Pre-reg Sample Open Book Exam

see bnf

The symptoms described are of jaundice. Jaundice is caused by liver failure, by bilirubin leaking out and depositing in the skin leaving a yellow colour and causing itching. The symptoms of jaundice should especially be reported to GP if they have just returned from a foreign country. The other options of OTC treatment may help reduce itching, but referral to a GP is the best course of action

Rationale: Akathisia (uncontrollable motor restlessness), dystonia (involuntary jerking movements of the trunk and limbs) and tardive dyskinesia (twitching, mainly of the face and tongue) can be experienced by both men and women. Galactorrhoea (spontaneous flow of breast milk) is exclusive to women. Gynaecomastia is excessive breast development in males.

A pregnant woman taking medication for epilepsy is at an increased risk of giving birth to a baby with spina bifida. This is because certain anti-seizure medications used to treat epilepsy can interfere with the body's ability to absorb folic acid, which is important for the development of the baby's spine. Insufficient folic acid can lead to neural tube defects, including spina bifida, in the baby. Therefore, pregnant women with epilepsy need to closely monitor their folic acid levels and may require higher doses of folic acid supplements to reduce the risk of spina bifida.

Topical hydrocortisone is only licensed for OTC sale for over 10 years old. Therefore any age group below this should be referred.
- Topical hydrocortisone is not for OTC sale for the face, broken skin, mucus membranes, and sensitive areas of the skin such as the vulva.

Fluconazole is not an enzyme inducer. Enzyme inducers are drugs that increase the activity of certain enzymes in the body, which can affect the metabolism and clearance of other drugs. Phenytoin, carbamazepine, rifampicin, and griseofulvin are all known to be enzyme inducers, while fluconazole is not. Fluconazole is an antifungal medication that works by inhibiting the activity of certain enzymes involved in the synthesis of fungal cell membranes.

Gentamycin would be the most suitable antibiotic to give to a patient with a history of anaphylaxis to penicillins because it belongs to a different class of antibiotics called aminoglycosides, which have a different chemical structure and mode of action compared to penicillins. Therefore, the likelihood of cross-reactivity and causing an allergic reaction is lower with gentamycin.

Hypoglycaemic effect of antidiabetics is antagonised by thiazides

The correct answer is B because both sweating and weight gain can indicate that a patient who is taking levothyroxine is on too high a dose. Diarrhea, on the other hand, is not a symptom typically associated with an overdose of levothyroxine.

Rationale/calculation
Calculate his body mass index (BMI) using the formula: BMI = Weight (in kilograms) divided by height (in metres)2

Calculation: 70 / 1.8x1.8 = 70 / 3.24 = 21.6

A BMI between 18.5 and 24.9 is considered normal, so the patient is not overweight. However, he should be referred to his GP because his blood pressure is above the generally accepted target level of 140/90mmHg.

Vitamin C increases the absorption of iron from plant sources. Iron from plant sources, also known as non-heme iron, is not as easily absorbed by the body as heme iron from animal sources. However, consuming vitamin C along with non-heme iron can enhance its absorption. Vitamin C helps to convert non-heme iron into a more easily absorbable form, increasing its bioavailability. Therefore, including foods high in vitamin C, such as citrus fruits, bell peppers, and strawberries, can help improve the absorption of iron from plant sources.

all others are glucocorticoid

Day 5 to 24 = 20 days@3/day = 60 x 4 (cycles) = 240

Amiodarone is least likely to cause blood disorders compared to the other drugs listed. Amiodarone is an antiarrhythmic medication used to treat irregular heartbeats. While it can have side effects, such as lung or liver problems, it is not commonly associated with blood disorders. On the other hand, drugs like carbimazole, phenytoin, methotrexate, and mesalazine have been known to cause blood disorders such as agranulocytosis, aplastic anemia, or thrombocytopenia. Therefore, amiodarone is the least likely drug to cause blood disorders among the options provided.

Since November 2008, as result of an EU directive, pharmacists can make emergency supplies of prescription only medicines that have been previously prescribed by a practising doctor or dentist in Switzerland and the European Economic Area, which includes all EU states plus Norway, Iceland and Liechtenstein.

In May 2009, the Medicines Act 1968 regulations were amended to allow emergency supplies of POMs previously prescribed by a UK dentist.

Only B is prohibited by the Misuse of Drugs Regulations: prescribers have been advised by the Department of Health and the Scottish Executive not to prescribe more than 30 days supply of a Controlled Drug in Schedule 2, 3 or 4, but it is not unlawful to do so or for pharmacists to supply more than 30 days if prescribed.



Pharmacists can correct minor technical errors or omissions on CD scripts, and this applies to C. So long as the initial supply of a Schedule 4 CD is made within 28 days of being prescribed, and for a Schedule 5 CD within six months, there is no restriction on when repeats can be supplied. The question is closed book because pharmacists are expected to be conversant with the rules for supply of CDs and not have to look them up.

Headaches can be a common side effect of some medications, including dipyridamole. In many cases, a headache can be managed with over-the-counter pain relief or by adjusting the dosage. It does not typically warrant immediate withdrawal of the drug unless it is severe or accompanied by other concerning symptoms.

Lithium is known for having a narrow therapeutic range. This means that the difference between a therapeutically effective dose and a toxic dose is small, requiring careful monitoring of blood levels to ensure safety and effectiveness.

The correct answer is E because option 3 is the only correct response. Option 1 states that 0.25ml of chloroform is needed, which is not mentioned in the question. Option 2 states that 2.5ml of concentrated chloroform water is needed, but the question specifies that the chloroform water should be double strength, not concentrated. Option 3 states that 10ml of chloroform spirit is needed, which contains chloroform 1 part in 20, and this aligns with the requirement of 50% double strength chloroform water mentioned in the question. Therefore, only option 3 is correct.

Rationale/Explanation

The Health Act 2006 replaced the term “personal control” in the Medicines Act 1968 with the concept of a “responsible pharmacist”; the Responsible Pharmacist Regulations 2008 will bring that into effect. There are currently no proposals to amend the superintendent pharmacist provisions.

Notes

1. RPSGB registration exam syllabus, sections 1a: Sale and supply of medicines; 1b: Conditions for operating a registered pharmacy.

2. Closed book: Questions that pre-registration trainees are expected to answer without recourse to a reference.

One of the requirements for trainees is that they keep up to date with important developments in pharmacy. Information on this topic has appeared in the pharmacy press and a consultation on the proposals has been issued by the RPSGB.