC in Ireland. It is appropriate for mild, localised inflammation (dermatitis, insect bites) for up to 7 days. Stronger steroids require prescription.

Question 73: What is the pharmacist's duty of confidentiality regarding patient information?

Confidentiality only applies to medical records, not verbal information
Patient information can be discussed freely with anyone
To protect all patient information and only disclose it with consent or when legally required, in accordance with GDPR and professional standards (Correct answer)
Confidentiality does not apply in community pharmacies

Correct answer: To protect all patient information and only disclose it with consent or when legally required, in accordance with GDPR and professional standards

Pharmacists have both a professional and legal duty to maintain patient confidentiality. Under GDPR and the Data Protection Act 2018, patient data must be processed lawfully, stored securely, and only shared with authorised persons for legitimate purposes. Breaches have serious professional and legal consequences.

Question 74: A patient requires 250 mg of amoxicillin. The suspension contains 125 mg/5 mL. What volume should be dispensed per dose?

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

Correct answer: 10 mL

125 mg = 5 mL, therefore 250 mg = 10 mL. Using the formula: required dose / stock strength × volume = 250/125 × 5 = 10 mL.

Question 75: What is the pharmacist's responsibility regarding cold chain management for medicines requiring refrigeration?

To maintain the cold chain (2-8°C) throughout storage and supply, monitor and record temperatures daily, investigate any breaches, and not supply medicines that have been compromised (Correct answer)
Temperature monitoring is optional
Medicines can be returned to the fridge after being left out overnight
Only the wholesaler is responsible for cold chain

Correct answer: To maintain the cold chain (2-8°C) throughout storage and supply, monitor and record temperatures daily, investigate any breaches, and not supply medicines that have been compromised

Cold chain management ensures temperature-sensitive medicines (vaccines, insulin, biologics) remain within 2-8°C from receipt to supply. Daily temperature monitoring, calibrated equipment, breach protocols, and patient counselling on home storage are all pharmacist responsibilities.

Question 76: An aminoglycoside is to be dosed to achieve a peak concentration of 8 mg/L. The patient weighs 60 kg and the volume of distribution is 0.25 L/kg. What loading dose is required?

60 mg
30 mg
120 mg (Correct answer)
480 mg

Correct answer: 120 mg

Loading dose = target Cp × Vd = 8 mg/L × (0.25 L/kg × 60 kg) = 8 × 15 = 120 mg.

Question 77: What is the importance of patient counselling at the point of dispensing?

It improves medication adherence, helps patients understand their treatment, reduces errors in self-administration, and identifies potential problems before they cause harm (Correct answer)
Patient counselling is a waste of time
Written labels are sufficient — no verbal counselling is needed
Counselling should only be provided if the patient asks for it

Correct answer: It improves medication adherence, helps patients understand their treatment, reduces errors in self-administration, and identifies potential problems before they cause harm

Patient counselling is a core pharmacy activity that significantly impacts treatment outcomes. It should cover: how to take the medicine, expected effects, potential side effects, storage, what to do if a dose is missed, and when to seek medical attention. Counselling improves adherence by up to 50%.

Question 78: Which device is used to measure liquid medicines accurately for paediatric doses?

Dropper alone for all volumes
Oral syringe (Correct answer)
Measuring jug
Standard kitchen teaspoon

Correct answer: Oral syringe

Oral syringes are the most accurate method for measuring small paediatric liquid doses. Kitchen spoons are inaccurate (may hold 3–7 mL) and should never be recommended for medicine measurement.

Question 79: Which OTC nicotine replacement therapy formulation has the fastest onset of action for craving relief?

Nicotine inhaler
Nicotine mouth spray (reaches peak levels in 10–15 minutes) (Correct answer)
Nicotine lozenge
Nicotine patch

Correct answer: Nicotine mouth spray (reaches peak levels in 10–15 minutes)

Nicotine mouth spray (e.g., Nicorette Quickmist) provides rapid buccal absorption, achieving peak nicotine levels in 10–15 minutes. Patches provide slow sustained release.

Question 80: For patients on multiple medicines, a Medicines Use Review (MUR) aims to:

Identify adherence issues, side effects and interactions to optimise therapy (Correct answer)
Generate additional prescriptions
Replace the prescriber consultation
Only check expiry dates

Correct answer: Identify adherence issues, side effects and interactions to optimise therapy

MURs are structured, pharmacist-led consultations for patients on multiple long-term medicines, identifying problems with understanding, adherence, side effects and interactions to improve outcomes.

Question 81: A patient on an SSRI antidepressant wants to buy an OTC product containing ibuprofen. What should the pharmacist consider?

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 (Correct answer)
SSRIs make NSAIDs more effective
There is no interaction between SSRIs and NSAIDs
Recommend a higher dose of ibuprofen

Correct 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

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.

Question 82: What is the pharmacist's ethical responsibility regarding counterfeit medicines?

Check medicines only if a patient complains
Only customs officials deal with counterfeit medicines
Counterfeit medicines are not a concern in Ireland
To source medicines only from authorised suppliers, be vigilant for counterfeit products, report any suspicious products to the HPRA, and protect patients from potentially dangerous fake medicines (Correct answer)

Correct answer: To source medicines only from authorised suppliers, be vigilant for counterfeit products, report any suspicious products to the HPRA, and protect patients from potentially dangerous fake medicines

Pharmacists have an ethical and legal responsibility to maintain the integrity of the medicine supply chain. This includes sourcing only from authorised wholesalers, checking deliveries for signs of counterfeiting, using the FMD (Falsified Medicines Directive) verification system, and reporting any suspicious products.

Question 83: What ethical principles should guide a pharmacist when dealing with a patient's request for information about their medication that may cause anxiety?

Withhold negative information to avoid causing distress
Give all information regardless of the patient's emotional state
Refuse to provide any information and refer to the prescriber
Provide truthful, balanced information about benefits and risks, using appropriate language, while being sensitive to the patient's emotional state and level of understanding (Correct answer)

Correct answer: Provide truthful, balanced information about benefits and risks, using appropriate language, while being sensitive to the patient's emotional state and level of understanding

The ethical principles of veracity (truthfulness), beneficence, and autonomy require pharmacists to provide honest, complete information while being sensitive to the patient's needs. Information should be tailored to the patient's level of understanding, delivered with empathy, and balanced between risks and benefits.

Question 84: Reconstituted amoxicillin oral suspension should be stored in the refrigerator and discarded after:

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

Correct answer: 14 days

Once reconstituted, amoxicillin suspension is stable for 14 days when refrigerated. Beyond this, bacterial contamination and drug degradation are concerns.

Question 85: What is the correct sequence of steps in the dispensing process?

Receive prescription → clinical check → label → dispense → accuracy check → counsel patient (Correct answer)
Clinical check → label → dispense → skip counselling
Dispense immediately → check → label
Label first → clinical check → dispense

Correct answer: Receive prescription → clinical check → label → dispense → accuracy check → counsel patient

The standard dispensing process: receive and validate the prescription, perform a clinical check, generate a label, select and dispense the product, accuracy check, then counsel the patient on proper use.

Question 86: Michaelis-Menten kinetics apply when enzyme-mediated metabolism is:

Independent of substrate concentration
Linear at all concentrations
Saturated at high drug concentrations (Correct answer)
Only seen with CYP3A4

Correct answer: Saturated at high drug concentrations

At high concentrations, metabolic enzymes become saturated and elimination shifts from first-order to zero-order kinetics — described by Michaelis-Menten equations.

Question 87: Lyophilisation (freeze-drying) is used primarily to improve the stability of:

Enteric-coated tablets
Highly lipophilic drugs
Controlled-release matrix tablets
Thermolabile or moisture-sensitive drugs (Correct answer)

Correct answer: Thermolabile or moisture-sensitive drugs

Freeze-drying removes water by sublimation under vacuum, preserving the drug structure without heat. It is used for biologicals, vaccines and unstable drugs.

Question 88: What is the 'high alert medications' concept and which medicines fall into this category?

Medicines that bear a heightened risk of causing significant patient harm when used in error, including anticoagulants, insulin, opioids, and chemotherapy agents (Correct answer)
Medicines that have been recalled
Any medicine that costs over €100
Only medicines administered by injection

Correct answer: Medicines that bear a heightened risk of causing significant patient harm when used in error, including anticoagulants, insulin, opioids, and chemotherapy agents

High-alert medications carry an elevated risk of harm when errors occur. The ISMP (Institute for Safe Medication Practices) list includes anticoagulants, insulin, opioids, neuromuscular blocking agents, and concentrated electrolytes. Extra safeguards (independent double-checks, dose limits) should be applied.

Question 89: Pharmaceutical compounding in a pharmacy must comply with which quality standard?

No specific standard — pharmacist's discretion
PSI guidance on extemporaneous/compounding preparation and Pharmacopoeia standards (Correct answer)
ISO 9001 quality management
GMP for industrial manufacturing only

Correct answer: PSI guidance on extemporaneous/compounding preparation and Pharmacopoeia standards

PSI provides guidance on extemporaneous compounding, requiring: appropriate premises/equipment, trained staff, quality control checks, stability data and documentation. BP/EP monographs provide quality standards.

Question 90: What is the pharmacist's role in pharmacovigilance?

Pharmacists have no role in pharmacovigilance
Pharmacovigilance is only the manufacturer's responsibility
To monitor the safety of medicines in everyday use, detect new or changing safety signals, report adverse events, and contribute to the ongoing assessment of medicine benefit-risk profiles (Correct answer)
It only applies during clinical trials

Correct answer: To monitor the safety of medicines in everyday use, detect new or changing safety signals, report adverse events, and contribute to the ongoing assessment of medicine benefit-risk profiles

Pharmacovigilance (the science of monitoring drug safety) is a responsibility shared by all healthcare professionals. Pharmacists contribute by reporting ADRs to the HPRA, monitoring patients for drug safety issues, educating patients about potential adverse effects, and staying informed about drug safety alerts.

Question 91: What is the legal position on pharmacist-administered vaccinations in Ireland?

Pharmacists can administer all vaccines without restriction
Pharmacists can administer certain vaccines (including flu and COVID-19) following approved training and within a collaborative practice framework (Correct answer)
Pharmacists cannot administer any vaccines
Only hospital pharmacists can administer vaccines

Correct answer: Pharmacists can administer certain vaccines (including flu and COVID-19) following approved training and within a collaborative practice framework

Since 2011, pharmacists in Ireland have been authorised to administer certain vaccines including seasonal influenza and, more recently, COVID-19. Pharmacists must complete PSI-approved training, maintain competence, and operate within the relevant protocols and collaborative practice agreements.

Question 92: Which process converts a prodrug to its active form?

Renal filtration
Protein binding
Bioactivation (Correct answer)
Glucuronidation

Correct answer: Bioactivation

Bioactivation is metabolic conversion of an inactive prodrug to its pharmacologically active metabolite. Example: enalapril → enalaprilat; codeine → morphine (via CYP2D6).

Question 93: A patient requests their prescription be returned after it has been dispensed. Under Irish law:

Pharmacists must retain dispensed prescriptions and cannot return them (Correct answer)
Prescriptions must be returned on request
The patient has a GDPR right to have the prescription returned
Only GMS prescriptions are retained

Correct answer: Pharmacists must retain dispensed prescriptions and cannot return them

Under Irish pharmacy regulations, dispensed prescriptions must be retained by the pharmacy for the required period. They form part of the legal dispensing record and cannot be returned to patients.

Question 94: What is the difference between a generic medicine and a branded medicine?

Generic medicines contain different active ingredients
Generic medicines are less effective than branded medicines
There is no difference — the terms are interchangeable
A generic contains the same active ingredient, dose, and dosage form as the brand but is marketed under the non-proprietary (generic) name, usually at a lower cost (Correct answer)

Correct answer: A generic contains the same active ingredient, dose, and dosage form as the brand but is marketed under the non-proprietary (generic) name, usually at a lower cost

Generic medicines must contain the same active ingredient in the same dose and dosage form as the reference (branded) product and must demonstrate bioequivalence. They are approved by the HPRA and meet the same quality standards but are typically less expensive as they do not carry development costs.

Question 95: Which important counselling point applies to all patients using topical corticosteroids long-term on the face?

Face application is always safe regardless of duration
Avoid prolonged use — risk of skin atrophy, telangiectasia, perioral dermatitis and steroid-induced rosacea (Correct answer)
Stronger is better for faster results on the face
Moisturisers should not be used on the face with topical steroids

Correct answer: Avoid prolonged use — risk of skin atrophy, telangiectasia, perioral dermatitis and steroid-induced rosacea

Facial skin is thin and absorbs corticosteroids more readily. Prolonged use causes skin thinning (atrophy), visible blood vessels (telangiectasia), and steroid rosacea/perioral dermatitis — all difficult to reverse.

Question 96: What health screening services can pharmacists provide in Ireland?

Only GP practices can offer health screenings
Pharmacists can only provide advice, not measurements
Pharmacists cannot provide any screening services
Blood pressure monitoring, blood glucose testing, cholesterol screening, BMI assessment, and health risk assessments (Correct answer)

Correct answer: Blood pressure monitoring, blood glucose testing, cholesterol screening, BMI assessment, and health risk assessments

Community pharmacists increasingly provide accessible health screening services including blood pressure measurement, blood glucose testing, cholesterol checks, BMI calculation, and general health assessments. These services improve early detection of conditions like hypertension and diabetes.

Question 97: A patient presents with symptoms of an uncomplicated urinary tract infection (UTI). What is the first-line recommended antibiotic treatment in Ireland?

Amoxicillin for 5 days
Nitrofurantoin (modified release) for 3 days in non-pregnant women (Correct answer)
Ciprofloxacin for 7 days
Co-amoxiclav for 14 days

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

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 98: What is the pharmacist's obligation regarding the notification of infectious diseases in Ireland?

Infectious disease notification has nothing to do with pharmacy
Only hospital pharmacists need to know about notifiable diseases
Pharmacists must directly report all infectious diseases
Pharmacists should be aware of notifiable diseases and facilitate the notification process, though the primary reporting obligation lies with the attending medical practitioner (Correct answer)

Correct answer: Pharmacists should be aware of notifiable diseases and facilitate the notification process, though the primary reporting obligation lies with the attending medical practitioner

While the legal obligation to notify lies primarily with the medical practitioner, pharmacists play a supporting role by being aware of notifiable diseases, recognising unusual patterns in OTC sales that might indicate outbreaks, and facilitating the public health response through medicine supply and public information.

Question 99: A patient is prescribed warfarin. Which of the following interactions should the pharmacist be most concerned about?

Concurrent use of NSAIDs such as ibuprofen, which increases the risk of bleeding (Correct answer)
Drinking water with the medication
Taking warfarin in the morning versus evening
Taking the warfarin with food

Correct answer: Concurrent use of NSAIDs such as ibuprofen, which increases the risk of bleeding

NSAIDs increase bleeding risk with warfarin through multiple mechanisms: they inhibit platelet function, can cause GI erosion, and some (like fluconazole) inhibit CYP2C9, which metabolises warfarin. Pharmacists should counsel patients about avoiding OTC NSAIDs and reporting any signs of bleeding.

Question 100: Which dosage form is designed to release drug in the small intestine rather than the stomach?

Buccal film
Enteric-coated tablet (Correct answer)
Sublingual tablet
Effervescent tablet

Correct answer: Enteric-coated tablet

Enteric coatings (e.g., HPMC phthalate) resist acidic gastric pH but dissolve at the higher pH of the small intestine, protecting acid-labile drugs or preventing gastric irritation.

Question 101: Which method of sterilisation uses moist heat under pressure?

Dry heat oven
Autoclaving (Correct answer)
Ethylene oxide gas
Gamma irradiation

Correct answer: Autoclaving

Autoclaving (121°C, 15 psi, 15 minutes) uses saturated steam under pressure to kill microorganisms including spores. It is the preferred method for aqueous injections and surgical instruments.

Question 102: Which antiplatelet drug requires hepatic activation by CYP2C19 to exert its effect?

Clopidogrel (Correct answer)
Ticagrelor
Aspirin
Dipyridamole

Correct answer: Clopidogrel

Clopidogrel is a prodrug requiring CYP2C19-mediated activation. Poor metabolisers of CYP2C19 have reduced antiplatelet effect, increasing cardiovascular risk.

Question 103: What is the pharmacist's role in managing minor ailments in the community?

Diagnosing diseases and prescribing medications
Telling all patients to see their GP
Assessing symptoms, recommending appropriate OTC treatments, providing self-care advice, and referring to a GP when symptoms suggest a more serious condition (Correct answer)
Only selling products without any assessment

Correct answer: Assessing symptoms, recommending appropriate OTC treatments, providing self-care advice, and referring to a GP when symptoms suggest a more serious condition

Pharmacists manage common minor ailments (colds, headaches, hayfever, mild skin conditions) by assessing symptoms, recommending appropriate OTC treatments, providing lifestyle and self-care advice, and making appropriate referrals. This reduces pressure on GP services and provides convenient healthcare access.

Question 104: Fickian diffusion through a membrane is enhanced by:

Increased membrane thickness
Increased concentration gradient and membrane surface area (Correct answer)
Increased molecular weight
Decreased lipophilicity of drug

Correct answer: Increased concentration gradient and membrane surface area

Fick's first law states: flux = D × A × ΔC / h. Flux increases with diffusion coefficient (D), surface area (A), and concentration gradient (ΔC), but decreases with membrane thickness (h).

Question 105: Which auxiliary label should be added to tetracycline capsules?

Avoid dairy products and antacids — take on an empty stomach (Correct answer)
Take with food and milk
May cause drowsiness
Keep refrigerated after opening

Correct answer: Avoid dairy products and antacids — take on an empty stomach

Tetracyclines chelate divalent cations (Ca2+, Mg2+, Al3+) in dairy and antacids, forming insoluble complexes that reduce absorption by up to 80%. They should be taken 1 hour before or 2 hours after food/dairy.

Question 106: Lithium toxicity risk increases with concurrent use of which drug?

Thiazide diuretics reduce lithium only (this option is wrong placement)
Antacids have no effect
NSAIDs (reduce renal lithium excretion) (Correct answer)
ACE inhibitors only slightly affect lithium

Correct answer: NSAIDs (reduce renal lithium excretion)

NSAIDs inhibit prostaglandin-mediated renal blood flow, reducing GFR and lithium excretion. This can rapidly elevate lithium plasma levels into the toxic range.

Question 107: What ethical considerations apply when a pharmacist suspects a patient is being abused or neglected?

Pharmacists should only act if the patient explicitly asks for help
The pharmacist has an ethical duty to safeguard vulnerable patients, which may require breaking confidentiality to report concerns to appropriate authorities such as the HSE or Tusla (Correct answer)
Patient confidentiality prevents any reporting
Abuse is a matter only for the Gardaí, not pharmacists

Correct answer: The pharmacist has an ethical duty to safeguard vulnerable patients, which may require breaking confidentiality to report concerns to appropriate authorities such as the HSE or Tusla

Pharmacists have a duty of care that extends to safeguarding vulnerable patients. When abuse or neglect is suspected, confidentiality may be broken to protect the patient. The pharmacist should document concerns, report to appropriate authorities (HSE, Tusla for children), and follow safeguarding protocols.

Question 108: A patient asks why they must avoid grapefruit juice with their simvastatin. The pharmacist explains:

Grapefruit inhibits CYP3A4 in the intestinal wall, raising simvastatin plasma levels and increasing myopathy risk (Correct answer)
Grapefruit increases renal excretion of simvastatin
Grapefruit causes a taste interaction only
Grapefruit reduces simvastatin absorption

Correct answer: Grapefruit inhibits CYP3A4 in the intestinal wall, raising simvastatin plasma levels and increasing myopathy risk

Grapefruit contains furanocoumarins that irreversibly inhibit intestinal CYP3A4, increasing oral bioavailability of simvastatin. This raises plasma levels, increasing the risk of myopathy and rhabdomyolysis.

Question 109: A patient on MAO inhibitor phenelzine is brought into the pharmacy having eaten aged cheese. They complain of severe headache. This suggests:

Anaphylaxis
Hypertensive crisis due to tyramine interaction (cheese reaction) (Correct answer)
Migraine only
Serotonin syndrome

Correct answer: Hypertensive crisis due to tyramine interaction (cheese reaction)

MAO inhibitors block breakdown of dietary tyramine (found in aged cheese, fermented foods, red wine). Tyramine accumulation causes massive noradrenaline release, causing hypertensive crisis — a potentially fatal emergency.

Question 110: Which question is most useful when assessing if a patient has understood their new antibiotic prescription?

'Can you tell me in your own words how you'll take this antibiotic and what to watch for?' (Correct answer)
'Did you read the patient information leaflet?'
'Do you have any allergies?'
'Have you taken antibiotics before?'

Correct answer: 'Can you tell me in your own words how you'll take this antibiotic and what to watch for?'

The 'teach-back' method — asking the patient to explain in their own words — is the most effective way to confirm comprehension, identifying gaps before the patient leaves the pharmacy.

Question 111: What are Scheduled Substances under the Misuse of Drugs Acts 1977-2016 in Ireland?

Controlled drugs classified into five schedules based on their therapeutic value and potential for misuse, with different regulations for each schedule (Correct answer)
All prescription-only medicines
Substances used in food production
Only illegal street drugs

Correct answer: Controlled drugs classified into five schedules based on their therapeutic value and potential for misuse, with different regulations for each schedule

The Misuse of Drugs Acts classify controlled substances into five schedules: Schedule 1 (highest restriction, e.g., LSD), Schedule 2 (e.g., morphine, fentanyl), Schedule 3 (e.g., buprenorphine), Schedule 4 (benzodiazepines), and Schedule 5 (preparations with low risk of misuse).

Question 112: What is 'conscientious objection' in pharmacy practice?

The right to refuse to stock any product the pharmacist disagrees with
The right to refuse to serve any customer for any reason
An objection to working on certain days of the week
A pharmacist's right to decline providing certain services based on personal moral or religious beliefs, provided the patient is referred to another provider without delay (Correct answer)

Correct answer: A pharmacist's right to decline providing certain services based on personal moral or religious beliefs, provided the patient is referred to another provider without delay

Pharmacists may exercise conscientious objection to certain services (e.g., emergency contraception) based on genuine moral or religious beliefs. However, they must not impose their beliefs on patients, must inform the patient and refer them to another pharmacist who can provide the service without delay.

Question 113: What are the key principles of health promotion that pharmacists should apply?

Only promoting health during specific awareness weeks
Empowerment, accessibility, evidence-based practice, equity, and a whole-population approach combining individual and community health interventions (Correct answer)
Focusing exclusively on medication-related issues
Only providing information to patients who ask for it

Correct answer: Empowerment, accessibility, evidence-based practice, equity, and a whole-population approach combining individual and community health interventions

Health promotion in pharmacy involves empowering patients with knowledge and skills, ensuring accessibility of services, using evidence-based approaches, addressing health inequalities, and taking opportunities for brief interventions during every patient interaction — not just during awareness campaigns.

Question 114: How should a pharmacist approach end-of-life care and palliative pharmacy services?

End-of-life care is not relevant to pharmacy practice
Refer all palliative patients to their GP without providing any service
Only hospital pharmacists are involved in palliative care
With compassion and respect, ensuring timely access to palliative medications, providing advice on symptom management, supporting the patient's wishes, and collaborating with the palliative care team (Correct answer)

Correct answer: With compassion and respect, ensuring timely access to palliative medications, providing advice on symptom management, supporting the patient's wishes, and collaborating with the palliative care team

Community pharmacists play an important role in end-of-life care: ensuring palliative medications (especially controlled drugs for pain management) are readily available, advising on administration and dosing, supporting carers, maintaining dignity and respect, and collaborating with the palliative care team.

Question 115: Which counselling point is essential for a patient starting bisphosphonate therapy for osteoporosis?

No specific timing requirements
Take at bedtime for best absorption
Can be taken with milk for GI comfort
Take on an empty stomach with a full glass of water, remain upright for 30 minutes, and take calcium/vitamin D at a different time (Correct answer)

Correct answer: Take on an empty stomach with a full glass of water, remain upright for 30 minutes, and take calcium/vitamin D at a different time

Bisphosphonates are poorly absorbed and inactivated by food/calcium/dairy. They must be taken on an empty stomach, with plain water only, with 30 minutes upright to prevent oesophageal damage.

Question 116: Which type of error occurs when the correct drug is given to the wrong patient?

Patient identification error (Correct answer)
Prescribing error
Wrong drug error
Dose omission error

Correct answer: Patient identification error

A patient identification error is a dispensing/administration error where the correct medicine is given to the incorrect patient. Two patient identifiers (name + DOB) should always be confirmed before dispensing.

Question 117: A patient taking atorvastatin is started on clarithromycin for a chest infection. The pharmacist should:

Switch to a different antibiotic only if myopathy develops
Reduce atorvastatin dose by half
Continue both without concern
Recommend temporarily stopping atorvastatin during the course — clarithromycin strongly inhibits CYP3A4, raising statin levels and myopathy risk (Correct answer)

Correct answer: Recommend temporarily stopping atorvastatin during the course — clarithromycin strongly inhibits CYP3A4, raising statin levels and myopathy risk

Clarithromycin is a potent CYP3A4 inhibitor. Combined with atorvastatin (CYP3A4 substrate), plasma statin levels increase substantially, increasing risk of myopathy and rhabdomyolysis. Temporary statin suspension is safest.

Question 118: A patient requires amoxicillin 250 mg. The available suspension contains 125 mg/5 mL. What volume should be dispensed per dose?

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

Correct answer: 10 mL

250 mg ÷ (125 mg/5 mL) = 10 mL per dose.

Question 119: Which piece of information is NOT required on a controlled drug prescription under Irish Misuse of Drugs Regulations?

Total quantity in words and figures
Patient's full name and address
The patient's occupation (Correct answer)
Prescriber's signature

Correct answer: The patient's occupation

Irish CD prescription requirements include patient name/address, drug/strength/form, dose instructions, total quantity in words AND figures, date, and prescriber's signature and address. Occupation is not required.

Question 120: What is antimicrobial stewardship and why is it important for pharmacists?

A systematic approach to optimising antibiotic use by ensuring the right drug, dose, and duration to improve outcomes and reduce antimicrobial resistance (Correct answer)
Keeping antibiotics in stock at all times
Only prescribing the newest antibiotics available
Selling as many antibiotics as possible

Correct answer: A systematic approach to optimising antibiotic use by ensuring the right drug, dose, and duration to improve outcomes and reduce antimicrobial resistance

Antimicrobial stewardship involves selecting the optimal antibiotic, dose, and duration of therapy to maximise clinical cure while minimising side effects and the development of antimicrobial resistance. Pharmacists play a key role in reviewing prescriptions, advising prescribers, and educating patients.

PSI Pharmacy Registration Assessment Ireland

The PSI (Pharmaceutical Society of Ireland) Registration Assessment is the qualifying exam for pharmacists seeking registration in Ireland. It covers Irish pharmacy law and ethics, clinical therapeutics, dispensing practice, patient safety, public health, pharmaceutical sciences, pharmacology, and patient counselling. Candidates must demonstrate competency in both clinical and legal aspects of pharmacy practice in Ireland.

120

Questions

180 min

Time Limit

65%

To Pass

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