The Ultimate GPhC Registration Assessment Exam Guide
Wojtek Michael Bereza Mharm! "ounder o# Pharmac$ca%com !chool o# Pharmac$ &ondon
'''%harmac$ca%com Communit$ mem(ers !ecial thanks to) *oma Al+ahmad ,a$di Ghosh Amit !hah
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This (ook 'as created to hel harmac$ re+registration students ass the GPhC exam% -t de.eloed/ not #rom one 'riter/ (ut hundreds o# 'riters 'ho contri(uted to '''%harmac$ca%com '''%harmac$ca%com 'hich is a GPhC indeendent/ online communit$% This rocess o# ha.ing multile 'riters ena(led us to create an amalgamation o# exeriences o# the exam 'hich 'ould (e directl$ rele.ant to our readers% -# $ou ha.e not alread$ .isited the 'e(site it is strongl$ recommended $ou do so/ as $ou can articiate in online ractice exams and get $our 0uestions ans'ered ($ our dedicated team o# harmac$ tutors% The urose o# this (ook is not to ro.ide $ou 'ith all the ans'ers #or the exam/ (ut to highlight ke$ areas 'hich $ou must kno' in order to ass% To make the most o# this (ook/ read it 'ith the B*"/ B*"/ 1rug Tari## Tari## and MEP to hand% This 'ill gi.e $ou in.alua(le re#erence ractice #or the exam and allo' $ou to exlore the di##erent toics raised%
Wh$ not tr$ our ne' Pharmac$CPA iPhone a2 • •
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3.er 455 0uestions all (uilt into the a 6no need #or the internet7% Wide su(ject range co.ering calculations/ P-& and licensing texts/ MEP and 1rug Tari##% 1etailed #eed(ack sho'ing $ou the (est resources #or each 0uestion% Eas$ to use design% 8uestions ans'ered automaticall$% automaticall$% !earated 3en Book and Closed Book 0uestions Each 0uestions is timed just like the real exam% Constantl$ udated 0uestions% Easter egg 0uestions to kee $ou amused%
This (ook 'as created to hel harmac$ re+registration students ass the GPhC exam% -t de.eloed/ not #rom one 'riter/ (ut hundreds o# 'riters 'ho contri(uted to '''%harmac$ca%com '''%harmac$ca%com 'hich is a GPhC indeendent/ online communit$% This rocess o# ha.ing multile 'riters ena(led us to create an amalgamation o# exeriences o# the exam 'hich 'ould (e directl$ rele.ant to our readers% -# $ou ha.e not alread$ .isited the 'e(site it is strongl$ recommended $ou do so/ as $ou can articiate in online ractice exams and get $our 0uestions ans'ered ($ our dedicated team o# harmac$ tutors% The urose o# this (ook is not to ro.ide $ou 'ith all the ans'ers #or the exam/ (ut to highlight ke$ areas 'hich $ou must kno' in order to ass% To make the most o# this (ook/ read it 'ith the B*"/ B*"/ 1rug Tari## Tari## and MEP to hand% This 'ill gi.e $ou in.alua(le re#erence ractice #or the exam and allo' $ou to exlore the di##erent toics raised%
Wh$ not tr$ our ne' Pharmac$CPA iPhone a2 • •
• • • •
• •
3.er 455 0uestions all (uilt into the a 6no need #or the internet7% Wide su(ject range co.ering calculations/ P-& and licensing texts/ MEP and 1rug Tari##% 1etailed #eed(ack sho'ing $ou the (est resources #or each 0uestion% Eas$ to use design% 8uestions ans'ered automaticall$% automaticall$% !earated 3en Book and Closed Book 0uestions Each 0uestions is timed just like the real exam% Constantl$ udated 0uestions% Easter egg 0uestions to kee $ou amused%
Table of Contents Chater :) The GPhC Exam%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Exam%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%% %% ; !$lla(us%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% !$lla(us%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%; %%%%%%%%%%%; The Closed Book Exam%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Exam%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%% %%% < The 3en Book Exam%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Exam%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%< %%%%%%%%%%< 8uestion !tructure%%%%%%%%%%%%%%%%%%%%%%% !tructure%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%% < Pre+registration =ear !chedule%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% !chedule%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%> %%%%%%%%%%%%%%%> 3n The 1a$%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 1a$%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:5 %%%%%%%%%%%%%%%%%%%%%%%:5 Chater 9) Working as a Pre+reg%%%%%%%%%%%%%%%%%%%%%%%%%%% Pre+reg%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%:: :: Pre+reg Tis%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Tis%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%% :: Tagging sections o# the B*" and Tari##%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Tari##%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%% :: The B*"%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% B*"%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:9 %%%%%%%%%%%%%%%%%%%%%%%:9 The 1rug Tari##%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ari##%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%% :9 Pre+Reg !ocial !kills%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% !kills%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%% :9 Patients to look out #or%%%%%%%%%%%%%%%%%%%%%%%%%%% #or%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%% :? Pregnant 'omen%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 'omen%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:? %%%%%%%%%%%:? Children%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Children%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%:4 %%%:4 Constiation%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Constiation%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:4 %%%%%%%%%%%%%%%%:4 1iarrhoea%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 1iarrhoea%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%% :4 "e.er%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% "e.er%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:4 %%%%%%%%%%%%%%%%%%%%%%:4 Teething%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% eething%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%% :; Rashes%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Rashes%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:; %%%%%%%%%%%%%%%%%:; -metigo 6!tah$lococcus aureus7%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% aureus7%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%% :; Chickenox 6@aricella 6@aricella oster @irus7%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% irus7%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%% %%%% :< &ice 6Pediculus humanus caitis7%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% caitis7%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:< %%%%%%%%%%%%%:< Thread'orm 6Entero(ius .ermicularis7%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% .ermicularis7%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%% : Additional 1rugs 'hich ma$ (e used in Children%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Children%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%% : Chater ) The B*"%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% B*"%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%% :> B*" -ntroduction !ection%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% !ection%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:> %%%%%%%%%%%%%%%%%%%%%%:> !hort Dand and &atin A((re.iations%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% A((re.iations%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%% 95 !ection :) Gastrointestinal !$stem%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% !$stem%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%% 9 Gastrointestinal Tract%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Tract%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%% %%% 9 !ection 9) Cardio.ascular !$stem%%%%%%%%%%%%%%%%%%%%%%%%%% !$stem%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%% %% 9 Blood Pressure%%%%%%%%%%%%%%%%%%%%%%%%%% Pressure%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%% %%%% 9 War#arin%%%%%%%%%%%%%%%%%%%%%%%%%% ar#arin%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9? %%%%%%%%%%%%%%%9? !ection ) Resirator$ !$stem%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% !$stem%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%94 94 Asthma%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Asthma%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%% 94 !ection ?) Central *er.ous !$stem%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% !$stem%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%% 94 Migraine%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Migraine%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%% 94 Pain &adder%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% &adder%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%% 9; 1eression%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 1eression%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9; %%%%%%%%%%%%%%%%%%%9; Ps$chosis%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Ps$chosis%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9; %%%%%%%%%%%%%%%%%%%%%9; 1rugs o# 'ithdra'al%%%%%%%%%%%%%%%%%%%% 'ithdra'al%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%9; %%9; Antimuscarinic A1Rs%%%%%%%%%%%%%%%%%%%%%%%%%% A1Rs%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9< %%%%%%%%%%%%%%%%9< !ection 4) -n#ections%%%%%%%%%%%%%%%%%%%%%%%% -n#ections%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%% %% 9 Anti(iotics%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Anti(iotics%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%9 9 1rugs and anti(iotics in relation to #ood and alcohol%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% alcohol%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%% 9 !ection ;) Endocrine !$stem%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% !$stem%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%% 9 1ia(etes%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 1ia(etes%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 %%%%%%%%%%%%%%%%%%%9 Dormone Relacement Thera$ 6DRT7%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 6DRT7%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%% 9> !ection <) G$naecolog$ and UT-%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% UT-%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9> %%%%%%%%9> The morning a#ter ill%%%%%%%%%%%%%%%%%%%% ill %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%% 9> &ong term contraceti.es%%%%%%%%%%%%%%%%%%%%%%%%%% contraceti.es%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%9> 9>
!ection >) *utrition and Blood%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 5 Porh$rias%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 5 -ron Con.ersion ta(le%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%5 @itamins%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 5 @itamin ta(le%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% : !ection :5) Musculoskeletal%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9 !ection ::) E$e%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9 !ection :) !kin%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Corticosteroid otenc$%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ? !ection :?) -mmunological roducts%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ? Additional *otes on the B*"%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 4 1rug induced (lood d$scrasia and agranuloc$tosis%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 4 Common Ad.erse drug reactions%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4 Medicines and their side e##ects%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%; =ello' Card !cheme%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%< Enz$me -nducers%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%< Enz$me -nhi(itors%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% < Chater ?) The MEP%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% !ection :) General legal re0uirements%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Medicines #or human use%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% The Resonsi(le Pharmacist%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% P3M! F Prescrition 3nl$ Medicines%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%> !ection :% F &ist o# medicines #or humans%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%? Medicines #or @eterinar$ Use @eterinar$ Medicines Regulations 955 %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%?< !ection 9%:) Ethics Pro#essional Guidance %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ?> 9%9) Pro#essional !tandards H Guidance 1ocuments%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ?> ) -mro.ing Pharmac$ Practice%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%?> Re#erences%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ?> Chater 4) The 1rug Tari##%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 45 -mortant sections%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%45 !ummar$ o# 1rug Tari##%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 4: Part -%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4: Part --%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4: Use#ul endorsing%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 4: 3ther Tari## !ections%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4 PART I@ Borderline !u(stances%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4 Chater ;) Resonding to !$mtoms%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 44 Resirator$%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 44 Coughs%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%44 !ore throat%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 44 Cold and #lu%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 4; Da$#e.er%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 4; Gastrointestinal 1isorders%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4< 1iarrhoea%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 4< Constiation%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4< -ndigestion and heart(urn%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4 -rrita(le (o'el s$ndrome 6-B!7%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4 *ausea and .omiting%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 4> Daemorrhoids JPilesK%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4> !kin Conditions%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;5 Eczema%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;5 !un(urn%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;5 !ca(ies%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;5 Ring'orm and Athletes #oot%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;:
Cold sores 6heres la(ialis7%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;: Warts and .errucas 6ailloma .irus 6DP@7%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;: -nsect (ites and stings%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;: E$e Conditions%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;9 Bacterial and Allergic Conjuncti.itis%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;9 1r$ e$es%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;9 Central *er.ous !$stem%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%; Pain%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ; -nsomnia%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;? 1eression%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;? Motion sickness%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;4 Womens Dealth%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;4 C$stitis%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;4 @aginal Thrush%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;4 The morning a#ter ill 6EDC7 &e.onorgestrel%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;; EDC 8uestion Ta(le%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;; &i#est$le%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;; Der(al Medicines%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;; Weight loss and diet%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;< !moking Cessation and *icotine Relacement Thera$ 6*RT7%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;< Chater <) Calculations and &ocum Checklist %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ; Addition%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ; !u(traction%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ; Multilication%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;> Rounding%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;> "actoring%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;> Multilication ($ ::%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%<5 1i.ision%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%<: Estimation%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% <: 3ther techni0ues%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% <9 &ocum Checklist%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% < Comuter skills%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% < CP1 .ia CPPE %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% < Area seci#ic ser.ices%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% < Chater ) 3en Book MC8s%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%) Closed Book MC8s%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% > Chater :5) Calculation MC8s%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:99 Chater ::) Ans'ers%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:: Ans'ers #or 3en Book !ection%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% :: Ans'ers #or Closed Book !ection%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:> Ans'ers #or Calculation 8uestions%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% :?
Chater :) The GPhC Exam The GPhC sets the exam #or harmacists 'ishing to ractice in the UL% This is a#ter the$ ha.e satis#actoril$ comleted ?4 'eeks 'ork in a harmac$ as a re+registration student% Each student can ha.e three attemts at the exam/ i# the$ #ail the third attemt the$ are not allo'ed to (e a harmacist in the UL 6i# this does occur there ma$ (e the ossi(ilit$ o# aeal7% The examination takes lace on t'o occasions each $ear) The summer 6the last "rida$ in ,une7 and the autumn 6the last "rida$ in !etem(er7%
Syllabus The exam itsel# has a .er$ (road s$lla(us/ 'hich contains) Toic
Brie# summar$
GPhC Code of Ethics
-nterret the code o# ethics in the MEP and use it e##ecti.el
%$Clinical governance and Principles of audit
Understand the use and ho' to al$ Clinical Go.ernance and the relation to audits%
Continuing professional development
CP1 and 'h$ it is used in relation to Clinical go.ernance%
Sale and supply of medicines
&egal la(elling re0uirements/ C1s/ oisons/ chemical reagents/ sirits%
Operating a registered pharmacy
Resonsi(le harmacist and suerintendent regulations%
National Health Service
*D! legislation and its rele.ance to harmac
%$Health and safety
&egal resonsi(ilities o# harmacists and sta##/ risk assessment and management%
Environmental protection
!a#e disosal o# medicines and controlled drugs%
Consumer and ata protection
&egislation #or the rotection o# consumers and their in#ormation%
Evidence!based practice
3(taining and using e.idence to enhance ractice%
"ction and uses of drugs
The rinciles o# A1ME and harmacokinetics%
Non prescription remedies
*on+P3M medicine use/ and the treatment o# minor ailments%
Triage
Re#errals and di##erentiating (et'een minor ailments and chronic illness%
"dverse effects of medicines
Recognition o# ad.erse e##ects o# commonl$ rescri(ed medicines%
Contra!indications and drug interactions
Bet'een readil$ a.aila(le and P3M medicines%
Counselling re#uirements
When to deli.er that in#ormation in the most aroriate 'a
%$Optimising patients$ drug therapy
Medicines management and harmaceutical care%
%nterpretation of test results
BP/ (lood comonents/ *T- drugs and managing outside o# arameters%
Health promotion and disease prevention
Counselling in.ol.ing diet/ li#est$le and health romotion rogrammes%
Calculation and ilution
Per#orming calculations and dilutions relating to harmac$ ractice%
&ormulation' preparation' GP
Prearation o# non sterile harmaceutical goods using G1P and GMP%
Special handling re#uirements
C$totoxics and drugs 'hich re0uire secial handling%
Stability
"actors a##ecting drug sta(ilit$ and their imact on la(elling and storage%
NHS Complaints procedures
Do' atients can make a comlaint a(out the *D! and its ser.ices%
NHS funding for pharmacy services
The 1rug Tari##/ .alidit$ o# rescritions and collecting correct charges%
Prescribing guidelines
Purose o# local #ormularies and sources o# rescri(ing guidelines%
Operating procedures
!3Ps in rimar$ and secondar$ care and the reason 'h$ the$ are needed%
(uality assurance
Methods assuring the 0ualit$ o# harmaceutical roducts and ser.ice%
The Closed )oo* Exam The exam is slit into t'o aers/ sat searatel$% The #irst art o# the exam/ taken in the morning/ is the closed (ook exam% -n this art o# the exam/ no resources are a.aila(le and the candidate must rel$ solel$ on their o'n kno'ledge% This is considered the hardest art o# the exam (ut $ou ma$ think it re#era(le to get the 'orst art o.er #irs t% There are >5 0uestions in >5 minutes 6: minute er 0uestion7 and all 0uestions are in an Multile Choice 8uestions 6MC8s7 #ormat%
The Open )oo* Exam The second art o# the exam is sat in the a#ternoon% This is the oen aer/ 'here the candidate can use designated resources/ these include exclusi.el$ the B*"/ MEP and 1rug Tari##% -n resects to these (ooks $ou must make sure $ou ha.e the correct .ersion #or the exam 6the most u to date one is not necessaril$ the correct .ersion7% The .ersions acceted #or the exam can (e #ound on the societ$ 'e(site% The oen (ook exam also contains a 95+0uestion calculations section 'here the candidate is asked to comlete common harmaceutical calculation ro(lems% This must (e comleted 'ithout the aid o# a calculator% The ass mark #or this is <5 and must (e assed other'ise the candidate 'ill #ail the entire exam% 3.erall/ there are 5 0uestions to (e ans'ered in :45 minutes/ 'hich is an a.erage o# a(out a minute and a hal# er 0uestion%
(uestion Structure All 0uestions are in the #ormat o# non+negati.el$ marked MC8s% There are #our t$es o# GPhC MC8s) :% Standard +C($s F select the correct ans'er out o# 4 otions% A (asic examle is as #ollo's) The &atin taxonomic name #or Cra( &ice is 'hich o# the #ollo'ing) A% Tinea pedia B% #thirus pubis C% !acoptes scabei 1% #ediculus capitis E% $oster varicellus 9% ,easoning +C($s F here $ou are gi.en t'o statements and and ha.e to determine their relationshi using the #ollo'ing ta(le)
An examle o# a 0uestion using this structure is as #ollo's) &irst Statement- A resonsi(le harmacist ma$ (e a(sent #rom the remises #or u to t'o hours% Second Statement- A harmacist must (e contacta(le 'hilst a(sent #rom a harmac
%$ Both statements are correct ho'e.er/ unrelated% The second statement does not ro.ide and exlanation #or the #irst and there#ore/ the ans'er can onl$ (e B% % Combination statement +C($s using• :/ 9 and are correct 6A7 • : and 9 onl$ are correct 6B7 • 9 and onl$ are correct 6C7 • : onl$ is correct 617 • onl$ is correct 6E7 This ta(le is usuall$ summarised into the #ollo'ing) irections Summarised " .' /' 0
) .' / onl$
C /' 0 onl$
. onl$
E 0 onl$
This otion re0uires a tactical aroach% -n all o# these t$es o# 0uestions $ou kno' that statement 9 cannot (e the onl$ statement that is correct / this o#ten hels in making the right decision% This logic can ro.e a little trick$/ so here is an examle) Which o# the #ollo'ing are the greatest e.er guitarist6s7 that e.er li.ed2 :% ,imm$ Choo 9% ,immi Dendrix % ,imm$ Page With this 0uestion $ou kno' Dendrix is de#initel$ a guitarist (ut $ou are unsure a(out the others% ,ust ($ kno'ing this/ $ou ha.e alread$ eliminated otions 1 and E% =ou also kno' that it de#initel$ is not ,imm$ Choo there#ore/ this lea.es $ou 'ith either E or C% The actual ans'er is E (ut as $ou eliminated the rest o# the otions it makes choosing the correct one a (it easier% ?% 1in*ing +C($s + $ou are resented 'ith a list o# 9+4 statements/ #ollo'ed ($ another 9+4 statements/ these ha.e to (e linked ($ selecting the aroriate otion% An examle o# this is) A) @itamin A B) @itamin B; C) @itamin C 1) @itamin 1 E) @itamin E !elect/ #rom A to E/ 'hich .itamin alies to the correct statements% .2 -s 'ater solu(le and #ound in nuts% /2 Pre.ents scur.$% 02 -ncreases intestinal a(sortion o# calcium% 32 -ncreases a(sortion o# iron #rom lant sources% 42 -s created during skins exosure to sunlight%
The ans'er to this 'ould (e) :%B/ 9%C/ %1/ ?%C/ 4%1
Pre!registration 5ear Schedule A num(er o# '''%harmac$ca%com students/ ha.e re0uested that 'e create a rudimentar$ schedule #or the re+reg $ear% We recommend creating $our o'n as di##erent eole learn and stud$ at di##erent rates% Do'e.er/ (elo' is a general lan #or those 'ho are unsure a(out ho' to roceed%
-n general/ relax/ acclimatise and enjo$ $our time till the end o# Christmas% Then start to tr$ and learn e.er$ da$ making sure $ou kno' all $our drugs% T'o months (e#ore the exam make sure that $ou ha.e reser.ed su##icient holida$ time and start rigorousl$ re.ising%
Period
Plan
September Acclimatise to $our ne' en.ironment/ get to kno' the atients and the di##erent clinicians that $ou 'ill (e 'orking 'ith% &earn 'here the di##erent surgeries are and to all the di##erent ser.ices ro.ided ($ $our ne' harmac$% October )ro6se through the )N&' Tariff' +EP and get a good minor ailments boo*2
3nce $ou ha.e gained a little more con#idence in $our a(ilities/ use them% Tr$ counselling atients under the suer.ision o# the harmacist and get as much to #eed(ack as $ou can a(out $our er#ormance% -# $ou are criticised/ take note and November imro.e on these areas% Make sure $ou are re.ising regularl$% October
7no6 you drugs' at this point you should *no6 every drug 6hich you use2 November Concentrate on the cometencies/ there is no recommended amount that $ou should comlete% =ou need to sho' that $ou are cometent in all the asects o# the s$lla(us% to 3n a.erage students comlete 955+55 cometencies e .er$ $ear% ecember "t this point you should have read thoroughly the first 3 )N& chapters2 ecember to &ebruary &ebruary to "pril "pril to +ay +ay to 9une
At this stage it is (est to increase the intensit$ o# $our re.ision/ learn something #rom it and then utilise it in ractice% This 'a$ $ou 'ill ha.e an incidence in mind as a re#erence 'hich 'ill hel $ou remem(er the in#ormation (etter% "t this point you should have finished annotating and tagging )N&8Tariff8+EP2
Comlete $our cometencies so that $ou can concentrate on re.ision in the #ollo'ing months% This is also a good time to start ractising calculations% Prepare to finish all competencies and aim to finish t6o full exam papers2
B$ this time all $our cometencies should (e comlete and $ou should almost (e read$ to (e signed o## ($ $our tutor% Make sure $ou are enrolled correctl$ #or the exam and $ou kno' 'hich exam centre $ou 'ill attend% Send off you competencies to the governing body2
!tudents usuall$ reser.e 9+? 'eeks o# holida$ time #or just (e#ore their exam to s'ot u% Make sure (e#ore the exam that $ou ha.e comleted as man$ exam 0uestions as ossi(le 6ie all on the PCPA 'e(site7 and $ou #eel con#ident in calculations% o all #uestions in this boo* and start %NTENS%:E15 revising;
On The ay :% ,elax + although the ass mark is around <5/ on a.erage >5 o# all eole 'ho take the exam ass #irst time% The :5 'ho #ail/ usuall$ ha.e a roer excuse #or not assing i%e% the$ did not ha.e the correct resources/ the$ had an ad.erse e.ent 'hich a##ected stud$ er#ormance/ turned u late etc% 9% %t is not as hard as you thin* + 'e ha.e urosel$ made the 0uestions in this (ook slightl$ more di##icult than those in the exam $ou 'ill (e taking/ to make $ou just that little (it more reared% -# $ou ha.e assed all the 0uestions in this (ook 'ith a <5 a.erage/ should exect 5 on the actual exam% % Get there on time + make sure $ou kno' 'here $ou are going/ check the transort $ou are taking online/ journe$ lanner is a good resource #or &ondon/ also rint o## a ma i# $ou can% ?% Hydration and nutrition + there are no real rules here #or students/ do not (ring a #our course meal/ (ut do (ring a (ottle o# non+#izz$ 'ater and a snack 'hich is high in car(oh$drate% 4% The night before + get e.er$thing $ou need together in one lace% All the id re0uirements/ the correct B*"/ MEP and drug tari##/ encil/ eraser/ calculator and en% -# $ou are unsure 'hat $ou need check the GPhC 'e(site% ;% Timing + #or the oen (ook there is a(out : and a hal# minutes er 0uestion 'hereas/ the closed (ook is a(out : minute% A good techni0ue is to go through all o# the 0uestions ans'ering the ones $ou kno' instincti.el$ and lea.e the ones $ou dou(t till later% <% % &ragrance F this ma$ sound a little strange/ (ut there has (een some research 'hich suggests that i# $ou 'ear a certain #ragrance 'hen re.ising $ou should 'ear it during the exam as it 'ill hel 'ith memor$ recall ($ association% Although the science is a (it susect/ e.en i# it has some truth/ aromathera$ and nice smells ha.e (een sho'n to ut eole in a more relaxed mood 'hich ma$ (e use#ul 'hen going into a stress#ul exam% :5% ,eserve extra calculation time F it is al'a$s good to sa.e some extra time at the end o# $our exam so that $ou can go o.er the calculation 0uestions just one more time% When $ou do this/ do not assume that $ou are doing the eas$ arts o# the calculation correctl$ such as minor multilications and additions/ check e.er$thing%
Chater 9) =or*ing as a Pre!reg Pre!reg Tips222 •
Use WWDAM as much as ossi(le until it (ecomes natural) =ho is it #or2 =hat s$mtoms is the atient exeriencing2 Ho' long has it (een a ro(lem2 What "ction has (een taken2 -s the atient taking an$ other +edicines2
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•
• •
•
Use as man$ resources as ossi(le/ although the B*" gi.es de#initi.e ans'ers in resects to clinical medicine/ it does not gi.e $ou all the in#ormation regarding licensing and recommendations o# 3TC medicines% Use this (ook and others to construct $our o'n Jharmac$ #ormular$K o# medicines 'hich $ou 'ould recommend (ased on u to date clinical e.idence% "amiliarise $oursel# 'ith the GPhC s$lla(us/ during $our 'ork as a re+reg $ou 'ill gain a lot o# kno'ledge 'hich is not alica(le to the exam/ make sure $ou kno' 'hat is 'hat and $ou could sa.e a lot o# time% "or the exam/ ractice makes er#ect/ comlete the samle exams on Pharmac$CPA under exam conditions e.er$ time% Use the eole around $ou% =our tutor has a lot o# exerience in harmac$/ ma$(e the$ are not the (est at clinical kno'ledge/ (ut the$ ma$ (e to notch at harmac$ management or ethics #ind these strengths and learn #rom them% 1o $ou ha.e a learning disa(ilit$2 =ou ma$ ha.e come across this during $our studies at uni.ersit$% -# $ou ha.e (een diagnosed 'ith a condition such as d$slexia $ou ma$ (e eligi(le #or extra time during the exam%
3.erall/ kee a cool head and use $our re+registration $ear as a learning oortunit$% The harmac$ ro#ession is something $ou 'ill ro(a(l$ do #or the rest o# $our li#e/ so it makes sense to create solid #oundation in clinical exertise and kno'ledge to (uild uon%
Tagging sections of the )N& and Tariff "or 0uick and eas$ re#erence during the exam it is highl$ recommended that $ou JtagK the aroriate sections% !tudents do not generall$ tag the MEP (ut $ou ma$ do so i# $ou 'ish%
Tags are created using tae 'hich $ou can annotate% The (est t$e o# tae 'e ha.e #ound is !cotch tae/ it is 0uite dura(le and can easil$ (e 'ritten on 'ith a #ine ti en% !ome students re#er to use colour coded tags 'hich can (e 0uickl$ identi#ied% Generall$/ sections to tag at the to o# the (ook 6see icture7 include ta(les/ indexes and aendices% Perendicular to this/ on the side/ the di##erent chaters and imortant drug classes%
The #ollo'ing section sho's a suggested method o# tagging/ i# $ou #eel com#orta(le/ doing it another 'a$/ do so%
The )N& Morhine salt and "entan$l atch ta(le% Morhine and diamorhine ta(le% Poisoning/ corticosteroid ta(le% "errous salts e0ui.alence ta(le% Aendices% -nteractions/ cautionar$ la(els%
The rug Tariff 1entist rescritions/ nurse #ormular$% !&! and ACB!% !toma and dressings% *otes on charges/ (lack listed su(stances% ero discount%
Pre!,eg Social S*ills A (ig art o# (eing a harmacist/ 'hich un#ortunatel$ a lot o# harmacist lack/ are social skills% Pharmacies are communal lacesN grannies/ granddads/ mothers/ #athers lo.e to go to the harmac$ to get their medicines and ad.ice% As a harmacist $ou are the eicentre o# this/ to listen to the 'oes and tri(ulations o# eole/ 'hilst o##ering them good/ #ree medical ad.ice% This is all 'ell and true/ i# $ou o'n $our o'n harmac$ and ha.e kno'n the communit$ #or nigh on 95 $ears (ut ho'/ as a re+reg/ can $ou integrate e##ecti.el$2 The #ollo'ing section is dedicated to this% Put aside learning medical #acts #or a minute and concentrate on communication and inter+ersonal relationshis% There are a .ariet$ o# (ooks out there 'hich can hel $ou (ecome a more e##ecti.e communicator/ (ut none o# 'hich ha.e (een 'ritten in the context o# a harmacist/ let alone a harmac$ re+reg% !o 'here to (egin2 1e#ining $our role as a re+reg is the most #undamental thing $ou can do 'hen $ou start% Un#ortunatel$/ $ou are rett$ much the dogs (od$% That ma$ sound a little harsh (ut it is not #ar #rom the truth% The harmac$ does not need to a$ $ou #or the time that $ou 'ork there/ the go.ernment does/ so in essence $ou are a (onus 6or a hindrance7 to the harmac$ 'ork #orce% -n general/ most harmacies ha.e had a di##erent re+reg e.er$ $ear/ (ut some are One'(iesO/ 'ho ha.e ne.er had one% *e'(ies are di##icult as the$ usuall$ do not ha.e the in#rastructure in lace to ensure that the re+reg gets ade0uate training% Do'e.er/ -# $ou 'ork at a ne'(ie/ do not desair/ as i# $ou take the lead and stick u #or 'hat $ou are entitled to/ $ou should (e #ine% Most o# the skills listed here are ro(a(l$ innate to $ou/ $ou almost certainl$ ha.e learned o.er time that it is a good idea to smile o#ten and kee good e$e contact% E.en so/ e.en i# $ou are the #riendliest/ greatest re+reg in the 'orld/ it is a good idea to read through the #ollo'ing oints as $ou 'ill see them a (it more o(jecti.el$ and hoe#ull$ realize their 'orth%
•
5ou Cannot =in an "rgument + e.er hear the term Othe customer is al'a$s rightO2 Peole ne.er 'ant to (e told that the$ are 'rong/ no matter 'ho the$ are% This is not to sa$ $ou al'a$s ha.e to (e assi.e/ (ut kee it in mind 'hen $ou are con.ersing 'ith a atient% Ask $oursel#/ ho' much does it mean to $ou to 'in this argument2 -s this 'orth more than creating a good imression and gi.ing good customer ser.ice2
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Name Calling + i# $ou ha.e a rescrition #or Mrs% !ohia Al(urkurck$%%% -s it !ohia2%%% Mrs% Al(urkurck$2%%% Mrs%A2 Well/ there is no right ans'er to this/ the sa#est otion is al'a$s to address someone ($ their #ull title ie Mrs% Al(urkurck$/ ho'e.er/ $ou 'ill #ind that sometimes/ 'ith 'omen/ their title is sometimes 'rong ie a Mrs (ecomes a Ms 6due to her (ecoming a 'ido'7/ so it ma$(e easier to call them !ohia% -n general/ i# the erson is the same age as $ou or $ounger address them ($ their #irst name i# the$ are older address them ($ their #ull title% !ome eole re#ute this and onl$ stick 'ith titles and last names/ (ut to (uild raort 'ith a customer #irst names can (e reall$ use#ul%
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O,emember that a person$s name is' to him or her' the s6eetest and most important sound in any language %O Tr$ to remem(er atients names/ $ou do not ha.e to ask them as it is 'ritten on the rescrition% But ne.er the less 'hen the erson comes in next and $ou sa$ OGood morning Mr%IO 'ithout a rescrition $ou 'ill (e recei.ed 'ith a guaranteed smile%
•
%f 5ou +ust &ind &ault' o it Cautiously + do not criticize a atient at the (eginning o# a statement/ al'a$s state a leasantr$ (e#ore a criticism% !a$ing O'e reall$ areciate $ou coming toda$O/ O'ith all due resectO or Othank $ou #or (ringing that to our attention/ assure $ou it 'ill not haen againO can make the 'orld o# di##erence% !tarting 'ith a criticism can also set the tone #or the entire con.ersation and it can (e di##icult to get eole to do 'hat $ou 'ant i# the$ are in a negati.e mode%
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No One 1i*es to Ta*e Orders + Go to $our room and do $our home 'ork Eat $our greens Bringing (ack an$ memories2 We ha.e all (een told 'hat to do ($ an authoritati.e #igure and >> o# the time 'e ne.er liked it% The same 'ill haen in harmac$/ (ut $ou 'ill (e the one gi.ing orders% There is an unsoken imortance heirach$ in the harmac$ it usuall$ goes like this%%% PharmacistQTechnicianQPharmac$ AssistantQ Counter AssistantQ Pre+reg% =ou ma$ ask 'h$ is the re+reg last/ this is usuall$ due to ranking ($ exerience and age% Although $ou ha.e (een to uni.ersit$ #or the ast ? $ears at the (eginning o# $our re+reg $ou usuall$ are the Odogs (od$O% As $ou rogress through the $ear this should imro.e% *o matter 'here $ou are in this hierarch$ $ou 'ill still need to gi.e orders% When doing so al'a$s remain olite sa$ing lease and thank $ou and also structure the re0uest so it does not sound like $ou are gi.ing an order% "or instance instead o# sa$ing Ogo and take out the ru((ishO $ou could sa$ O- think it 'ould (e a good idea i# 'e got rid o# the trashO or Ocould $ou do me a #a.our and%%%O
Patients to loo* out for222 Pregnant 6omen Pregnant 'omen commonl$ su##er #rom a lethora o# ailments ranging #rom (ack ache to constiation% Do'e.er/ due to the #ragilit$ o# the de.eloing #oetus 6most sensiti.e during 4 th to :5 th 'eek F em(rionic eriod7 man$ drugs are contradicted% Belo' is a list o# common ailments and treatments #or regnant 'omen% Pregnant 'omen regularl$ su##er #rom constiation/ this is usuall$ due to h$sical hormonal changes during regnanc$ or iron sulementation 6due to increased re.alence o# anaemia during regnanc$7% There is an extensi.e list o# drugs 'hich cannot (e used in regnanc$% There used to (e an aendix #or it in the B*" (ut no' it is integrated into the (ook% The in#ormation on regnanc$ changes #re0uentl$/ (ut generall$/ the #ollo'ing are considered sa#e% 6Again this is not a list that should (e used as re#erence/ onl$ general guidance/ i# $ou are to gi.e out medicines to a regnant 'oman check the most u to date literature such as the B*" #or contra+ indications7% Paracetamol 1axatives 6non+stimulant7 "ntacids Plain emollients +ethyldopa 6(lood ressure7 Penicillins Clotrima>ole 6must (e rescri(ed ($ a doctor7 %nhalers + it is (etter to risk the side e##ects o# inhalers than risk not using them and causing h$oxia% Condition
Clinicall$ Pro.en !a#e Treatment
Constipation
1ietar$ measurements F #i(re increase #luid intake% Exercise can (e use#ul% Bulk+#orming laxati.es% &actulose
Heartburn
Antacids Alginates
Pain
*on+harmacological F head massage/ stretching/ 'arm (ath% Paracetamol F short term%
Hayfever
Reduce allergen exosure% !odium cromogl$cate Chlorhenamine onl$ anti+histamine that can (e sa#el$ recommended%
Coughs and Colds Guai#enesin F although drinking lots o# 'ater is e0uall$ as e##ecti.e% iarrhoea
1ioral$te
Children The main childhood conditions/ 'hich as a harmacist $ou are likel$ to encounter include) constiation diarrhoea/ #e.er/ teething/ rashes/ imetigo/ chickenox/ lice and thread'orm% Constipation =hen to refer222 • Chronic constiation%
Mild constiation in children is .er$ common/ this usuall$ onl$ lasts #or a #e' da$s% This can (e a.oided ($ increasing #luid intake and mo.ing to a #i(rous .egeta(le hea.$ diet% Children sometimes hold in stools and resist going to the toilet/ this is o#ten due to (ad associations 'ith going to the toilet% Treatment o# chronic constiation should (e re#er red to a doctor% Order &irst 1ine
Treatment Change in the diet increasing #i(re and #luids%
Second 1ine
&actulose ma$ (e gi.en in some cases%
WWHAM : !everity% &ess than ' stools in one wee% iarrhoea =hen to refer222 Re#erral to a doctor is (ased on age and the duration o# diarrhoea)
: $ear old Q 9? hours duration S re#erral% $ears old Q ? hours duration S re#erral% Q $ears old adults Q <9 hours duration S re#erral% -n most cases the condition is sel# limiting and does not exceed 9+ da$s%% Order Treatment -ncrease #luid utake 'ith ossi(le addition o# oral reh$dration salts 63R!7% &irst 1ine WWHAM : uration% luid intae% *lectrolytes% ood poisoning% &ever =hen to refer222 months old/ as diagnosis is 0uite di##icult% • • Associated sti## neck or #e(rile con.ulsions% • Prolonged #e.er unresonsi.e to medicines%
3#ten a #e.er is diagnosed ($ a arent or guardians touch Jthe child #eels 'armK% The most accurate 'a$ o# diagnosis is ($ using a thermometer 6non+mercuric7 and the temeratures) Point of measurement
1o6 grade
+oderate
High Grade
Mouth 6oral7
Q <%4C
+>C
Q >C
Ear 6otic7
Q <%9C
+>C
Q >C
Anus 6rectalrectum7
Q <%C
+?5C
Q ?5C
Under arm 6axillar$7
Q <%9C
<%4+>C
Q >C
Anti$retics should (e gi.en to reduce the #e.er% The childs #luid intake should (e increase to a.oid deh$dration #rom excessi.e s'eating% An$ rolonged #e.er should (e re#erred% Order Treatment &irst 1ine Paracetamol e.er$ #our to six hours to reduce #e.er% Second 1ine
-(uro#en 6also an anti$retic7 can (e gi.en to children o.er months%
WWHAM : +ge% #rolonged fever% !tiff nec% ther symptoms%
Teething Teething usuall$ takes lace (et'een three months and t'o $ears o# age% As teething usuall$ occurs at such a $oung age it is (est not to gi.e an$ medication% Order &irst 1ine
Treatment Teething ring 'hich is a hard/ cool iece o# lastic #illed 'ith li0uid that $ou store in the #ridge% -t num(s the gums and hels the teeth enetrate through%
Second 1ine
Paracetamol or i(uro#en 6Q months7 ma$(e gi.en i# the #irst line is not su##icient% Alternati.el$/ rearations such as Bonjela Teething Gel ma$(e used% Make sure these do not contain choline salic$lates as these are contraindicated in children ($ the MDRA%
WWHAM : ther symptoms% ever% Mouth ulcers% ,ashes =hen to refer222 • Rarel$ meningitis occurs in $oung children% This could (e susected i# rashes do not (lanche 'hen under ressure% • Bacterial in#ections%
Children in in#anc$ 'ill o#ten get na$ rash% -t is extremel$ common and arises #rom naies (ecoming moist #or rolonged eriods o# time% This can cause local irritation #rom the ammonia in the urine or a reaction due to a minor #ungal in#ection%
-t usuall$ resents itsel# as a red rash around the (uttock area/ i# there are characteristics o# (acterial in#ection 6'eeing or $ello' crusting7 a re#erral is re0uired%
Order Prophylaxis
Treatment Lee the area dr$ F more #re0uent na$ changes or the use o# talc o'der can reduce occurrence%
&irst 1ine
Barrier creams + a t$e o# emollient 'hich reels 'ater and hels kee the area dr$% These include) inc/ !udocrem and dimeticone rearations%%
Second 1ine
-# a #ungal in#ection is resent F azoles such as clotrimazole miconazole can (e alied t'ice dail
%$WWHAM : !tiff nec% uration% &ocation% +llergens% %mpetigo ?!taphylococcus aureus) =hen to refer222 All cases/ as treatment is not a.aila(le #rom harmacies% •
-metigo is caused ($ the (acteria !taphylococcus aureus. The (acteria cause a characteristic golden crust/ skin lesion% -t is most common in re+school children and eole 'ho la$ contact sorts% -metigo is highl$ contagious and is sread ($ direct contact% All atients su##ering #rom imetigo should (e re#erred% WWHAM : -olden crust% &ocation% !everity%
Chic*enpox 6@aricella oster @irus7 =hen to refer222 • -n all cases/ gi.e reassurance% Pregnanc$ •
Chickenox s$mtoms include a headache / fever/ and general malaise% This (egins t$icall$ .@! /. days follo6ing exposure and in#ection% A characteristic rash o# small/ red spots t$icall$ 'ill #orm /3!3A hours #ollo'ing the initial chicken ox s$mtoms/ usuall$ (eginning on the trun* and face% Chicken ox is the result o# in#ection 'ith the :aricella! Boster .irus/ 'hich also causes shingles% -t t$icall$ in#ects the majorit$ o# children under the age o# :5 and is an air(orne contagious .irus% The sots can graduall$ sread to the arms and legs and #orm itch$/ raised (listers o.er a eriod o# !A hours% !ots t$icall$ sto #orming and sreading 4 days #ollo'ing the initial s$mtoms% The$ t$icall$ last an$'here #rom .!0 6ee*s% More serious in#ections ma$ occur i# the (listers (ecome in#ected/ or i# the chickenox .irus in#ects the lungs/ heart/ or (rain% 3nce $ou ha.e had Chickenox it is highl$ unlikel$ that $ou 'ill get it again/ (ut it is ossi(le that $ou 'ill get shingles later in li#e% Order &irst 1ine
Treatment Calamine lotion F the main ro(lem 'ith chickenox is that the sca(s (ecome itch$ and 'hen itched the atient causes li#e long scarring% Calamine is an excellent #irst line as it has an excetional sa#et$ ro#ile%
Second 1ine
3ther anti+itch roducts%
WWHAM : !everity% ther children%
1ice 6 #ediculus humanus capitis) =hen to refer222 Patients should (e re#erred i# the cost o# treatment is too rohi(iti.e/ it is a.aila(le on the • minor ailments scheme%
&ice in#est the scal and cause itchiness% 1iagnosis is exclusi.el$ er#ormed using a #ine tooth com( to #ind the (lack li.e eggs/ 'hich li.e attached to the hair close to the scal% White JeggsK are emt$ and do not necessaril$ indicate an in#ection% -t is usuall$ sread ($ head to head contact at school or home% Treatment is either 'ith dimeticone/ malathion/ ermethrin or henothrin% Order Treatment 1ue to the emergence o# resistance to common insecticides/ nit com(ing is &irst 1ine most e##ecti.e in com(ination 'ith dimeticone 6>< e##icac$7% Second 1ine
Malathion F in general the longer it is alied to the hair the more e##ecti.e it 'ill (e% Malathion is usuall$ #irst line unless the child has asthma or eczema in 'hich case the alcohol (ase can exacer(ate their condition%
Third 1ine
Permethrin o# henothrin%
WWHAM : otify school% amily infected% &ong hair%
Thread6orm 6 *nterobius vermicularis) =hen to refer222 • When cost o# treatment is rohi(iti.e/ treatment is a.aila(le on the minor ailments scheme%
!ometimes termed entero(iasis/ transmission occurs .ia #aecal to oral route% Re+in#ection occurs 'hen lar.ae 6 *nterobius vermicularis) hatch in the eri+anal area and migrate (ack into the colon .ia oral ingestion% Unlike lice/ thread'orm eggs can (e transmitted .ia a .ector such as (ed linen or clothing% There#ore/ non+medicinal treatment can (e 0uite e##ecti.e such as changing (ed linen/ 'earing $jamas/ cutting nails short and 'ashing hands (e#ore meals and a#ter going to the toilet% Order Treatment The most common treatments include me(endazole 'hich is a single dose &irst 1ine treatment% This can (e retaken a#ter 9 'eeks/ to (e certain o# eradication% A less oular treatment is ierazine%
Second 1ine
WWHAM : Correct diagnosis% ther family members infected% /ygiene% ingernails% "dditional rugs 6hich may be used in Children Certain drugs ma$ (e used 'hen treating children% These notes are not to (e used #or direct re#erence/ the$ are ro.ided onl$ as a general re#erence #or learning/ more in#ormation can (e o(tained #rom the Childrens B*"% •
• • • •
Chlorhenaminecetirizine can (e used in children a(o.e 9 $ears old all other anti+ histamines can onl$ (e used a(o.e :9 $ears old/ exect l oratidine 'hich can (e used in children a(o.e $ears old% Children cannot use 8@AR 6P3M7 as it is onl$ licensed #or atients a(o.e :9 $ears old% "e(rile con.ulsions in children are o#ten treated using diazeam suositories 6P3M7% 1esmoressin 6P3M7 can sometimes (e gi.en to children to sto night time enuresis 6(ed 'etting7% All susected side e##ects in children should (e reorted to the MDRA .ia the $ello' card scheme%
=hen to immunise
=hat vaccine is given
T'o months old
1TPP/ D/ PC@
Three months old
1TPP/ D/ MC
"our months old
1TPP/ D/ MC/ PC@
T'el.e months old
D/ MC
Around thirteen months old
MMR/ PC@
Three $ears #our months to #i.e $ears old
1TPP/ MMR
Thirteen to eighteen $ears old
1TPP
TTP F 1itheria/ tetanus/ ertussis 6'hooing cough7/ olio H F Daemohilus in#luenzae PC: F Pneumococcal conjugate .accine +C F Meningitis C ++, F Measles/ mums and ru(ella
Chater ) The )N& This section exlores the B*" in resects to drugs and conditions 'hich are commonl$ missed out during re.ision or just hard to #ind% This is ($ no means a comlete summar$ o# the B*"/ this chater ser.es to highlight ke$ areas to hel $ou in $our re.ision% The B*" is constantl$ changing/ (ut here 'e ha.e tried to concentrate on the core clinical kno'ledge 'hich/ relati.el$ is constant%
)N& %ntroduction Section Much o# the introduction section is in the MEP 6such as rescrition 'riting and legalit$7/ ho'e.er/ some in#ormation here is .er$ seci#ic and can onl$ (e #ound in the B*"% These include) Side effect ris* definition-
@er$ common) More than :5 Common) :+:5 Uncommon) 5%:+:%5 Rare) 5%:+5%5: @er$ Rare) &ess than 5%5: Oral side effects of drugs' most importantly-
Methotrexate *!A-1s ACE inhi(itors 3ral anti+dia(etics SpecificallyChlorhexidine' tetracyclines' iron F staining o# teeth% Phenytoin' ciclosporin F gingi.ial o.ergro'th% "ntimuscarinics' opioids' diuretics + Ierostomia 6reduced sali.ation7% +eformin' amiodarone' "CE inhibitors F taste distur(ances%
Palliative care prescribing' most importantlyE0ui.alent doses o# morhine sulhate and diamorhine and their #ormulations% Morhine salts and the #entan$l e0ui.alent% Emergency treatment in poisoning' most importantly *!A-1s/ esticides/ aracetamol grah/ oioids and antideressants% +edical problems in dentistryCertain seci#ic ro(lems can arise during dental treatments% Elderly prescribingUse the kno'ledge resented here to demonstrate the understanding the harmacolog$ o# elderl$ di##ers #rom Jnormal atientsK
Short Hand and 1atin "bbreviations Hour "bbreviation 0%alt% h% 0%h% 0%:h
1atin 0ua0ue alternis horis 0ua0ue hora 0ua0ue : hora
00h
0uater 0ua0ue hora
+eaning e.er$ other hour e.er$ hour e.er$ : hourN 6can relace O:O 'ith other num(ers7 e.er$ #our hours
1atin die(us alternis 0uo0ue alternis die 0ua0ue die 0ua0ue die ante meridiem 0ua0ue die ost meridiem 0uater in die ter in die 0uater die sumendus ter die sumendum (is in die
+eaning e.er$ other da$ e.er$ other da$ e.er$ da$ e.er$ da$ (e#ore noon e.er$ da$ a#ter noon #our times a da$ three times a da$ #our times a da$ three times a da$ t'ice dail$
1atin
+eaning e.er$ 'eek three times a 'eek
ay "bbreviation die(% alt% 0%a%d% 0%d% 0%a%m% 0%%m% 0%i%d% t%i%d% 0%d%s% t%d%s% (%d%(%i%d% =ee* "bbreviation 8WL T%i%'%
,elative to &ood "bbreviation %c% a%c% cc ex a0 c
1atin ost ci(um ante ci(um cum ci(os ex a0ua ci(os
+eaning a#ter meals (e#ore meals 'ith #ood/ in 'ater #ood
,elative to Sleep "bbreviation h%s% 0%h%s%
1atin hora somni 0ua0ue hora somni
+eaning at (edtime e.er$ night at (edtime
,elative to Time "bbreviation a%m% %m% 0%a%m% 0%%m% stat A%T%C% h/ hr noct%
1atin Ante Meridiem Post Meridiem 0ua0ue die ante meridiem 0ua0ue die ost meridiem statim
hora nocte
+eaning morning/ (e#ore noon e.ening or a#ternoon e.er$ da$ (e#ore noon e.er$ da$ a#ter noon immediatel$ around the clock hour at night
,elative to need "bbreviation rn s%o%s%/ si o% sit
1atin ro re nata si ous sit
+eaning as needed i# there is a need
,elative to Organ "bbreviation a%d% a%l%/ a%s% a%u% o%d% o%s% o%u%
1atin auris dextra auris lae.a/ auris sinistra auris utra0ue oculus dexter oculus sinister oculus uter0ue
+eaning right ear le#t ear (oth ears right e$e O3 3O/ like e$es le#t e$e (oth e$es
,elative to ,oute "bbreviation (ucc h id im inj% -P -@ -@P -@PB ne(ul %o% %r% R !C/ su(c/
!& To% .ag
1atin
injectio
ne(ula er os
+eaning inside cheek h$odermic intradermal intramuscular injection intraeritoneal intra.enous intra.enous ush intra.enous igg$(ack a sra$ ($ mouth or orall$ ($ rectum rectal su(cutaneous
su(linguall$/ under the tongue toical .aginall$
,elative to irections "bbreviation aa ad admo.% agit 1%A%W% dc/ 1C/ disc dil% dis% di.% d%t%d% e%m%% #t% &%A%!% *%M%T% *%T%E% s sig u%d%/ ut% dict% re%/ ret% s%a% 0%s% *%T%E%
1atin ana ad admo.e agita
dentur tales doses ex modo rescrito #iat
sine ut dictum reetatur secundum artum 0uantum su##iciat
+eaning o# each u to al$ stirshake disense as 'ritten discontinue dilute disense di.ide gi.e o# such doses as directed makeN let it (e made la(el as such not more than not to exceed 'ithout 'rite on la(el as directed reeats use $our judgment a su##icient 0uantit$ not to exceed
Section .- Gastrointestinal System rugs to 7no6222 • Hyoscine butylbromide ! Buscoan #or G-T sasms% • Hyoscine hydrobromide ! !coolamine #or secretions% • "minosalicylates such as mesalazine can cause (lood d$scrasia%
Gastrointestinal Tract Type of laxative
Example
Note
!timulant
!enna/ (isacod$l
3nset o# Action) ; F :9 hours
3smotic
&actulose macrogol
3nset o# Action) 9? F ? hours
Bulk+#orming
-saghula husk
3nset o# Action) :9 F <9 hours
"aecal so#teners
&i0uid ara##in
Rarel$ used
Bo'el cleansing
Prorietar$
Uncommon/ used (e#ore surgical rocedures
• • • •
&actulose has a dela$ed onset o# action 6a(out ? hours7 it should not (e used #or acute constiation% &actulose is generall$ the (est treatment #or children/ a#ter li#est$le changes such increasing #i(re in the diet has (een tried% Co+danthamer is last line #or constiation as it is kno'n to (e carcinogenic% &i0uid ara##in is rarel$ used as it can ool in the lungs and ash$xiate atients%
Section /- Cardiovascular System rugs to 7no6222 • :erapamil ! a calcium channel (locker% • E>etimibe + an alternati.e to sim.astatin/ is an otion #or the treatment o# adults 'ith rimar$ h$ercholesterolaemia 6*-CE guidelines7 it inhi(its cholesterol a(sortion% • ,osuvastatin F used #or ele.ated cholesterol% &ike sim.astatin it can cause muscle (reakdo'n ain 6m$algia7 and kidne$ damage% • Celecoxib F ma$ increase risk o# heart attack% A.oid this i# $ou are at an ele.ated risk% • "lflu>osin + an alha+(locker used in BPD and #or BP% • Nicorandil + anti+angina drug 'ith a nitrate comonent/ secial container%
)lood Pressure • • •
• •
•
-sosor(ide mononitrate is more sta(le than gl$cer$l trinitrate and there#ore/ has less ackaging restrictions% ACE inhi(itors 6drugs ending in +ril7 can cause h$erkalaemia as a side e##ect% "urosemide is one o# the most oular diuretics and is o#ten gi.en #or resistant h$ertension in addition to other antih$ertensi.es/ another common indication is ulmonar$ oedema 'hich is o#ten a result o# heart #ailure% Meth$ldoa is o#ten said to (e the sa#est (lood ressure medication during regnanc$% Beta+(locker side e##ects mnemonic+ O ))C 1oses :%e'e, s %n , ochedaleO))rad$cardia/ )ronchoconstriction/ Claudication/ 1iids/ :i.id dreams H nightmares/ +.e %notroic action/ , educed sensiti.it$ to h$ogl$caemia% An acron$m to remem(er (eta (locker contraindications 6mainl$ roranolol7 is ")CE "sthma/ heart )lock/ Cardiac #ailure/ M 6h$ogl$caemic shock7/ Extremities 6occlusi.earterial disease7%
=arfarin • • • • •
War#arin should onl$ (e disensed i# the atient 'ith the rescrition has their 'ar#arin (ook% War#arin is usuall$ gi.en a#ter hearin in hosital as it has a longer hal# li#e and takes a 'hile to get into the s$stem 6a(out ? hours7% The 'ar#arin (ook states 'hat the atients -*R is this ideall$ should (e (et'een 9%4+%5 (ut this is deendant on their condition% War#arin is mainl$ rescri(ed #or eole at risk o# throm(osis + i%e% ulmonar$ em(olism/ dee .ein throm(osis and atrial #i(rillation% War#arin is not to (e gi.en in regnanc
%$&actors 6hich affect %N, ! there are man$ #actors 'hich e##ect -*R/ and there#ore/ the dose o# 'ar#arin the atient is to recei.e/ these include) "lcohol inta*e + all alcohol should (e a.oided/ although regular moderate alcohol is deemed sa#e in certain hosital% The oinion o# man$ health ro#essionals is that a soradic alcohol intake is more detrimental to -*R #luctuations than consistent drinking% ar* green vegetables can change -*R these include curl$ kale/ ca((age/ (roccoli etc% OTC drugs + aracetamol can cause #luctuations in a atients -*R is $ou are not sure check the B*" under coumarins #or interactions% Herbal medicines + 'ar#arin also interacts 'ith man$ her(al medicines/ some are used in #ood such as ginger and !t ,ohn Wort/ these cause a reduced anticoagulant e##ect%
The main drugs 'hich interact 'ith 'ar#arin are) -nteracting 1rug
Additional Comment 6 S otentiall$ serious interaction as er B*"7
"lcohol
"luctuations in -*R articularl$ in those 'ith damaged li.ers%
!">ole &ungals
Anticoagulant e##ects enhanced%
"llopurinol
Anticoagulant e##ects ossi(l$ enhanced F monitor closel
%$"miodarone
!lo' onset F ma$ ersist long a#ter amiodarone is stoed%
"ntibioticsCefaclor Clarithromycin Erythromycin +etronida>ole
Ce#alexin/ Ce#radine and Ce#uroxime are sa#er alternati.es to ceflacor % !erious interaction (ut unredicta(le and uncommon 'ith clarithromycin F use azithrom$cin as an alternati.e% Erythromycin + elderl$ at greatest risk monitor closel$% +etronida>ole a.oid 'here ossi(le% War#arin dose ma$ need to (e reduced ($ u to hal#%
Carbama>epine
Causes increased 'ar#arin meta(olism%
Cimetidine
Meta(olism o# 'ar#arin inhi(ited%
Cranberry
-ncreased anticoagulant e##ect%
&luoxetine
-solated reorts o# raised -*R andor haemorrhage + monitor
%nfluen>a vaccine Anticoagulant e##ects ossi(l$ enhanced F monitor closel$% 1ipid!regulating !im.astatin/ colest$ramine and use caution 'ith ezetimi(e% +icona>ole
A.oid% Use n$statin 'here ossi(le%
NS"%s
-ncreased (leeding risk) Asirin/ cloidogrel and di$ridamole%
SS,%$s
Anticoagulant e##ect reduced/ also !,W%
Section 0- ,espiratory System rugs to 7no6222 • (:", inhalers D are not e0ui.alent to generic (eclometasone as the article size is smaller/ there#ore/ the same dose o# 8@AR as the generic 'ill (e a higher strength% -n this case the drug should (e rescri(ed ($ (rand% • Napha>oline + s$mathomimetic used as a nasal decongestant%
"sthma Treatment is graded into stes i# one does not 'ork mo.e to the next ste% Step .) -nhaled short acting Beta agonist%%% Step /) Add an inhaled steroid such as (eclomathasone%%% Step 0) Add a long acting (eta agonist 6such as salmeterol7%%% Step 3) Add a oral drug such as theoh$lline%%% Step 4) &ast ste is to add a steroid such as rednisolone%%% • • •
•
!acers should (e 'ashed e.er$ month 'ith a mild detergent other'ise/ this can damage their #unctioning% Asirini(uro#en sensiti.it$ 6causing a (ronchosasm7 occurs in :5 o# asthmatics% The MDRA has stiulated that 8@AR inhalers and (eclomethasone generic inhalers are not interchangea(le% 8@AR has #iner articles and is there#ore/ a higher otenc$ 6aroximatel$ dou(le7% *-CE guidance states that to ensure good comliance children under 4 $ears old should recei.e a sacer and i# needed a #ace mask 'ith their inhaler% -t is also good ractice to rescri(e a sacer u to the age o# :4 i# needed%
Section 3- Central Nervous System rugs to *no6222 • • • • •
Piroxicam ! a selecti.e *!A-1 6restricted use CDMP7% Phenothia>ines + #or s$chosis and nausea% SS,%$s F used in deression 6such as citaloram7% 1uring initial stages o# dosage change there can (e increased suicidal tendencies% Chlordia>epoxide + a (enzodiazeine exclusi.el$ used in alcohol 'ithdra'al% +ida>olam + a (enzodiazeine%
+igraine • • • •
Migraines o#ten haen at random (ut are sometimes associated 'ith triggers such as) missing meals/ ca##eine/ alcohol and the 'eather% Generall$ solu(le rearations are (etter as eristalsis is decreased in migraine attacks% Treatment usuall$ in.ol.es 3TCrescrition medicines o#ten this includes a com(ination o# a simle analgesic 'ith an anti+emetic or sumatritan% Pre.ention is exclusi.el$ rescrition onl$% A good 'a$ to remem(er these drugs is the hand$ mnemonic) O:er$ :olatile Pharmacotheraeutic "gents &or +igraine Proh$laxisO
:eramil/ :alroic acid/ Pizoti#en/ "mitrit$line/ &lunarizine/ +eth$sergide/ Proranolol%
Pain 1adder • • • • • • •
&irst step- start 'ith simle aracetamol 'hich has a relati.el$ lo' side e##ect ro#ile%%% Second step) add an *!A-1 such as diclo#enac or i(uro#en% Alternati.el$/ TE*! 6Transcutaneous Electrical *er.e !timulation7 has (een cli nicall$ ro.en%%% Third step) add 'eak oioids such codeine%%% &ourth step) is usuall$ P3M onl$ + tramadol/ codeine%%% &ifth step) Morhine has a hal# li#e o# ? hours unless it is a modi#ied release rearation%%% Sixth step) "entan$l + a .er$ strong oioid o#ten used in alliati.e care%%% Additionall$) Ga(aentin and amitrit$line can (e added at an$ stage #or neuroathic ain%%%
epression • • • • • • •
SS,%$s) Rarel$ i# the atient is under : $ears old and no other otion is a.aila(le/ #luoxetine should (e gi.en% An eas$ 'a$ to remem(er !!R- side e##ects is the acron$m + SS,%) Serotonin s$ndrome/ Stimulate C*!/ , eroducti.e dis#unctions in male/ %nsomnia% Paroxetine is sometimes gi.en 'hen there is anxiet$ resent% TC"$s- a use#ul acron$m to remem(er their side e##ects Throm(oc$toenia/ Cardiac 6ar$th$mia/ M-/ stroke7/ "nticholinergic 6tach$cardia/ urinar$ retention/ etc%7/ Seizures% There is a ossi(ilit$ o# suicidal ideation 'ith eole 'ho are initiated in antideressants or anti+eiletics ?CS+8+H," 6arning% Examles o# MA3s are moclo(emide/ henelezine/ isocar(oxazid 'ith these certain #oods 6Marmite/ mature cheese%%%7 should (e a.oided% The use o# lithium (ecause o# its narro' theraeutic index re0uires the atient to carr$ a lithium card as to 'hich rorietar$ #orm the$ take% 3ther medicines 'hich re0uire a card or a (ook include 'ar#arin/ steroids and methotrexate%
Psychosis Anti+s$chotics are thought to 'ork .ia doamine antagonism and there#ore/ ma$ cause extra+ $ramidal side e##ects these include) • • • •
Parkinsonian s$mtoms + tremor/ d$stonia/ akathisia 6restlessness7/ tardi.e d$skinesia 6in.oluntar$ mo.ements7% At$ical antis$chotics are most oular) riseridone/ olanzaine 6z$rexa7/ amisulride/ 0uetiaine/ clozaine%%% T$ical antis$chotics are less oular) haloeridol/ #luenthixol/ sulride%%% There is an e0ui.alence ta(le in the B*" #or trans#erring (et'een oral and deot injection antis$chotics%
rugs of 6ithdra6al •
•
• • •
Anxiol$tics + (enzodiazeines such as diazeam and nitrazeam/ should onl$ (e gi.en #or short term anxiet$ lasting onl$ 9+? 'eeks and can cause a aradoxical increase in hostilit$ and aggression% Alcohol 'ithdra'al can (e controlled ($ (enzodiazeines such as chlordiazeoxide% Additionall$/ disul#iram can (e used to create unleasant side e##ects 'hen the atient drinks alcohol% D$notics 'ork much the same 'a$ as (enzodiazeines (ut similaril$ eole can get .er$ deendant on them% Corticosteroids + such as rednisolone should not (e stoed a(rutl$ and are usuall$ titrated do'n i# longer than 'eeks on Q?5mg% *icotine + drugs to com(at smoking include + *RT/ (urorion/ .arencicline% Ad.ice #rom
•
the CS+ states (uroion is contraindicated in atients 'ho su##er #rom seizures and eating disorders and has a relati.el$ common side e##ect o# hallucinations% "or this reason (uroion has (een mainl$ suerseded ($ .arencicline 6Chamix7% 3ioids + drugs to 'ean a atient o## oioid use include methadone/ (urenorhrine and naltrexone imlants 'ithdra'al s$mtoms include insomnia/ 'eakness and diarrhoea%
"ntimuscarinic ",$s -# a drug causes an anti+muscarinic side e##ect/ it means that eole 'ho ha.e a re+existing condition 'hich is similar to that side+e##ect the$ should not take that medicine as it 'ould make s$mtoms 'orse% !iml$ ut/ #or examle/ $ou ha.e (enign rostatic h$erlasia 6BPD7 a condition 'here $ou ha.e an enlarged rostate 'hich stos men #rom urinating% Then $ou should not take a drug 'hich can otentiall$ causes this s$mtom 6such as chlorhenamine7% -t cannot (e stressed enough ho' imortant these interactions are in harmac$% &ook in the B*" at the contra+indications #or antihistamines/ it is .er$ re.ealing% A good 'a$ to remem(er these side e##ects is Oshitsit and eeO% 3r the mnemonic S1<+ )"G meaning Sali.ation Secretions S'eating/ 1acrimation/
AtaxiaN loss o# coordination% 1ecreased mucus roduction in the nose and throatN conse0uent dr$/ sore throat% Ierostomia or dr$+mouth 'ith ossi(le acceleration o# caries% Cessation o# ersirationN conse0uent decreased eidermal thermal dissiation leading to 'arm/ (lotch$/ or red skin% Puil dilation 6m$driasis7N conse0uent sensiti.it$ to (right light hotoho(ia% &oss o# accommodation 6loss o# #ocusing a(ilit$/ (lurred .ision F c$clolegia7% -ncreased heart rate 6tach$cardia7% Tendenc$ to (e easil$ startled% Urinar$ retention% 1iminished (o'el mo.ement% -ncreased intraocular ressureN dangerous #or eole 'ith narro'+angle glaucoma%
Section 4- %nfections rugs to *no6222 •
Trimethoprim is 'idel$ used to treat urinar$ tract in#ection% • Clarithromycin is recommended #irst line #or chest in#ections as it generall$ has #e'er side+e##ects than er$throm$cin% • &lucloxacillin is mainl$ used #or skin in#ections and there is a CS+ 'arning that it ma$ rarel$ cause cholestatic jaundice % • +etronida>ole is mainl$ used to treat dental anaero(ic (acteria%
"ntibiotics • • •
• •
Co!amoxiclav is a com(ination o# cla.ulanic acid 6(eta+lactamase inhi(itor7 and amoxicillin its is generall$ considered more e##ecti.e than amoxicillin alone% Ciprofloxacin ma$ imair dri.ing/ not recommended #or :9$o/ has a high a##init$ #or cartilage/ the main side e##ect to remem(er is tendonitis% +eflo#uine D used in malaria roh$laxis% Can cause se.ere anxiet$/ aranoia and hallucinations% -n some cases it is more rudent to choose an alternati.e such as dox$c$cline% There is a cross sensiti.it$ (et'een enicillins and cehalosorins/ i%e% ce#alexin is not comletel$ sa#e in enicillin h$ersensiti.e atients% &lucloxacillin ma$ cause cholestatic jaundice or heatitis as a side e##ect%
rugs and antibiotics in relation to food and alcohol )efore foodPenicillin "lucloxaclillin Letoconazole Amicillin
"fter foodMetronidazole Ato.a0uonone Malarone &ariam *itro#urantoin
No alcoholMetronidazole + causes disul#iram like reaction F #lushing%%%
Section F- Endocrine System rugs to *no6222 • • •
Glicla>ide F a .er$ oular mem(er o# the sulhon$lureas% Carbima>ole F used in the treatment o# h$erth$roidism although it can cause (one marro' suression% +etformin is the main drug gi.en in dia(etes% Met#ormins main side e##ect is gastro+ intestinal distur(ance there#ore/ it should (e taken 'ith #ood%
iabetes • • •
A #asting (lood glucose le.el a(o.e
Hormone ,eplacement Therapy ?H,T • • •
There are man$ rorietar$ rearations containing di##erent hormones/ mainl$ rogesterones and oestrogens% DRT is .er$ e##ecti.e #or the treatment o# menoause (ut it can cause an increase risk o# .enous throm(oem(olism/ endometrial cancer and (reast cancer% These negati.es ha.e to (e 'eighed against the ositi.es% DRT is ($ #ar the most e##ecti.e treatment #or menoause and treatment also reduces the rogression o# osteoorosis/ (ut it is rarel$ rescri(ed%
Section - Gynaecology and
The morning after pill • • • • • • •
&egall$ onl$ a harmacist can sell emergenc$ hormonal contraceti.e 6such as &e.onelle7% -t is not usuall$ gi.en under :; this must (e re#erred unless there is a seci#ic PG1% -t can onl$ (e gi.en to the erson taking it/ not a reresentati.e% Ad.anced sul$ 6u to 7 o# EDC can (e ro.ided as long as there is an ade0uate reason% -t is onl$ e##ecti.e 'ithin <9 hours and should re#era(l$ used 'ithin :9 hours as e##icac$ decreases 'ith time% The harmacist must make sure that the atient is not alread$ regnant 6other'ise this ma$ result in an ectoic regnanc$7% A#ter taking the ill/ i# the atient is sick 'ithin hours the ill ma$ not ha.e 'orked and another ill should (e taken/ i# this does not 'ork then a re#erral is 'arranted%
1ong term contraceptives • • •
Com(ined oral contraceti.es 6C3Cs7 include Microg$non are the most oular t$e o# #emale contraceti.es/ the$ regularize menstruation and reduce risk o# certain cancers% Progesterone onl$ contraceti.es 6P3Cs7 include Cerazette / "emulen and are not as oular (ut are gi.en to atients 'ith a redisosition to 1@T% Medrox$+rogesterone + 1eoPro.era is a long acting contraceti.e gi.en ($ intramuscular injection%
Section - Nutrition and )lood rugs to *no6222 •
) vitamins D most imortantl$ Thiamine/ Ri(o#la.in/ *iacin and C$anoco(alamin%
Porphyrias Porh$ria is a hereditar$ disorder o# haem (ios$nthesis% Certain drugs ma$ induce acute orh$ria and there#ore/ great care must (e taken 'hen rescri(ing to su##erers% The B*" lists all the current drugs 'hich are kno'n to induce the conditions%
%ron Conversion table %ron content of different iron salts
-ron salt
Amount
Content o# #errous iron
"errous #umarate
955mg
;4mg
"errous gluconate
55mg
4mg
"errous sulhate
55mg
;5mg
"errous sulhate dried
955mg
;4mg
Make sure $ou mark this in $our B*"% A standard 0uestion 'ould (e) " octor rings and as*s for the approximate e#uivalent dose of ferrous gluconate 6hich should be given for @@mg of ferrous sulphate2 =hat is your ans6er
=ou need to #ind out ho' much #errous iron is in #errous sulhate this is ;5mg I is :5mg% :54 S 4%:?9% There#ore/ $ou need 4 ta(lets o# #errous gluconate 'hich is :455mg S :%4g%
:itamins • • •
&+&$sine is a sulement clinicall$ ro.en to hel rotect against cold sores% A1EL F a use#ul acron$m to remem(er #at solu(le .itamins% The B .itamins can (e easil$ learned using the #ollo'ing mnemonic OThe , h$thm Nearl$ Pro.ed ContagiousO the #irst letter o# each 'ord corresonds to the main B .itamins in se0uence) ). F Thiamine )/ F Ri(o#la.in )0 F *iacin *icotinamide )F + P$ridoxine/ ) F Biotin ) F "olic acid )./ F C$anoco(alamin
:itamin table Nutrient and "ood source
&unction
Special considerations
&olate 6&olic acid + Cereal grains/ dark lea#$ .egeta(les%
Pre.ents megalo(lastic anaemia and neural tu(e de#ects #or #oetuses%
:itamin " 6,etinol + &i.er/ dair$/ dark #ruits%
Re0uired #or normal "at solu(le/ teratogenic/ do not use during regnanc$% .ision/ reroduction and immune #unction%
:itamin ). 6Thiamin + Whole grain roducts%
Coenz$me in the meta(olism o# car(oh$drates%
Thiamin is o#ten taken ($ reco.ering alcoholics/ and those undergoing haemod$alisis%
Coenz$me in :itamin )/ ?,iboflavin + numerous redox 3##al/ (read% reactions% :itamin )F ?Niacin + Cereals/ so
%$Pregnant 'omen take ?55 mcg #olic acid dail$/ 'hereas eole taking methotrexate take 4mg dail$ to re.ent side e##ects%
Used in hotothera$ in neonatal jaundice%
Coenz$me in the Water solu(le% Extra niacin ma$ (e re0uired ($ eole meta(olism o# amino undergoing haemodial$sis% acids and gl$cogen%
Nutrient and "ood source :itamin )./ ?Cyanocobalamin + Cereals
&unction
Coenz$me in nucleic acid meta(olism%
Special considerations
:5+5 o# Q45$o do not meet their R1A/ so it is recommended to consume #orti#ied cereals%
:itamin C ?"scorbic Co#actor #or reactions re0uiring !mokers need more @itamin C then non+ reduced coer or iron% smokers% &ack o# @itamin C causes acid + Citrus #ruits/ tomatoes% scur.$% :itamin ?Calciferol F "ish li.er oils/ eggs/ milk%
Maintain serum calcium and hoshorous le.els%
"at solu(le/ (ios$nthesised ($ sunlight and the skin% Patients on glucocorticoid thera$ ma$ re0uire additional .itamin 1%
:itamin E F @egeta(le oils/ nuts%
Antioxidant
"at solu(le%
:itamin 7 F 1ark green .egeta(les%
Coenz$me in the s$nthesis o# man$ roteins in.ol.ed in (lood clotting and (one meta(olism%
Patients on anti+coagulant thera$ should (e monitored o# their .itamin L intake% @itamin L can (e used in (lood clotting #or neonates%
:itamin )./ ?Cyanocobalamin + Cereals
Coenz$me in nucleic acid meta(olism%
:5+5 o# Q45$o do not meet their R1A/ so it is recommended to consume #orti#ied cereals%
:itamin C ?"scorbic Co#actor #or reactions re0uiring !mokers need more @itamin C then non+ reduced coer or iron% smokers% &ack o# @itamin C causes acid + Citrus #ruits/ tomatoes% scur.
%$ +inerals+ineral and !ource
Notes
Calcium F 1air$/ .egeta(les/ nuts%
"ormation and maintenance o# (one% Use#ul #or stoing the reduction in calcium later in li#e o# 'omen%
%ron F Red meat/ green .egeta(les%
Re0uired #or the #ormation o# haemoglo(in% A(sor(ed (etter in a0ueous #orm 'ith added .itamin C%
+agnesium F Bread/ cereals% Aids heart and ner.ous s$stem #unction% Phosphorous F Meat/ dair$/ nuts%
Aids calcium in #ormation o# (one%
Selenium F *uts/ cereal%
Comonent o# antioxidant enz$mes%
Sodium F !alt/ most #oods%
Essential #or muscle #unction and #luid (alance%
Binc F !hell#ish/ dair
%$Essential #or immune s$stem and serm gro'th%
Section .@- +usculos*eletal rugs to *no6222 • •
NS"%s and all cyclo!oxygenase!/ selective inhibitors F are associated 'ith an increased risk o# throm(otic e.ents/ gastric side e##ects/ and asthmatic side e##ects% +ethotrexate F is usuall$ taken 'eekl$ and can cause (lood d$scrasias% The atient should (e monitored #or an$ signs o# in#ection such a sore throat%
Gout • •
"or acute eisodes diclo#enac/ indometacin and colchicine in atients 'ho are *!A-1s contraindicated% Asirin is contraindicated% Proh$lacticall$) allourinol can (e used 6this should not (e used in acute gout as this can exacer(ate the ro(lem7%
Section ..- Eye rugs to *no6222 • •
Chloramphenicol is a P line ocular anti(iotic a.aila(le as an ointment and dros% "ciclovir e$e ointment can (e used to treat Deres simlex in#ection in the e$e%
&ormulation • E$e ointments ha.e a lo'er s$stemic a(sortion than e$e dros as the$ JstickK to the e$e% E$e dros in multile alication containers #or use in the home should not (e used #or more • than ? 'eeks #rom the same container% -n hosital this duration dros to one 'eek% Glaucoma •
Glaucoma is an increase in intraocular ressure and can cause damage to the otic ner.e i# untreated% Man$ drugs are used in glaucoma the main three are) :% Prostaglandin analogues such as Ialatan 6latanorost7 usuall$ used once dail$ and ket in the #ridge i# unoened% 9% )etabloc*ers such as timolol o# le.o(unolol used t'ice dail$% % Parasympathomimetics such as ilocarine are usuall$ used three times a da
%$ Section .0- S*in rugs to *no6222 • %sotretinoin F a .itamin A deri.ati.e/ used in acne% Can cause (irth de#ects/ deression/ s$chosis and suicidal tendencies% • +alathion F a oular treatment to eradicate head lice 6although dimeticone has (een ro.en to (e the most e##ecti.e7% Can cause #lamma(ilit$ o# hair and neurotoxicit$% Emollients !ome emollients 'hich contain ara##in carr$ a #ire hazard there#ore/ naked #lames should • (e a.oided% A0ueous cream and emulsi#$ing ointment can (e used as a relacement #or soas% • Suitable #uantities
The B*" states recommended 0uantities o# certain rearations in t'o searate ta(les/ the$ are com(ined (elo'% !uita(le 0uantities o# toical rearations #or seci#ic areas% Creams and ointments
1otions
Corticosteroid creams and ointments
&ace
:4+5g
:55ml
:4+5g
)oth hands
94+45g
955ml
:4+5g
Scalp
45+:55g
955ml
:4 to 5g
)oth arms
:55g+955g
955ml
5+;5g
)oth legs
:55g+955g
955ml
:55g
Trun*
?55g
455ml
:55g
Groin 8 genitalia
:4+94g
:55ml
:4+5g
The ta(le a(o.e reresents the recommended 0uantit$ that should (e rescri(ed to an adult/ as a single dail$ alication #or t'o 'eeks% An examle o# ho' this can (e #ormulated into an exam 0uestion #ollo's% " doctor calls your pharmacy 6hilst you are on duty2 The doctor has a patient 6aiting and needs your advice2 The patient re#uires a #uantity of corticosteroid cream that they can apply t6ice daily 6hich 6ould cover both their arms and legs for a period of 3 6ee*s2 The patient is #uite over6eight and has a large surface area to cover2 =hat #uantity should you recommend A% ? g B% 49 g C% ;?5 g 1% ::95 g E% ;? g
-n this 0uestions there are ? #actors to consider these are) :% &ormulation F is it a corticosteroid2 9% Specific area of application F trunk/ #ace%%%2 % ,ate of application F usuall$ either once or t'ice dail$% ?% Period of treatment F one 'eek/ t'o 'eeks%%%
-n relation to this 0uestion the #ormulation is a corticosteroid% The steroid is to (e alied to the arms 6;5g F uer limit as the atient has a large sur#ace area7 and legs 6V:55g7 t'ice a da$ 6multil$ ($ 97 #or ? 'eeks 6multil$ ($ 97% This com(ines to :;5g I ? S ;?5g% !o the ans'er is C%
Corticosteroid potency Toical corticosteroids ha.e di##erent otenc$ ranging #rom mild to .er$ otent% The most common ones include) +ild) D$drocortisone 9%4 +oderate ) Eumo.ate Potent ) Betamethasone :ery Potent) 1ermo.ate
Section .3- %mmunological products rugs to *no6222 • iptheria' Tetanus' Pertusis' Polio ?TPP F Com(ined .accine% • Hib ?H F /aemophilus influen0ae • Pneumococcal ?PC: D !treptococcus pneumoniae • +eningitis C ?+C D eisseria meningitidis • +easels' +umps and ,ubella ?++, D Contro.ersial .accine/ ro.en *3T to cause autism% =hen to immunise
=hat vaccine is given
T'o months old
1TPP/ D/ PC@
Three months old
1TPP/ D/ MC
"our months old
1TPP/ D/ MC/ PC@
T'el.e months old
D/ MC
Around thirteen months old
MMR/ PC@
$ears/ ? months to 4 $ears old
1TPP/ MMR
Thirteen to eighteen $ears old
1TPP
TTP F 1itheria/ tetanus/ ertussis 6'hooing cough7/ olio H F Daemohilus in#luenzae PC: F Pneumococcal conjugate .accine +C F Meningitis C ++, F Measles/ mums and ru(ella
• • •
Man$ o# the .accinations are gi.en as com(ination rearations/ according to 'hat is re0uired% -# a .accination histor$ is incomlete or unkno'n the olic$ is to assume that no .accination has occurred and all .accinations administered accordingl$% Travel vaccinations F the main recommendations are to ha.e $our normal .accine schedule u to date and then $ello' #e.er/ t$hoid/ and De A can (e added deendent on $our destination%
"dditional Notes on the )N& Remem(er that all a((re.iations/ units/ E num(ers and s$m(ols used in the B*" can (e #ound on the inside o# the (ack co.er o# the B*"% 3ccasionall$/ in the exam $ou get a 0uestion a(out emergenc$ in the communit$ this 'ill o#ten come as Ja mother and child come into $our harmac$/ the child is ha.ing an anah$laxisK% =ou #irst instinct here 'ould (e to look u anah$laxis or adrenaline% -nstead/ $ou should go right to the (ack o# the B*" to the section entitles Jmedical emergencies in the communit$K%
rug induced blood dyscrasia and agranulocytosis !ome drugs can induce certain (lood disorders called d$scrasias% A d$scrasia is de#ined as a athological condition o# the (lood/ usuall$ in.ol.ing disorders o# cellular elements% The examiners lo.e to ask 0uestions on this so make sure $ou are #amiliar 'ith this section in the B*"/ it is extremel$ 'orth'hile to tag this section% To identi#$ atients 'ho ha.e (lood d$scrasias/ all ne' drugs 'hich are gi.en to atients 'hich ose a otential risk/ should (e gi.en 'ith the 'arning to look out #or certain s$mtoms such as unexlained (leeding/ (ruising/ sore throat/ in#ections and #e.er and malaise% The most nota(le drugs include) "minosalicylates such as sulfasala>ine Carbima>ole +ethotrexate Clo>apine Carbama>epine Captopril
Common "dverse drug reactions222 • • • • • • • •
ACE inhi(itors such as enalaril can cause #irst dose h$otension and dr$ cough% *!A-1s ulceration + one o# the most common A1Rs seen in hosital% Metallic taste in the mouth 'ith met#ormin% Taste distur(ances 'ith amiodarone/ catoril/ car(imazole/ metronidazole and zoiclone% Ri#amicin can cause the urine to go red and cause contacts to discolour% &e.odoa can make the urine dark red% Ierostomia 6dr$ mouth antimuscarinic side+e##ects7 + Tric$clic antderessants and antimuscarinics% Unlike roranolol/ atenolol does not ass through the (lood (rain (arrier thus a.oiding .arious C*! side e##ects such as (ad dreams%
+edicines and their side effects !ide E##ects
Medicine
"bortion' miscarriage or Misorostol/ a la(our inducing drug 6this is a case 'here the ad.erse e##ect uterine haemorrhage "ddiction
Man$ sedati.es and analgesics such as diazeam/ morhine/ etc%
)irth defects
Thalidomide and Accutane
)leeding of the intestine
Asirin thera
%$Cardiovascular disease
C3I+9 inhi(itors
eafness and *idney failure
Gentamicin 6an anti(iotic7
eath' follo6ing sedation Proo#ol 61iri.an7 ementia
Deart ($ass surger$
epression or hepatic inIury
-nter#eron
iabetes
At$ical antis$chotic medications 6neuroletic s$chiatric drugs7
iarrhoea
3rlistat 6Ienical7
Erectile dysfunction
Man$ drugs/ such as antideressants
&ever
@accination/ children are o#ten gi.en ost immunization anti$retic%
Glaucoma
Corticosteroid (ased e$e dros
Hair loss and anaemia
Chemothera$ against cancer/ leukaemia/ etc%
Headache
!inal anesthesia
Hypertension
Ehedrine and seudoehedrine/ cold remedies%
%nsomnia
!timulants/ Ritalin/ Adderall/ etc%
1actic acidosis
!ta.udine 6erit/ #or anti+D-@ thera$7 or met#ormin 6#or dia(etes7
1iver
Paracetamol o.erdose
+elasma and thrombosis
Estrogen+containing hormonal contracetion such as the com(ined oral contraceti.e ill
%rreversible Peripheral neuropathy
"luoro0uinolone medications
,habdomyolysis
!tatins 6anti+cholesterol drugs7
Sei>ures
Withdra'al #rom (enzodiazeine
ro6siness or increase in Antihistamine use% !ome antihistamines are used in slee aids exlicitl$ (ecause the$ cause dro'siness% appetite Stro*e or heart attac*
!ildena#il 6@iagra7 'hen used 'ith nitrogl$cerine
Suicide' increased tendency
"luoxetine and other !!R- antideressants
Par*insonism
MPTP a meeridine related drug considered highl$ neurotoxic
Tardive dys*inesia
&ong+term use o# metocloramide and man$ antis$chotic medications
Spontaneous Tendon rupture
"luoro0uinolone drugs e.en occurring as late as ; months a#ter treatment had (een terminated%
5ello6 Card Scheme Make a reort in one or more o# the #ollo'ing scenarios) :% Reort all (lack triangle drugs 6intensel$ monitored7% 9% "or esta(lished drugs and her(al remedies reort all !ER-3U! ad.erse A1Rs in adults% % Reort all serious and minor ad.erse e##ects reorted in children 6under :7%
En>yme %nducers A good 'a$ to remem(er enz$me inducers is) O, and$s )lack Car Goes Putt Putt and Smo*es O) , i#amin )ar(iturates Car(amazeine Grisoe#ul.in Phen$toin Pheno(ar(itone Smo*ing cigarettes%
These drugs cause the induction o# enz$mes/ mainl$ in the li.er/ causing an increase in seci#ic drug meta(olism%
En>yme %nhibitors The main enz$me inhi(itors 'hich $ou 'ill come across are) -soniazid Cimetidine Grae#ruit 1ilsul#iram 8uinolones 6Er$throm$cin and Ciro#loxacin7 "luconazole !odium @alroate These drugs/ again/ usuall$ 'ork in the li.er to inhi(it enz$mes% Although clinicall$ $ou 'ill o#ten see these interactions as non intentional some secialist clinicians use these interactions to increase the otenc$ o# some drugs% This means that as soon as $ou see an interaction it does not necessaril$ mean that it is an error/ 'hereas enz$me inducers o#ten are% 3ne otential lethal interaction 'ith enz$me inducers is 'hen the$ are gi.en 'ith narro' theraeutic drugs such as 'ar#arin/ theoh$lline and hen$toin% An$ de.iation #rom (lood le.els can ha.e dire conse0uences%
Chater ?- The +EP The MEP is ro(a(l$ the most (oring (ook $ou 'ill come across in $our career as a harmacist% The #act that its 'ritten in columns makes it di##icult to look u in#ormation and it is also hard to TAB ages as $ou ma$ 'ant to TAB t'o toics on the same age% But guess 'hat/ luck$ $ou/ $ou ha.e to kno' it 0uite 'ell #or the exam% The more #amiliar $ou get 'ith it the easier $ou 'ill #ind the MEP 0uestions% -t is highl$ recommend to read the 'hole MEP (ack to #ront/ highlighting ke$ oints/ (ring it to li#e/ make it colour#ul/ e.en dra' ictures to illustrate ke$ issues and most imortantl$ make sure $ou U*1ER!TA*1 it% The MEP is di.ided into #our sections :% General legal re#uirements 9% Code of ethics J Professional Standards' guidance documents % %mproving pharmacy practice ?% ,eferences
Section .- General legal re#uirements 1+ practical guide to the legal restrictions on the sale or supply of medicinal products and poisons2
+edicines for human use There are three classes o# medicinal roducts) :% GS1 F can (e sold or sulied 'ithout the suer.ision o# a harmacist% 9% PO+ F medicinal roducts that can onl$ (e sold or sulied #rom harmacies and in accordance 'ith a rescrition% % P classed medications F medicinal roducts that are not a P3M or G!& medicine% These roducts can onl$ (e sold #rom a harmac$ 'here a harmacist is resent 6like a harmacists #ormular$7% !ulies o# P3Ms and P medicines #rom registered retail chemists must (e under the suer.ision o# a harmacist !uer.ision F harmacist must (e in a osition to inter.ene i# need (e% Where a resonsi(le harmacist has (een aointed/ G!& medicines can continue to (e sold o.er the counter in the a(sence o# the resonsi(le harmacist%
The ,esponsible Pharmacist The Resonsi(le Pharmacist 6RP7 legislation came into e##ect on : st 3cto(er 955>% -t relaced older legislation relating to ersonal control 'hich 'as seen to (e imractical% Le$ oints in the ne' legislation) One ,esponsible Pharmacist per pharmacy2 -# there are t'o harmacists 'orking on the remises/ one harmacist must nominate to (e the RP% This erson is then resonsi(le ($ la' #or all acti.ities carried out ($ the harmac$% Additionall$/ a RP cannot (e resonsi(le #or more than one harmac$ at an$ one time%
,esponsible Pharmacist notice F the u(lic must (e a(le to see a sign designating 'ho is the RP% This notice must include the name and GPhC registration num(er o# the harmacist% Pharmacy ,ecord F this is either a hardco$ or electronic register% &egall$ it must seci#$) +1ate +"ull name +Registration num(er +RP login log out time +!um o# total a(sence +Good practice F reason #or a(sence / hours F this is the amount o# time the resonsi(le harmacist can (e a(sent #rom the remises% -n the e.ent that there are t'o 6or7 more harmacists on the remises in one oening da$/ this is seen as one resonsi(le harmacist throughout the da$% "or instance 9 harmacists 'ork one harmac$ 'orking da$% The #irst harmacist is a(sent #or >5 minutes/ this means the second harmacist can onl$ (e a(sent #rom the harmac$ #or 5 minutes or the$ 'ould contra.ene the RP legislation% "bsence F during the a(sence 6o# no more than Q 9 hours7 nothing can (e sold aart #rom G!& roducts/ also the harmacist must ensure securing the sa#e and e##ecti.e running o# the harmac
%$PO+S D Prescription Only +edicines "dministration of PO+s % This section lists the P3M! 'hich can (e administered in certain situations such as emergencies/ ($ oerators/ in hositals and administration o# smallox .accine% =ou 'ill need to re#er to this section i# $ou get an oen (ook exam 0uestion 'hich asks $ou to look u 'hat drugs can (e administered and 'hen%
"or emergenc$ sulies o# P3Ms #rom a rescri(er) 6note) check the nature o# rescri(ers allo'ed to make a re0uest + dentists are no' a(le to make re0uests7
Pharmacist must ha.e the rescrition 'ithin <9 hours% *o Controlled 1rugs% Entr$ in the ri.ate rescrition register%
-n the case o# Emergenc$ !ulies o# P3Ms made at the re0uest o# a atient) -nter.ie' the atient% Gi.e a maximum o# 4 da$s i# C1 i%e% heno(ar(itone or a schedule ? or 4 controlled drug% Gi.e a maximum o# 5 da$s treatment unless) F insulin F ointment/ cream or aerosol #or RE&-E" o# asthma made u #or sale in the container else'here than in the harmac$ F oral contraceti.es F li0uid anti(iotic Entr$ in ri.ate rescrition register and la(elling%
1abelling of medicinal products This section exlains the la(elling re0uirements #or the #ollo'ing)
1isensed medicinal roducts Assem(led 6re+acked7 medicines Chemists nostrums Rele.ant medicinal roducts G!& medications P medications P3M medications
Make sure $ou highlight all the ke$ la(elling re0uirements in the MEP% "luted (ottles ha.e an outer sur#ace 'hich is #luted .erticall$ and the ri(s groo.es are recognisa(le ($ touch/ the$ are used #or li0uid medications/ to (e alied externally2 A 0uestion a(out the su(stances to (e contained in #luted (ottles ma$ o u in $our exams% But (e a'are that there are also some excetions to the #luted (ottle re0uirements e%g% the$ do not al$ 'here e$eear dros are in a lastic container etc% Chloroform This section o# the MEP gi.es a list o# circumstances 'hen chloro#orm medicinal roducts can (e sold or sulied #or human use% "or examle/ i# the medicinal roduct contains X5%4 '' or .. chloro#orm%
Although in $our #uture career $ou 'ill ro(a(l$ ne.er ha.e to touch chloro#orm/ the GPhC examiners lo.e to ask 0uestions on it% This is (ecause a long time ago a re+reg created a chloro#orm mixture under the directions o# a harmacist% The mixture 'as su(se0uentl$ incorrect and the harmacist got all the (lame% A t$ical GPhC 0uestion a(out chloro#orm) " local GP comes to your pharmacy and 6rites an &P.@ for you to dispense2 The prescription as*s for 4@@ ml of Gentian +ixture' "l*aline )P2 5ou try to find this on your computer and you find that you 6ill need to extemporaneously create the mixture yourself2 The formula re#uires you to include 4ml double strength chloroform 6ater per .@ml dose2 5ou chec* your stoc* and find that you do not have double strength but you do have regular chloroform 6ater instead2 Chloroform 6ater contains @2/4K chloroform Concentrated chloroform contains .@K chloroform
The Rx re0uires $ou to create a 455 ml solution 'hich is 45 dou(le strength chloro#orm% =ou onl$ ha.e normal strength chloro#orm% Dere $ou can make the assumtion that the dou(le strength is t'ice the strength o# the original% !o $ou 'ill need dou(le the amount o# regular in comarison to the dou(le strength% "ollo'ing this train o# thought $ou 'ill need 945 ml o# the dou(le strength to #ollo' the original recie as it is 455 ml o# a 45 solution% There#ore/ $ou need dou(le this amount o# the regular strength 'hich is 945 ml x 9 S 455 ml% This is 0uiet an eas$ 0uestion (ut a little trick$ as there is additional in#ormation included in the 0uestion to misguide $ou% 3ther .ariations o# this 0uestion ha.e (een seen 'here the chloro#orm on $ou shel# is not the regular (ut concentrated% Tr$ the 0uestion again (ut change the 0uestion so that $ou onl$ ha.e the concentrated chloro#orm%
Controlled rugs Schedule / ?C PO+
Examples
3iates/ major stimulants amhetamines 0uinal(ar(itone
,x re#uirements
=es
"dditional Private =es ,x re#Ls :alidity 9 da$s Prescriber address =es must be in <7 *o ,epeats allo6ed *o Emergency Supplies allo6ed ,etain invoices for *o / years Safe custody =es excet ?C cabinet 0uinal(ar(itone
Schedule 0 ?C no reg PO+
*o
Schedule 3 Schedule 4 Part %% ?C %N: ?C "nab P8PO+ PO+ Ana(olic H Codeine/ androgenic holcodine steroids lo' strength morhine medicines *o *o
*o
*o
*o
9 da$s =es
9 da$s *o
9 da$s *o
; months *o
*o *o heno(ar(itone #or eiles$ =es
=es =es
=es =es
=es =es
*o
*o
=es
*o
*o
*o
=es
Minor stimulants Burenorhine midazolam heno(ar(itone temazeam =es/ excet temazeam =es
Schedule 3' Part % ?C )en> PO+ Benzos
1icense to import and export
=es
=es/ (ut exemted) Temazeam/ dieth$lroion/ (urenorhine/ #lunitrazeam =es
,ecords in C register +ust ascertain % of person collecting C +ust record person collecting in register2 %& HCP' record name and address ,ecord 6hether proof of % re#uested ,ecord 6hether proof of % provided
=es
*o
*o
=es/ unless *o its in the #orm o# med #or sel# admin% *o *o
=es
*o
*o
*o
*o
=es
*o
*o
*o
*o
=es
*o
*o
*o
*o
=es
*o
*o
*o
*o
=es
*o
*o
*o
*o
C1s are classi#ied into 4 schedules deending on the di##erent le.els o# control) !chedule : F C1 &ic !chedule 9 F C1 P3M !chedule F C1 *o Register !chedule ? F Part -) C1 Benz and Part --) C1 Ana( !chedule 4 F C1 -n. There are al'a$s 0uestions on Controlled 1rugs in the re+reg exam and the$ can c ome u in (oth the closed and oen (ook exam% Prescription ,e#uirements Schedule /J0
:% @alid #or 9 da$s #rom date o# issue 6do not con#use this 'ith rescri(ing #or u to 5 da$s 'hich is good ractice7 9% -ndeli(le % Prescri(ers address ?% *ame H address o# atient 4% "orm H strength ;% Total 0uantit$ or dose units in (oth 'ords H #igures <% The dose % The 'ords #or dental treatment onl$ i# issued ($ a dentist >% !ignature o# rescri(er :5% 1ate -ssued "or ri.ate controlled drug rescritions a standardised #orm "P:5PC1 in England 6ink7 must (e used% • -t must state the identification number o# the ri.ate rescri(er% The original #orm should (e sent to the *D! Business !er.ices Authorit$ 6*D!B!A7 at the • end o# the month% • *B) *o other medicines can (e rescri(ed on this #orm • *B) These re0uirements do not al$ to .eterinar$ C1 Rxs% Exemtions) !ome C1s #all outside the re0uirements) :% Tema>epam ) The onl$ schedule C1 'hich does not ha.e C1 rescrition re0uirements/ just has to coml$ 'ith usual rescrition re0uirements% 9% Phenobarbitone) An emergenc$ sul$ is ermitted #or eiles$% % (unialbarbitone) !chedule 9 C1 'hich does not ha.e to (e ket in the C1 ca(inet% Make sure $ou ta( the C1 ta(les/ the$ outline the ke$ re0uirements #or C1s% C registers =ou 'ill need to kno' 'hat should (e to recorded 'hen C1s are sulied and recei.ed% Safe custody This section outlines 'hich C1s should (e locked a'a$ in the C1 ca(inet and 'hich are exemt #rom this re0uirement% "mending +inor MtechnicalL errors Pharmacist is a(le to amend minor technical errors on schedule 9H C1 rescritions% Examles o# common errors include) !elling mistakes%
Prearation is 'ritten in 'ords/ $ou can 'rite in #igures% -# 'ritten in #igures $ou can 'rite in 'ords%
Section .20 D 1ist of medicines for humans • • • •
&ists medicines in alha(etical order% -ncludes medicine status i%e% 'hether P3M/ G!& or P% *ote) ta( the asirin and aracetamol ta(les% *ote) C1 status changes according to rearation andor strength e%g% codeine/ morhine/ dih$drocodeine%
PoisonsA Poison is a 1substance included in the poisons list made under the poisons act 34562
The oisons list di.ided into 9 arts) Part - includes su(stances that can onl$ (e sold #rom a registered harmac$ under the suer.ision o# a harmacist% Part -- oisons can also (e sold ($ listed sellers 6as 'ell as #rom harmacies7% Read through the section on oisons and understand the rules #or sale and sul$/ la(elling/ storage/ signed orders and keeing records% Ta( the ta(le alha(etical list o# non+medicinal oisons% "rom this ta(le $ou can 'ork out to 'hich art and 'hich schedule a oison (elongs and there#ore 'hich rules al$% "or examle) Antimon$ Barium Tartrate P:N!: means it is in Part : !chedule : @alidit$ o# 1ental Prescritions% •
An "P:5 617 rescrition is onl$ .alid i# the item rescri(ed is on the 1ental Practitioners "ormular
%$•
But a ri.ate rescrition can order an$ P3M or G!& medicine%
1entists are ho'e.er re0uired to restrict their rescri(ing to areas in 'hich the$ are cometent "re faxed prescriptions legally valid •
This is not a legall$ .alid rescrition (ecause it is not 'ritten in indeli(le ink%
•
-# a harmacist decides to disense a #ax against a P3M the$ must ensure that the rescrition 'ill (e in his ossession 'ithin a short time%
•
"axes #or !chedule 9H C1s should not (e disensed%
&orged prescriptions Be a'are o# #orged rescritions% The #ollo'ing should alert $ou to make #urther checks%
:% Unkno'n rescri(er 9% *e' Patient % Excessi.e 0uantities ?% Uncharacteristic rescri(ing or method o# 'riting rescrition ($ a kno'n doctor 4% 1r (e#ore or a#ter rescri(ers signature
=ou should al$ these recautions to all rescrition drugs lia(le to misuse% 1isensing o# #orged rescrition can constitute a criminal o##ence% =ritten directions to supply ?in hospitals
This allo's a hosital to sell or sul$ a P3M against a seci#ic J'ritten directionK eg against a atients (ed card or notes% =hat is a Patient group direction
A PG1 is a 'ritten direction relating to sul$ andor administer o# a P3M to ersons generall$ and is signed ($ a doctor or a dentist/ and ($ a harmacist% =hat are the 0 main types of PG
:7 Allo's authorised healthcare ro#essionals to sul$ medicines on (ehal# o# an *D! (od$ 97 To assist a doctor or dentist ro.iding rimar$ care *D! ser.ices% 7 Where an *D! (od$ authorises a PG1 #or the sul$ andor administration o# a P3M ($ a named erson la'#ull$ conducting a retail harmac$ (usiness% Community practitioner nurse prescribers and nurse independent prescribers Communit$ ractitioner nurse rescri(ers) Are a(le to rescri(e medicines included in the nurse rescri(ers #ormular$ #or communit$ ractitioners%
*urse indeendent rescri(ers) can rescri(e an$ licensed medicine #or an$ medical condition that the nurse rescri(er is cometent to treat% Prescription ,ecords
What should (e recorded in the case o# a sale or sul$ o# a P3M2 a7 1ate o# sul$ (7 *ame/ 0uantit$/ harmaceutical #orm and strength c7 1ate on rescrition d7 *ame and address o# ractitioner e7 *ame and address o# atient =hat are the exemptions for *eeping records
:7A rescrition #or oral contraceti.es 97Where a searate record is made in the C1 register 7The sale is ($ 'a$ o# 'holesale dealing and the orderin.oice is retained #or 9 $ears .2/24 Sales of medicines to exempted organisations' healthcare professionals or other persons2 •
This art o# the MEP lists the eole and organisations that are exemt #rom the controls that al
%$•
3utlines the conditions 6i# an$7 there are on that erson or organisation 'hen the$ sell sul$ or administer those medicines to an indi.idual%
•
-t ma$ (e use#ul to highlight $our MEP 'ith ictures #or each o# those #or examle #or 3tometrists dra' a air o# glasses/ 'hen asked a 0uestion in the exam a(out otometrists
$ou 'ill #ind 'hat $ou are looking #or much #aster i# $ou use are s$m(ols to illustrate% .2/2F 1abelling of medicinal products
&a(elling o# disensed rele.ant medicinal roducts eg% :55 Paracetamol 455mg ta(lets Take 3*E to TW3 ta(lets u to "3UR times a da$ 13 *3T EICEE1 TDE !TATE1 13!E LEEP 3UT 3" TDE REACD 3" CD-&1RE* Mr 1iesh Patel 945:955> ,allas Pharmac$/ :9 3ld 3ak &ane/ W 5BU &egal re0uirements) Name of patient and Name J address of pharmacy ate on 6hich dispensed irections for use Name of product (uantity (uestion example- -t is mandator$ to lace the hrase JLee out o# the reach and sight of children K on a disensing la(el 6T"72
The answer is +&!* as the -#hC strongly advises to use this wording, but it is not compulsory7 This is a good practice re8uirement and not mandatory .2F Chemicals • Chemicals in the UL are classi#ied and la(elled under the Chemicals 6Dazard -n#ormation H
Packaging #or sul$7 regulations 9559 CD-P% •
The$ imlement the dangerous su(stance and dangerous rearations directi.es 'hich are due to (e relaced o.er a transitional eriod ($ the C&P regulation/ 'hich adots the GD! s$stem in the EU%
•
The CD-P regulations 'ere amended ($ the CD-P regulations 6CD-P?7 955>%
•
CD-P ? ensures the UL la' is consistent 'ith the ne' EU regulations during the transitional eriod%
=hat is the GHS
Glo(all$ Darmonised !$stem o# Classi#ication and &a(elling o# Chemicals 6GD!7 •
The U* created the GD!%
•
The aim is to ha.e the same criteria #or classi#$ing chemicals 'orld'ide%
%s the GHS legally binding
The GD! is not legall$ (inding and each countr$ has to introduce its o'n legislation to adot it% =hat is C1P
Classi#ication/ &a(elling and Packaging o# !u(stances and mixtures 6C&P7 regulation% The EU has
introduced the C&P regulation to adot the GD! s$stem in the EU% There#ore o.ertime this 'ill relace) •
The dangerous su(stances directi.e
•
The dangerous rearations directi.e
•
CD-P
Back to CD-P) =hat are the main obIectives of CH%P •
-denti#ication o# harm#ul roerties o# chemicals 'ith aroriate la(els%
•
To co.er hazards to health/ sa#et$ and the en.ironment and use o# chemicals (oth in the home and at 'ork%
.2F2. Supply re#uirements2 This section outlines the re0uirements o#) •
Classification
•
1abelling) CD-P outlines re0uirements #or the in#ormation 'hich has to (e on la(els o#
dangerous su(stances and rearations 'hen sulied to a erson% • •
!a#et$ 1ata sheet re0uirements are no longer a art o# CD-P% *ote the di##erence in the re0uirements #or dangerous su(stance and rearations%
•
!u(stance S usuall$ a single chemical%
•
Prearation S a mixture o# su(stances%
•
angerous preparations to be supplied to the general public2
•
Pac*aging
•
"dvertising- note The C&P regulation no' alies% This re0uires all ad.ertisements #or a
su(stance classi#ied as hazardous to mention the hazard classes and categories concerned% =hat is ,E"CH
Reach is the Euroean regulation on the Registration/ E.aluation/ Authorisation and restriction o# Chemicals% -t co.ers the registration/ re+registration/ e.aluation/ authorisation/ restrictions/ classi#ication and la(elling and in#ormation ro.ision o# chemicals% =hat is denatured alcohol
1enatured alcohol is alcohol that has (een made unsuita(le #or drinking ($ the addition o# denaturants%
.22. Type of denatured alcohol2 =hat are the three types of denatured alcohol approved in the <7 Type
C" %" TS"
Deating/ lighting/ cleaning -ndustrial/ scienti#ic Trade needs
Pharmacists must be authori>ed by H+ ,evenue and customs to receive *o =es =es
.22/ "pplication for authority to receive %" or TS"
An alication has to (e made to DM Re.enue and customs%
-# aro.ed the commissioners ma$ authorise a erson in 'riting to recei.e -1A or T!1A stating)
-
'hat the$ are entitled to recei.e conditions that must (e o(ser.ed
-
'hat it can (e used #or
-
Conditions o# use%
+edicines for :eterinary
Authorised .eterinar$ medicine F general sale list 6A@M+G!&7 *on+#ood roducing animal .eterinarian/ harmacist suita(l$ 0uali#ied erson 6*"A+@P!7 Prescrition+onl$ medicines .eterinarian/ harmacist/ suita(l$ 0uali#ied erson 6P3M+@P!7 Prescrition onl$ medicines .eterinarian 6P3M+@7
.2A2. :eterinary Prescriptions- P3M+@ or P3M+@P! rescritions ma$ (e) • •
3ral) ie i# the harmacist rescri(ing it also sulies it Written) 'here a @MP is not sulied ($ the erson 'ho has rescri(ed it
@eterinar$ Rx re0uirements) a7 *ame address and telehone num(er (7 8uali#ications o# rescri(er c7 *ame and address o# o'nerkeeer d7 -1 and secies o# the animals e7 Premises at 'hich animals are ket i# di##erent #rom o'ners #7 1ate g7 Prescri(er signature or i# not C1 other authentication h7 *ame and amount o# roduct i7 1osage and administration instructions Jas directedK not acceta(le
j7 Warnings k7 Withdra'al eriod i# rele.ant l7 !tatement -# rescri(ed under cascade •
Rx is .alid #or ; months excet schedule :+? C1 69 da$s7
•
Reeata(le Rx must seci#$ num(er o# times to (e sulied not acceted #or !9H C1s
:eterinary Controlled rug Prescriptions
@MPs 'hich are schedule 9 or C1s 6excet temazeam7 must also include the #ollo'ing) a7 Address o# rescri(er 'hich must (e in UL (7 "orm o# rearation c7 !trength 6'hen more than one strength is a.aila(le7 d7 Total 0uantit$ in 'ords and #igures e7 1eclaration to state #or use in animalherd under the .eterinar$ surgeonractitoners care #7 *ame and address o# erson to 'hom C1 'ill (e deli.ered g7 -# to (e disensed in instalments must seci#$ amount and inter.al o# instalment 9e8uirement to use standardised prescription forms do not apply to veterinary prescriptions .2A2/ Prescribing Cascade2 =hat is the prescribing cascade
All .eterinar$ medicines must (e authorized% Use o# an unauthorized medicine or use in an unauthorized 'a$ is an o##ence% This rotects animals/ users/ consumers and the en.ironment #rom the otentiall$ serious e##ects o# untested or oor 0ualit$ medicines% Do'e.er/ there are circumstances 'here the (ene#its o# treatment 'ith unauthorized medicines out'eigh the risks and .eterinar$ surgeons ha.e (een gi.en an exemtion #rom this rule kno'n as the rescri(ing cascade% This means that i# there is no medicine authorized in the UL #or a seci#ic condition/ the .eterinar$ surgeon resonsi(le #or treating the animal6s7 ma$/ in articular in order to a.oid unacceta(le su##ering/ treat the animal6s7 in accordance 'ith the #ollo'ing se0uence) :% A .eterinar$ medicine authorized in the UL #or use in another animal secies or #or a di##erent condition in the same secies 6o##+la(el use7% 9% -# there is no such medicine/ use either) 6a7 A medicine authorized in the UL #or human use 6(7 A .eterinar$ medicine authorised in another Mem(er !tate #or use 'ith an$ animal secies % % -# there is no such medicine/ a medicine reared extemoraneousl$ ($ a .eterinar$ surgeon/ harmacist or a erson holding an aroriate manu#acturers authorization% • Permitted onl$ i# it is in accordance 'ith a rescrition issued ($ a .eterinar$ surgeon under 'hose care the animal has (een laced% • A Prescrition must state 6#or administration under the cascade7%
.2A20 ,ecords- Records o# receit and sul$ o# P3M @ @P! must (e ket #or at least 4 $ears% "<%T !hould (e carried out at least once a $ear ($ e.er$ erson entitled to sul$ a @MP on rescrition% Class "udit P3M @ =es at least once a $ear P3M @P! =es at least once a $ear *"A @P! Fgood ractice Good ractice A@M+G!& Fnot necessar$ *ot re0uired
Proo# o# Purchase) Leeer o# a #ood roducing animal/ must retain roo# o# urchase or ho' the$ 'ere ac0uired o# all @MPs%
Section /2.- Ethics 8 Professional Guidance The se.en rinciles and ho' to al$ them in ractice) .2 +a*e the care of patients your first concern2 /2 Exercise your professional Iudgement in the interests of patients and the public2 02 Sho6 respect for others2 32 Encourage patients to participate in decisions about their care2 42 evelop your professional *no6ledge and competence2 F2 )e honest and trust6orthy2 2 Ta*e responsibility for your 6or*ing practices2
/2/- Professional Standards J Guidance ocuments =ou must coml$ 'ith legal re0uirements/ mandator$ ro#essional standards and acceted (est ractice guidance% The oen (ook exam 'ill contain a lot o# 0uestions make sure $ou understand the di##erence (et'een 'hat is a legal re0uirement and 'hat is good ractice% Mandator$ ro#essional standards) MU!T Guidance on good ractice) !D3U&1
0- %mproving Pharmacy Practice2 Practice guidance documents) these are a.aila(le .ia the GPhC 'e(site and the$ are 'orth reading as the$ contain a lot o# toics 'hich can come u in (oth oen and closed (ook aers%
,eferences -n the re#erences section $ou 'ill #ind in#ormation a(out ser.ices and a list o# use#ul telehone num(ers as 'ell as in#ormation on the use o# ex+director$ telehone num(ers%
Chater 4- The rug Tariff The 1rug Tari## one o# the (ooks allo'ed as re#erence during the oen (ook exam% -t is 'ritten in .er$ small hand'riting and di.ided into .arious sections using roman numerals% But (e#ore $ou get ut o##%%% it is actuall$ not as (ad as it seems% The drug tari## is roduced monthl$ ($ the harmaceutical directorate o# the *D! Business !er.ices Agenc$/ 6*D!B!A7% -t outlines 'hat rice 'ill (e aid to contractors #or *D! ser.ices ro.ided% 3nce $ou #amiliarise $oursel# 'ith the di##erent sections and kno' ho' to use each section/ it can actuall$ (e 0uite #un to use as $ou can #igure ho' much ocket mone$ a harmacist makes% The (est 'a$ 'e #ound to get used to it to go to their s'ank$ ne' 'e(site at '''%drugtari##%co%uk% The 'e(site has lots o# summaries in a much (etter #ormat #or learning% Another use#ul site #or learning is the P!*C% The P!*C do a lot o# negotiating on (ehal# o# harmac$ to esta(lish the rices set ($ the Tari##% Their 'e(site contains use#ul introductor$ documents to the Tari## lus simleton exlanations o# all the rele.ant terms such as *C!3/ !&! etc% Pharmacists use the drug tari## to check) :% The drug and aliance rices% 9% The #ees and allo'ances the$ 'ill (e aid% % Blacklisted medicines% ?% *D! a$ments #or harmac$ contracts% There is no need to #ull$ read the drug tari##% As long as $ou kno' ho' to use it and look u in#ormation #rom the rele.ant sections $ou 'ill (e #ine #or the exam% When re#erencing/ the most imortant 'ords to kno' are Reim(ursement and Remuneration% ➔
,eimbursement is the cost o# drugs and aliances 'hich ha.e (een sulied against an *D! rescrition% ➔ ,emuneration are the #ees aid as art o# disensing contracts 'ith rimar$ care trusts such as ro#essional #ees and allo'ances%
%mportant sections The main section of the Tariff include• Basic Price 6Part --/ Clause 7 1eduction !cale 6Part @7 • • Container Allo'ance 6Part -@7 • Pro#essional "ees 6Part ---A7 Additional "ees 6Part ---A7 • 3ut o# ocket exenses 6Part --/ Clause :97 • • 1rugs #or 'hich discount is not deducted 6Part --7 • Pa$ments #or Ad.anced !er.ices 6Part @-C7
The main sections you need to *no6 ?sections you should tagNG + 1iscount not gi.en &ees + additional and ro#essional/ &!/ M1 + additional #ees harmacist can charge #or% )asic prices + 'hat the *D! a$s #or the medicine "C)S + Borderline su(stance usuall$ a #ood ie 'heat #ree Notes on Charges + ho' man$ charges #or a stocking2 ental and Nurse formulary Out of hours formulary + minimum drugs atient should (e a(le to access 9?< decided locall$ )lac* list + can - gi.e it2 S1S + !elected list su(stance .er$ much like ACB!
Summary of rug Tariff The Preface- 1etails changes to that months tari##/ this includes ne' roducts and deletions% Part %
This section outlines the re0uirements #or the sul$ o# drugs/ aliances and chemical reagents% Part %%
This section contains a lot o# clauses regarding the sul$ o# drugs/ aliances and chemical reagents% -t also contains the >ero discount list 'hich $ou should ta( 6 drugs for 6hich discount is not deducted7% This is the list o# drugs 'hich Pharmacists do not recei.e discounts on #rom the 'holesaler% 1ont #orget to take account o# the grou items listed in the (eginning o# this list) • Cold chain storage • Controlled drugs schedule :/9/ C$totoxic or c$ostatic items • • -mmunoglo(ulins • -nsulins #or injection @accines and Antisera • !o i# an exam 0uestion re0uires $ou to check 'hether &eme.ir en#ill is a 1 item/ $ou 'ouldnt e.en ha.e to re#er to the list as all insulins #or injection are 1%
When $ou (u$ a drug #or a rescrition/ the Wholesaler 6like AAD or Alliance7 gi.es $ou a discount on the rice $ou a$% =ou then gi.e out the roduct and then claim #rom the PPA the amount the drug cost 6'ithout the discount7% !o harmacists make mone$ this 'a$ ($ (u$ing at a :5 discount and getting reim(ursed #rom the PPA% The go.ernment kno' this and thinks the$ 'ant a iece o# that ie so the$ take a cut o# this ro#it $ou make% This Cla'Back is deendent on ho' man$ Rxs $ou do in a month% :% =ou get an Rx #or 9 aracetamol% 9% =ou (u$ it #rom AAD #or >5 6at :5 discount7 and gi.e it to the atient% % =ou send o## the Rx to PPA and ask #or Y:%55% ?% The PPA sends $ou >5 as $ou do 4/555 Rx a month% Do'e.er/ some items are not gi.en a discount ($ 'holesalers% -# $ou 'rite 1*G next to this item and it is on the P!*C list $ou 'ill get (ack Y:%55 #rom the PPA% The list o# 1rugs #or 'hich discount is not deducted is a d$namic list 'ith additions and deletions each month% Products can (e added to the list i# re0uested ($ P!*C and 'here one or more o# the #ollo'ing criteria al$) • • • •
!chedule 9 or Controlled 1rug DazChem 6roduct co.ered ($ the Chemical 6Dazard -n#ormation and Packaging #or !ul$7 Regulations 9559 and aroriate #or Pharmaceutical !er.ices7 C$totoxic or c$tostatic item + a list o# c$totoxic roducts can (e #ound in !ection %: o# the B*"% Cold+chain storage item 6the roduct must (e stored at 9 + C rior to disensing7
Products 6here all three of the follo6ing apply-
Contractors onl$ ha.e to endorse 6to indicate that no discount has (een recei.ed7 rescritions #or unlicensed medicines 6including secials and imorted drugs7 o(tained 'ithout discount% Prescritions #or these roducts should (e endorsed 1*G 6the 1 endorsement 'ill no longer (e acceted7% NCSO + -# a drug is included in Part @--- the rice sho'n 'ill (e used #or reim(ursement regardless o# 'hat a harmacist has disensed to meet the order%
The onl$ excetion to this rule is 'hen a shortage o# a Part @--- generic has (een identi#ied ($ the 1eartment o# Dealth and a Zno cheaer stock o(taina(le 6*C!37 status has (een granted% -n this situation i# a harmacist has to a$ a higher rice #or the item 'hich exceed the tari##/ to recei.e a a$ment (ased on 'hat he has sulied the$ can endorse J*C!3K% Do'e.er/ the endorsement must include the #ollo'ing) The sulier • The signature o# the harmacist 'ho disensed the medicine • • 1ate 1isensed • The rice aid 6usuall$ e0uates to the (randed e0ui.alent .ersion7 *C!3 lists can (e #ound online at the P!*Cs 'e(site or the P,%
Other Tariff Sections Part %%%" Professional fees These #ees al$ to harmac$ contractors Part %%%) Scale of fees These #ees al$ too aliance contractors% Part %: Containers This section gi.es guidelines #or the t$es o# container that must (e used 'hen disensing% Part : eduction Scale =ou 'ill need to kno' ho' to use this scale% A#ter the total cost o# medicines has (een determined a ercentage is deducted% The reasons #or this deduction are that harmacists recei.e discounts #rom the 'holesaler% The deduction scale does not al$ to 1 drugs 'here discount has not (een deducted%
The size o# the deduction deends on the total monthl$ .alue o# the contractors reim(ursement The deduction is made (e#ore the addition o# a container allo'ance and an$ ro#essional #ees Part :%" to :%- Read through these sections 'hich exlain the a$ments #or the essential/ ad.anced and enhanced ser.ices conducted ($ harmac$ contractors% P",T :%%% )asic Price of rugs This section lists the (asic rices o# drugs on 'hich a$ments 'ill (e calculated #or the disensing o# a listed drug% =ou 'ill need to understand the de#initions o# the di##erent categories A/ B/ C/ E and M and ho' to look u rices o# drugs in this list% Part % "ppliances This art exclusi.el$ lists medical de.ices/ aliances and chemical reagents 'hich can (e rescri(ed and disensed on *D! rescritions% This section is slit into #our su(sections) Part %"- Prescribable appliances This section contains aliances such as dressings and (andages and h$odermic e0uiment% All items included in this section 'ill also (e listed in the index so 'ill (e eas$ to look u% Part %) %ncontinence "ppliances At the (eginning o# this section $ou 'ill #ind a list o# headings% The roducts in each section are then listed according to manu#acturers name alha(eticall$% Part %C Stoma "ppliances This section is 'ritten according to manu#acturer as in section -IB% Part %, Chemical ,eagents The chemical reagents in this section are also listed ($ (rand name in the index at the (ack o# the drug tari##%
P",T : )orderline Substances The Ad.isor$ Committee on Borderline !u(stances ad.ises as to the circumstances in 'hich certain #oods and incontinence rearations can (e regarded as drugs in certain conditions% Prescritions #or roducts recommended ($ the committee should (e endorsed ACB! ($ the rescri(er%
&-!T A) -s an alha(etical list o# roducts 'ith a list o# 'hich conditions it 'ould (e aroriate to rescri(e the roduct% &-!T B) -s an alha(etical list o# conditions 'ith the roducts 'hich can (e rescri(ed% P",T :% Notes on Charges=ou should read through this section thoroughl$ and look at the examles gi.en% -t exlains all $ou need to kno' a(out charges% P",T :%%" ental Prescribing 3nl$ those items listed can (e rescri(ed ($ dentists on "orms "P:5617% -# the strength o# the item is stated then onl$ that strength is allo'ed% P",T :%%%" rugs and other substances not to be ordered under a general medical services contract2 This is commonl$ kno'n as the J )lac* 1istK% -t is a list o# drugs and other su(stances that cannot (e rescri(ed under the *ational Dealth !er.ice% Pharmacists sul$ing an$ roducts on an *D! scrit/ named under this list 'ill not (e reim(ursed% 1octors rescri(ing and harmacists disensing (lacklisted roducts are in (reach o# their terms o# ser.ice% Pharmacists ma$ sul$ (lacklisted roducts on a ri.ate rescrition% The atient then a$s the #ull cost o# the medication lus a disensing #ee% P",T :%%%) 1rugs that ma$ (e ordered onl$ in certain circumstances% Also kno'n as the !elected &ist !cheme 6!&!7% This is a list o# drugs 'hich can onl$ (e rescri(ed to the atient listed #or the treatment o# the urose seci#ied% The rescri(er must endorse the rescrition 'ith the re#erence Z!&!%
Chater ;- ,esponding to Symptoms The GPhC exam not onl$ asks clinical 0uestions (ased on kno'ledge #rom the B*"/ the s$lla(us also co.ers other areas 'hich a harmacist deals 'ith in e.er$da$ situations% This next section is dedicated to those 0uestions%
,espiratory The main conditions $ou 'ill encounter in a harmac$ situation are coughs/ colds and #lu and seasonal ha$#e.er% Coughs =hen to refer222 • 1uration + i# the atient has had the cough #or more that 9 'eeks the atient should (e re#erred to their doctor% • !utum is (ro'n (lood coloured%
Currentl$/ a UL *D! GP cannot rescri(e an$thing #or a chest$ cough/ excet anti(iotics during in#ection% This is (ecause there is little to no clinical e.idence #or chest$ cough remedies% Acute coughs are usuall$ the result o# a .iral in#ection 'hich are usuall$ sel# limiting% Remem(er that a recurrent night time cough in children ma$ indicate something more sinister such as asthma% The reason 'h$ most dr$ cough remedies are (ased around oioids 6think olcodiene/ dextromethorhan7 is that the$ are resirator$ deressants% Order &irst 1ine
Treatment 1r$ coughs ma$ (e treated 'ith a range o# anti+tussi.es% Pholcodeine is articularl$ e##ecti.e and comes as a sugar #ree .ersion 6Pa.acol+17%
Second 1ine
Antihistamines such as dihenh$dramine% The mechanism o# action is thought to (e .ia the anticholinergic dr$ing acti.it$ at mucous mem(ranes%
WWHAM : +sthma% !moing% iabetic% Sore throat =hen to refer222 • Medication comlications F certain drugs can cause agranuloc$tosis such as car(imazole these can sometimes (e resented in harmac$ as a sore throat accomanied ($ signs o# in#ection% 1$shagia% • • Associated skin rash% • 1uration o# more than 9 'eeks%
@iruses account #or <5+>5 o# all cases o# sore throat and there#ore should (e sel# limiting o# a duration o# less than t'o 'eeks% Order &irst 1ine
Treatment &ocal anaesthetics anti+in#lammatories F i# in#lammation is resent the (est otion is #lu(riro#en%
Second 1ine
Anaesthetic F such as (enzocaine or lidocaine%
WWHAM : Ulceration% *udate from tonsils% Tender glands%
Cold and flu =hen to refer refer222 222 Earache F ossi(le Eustachian tu(e (lockage F otitis media% • • Age F the .er$ $oung or .er$ old% • Persistent #e.ers or roducti.e coughs%
Patients o#ten resent themsel.es sa$ing that the$ ha.e #lu ho'e.er/ it is o#ten the case it is a cold% Most conditions are sel#+limiting (ut atients o#ten seek medicines to aid their reco.er$% "lu has the same s$mtoms as a cold (ut there is an increase in m$algia/ loss o# aetite/ chills and malaise% Order &irst 1ine
Treatment Paracetamol F to reduce aches and #e.er%
Second 1ine
1econgestants i# congestion is resent such as seudoehedrine%
Third 1ine
!team inhalation 'ith menthol and eucal$tus ma$ (e used in those 'ith other medical conditions%
WWHAM : ;lood pressure% Hayfever
Da$#e.er is allergic seasonal rhinitis due to ollen% Patients usuall$ resent themsel.es 'ith a seasonal unkno'n cause o# sneezing% -n this scenario/ other allergens should (e eliminated such as cats or dust mites and take heed o# 'hat time o# $ear it is 6ollen counts are usuall$ highest in the 'armer months7% -# the s$mtoms are all $ear round the most likel$ cause is erennial rhinitis% Order Prophylaxis
Treatment A.oid high ollen counts%
&irst 1ine
The most con.enient treatments are the once dail$/ non+dro's$/ non+dro's$/ antihistamines such as loratidine or cetirizine% Do'e.er/ some atients re#er chlorhenamine 6Piriton7 as it hels to sto night time sneezing (outs%
Second 1ine
*asal administration o# corticosteroids%
Third 1ine
3cular s$mtoms ma$ (e heled ($ the use o# a mast cell sta(iliser such as sodium cromogl$cate%
Pollen #orecasts are then reared ($ using the ollen count in#ormation/ kno'ledge o# local .egetation and 'eather atterns/ $ou ma$ ha.e seen them a#ter the local 'eather reort on t.% The ollen #orecasts can hel ha$ #e.er su##erers to lan their acti.ities and medication% medication% The index o# risk relates to the 0uantitati.e categories as #ollo's) %ndex
Conditions
to :5
@er$ Digh Risk
; to <
Digh Risk
? to 4
Medium Risk
: to
&o' Risk
WWHAM : !easonal% +llergen% Cats% Mites%+sthma%
Gastrointestinal isorders iarrhoea =hen to refer refer222 222 • 1rug induced diarrhoea mainl$ ($ *!A-1s/ digoxin/ PP-s and thiazide diuretics% •
Recent tra.el a(road%
•
Presence o# (lood or #at in the stool%
•
Age o# atient and duration o# diarrhoea are re#erral criteria) : $ear old Q 9? hours duration S re#erral% $ears old Q ? hours duration S re#erral% Q $ears old adults Q <9 hours duration S re#erral%
-n most cases the condition is sel# limiting and does not exceed 9+ da$s in 'hich case oral reh$dration sachets 63R!7 ma$(e gi.en at an$ stage% This is eseciall$ use#ul #or the elderl$ or children under one $ear old as the$ are more susceti(le to deh$dration%
Order Prophylaxis
Treatment When a(road a.oid non+(ottled 'ater%
&irst 1ine
3ral reh$dration sachets 63R!7 ma$(e gi.en at an$ stage%
Second 1ine
-# the atient is o.er :9 $ears old loeramide ma$ (e gi.en i# there is a direct need #or a seed$ reco.er
%$WWHAM : ood poisoning% 9ecent travel%
Constipation =hen to refer refer222 222 • 1rug induced constiation mainl$ ($) Anticholinergics/ Anticholinergics/ oiates/ iron and antih$ertensi.es% longer than :? da$s% • *o identi#ia(le cause and the duration lasts #or longer Blood mixed into the #aces re0uires re#erral 'hereas (lood coating the stool ma$ indicate • haemorrhoids%
Common identi#ia(le causes include oiate use/ iron sulementation/ immo(ilit$ and oor diet% The elderl$ usuall$ su##er the most due to reduced gut motilit$% Type )ul*!forming
Treatment -saghula husk 6"$(ogel7%
Stimulant
!enna or (isacod$l% !enna should not (e gi.en to regnant 'omen/ a (etter alternati.e is lactulose%
Osmotic
&actulose has a dela$ed onset o# action 6a(out ? hours7 it should not (e used #or acute constiation% &actulose is generall$ the (est treatment #or children a#ter li#est$le changes such increasing #i(re in the diet%
WWHAM : Medication% iet% *ercise% #ain%
%ndigestion and heartburn =hen to refer refer222 222 Children should (e re#erred as this is .er$ uncommon% • • !e.ere rolonged 6Q9 hours7 ain% • Recurrent/ ersistent ain 'hich is not cured ($ antacids% Associated 'eight loss% •
A ke$ oint here is the di##erential diagnosis (et'een heart (urn and chest ains 'hich ma$ indicate a heart condition% The main ro(lem is that the t'o t$es o# atients 'ho are a##ected ($ heart (urn and heart ro(lems are .er$ similar i%e% male/ o.er'eight and has has a oor diet% The easiest 'a$ to di##erentiate is to use the #ollo'ing criteria) Criteria
Heart conditions
Heartburn
&ocation
Retrosternal to their le#t side%
Retrosternal central a(o.e stomach%
Mo.ement o# o# a ain
Can ra radiate do do'n th the le le#t ar arm%
Constant/ ce central lo location%
T$e o# ain
!har/ acute%
1ull/ (urning/ ache%
Timing o# the ain
Exercise related%
"att$ #ood/ l$ing do'n related%
Order Prophylaxis
Treatment &o' #at diet/ reduce alcohol intake%
&irst 1ine
Antacid in com(ination 'ith an alginate% The alginate #orms a ra#t on to o# the stomachs contents rotecting the oesohagus #rom acid re#lux%
Second 1ine
!$stemic treatment to reduce acid in the stomach such as ranitidine 6antac7 or omerazole%
WWHAM : verweight% +lcohol intae% 9ecent diet% %rritable bo6el syndrome ?%)S =hen to refer refer222 222 Treatment in harmac$ usuall$ in.ol.es a re.iousl$ diagnosed atient/ other'ise a • re#erral is re0uired% Children :; $ears old% • • Blood in the stool% • Patients aged Q?5 $ears old 'ith associated change in (o'el ha(it%
-B! is a general term #or a collection o# gastrointestinal ro(lems exerienced ($ the same atient these include diarrhoea/ constiation/ ain/ (loating these can all (e treated trea ted indi.iduall$% indi.iduall$% "ilment Spasms
Treatment D$oscine (ut$l(romide 6Buscoan7 a otent amtimuscarinic antisasmodic or me(e.erine 6Colo#ac7 is another oular antisasmodic%
Constipation
&axati.e F stimulant/ (ulk or osmotic%
iarrhoea
&oeramide
&latulence
1imeticone
WWHAM : #re
Nausea and vomiting =hen to refer222 1uration Q9 da$s in adults and automatic re#erral in in#ants% • • Blood in the .omit% • Medicines F certain medicines such as digoxin can cause .omiting%
A .er$ common condition in communit$ harmac$/ eseciall$ 'ith regnant 'omen 6(est harmac$ otion is ginger7% The main causes are) • • •
&ood poisoning 8 %nfections F ma$ last :+9 da$s/ rota.irus/ !almonella/ *.Coli. Stomach irritants 8 Noxious stimulus F alcohol/ *!A-1s/ smells and sounds% GO, 8
Order &irst 1ine
Treatment As a standard/ anti+emetics are not gi.en #or .omiting unless the cause is kno'n/ this is (ecause the (od$ ma$ (e tr$ing to exel a toxin/ in 'hich case it is (etter to eject it #rom the stomach% WWHAM : #regnant% Medication% Haemorrhoids 8 Piles =hen to refer222 A(dominal ain and .omiting% • • Blood in the stool% • Associated #e.er% Change #rom regular (o'el ha(it 'hich has a duration Q 'eeks% • • !usected drug induced constiation%
Daemorrhoids are s'ollen/ internal external rotruding .eins located in the anal area 'hich cause ain and rectal (leeding% A num(er o# #actors ma$ lead to the #ormations o# haemorrhoids including irregular (o'el ha(its 6constiation or diarrhoea7/ exercise/ nutrition 6lo'+#i(re diet7/ increased intra+a(dominal ressure 6rolonged straining7/ regnanc$/ genetics/ a(sence o# .al.es 'ithin the haemorrhoidal .eins/ and ageing% 1uring regnanc$/ ressure #rom the #oetus on the a(domen and hormonal changes cause the haemorrhoidal .essels to enlarge% 1eli.er$ also leads to increased intra+a(dominal ressures% 3ther #actors that can increase the rectal .ein ressure resulting in haemorrhoids include o(esit$ and sitting #or long eriods o# time Order Prophylaxis
Treatment Constiation is the main causati.e agent o# haemorrhoids this ma$ (e sol.ed ($ li#est$le change or a suita(le laxati.e%
&irst 1ine
&ocal anaesthetics F (enzocaine/ lidocaine 6mainl$ +caine re#ix7 used to relie.e ain and uritis% Also a haemorrhoid cushion could (e r ecommended as this 'ill relie.e ressure in the area%
Second 1ine
Astringents F such as zinc oxide #orm a rotecti.e la$er around the haemorrhoid to aid in healing%
Third 1ine
Anti+in#lammator$ F h$drocortisone reduces in#lammation%
WWHAM : ;leeding% #ain when sitting = defecating%
S*in Conditions Ec>ema =hen to refer222 • E.idence o# in#ections such as 'eeing or crusts% • 1uration #or longer than 9 'eeks% !e.erit$ + cracked (leeding skin% •
Eczema is a chronic skin condition characterised ($ dr$/ red/ #lak$ skin% Order Treatment Prophylaxis Regular o# emollients re.ent acute #lair us% General emollients on rotation to #ind the (est resonse can hel treat the &irst 1ine condition% Second 1ine D$drocortisone and corticosteroids are e##ecti.e% The$ cannot (e used at earl$ stages or outside or their license) Corticosteroids 'hen sold #rom a harmac$ come under secial licensing restrictions/ these are detailed (elo') 1icense re#uirement
Specific
&ocation o# alication Corticosteroids cannot (e used on the #ace or anogenital regions% Age restriction
D$drocortisone Q:5 $ears old% Clo(etasone Eumo.ate Q:9 $ears old%
1uration
*ot (e used #or longer than one 'eek%
Alication
All corticosteroids should (e sread thinl$ on the skin%
WWHAM : #re
Pre.ention is (etter than cure/ it is recommended that eole 'ith #air skin al$ a high !P" as li(erall$ as ossi(le% Order Treatment Prophylaxis A.oid long exosure to direct sunlight% &irst 1ine
General emollients%
WWHAM : Melanoma% Change in mole si0e% Scabies =hen to refer222 • Children and (a(ies% • Bacterial comlications%
!ca(ies mite (urro' into the skin/ transmission is through close contact not .ia a .ector 6as the$ cannot li.e a'a$ #rom a host #or rolonged eriods7% Order Treatment Proh$laxis A.oid contact 'ith in#ected eole% "irst &ine
Malathion
!econd &ine
Permethrin
WWHAM : thers who may be affected% /ow old is the child% >nfection%
,ing6orm and "thletes foot =hen to refer222 • An$ nail or (acterial in.ol.ement or dia(etic atients or those 'ith neuroath
%$These conditions are (oth #ungal in#ections 'hich can (e indirectl$ transmitted% Ring'orm is characterised ($ a raised/ red atch o# the skin% Athletes #oot is characteristicall$ #ound (et'een the toes% Order Treatment Good skin care/ dr$ #eet thoroughl$% Prophylaxis &irst 1ine
+azoles F clotrimazole%
Second 1ine
Ter(ina#ine
WWHAM : thers who may be affected% Cold sores ?herpes labialis =hen to refer222 • Ba(ies and $oung children% • 1uration Q9 'eeks% Associated e$e in#ections or ainless sores% •
Cold sores usuall$ resent in the harmac$ as a atient 'ith a tingling sensation on their li or resenting the later de.eloment o# a sore% Cold sores usuall$ ha.e triggers 'hich cause the sore to arise these include sunlight/ 'ind/ #e.er and menstruation% Order Treatment &irst 1ine Aciclo.ir Second 1ine
Penciclo.ir
WWHAM : Triggers% =arts and verrucas ?papilloma virus ?HP: =hen to refer222 • Changed aearance o# lesions size or colour% • Multile/ #acial or genital 'arts% Bleeding or itching% • • 1ia(etics%
Warts are .er$ common in children% Order Treatment Good #oot care/ a.oid u(lic s'imming ools% Prophylaxis &irst 1ine
Acidic rearations such as salic$lic acid or #reezing rearations
WWHAM : Multiple warts% iabetic% %nsect bites and stings =hen to refer222 Associated (reathing ro(lems due to anah$laxis% • -n#ected (ites% • Order Treatment &irst 1ine Oral 3ral antihistamines F cetirizine or loratidine% D$drocortisone WWHAM : ;reathing problems% ;roen sin%
Eye Conditions )acterial and "llergic ConIunctivitis =hen to refer222 • Photoho(ia% • Pain inside the e$e% Associated headache or .omiting% • • Cloud$ uil or a##ected e$esight% • Glaucoma or raised intraocular ressure%
Patients o#ten resent as ha.ing one or (oth e$es red 6around the 'hite o# the e$e7 'ith stickiness in the morning% -t is imortant to di##erentiate (et'een (acterial and allergic conjuncti.itis 'hich is caused ($ an allergen and usuall$ a##ects (oth e$es simultaneousl$% The (est treatment #or (acterial conjuncti.itis is chloramhenicol/ ho'e.er/ restrictions al$) Chloramphenicol Product %nformation 1eaflet • • • •
This medicine can (e used ($ adults and children aged / years and over % 1o not use this medicine i# $ou ha.e ro(lems 'ith bone marro6/ blood or dyscrasias or i# $ou are pregnant or breast feeding % !tore this medicine in a refrigerator bet6een /QC and AQC % 1irections #or use are) #or the first 3A hours use every / hours and then use every 3 hours %
Order &irst 1ine
)acterial Chloramhenicol 6not #or children 9 $ears old7 e$e dros 6kee in the #ridge7 or ointment%
"llergic !odium cromogl$cate is a mast cell sta(iliser 'hich can (e gi.en to all atient grous%
Second 1ine
Proamidine isetionate e$e dros 6Brolene7%
Azelastine 6Aller+eze7 #or use in Q:9 $ears old%
WWHAM : -laucoma% Cross
This is common in the elderl$ or eole taking drugs 'hich ha.e anitmuscarinic side e##ects% Usuall$ the antimuscarinic treatment is more imortant than the dr$ e$es so atients are o#ten on ocular lu(ricants #or a long time% Order &irst 1ine
Treatment D$romellose F chea/ $et there is a need #or #re0uent alication%
Second 1ine
Car(omer gel 6@iscotears7 F can (e instilled into the e$es and is retained 'ell/ although ma$ temoraril$ (lur .ision%
WWHAM : &ong term% riving%
Central Nervous System Pain =hen to refer222 • 1eendant on seci#ic condition% • -n chronic/ ersistent ain should (e re#erred% Pain in the elderl$ and .er$ $oung children% • • !usected #ractures or trauma% • Pain at rest% • *o imro.ement 'ith in < da$s o# treatment% Deadaches in children :9 $ears old% • • *eck sti##ness%
Acute musculoskeletal injur$ should (e treated using) , est F stos #urther damage% %ce F reduces (lood #lo' thus reduces (ruising and s'elling% Comression F reduces s'elling% Ele.ation F reduces (lood #lo' thus s'elling%
Ru(e#acients such as casaicin 61ee Deat7 can (e e##ecti.e in distracting the atient #rom the ain% Deat ads can also (e a use#ul addition although the$ can (e exensi.e% Pain 1adder &irst Step
Treatment Paracetamol/ relati.el$ lo' side e##ects%
Second Step
Add an *!A-1 such as diclo#enac or i(uro#en/ additionall$ TE*! 6Transcutaneous Electrical *er.e !timulation7 could (e recommended%
Third Step
Add a 'eak oioid such as codeine%
&ourth Step
Usuall$ P3M onl$ F the most otent analgesic com(ination in communit$ harmac$ is a com(ination o# aracetamol/ dih$drocodeine and an *!A-1%
WWHAM : Type of pain% &ocation% Chronic% +cute%
%nsomnia =hen to refer222 Associated susected deression% • • 1uration Q 'eeks% • Age :; $ears old%
-nsomnia can (e either acute or chronic% Acute/ short+term insomnia ma$ (e treated 'ith antihistamines 'hereas long term should (e re#erred% When gi.ing out remedies #or insomnia $ou must make sure the atient is onl$ taking it #or a short eriod o# time and not regularl$/ other'ise a re#erral is needed% Order Prophylactic 1ifestyle "dvice
Treatment !lee h$giene measures F regularise 'aking and sleeing/ reduce da$ time nas/ restrict alcohol and ca##eine intake and take hot (aths%
&irst 1ine
1ihenh$dramine 6*$tol7 or romethazine 6Phenegan7 + dro's$ antihistamines can (e used #or the short+term relie# o# insomnia%
Second 1ine
Der(al medicines such as lemon (alm/ hos and .alerian 6or a com(ination such as Lalms7%
WWHAM : &ong term% +ge% !leep hygiene% epression =hen to refer222 All cases aart #rom mild deression% • • Pharmacist can onl$ ad.ise or treat mild deression% • !uicidal or sel# harm tendencies% A risk osed to other eole% •
1eression is a recognised medical condition and in an$ gi.en $ear :5 o# the oulation su##ers #rom a deressi.e illness% The diagnosis o# major deressi.e disorder is (ased on the atients sel#+reorted exeriences so it is a good idea to recommend to the atient to kee record o# s$mtoms% !uch s$mtoms include ersistent sad/ anxious/ or Oemt$O moodN #eelings o# hoelessness/ loss o# interest or leasure in ho((ies and acti.ities/ insomnia/ aetite andor 'eight loss or o.ereating and 'eight gain/ suicide attemtsN restlessness/ irrita(ilit$/ ersistent h$sical s$mtoms that do not resond to treatment/ such as headaches/ digesti.e disorders/ and chronic ain% Alcoholism or excessi.e alcohol consumtion signi#icantl$ increases the risk o# de.eloing major deression% Order 1ifestyle
Treatment Exercise can ha.e a huge (ene#it on deression% Also exosure to sunlight is use#ul in some seasonal a##ecti.e disorders%
&irst 1ine
-# li#est$le ad.ice does not 'ork $ou could either re#er to a doctor i# $ou (elie.e the case to (e a(o.e moderate or $ou could recommend !t ,ohns Wort/ ho'e.er/ (e sure to mention drug interactions%
WWHAM : Triggers% #ersonal &ife% uration%
+otion sic*ness
A condition 'here the (rain recei.es con#licting in#ormation to the inner ear% This mainl$ e##ects $oung children (ut is seen in adults 'ith a re.ious histor$% Order Treatment Prophylactic &irst Cinnarizine and romethazine 6most sedati.e7% *ot recommended #or 4 $ears old% D$oscine 6,o$ Rides7 can (e used Q $ears old% 1ine Prophylactic Second 1ine
Alternati.e aroaches% Ginger or acuuncture 'rist (ands 6little to no e.idence7%
WWHAM : +ge% Mode of transport% &ength of ?ourney%
=omen$s Health Cystitis =hen to refer222 All men/ children/ regnant and dia(etic atients% • • "e.er/ nausea or .omiting% • Daematuria or .aginal discharge% Persistent c$stitis or a duration Q9 da$s% •
C$stitis is usuall$ caused ($ a (acterial in#ection% Presented s$mtoms usuall$ include a (urning sensation 'hen urinating 'hich is due to increased D o# the urine% Patients o#ten reort increase urgenc$ to urinate% Order 1ifestyle
Treatment 1rink large amounts o# 'ater to increase J#lushingK%
&irst 1ine
Potassium citrate ma$ (e used to alkalinise the urine reducing J(urningK%
WWHAM : -ender% #regnant% uration% :aginal Thrush =hen to refer222 • Age + Women :; $ears old or Q;5 $ears old% "re0uenc$ F#irst occurrence or more than t'o attacks in six months% • • A(normal (leeding in discharge or susected regnanc$% • Associated lo'er a(dominal ain% 1uration F unsuccess#ul treatment a#ter one 'eek% •
@aginal thrush is caused ($ the #ungal in#ection caused ($ Candida albicans% -t is sometimes con#used 'ith (acterial in#ections/ the di##erential diagnosis is that (acterial in#ections o#ten emit a 'hite discharge 'ith a #ish$ smell 'hereas thrush has neither% @aginal thrush o#ten roceeds anti(acterial thera$ due to degradation o# the .aginal #lora% Order &irst 1ine
Treatment +azoles #ormulated as a essar$/ cream or casules% "luconazole as a casule is o#ten seen as the most con.enient choice ho'e.er/ it is more e##ecti.e taken in com(ination 'ith a clotrimazole essar$ or cream% WWHAM : !eually transmitted% +ntibiotic related%
The morning after pill ?EHC 1evonorgestrel =hen to refer222 -t is not usuall$ gi.en under :;/ this must (e re#erred unless there is a seci#ic PG1% • • Q <9 hours a#ter unrotected sex% • @omiting Q 9 hours a#ter ingestion o# EDC% 1eending on 'hich area the ser.ice is commissioned sometimes harmacists can gi.e • EDC t'ice to the same erson i# the$ ha.e .omited and return 'ithin hours%
&egall$/ only a pharmacist can sell emergency hormonal contraceptives 6such as &e.onorgestrel7% -t can onl$ (e gi.en to the erson taking the medication/ not a representative % -t is onl$ effective 6ithin / hours ?A3K after unprotected sex % The harmacist must make sure that the atient is not already pregnant 6other'ise this ma$ result in an ectoic regnanc$7% A#ter taking the ill/ i# the atient is sic* 6ithin 0 hours the ill ma$ not ha.e 'orked/ this 'arrants a re#erral% EHC (uestion Table
What is $our date o# (irth and is this medication #or $oursel#2 What 'as the date o# $our last eriod2 Was it unusual irregular2 Do' man$ hours has it (een since $ou had unrotected sex2 -s this the onl$ time $ou ha.e had sex since $our last eriod2 Are $ou allergic to an$ o# the exciients in the medication2 1o $ou take an$ medicines2 !t ,ohn Wort or 3TC2 -# the atient exceeds the <9 hour deadline the$ should (e re#erred to a suita(le ractitioner% An inter uterine de.ice 6-U17 ma$(e rescri(ed or uliristal 'hich is e##ecti.e u to 4 da$s% Order Prophylaxis
Treatment Practice sa#e sex%
&irst 1ine
Emergenc$ hormonal contraceti.e 6such as &e.onelle7%
Second 1ine
-U1 or uliristal 6must (e rescri(ed ($ a medical ractitioner7%
WWHAM : &ong term contraception% !T%
1ifestyle Herbal +edicines =hen to refer222 Peole on !t ,ohns Wort 'ho take medicines 'hich ma$ interact% • • • • • • • • •
!a' almetto + used in BPD to reduce rostate size% !t ,ohns Wort + used #or mild to moderate deression% Gingko Bil(ao + used #or memor$ loss and Jcere(ral insu##icienc$K% Red Clo.er and Black Cohosh + used to com(at s$mtoms o# menoause% 1e.ils Cla' + sometimes used as an *!A-1 alternati.e #or (ack ain% Arnica and Witch Dazel + used #or cuts and (ruises% Ginseng + general .italit$ JtonicK used to decrease #atigue and increase restorati.e o'er in traditional Chinese medicine% Domeoathic medicines + comletel$ unro.en (ut ma$ ha.e a use as a lace(o%
=eight loss and diet =hen to refer222 Mor(idl$ o(ese atients% • • Medical comlications such as deression or dia(etes% • Patients a(using laxati.es or medicines #or 'eight loss% Anorexia or (ulimia% •
BM- is calculated ($ taking the atients height and 'eight in metres and kilograms% =ou must s0uare the height and then di.ide the 'eight ($ this #igure% There are a lot o# m$ths in harmac$ a(out 'eight loss (elo' is a summar$ 'hich tries to disel some o# these% Change
Basic dietar$ ad.ice
Minimize
!alt 6;g dail$7/ sugar/ oil/ cheese/ red meat/ #ried #oods/ high #at dair$ roducts/ alcohol%
Maximize
Unrocessed #oods/ #ish/ nuts/ eggs/ .egeta(les and #ruit 64 ortions a da$7/ lo' G- #oods 6(eans/ tomatoes/ ales7/ e.er$da$ acti.it$/ eating sou as this gi.es greater satiet
%$Extra ad.ice
A normal BM- should (e (et'een :%4 and 9?%>/ 'aist size is a (etter indication o# cardio.ascular comlications%
Order Prophylaxis
Treatment A health$ diet and exercise see a(o.e%
&irst 1ine
-# BM- is o.er 9 and the atient comlies 'ith all other license re0uirements 3rlistat ma$ (e gi.en in com(ination 'ith a calorie restricted diet%
WWHAM : ;M>% iet% #rofession% *ercise% Smo*ing Cessation and Nicotine ,eplacement Therapy ?N,T =hen to refer222 Multile #ailed attemts at using *RT% • • Medicine comlications%
All #orms o# *RT ma$ (e (ought #rom a harmac$% Using *RT can increase the chances o# gi.ing u ($ u to ?5% !ome harmacies can o##er the (elo' #ormulations .ia a PG1/ dramaticall$ reducing the cost to the atient% The main side e##ects o# *RT are slee distur(ances this can (e a.oided ($ a.oiding night time administration% "ormulations
*otes on use
Gum
Gum is che'ed and JarkedK #or a(sortion through the oral mucosa%
&ozenges
Used in the same 'a$ as gum%
Patches
Patches gi.e a rolonged release nicotine release ro#ile%
-nhalator
Use#ul #or atients 'ho need ha(itual hand to mouth contact%
Microta(s
1iscreet #ormulation/ laced under the tongue%
*asal !ra$
A #ast acting *RT de.ice% Associated 'ith higher success rates (ut can o#ten (e seen as uncom#orta(le and ma$ cause nose (leeds%
WWHAM : /ow many cigarettes% @uit attempts% irst cigarette%
Chater <- Calculations and 1ocum Chec*list Calculating things in $our head can (e a di##icult task% -# $ou cant remem(er 'hat $ou.e 'orked out or siml$ dont kno' ho' to sol.e a ro(lem then it can (e .er$ challenging and #rustrating% -m going to tr$ and gi.e a #e' tis on ho' to do it more easil$% M$ o'n mental calculation skills are (elo' m$ general maths a(ilit$ due to ro(lems 'ith short term memor$/ (ut 'ith a #e' shortcuts can o#ten calculate things scaril$ #ast%
"ddition A use#ul trick 'hen adding lots o# small num(ers is to clum together the ones that add u to multiles o# :5% "or examle/ i# $ou ha.e to add 9 V V 4 V < V > V :: V / that can (e rearranged as 6 V <7 V 6> V ::7 V 69 V 7 V 4 S :5 V 95 V :5 V 4 S ?4% This method is also use#ul 'hen er#orming column addition 'ith more than t'o num(ers% "or examle/ in the ro(lem) 4; 4 ?< 9: :9 9 V9 +++ Column addition is generall$ er#ormed ($ adding the digits in the ones lace/ carr$ing them o.er/ and then adding the digits in the tens lace%/ and so on% A 'a$ to make this task easier is to grou the digits in the ones lace in grous o# ten/ and mark them on $our aer like this) 4 ; 4 ? <[ 9 : [ : 9 ++ :5 9 V9 +++
!imilarl$ the ;/ 9/ and 9 'ould (e crossed o##/ $ielding another :5% There#ore the digits in the ones lace add u to :5V:5V4V: 6'hats le#t7 or 9;%
Subtraction A use#ul trick 'hen su(tracting num(ers is to (egin 'ith the smaller .alue and mentall$ ski $our 'a$ u the di##erence/ 'ith juming oints at recogniza(le (oundaries/ such as o'ers o# :5% "or examle/ to su(tract ;< #rom 9: - 'ould start 'ith ;
Subtraction from Numbers consisting of . follo6ed by >eros- .@@R .'@@@R .@'@@@R etc
"or examle :/555 + 94 We siml$ su(tract each digit in 94 #rom > and the last digit #rom :5% 9 4 #rom > #rom > #rom :5 < ? 9 !o the ans'er is :/555 + 94 S >> i# su(tracting #rom :/555/ and then adding : (ack% !ame #or :5/555/ su(tract #rom >>>> and add :% "or examle/ :555+ ;;; S >>> + ;;; V :S V : S ? !imilarl$ :5/555 + :5; S 6>>>>+:5;7V: S 6>:7V: S>9 !o the ans'er is :5/555 + :5; S >9 "or :/555 + ;/ in 'hich 'e ha.e more zeros than #igures in the num(ers (eing su(tracted/ 'e siml$ suose ; is 5;% !o :/555 + ; (ecomes :/555 + 5; S >:?
+ultiplication When multil$ing it is .er$ imortant to ick the correct sums to do% -# $ou multil$ 94: ($ 9 straight o## it can (e .er$ di##icult/ (ut it is actuall$ a .er$ eas$ sum i# aroached in the right 'a$% 94:x V 94:x95 V 94:x55 is a scar$ rosect/ so $ou ha.e to 'ork out the simlest method%
,ounding 3ne o# the #irst things to do is to look i# the num(ers are near an$thing eas$ to 'ork out% -n this examle there is/ .er$ con.enientl$/ the num(er 94:/ 'hich is next to 945% !o all $ou ha.e to do is 9x945 V 9 + much easier/ (ut 9x945 still doesnt look too simle% There is/ ho'e.er/ an eas$ 'a$ o# multil$ing ($ 945 'hich can also al$ to other num(ers% =ou multil$ ($ :555 then di.ide ($ ?% !o 9x:555 S 9/555/ di.ide ($ t'o and $ou get :;:/455/ di.ide ($ 9 again and $ou get 5/<45% *o' this ma$ not seem eas$/ (ut once $ou.e gotten used to it/ di.iding ($ #our 6or other lo' num(ers7 in that 'a$ (ecomes natural and takes onl$ a #raction o# a second% 5/<45V9 S :/5< / so $ou.e got the ans'er 'ith a minimum o# e##ort comared to 'hat $ou 'ould other'ise ha.e done% =ou cant al'a$s do it this easil$/ (ut it is al'a$s use#ul to look #or the more o(.ious shortcuts in this st$le% An e.en more e##ecti.e 'a$ in some circumstances is to kno' a simle rule #or a set o# circumstances% There are a large num(er o# rules 'hich can (e #ound/ some o# 'hich are exlained (elo'%
&actoring -# $ou recognize that one or (oth num(ers are easil$ di.isi(le/ this is one 'a$ to make the ro(lem much easier% "or examle/ <9 x > ma$ seem daunting/ (ut i# taken as x > x x :/ it (ecomes
much easier% "irst/ rearrange the num(ers in the hardest to multil$ order% -n this case/ -d go 'ith : x x > x % Then multil$ them one at a time% :% : x S :5 x V x S 5 V 9? S :5? 9% :5? x > S >; % >; x S 95
+ultiplication by .. To multil$ an$ 9+digit num(er ($ :: 'e just ut the total o# the t'o digits (et'een the 9 #igures% #or examle) 9< Another examle) x:: can (e 'ritten as \]\V]\] Thus/ x::S;% To .isualise) 5 V ++++ ; Carryovers-
<< x :: S ?< This in.ol.es a carr$ #igure (ecause < V < S :? 'e get << x :: S \<]\:?]\<]% We add the : #rom :? as carr$ o.er to < and get <9? "or digit num(ers multilied ($ ::) 94? x :: S 9<>? We ut the 9 and the ? at the ends% We add the #irst air 9 V 4 S <% and 'e add the last air) 4 V ? S >% !o 'e can 'rite 94? x :: as \9]\9V4]\4V?]\?] i%e% 94?x::S9<>? !imilarl$/ >5>x:: can (e 'ritten as \>]\>V5]\5V>]\>] i%e% >5>x::S>>>> Same &irst igit' Second igits "dd to .@
&ets sa$ $ou are multil$ing t'o num(ers/ just t'o t'o+digit num(ers #or no' 6though the rules could (e adated #or others7 'hich start 'ith the same digit and the sum o# their unit digits is :5% "or examle/ <^ 6sum o# unit digits) S <97% Then multil$ the second digits together 6<^ S 9:7% Then stick the #irst ans'er at the start o# the second to get the ans'er 6<99:7% -# the result #rom the multilication o# the unit digits is less than :5/ siml$ add a zero in #ront o# the num(er 6i%e%/ > (ecomes 5>7% "or examle/ 4>^4: is e0ual to \4^;]\>^:] 'hich e0uals \5]\5>]% Thus 4>^4: S 55>% S#uaring a Number That Ends 6ith 4
This is a secial case o# the re.ious method% 1iscard the 4/ and multil$ the remaining num(er ($ itsel# lus one% Then tack on a 94 6'hich as in the re.ious section/ is 4x47% "or examle/ ;4x;4% 1iscarding the 4 #rom ;4 lea.es us 'ith ;4 S ;% Multil$ing ; ($ itsel# lus one gi.es us ?9 6;x< S
?97% Tacking on a 94 $ields ?994/ so ;4x;4S?994% "or examle/ ?4x?4 can (e 'ritten as \ ?x4] \4x4]thus ?4x?4 S 9594 S#uaring a t6o!digit number Rather than doing :?_ or ?<_ as :?x:? or ?; -n other 'ords/ add 'hats in the ones lace to the num(er/ multil$ it ($ 'hat 'as originall$ in the tens lace 6sometimes $oull get a sum 'ith the next num(er u in the tens i%e% ?< V < S 4? so use ? not 4 in this examle7 tack a zero at the end/ then add the s0uare o# the ones lace% !o) ?<_ S :5 ^ ?6?< V <7 V 6< ^ <7 S :5 ^ ?64?7 V ?> S :5 ^ 9:; V ?> S 9:;5 V ?> S 995> !o no' 'e kno' that ?<_ is 995>% When s0uaring t'o digit num(ers that are onl$ : a'a$ #rom a num(er ending in zero $ou can also use the (asic alge(raic #ormulas 6A_7+6A+:7_ S 9A+: and 6AV:7_ + 6A_7 S 9A V :% "or examle 'hen s0uaring >> $ou can set :55 as A then) :55_ S :5555 9 ` :55 S 955 !o the ans'er is 6:5555 + 9557 V : S >5: To s0uare >: use the second #ormula% Then) >5_ S :55 9`>5 S :5 !o the ans'er is :55 V :5 V : S 9:
ivision Again there are man$ ossi(le techni0ues/ (ut $ou can make do 'ith the #ollo'ing or research $our o'n% All num(ers are the roducts o# rimes 6$ou can make them ($ multil$ing together rime num(ers7% -# $ou are di.iding $ou can di.ide ($ all the rime roducts o# the num(er $ou are di.iding ($ to get the ans'er% This means that :559? S 666 :55979797% Although this means $ou ha.e a lot more stages to do the$ are all much simler% :559 S 45 / 459 S 94 / 949 S :9%4 / :9%4 S ?45 S ?:; S ?%:;;;;;;;;recurring Also/ another hel#ul trick is/ 'hen $ou ha.e to multil$ and then di.ide ($ a num(er/ al'a$s di.ide #irst/ until $ou.e reached num(ers that are relati.el$ rime/ and then multil$% This kees num(ers #rom (eing too large% "or examle/ i# $ou must do 6: ` ::47:4/ it is much easier to di.ide ::4 ($ 4 and : ($ / and then multil$ them together to get 9 ` ; S :%
Estimation The (est 'a$ to make estimation 0uickl$ in mental math is to round to one or t'o signi#icant digits 6that is/ round it to the nearest lace o# the highest order6s7 o# magnitude7/ and then roceed 'ith t$ical oerations% Thus/ :9?9 ` :4;?4 is aroximatel$ e0ual to :955 ` :;555 S :>955555/ 'hich is reasona(l$ close to the correct ans'er o# :>?:5>5% -n certain cases/ one can e.en round to siml$ the nearest o'er o# ten 6'hich is use#ul 'hen making estimations 'ith much error and large num(ers7%
,ange Search
-t is sometimes easier to make a calculation in the oosite direction #rom the one $ou 'ant/ and this can (e used to 0uickl$ estimate the .alue $ou 'ant% !0uare root is a good examle% -t is easier to s0uare num(ers than to take the s0uare root% !o $ou take an$ num(er that 'ill s0uare to a little larger than the one $ou 'ant/ take another that s0uares to less than the one $ou 'ant and use an a.erage o# the t'o% The trick no' is to al$ a general techni0ue 6 the Bisection Method 7% We create a ne' estimate using the a.erage o# our #irst t'o num(ers% !0uare this% -# its .alue is higher than 'e 'ant/ 'e use it as the uer .alue o# our range% -# it is lo'er than 'e 'ant/ 'e use it as the lo'er .alue o# our range% We no' ha.e a ne' range that must contain the s0uare root 'e 'ant% We can al$ the same rocess again to get a more accurate .alue 6 this is kno'n as -teration 7% This techni0ue is 'idel$ alied in comuting/ (ut also .er$ hand$ #or some mental mathematics%
Other techni#ues Perhas one o# the more use#ul tricks to mental math is memorization% Although it ma$ seem an anno$ance to need to memorize certain math #acts/ such as er#ect s0uares and cu(es 6eseciall$ o'ers o# t'o7/ rime #actorizations o# certain num(ers/ or the decimal e0ui.alents o# common #ractions 6such as :< S %:?9%%%7% Man$ are simle/ such as : S %%%% and 94 S 9/ (ut seed u $our calculations enormousl$ 'hen $ou dont ha.e to do the di.ision or multilication in $our head% "or examle/ tr$ing to #igure out :59?9 is much easier kno'ing that that is the same as 9:594/ or 'hich/ su(tracting exonents/ gi.es 94/ or 9% Man$ o# these are memorized siml$ ($ #re0uent useN so/ the (est 'a$ to get good is much ractice% -ts a good idea to memorize x :< S 4:% We can extend this to ; x :< S :59% -# 'e round these num(ers x :< is arox 45/ ; x :< is arox :55/ > x :< is arox :45/ and so on% These are .er$ hel#ul in estimating since / ;/ >/ 45/ :55 %%% are common num(ers%
1ocum Chec*list 3nce $ou ha.e (ecome a #ull$ 0uali#ied harmacist and em(ark on the #reelancing 'orld/ the learning does not sto there%%% Welcome to the 'onder#ul 'orld o# CP1% There are a #e' attri(utes 'hich e.er$ good locum has on their C@)
Computer s*ills !$stem
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Pharmac$CPA Pharmac$CPA o##ers a training ser.ice #or ne'l$ 0uali#ied harmac$ locums called The Pharmac$ Cross Plat#orm Accreditation% This online accredited course allo's $ou to train on all harmac$ PMR s$stems% The course ends 'ith a small test and i# $ou ass $ou 'ill recei.e a hardco$ CP1 certi#icate%
CP via CPPE 6look at '''%ce%manchester '''%ce%manchester%ac%uk7 %ac%uk7 • • •
!u(stance misuse certi#ication Reeat disensing certi#ication MUR certi#ied + a must 'ith some o# the (ig chains and u to date Continual Pro#essional 1e.eloment 1iar$ 6'''%utodate%org%uk 6'''%utodate%org%uk77
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!moking cessation @accinations 6seci#icall$ #lu7 Minor Ailments 6seci#icall$ chloramhenicol PG17 Chlam$dia screening Bo'el cancer screening Cardio.ascular risk assessment *eedle exchange
Chater - Open )oo* +C($s :% J@aloidK J@aloidK ma$(e used #or 'hat urose2 A% Anti+s$chosis% B% &a($rinthine disorders% C% !edation% 1% As an o.er the counter anti+histamine% E% -ncreasing urinar$ #lo'% #lo'% 9% E?95 relates to 'hich o# the #ollo'ing comounds2 A% !or(itol B% Mannitol C% Gl$cerol 1% Bees'ax E% Ponceau ?R % A dose o# $ridoxine o# a(o.e 955mg dail$ has (een associated 'ith 'hich o# the #ollo'ing conditions2 A% "i(rosis B% M$algia C% *euroath$ 1% Anah$laxis E% *eurotoxicit$ ?% Which o# the #ollo'ing drugs is &EA!T likel$ to cause a d$stonic reaction) A% 1omeridone B% Metocloramide C% Prochlorerazine 1% Tri#luoerazine E% Perhenazine 4% Which drug can sa#el$ (e used during (reast #eeding2 A% Moxonidine B% Met#ormin C% Prega(alin 1% -ratroium E% Ator.astatin ;% A ;< $ear old atient 'ith a histor$ o# eriheral .ascular disease/ 'hich has (een resol.ed ($ angiolast$ 'as #ound to (e h$ertensi.e and gi.en lisinoril% A 'eek a#ter taking the #irst dose he returned comlaining o# nausea and a lack o# aetite% Which one o# the #ollo'ing could (e a #urther diagnosis ossi(ilit$2 A% &i.er #ailure B% Lidne$ #ailure C% Deart #ailure 1% 1ia(etes E% !tomach cancer <% A (rand name #or amisulride is) A% aonex B% 1enzaine C% oleti
1% !olian E% Cloixol % A doctor asks ho' .asoressin .asoress in should (e administered #or initial control o# .ariceal (leeding/ 'hat do $ou rel$2 A% @ia su(cutaneousintramuscular injection or in#usion% B% 3rall$ or rectall$% C% 3rall$ or su(linguall$% 1% Rectall$ or .ia in#usion% E% 3rall$ or .ia s$ringe s $ringe dri.er% >% A doctor asks $ou to recommend an anti(iotic #or a regnant lad$ in her #irst trimester% !he has (een su##ering 0uite (adl$ #rom a urinar$ tract in#ection 6UT-7% The organism organism causing the in#ection has (een #ound to (e resistant to amicillin (ut sensiti.e to nitro#urantoin 6a.oid due to excessi.e nausea7% A% Gentamicin B% Tetrac$cline C% Trimethorim 1% Ce#alexin E% @ancom$ci @ancom$cin n :5% A doctor 'ants to trans#er a atient #rom >5 mg tds morhine to the e0ui.alent diamorhine dose due to hositalisation/ 'hat dose do $ou recommend2 A% : mg (d B% : mg od C% 9< mg tds 1% 9< mg od E% 9< mg (d ::% A 1octor rings and asks #or the aroximate e0ui.alent dose o# #errous gluconate 'hich should (e gi.en #or ;55mg o# o# #errous sulhate% What is $our ans'er2 A% :%9 g B% 5% g C% 5%; g 1% 5%9 g E% :%; g :9% What dose o# 3x$codone 6oral7 is e0ui.alent to 95 mg o# Morhine salts 6oral72 A% 4 mg B% :5 mg C% :4 mg 1% 95 mg E% 94 mg :% A nurse asks #or $our ad.ice% !he has had an elderl$ atient on the 'ard #or sometime and the atient is comletel$ immo(ile% 1ue to this/ the elderl$ atient has de.eloed sores% The nurse 'ould like $ou to recommend a rearation #or this condition% Which one o# the #ollo'ing could $ou recommend2 A% 1ermol B% Emulsiderm C% Eurax 1% Calamin E% !udocrem
:?% A alliati.e care nurse asks $ou a 0uestion% De is looking to rescri(e a #entan$l containing roduct 'hich a atient can retain in their mouth/ 'hich roduct 'ould $ou recommend2 A% -ons$s B% Acti0 C% 1urogesic 1% Palladone E% Metid :4% A arent and a :5 $ear old child come into the harmac$% The child 'as stung ($ a (ee and $ou recognise is in anah$laxis% An am(ulance 'ill not (e there #or : hour and $ou decide to administer adrenaline% What dose do $ou gi.e2 A% :45 mcg B% 945 mcg C% 455 mcg 1% 5%: mg E% 5%9 mg :;% A atient has (een diagnosed 'ith s$mtomatic arox$smal atrial #i(rillation% Which one o# the #ollo'ing is *3T considered a second line treatment a#ter administration o# a #ailed (eta+(locker2 A% !otalol B% "lecainide C% Proa#enone 1% Amiodarone E% @eraamil :<% A atient is admitted to $our hosital 'ith angiodema% =ou comile a medication histor$ the atient has the #ollo'ing drug regimen) Enoxime inj 5mg dail$ Catoril :9%4mg t'ice dail$ 1igoxin :94mcg dail$ Asirin <4mg dail$ Amoxicillin 945mg three times a da$ #or 4 da$s Which one o# the drugs on this regimen is the likel$ culrit #or the atients admission2 A% Enoxime inj 5mg dail$ B% Catoril C% 1igoxin :94mcg 1% Asirin E% Amoxicillin :% A atient is (eing initiated on a drug com(ination o# amiloride and h$drochlorthiazide% Which drug ma$ interact 'ith the diuretic2 A% Beclomethasone B% Enalaril C% Temazeam 1% Bisacod$l E% Proranolol :>% A atient is taking Methotrexate 6MTI7% What is the maximum recommended dose the$ can take2 A% :5 mg 'eekl$ B% :5 mg monthl$ C% 94 mg monthl$ 1% 95 mg 'eekl$
E% 94 mg 'eekl$ 95% A atient returns #i.e :55mcg #entan$l atches 'hich are unneeded due to the atient assing a'a$% The$ are in an unoened (ox/ ha.e not (een used and exire in ? $ears time% What is the (est method o# disosal2 A% Accet the atches and lace them in the Controlled 1rugs ca(inet read$ #or disosal at a suita(le time% B% Accet the drugs/ denature them and 'ait #or the insector to disose o# the remaining mixture% C% Accet the drugs and 'ait #or the insector to disose o# them% 1% Accet the atches/ record recei.ing them in the aroriate register and lace them in the Controlled 1rugs ca(inet read$ #or disosal at a suita(le time% E% !end them (ack to the sulier exlaining that the$ 'ere returned ($ the atient% 9:% A atient 'ho is at risk o# arterial h$oxaemia is going on a #light to Cam(odia% Where should the necessar$ in#ormation (e o(tained to calculate the re0uired amount o# ox$gen to (e gi.en2 A% The GP% B% The ractice nurse% C% The airline #or #urther in#ormation% 1% The ox$gen sulier% E% The la(el o# the ox$gen canister% 99% A atient 'ho 'as just sold EDC #rom $our harmac$ returns and sa$s that she .omited the medication >5 minutes a#ter ingestion% What do $ou r ecommend2 A% The drug has had enough time to get into the s$stem% B% The atient needs to ha.e an -U1 #itted% C% Re#er to a doctor 'ho ma$ rescri(e ondansteron% 1% R Re#er to a doctor 'ho ma$ rescri(e haloeridol% E% Re#er to a doctor 'ho ma$ rescri(e domeridone% 9% A rescrition arri.es in the ost #or a atient%
Which o# the #ollo'ing (rands 'ould (e aroriate to disense2 A% Calciche' B% Calciche' 1 "orte C% Adcal 1 1% Adcal E% Calciche' 1 9?% A GPhC insector is in $our area and 'ill (e making an insection soon% Which o# the #ollo'ing is not a legal re0uirement #or harmacies2 A% A consulting room i# MURs are to (e conducted% B% *o drug romotional o##ers such as (u$ one get one #ree% C% The oening hours should (e consicuousl$ disla$ed% 1% Dot and cold running 'ater in the disensar$% E% !eats a.aila(le/ so that atients can sit do'n% 94% A .et enters $ou harmac$ and asks #or an emergenc$ sul$ o# amoxicillin #or a dog under his care/ 'h$ is this an in.alid re0uest2 A% Amoxicillin is not #or use in animals% B% De has not gi.en an$ details o# the animal in.ol.ed% C% The animal needs to (e resent in emergenc$ situations% 1% @ets cannot gi.e emergenc$ re0uests% E% The o'ner o# the animal needs to (e resent% 9;% A 'oman 'ho .isited a ri.ate clinic a #e' 'eeks (ack is comlaining that she is not roducing enough milk #or her ne'+(orn child% Which drug ma$ (e resonsi(le2 A% Pergolide B% Pantorazole C% @asoressin 1% Tra.orost E% Methanamine 9<% According to *-CE guidelines 'hich one o# these is *3T considered a #irst line treatment #or ne'l$ diagnosed schizohrenia2 A% Arirazole B% 3lanzaine C% Riseridone 1% 8uetiaine E% Amisulride 9% According to o##icial sources ho' long does the =ello' "e.er .accine last #or2 A% 9 $ears B% 4 $ears C% :5 $ears 1% 95 $ears E% &i#e 9>% Which one o# the #ollo'ing is not included in the CP1 c$cle2 A% Re#lection B% Planning C% Contemlation 1% Action E% E.aluation 5% Which one o# the #ollo'ing are standards set out ($ the MEP #or deli.er$ o# medicines2
A% Ensure the deli.er$ mechanism is secure% B% A signature has to (e o(tained% C% Medicines are acked and deli.ered securel$% 1% The deli.er$ should ha.e a .eri#ia(le audit trail% E% Con#idential in#ormation should (e rotected% :% 1ox$c$cline should not (e taken at the same time o# da$ as iron ta(lets (ecause o# 'hich o# the #ollo'ing) A% The side e##ects o# iron 'ill increase% B% The side e##ects o# dox$c$cline 'ill increase% C% The a(sortion o# dox$c$cline 'ill decrease% 1% -t ma$ 'orsen the atients asthma% E% The meta(olism o# iron 'ill (e increased% 9% A $oung child is (eing treated #or an o.er acti.e th$roid 'ith car(imazole% A doctor rings $ou #or $our ad.ice as the atient has just (een to see him a(out an uncomlicated rash o.er a large area% What is the (est course o# action2 A% 1o not gi.e an$ medication% B% 1iscontinue the thera$ and gi.e an antihistamine% C% Continue the thera$ and gi.e an antihistamine% 1% Use h$drocortisone on the rash% E% Gi.e rednisolone ta(lets o.er a short eriod% % "or ho' man$ $ears must ri.ate rescritions #or P3Ms (e retained in the harmac$2 A% : $ear B% 9 $ears C% $ears 1% ? $ears E% 4 $ears ?% "or o(sessi.e comulsi.e disorder/ 'hat does o# #luoxetine is gi.en #or an other'ise health$ $oung male2 A% :5 mg 31 B% 95 mg 31 C% 95 mg B1 1% ?5 mg 31 E% ?5 mg B1 4% "or 'hich o# the #ollo'ing is immunisation *3T ro.ided to children) A% Measles B% Mums C% Cholera 1% Ru(ella E% 1ihtheria ;% -n hosital/ the micro(iolog$ la( rings the harmac$ and exlains that a recent culture o# stah$lococci #rom a atient has sho'n to (e resistant to (enz$lenicillin% The atient 'ill need to change onto another anti(iotic 'hich is most aroriate in this circumstance2 A% Clindam$cin B% Clarithrom$cin C% Amoxicillin 1% "lucloxacillin E% "ucidic acid
<% The internationall$ acceted a((re.iation R!@ means) A% Re.erse s$latic .erticulation B% Retro.iral standard .olume C% Resirator$ s$nc$tial .irus 1% Rate standard .olume E% Resirator$ suction .olume % -n resects to Methicillin resistant !taphylococcus aureus in#ections 'hat role does clarithrom$cin la$2 A% -t is regularl$ gi.en #irst line% B% -t is common ractice to administer the drug #or enicillin h$ersensiti.es% C% -ts is al'a$s gi.en ($ a secialist% 1% -t has no lace in its treatment% E% -t is used #or skin and so#t tissue in#ections% >% -n resects to hen$toin 'hich one o# the #ollo'ing is a "A&!E statement2 A% "oshen$toin is the ro+drug o# hen$toin% B% Eanutin is a (rand o# hen$toin% C% Phen$toin can (e used #or tonic+clonic seizures% 1% 3ne side e##ect o# he$toin is acne% E% Phen$toin can (e used in all t$es o# seizures% ?5% &e.onorgestrel is classi#ied as 'hich o# the #ollo'ing) A% Progestogen B% 3estrogen C% Prostaglandin 1% Anti+emetic E% Glucocorticoid ?:% MR%B is taking methotrexate and comes into $our harmac$% De is lanning his holida$ to *ami(ia and 'ould like to kno' ho' long he can go #or% De kno's that he has to go #or Oli.er testsO (ut does not kno' ho' regularl$% Do' o#ten are these tests er#ormed on a atient taking methotrexate2 A% 9+ months B% 9+ 'eeks C% ;+ 'eeks 1% :+9 months E% 9+? 'eeks ?9% Mr% has just (een to the doctor% The doctor did a thorough examination as Mr% had not (een #or a roer check u in t'o decades% De realised o.er the ast coule o# 'eeks he has (een going to the toilet/ a lot/ has recurrent in#ections and has chest ains% "urther examination re.ealed eriheral neuroath$/ dia(etes and angina% The next 'eek Mr% is resents himsel# to $ou comlaining o# extremel$ (ad headaches% Which o# the #ollo'ing medications ma$ ha.e caused them2 A% Met#ormin !R B% Atenolol C% Gl$cer$l trinitrate 1% &isinoril E% 1iazeam ?% Penciclo.ir can (e (oth a P and a P3M (ut under 'hat circumstance can it (e sold to a atient in a harmac$2 A% When the ack size is o# no greater size than ?g
B% When the ack size is o# no greater size than :9g C% When the strength does not exceed 9 1% When the strength does not exceed ? E% When the strength does not exceed : ??% Pharmac$ CP1 records can (e o##iciall$ stored at 'hich o# the #ollo'ing internet addresses2 A% GPhC%org B% cd%com C% cdutodate%org 1% utodate%org%uk E% continuingro#essionalde.eloment%org ?4% Phenothiazines are normall$ a.oided in atient 'ith 'hich o# the #ollo'ing conditions2 A% D$ertension B% Anxiet$ C% 1eression 1% Closed angle glaucoma E% -nsomnia ?;% Mr L resents at the harmac$ re0uesting .arious medications #or his ucoming holida$% =ou kno' he has moderate renal imairment 6creatinine clearance o# less than 6Aml=min). Which o# the #ollo'ing drugs should he not (e sold2 A% -(uro#en B% Chloro0uine C% &oeramide 1% 1omeridone E% 3merazole ?<% Proh$laxis o# angina can (e treated 'ith all these drugs (elo' EICEPT) A% Gl$cer$l trinitrate B% -sosor(ide dinitrate C% *i#ediine 1% Atenolol E% Candesartan ?% The correct temerature a harmac$ #ridge should (e ket at is) A% 5+ C B% 9+ C C% 4+:5 C 1% ;+:9 C E% + C ?>% The #irst line o# treatment #or rheumathoid arthritis is) A% Gold !alts B% Paracetamol C% -ndometacin 1% 1iclo#enac E% 1examethasone 45% The &atin taxonomic name #or Cra( &ice is 'hich o# the #ollo'ing) A% Tinea pedia B% #thirus pubis C% !acoptes scabei 1% #ediculus capitis
E% $oster varicellus 4:% The Meth$lated !irits Regulation/ set do'n in :>
C% 3merazole 1% Atenolol E% Ranitidine 4% Which juice interacts 'ith sim.astatin2 A% Cran(err$ ,uice B% Pineale ,uice C% Grae#ruit ,uice 1% 3range ,uice E% Pomegranite ,uice 4>% Which medication can a dentist *3T rescri(e2 A% Asirin EC ta(lets B% Car(amazeine ta(lets C% "luconazole ta(lets 1% D$drocortisone cream E% D$drogen Peroxide mouth'ash ;5% Which o# the #ollo'ing agents is *3T used in the treatment o# deression2 A% 1iazeam B% -miramine C% Paroxetine 1% @enla#axine E% Citaloram ;:% Which o# the #ollo'ing analgesics are unsa#e to rescri(e to a atient 'ho su##ers #rom orh$rias2 A% Codeine B% 1iamorhine C% 1iclo#enac 1% Pethidine E% "entan$l ;9% Which o# the #ollo'ing anti(acterial drugs is *3T a.aila(le #or oral administration2 A% Tetrac$cline B% "usidic acid C% Gentamicin 1% Er$throm$cin E% Ciro#loxacin ;% Which o# the #ollo'ing anti(acterials 'ould (e an aroriate treatment #or Daemohilus in#luenzae eiglottis2 A% Amoxicillin B% 1ox$c$cline C% Benz$lenicillin 1% Ce#otaxim E% @ancom$cin ;?% Which o# the #ollo'ing anti(iotics are gi.en as a second anti(iotic to re.ent the emergence o# resistance2 A% !odium #usidate B% Amxocillin C% Metronidazole 1% "lucloxacillin
E% Ciro#loxacin ;4% Which o# the #ollo'ing (enzodiazeines is regularl$ used #or alcoholics in reco.er$2 A% Temazeam B% !hort hal#+li#e (enzodiazeines C% Midazolam 1% Triazolam E% Chlordiazeoxide ;;% Which o# the #ollo'ing drugs can (e used to reduce the side e##ects exerienced ($ methotrexate administration2 A% *iacin B% @itamin 1 C% Thiamine 1% "olinic acid E% Ergocalci#erol ;<% Which o# the #ollo'ing is a !chedule drug2 A% !eco(ar(ital B% 1examhetamine C% Burenorhrine 1% Pethidine E% Glutethimide ;% Which o# the #ollo'ing treatments is most likel$ to (e used #or the initial management o# se.ere G3R12 A% Ranitidine B% !ucral#ate susension C% Cimetidine 1% Magnesium Trisilicate mixture E% &ansorazole casule ;>% Which o# the #ollo'ing is *3T a c$totoxic drug2 A% @incristine B% 1oxoru(icin C% Ciclosorin 1% Bleom$cin E% Methotrexate <5% Which o# the #ollo'ing is *3T a rescrition re0uirement #or controlled drugs such as morhine2 A% *ame and address o# atient% B% Must (e indeli(le% C% The dose% 1% Age i# o.er :9 $ears old% E% The 'ords O#or dental treatmentO i# issued ($ a dentist% <:% Which o# the #ollo'ing medicines is recommended ($ the C!M as to (e the !A"E!T harmacological otion in treating deression in atients under : $ears old2 A% Citaloram B% Mirtazeine C% Moclo(emide 1% "luoxetine E% "luenthixol
<9% Which o# these drugs has a !ER-3U! interaction 'ith cardiac gl$cosides2 A% Prazosin B% Gentamicin C% Tizanidine 1% Penicillamine E% Ciclosorin <% Which one o# the #ollo'ing is a standard anti(iotic #or a generalised chest in#ection2 A% Trimethorim B% Metronidazole C% "lucloxacillin 1% Ciro#loxacin E% Clarithrom$cin
<>% Concerning the #ollo'ing rescrition)
Which one o# the #ollo'ing cautionar$ la(els should (e ut on the container o# atenolol2 A% %%% 'ith or a#ter #ood% B% Warning% A.oid alcoholic drink% C% 1o not sto taking this medicine excet on $our doctor% 1% Warning% Ma$ cause dro'siness% -# a##ected do not dri.e or oerate machiner$% E% %%% 'ith lent$ o# 'ater% 5% Which one o# the #ollo'ing class can (e alied to (eza#i(rate2 A% &iid+regulating drug B% D$ogl$caemic agent C% &axati.e 1% Antisasmodic E% Calcium+channel (locker :% Which one o# the #ollo'ing is a com(ined oral contraceti.e2 A% Cerazette B% "emulen C% Micronor 1% *orida$ E% "emodette 9% Which one o# the #ollo'ing is a !chedule ? drug2 A% Temazeam B% Ana(olic steroids C% Bar(ituates
1% Pentazocine E% Burenorhrine % Which one o# the #ollo'ing is *3T likel$ to cause an admission to hosital due to a #all o# an elderl$ atient2 A% Citaloram B% !inemet+Plus C% Bromocritine 1% Temazeam E% Me#enamic acid ?% Which one o# the #ollo'ing is sa#e to take #or a (reast #eeding 'oman2 A% Ranitidine B% Asirin C% Atenolol 1% Cloidrogel E% -sotretonoin 4% Which one o# the #ollo'ing is the correct recommended dose #or otassium and sodium citrate sachets #or c$stitis2 A% : sachet three times a da$% B% : sachet t'ice dail$% C% : sachet dail$% 1% : sachet taken 'hen needed% E% : sachet taken as re0uired% ;% Which one o# the #ollo'ing .itamins is gi.en to ne'(orns to re.ent haemorrhagic disease 2 A% @itamin L B% @itamin A C% @itamin B 1% @itamin C E% @itamin E <% Which one o# these is classi#ied in the B*" as a Central *er.ous !$stem disease2 A% Meningitis B% Acute $leonehritis C% !$hilis 1% Periodontinitis E% 3steom$elitis % Which one o# these is not a s$mtom o# li.er disease2 A% D$oroteinaemia B% -ncreased clotting C% Deatic encehaloath$ 1% "luid o.erload E% -maired drug meta(olism >% Which one o# these is not a term o# ser.ice under the harmac$ contract2 A% *ot to o##er gi#ts or re'ards to entice eole to (ring rescritions into the harmac$% B% Prescrition charges must (e collected on (ehal# o# the 1eartment o# Dealth% C% 1isense *D! rescritions irrele.ant o# the time it takes to get stock% 1% 1isla$ shos oening times 'ith rota details% E% !ul$ medicines in a suita(le container 'ith 4ml soon or s$ringe i# re0uired%
>5% Which s$mtom is *3T a s$mtom o# Pol$c$stic 3.ar$ !$ndrome2 A% -n#ertilit$ B% Amenorrhea C% Dirsutism 1% D$erhiridosis E% @aginal discom#ort >:% =ou are looking on a health #orum on the internet and see a ost a(out dia(etes% O1ia(etics cannot dri.e as it is too dangerous to other road users% Do'e.er/ the 1@&A ermits them to use other .ehicles such as (ic$clesO% =ou decide to 'rite a rel$ to this ost% Which o# the #ollo'ing is the (est resonse2 A% This statement is correct and - #ull$ agree% B% 1ia(etics should not dri.e as it is too dangerous% C% 1ia(etics and eiletics should not dri.e as the$ are a danger to the u(lic% 1% Medicated dia(etics ma$ dri.e onl$ i# the$ ha.e contacted the 1@&A% E% 1ia(etics dri.ing on long journe$s should tes t their (lood glucose e.er$ ; hours% >9% =ou are 'orking as a harmacist in a secialist dia(etic clinic% =ou are measuring di##erent atients DB:AC le.els% What is the otimum range #or atients2 A% ?%4+4%4 B% 4%4+;%4 C% ;%4+<%4 1% <%4+%4 E% %4+>%4 >% =ou are 'orking in a hosital harmac$ and a doctor asks $our ad.ice on an admitted atient% The atient is :? $ears old and has c$stic #i(rosis% The atient 'as admitted 'ith shortness o# (reath and is at risk o# h$ercanic resirator$ #ailure% The$ ha.e (een on ox$gen #or the ast da$ and their ox$gen saturation is at > 'hat action should (e taken2 A% Carr$ on 'ith the same dose% B% -ncrease the dosage% C% 1ecrease the dosage% 1% Put the atient onto sal(utamol ne(ules% E% Put the atient on iratroium ne(ules% >?% =ou are 'orking as a harmacist in a hosital% Mr%D is admitted 'ith in.asi.e salmonellosis% A doctor decides to rescri(e ciro#loxacin% Which o# the #ollo'ing 'ould contraindicate this choice2 A% The atient has asthma% B% The atient is taking digoxin% C% The atient has eiles$% 1% The atient is (lind% E% The atient has no next o# kin% >4% =ou are 'orking in the extemoraneous rearation deartment in hosital% =ou recei.e an order #rom a doctor #or 955ml otassium citrate% The re0uest is to make the solution so that 'hen diluted ?5 times a : in 555 solution is o(tained% What 'eight o# otass ium citrate do $ou re0uire2 A% 5%: gram B% 5%4 grams C% 5%<4 grams 1% : gram E% 9 grams >;% A ?; $ear old 'oman 'ith t$e 9 dia(etes/ h$ertension and osteoarthritis 'as admitted into hosital ha.ing #orgotten to her medicines% A ne' regimen 'as constructed)
Asirin <4mg dail$ Ramiril :5mg dail$ Glilizide :5mg t'ice dail$ 1iclo#enac modi#ied release <% Which o# the #ollo'ing diseases is re0uired ($ la' #or a doctor to *3T noti#$ the Proer 3##icer o# the local authorit$2 A% Malaria B% Tu(erculosis C% Mums 1% "ood oisoning E% D-@ >% The mineralocorticoid acti.it$ o# h$drocortisone can (e seen ($ 'hich o# the #ollo'ing side e##ects2 A% D$ertension B% 1ia(etes C% M$algia 1% *ausea E% 3steoorosis >>% The #ollo'ing 0uestion concerns the #ollo'ing faxed rescrition recei.ed on 99+5+5>)
irections Summarised " .'/'0
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:% The rescrition cannot (e disensed as it has (een #axed% 9% The rescrition cannot (e disensed 'ithout the original co$ resent% % =ou can re#use disensing this medication although $ou kno' it is genuine and 'ill (e in $our ossession in a coule o# hours% :55% Which o# the #ollo'ing drug arahernalia cannot (e sold to drug a(users2 A% ?ml amoule 'ater #or injection% B% !ecialised drug #ilters% C% Utensils #or the rearation o# Controlled 1rugs% 1% Citric acid% E% Ascor(ic acid% :5:% Mrs% !mith is lactose intolerant and has a histor$ o# an anah$laxis to eggs% !he is .isiting her GP #or .accinations (e#ore she goes on holida$/ 'hich one o# the #ollo'ing 'ill (e contraindicated2 A% T$hoid B% Anthrax C% =ello' "e.er 1% 1itheria E% Deatitis A 1irections #or 0uestions :59 to :54% "or each num(ered 0uestion select the one lettered otion a(o.e it 'hich is most closel$ related to it% Within each grou o# 0uestions each lettered otion ma$ (e used once/ more than once/ or not at all% 8uestions :59 to :54 concern rescrition charges) A% 3ne B% T'o C% Three 1% "our E% *one !elect #rom A to E/ 'hich one o# the a(o.e rescrition charges al$ #or a atient 'ho normall$ a$s rescrition charges and is rescri(ed the #ollo'ing) :59% !choll so#tgri stockings class : t'o airs% :5% Canesten cream com(i and Microg$non% :5?% 1osulein 94mg casules and 1osulein <4mg ta(lets% :54% L+"our (andage kit% 8uestions :5; to :5 concern the #ollo'ing otions #or malaria roh$laxis A% 9 Malarone ta(lets% B% > Me#lo0uine ta(lets% C% *o roh$laxis is needed% 1% :? Chloro0uine 955 mg and > roguanil :55 mg ta(lets% E% ?> 1ox$c$cline casules%
!elect #rom A to E/ 'hich one o# the a(o.e is the most aroriate otion to recommend #or the #ollo'ing health$ indi.iduals 'ho ha.e taken malaria roh$laxis (e#ore and are lanning to tra.el in a(out 9 'eeks time) :5;% A 9? $ear old male .isiting the !oloman -slands #or :< da$s :5<% A :5 $ear old 'eighing ?4kg .isiting &aos #or :? da$s% The atient 'as (orn and li.ed in &aos u until the age o# six 'hen the$ came to the UL% Their guardian states the$ ha.e a natural immunit$ as a conse0uence does not need roh$laxis% :5% A ?4 $ear old #emale .isiting the Mekong Ri.er in @ietnam #or :? da$s% 8uestions :5> to ::: concern the #ollo'ing medicines) A% Temazeam :5mg ta(lets B% 3ramorh :5mg4ml solution C% BuTrans ! atches 1% !e.redol 95mg ta(lets E% !econal sodium :55mg casules !elect/ #rom A to E/ 'hich one o# the a(o.e) :5>% -s a controlled drug that must legall$ (e ket in the controlled drugs ca(inet/ #or 'hich rescritions must state the total 0uantit$ rescri(ed in 'ords and #igures and needs to (e entered in the controlled drugs register% ::5% -s a controlled drug that does *3T legall$ need to (e ket in the controlled drugs ca(inet/ (ut #or 'hich rescritions do need to state the total 0uantit$ rescri(ed in 'ords and #igures% :::% -s a controlled drug that must legall$ (e ket in the controlled drugs ca(inet/ #or 'hich rescritions must state the total 0uantit$ rescri(ed in 'ords and #igures (ut does *3T need to (e entered in the controlled drugs register% 8uestions ::9 to ::? concern the #ollo'ing di##erent t$es o# insulins) A% Dumalog B% Dumulin ! C% -nsulatard 1% &antus E% &e.emir !elect #rom A to E a(o.e 'hich) ::9% Can (e o##ered as a trial to those 'ho ha.e used isohane insulin and exerienced signi#icant nocturnal h$ogl$camia% ::% -s a human insulin analogue 'ith a short duration o# action% ::?% Contains rotamine 'hich ma$ cause an allergic reaction% 8uestions ::4 to :: concern the #ollo'ing anti(iotics% A% Amoxicillin B% Ce#otaxime C% Tetrac$cline 1% Gentam$cin
E% Ciro#loxacin !elect #rom A to E 'hich one o# the a(o.e anti(iotics% ::4% Would (e the aroriate treatment #or ericoronitis% ::;% Ma$ (e an alternati.e #or (acterial meningitis i# the atient is allergic to enicillin% ::<% -s a (road sectrum anti(iotic 'hich is inacti.e against anaero(es and has oor acti.it$ against haemol$tic stretococci and neumococci% ::% -s contra+indicated #or use in children under :9 as it can cause staining o# the teeth% 1irections #or 0uestions ::> to : Each o# the 0uestions or incomlete statements in this section is #ollo'ed ($ three resonses% "or each 0uestion 3*E or M3RE o# the resonses is 6are7 correct% 1ecide 'hich o# the resonses is 6are7 correct% Then choose) A i# :/ 9 and are correct B i# : and 9 onl$ are correct C i# 9 and onl$ are correct 1 i# : onl$ is correct E i# onl$ is correct irections Summarised " .'/'0
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::>% =ou recei.e a rescrition #rom a local .et% Which o# the #ollo'ing are needed on the rescrition2 :% The secies o# the animal% 9% The remises the animal is ket i# di##erent #rom the o'ner% % The condition #or 'hich the animal is (eing treated% :95% Mrs E has (een ne'l$ diagnosed 'ith coeliac disease and has started collecting rescritions #or gluten #ree roducts% Which o# the #ollo'ing can (e rescri(ed #or her2 :% Ener+G gluten #ree dinner rolls% 9% ,u.ela gluten #ree tagliatelle% % !char gluten #ree crackers% :9:% Which o# the #ollo'ing are TRUE o# (ishoshonates2 :% Cannot (e taken during regnanc$% 9% -ncrease the rate o# (one turno.er% % !hould (e taken 'hile crouched do'n% :99% Regarding the sul$ o# o.er the counter medicines/ 'hich o# the #ollo'ing statements are true2 :% -# an 3TC re0uest is not suita(le/ the reason must (e exlained to the atient% 9% Patients can sel# select G!& and P roducts% % A harmac$ assistant 'ho has comleted their *@8 9 or e0ui.alent can sell an$ P roduct 'ithout re#erring to the harmacist% :9% Which o# the #ollo'ing is true o# diclo#enac sodium2
:% 1iclo#enac is a c$clo+ox$genase+9 selecti.e inhi(itor% 9% Digh doses are associated 'ith an increased risk o# throm(otic e.ents% % Can (e gi.en ($ intramuscular injection #or ostoerati.e ain% irections Summarised " .'/'0
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:9?% Which o# the #ollo'ing ractitioners can res cri(e (urenorhine2 :% *urse indeendent rescri(ers% 9% Pharmacist indeendent rescri(ers% % Communit$ nurse i# the drug is 'ritten in the atients care lan% :94% Which o# the #ollo'ing drugs interact 'ith car(amazeine2 :% !t% ,ohns Wort 9% Amitr$t$line % Prednisolone :9;% Clinical go.ernance can (e descri(ed as the rocess ($ 'hich high 0ualit$ ser.ices are deli.ered% Which o# the #ollo'ing acti.ities 'ould # all under this heading2 :% Reorting disensing errors and in.estigating the cause% 9% Comletion o# CP1 records % Comletion o# atient 0uestionnaires on (ranch s er.ice% :9<% Which o# the #ollo'ing statements regarding 'ar#arin thera$ are true2 :% The target -*R #or a atient 'ith atrial #i(rillation is 9%4% 9% War#arin should (e a.oided in all stages o# regnanc$% % Patients should ha.e their -*R checked regularl$ at least e.er$ 'eeks% :9% Mr%C has (een rescri(ed ri#amicin #or the treatment o# tu(erculosis% Which o# the #ollo'ing should (e on the la(el 'hen $ou disense it #or him2 :% 1o not sto taking this medicine excet on $our doctors ad.ice% 9% This medicine ma$ colour the urine% % Take hal# to one hour (e#ore #ood% irections Summarised " .'/'0
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:9>% Which o# the #ollo'ing drugs #or intra.enous in#usion should (e gi.en intermittentl$ in glucose 42 :% Paclitaxel 9% 1iamorhine h$drochloride % ido.udine :5% Agranuloc$tosis is a side e##ect o# 'hich o# the #ollo'ing drugs2 :% &e.odoa 9% Pheno(ar(ital % oiclone ::% Pharmacies 'ill recei.e an extra ro#essional #ee #or 'hich o# the #ollo'ing2
:% Pro.iding a 4ml s$ringe #or amoxicillin :94mg4ml% 9% 1isensing iner$t lotion% % 3ne ack o# G$no+re.ar$l : CP ack% :9% Which o# the #ollo'ing are true regarding Patient Grou 1irections2 :% -t is a 'ritten direction relating to the sul$ and administration o# rescrition onl$ medicines% 9% Midazolam is the onl$ !chedule C1 that can (e included in a PG1% % 1entists can sign and sul$ #rom a PG1% :% Which o# the #ollo'ing &atin a((re.iations used 'hen res cri(ing are correctl$ translated2 :% t%d%s S three times dail$ 9% a%c% S 'ith #ood % o%m% S e.er$ morning 1irections #or 0uestions :? to :?: The #ollo'ing 0uestions consist o# a statement in the le#t+hand column #ollo'ed ($ a second statement in the right+hand column% 1ecide 'hether the #irst statement is true or #alse% 1ecide 'hether the second statement is true or #alse% Then choose) A i# (oth statements are true and the second statement is a correct exlanation o# the #irst statement% B i# (oth statements are true (ut the second statement is *3T a correct exlanation o# the #irst statement% C i# the #irst statement is true (ut the second statement is #alse% 1 i# the #irst statement is #alse (ut the second statement is true% E i# (oth statements are #alse%
:?% &%,ST ST"TE+ENT Thiazide and loo diuretics are (oth used in heart #ailure to reduce #luid o.erload% SECON ST"TE+ENT A com(ination o# a thiazide and loo diuretic can (e use#ul i# a single agent is ine##ecti.e at relie.ing s$mtoms%
:4% &%,ST ST"TE+ENT 1iazeam and temazeam are (oth short acting (enzodiazeines indicated #or the short+term relie# o# anxiet$% SECON ST"TE+ENT When #irst taking (enzodiazeines atients ma$ exerience the oosite e##ects as 'hat it should do/ i%e% instead o# #eeling dro's$ the$ could #eel excitement and aggression%
:;% &%,ST ST"TE+ENT 1iamorhine returned ($ a atient should (e recorded and destro$ed ($ denaturing% SECON ST"TE+ENT Under the Controlled 1rugs Regulations 955; !tandard 3erating Procedures need to (e in lace and rocedures carried out #or maintaining a record o# the C1s seci#ied in !chedule 9 that ha.e (een returned ($ atients%
:<% &%,ST ST"TE+ENT Clindam$cin should (e discontinued immediatel$ i# diarrhoea or colitis de.elos% SECON ST"TE+ENT Clindam$cin should not (e used routinel$ #or the treatment o# oral in#ections%
:% &%,ST ST"TE+ENT "or a child o# ? $ears o# age/ asthma 'hich is 'ell controlled can (e managed in ste o# asthma treatment 'ith the use o# &ABAs 6long acting (eta agonists7 such as salmeterol% SECON ST"TE+ENT Beclomethasone dirorionate C"C+#ree ressurised metered+dose inhalers should (e rescri(ed ($ (rand name%
:>% &%,ST ST"TE+ENT 1etails on the a$ments in resect to re+registration trainees can (e #ound in the 1rug Tari##% SECON ST"TE+ENT -# x$lometazoline nasal sra$ is rescri(ed/ 3tri.ine nasal sra$ can (e disensed%
:?5% &%,ST ST"TE+ENT 3n each occasion a deli.er$ ser.ice is ro.ided the harmacist needs to use hisher ro#essional judgement to determine 'hether direct #ace+to+#ace contact 'ith the atient or their carer is necessar$% SECON ST"TE+ENT A signature needs to (e o(tained in order to indicate sa#e receit o# medicines%
:?:% &%,ST ST"TE+ENT The =ello' Card scheme is used to reort ad.erse drug reactions to the MRA% SECON ST"TE+ENT =ou should reort all susected ad.erse drug reactions to intensi.el$ monitored medicines identi#ied ($ the (lack triangle s$m(ol through the $ello' card scheme%
:?9% =ou decide Mrs B 'ould (ene#it #rom a Medication Use Re.ie' and in.ite her (ack the #ollo'ing 'eek to discuss her regime% Which o# the #ollo'ing statements regarding ad.anced ser.ices is "A&!E2 A% MURs can (e conducted outside o# the harmac$ remises as long as the correct PC3 has (een noti#ied%
B% An MUR ma$ (e er#ormed on a 9 $ear old child i# their guardian is resent% C% Contractors are aid monthl$ (ased on num(er o# MURs claimed #or% 1% Pa$ment #or u to ?55 MURs 'ill (e made annuall$ #rom :st Aril to the :st March% E% MURs should (e carried out in the consultation room% :?% Which o# the #ollo'ing drugs is unlicensed #or the treatment o# neuroathic ain (ut is used #or this urose2 A% Casaicin B% Ga(aentin C% Prega(alin 1% Amitrit$line E% Car(amazeine :??% Which o# the #ollo'ing is *3T a.aila(le on "P:52 A% Uro+Tainer T'in !U($ G 9 x 5mB% Cosmoor E ; x :5 C% *+A 1ressing :> x >%4 1% "ertilit$ 63.ulation7 Thermometer E% @iscoaste PB< 6:57 <%4 x ; :?4% Which o# the counselling oints #or the #ollo'ing drugs is C3RRECT2 A% 3rlistat should (e regularl$ taken three times dail$ (e#ore/ during or u to : hour a#ter meals% B% !!R-s can cause gastro+intestinal distur(ances including nausea and .omiting and should (e 'ithdra'n o.er a #e' months 'hen no longer needed% C% When taking .eraamil/ do not dri.e or oerate machiner$ until it is esta(lished that er#ormance is unimaired% 1% Pauci(acillar$ leros$ should (e treated 'ith a ; month regimen% E% 3nl$ one dose o# tadala#il should (e taken in a 9? hour eriod and the e##ects 'ear o## in 9? hours% :?;% A local dentist contacts $ou as he 'ants to rescri(e anti(iotics #or an oral a(scess% Which o# the #ollo'ing 'ould $ou recommend2 A% Metronidazole 955mg ta(lets B% 1ox$c$cline :55mg casules C% Phenox$meth$lenicillin 945mg ta(lets 1% Er$maI 945mg casules E% Amicillin 945mg casules :?<% Which o# the #ollo'ing statements regarding oisons is "A&!E2 A% Arsenic is a !chedule : oison% B% Mercuric oxide 6$ello'7 is exemt #rom the re0uirements o# the Poisons Act :><9% C% !odium c$anide can (e sold ($ a listed seller in the local authorit$ list% 1% When a harmac$ sells Magnesium hoshide the urchaser must (e kno'n to the seller% E% The indication o# danger 'ith associated s$m(ols must (e on the la(el o# all oisons% :?% Mr 1 is a ?> $ear old/ non+dia(etic/ smoker% Dis a.erage (lood ressure is :;4>4mmDg% Dis serum total cholesterol to D1& ratio is ?% What is his cardio.ascular risk rediction o.er the next :5 $ears2 A% Q5 B% :5 C% :5+95 1% 95+5 E% :4
:?>% Which o# the #ollo'ing is #alse regarding the .accination rogramme #or a (a($ in the #irst $ear o# li#e2 A% Poliom$elitis/ dihtheria and haemohilis B are gi.en% B% The #irst dose is gi.en at 9 months% C% -(uro#en can (e gi.en #or ost+immunisation $rexia% 1% A suita(le dose o# aracetamol #or $rexia is ;5mg% E% 9 doses are gi.en in total% :45% Which one o# the #ollo'ing atient t$es 'ould not (e entitled to an exemtion #rom charges2 A% A 'oman 'ho has an month old child% B% A ?4 $ear old man 'ith Addisons disease% C% A atient 'ith a h$sical disa(ilit$ re0uiring #ull time aid% 1% A 99 $ear old/ long term/ chronic schizohrenic% E% A 44 $ear old su##ering #rom h$oarath$roidism% :4:% Man$ drugs ha.e oral+mucosal side e##ects% Which one o# the #ollo'ing drugs can cause gingi.ial o.er gro'th2 A% Penicillamine B% Co+amoxicla. C% Phe$toin 1% 1ox$c$cline E% Proguanil
Chater >- Closed )oo* +C($s :49% A :< $ear old (o$ comes on his (ike to $our harmac$% De has a small rash on his #ace% De exlains he has no other s$mtoms excet a small itch and that he recentl$ (ought a ne' scar#% What is the most aroriate action to take2 A% Gi.e h$drocortisone : and sa$ not to 'ear the scar#% B% Gi.e Piriton and tell him not to 'ear the scar#% C% Gi.e casaicin cream and tell him not to 'ear the scar#% 1% Gi.e an emollient and tell him not to 'ear the scar#% E% Gi.e him nothing and tell him it 'ill su(side ($ itsel#% :4% A 4+$ear+old man/ 'ho 'orks as a #ireman is (eing treated #or h$ertension% Dis drug regimen includes roranolol 5 mg once dail$% Which o# the #ollo'ing side e##ects is he M3!T likel$ to reort) A% Ticks B% Candidiasis C% Pol$uria 1% G$naecomastia E% "atigue :4?% Which o# the #ollo'ing is another name #or Thiamine2 A% @itamine B: B% @iatmnin B9 C% @itamin B 1% @itamin B; E% @itamin B:9 :44% A ;:+$ear+old/ retired ensioner/ recei.ing 95 mg #lu.astatin dail$ ma$ reort 'hich o# the #ollo'ing side e##ects2 A% Muscle ain B% 1ro'siness C% Palitations 1% Constiation E% Deadaches :4;% A (lack triangle/ 'hich is alied to a medicine listing in the B*" means that the drug is%%% A% Prone to causing dangerous side e##ects% B% -t is 'ell kno'n to (e the (est drug o# choice% C% -t is 'ell kno'n to *3T (e the (est drug o# choice% 1% Means its is usuall$ less than 9 $ears old% E% An$ ad.erse reaction must (e reorted to the P!*C% :4<% A child 'ith an unkno'n cause o# .omiting resents themsel.es to a doctor% The doctor asks $our ad.ice as to 'hat to recommend% A% C$clizine B% Metocloramide C% *a(ilone 1% Cinnarizine E% *one o# the a(o.e drugs% :4% A child 'ith a arent comes in to $our harmac$ 'ith a (ro'n and a (lue inhaler% !he uses a @olumatic sacer de.ice to imro.e comliance% Which one o# the #ollo'ing is a TRUE statement2
A% The$ should use the @olumatic occasionall$% B% The @olumatic should (e 'ashed in a strong detergent e.er$ ; months% C% The atient should 'ash their mouth out (e#ore using the (ro'n inhaler% 1% The (ro'n inhaler ma$ cause 'hite sots on the tongue% E% &o' dose (ro'n inhalers should not (e stoed suddenl$ as the$ are a corticosteroid% :4>% A comedone is a recognisa(le sign o# 'hich condition2 A% Tinea edis B% Deres simlex C% Deres zoster 1% Acne .ulgaris E% !e(orrhoea caitis :;5% A disad.antage o# using inhaled lo'+dose (eclomethasone include 'hich o# the #ollo'ing side e##ects) A% Adrenal suression% B% Doarseness% C% The atient cannot sto treatment a(rutl$% 1% -t onl$ comes as one strength% E% 1uring long term use it can cause macular degeneration% :;:% A distincti.e #eature o# ring'orm is) A% -t has a golden crust% B% A red/ in#lamed/ raised area% C% -t mo.es 'hilst under the skin% 1% -t is associated 'ith dr$ skin% E% -t disaears 'ith short+term use o# h$drocortisone% :;9% A #ather and son 'alk into $our chemist% The child is ? $ears old and has had a soradic cough #or a #e' 'eeks% De mainl$ gets it at night and it is distur(ing his slee% The #ather took his son to the 1r three 'eeks ago and the 1r said that no anti(iotics 'ere needed as it 'as a transient cough% The atient has no other medical conditions and is on no medications% What is the (est course o# action2 A% !ell the arent Tix$lix as the child is o.er 9 $ears old% B% !ell the atient Ben$lin 1r$ Cough% C% Recommend that the arent takes the child to AHE% 1% Re#er the atient to their GP% E% Gi.e the arent a dro's$ antihistamine #or the child% :;% A #emale atient enters the harmac$ 'here $ou are 'orking as a locum% 3.er the ast coule o# da$s/ she has #ound a (listering rash 'hich starts in the middle o# her (ack and #ollo's a line to her right (reast% !he does not kno' 'hether it is related or not (ut #inds she is exeriencing a tingling sensation around the rash% What could (e the ro(lem2 A% Psoriasis B% Cold sore C% -metigo 1% Rosacea E% !hingles :;?% A #riend o# $ours comes into the harmac$ one da$% De has a (ag o# used and unused medicines #rom his #ather 'ho recentl$ died% =ou ha.e a look inside and it contains onl$ P3Ms 6rescrition onl$ medicines7% What is the (est course o# action2 A% Put them in a sa#e storage lace until the insector comes% B% Use $our kno'ledge as a harmacist to harmaceuticall$ assess the medicines and
disose o# medicines 'hich cannot (e used% C% 1issol.e the medicines and 'ash the result do'n the sink% 1% 1isose o# the medicines .ia an aro.ed agent% E% Make sure the regular gar(age disosal ser.ices kno' that there are medicines% :;4% A man enters the harmac$ and tells $ou a(out his 'i#e% !he is 45 $ears old and has gastric ulcers and takes atenolol #or h$ertension% !he has had a cold 6(locked nose and slight #e.er7 #or the ast #e' da$s% What is the most aroriate aroriate course o# action2 A% Re#er the atient as there are re#erral s$mtoms% B% Gi.e !inuta( C% Gi.e &emsi Max 1% Gi.e menthol and eucal$tus #or steam inhalation% E% There is nothing ro.en to hel #or the common cold% :;;% Which .itamin is other'ise kno'n as C$anoco(alamin2 A% B: B% B C% B; 1% B E% B:9 :;<% A mother comes to the harmac$ 'ith her :+$ear+old son 'ho has a Ostu##$ noseO 'hich #ormulation is most aroriate2 A% 3tri.ine sra$ B% Generic x$lometazolide nasal sra$ C% Bactro(an nasal ointment 1% !aline nasal dros E% Eucal$tus and menthol steam inhalation :;% A mother comes to $our harmac$ 'ith her +$ear+old son 'ho has a cough% Which o# the #ollo'ing list o# s$mtoms is most likel$ to indicate an allerg$2 A% *octurnal cough B% Chest$ cough C% Rhinorrhoea 1% Deadache E% Malaise :;>% =ou =ou are a harmacist 'orking as a locum in a ne' harmac$% harmac$% At the (eginning o# the da$ $ou/ as normal/ 'ant to #ull #ill $our legal o(ligations as a resonsi(le harmacist and enter $our details into the harmac$ record% Do'e.er/ $ou cannot #ind it% =ou =ou ask the counter assistant a ssistant and the technician and the$ ha.e no idea 'hat $ou are talking a(out% Do' should $ou roceed2 A% Create $our o'n record and tr$ and #ile it a'a$% a'a$% B% 1o nothing as it is solel$ the the resonsi(ilit$ o# the !uerintendent% C% Create $our o'n record and tr$ contact the !uerintendent% 1% Ring the societ$ immediatel$ #or ad.ice% E% 1o nothing as it is not a legal re0uirement%
:<5% A arent and child come into the harmac$/ harmac$/ the child is : months and the mother asks #or $our oinion% !he had seen on the ne's that the MMR ja( causes autism/ 'hat do $ou recommend to the arent2 A% Tell her that she is (eing ridiculous and should not (elie.e e.er$thing she reads in the aers% B% Tell Tell her that the child does not e.en need the injection at : months%
C% Reassure her that there is nothing to 'orr$ a(out as current clinical kno'ledge re#utes those claims% 1% The .accination is onl$ gi.en to those at risk so the child does not need one% E% Tell Tell her that the child is not eligi(le #or # or the treatment% :<:% A atient comes into $our harmac$% !he asks the counter ass istant #or some ad.ice% The assistant goes through WWDAM 0uestions and re.eals the #ollo'ing% !he is getting a (urning sensation 'hen she asses urine% !he has had it #or t'o da$s/ is not on an$ medication and has no other medical conditions% 3n this (asis the assistant sells the atient #luconazole% What is the (est course o# action2 A% -nter.ene as Canestan 'ould (e the (etter otion% B% &et the sale roceed% C% &et the sale roceed/ (ut tell the assistant the$ could ha.e sold a cream in addition% 1% -nter.ene and handle the consultation $oursel# more aroriatel$% E% &et the sale roceed/ (ut call a doctor #or ad.ice% :<9% A atient comes to the harmac$ 'ith rhinorrhoea% Which o# the #ollo'ing list o# s$mtoms is most likel$ to indicate allergic rhinitis 2 A% Coloured sutum B% "e.er C% Cough 1% !neezing E% *ausea :<% Which .itamin 'hilst taken during regnanc$ can cause (irth de#ects2 A% @itamin C B% @itamin 1 C% @itamin A 1% @itamin B E% @itamin L :
:<<% A atient rings $ou on the hone asking as king #or ad.ice/ the$ are going tra.elling and 'anted a recommendation as the (est thing to reel mos0uitos/ 'hich otion 'ould (e (est2 A% Citronella B% Tea Tree 3il C% Casaicin extract 1% 1EET E% 1!T :<% A rorietar$ name #or diazeam is) A% $(an B% @alsartan C% 1io.an 1% @alium E% Mogadon :<>% A side e##ect 'hich is descri(ed as OcommonO means that it occurs in 'hat ercentage range o# eole2 A% 5%5:+5%: B% 5%:+: C% :+:5 1% :+:5 E% :5+95 :5% What is the (est de#inition o# the term OanorexiaO2 A% The ina(ilit$ to eat% B% The tendenc$ to .omit a#ter eating% C% The loss o# aetite% 1% The raid loss o# 'eight due to not eating% E% The clinical de#inition o# a BM- under :4% ::% What is the (est roduct #or sickness during the #irst trimester #or a regnant 'oman2 A% 1omeridone B% 3ndansetron C% Ginger 1% &oeramide E% Peto+(ismol :9% A $oung coule come into $our harmac$ 'ith their ? $ear old child% =ou =ou recognise that the child ma$ ha.e s$mtoms o# an ear in#ection and seems #e.erish% =ou =ou ask the coule ho' the child seems other'ise and the$ state that he has (een hot and irrita(le #or the ast coule o# da$s% A% Gi.e the child aracetamol and re#er to a 1r% B% Tell Tell the arents to take the child to a 1r immediatel$% immediatel$% C% Re#er to hosital immediatel$ as there ma$ (e other comlications% 1% Gi.e the child aracetamol and tell the coule to gi.e the child al lot o# (ed rest% E% *o action is re0uired excet lots o# #luids% :% A $oung lad$ 'ith #air skin comes into $our harmac$ #or sun rotection% Which roduct 'ould $ou recommend2 A% Tanning oil !P" 9 B% Tanning oil !P" ? C% &otion !P" ? 1% &otion !P" ; E% &otion !P"
:?% A atient 'ith high (lood ressure has come into $our harmac$ 'ith acute gout% De gi.es his doctors hone num(er and $ou call it% The doctor asks $ou to take a rescrition o.er the hone and $ou agree% The doctor asks 'hat in $our oinion 'ould (e the (est treatment% A% Allourinol B% Asirin C% Paracetamol 1% -ndomethacin E% R%-%C%E + rest/ ice/ comression/ ele.ation :4% Agents that could (e recommended #or dandru## include all EICEPT) A% !elenium sulhide B% Coal tar C% Letoconazole 1% Permethrin E% !alic$lic acid :;% Alcohol should (e a.oided in all atients taking) A% Penicillin B% Metronidazole C% Ciro#loxacin 1% 1ox$c$cline E% Amoxicillin :<% Alginates are #ound in some antacid rearations% What is there main #unction2 A% An anti#oaming agent% B% Acceleration o# gastric emt$ing% C% "loating on to o# the stomach contents% 1% An antisasmotic% E% A #la.ouring agent% :% =ou check 'ith the manu#acturer and amoxicillin onl$ lasts #or : 'eek a#ter (eing made u% =ou decide to disense one (ottle and kee one o'ing 'hich the atient can ick u the #ollo'ing 'eek% What endorsement 'ill ena(le $ou to (e aid #or this ser.ice $ou are ro.iding2 A% !&! B% &! C% ACB! 1% *C3! E% C1 :>% An alcoholic atient is taking metronidazole 'hat s$mtoms might the$ exect i# the$ drink alcohol 'hilst on the medicine2 A% A disul#iram+like reaction B% Tendonitis C% An anah$lactic reaction 1% Dallucinations E% &ittle to no side+e##ects :>5% An "P:5M1A is #or u to ho' man$ da$s2 A% < da$s B% :? da$s C% 9 da$s 1% 9 months E% ; months
:>:% As a locum 'orking in man$ di##erent harmacies $ou ha.e a rerogati.e that $ou must) A% Take $our GPhC certi#icate to e.er$'here $ou 'ork% B% Make sure $ou call the harmac$ (e#ore hand% C% *3T lea.e the remises under an$ circumstance% 1% Create $ou o'n resonsi(le harmacist record% E% Bring lunch N7 :>9% As a harmacist $ou ha.e to lea.e the harmac$ to deli.er some urgent ox$gen% There is no Resonsi(le Pharmacist on the remises 'hilst $ou are gone% A atient 'ho takes omerazole asks the harmac$ assistant #or the sale o# ? i(uro#en ta(lets% Wh$ can the medicine *3T (e sold2 A% -t is classi#ied as a P% B% -t is classi#ied as a P3M% C% -t is classi#ied as G!&% 1% The$ are taking omerazole% E% *o items can (e gi.en out 'hen a harmacist is out o# ersonal control o# the harmac$% :>% Bioa.aila(ilit$ descri(es the amount o# drug that reaches the) A% Lidne$ #or excretion B% !$stemic circulation C% &i.er 1% Blood Brain Barrier E% !mall intestine :>?% 1uring regnanc$/ 'hich one is #irst line #or constiation2 A% A (ulk #orming laxati.e B% Bisacod$l C% !enna 1% 1antron E% 1ioct$l :>4% 1uring $our 'ork in a dia(etes clinic/ a atients random non+#asting (lood glucose 'as measured at ?mmol&itre% What is the (est course o# action2 A% This is considered dangerousl$ h$ogl$caemic% B% Make the atient call their GP to make an aointment% C% Tell the atient that the$ ma$ (e dia(etic% 1% Gi.e the atient some high in glucose #ood or so#t drink% E% Tell the atient that this is comletel$ normal% :>;% "or 'hich o# the #ollo'ing drugs should the la(el %c% (e used) A% !al(utamol B% Tetrac$cline C% Prednisolone 1% 1extroroox$hene E% -sosor(ide mononitrate :><% Generall$ 'hat is considered an otimum -*R range #or a atient on 'ar#arin2 A% 5+5%4 B% :+:%4 C% :%4+9%4 1% 9%4+%5 E% +4 :>% Gingi.itis re#ers to in#lammation o# 'hich (od$ art)
A% Tonsils B% Tongue C% Gums 1% &ar$nx E% 3esohagus :>>% Concerning i(uro#en 'hich is true2 A% -t does not e##ect c$clo+oxegenase% B% -t does not ha.e an$ anti+$ritic e##ect% C% -t has use in d$smenorrhea% 1% The 3TC maximum dose is usuall$ 9%?g% E% 1oes not cause (ronchosasm% 955% -metigo is characterised ($ 'hich s$mtom2 A% -tch$ #lak$ skin B% Raised area o# skin C% Golden crust 1% "e.er E% Eczema 95:% -n resects to metocloramide 'hich is true2 A% -t is a doamine agonist% B% -t is not associated 'ith extra$ramidal s$mtoms% C% -t ma$ (e used #or roh$laxis o# tra.el sickness% 1% -t is an anti+emetic% E% -t increases oesohageal shincter contraction% 959% -n resects to the Omorning a#ter illO 'hich one is correct2 A% -t cannot (e taken more than once in the same c$cle% B% -t 'ould (e ine##ecti.e a#ter ? hours and another #orm o# rotection 'ould (e needed% C% Another otion 'ould (e to ha.e an interuterine de.ice 6-U17 #itted% 1% -U1s are a.aila(le #rom harmacies 'ithout rescrition% E% The consultation can (e handled ($ a re+registration student and sold like'ise% 95% -n 'hich atient categor$ could $ou sell Ranitidine <4 ta(lets to2 A% A :? $ear old girl% B% A 99 second trimester regnant 'oman% C% A ?? $ear old atient 'hose s$mtom constantl$ change% 1% A ? male 'ith heatic imairment% E% A $ear old lad$ 'ho is also taking hen$toin% 95?% -ts is a !aturda$ morning and a lad$ comes into $our harmac$ stating she is on holida$ and .er$ anxious (ecause she has le#t her medication at home% !he asks #or an emergenc$ sul$ o# Temazeam :5mg and sho's $ou her medication card% What is the (est course o# action2 A% Take the medication card as e.idence and gi.e out the medication% B% Check on her records i# she has had it (e#ore and i# she has create an emergenc$ sul$% C% 1en$ her the medication although she is anxious 1% 1en$ her the medication as this is not deemed an emergenc$% E% 1en$ her the medication as she has no real roo# that she takes the medication%
irections Summarised " .'/'0
) .'/ onl$
C /'0 onl$
. onl$
E 0 onl$
954% -t is the summer time and a atient is just a(out to go on holida$ to &aos% The$ ha.e ne.er (een to such and exotic location and 'onder a(out mos0uito (ites% =ou #ind #rom the B*" that the is no malaria in the seci#ic holida$ destination (ut $ou gi.e ad.ice a(out rotecting against (ites% Which o# the #ollo'ing is the (est iece o# ad.ice to gi.e2 :% Wear short slee.ed garments a#ter dusk and long slee.es during the da$% 9% !ta$ a'a$ #rom ri.ers/ as this is 'here mos0uitos li.e% % Wear long slee.ed garments a#ter dusk% 95;% &egionnairebs disease a##ects 'hich art o# the (od$ the most) A% Resirator$ s$stem B% Central *er.ous !$stem C% &egs 1% E$e E% Gums 95<% JMa$ cause dro'sinessK is a recautionar$ la(el 'hich should (e on all roducts (elo' EICEPT) A% Mirtazeine B% !umatritan C% Tramadol 1% Co+roxamol E% 1iclo#enac 95% Mrs A has recentl$ disco.ered a ain% -t is located at the (ack o# her #oot a(o.e the heal on the outer edge o# the lo'er cal#% !he (elie.es it ma$ (e drug related/ 'hich one o# the #ollo'ing ma$ ha.e caused the ro(lem2 A% Bendro#lumethazide B% Ramiril C% Amoxicillin 1% 1iltiazem E% Ciro#loxacin 95>% Mrs = comes into $our harmac$% =ou see on her PMR she has (een on antorazole/ aracetamol and enalaril #or the ast ; months% !he resents $ou 'ith a $ello' (ook #rom the hosital containing initiation -*R records and a rescrition #or War#arin% -# all her -*R records are in order #or 'hat reason 'ould $ou call the rescri(er2 A% Enalaril is contraindicated% B% War#arin is usuall$ managed outside o# rimar$ care% C% Paracetamol is contraindicated% 1% Pantorazole can enhance the e##ect o# 'ar#arin% E% The enalaril 'ill ha.e to (e remo.ed% 9:5% *ational ser.ice #rame'orks 6*!"7 ha.e (een u(lished on 'hich toics2 A% Asthma B% &i.er disease C% Blood ressure 1% 1rug interactions E% Common ad.erse drug reactions
9::% Concerning the *D! 1irect ser.ice 'hich one o# the #ollo'ing is #alse2 A% Pro.ides out o# hours direct suort #or GPs ser.ices% B% Pro.ides 9? hour resonse to health scares% C% Concentrates on atients 'ith short+term conditions% 1% Pro.ides commissioned ser.ices to arts o# the *D!% E% Pro.ides remote clinics .ia telehone% 9:9% 3n a 'eekend/ a atient comes in and states that their elderl$ mother 'ho is (ed ridden has run out o# (lood ressure medication and asks i# $ou can do an emergenc$ sul$/ 'hat do $ou do2 A% Gi.e out the medication as this is classi#ied as a medical emergenc$% B% Ring the doctor and exlain 'hat has haened and tr$ to arrange alternate means% C% Tell the resenting client to take her mother immediatel$ to hosital% 1% 1o not ring the doctor% -nitiate a loan and take it o## the next rescrition E% Tell the atient the$ 'ill ha.e to 'ait until the$ can get a ne' rescrition 9:% Paracetamol o.erdose is most likel$ to cause) A% Renal damage B% Blindness C% Deatic damage 1% !eizures E% Brad$cardia 9:?% Pharmacological e##ects o# calcium+channel (locking agents ma$ include 'hich o# the #ollo'ing) A% @enoconstriction B% Arteriodilatation C% D$ertension 1% Positi.e inotroic e##ect% E% -ncreases sinoatrial and atrio.entricular node conduction% 9:4% Photosensiti.it$ is a ossi(le side e##ect o# 'hich drug2 A% Amiodarone B% "errous sulhate C% Pilocarine 1% -sosor(ide dinitrate E% Atenolol 9:;% Prearations used #or colic in in#ants contain) A% Acti.ated dimeticone B% Metocloramide C% 1omeridone 1% Cimetidine E% Ranitidine 9:<% "or an in#ant 'ith nasal congestion/ 'hich o# the #ollo'ing roducts ma$ (e sa#el$ recommended) A% Toical seudoehedrine B% *ormal saline C% !$stemic seudoehedrine 1% Cetirizine E% Me#enamic acid 9:% Which 3*E o# the #ollo'ing statements regarding *D! reeat disensing is incorrect)
A% The RA 6authorising7 rescrition must (e signed ($ the ractitioner% B% The #irst disensing o# a drug 6other than a controlled drug7 must (e 'ithin ; months o# the date o# signing the RA% C% Batch issues 6R1 rescritions7 must (e signed ($ the ractitioner% 1% All schedule 9 and controlled drugs are not ermitted to (e rescri(ed on *D! reeat disensing% E% Batch issues ma$(e ket ($ the atient until the$ are disensed% 9:>% !hingles is caused ($ 'hat t$e o# in#ection%%% A% Candida albicans B% Duman Pailloma @irus C% Deres oster 1% !taph aureus E% !almonella thyphi 995% The (est treatment #or an adult 'ho is a(out to dri.e/ 'ith 4/ uncomlicated/ mos0uito (ites is2 A% Paracetamol ta(lets B% D$drocortisone cream C% "usidic acid cream 1% Benzocaine cream E% Piriton 99:% The ru(ella .irus has the most serious e##ect on) A% An elderl$ atient% B% A regnant 'oman% C% A ne'(orn in#ant% 1% A #irst+trimester #oetus% E% An adolescent girl% 999% The usual exir$ date that should (e laced on a cream reared in a harmac$ is) A% : 'eek B% 9 'eeks C% ? 'eeks 1% 'eeks E% :9 'eeks 99% There is a restriction on the amount o# seudoehedrine a harmac$ can sell in a single transaction (ecause) A% -t can easil$ (e con.erted to cocaine% B% -t is a su(stance o# misuse% C% -t can (e con.erted to methamhetamine% 1% -t can (e concerted to *1MA% E% -t can (e con.erted to ecstas$% 99?% Thiamine is other'ise kno'n as 'hich B .itamin2 A% : B% 9 C% 1% ; E% :9 994% Toical roducts #or acne ma$ contain (enzo$l eroxide #or 'hich o# the #ollo'ing uroses) A% Antimicro(ial B% Emollient
C% Leratol$tic 1% Bactericidal E% Retinoid 99;% Toical roducts used in h$erhidrosis ma$ contain aluminium chloride as a 6an7) A% Moisturiser B% Antiersirant C% Astringent 1% Anti#ungal E% Barrier rearation 99<% =ou recei.e the #ollo'ing rescrition) To (e reim(ursed ($ the PPA 'hat amendment must (e made ($ the doctor2
A% !&! B% ACB! C% &! 1% *C3! E% 1*G 99% Warts are cause ($%%% A% %%%Tinea pedis B% %%% #apilloma virus C% %%%Candida albicans 1% %%% /erpes simple E% %%%Corpus molluscum 99>% What cut o## oint is considered a higher than normal temerature in a health$ #emale2
A% Q9;C B% Q5C C% Q;C 1% QC E% Q?5C irections Summarised " .'/'0
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95% Which one 6s7 o# the #ollo'ing de#initions 'ould (e the (est #or an in#luenza andemic out(reak2% :% An out(reak o# the .irus% 9% A glo(al sread o# the disease% % A national out(reak o# the .irus% 9:% What is the go.ernment set maximum recommended le.el o# alcohol that can (e consumed in one 'eek ($ a #emale2 A% :? units B% : units C% 9: units 1% 94 units E% 9> units 99% What is the MA-* side e##ect o# 3rlistat2 A% !teatorrhoea B% Deadaches C% 1i.erticulitis 1% Deatitis E% Rectal (leeding 9% When a drug is administered as a solid oral dosage #orm/ the last rocess 'hich occurs is) A% A(sortion B% Excretion C% 1issolution 1% -onisation E% Meta(olism 9?% When do $ou re#er in resects to atients 'ith c$stitis #or the #irst time2 A% A 9 $ear old man% B% A 'oman 'ith more than a da$ old/ mild c$stitis% C% A #emale atient on ramiril% 1% A :; $ear old 'oman% E% A 49 $ear old 'oman% irections Summarised " .'/'0
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94% When #illing rescritions to the PPA the (ack o# the rescrition does need to (e #illed in/ in
'hat circumstance 6to o(tain correct reim(ursement72 :% The atient is o.er <5 $ears old and the date o# (irth is rinted on the #ront% 9% The atient is under :; and the date o# (irth is rinted on the #ront% % The atient is under : and the date o# (irth is rinted on the #ront 9;% Where does the =ello' Card scheme get reorted to2 A% BP!A B% *!A C% PCT 1% The strategic Dealth authorit$ E% MDRA 9<% Which is not a common treatment #or arasites2 A% Benz$l (enzoate B% Benzo$l eroxide C% Crotamiton 1% Permethrin E% -n.ermectin 9% Which normal tissue is eseciall$ lia(le to (e damaged ($ c$totoxic drugs2 A% Brain B% !kin C% E$e .asculature 1% Gut musosa E% Bone 9>% Which o# the #ollo'ing acti.e ingredients is *3T used #or management o# cough2 A% Guahenisin B% 1extromethorhan C% Pholcodine 1% @itamin C E% -ecchuana 9?5% Which o# the #ollo'ing BM-s 'ould (e considered clinicall$ under'eight2 A% :%4 B% 95 C% 94 1% 5 E% 4 9?:% Which o# the #ollo'ing conditions is *3T caused ($ a (acterial in#ection2 A% !eticaemia B% !ca(ies C% Endocarditis 1% Peritonitis E% -metigo 9?9% The maximum amount o# Resonsi(le Pharmacists that can (e recorded at one time is2 A% : B% 9 C% 1% ? E% 4
9?% Which o# the #ollo'ing has no lace in the treatment o# menoause2 A% L= ,ell$ B% E.ening Primrose 3il C% -so#la.ones 1% @itamin A E% Black cohosh 9??% Which o# the #ollo'ing is *3T an in#lammator$ mediator2 A% Brad$kinin B% Distamine C% &$mhokines 1% CCL E% &$sosomal enz$mes 9?4% Which o# the #ollo'ing is articularl$ use#ul in a h$ogl$caemic reaction2 A% !'eet/ orange lozenges B% "i(re C% 3range concentrate 1% Bread E% !alad 9?;% Which o# the #ollo'ing medicines is most likel$ to cause diarrhoea2 A% Actal B% Aludrox C% Asilone 1% Bismag E% entrota(s 9?<% Which one o# the #ollo'ing is a classical dro's$ anti+histamine2 A% &oratidine B% Cetirizine C% 1esloratidine 1% Chlorhenamine E% Mizolastine 9?% Which one is a legal re0uirement on a rescrition #or ethidine 45mg ta(lets2 A% Printed name o# a doctor% B% 8uantit$ ma$ not exceed 5 da$s% C% 1ose in 'ords and #igures% 1% -t can (e 'ritten as a standard ri.ate rescrition% E% Cannot (e a car(on co$% 9?>% Which o# the #ollo'ing is a good source o# @itamin A2 A% &i.er B% Pulses C% 3ranges 1% Lidne$ E% All o# the a(o.e% 945% Which one o# the #ollo'ing #ood roducts ma$ ha.e an e##ect on 'ar#arin -*R le.els2 A% Cheeses B% Marmite C% "ish 1% Green .egeta(les
E% Digh #at #oods 94:% Which one o# the #ollo'ing her(al remedies could (e used to treat the s$mtoms o# the menoause2 A% Cran(err$ B% Echinacea C% Black Cohosh 1% Ginseng E% Green tea 949% Which one o# the #ollo'ing is a true statement a(out (aclo#en) A% -t is a rostaglandin% B% -t is a corticosteroid% C% -t is a skeletal muscle relaxant% 1% -t is a non+steroidal anti+in#lammator$ drug% E% -s related to aracetamol% 94% Which 3*E o# the #ollo'ing is not good ad.ice to gi.e to a 'oman su##ering #rom c$stitis2 A% 1rink large 0uantities o# #luid% B% Routinel$ ensure the (ladder is emtied% C% Emt$ the (ladder a#ter sexual intercourse% 1% Use sodium icosul#ate to de+cloud the urine% E% 1rink lent$ o# cran(err$ juice% 94?% Which one o# the #ollo'ing need to kee CP1 records2 A% Pharmac$ Technicians% B% Counter assistants% C% All 'orkers associated 'ith heling disense medicines% 1% *o one aart #orm the harmacist% E% The manager o# the harmac$% 944% Which one o# the #ollo'ing .itamins is a retinoid2 A% @itamin L B% @itamin A C% @itamin B 1% @itamin C E% @itamin E 94;% Which one o# these is *3T generall$ considered a s$mtom o# direct re#erral in an other'ise health$ atient2 A% @ertigo% B% 1i##icult$ assing urine% C% @omiting once 'ith unkno'n cause% 1% Chest ain% E% A ersistent cough #or more than 9 'eeks% 94<% Which o.er+the+counter roduct is indicated #or acute constiation2 A% -modium B% "$(ogel C% Laolin and morhine 1% &actulose E% 1ulcolax
irections Summarised " .'/'0
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94% Mr% , is a regular customer o# $ours% De regularl$ resents $ou #or a rescrition #or medicines #ollo'ing his renal translant% -n 'hat situation could $ou (reach the atients con#identialit$2 :% To Mr% ,s artner 'ho is 'orried a(out him% 9% To a ,udge 'ho is assing sentence on Mr% ,% % To a hosital doctor 'ho is treating his artner as she accidentall$ took some o# Mr%,s medicines and there ma$ ha.e (een an o.erdose%
94>% A atient come into $our harmac$% -n 'hich i# the #ollo'ing instances should $ou gi.e a non rescrition medicine instead o# re#erring to a suita(le ractitioner2 :% A 'oman 'ith (lurred .ision% 9% A man 'ith ain in his e$e% % A 'oman 'ith an itchiness on her e$es sur#ace%
9;5% What does the #ollo'ing medical a((re.iation mean + AC2 A% At night% B% Use 'ith caution% C% A#ter #ood% 1% Be#ore #ood% E% With #ood% 8uestions ::5 to ::? concern the #ollo'ing asthma treatments A% !almeterol B% !al(utamol C% Theoh$lline 1% !odium cromoglicate E% "luticasone !elect #rom A to E a(o.e/ 'hich one o# the drugs) 9;:% -s o#ten re#erred to as a Orelie.erO% 9;9% Das an increased meta(olism 'ith to(acco% 9;% Can cause oral thrush% 9;?% Das a narro' theraeutic index% 1irections #or 0uestions ::? to ::;% "or each num(ered 0uestions select the one lettered otion a(o.e it 'hich is most closel$ related to it% 8uestions 9;4 to 9;< concern the #ollo'ing h$ertensi.es)
A% Ramiril B% Atenolol C% "urosemide 1% 1oxasozin E% Meth$ldoa !elect #rom A to E a(o.e 'hich is the correct #or each statement) 9;4% !hould (e used in caution in dia(etes due to the masking o# h$ogl$caemic s$mtoms% 9;;% -s used to treat gestational h$ertension% 9;<% -s also indicated #or use in (enign rostatic h$erlasia% 1irections #or 0uestions 9; to 9<5% "or each num(ered examles o# atients in a harmac$ select the one lettered otion a(o.e it 'hich is the most aroriate course o# action% A% Re#er the atient to a medical ractitioner 'ithout dela$% B% Recommend aroriate non+rescrition treatment and ad.ise the atient to see a medical ractitioner i# s$mtoms ersist #or/ or 'orsen during/ the next #i.e da$s% C% Recommend aroriate non+rescrition treatment or medication and ad.ise the atient to see a medical ractitioner i# s$mtoms ha.e not imro.ed in one 'eek% 1% Reassure the atient and ad.ise that the condition 'ill imro.e on its o'n 'ithout an$ inter.ention% E% Reassure the atient and ad.ise that the condition 'ill imro.e i# the aroriate li#est$le ad.ice is #ollo'ed% !elect #rom A to E a(o.e) 9;% A atient 'ho descri(es a red/ sore e$e that is roducing a $ello' discharge and has no other s$mtoms% 9;>% A atient 'ho descri(es a sudden ache in one e$e/ (lurring o# .ision and seeing a halo around lights% 9<5% A atient descri(es a small red lum on the edge o# the e$elid 'hich aeared the da$ (e#ore% 8uestions 9<: to 9< concern the #ollo'ing .itamins) A% @itamin A B% "olic Acid 6@itamin >7 C% @itamin C 1% @itamin 1 E% @itamin L !elect #rom A to E 'hich o# the a(o.e .itamins) 9<:% 1e#icienc$ in 'hich ma$ result in night (lindness 6n$ctaloia7% 9<9% Aids in the intestinal a(sortion o# iron #rom lant sources% 9<% -s necessar$ #or the s$nthesis o# 1*A (ases in cell roduction%
8uestions 9% Chloramhenicol e$e ointment% 95% *$statin :mgml oral susension% 8uestions 9: to 9? concern ad.ice that might (e gi.en to atients 'ho are concerned a(out their medication or s$mtoms) A% Ad.ise the atient to sto taking the medication and see their GP as soon as ossi(le% B% Ad.ise the atient to see their GP as soon as ossi(l$ as the dose o# their medication ma$ need to (e increased% C% Ad.ise the atient to see their GP as soon as ossi(le as the dose o# their medication ma$ need to (e decreased% 1% Ad.ise the atient that the s$mtoms the$ are exerience are not kno'n to (e caused ($ their medication% E% Ad.ise the atient that the$ are exeriencing a side e##ect o# the medication% -t is sa#e to continue taking their medication (ut the$ ma$ 'ish to mention it to their GP or ask #or an alternati.e% !elect #rom A to E a(o.e/ the (est otion #or each o# the #ollo'ing statements) 9:% A atient taking ramiril re0uesting something #or an irritating/ tickl$ cough% 99% A atient taking #luoxetine re0uesting something #or nausea% 9% A atient re0uesting something to relie.e a sore throat and is taking sul#asalazine %
9?% A distressed atient descri(ing in.oluntar$ mo.ements and is taking riseridone% 94% Mr% D is seeking ad.ice a(out this 'i#e/ Mrs% D 6aged 57% The$ ha.e just returned #rom their holida$ in Australia and Mrs% D is comlaining o# a sti## in#lamed lo'er leg% De sa$s it is 0uite red and hot% !he is not taking an$ medication excet the oral contraceti.e ill/ What is the most aroriate ad.ice2 A% Make an aointment to see her GP% B% !ell i(uro#en ?55mg and tell her to take it regularl$ #or #i.e da$s% C% !ell asirin #or 1@T roh$laxis% 1% Recommend that she #ollo's the R-CE aroach and seek #urther ad.ice i# no imro.ement a#ter se.en da$s% E% !eek medical hel immediatel$% 9;% Which o# the #ollo'ing eole are 'ithin limits o# the recommended dail$ alcohol intake according to the 1eartment o# Dealth guidelines2 A% : $ear old #emale 'ho drinks ints o# ordinar$ strength cider #our da$s a 'eek2 B% ;4 $ear old male 'ho drinks 9 measures 694m-7 o# 'hiske$ three da$s a 'eek C% 5 $ear old #emale 'ho drinks 9 glasses 6:<4ml7 o# 'ine six da$s a 'eek 1% ?5 $ear old male 'ho drinks 9 ints o# Osuer strengthO lager three times a 'eek E% 4 $ear old #emale drinks u( measures o# .odka and (ottles 69<4ml7 o# OalcoosO once a 'eek% 9<% 3# 'hich o# the #ollo'ing doses 'ould $ou consider to contact the rescri(er2 A% Asirin >55mg 81! B% Aciclo.ir 955mg #i.e times a da$ C% 1igoxin 945mcg B1 1% 1iclo#enac 45mg T1! E% Methotrexate 95mg er 'eek 9% =ou are a harmacist indeendent rescri(er running an anticoagulant clinic 'ithin $our local health centre% The #ollo'ing atients ha.e taken 'ar#arin #or a num(er o# months and their -*R has remained sta(le% Which atient do $ou think is the most likel$ to re0uire closer monitoring/ assuming that other #actors remain constant2 A% 4; $ear old male 'anting to cease smoking and has started using nicotine atches% B% ;5 $ear old male starting on sim.astatin to reduce serum cholesterol% C% ;? $ear old #emale increasing the strength o# her J(ro'n inhalerK due to an exacer(ation o# her asthma% 1% <5 $ear old male increasing his insulin dose to control h$ergl$caemia% E% ; $ear old #emale taking aracetamol intermittentl$ #or cold s$mtoms% 9>% Whilst 'orking #or a health centre $ou ha.e the oortunit$ to measure atients (lood ressure and gi.e ad.ice% =our #irst atient is an o.er'eight/ ?4 $ear old/ Caucasian male% 3n resentation he seems a(solutel$ #ine/ $ou measure his (lood ressure and ulse and the machine reads as #ollo's) )P .A@84 Pulse A@ )P+
What is the (est course o# action2 A% Call an am(ulance immediatel$% B% Ring #or a doctor right a'a$% C% &ie the man do'n in the consultation room% 1% !it the man do'n and reeat the reading in 4 minutes% E% Redo the reading immediatel
%$ 9>5% Which o# the #ollo'ing is not legall$ re0uired on the disensing la(el o# a rescrition onl$ roduct2 A% *ame o# the atient% B% 1ate o# disensing% C% The name and address o# the harmac$% 1% Lee out o# reach o# children% E% The name o# the rescri(er% 9>:% According to the ,oint British Guidelines 9554 on re.ention o# cardio.ascular disease/ 'hich o# the #ollo'ing statements is "A&!E2 A% Beta+(lockers are #irst+line treatment o# h$ertension #or dia(etics% B% &iid regulating drugs should (e considered #or an$one 'ith a :5 $ear c ardio.ascular risk o# more than 95% C% All atients should (e gi.en ad.ice on li#est$le changes to hel reduce their h$ertension regardless o# 'hether or not drug thera$ is gi.en% 1% A non+dia(etic atient should aim #or a BP o# :?5 >5mmDg% E% "irst+line treatment #or h$ertension in 45 $ear old Caucasian is an ACE -nhi(itor% 9>9% Which o# the #ollo'ing statements regarding the 3TC sale o# -migran is incorrect2 A %Patients should (e counselled on the ossi(ilit$ that it ma$ cause dro'siness% B% -t is licensed to (e sold #or atients aged (et'een : and ;4 $ears% C% =ou should ad.ise that one ta(let is to (e taken as soon as migraine s$mtoms are aarent and another can (e taken an hour later i# necessar$% 1% -t can onl$ (e sold to atients 'ho ha.e re.iousl$ (een diagnosed 'ith migraine% E An$one o.er the age o# 45 'ho ha.e ne' resenting s$mtoms o# migraine should (e re#erred to their GP #or #urther in.estigation% 9>% Which o# the #ollo'ing medicines are *3T used to treat the s$mtoms o# d$sesia2 A% Co+henotroe B% Cimetidine C% Magnesium trisilicate 1% &ansorazole E% 1omeridone 9>?% Which o# the #ollo'ing statements regarding the data+rotection act is "A&!E2 A% Pharmacists can charge #or administration costs i# a atient re0uests a co$ o# their PMR% B% An$ re0uest #or in#ormation must (e made #ormall$ in 'riting to the data controller% C% A arent o# a $oung child ma$ re0uest data on (ehal# o# their child 'ithout ermission o# that child% 1% The data+rotection act co.ers the collection o# data on a PMR 'ithin a harmac$% E% A re0uest #or a co$ o# a atients PMR #rom that atient must (e acted on immediatel$% 9>4% Mrs% = (rings a rescrition #or isoniazid and $ridoxine #or the treatment o# tu(erculosis% !he is curious as to 'h$ the $ridoxine has (een added% Which ad.erse e##ect o# isoniazid can (e re.ented ($ the use o# $ridoxine2 A% !eizures% B% Atroh$ o# the mucous mem(ranes% C% !kin rash% 1% Corneal micro deosits% E% Periheral neuroath$% 9>;% Which o# the #ollo'ing is correct/ regarding the sul$ o# #entan$l atches 6C1 !chedule 97 against a ri.ate rescrition2
A% An entr$ in the C1 register is not legall$ re0uired (ut it is a legal re0uirement to record the sul$ in the P3M register% B% The rescrition is .alid #or : 'eeks #rom the date on the rescrition% C% All rescrition details need to (e hand'ritten% 1% -t is illegal to disense i# not rescri(ed on a standardised #orm% E% 3nl$ a rescri(ers re0uest #or an emergenc$ sul$ is ermitted% 9><% Mrs% A@ has .isited $our harmac$ to ask ad.ice a(out 'eight loss% 3n 0uestioning she states that her height is :;5 cm and 'eighs ;kg% What is her BM- and 'eight classi#ication2 A% 94 + normal B% 9 + o.er'eight C% 9; + o(ese 1% 5 + o(ese E% 9< F o.er'eight 9>% Which o# the #ollo'ing atients are exemt #rom *D! #or rescrition charges2 A% A 4; $ear old on car(imazole 4mg ta(lets% B% A ?> $ear old using *o.oRaid% C% A ;5 $ear old using a !al(utamol inhaler% 1% A 9 $ear old taking Airin ta(lets on income suort% E A :4 $ear old taking 1ianette% 9>>% Which one o# the #ollo'ing rescrition errors #or schedule 9 controlled drugs could not legall$ (e amended ($ a harmacist 6assuming that $ou are satis#ied that the rescrition is genuine and $ou are satis#ied 'ith the rescri(ers intentions72 A% Total amount in 'ords omitted #rom rescrition/ (ut total amount in #igures resent% B% Patients surname is selt incorrectl$% C% Total amount in #igures omitted #rom rescrition/ (ut total amount in 'ords resent% 1% M!T rescri(ed (ut rescri(er has omitted the #orm% E% D$dromorhone selt incorrectl$% 55% Which item re0uires the endorsement O!&!O ($ the rescri(er2 A% Letoconazole 9 shamoo B% Microg$non 5 ta(lets C% Ensure Plus 1% *izoral 6ketoconazole7 cream E% Temazeam :5mg ta(lets 5:% 3n a !aturda$ a#ternoon/ a atient re0uests a sul$ o# the emergenc$ oral contraceti.e% =ou intend to sell the &e.onelle 3ne !te rearation/ (ut in 'hich o# the #ollo'ing situations should $ou not sul$2 A% A 9? $ear old 'oman 'ho has had unrotected sex/ and has missed t'o concurrent Micronor ta(lets% B% A ?> $ear old 'oman 'ho had unrotected sex in the last 9? hours% Der last eriod 'as t'o months ago (ut a recent regnanc$ test 'as negati.e% C% An : $ear old girl 'ho has had unrotected sex t'ice% The #irst time 'as #i.e da$s ago and the second time 'as $esterda$% Der last eriod 'as three 'eeks ago and she has not taken an$ other EDC% 1% A :; $ear old girl 'ho has had unrotected sex in the last ? hours and regularl$ takes #luoxetine% E% A ; $ear old 'oman 'ho is taking amitrit$line #or neuroathic ain and has had unrotected sex in the last da$% 59% While 'orking in a communit$ harmac$ $ou recei.e a rescrition #or the #ollo'ing
medication% Regarding the dosage o# each o# the medicines/ 'hich one is least likel$ to (e correct2 A% "lucloxacillin 455mg 81! B% !al(utamol inhaler 955mcg 81! rn C% "errous sulhate 955mg T1! 1% Risedronate 4mg 51 E% Enalaril :5mg 51 5% Which o# the #ollo'ing drugs does not commonl$ cause constiation2 A% 1iazeam ta(lets B% Aluminium h$drochloride ta(lets C% Codeine ta(lets 1% @eraamil ta(lets E% Misorostol ta(lets 5?% Mr% MW has come into $our harmac$ asking #or something #or his red/ itch$ e$es% 3n 0uestioning/ he is not taking an$ other medicationN his e$es are 'orse in the morning and in the e.eningN and he is also comlaining that he kees sneezing and his nose is .er$ itch$% What is the most aroriate treatment otion #or this atient2 A% Chloramhenicol e$edros B% &oratadine ta(lets C% Re#erral to his GP 1% D$romellose e$e dros E% Proamidine isetionate e$e dros 54% Which o# the #ollo'ing medication should *3T (e used #or eczema2 A% D$drocortisone : cream B% Calciotriol 45mcgg ointment C% Chlorheniramine ?mg ta(lets 1% A0ueous cream E% Tacrolimus 5%5 ointment 5;% Which o# the #ollo'ing statements is -*C3RRECT2 A% @itamin L has a s$nergistic e##ect on 'ar#arin% B% inc can aid the a(sortion o# .itamin C% C% @itamin 1 increases the utake o# calcium in the (ones% 1% @itamin B toxicit$ can cause to neurological s$mtoms% E% 1uring regnanc$ retinol consumtion should (e a.oided% 5<% Which o# the #ollo'ing concerning *!A-1s is -*C3RRECT2 A% Patients taking lithium should a.oid taking *!A-1!% B% Asirin has an irre.ersi(le e##ect on latelets% C% *!A-1s ha.e anti+$rexial and anti+in#lammator$ action% 1% Patients are ad.ised to take *!A-1s 'ith #ood E% *!A-1 use is contra+indicated in asthmatics 5% A #emale atient resents 'ith a ne' rescrition #or Microg$non/ one ta(let each da$% Der PMR sho's that she recei.es a regular rescrition #or ox$tetrac$cline 455mg B1% Which o# the #ollo'ing is the most aroriate counselling issue to mention 'hen handing out the ne' rescrition2 A% A.oid taking this medication 'ith roducts containing calcium such as milk and dair$ roducts% B% =ou must 'ait #or $our next menstrual eriod (e#ore taking the Microg$non or use a contraceti.e #or the #irst se.en da$s% C% A.oid consumtion o# alcohol%
1% Take this medication a#ter #ood% E% =our contraceti.e ill 'ill (e ine##ecti.e #or the #irst three 'eeks/ so $ou should use other recautions during this eriod o# time% 5>% Which o# the #ollo'ing counselling oints 'ould *3T (e aroriate 'hen talking to a atient a(out their azathiorine ta(lets2 A% =ou 'ill need regular (lood tests 'hile taking this medication% B% =ou should in#orm $our doctor i# $ou de.elo an unexlained sore throat% C% =ou should in#orm $ou doctor i# $ou de.elo an unexlained rash% 1% =ou should a.oid coming into contact 'ith an$one 'ith chicken ox% E% =ou ma$ #eel dro's$ 'ith this medication and i# a##ected $ou should a.oid dri.ing or using machiner
%$ Chapter .@- Calculation MC8s :5% A : & in#usion o# otassium chloride 5%> is (eing gi.en o.er 9 o# a 9? hour da$% -# the rate set is 9: dros er minute 6:ml is 95 dros7 o.er 'hat time 'ill the in#usion run2 A% :4 hours and 49 minutes B% :; hours and 49 minutes C% :4 hours and :9 minutes 1% :? hours and 49 minutes E% :9 hours and ?9 minutes ::% A :9 $ear old child recommended dose o# drug = is ?mgkgda$% What is each dose strength i# the rescrition states J88DK #or a atient 'ho 'eighs ;5kg2 A% ?5 mg B% :5 mg C% 95 mg 1% ;5 mg E% 95 mcg :9% A 9 solution o# a (enzo$l eroxide contains) A% 9 mg in :55 m& B% 95/555 mg in : & C% 955 mg in : m& 1% 9 g in : m& E% 955 mg in :55 m& :% A child is gi.en a susension containing 9mgml o# lidocaine% The doctor has seci#ied :5ml tds #or a 'eek% 3.erall/ ho' much 'ill the child recei.e2 A% :54 mg B% :%54 mg C% ?95 mg 1% 9%: g E% ?%9 g :?% A child is to recei.e an in#usion o# insulin at a rate o# 5%: unitskghr% The s$ringe um contains 45 units o# insulin in 45ml o# a standard saline solution% at 'hat seed in mlhr should the um (e set at #or a child 'eighing ?5 kg2 A% : mlhr B% 9 mlhr C% ? mlhr 1% ; mlhr E% mlhr :4% A child 'eighing 4%; kg re0uires ce#alexin at a dose o# :55 mgkg dail$ in #our di.ided doses% The onl$ #ormulation a.aila(le is 455 mg .ials 'hich are reconstituted to 9ml% Do' much o# the solution does the atient need er dose2 A% 5%: ml B% 5%?4 ml C% 5%4; ml 1% 4%; ml E% ::%9 ml :;% What is the 'eight o# lithium contained in a 55mg ta(let o# 5 lithium car(onate2 6one
molecule o# lithium car(onate contains t'o lithium atoms/ one car(on atom and three ox$gen atoms7% 6&i S 5 mg E% ; mg :<% A 1octor rescri(es diazeam to a 5kg% -t is to (e gi.en as :5mcgkghr% =ou are gi.en an in#usion (ag that contains :55ml o# a : mg in :55ml solution% Do' long 'ill the in#usion last at the gi.en dose2 A% : hour B% :%94 hours C% :%4 hours 1% 9%5 hours E% %5 hours :% A 1octor rescri(es digoxin to a 5kg% -t is to (e gi.en as :5mcgkghr% =ou are gi.en an in#usion (ag that contains : mg in :55ml% What is the dro rate 6dro er minute7 to (e gi.en 65%54ml S : dro72 A% 95 dros B% 9< dros C% ?; dros 1% 44 dros E% ;> dros :>% A drug has a clearance o# ? &h ho' much 'ill (e remo.ed #rom the (od$ in 9? hours i# the serum concentration is ?mg&2 Gi.e $our ans'er to the nearest t'o signi#icant #igures% A% 5% g B% % g C% % mg 1% 5%? mg E% 5% mg 95% A drug has a hal# li#e o# < hours% The drug is administered intra.enousl$ and a t5 the lasma le.el is ;mcgml% What 'ould the lasma le.el (e a#ter 9? hours2 A% %4 mcgml B% :%94 mcgml C% 9% mcgml 1% ?%>9 mcgml E% <%94 mcgml 9:% The concentration o# ammonia in a solution is 5%94 m '. ho' man$ litres 'ould contain 9mg o# ammonia2 A% : B% 9 C% ? 1% E% :; 99% A elderl$ lad$ is to recei.e an in#usion o# insulin at a rate o# 5%: unitskghr% The s$ringe um contains 45 units o# insulin in 45ml o# a standard saline solution% at 'hat seed in mlhr should the um (e set at #or a lad$ 'eighing 5 kg2 A% : mlhr
B% 9 mlhr C% ? mlhr 1% ; mlhr E% mlhr 9% A atient is admitted to A and E 'hilst $ou are on dut$% The atient took an o.erdose o# heroin and arri.es in a coma% -t 'ill not (e ossi(le to treat the atient (e#ore drug lasma le.els #all (elo' :5mg&/ the hal# li#e o# the drug in this articular atient is : hours% =ou measure her lasma le.el and $ou #ind that it is ? mg&% Do' long 6to the nearest hour7 until $ou can treat her2 A% :> hours B% 9> hours C% > hours 1% ?> hours E% 4> hours 9?% A atient is gi.en the #ollo'ing reducing dose o# diazeam/ 'hat 0uantit$ o# drug/ in grams/ 'ill the$ recei.e o.er the duration o# the treatment2 Ta*e A x 4mg on day one to t6o' ta*e 4 x 4mg on day three to four' then ta*e 0 x /mg for the remainder of the 6ee*2
A% 5%5? g B% 5%:9> g C% 5%:4 g 1% 5%:? g E% 5%::: g 94% A atient is rescri(ed 5%mmhr 1% :9mmhr E% :4mmhr 9<% A s$ringe dri.er is set to deli.er 95ml o# a : in ?55/555 solution o# diazeam o.er hours/ ho' man$ milligrams 'ill the atient recei.e o.erall2 A% 5%54 mg B% 5%4 g C% 5%: ng 1% : g E% : mg 9% A s$ringe dri.er reads that a drug W is (eing administered at a rate o# %4mlhr% The la(el on the attached drug reads 945mg in 45ml% The atient 'eighs ;5kg/ 'hat aroximate dose o# drug is
the atient recei.ing in mcgkgmin2 A% ? B% 9 C% ; 1% E% :5 9>% A ta(let contains the #ollo'ing ingredients) Chlorphenamine 3mg ylomata>olide /@mg +a*e up to 3@mg 6ith lactose2
Do' much lactose is re0uired to make :5/555 ta(lets2 A% 5%9 kg B% 5%:; kg C% 5% kg 1% :; g E% :%; kg 5% Add Add $ou are 'orking as an extemoraneous harmacist and $ou recei.e the #ollo'ing rescrition)
=ou are charged 'ith creating the ta(lets #rom scratch/ as the atient has allergies to all exciients in commerciall$ a.aila(le rearations% The #ormulation is as #ollo's) ;5mg morhine sulhate/ 9mg magnesium stearate/ Make u to :45mg 'ith cellulose% When the cellulose dries out a#ter the ta(let has (een stored the anh$drous .ersion o# cellulose 'ill (e :4 less in mass% What 'ill the resulting mass o# the ta(let (e a#ter storage2 A% ::;%9 mg B% :5:%9 mg C% >%; mg 1% :;% mg E% :9;% mg 9% Do' man$ millimoles o# sodium ions are there in 9 &itres o# !odium Chloride 5%>2 A% 55 B% 955 C% :55 1% 45 E% 4 % Working Working in a harmac$ as a harmacist/ $ou recei.e the #ollo'ing rescrition)
The lo'est strength rearation a.aila(le to $ou are :9%4mg ta(lets/ each 'eighing <4mg/ a#ter discussion 'ith the rescri(er/ $ou decide to sul$ 955mg o'ders each containing %:94mg o# catoril using lactose as the diluent% What 'eight o# lactose needs to (e added to the ta(lets to sul$ the exact amount re0uired on the rescrition2 A% :4%:94 g B% 9:%<4 g C% 99% g
1% 9%;94 g E% 9?%<4 g ?% "or drug R/ the recommended dose is 94mg er metre s0uared% ,ohn !mith a atient/ 'eighs <5 kg and is :%4 metres tall% What dose is re0uired making the assumtion the atient is a s0uare2 A% ?;%94 mg B% 4%4; mg C% :4%9> mg 1% <>%:? mg E% ?4%5 mg 4% - 'eigh 5 kg and m$ height is :%< M/ 'hat is m$ BM-2 A% 9<%: B% 9<%< C% 9;% 1% 94%9 E% 9>%> ;% -# the theraeutic drug is i s :5mgkgda$/ :5mgkgda$/ ho' man$ 945mg :55ml in#usion (ags should (e disensed #or a atient 'eighing <:kg #or one da$% A% : (ag B% 9 (ags C% (ags 1% ? (ags E% 4 (ags <% -n resects to the (etamethasone contained in the #ollo'ing rearations ho' man$ Betno.ate+ R1 5g do $ou re0uire to ha.e the same amount o# (etamethasone as in one ack o# 5g Betno.ate2 A% : ack B% 9 acks C% ? acks 1% acks E% :; acks % What .olume o# 'ater should (e mixed 'ith <5 ethanol to reare <55ml o# 95 ethanol2 A% 455 ml B% 45 ml C% <45 ml 1% >5 ml E% 95 ml >% 3.er a :9hr eriod/ 'hat 0uantit$ o# car(amazeine 'ould $ou recommend #or a child o# < $ears/ 'ho is a standard 'eight #or his age and should recei.e 955mcgkghr dose2 A% 44%9 mg B% 5%449 mg C% 44%9 mcg 1% ::5%>9? mcg E% :%>9? g ?5% The .olume o# distri(ution 6@d7 is de#ined as 6(ioa.aila(ilit$ x salt #raction x dose7 di.ided ($ the concentration% -# the (ioa.aila(ilit$ is : the dose is ?g/ the salt #raction is 9 and the concentration is 9mg& 'hat is the @d2 A% &
B% :55 & C% 955 & 1% :555 & E% ?555 & ?:% What does the #ollo'ing a((re.iation iml$) / #d ac /8./
A% Take t'o #our times a da$ mitte%?? B% Take t'o e.er$ #our months mitte%?? C% Take t'o #our times a da$ (e#ore #ood mitte% ?? 1% Take t'o #our times a da$ 'ith #ood mitte%?? E% Take t'o #our times a da$ on an emt$ stomach mitte ?? ?9% What 0uantit$ o# acti.e ingredient is re0uired to manu#acture a (atch o# granules #or a comressed ta(let 'here the (atch size is ?95 Lg and ta(let mean 'eight i# <55 mg 6acti.e ingredient content is ;55 mg7% A% :5 Lg B% ;5 Lg C% 95 Lg 1% 9>5 Lg E% 5 Lg ?% A graduated s$ringe o# hearin has a concentration o# 95/555iuml% What .olume o# a 5%
1% %? kg E% ? kg ?<% =ou are asked to reare a 45mgml o# drug #or injection% 455 mg o# .ancom$cin is a.aila(le in a .ial% The dislacement .alue #or 'hich is 5%;ml er : gram% What .olume o# diluent should (e added to create the rescri(ed dose2 A% >%< ml B% :5 ml C% %; ml 1% :5%ml E% >%? ml ?% =ou are tr$ing to 'ork out $our BM-/ $ou 'eigh :9 stone and are ; #oot 9 inches 'hat is $our aroximate BM-2 A% 95 B% 99 C% 9? 1% 9; E% 9 ?>% =ou need to create 5 g o# : h$drocortisone cream% =ou ha.e h$drocortisone cream 9% Do' man$ grams o# the 9 cream could (e diluted 'ith 'hite so#t ara##in to reare this order2 A% :4 g B% 5 g C% 5%:4 g 1% 5%4 g E% :%4 g 45% =ou need to gi.e :g amoxicillin orall$ each da$ o.er a eriod o# a 'eek% =ou ha.e a 945mg4ml susension/ 'hat .olume do $ou need #or ? da$s treatment2 A% 5 ml B% 5%5; & C% 5 ml 1% 5%; & E% 5%5; ml 4:% =our #riend/ a consultant o# gastroenterolog$/ calls $ou on :9+5;+5> a nd tells $ou a(out a atient% De had 'ritten the #ollo'ing rescrition) balsala>ide capsule /2/4g ) mitte 384/
3n :9+54+5> and the atient has (een using it consistentl$ #or the ast month% Which one o# the #ollo'ing is correct2 A% The atient recei.ed :; casules o# (alsalazide <45mg% B% The atient recei.ed ? casules o# (alsalazide <45mg% C% The atient recei.ed ?9 casules o# (alsalazide <45mg% 1% The atient recei.ed <9 casules o# (alsalazide <45mg% E% The atient recei.ed 9?9 casules o# (alsalazide <45mg% 49% What 'eight o# calcium rematine is re0uired to roduce 55ml o# a solution such that 94ml o# this solution diluted to 9555& gi.es a 5%4m solution2 A% 9? mg B% :9 g C% :9 mg
1% ; g E% ; mg 4% What #entan$l transdermal dose is e0ui.alent to :5mg o# morhine salt dail$2 A% :9 atch B% 94 atch C% 45 atch 1% :55 atch E% 955 atch 4?% A atient has just had a consultation 'ith a doctor% The doctor said to the atient to ask in a harmac$ ho' much corticosteroid cream the$ need to (e treated #or 9 'eeks #or (oth hands% =ou olitel$ o(lige and sa$%%% A% :4+5 g B% 5+;5 g C% ::4+:5 g 1% 9:4+95 g E% ?:4+?5 g 44% A ne' drug called !u(unetex comes onto the market/ it comes as 5%;mg su(lingual ta(lets% -t is an ta(let #orm oioid artial antagonist and has the e##ect o# (eing <5 acti.e in comarison to methadone solution% A atients current dose is 5ml o# :mg4ml Methadone dail$ and their doctor rings to ask $our ad.ice% De had heard o# this ne' !u(unetex drug and 'ondered ho' much he should rescri(e #or a 'eek/ 'hat do $ou recommend2 A% < ta(lets 'eekl$ B% :55 ta(lets 'eekl$ C% 9: ta(lets 'eekl$ 1% 9 ta(lets 'eekl$ E% ?9 ta(lets 'eekl$ 4;% !tretom$cin is a.aila(le in 9g .ials% A doctor rescri(es stretom$cin 55mg -M 31% Each .ial has a dislacement .alue o# 5%ml% The nurse adds %9ml W"- to reconstitute the .ial% Do' man$ ml o# the reconstituted solution must the nurse administer to the atient2 A% 9%45ml B% :%ml C% :%;>ml 1% 9%94ml E% :%;5ml
Chater ::) "ns6ers "ns6ers for Open )oo* Section "ns6er
Comment
:
B
@aloid is a (rand name #or c$clizine% -t can (e used in the treatment o# la($rinthine disorders%
9
A
=ou can #ind a list o# all JE num(ersK at the (ack o# the B*"%
C
=ou can #ind this in#ormation ($ looking u $ridoxine in the B*" index and re#erring to the .itamin section% P$ridoxine has (een associated 'ith neuroath$ at high doses%
?
A
1omeridone is least likel$ to cause d$stonic reaction as it is least likel$ to cross the (lood (rain (arrier% Check the B*" in relation to drugs used in the treatment o# nausea and .ertigo%
4
1
-ratroium is correct as the amount resent in the (lood is ro(a(l$ too small to (e harm#ul%
;
B
ACE inhi(itors are reno'ned #or causing renal #ailure%
<
1
!olian is a (rand o# amisulride% This is not commonl$ rescri(ed as it has no' (ecome generic%
A
The onl$ route o# administration is .ia su(cutaneous intramuscular injection or in#usion/ this can (e #ound ($ checking the di##erent #ormulations o# the drug resented in the B*"%
>
1
Gentamicin is incorrect/ it cannot (e gi.en to regnant 'omen/ tetrac$cline causes dental discolouration/ trimethorim theoreticall$/ a #olate antagonist and there#ore teratogenic% Ce#alexin is the (est choice in this circumstance%
:5
C
1i.ide ($ :5 then multil$ ($ % ie 6>5:57 x S 9< mg
::
A
This is 0uite a simle calculation ro(lem% To ans'er the 0uestion $ou must re#er to the Jiron content o# di##erent iron saltsK ta(le 6this should (e tagged in $our B*" #or 0uick access7% The ans'er is :%9g/ as it cannot (e an$ o# the others% ;55mg o# #errous sulhate is e0ui.alent to :95mg o# #errous iron% There is 4mg in 55mg o# #errous gluconate 'hich e0uates to :954 S %?% Which is a(out 55mg x %4 S :%54g the closest ans'er to 'hich is :%9g%
:9
B
This in#ormation can (e #ound in the morhine salt con.ersion ta(le in the B*"%
:
E
-n this case it is (est to look u J(edsoresK in the B*"% "rom this $ou should #ind that the (est treatment is to use a (arrier rearation such as !udocrem%
:?
B
Acti0/ is the onl$ rearation here 'hich is #ormulated in to a lozenge% The actual rearation looks much like a lollio and is use#ul #or atients 'ho ha.e oromucosal diseases%
:4
B
This is a .er$ trick$ situation% Adrenaline should onl$ (e administered i# there is no alternati.e a.aila(le% -n this case the am(ulance 'ill (e dela$ed so there reall$ is no other otion% The (est 'a$ to go a(out this 0uestion is to look in the B*" index under Janah$laxisK this 'ill (ring $ou to a ta(le illustrating dose o# intramuscular adrenaline% The ta(le sho's a ;+:9 $ear old child should (e gi.en 945 mcg 'hich is otion B%
:;
E
3nl$ oral anti+arrh$thmic drugs are considered% !ee the B*" + Management o# arrh$thmias%
:<
B
ACE inhi(itors can cause angiodema% This could (e #ound out ($ searching each drug in the (ack o# the B*" and search #or their di##erent side e##ects%
:
B
ACE inhi(itors interact 'ith diuretics% Check the (ack o# the B*" in the interactions section%
:>
E
94mg is the maximum 'eekl$ dose that should (e taken o# MTI% Remem(er that the dose should (e taken WEEL&= oosed to dail$ or monthl$ this is a common little trick in the exam%
95
A
As the drugs are atient returned C1s there is no need to 'ait #or an aroriatel$ aointed erson to disose o# the medication% "urthermore/ it is good ractice to kee a register o# these drugs although it is not a legal re0uirement% Patches can (e destro$ed ($ eeling o# the rotecti.e #ilm and #olding them in hal# and then denaturing them 'ith a aroriate denaturing kit%
9:
C
This is 'hat is stated in the B*"/ the other sources do not reresent secialised in#ormation%
99
E
This is the drug o# choice 'hen emesis is resent 'ith EDC use%
9
B
The easiest 'a$ to check this is to look in the 1rug Tari##%
9?
E
!eating #or atients in a harmac$ is otional% All the other otions are a legal re0uirement 'hich need to (e #ul#illed% These include a consulting room i# MURs are to (e conducted/ no romotional o##ers on drugs such as (u$ one get one #ree/ oening hours should (e consicuousl$ disla$ed/ hot and cold running 'ater in the disensar$% These are all set out ($ the MEP%
94
1
@ets/ ($ la' are not allo'ed to make emergenc$ re0uests% The main ractitioners 'ho can make emergenc$ re0uests are doctors and dentists%
9;
A
The (est method o# o(taining in#ormation on lactation is to re#er to the (reast #eeding section in the (ack o# the B*"% !earching through all o# them highlights ergolide as ossi(l$ suressing lactation%
9<
A
Ariirazole causes the reduction o# lactation/ check the B*" in the (reast #eeding aendix #or more details%
9
C
=ello' #e.er .accines onl$ last #or :5 $ears/ check the B*" #or more details%
9>
C
The CP1 c$cle includes Re#lection Q Planning Q Action Q E.aluation% Contemlation is not included in the c$cle/ an illustration o# the CP1 c$cle can (e #ound in the MEP%
5
B
This is not art o# the standards/ it is art o# good ractice%
:
C
1ox$c$cline is a chelator and there#ore/ is a##ected ($ metal ions 'hen it is (eing a(sor(ed% -ron 'ill e##ect the a(sortion o# 3RA& dox$c$cline and .ice .ersa% The (est 'a$ to get this in#ormation is to re#er to the interaction section in the (ack o# the B*" scrolling do'n sho' that this interaction is not a serious ad.erse reaction 6i%e% not a (lack dot7 (ut it does occur%
9
C
Rashes and ruritis are common during antith$roid treatment% -t can (e managed siml$ using an antihistamine%
B
Pri.ate rescritions must (e retained #or 9 $ears #rom the date at 'hich the$ 'ere recei.ed%
?
B
95mg dail$ is the starting dose #or 3C1% Check the B*" #or the latest guidelines%
4
C
This is not routinel$ gi.en to children in the UL%
;
1
Although this is still a +cillin it is the main alternati.e in these circumstance/ this in#ormation can (e #ound #rom the B*" section on enicillin resistance%
<
C
Check the (ack o# the B*" #or a((re.iations%
1
This 0uestion is a little trick$% 3#ten students 'ill jum to clarithrom$cin and look under conditions that it can treat ho'e.er/ this ro.es un#ruit#ul% The (est 'a$ to do this is to look #or MR!A 6Methicillin resistant !taphylococcus aureus) in the index and this 'ill gi.e $ou the seci#ic regimen 'hich $ou can search through%
>
E
Phen$toin cannot (e used in a(sence seizures%
?5
A
&e.onorgestrel 6&e.onelle7 is a Progestogen% Check the B*" #or more details%
?:
A
&i.er tests should (e conducted e.er$ 9+ months%
?9
C
All nitrates such as Gl$cer$l trinitrate can cause headaches as a side e##ect% This is thought to do 'ith .asodialation o# .asculature in the (rain%
?
E
Penciclo.ir ma$ (e sold in a harmac$ 'hen the strength does not exceed :% "urther in#ormation can (e #ound in the MEP%
??
1
utodate%org%uk is the o##icial 'e(site #or recording CP1/ this can (e #ound in the (ack o# the MEP% Make sure that $ou kee u to date 'ith this 'e( address as it ma$ change in the #uture as ne' legislation de.elos%
?4
1
Because o# their antimuscarinic side e##ects/ henothiazines should not (e used ($ atients 'ith closed angle glaucoma as this ma$ make the condition 'orse% This can (e #ound under contra+indications although $ou should ha.e this as $our o'n kno'ledge #or the closed (ook exam%
?;
A
Caution is ad.ised 'ith all *!A-1s 'ith atients 'ho su##er #rom renal imairment%
?<
E
-n general all nitrates can (e used #or angina ains/ 'hereas ACE inhi(itors cannot%
?
B
This should (e recorded e.er$ da
%$?>
1
*!A-1s articularl$ diclo#enac/ are #irst line treatments #or rheumatoid arthritis%
45
B
#thirus pubis is the &atin term #or cra( lice% The 'ord that gi.es it a'a$ here is J pubisK 'hich is the &atin root #or the 'ord u(ic 'hich seci#ies the area 'hich cra( lice in#ect%
4:
1
The Meth$lated !irits Regulations can (e #ound in the MEP/ make sure $ou kno' ho' to #ind them
49
C
Theoh$lline should (e taken 'ith #ood% This in#ormation ma$ (e #ound in the (ack o# the B*" under cautionar$ la(els%
4
B
4 mg dail$ is the correct dose #or secondar$ roh$laxis% ?55 mcg is #or rimar$ roh$laxis #or regnant 'omen 'ho do not ha.e a ast histor$ o# gi.ing (irth to children 'ith the condition%
4?
A
Correct/ $ou can onl$ (e a(sent #or 9 hours in one 9? hour shi#t/ irrele.ant o# 'ho is the harmacist%
44
1
The suerintendent must ensure that a harmac$ remises has a resonsi(le harmacist 'hen oen%
4;
C
As a resonsi(le harmacist $ou ma$ lea.e the remises #or u to t'o hours (ut $ou must (e contacta(le%
4<
A
This in#ormation can (e #ound in the interactions section o# the B*" under anti#ungals and imidazoles%
4
C
Grae#ruit ,uice interacts 'ith sim.astatin the red herring here is cran(err$ juice 'hich interacts 'ith 'ar#arin%
4>
A
Check the items that a dentist can rescri(e in the 1rug Tari##%
;5
A
This is an !!R- used seci#icall$ in deression%
;:
C
&ook in the index o# the B*" #or orh$rias/ there is a list 'hich sho's all drugs 'hich are unsa#e to rescri(e%
;9
C
Un#ortunatel$ in this 0uestion the onl$ 'a$ to get the ans'er is to go through each drug indi.iduall$% "rom $our o'n kno'ledge $ou can ro(a(l$ eliminate all (ut #usidic acid and gentamicin so this should (e a good lace to start%
;
1
Ce#otaxim is the correct ans'er here/ this can (e #ound .ia the B*"%
;?
A
This can (e #ound in the in#ections section o# the B*"%
;4
E
Chlordiazeoxide is the (enzodiazeine o# choice #or treatment o# alcoholism%
;;
1
"olinic acid is another 'ord #or #olic acid this can (e used to rotect against methotrexate side e##ects%
;<
C
Burenorhine is a schedule drug this can (e checked in the MEP%
;
E
-nitial management o# G3R1 6acid re#lux7 is 'ith the use o# antacids to neutralise the acid and gi.e de#inite diagnosis%
;>
C
All o# them are c$totoxic excet ciclosorin%
<5
1
The age o# the atient i# under :9 is a legal re0uirement on all rescritions%
<:
1
C!M ad.ice seci#ies that this is the (est choice o# treatment in under : $ears old%
<9
E
This increases lasma concentration%
<
E
Clarithrom$cin is the drug o# choice chosen ($ the Thorasic !ociet$ #or an uncomlicated chest in#ection%
E
A ro and con section o# each t$e o# hormonal contracetion can (e #ound at the (eginning o# each o# the contraceti.e su(+sections in the B*"%
<4
1
This is not classi#ied as serious interaction%
<;
C
This is occasionall$ used ho'e.er/ it is generall$ not aroriate as earl$ imro.ement is generall$ not 'ell maintained%
<<
B
&oratidine is a non+dro's$ antihistamine/ although/ it can cause dro'siness in a small ercentage o# atients%
<
A
!moking interacts 'ith theoh$lline administration% More in#ormation can (e o(tained #rom the interaction section o# the B*"%
<>
C
Warning 'hich need to (e 'ritten on la(els can (e #ound in the (ack o# the B*"%
5
A
This is a simle 0uestion/ look u (eza#i(rate in the index o# the B*" and $ou 'ill #ind it is a #i(rate in the liid+regulating drugs section%
:
E
A com(ined oral contraceti.e 6C3C7 is a drug 'hich contains (oth a rogesteron and an oestrogen such as #emodette% The other contraceti.es are examles o# rogesterone onl$ contraceti.es 6P3Cs7%
9
B
Ana(olic steroids are !chedule ? drugs% This can (e checked in the MEP%
E
All the others are lia(le to cause a #all excet me#enamic acid% "or instance citaloram can cause h$onatraemia 'hich can lead to #alls%
?
A
Ranitidine is the (est ans'er here as all the other drugs mentioned are (est to a.oid during (reast #eeding% Ranitidine can (e #ound in a signi#icant amount in milk that is roduced (ut it is not kno'n to (e harm#ul%
4
A
3ne sachet three times a da$ is correct this can (e #ound in the B*" under dosage #or c$stitis%
;
A
An eas$ 'a$ to remem(er this is that 'ar#arin is a .itamin L antagonist and is classi#ied as an anticoagulant% There#ore/ i# $ou turn this around .itamin L should (e used #or clotting 'hich is needed in haemorrhagic disease%
<
A
Meningitis is the in#lammation o# the meninges 'hich is art o# the (rain and there#ore/ the C*!%
B
The main s$mtoms o# li.er disease are jaundice/ reduction in aetite/ (loating and distension/ ol$disia ol$urea/ #luid o.erload/ imaired drug meta(olism%
>
C
*D! items should (e deli.ered as romtl$ as ossi(le%
>5
1
The main s$mtoms o# Pol$c$stic 3.ar$ !$ndrome include) A(sent/ in#re0uent or irregular eriods/ in#ertilit$/ o(esit$/ hirsutism 6usuall$ around niles or the lo'er a(domen7/ aloecia and acne% D$erhiridosis 6or excess s'eating7 is not one o# these%
>:
1
U to date in#ormation ma$(e o(tained #rom the 1@&A 'e(site 6the url is on the inside #ront co.er o# the B*"7 #or seci#ic conditions some in#ormation is ro.ided% -n this case looking u dia(etes 'ill take $ou to the (eginning o# the endocrine section 'here $ou can #ind more in#ormation%
>9
C
;%4+<%4 is the otimum range #or DAB:C% Daemoglo(in A:c is also kno'n as gl$cated haemoglo(in% The le.el o# D(A:c re#lects the a.erage (lood glucose le.el o.er the ast months and is a good clinical indicator o# ho' success#ul gl$caemic thera$ is%
>
A
3nce the atient has ox$gen saturation o# o.er $ou should maintain the same dose%
>?
C
All 0uinolones should (e used in caution 'ith atients 'ith a histor$ o# eiles$ or conditions 'hich redisose atients to seizures%
>4
1
The #inal solution has :g in 555ml there#ore/ in the original solution $ou re0uire :g o.erall%
>;
C
This is 0uite a long 0uestion/ 'ith a lot o# irrele.ant in#ormation% The most imortant in#ormation is the drug regimen% To aroach this/ s$stematicall$ 'ork through the drugs in the interaction section in the (ack o# the B*"% There is a ossi(le interaction (et'een *!A-1! and sulhon$lureas (ut this is .er$ rare% There is also an interaction (et'een sulhon$lureas 6glilizide7 and #luconazole% "luconazole inhi(its P?45 isoenz$me C=P9C> 'hich meta(olises sulhon$lureas% This in turn 'ill cause an increased concentration o# the drug 'hich 'ill lo'er (lood glucose le.el accordingl$ hence the dizziness and h$ogl$caemia%
><
E
D-@ does not need to (e noti#ied to the Proer 3##icer% A list o# the diseases 'hich do can (e #ound at the (eginning o# the -n#ections art o# the B*"% These diseases are usuall$ ones 'hich are easil$ transmissi(le like the lague or cholera%
>
A
!odium retention o#ten occurs during steroid use this is (ecause o# their mineralocorticoid acti.it
%$>>
1
As recommended in the MEP as diazeam is not a schedule 9 or it can (e disensed against a #ax%
:55
A
A list o# all drug arahernalia that can (e sold in a harmac$ can (e #ound in the MEP%
:5:
C
&ook in the B*" under .accines and the note a(out h$ersensiti.it$ to eggs% The main .accinations that are contraindicated are $ello' #e.er/ tick (orne encehalitis and in#luenza%
:59
1
Each air incurs t'o charges/ there#ore o.erall there are ? charges to the atient%
:5
A
As this is one drug in 'ith the same #ormulations it is onl$ counted as one charge microg$non is a contraceti.e and there#ore is automaticall$ exemt%
:5?
B
These t'o medicines are the same drug (ut in t'o di##erent #ormulations there#ore incur searate charges% -# (oth #ormulations 'ere casules then onl$ one charge 'ould (e incurred%
:54
1
Check the notes on charges in the 1rug Tari##%
:5;
B
The medication should (e taken t'o and a hal# 'eeks (e#ore lea.ing and #or #our 'eeks a#ter lea.ing the endemic area% The dose is once 'eekl$ there#ore/ this e0uates to > ta(lets%
:5<
A
There is no such thing as natural immunit$ to malaria% E.en i# $ou li.ed in an endemic countr$ all $our li#e there is still a ossi(ilit$ that the$ ma$ catch the disease% As #or the dose/ Malarone should (e taken :+9 da$s (e#ore dearture/ once dail$ in the endemic area #ollo'ed ($ one 'eek uon returning to the lace o# origin%
:5
C
A .er$ lo' risk is resent in the Mekong Ri.er and roh$laxis is rarel$ recommended%
:5>
1
!e.redol is a controlled drug 'hich needs all these arameters #ul#illed #or sa#e storage%
::5
E
Check the MEP schedule lists #or more details%
:::
C
Burenorhine is a artial oioid antagonist 'hich does not ha.e man$ o# the restrictions laced on other oioids%
::9
1
Check the B*" section on intermediate and long acting insulins%
::
A
The Dum+ re#ix o#ten indicates that the insulin is a human analogue%
::?
C
Protamine sulhate is added to insulin rearations so that insulin comlexes are #ormed 'hich take longer to (reakdo'n and there#ore/ gi.e a longer lasting rearation%
::4
A
Metronidazole o# amoxicillin ma$ (e used #or ericoronitis/ check the B*" section on anti(acterial drugs%
::;
B
Ce#otaxime is a good alternati.e to (enz$lenicillin 'hich is the other anti(iotic 'hich ma$ (e used%
::<
1
&ook u gentamicin in the index o# the B*"% The monograh lists the di##erent indications and (acterial sensiti.ities%
::
C
Tetrac$cline (inds to (one and thus cannot (e gi.en to gro'ing children%
::>
B
The secies and remises at 'hich the animal is ket i# di##erent #rom o'ner are legal re0uirements (ut the condition is not% This is much the same as a rescrition #or a human%
:95
A
All o# the listed items can (e rescri(ed #or coeliac disease this in#ormation can (e #ound in the drug tari##%
:9:
1
Bihoshonates cannot (e used during regnanc$ as manu#acturers ad.ise that the$ should (e a.oided/ the$ also reduce the rate o# (one turno.er/ meaning (one degradation 'ill roceed at a slo'er rate%
:99
1
Although atients can sel# select G!& roducts/ P roducts cannot (e sel# selected and must (e (ehind a suita(le (arrier% P medicines ma$ onl$ (e sold a#ter re#erring to a harmacist%
:9
C
*!A-1s all cause cardio.ascular e##ects and gastrointestinal e##ects to .ar$ing
degrees% &ook at the C!M ad.ice in the B*" under *!A-1s% :9?
1
The onl$ .ia(le otion here are *urse indeendent rescri(ers/ the other otions indeendent harmacist rescri(ers and communit$ nurses cannot rescri(e controlled drugs%
:94
A
All these drugs interact 'ith car(amazeine/ check the interaction section in the (ack o# the B*"%
:9;
A
All o# these otions are co.ered ($ clinical go.ernance%
:9<
B
-*R targets di##er according to 'hat condition the atient has in general a target -*R is (et'een 9%4 and %5% War#arin is contraindicated in regnanc$ see the regnanc$ contraindication section in the B*"%
:9
A
Ri#amicin should not (e stoed unless the doctor ad.ises as this 'ould other'ise mean incomlete thera$/ ri#amicin colour the urine and should (e take a#ter #ood% This in#ormation can (e #ound in the 'arning la(els section in the B*"%
:9>
E
An$ in#ormation that is re0uired a(out in#usions can (e gathered #rom the intra.enous additi.es section in the aendix o# the B*"% ido.udine 6Retro.ir7 should (e gi.en intermittentl$ 'ith glucose 4%
:5
B
Both le.odoa and heno(ar(ital can cause agranuloc$tosis% 3ther drugs 'hich can cause this condition include Aminosalic$lates such as sul#asalazine/ car(imazole/ methotrexate/ clozaine/ car(amazeine and catoril% !ee the notes in the (ook a(out agranuloc$tosis and (lood d$scrasias%
::
E
Check the drug tari## on the notes on charges/ onl$ G$no+re.ar$l : CP ack 'ill recei.e an extra ro#essional #ee%
:9
B
"or de#initions and legislation relating to PG1s lease re#er to the MEP%
:
E
This 0uestion is a little edantic/ (ut the onl$ correct translation is o%m%+ omni mane + e.er$ morning% a%c% means ante cibum F (e#ore #ood/ t%d%s% means ter die sumendum F to (e taken three times a da$ oosed to t%i%d% ter in die 'hich means three times a da
%$:?
B
Both statements are correct (ut are unrelated to one another%
:4
1
1iazeam is a longer+lasting (enzodiazeine 'hereas/ temazeam has a much shorter duration/ there#ore this statement is #alse% The second statement is true as some atient reort aradoxical e##ects 'hilst taking (enzodiazeines%
:;
A
Both statements are correct and the second statement is a correct exlanation o# the #irst% This is (ecause !3Ps go.erning the disosal o# returned controlled drugs must (e carried out%
:<
B
Both statements are correct (ut the$ are unrelated as clindam$cin is not used #or oral in#ections (ut not (ecause o# the diarrhoea side e##ect (ut (ecause there are more e##ecti.e drugs a.aila(le%
:
1
Both statements are #alse check the asthma stage ladder in the resirator$ section in the B*"% &ABAs cannot (e used in children 'ith WE&& C3*TR3&&E1 asthma in stage three% Beclomethasone dirorionate C"C+#ree ressurised metered+dose inhalers do not need to (e rescri(ed ($ (rand/ unless a rorietar$ #ormulation is re0uired such as 8.ar%
:>
B
Both statements are true/ (ut are unrelated% The #irst statement asks a(out re+ registration #ees this can (e #ound in the drug tari##/ $ou should kno' that "or the second statement/ the (asic rice o# drugs section in the #ront o# the 1rug Tari## the right hand column seci#ies 'hich (randed drugs can (e disensed i# a genericall$ 'ritten rescrition is recei.ed%
:?5
C
The #irst statement is correct the second statement is #alse% -t is onl$ good ractice to get a signature #or sa#e receit unless it is a controlled drug%
:?:
B
The #irst statement is incorrect as it should (e reorted to the MDRA and the second statement is correct/ all reactions (lack triangle drugs should (e reorted%
:?9
B
MURs can onl$ (e carried out on a atient 'ho can easil$ communicate 'ith the harmacist% -n this case a 9 $ear old child ro(a(l$ cannot seak there#ore/ no MUR can (e conducted%
:?
1
Check the section in the B*" under neuroathic ain% Amitr$tilline is #re0uentl$ rescri(ed (ut is unlicensed%
:??
B
This in#ormation can (e #ound in the drug tari##%
:?4
1
Pauci(acillar$ leros$ should (e treated 'ith a ; month regimen% Check the B*" section on leros
%$:?;
A
Metronidazole is a #a.ourite o# dentists as it 'ill seci#icall$ treat anaero(ic (acteria 'hich is #ound in the mouth%
:?<
1
Check the MEP schedules #or medicine classi#ications%
:?
C
Cardio.ascular risk can (e calculated #rom the ta(les in the (ack o# the B*"%
:?>
E
The B*" lists an immunisation schedule 'hich details 'hich .accinations are to (e gi.en at 'hat age%
:45
1
A 99 $ear old/ long term/ chronic schizohrenic is not exemt and there#ore/ must a$ #or their rescritions% All the others should (e exemt these details can (e #ound in the drug tari## under notes on charges%
:4:
C
Check the introduction section o# the B*"/ under oral side+e##ects o# drugs%
"ns6ers for Closed )oo* Section "ns6er
Comment
:49
1
This is a rather simle case o# contact dermatitis% The (est thing to recommend in this situation is to a.oid the ossi(le cause o# the reaction in this case the red scar# and ma$(e gi.e an emollient% 3tion A F gi.e h$drocortisone is inaroriate as it 'ould (e outside the roducts license% 3tion B + Piriton 6chlorhenamine7 'ould not (e aroriate as the child came on his (ike and the drug ma$ make him #eel dro's
%$:4
E
"atigue% This is correct in t'o 'a$s% "irstl$ an$ (eta (locker ma$ cause #atigue as it is one o# their documented side e##ects% "urthermore/ roranolol is liid solu(le and enetrates into the C*!% This o#ten results in the reciitation o# (ad dreams 'hich in turn can 'orsen #atigue%
:4?
A
B: F Thiamine/ B9 F Ri(o#la.in/ B F *iacin *icotinamide/ B; $ridoxine/ B< F Biotin/ B> F "olic acid/ B:9 F C$anoco(alamin% Mnemonic + OThe Rh$thm *earl$ Pro.ed ContagiousO
:44
A
3ther'ise kno'n as m$algia this is one o# the more common side e##ect o# the statins%
:4;
1
A (lack triangle means that the drug is relati.el$ ne' and should (e monitored #or an$ unexected side e##ects that ma$ come #rom its use%
:4<
E
-rrele.ant o# age it is (ad ractice to rescri(e an anti+emetic 'ith out #irst kno'ing the cause%
:4
1
A (ro'n inhaler seci#ies that it is (eclomethasone% All inhaled corticosteroids ma$ cause oral candidiasis 6oral thrush7 as a side e##ect% -t is recommended that the atient should 'ash their mouth out a#ter use o# the inhaler%
:4>
1
Acne .ulgaris other'ise kno'n as acne is characterised ($ comedones other'ise kno'n as (lackheads% These are se(aceous glands or hair #ollicles in the skin 'hich (ecome clogged 'ith oils% 3ther characteristic #eatures o# acne include ustules/ nodules and aules%
:;5
B
Doarseness is the main disad.antage to using inhaled corticosteroids% Be 'ar$ here as in the exam the$ like to su(stitute the drug name #or the colour o# the inhaler i%e% a atient mentions their (ro'n inhaler F (eclomethasone/ (lue F sal(utamol/ urle F usuall$ a mix o# steroid and a (eta agonist%
:;:
B
A red/ in#lamed/ raised area is the correct ans'er% The #irst t'o 'ords F red/ in#lamed are .er$ generalised skin s$mtoms and could (e indicati.e o# man$ skin conditions% Do'e.er/ i# the area is raised this is a uni0ue #eature o# ring'orm%
:;9
1
An$ cough that lasts #or more than 9 'eeks should (e re#erred to the doctor% This is e.en more 'orr$ing as it has (een continuous #or the ast three 'eeks and is more ronounced at night this ma$ indicate asthma%
:;
E
This is a classic exam 0uestion and comes u almost e.er$ $ear% The atient is su##ering all the s$mtoms o# shingles% !hingles is a .iral in#ection caused ($ Deres oster .irus 6the same .irus that causes cold sores7% The usual rogression o# the disease is that as a child the .irus is contracted and exhi(its itsel# as Chickenox% 3nce this is resol.ed the .irus li.es dormant in ner.e cell (odies until later in li#e 'here it causes shingles%
:;?
1
Unless atient returns contain shars/ C1s or general G!& items then the$ should (e disosed o# using an aro.ed agent% This usuall$ takes the #orm o# a $ello' (in 'hich is stored in harmacies 'hich is icked u e.er$ #ortnight%
:;4
E
This is the correct ans'er although it seems a little harsh 1 'ould (e the onl$ other otion (ut $ou 'ould not gi.e menthol and eucal$tus #or a stu##$ nose as it is onl$ reall$ e##ecti.e #or cough%
:;;
E
Remem(er/ OThe Rh$thm *earl$ Pro.ed ContagiousO the #irst letter o# each 'ord corresonds to the main B .itamins in se0uence%
:;<
1
As the child is so $oung the onl$ thing $ou could recommend is saline dros% When these are gi.en out make sure that the guardian kno's ho' to use them e##ecti.el
%$:;
C
Rhinorrhoea/ is not usuall$ resent i# someone has a simle cough% The rest o# the s$mtoms are 0uite general and 'ould not indicate an$thing in seci#ic%
:;>
C
This is the (est ans'er as it is the harmacists and the suerintendents resonsi(ilit$ to make sure that the harmac$ record is ket u to date%
:<5
C
There 'as a scare in the earl$ 9555s 'here there 'ere claims that the MMR ja( caused autism this 'as re#uted and ro.en as clinicall$ incorrect%
:<:
1
The counter assistant is getting the t'o conditions o# c$stitis and thrush con#used% =ou should olitel$ inter.ene and tell the assistant ho' the$ made the error%
:<9
1
!neezing is the characteristic s$mtom o# allergic rhinitis%
:<
C
All retinoids can cause de#ects in #oetuses o# regnant 'omen% The$ should (e a.oided at all cost%
:
A
This is a common anti+muscarinic side e##ect o# the tric$clics%
:<4
C
There is a cross sensiti.it$ (et'een cehalosorins and enicillins o# a(out :5 there#ore/ the$ should not (e used as second line or the atient should (e closel$ monitored%
:<;
B
"lucloxacillin does not interact 'ith alcohol% Although alcohol at high le.els ma$ ro.e ro(lematic%
:<<
1
Although the other rearations 'ork the$ are not as e##ecti.e as 1EET% 1EET is the most e##ecti.e mos0uito reellant that can (e (ought in a harmac$ although there are some recent links to neurotoxicit
%$:<
1
@alium is an old rorietar$ name #or diazeam% The (rand is rarel$ rescri(ed as it has a generic e0ui.alent%
:<>
C
This is de#ined in the (ack o# this (ook in the lexicon%
:5
C
Anorexia is the decreased sensation o# aetite%
::
C
Unless in a critical condition/ no medicines should (e gi.en in the :st trimester o# regnanc
%$:9
A
Paracetamol 'ill hel 'ith the childs #e.er/ (ut a re#erral is needed as the$ ma$ need anti(iotics%
:
E
Tanning oil is not recommended #or eole 'ith #air skin% -t is recommended that eole 'ith #air skin al$ the highest !P" a.aila(le and al$ it as regularl$ as ossi(le%
:?
1
Re#er to the section on gout in this (ook #or contraindications and drugs that can (e taken%
:4
1
Permethrin is a common s$nthetic chemical/ 'idel$ used as an insecticide% -t has a use in harmac$ 'here it can (e used to com(at lice ho'e.er/ it is one o# the least e##ecti.e a (etter #irst line treatment is malathion%
:;
B
The B*" states that metronidazole should not (e taken 'ith alcohol as this roduces a disul#iram+like reaction 'hich includes nausea/ .omiting and #lushing o# the skin%
Alcohol consumtion should (e a.oided u to ? hours a#ter treatment% :<
C
Alignates act as a Jra#tK #loating on to o# gastric contents rotecting the oesohagus #rom acid gastric re#lux%
:
B
Please re#er to the section in this (ook entitled 1rug Tari##% The endorsement J&!K means limited sta(ilit$ and should (e alied to an$ roducts 'hich are disensed in art due to their limited sta(ilit
%$:>
A
A disul#iram+like reaction is one 'hich includes nausea/ .omiting and #lushing o# the skin%
:>5
B
:? da$s is correct% This can (e easil$ remem(ered i# $ou ha.e seen an "P:5 M1A it is a t'in sided rescrition 'hich has a counterart side to the rescrition% This contains :? su(di.ided lines/ allo'ing the harmacist to record ($ hand each time an item is disensed%
:>:
A
As a locum $ou must take $our GPhC certi#icate e.er$'here that $ou are emlo$ed as a harmacist% Also $ou must take 'ith $ou $our resonsi(le harmacist certi#icate%
:>9
1
The disenser cannot sell the roduct as it is classi#ied as a P medicine%
:>
B
Remem(er this #rom $our uni.ersit$ da$s2 This is a .er$ imortant concet to learn it relates to ho' much drug gets into the (lood and circulates around the (od
%$:>?
A
Bulk #orming laxati.es are al'a$s #irst line #or regnant 'omen as the$ do not enter the (lood stream% "or a list o# other medicines that a regnant 'oman can take lease look at the Jatients to look out #orK section in this (ook%
:>4
E
An$thing (elo' ;+
:>;
C
Post 6a#ter7 cu(icum 6#ood7 are &atin a((re.iations% The most common harmac$ &atin a((re.iations) ante cibum ?ac Be#ore meals/ bis in die ?bid T'ice a da$/ gutta ?gt 1ro/ hora somni ?hs At (edtime/ oculus dexter ?od Right e$e/ oculus sinister ?os &e#t e$e/ per os ?po B$ mouth/ pro re nata ?prn As needed/ #ua#ue 0 hora ?# 0 h E.er$ hours/ #ua#ue die ?#d E.er$ da$/ ter in die ?tid times a da$/ #uater in die ?#id ? times a da
%$:><
1
-n general this is correct/ ho'e.er it deends on 'hat t$e o# condition the atient has%
:>
C
Gingi.itis is the s'elling and soreness o# the gums that/ 'ithout treatment/ can cause ro(lematic gum ailments and disease%
:>>
C
-(uro#en has a use in d$smenorrhea/ mainl$ #or its analgesic roerties% 3ther drugs include co+codamol and naroxen/ also antisasmodics such as h$oscine are o#ten used%
955
C
The characteristic #eature o# imetigo is a golden crust 'hich can surround red/ in#lamed crust$ skin% Make sure $ou #amiliarise $oursel# 'ith 'hat it looks like/ check online #or more in#ormation% -tch$ #lak$ skin and #e.er are generalised s$mtoms and raised areas o# the skin o#ten indicates a #ungal in#ection such as ring'orm%
95:
1
Metocloramide is an e##ecti.e anti+emetic%
959
C
There is essentiall$ no limit to ho' man$ times $ou can take the morning a#ter ill in one c$cle% -t can (e taken u to <9 hours a#ter unrotected sex/ although its e##icac$ diminishes the longer the atient 'aits% -U1s are rescrition onl$ items (ut are a good alternati.e to EDC% Consultations can onl$ (e er#ormed ($ the harmacist and not ($ an assistant%
95
E
Re#er to the roduct license%
95?
C
Temazeam is a schedule drug and cannot (e gi.en as an emergenc$ sul$
954
E
=ou should 'ear long slee.es a#ter dusk as this is 'hen $ou are more likel$ to (e (itten% Adult #emales la$ their eggs in 'ater/ 'hich can (e a salt+marsh/ a lake/ a uddle/ a natural reser.oir on a lant/ or an arti#icial 'ater container such as a lastic (ucket% This cannot (e in mo.ing 'ater such as a ri.er%
95;
A
&egionellosis is an in#ectious disease caused ($ (acteria (elonging to the genus &egionella 'hich in#ect the resirator$ tract% Patients 'ith &egionnaires disease usuall$ ha.e #e.er/ chills/ and a cough/ 'hich ma$ (e dr$ or ma$ roduce sutum% !ome atients also ha.e muscle aches/ headache/ tiredness/ loss o# aetite/ loss o# coordination 6ataxia7/ and occasionall$ diarrhoea and .omiting%
95<
E
1iclo#enac 'ill not cause dro'siness% 3ioids/ mirtazeine and sumatritan 'ill cause a certain amount o# sedation%
95
E
This is a characteristic side e##ect o# ciro#loxacin% 3ther serious ad.erse e##ects that ma$ occur as a result o# ciro#loxacin thera$ include irre.ersi(le eriheral neuroath$/ sontaneous tendon ruture and tendonitis and ac ute li.er #ailure or serious li.er injur$ 6heatitis7%
95>
1
This is a common interaction 'ith 'ar#arin%
9:5
C
All *!"s do not ha.e to (e learned (ut $ou should kno' the most imortant ones% To check the ne'est de.eloments check the (ack o# the MEP%
9::
C
The *D! 1irect ser.ice mainl$ concentrates on chronic long+term conditions%
9:9
B
This seems to (e the most aroriate course o# action%
9:
C
Paracetamol has a de.astating e##ect on the li.er in o.erdose% Research sho's that the common threshold #or li.er damage to occur #rom a single aracetamol o.erdose is :4g 65 ta(lets7 although standard hosital guidelines allo' an extra sa#et$ margin and assume li.er damage could occur at a single o.erdose o# 9? standard ta(lets or :45 mgkg (od$ 'eight/ 'hiche.er is the smaller% "urthermore/ the o.erdose threshold ma$ (e lo'ered in a erson taking certain rescrition medicines/ or a erson 'ho is an alcoholic or is seriousl$ undernourished% -# the o.erdose is sread o.er a eriod o# time the threshold ma$ (e higher/ as the initial aracetamol dose is e##ecti.el$ meta(olised%
9:?
B
This is 0uite a di##icult 0uestion and relates (ack to harmacolog$ learnt at uni.ersit$% This cannot (e attemted 'ithout rior kno'ledge/ (ut the h$ertension otion can de#initel$ (e eliminated as this is 'hat the$ are used to treat% The ositi.e ionotroic e##ect can also (e ruled out as $ou kno' that the$ are calcium channel (lockers (lock the mo.ement o# ions reducing m$ocardial contractilit$/ in this sense $ou can also rule out otion E 6-ncreases sinoatrial and atrio.entricular node conduction7% This lea.es otions A and B/ .enoconstriction and arteriodilatation resecti.el$% The ans'er is otion B/ arteriodilatation%
9:4
A
Amiodarone has relati.el$ common side+e##ects% -ndi.iduals taking amiodarone ma$ (ecome more sensiti.e to the harm#ul e##ects o# U@A light% Using sun(lock that (locks U@A ra$s aears to re.ent this side e##ect% "urthermore/ long+term
administration o# amiodarone is associated 'ith a (lue+gre$ discolouration o# the skin% This is more commonl$ seen in indi.iduals 'ith lighter skin tones% The discolouration ma$ re.ert uon cessation o# the drug% Do'e.er/ the skin colour ma$ not return comletel$ to normal% 9:;
A
1imeticone is used in the treatment o# colic in in#ants%
9:<
B
As the atient is an in#ant/ normal saline is the (est otion here as it is harmacologicall$ inacti.e/ $et 0uite e##ecti.e%
9:
C
R1 6Batch issues7 do not need to (e signed ($ the rescri(er as long as the RA 6Authorising co$7 has (een signed%
9:>
C
!hingles is a .iral disease caused ($ Deres zoster .irus 6'hich also causes chickenox7% -t is characterised ($ a ain#ul skin rash 'ith (listers o#ten in a strie% -t sometimes causes chicken ox in children and the .irus la$s dormant till later in li#e 'here it can mani#est as shingles% Treatment can include analgesics/ steroids and anti+.irals%
995
B
Paracetamol 'ill not do an$thing #or this condition unless there is an$ associated ain/ #usidic acid 'ill not do an$thing unless the (ites are in#ected 6also this cannot (e gi.en out as it is a P3M7% Benzocaine cream could (e gi.en out (ut it is not usuall$ gi.en #or this urose and 'ould do nothing #or the in#lammation associated 'ith (ites% Piriton/ chlorhenamine 'ould not (e the (est choice as this can cause dro'siness and the atient is a(out to dri.e% There#ore/ h$drocortisone is the (est otion%
99:
1
The ru(ella .irus 'ill ha.e the 'orst e##ect on a #irst+trimester #oetus% Congenital ru(ella s$ndrome 6CR!7 can occur in a de.eloing #oetus o# a regnant 'oman 'ho has contracted ru(ella during her #irst trimester% -n#ants are not generall$ a##ected i# ru(ella is contracted during the third trimester/ or 9;+?5 'eeks a#ter concetion% Pro(lems rarel$ occur 'hen ru(ella is contracted ($ the mother a#ter 95 'eeks o# gestation%
999
C
? 'eeks/ this can (e #ound in the MEP%
99
C
Although uncommon in the UL methamhetamines can (e manu#actured #rom seudoehedrine% !ome areas are 'orse than others i# $ou are interested consult $ou local health authorit
%$99?
A
B: F Thiamine/ B9 F Ri(o#la.in/ B F *iacin *icotinamide/ B; $ridoxine/ B< F Biotin/ B> F "olic acid/ B:9 F C$anoco(alamin% Mnemonic + O The , h$thm Nearl$ Pro.ed ContagiousO%
994
C
Benzo$l eroxide is a keratol$tic 'hich increases skin cell turno.er/ ho'e.er it has a tendenc$ to 'hiten the skin and discolour clothing%
99;
B
Aluminium h$droxide is used in the treatment o# h$erhiridosis 6excessi.e s'eating7 as an antiersirant%
99<
A
To get roer reim(ursement/ !&! needs to (e 'ritten next to Cialis as it is a selected list su(stance% Do'e.er/ this rarel$ occurs as it is usuall$ automaticall$ rinted ($ the doctors comuter (ut 'atch out #or hand 'ritten rescritions
99
B
Warts are a .iral condition caused ($ the ailoma .irus%
99>
1
An$ temerature a(o.e C is considered a #e.er%
95
B
3ne and t'o are correct/ three is not% A andemic is a 'orld'ide out (reak o# a disease/ it is not national%
9:
A
According to UL guidelines/ #emales should consume no more than :? units or alcohol er 'eek%
99
A
!teatorrhoea is anal leakage o# an oil$ su(stance% This comes #rom the excess liid that is not a(sor(ed in the gastro+intestinal tract due to liase inhi(ition%
9
B
Pharmacokinetics2 Remem(er this at uni.ersit$2 Adsortion Q 1istri(ution Q Meta(olism Q Excretion%
9?
A
C$stitis is uncommon in men and should (e re#erred i# it is the #irst time the$ encounter the s$mtoms%
94
E
The ans'er to this 0uestion can onl$ (e the last otion in the three% The others do not need the (ack o# the rescrition #illed as the the reim(ursement (od$ kno' that the atient/ no matter their circumstance 'ill recei.e #ree rescritions% Whereas an : $ear old does not automaticall$ recei.e #ree rescritions/ the$ also need to (e in #ull time education%
9;
E
The MDRA controls the $ello' card scheme 'hich is used 'hen reorting susected drug reactions%
9<
B
Benzo$l eroxide is used in the treatment o# acne 'hereas the others are insecticidal%
9
1
Gut mucosa is lia(le to c$totoxic drugs as there is a high turno.er o# cells% C$totoxics in general 'ork ($ targeting these cells 6as malignant cancer usuall$ has a high cell turno.er7%
9>
1
@itamin C is not used clinicall$ in the management o# cough%
9?5
A
An$thing (elo' this #igure 'ould (e deemed under'eight/ ho'e.er/ this does not take into account #at or muscle
9?:
B
!ca(ies is an insect arasite that (urro's into the skin% !eticaemia is a (acterial in#ection o# the (lood/ endocarditis is a (acterial in#ection o# the heart/ eritonitis is a (acterial in#ection o# the gut 'all and imetigo is a (acterial in#ection o# the skin%
9?9
A
=ou can onl$ ha.e one RP at an$ one time%
9?
1
@itamin A has no lace in the treatment o# menoause% L= ,ell$ is used to treat .aginal dr$ness% E.ening rimrose oil/ iso#la.ones/ and (lack cohosh ha.e some limited clinical e.idence #or use in menoause%
9??
1
Gut mucosa is a #ast relicating cell% These t$e o# cells are a##ected most ($ c$totoxics%
9?4
C
-n a h$ogl$caemic reaction the most use#ul roducts are li0uid 6#or #ast release7 and high sugar/ such as orange concentrate%
9?;
1
Aluminium salts constiate 'hilst magnesium salts are laxati.es/ there#ore Bismag 6the name should gi.e it a'a$7 'ill ha.e a laxati.e e##ect and there#ore/ diarrhoea ma$ occur%%
9?<
1
Chlorhenamine is a classic dro's$ antihistamine% The (rand name is Piriton% The other otions are classi#ied as non+dro's$ although the$ can cause dro'siness in a small ercentage o# atients%
9?
E
3nl$ original rescritions are allo'ed/ an$ C1 needs a secialist #orm i# ri.ate/ onl$ the 0uantit$ needs to (e in 'ords and #igures% The 5 da$ rule and rinted name o# the doctor are onl$ good ractice/ not a legal re0uirement%
9?>
A
&i.er is the (est source o# .itamin A in this case%
945
1
Green .egeta(les such as ca((age and curl$ kale ha.e a high content o# .itamin L and there#ore/ can interact 'ith -*R le.els%
94:
C
The onl$ otion here is (lack cohosh as the others can (e eliminated% Cran(err$ is sometimes used #or c$stitis/ echinacea #or re.ention o# cold and #lu/ ginseng as a general tonic and green tea/ a simle antioxidant% Although the e.idence #or (lack
cohosh is not the (est/ it is the onl$ otion here 'hich is .ia(le% 949
C
Baclo#en is sometimes mistaken as an *!A-1% -t is a skeletal muscle relaxant%
94
1
The other otions ma$ hel 'ith c$stitis ho'e.er/ de+clouding the urine has nothing to do 'ith the condition%
94?
A
Technicians need to (e continuall$ u to date 'ith their kno'ledge and there#ore/ must articiate in CP1%
944
B
@itamin A is a retinoid%
94;
C
This could (e comletel$ innocuous%
94<
E
1ulcolax 6(iascod$l7 is indicated #or acute constiation%
94
C
=ou can onl$ gi.e out con#idential in#ormation i# it is a(solutel$ necessar$ i%e% in a li#e or death situation or re0uired ($ la' such as a court case% There#ore/ $ou can rationall$ eliminate A/B and 1% 3ut o# the remaining otions C is the most lausi(le%
94>
E
-tchiness on the sur#ace o# the e$es is not a s$mtom o# re#erral% The other t'o s$mtoms indicate there could (e something underl$ing and re0uires #urther in.estigation%
9;5
1
Ante cu(icum S (e#ore #ood%
9;:
B
!al(utamol is used 'hen re0uired/ to ease resirator$ ro(lems such as 'heezing and shortness o# (reath%
9;9
C
!ee B*" aendix :) interactions theoh$lline%
9;
E
3ne o# the main side e##ects o# inhaled corticosteroids is that the$ can cause oral thrush 6candidiasis7% -t is ad.ised that atients should rinse their mouth out 'ith 'ater or 'ash their teeth a#ter use%
9;?
C
Can (e toxic in high doses and lasma concentration needs monitoring%
9;4
B
!ee the B*" monograh #or atenolol/ most (eta (lockers can mask the e##ects o# h$ogl$caemia and th$rotoxicosis%
9;;
E
!ee aendix ? Pregnanc
%$9;<
1
Alha (lockers are used to treat BPD as the$ can reduce adrenergic acti.it$ in the rostate%
9;
B
The resented s$mtoms descri(e (acterial conjuncti.itis 'hich can (e treated 'ith chloramhenicol% Re#erral is re0uired i# there is no imro.ement 'ithin 9 da$s o# treatment%
9;>
A
!$mtoms descri(e acute glaucoma 'hich re0uires urgent re#erral as this can cause ermanent damage%
9<5
1
!$mtoms descri(e a st$e on the e$elid 'hich should resol.e 'ithout an$ inter.ention
9<:
A
@itamin A is stored in the rod+cells o# the retina and deletion o# these stores results in the e$es ina(ilit$ to adat to light changes%
9<9
C
@itamin C aids in the a(sortion o# iron in the gastrointestinal tract% -t is o#ten gi.en in com(ination rearations as iron is notoriousl$ oorl$ a(sor(ed%
9<
B
1e#icienc$ or inhi(ition o# #olic acid 6e%g% due to methotrexate7 results in the cessation o# cell roduction%
9
E
!ee the B*" monograh #or rednisolone%
9<4
A
!ee the B*" monograh #or lisinoril%
9<;
1
!ee the B*" monograh #or lithium%
9<<
B
1aktacort CREAM re0uires re#rigeration 'hereas the ointment does not%
9<
C
3x$codone is a schedule 9 C1 and re0uires sa#e storage%
9<>
A
Chloramhenicol ointment is sta(le at room temerature%
95
A
*$statin does not re0uire reconstituting and is sta(le at room temerature%
9:
E
A dr$ cough is a common ad.erse e##ect o# ACE inhi(itors% -t is not dose deendent and i# intolera(le the recommendation is to tr$ an alternati.e drug%
99
E
*ausea is a common ad.erse e##ect o# #luoxetine/ is dose indeendent and 'ill o#ten resol.e 'ithin t'o 'eeks o# commencing treatment%
9
A
C!M 'arning #or sulhasalazine) sore throat ma$ (e indicati.e o# agranuloc$tosis and re0uires re#erral%
9?
C
Patient descri(ing extra$ramidal e##ects that are dose+deendent%
94
E
!$mtoms descri(e otential 1@T 'hich re0uires urgent medical re#erral%
9;
B
1oD guidance o# recommended intake o# alcohol is no' in units per day 6not units er 'eek7) men +? units a da$/ 'omen 9+ units% : int ordinar$ strength lager S9 units : int o# suer strength lager S 4 units : u( measure o# sirit S: unit : standard glass o# 'ine S9% units : int ordinar$ strength cider S 9 units : (ottle o# alcoo S:%? units
9<
C
1igoxin dose should (e 31%
9
B
!im.astin is kno'n to increase anticoagulant e##ect o# 'ar#arin% 3ral corticosteroids can interact/ (ut inhaled there is no e##ect% Paracetamol can interact i# used continuousl$ o.er a long eriod o# time%
9>
1
The (est course o# action is to sit the man do'n #or a #e' minutes and then take another reading/ i# this reading is still high then #urther action 'ould (e necessar$ such as calling an am(ulance%
9>5
E
The name o# the rescri(er is not legall$ re0uired%
9>:
A
The use o# (eta+(lockers is cautioned in dia(etics due to the masking o# s$mtoms o# h$ogl$caemia%
9>9
C
3nce one ta(let has (een taken/ atient should onl$ take a #urther ta(let i# t'o hours has assed and i# s$mtoms return%
9>
A
Co+henotroe is licensed #or use in acute diarrhoea%
9>?
E
-n#ormation must (e gi.en 'ithin ?5 da$s o# re0uest
9>4
E
P$ridoxine is .itamin B; and used to re.ent eriheral neuroath
%$9>;
1
All ri.ate rescritions o# schedule 9 and C1s should (e rescri(ed on the standardized #orm% All in#ormation on C1s can (e #ound in the MEP%
9><
E
BM- S 9;%; there#ore classi#ied as o.er'eight%
9>
A
D$erth$roidism is not classi#ied as under a medical exemtion/ although h$oth$roidism is%
9>>
1
An$ amendments or additions o# date/ dose or #orm are not recognised as minor t$ograhical errors%
55
1
*izoral cream can (e gi.en to an$ atient 'ho needs treatment o# se(orrhoeic
dermatitis and it$riasis .ersicolor% 5:
C
EDC is ine##ecti.e to re.ent regnanc$ i# unrotected sex 'as more than <9 hours (e#ore Jthe incidentK% Coils 6-U17 are a more aroriate in this examle%
59
1
Risedronate 4mg is taken once 'eekl$/ not dail
%$5
E
Misorostol commonl$ causes diarrhoea not constiation% All the other drugs are commonl$ rescri(ed so $ou should (e a'are that the$ are associated 'ith constiation%
5?
B
The atient is most likel$ to (e su##ering #rom an allerg$/ so an antihistamine is most aroriate #rom the list%
54
B
Calciotriol is used in soriasis and not eczema%
5;
A
@itamin L is an antagonist to 'ar#arin%
5<
E
*!A-1 use is cautioned in asthmatics%
5
B
&ong+term anti(iotics do not a##ect ill a(sortion/ like'ise 'ith #ood or calcium or alcohol%
5>
E
Azathiorine is not kno'n to cause dro'siness% As a re+reg $ou should kno' a(out risk and signs o# (one marro' suression%
"ns6ers for Calculation (uestions "ns6er
Comment
:5
A
: & is :/555 ml 'hich is e0ui.alent to 95/555 dros% There#ore 95L9: is aroximatel$ :4%/ look at the otions there are t'o :4 hours otions one is (elo' :4 and :9 the other is a(o.e this/ there#ore it can onl$ (e this selection%
::
A
? I ;5 S 9?5mg er da$/ there are ; #our hour eriods in one da$ there#ore/ 9?5; is ?5 mg%
:9
B
95/555 mg in :555ml is the same as 9/555mg in :55ml 'hich is e0ui.alent to 9g in :55ml%
:
C
? I ;5 S 9?5mg er da$/ there are ; #our hour eriods in one da$ there#ore/ 9?5; is ?5 mg%
:?
C
5%: I ?5kg S ? units er hour% 45 units in 45ml is : unit in : ml% The child needs ? unit er hour there#ore/ the ans'er must (e ? mlhr%
:4
C
4%; I :55 S 4;5 mg dail$ in 64;5?7 :?5 mg doses% =ou ha.e a 455mg in 9ml solution% An estimation can (e er#ormed here there is 455mg in 9ml/ 945mg in :ml and :94mg in 5%4ml% =ou can sa#el$ assume the ans'er is just a(o.e 5%4ml% &ooking at the otions it can onl$ (e 5%4; ml%
:;
B
5 is :;5 F 55 S ;?5mg o# lithium car(onate% &ithium car(onate 'eighs 6
:<
B
:5 x 5 S 55 mcg er hour% There is :/555 mcg in :55ml% There#ore 6:555557 is :%94 hours 'hich is otion B%
:
B
55 mcg er hour 'hich is 655;57 S : mcg re0uired er minute% "ormulation contains :555 mcg er :55ml% Which is :5 mcg er ml% =ou re0uire then :%ml% :% 5%54 6dros er ml7 S 9;% The closest ans'er must (e B%
:>
A
? & x 9? 'ill (e ho' clearance occurs in 9? hours% This is >; litres% >; x ? is ? mg 'hich is e0ui.alent to 5% g%
95
A
E.er$ < hours the concentration o# the drug hal.es% i%e% ;9 S ?9 S :<9 S %4 mcgml%
9:
1
5%94 m means 5%94g in :/555/ 555 ml% Which is the e0ui.alent to 945mg% There#ore :/555/ 5555 945 x 9 is 555 ml% There#ore/ there is 9 mg in & o# solution%
99
E
This is an eas$ 0uestion/ 5%: x 5 is units er hour% The solution is 45 units er ml 'hich is : unit er ml% There#ore/ she needs ml er hours%
9
C
? 65 hours7 Q ?9 6: hours7 Q 9: 69; hours7 Q :5%4 6> hours7% The ans'er is a#ter > hours% Although this is not (elo' the re0uired :5 it is the (est ans'er in this case%
9?
1
6 x 47 x 9 S 5 mg% 64 x 47 x 9 S 45 mg% 6 x 97 x 6remainder o# the 'eek7 S :% There#ore 5 V 45 V : S :? mg 'hich is 5%:? g%
94
A
455 mcg is 5%4 mg er ml% This is 5%: mg er 5%9 ml% There#ore/ 5%9ml x < S :%? ml%
9;
A
The atient has to recei.e 9mg er hour 'hich is e0ui.alent to 5%4ml an hour% As a ercentage o# the total this is 5%44 'hich is :5% :5 o# the entire &E*GTD is 5%: x ; cm is 5%; cm 'hich is ;mm er hour%
9<
A
The 0uestion is reall$ asking 'hat 0uantit$ o# the drug is in 95ml o# a :g in ?55/ 555 ml solution% 5%4g in 955/555ml% 5%4 mg in 955ml 'hich is 5%54 mg in 95ml%
9
A
6%4I945745 :<%4 mghr% 6:<%4x:5557;5S 9>:%; then di.ide this ($ the atients 'eight ;5 kg
9>
B
?5+9? is the amount o# lactose er ta(let% :;mg x :5/555 ta(lets is :;5/ 555mg 'hich is :;5g% Which is 5%:; kg%
5
E
Trick$ 0uestion 'atch the units% 5%<4g V <4g V
:
1
The onl$ ingredient 'hich decreases in mass is the cellulose% As it looses 'ater/ mo.ing #rom h$drous to anh$drous/ mg dros to
9
A
This in#ormation can (e checked in the B*" in the section o# #luid and electrol$tes%
1
There seems to (e a lot o# irrele.ant in#ormation in this 0uestion% But $ou can assume that each o'der reresents one ta(let as it contains %:94mg o# catoril% There#ore/ $ou ha.e :>;%<4 mg o# lactose er ta(let% =ou need ? x 5 ta(lets% :95 x :>%<4 is 9%;94 g
?
B
Assuming that the atient is s0uare :%4m s0uared is %?994% The drug is administered er metre s0uare/ there#ore 94mg x %?994 is 4%4; mg%
4
B
:%% Then 5 di.ided ($ 9%> is in the late 9
;
C
<:5 mg is re0uired/ <:5945S 9%% =ou need more than t'o (ags and less than #our%
<
C
Betno.ate R1 is a ? times dilution o# the original rearation 5%594 instead o# : there#ore/ $ou re0uire #our acks%
A
This is a classic C:@: 0uestion% C:@:SC9@9/ <5 x .: S 95 x <55/ 695 x <557 <5 S 955 ml% !o $ou need 955ml o# the original solution to make <55ml 95/ so $ou need to mix <55 F 955 S 455ml%
>
C
!tandard 'eight o# a < $ear old is 9 kg o(tained #rom the (ack o# the B*"% !o/ 9 x 955 mcg is ?/;55 mcg er hour% :9 hours is re0uired so ?/;55 mcg x :9 hours S 44/955 mcg 'hich is 44%9 mg%
?5
E
: x 9 x ? S % This then must (e di.ided ($ the concentration% Do'e.er this is in mg% "irst $ou must con.ert the concentration to the correct units% -e 9mg er :555ml is 9:555 is 5%559% There#ore/ 5%559 is ?/555 &%
?:
1
9 0d ac 9:9% 9 x? 69 x 97% Take t'o #our times a da$ a#ter #ood 6or 'ith #ood7 mitte ??%
?9
B
The entire (atch 'eighs ?95kg% The ercentage o# acti.e ingredient is 6;55 <557% There#ore/ ?95/ 555 g x 6;55 <557 is ;5 kg%
?
C
Ans'er :9/555 di.ided ($ 95/555 S 5%;ml
??
B
The easiest 'a$ to calculate this 0uestion is to calculate 4 o# the entire amount and then deduct this #rom the total 0uantit$ 'hich is :9g% 4 o# :9g is 5%;g% There#ore >4 o# :9g is ::%?g%
?4
A
; hours is hal# li.es as ;9% 3ne the #irst hal# li#e there 'ill (e 45 on the second there 'ill (e 94 and on the third there 'ill (e :9%4%
?;
C
-# $ou con.ert #rom an anh$drous drug to a h$drous drug $ou 'ill al'a$s (e increasing the 'eight as $ou are adding 'ater% There#ore/ $ou re0uire :54 o# 55g 'hich is easil$ #igured out as :5 is 5g then 4 is ?5g/ there#ore adding 55g to ?5g $ou get ?5g%
?<
A
-# 5%;ml is dislaced ($ :g then hal# a gram 455mg dislaces 5%ml% =ou need to make a :5 times dilution there#ore/ the ans'er is :5+5%ml 'hich is >%
?
B
99 is the ans'er here as the 'eight in stone con.erts aroximatel$ to <;kg% The height con.erts to :%4m s0uared this is %?% <; di.ided ($ %? is aroximatel$ 99%
?>
A
=ou need recisel$ hal# the amount o# a 9 solution to make an e0ui.alent : solution%
45
C
=ou need 95ml dail$ o.er #our da$s% 95I? is 5ml%
4:
A
The atient recei.ed three <45mg casules t'ice a da$% There#ore/ ; casules dail$ #or #our 'eeks gi.es ;x9S:; casules%
49
C
9555ml o# a 5%4m 65%4g: 555 555ml7 contains :mg 'orking x9555S5%4: 555 555 so xS::5557%
4
C
This is a .er$ simle 0uestion% Check the B*" section Jrescri(ing in alliati.e careK there is a ta(le 'hich lists out morhine salts in comarison to #entan$l atches%
4?
A
&ook in the B*" under suita(le 0uantities o# corticosteroids/ no calculation is needed here%
44
B
5%;mg o# 'hich 65%;x<57 5%?9 is e0ui.alentl$ acti.e% The atient is taking ;mg o# methadone a da$ 'hich is ?9mg er 'eek% Do' man$ ta(lets does the atient need2 ?95%?9S:55 ta(lets
4;
E
!tes) 1islacement is 5%ml hence 'hen $ou add %9mls o# W"- $ou 'ill get total ?mls o# injection containing 9g o# !tretom$cin% ?ml S 9g so :g S 9ml so 55mg S 5%g S 5% I 9ml S :%;ml
1exicon- =ords to *no6222 • • • • • • • • •
Chemist nostrums + seen in MEP a lot/ means drugs made in a harmac$% Prodrome + a 'orring s$mtom 'hich roceeds an acute attack 6think angina ain and heart attack7% !tomatitis + -n#lammation o# the oral mucosa% !toma + a surgicall$ created oening% &o' *aV added a#ter some rearations in the B*" means that the sodium content is less than :mmol er ta(let% PEG + a tu(e through the a(domen into the stomach% Rha(dom$ol$sis + raid muscle deterioration seen 'ith statin side e##ect% Cholestatis + an inter#erence 'ith (ile #lo'% A%1%E%L + #at solu(le .itamins%
•
Ra$nauds !$ndrome + .asosasms causing restriction in (lood sul$ causing cold extremities%
•
•
Menieres disease + a disease o# unkno'n origin causing nausea and .omiting sometimes related to a distur(ance in the middle ear% Ierostomia ronounced Ozero stomiaO reduced sali.a secretions 6dr$ mouth7% !ina Bi#ida + a common (irth de#ect% Ascites + #luid in the a(domen%
•
@er$ solu(le means that Q:g o# su(stance dissol.es in :ml o# sol.ent%
•
Concentrate means I?5 strength o# the original solution % Eidural + an anaesthetic oeration during regnanc$ 'hich ro.ides ain relie# to the lo'er hal# o# the (od
%$• •
•
•
Risk% The 'ording in the B*" although it seems 0uite ar(itrar$/ ho'e.er/ it is 0uite seci#ic in its e.aluation o# risk o# side e##ect% These are the de#initions) @er$ common) More than :5 Common) :+:5 Uncommon) 5%:+:%5 Rare) 5%:+5%5: @er$ Rare) &ess than 5%5: -ts good to kno' the math (ehind these ercentages i%e% at least : in :5 eole 'ill exerience a .er$ common side e##ect o# drug%
%ndex "lphabetical %ndex Aciclo.ir%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;: Acne .ulgaris%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:> Acron$m%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9/ 9; A1Rs%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4 A#ter #ood%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 Agranuloc$tosis%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%44 Alcohol%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9?/ :?; Al#luzosin%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 Allourinol%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9? Amending errors%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%?9 Aminosalic$lates%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 Amiodarone%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9? Amisulride%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% B*" -ntroduction%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% :> Borderline !u(stances%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4 Bo'el cleansing%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9 BPD%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9< Broken Bulk/%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 4: Bulk+#orming laxati.es%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 Burorion%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9; Calamine%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% :< Calci#erol%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%: Calcium%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9 Calculation Ans'ers%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:? Calculation MC8s%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:99 Calculations and &ocum Checklist%%%%%%%%%%%%%%%; Casaicin%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%; Car(imazole%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9
Cardio.ascular !$stem%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 C1 registers%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%?9 Ce#aclor%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9? Celecoxi(%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 Central *er.ous !$stem%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%; Cerazette%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9> Cetirizine%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%: Chemical Reagents %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4 Chickenox%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% :< Children%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:4/ : Chloramhenicol%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;9 Chlordiazeoxide%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%94 Chloro#orm%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%?5 Chlorhenamine%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% : Cholestatic jaundice%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9 Cholesterol%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9 Cinnarizine%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;4 Ciro#loxacin%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 Clarithrom$cin%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9?/ 9 Closed Book Ans'ers%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%:> Closed Book Exam%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%< Closed Book MC8s%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%> Closed (ook timing%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% < Clotrimazole%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;4 Co+amoxicla.%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9 Co+danthamer %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 Cold and #lu%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4; Cold sores%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;: Com(ination MC8s%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Comuter skills%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% < Con#idential in#ormation%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:?4 Conjuncti.itis%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;9 Constiation%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:?%/ 4< Constiation in child%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% :4 Containers%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 4 Controlled 1rugs%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%?: Corticosteroids%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9; Coughs%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 44 CP1%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%< CPPE%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% < C$anoco(alamin%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%5% C$stitis%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;4 1econgestants%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4; 1eduction !cale %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4 1EET%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% :?5 1ental Prescri(ing %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4? 1eoPro.era%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9> 1eression%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9; 1esmoressin%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% : 1e.ils Cla'%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;;
1iarrhoea%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:4/ 4< 1ietar$ ad.ice%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;< 1i##icult$%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:5 1ihenh$dramine%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%44/ ;? 1ox$c$cline%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9 1rug Tari##%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%45 1rugs o# 'ithdra'al%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9; 1r$ e$es%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;9 1@&A%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:4 1$stonic reaction%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Endocrine !$stem%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 Entero(ius .ermicularis%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%: enz$me inducers%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%< Enz$me -nducers%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%< Enz$me -nhi(itors%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% < Er$throm$cin%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9? Estrogens%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9> Ethics%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%?> Exam re0uirements%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:5 Extra time%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% :: E$e%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9 E$e Conditions%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;9 Ezetimi(e%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 "aecal so#teners%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 "e(rile con.ulsions%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%: "emulen%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9> "errous e0ui.alence%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%<4 "e.er%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:4 "lu(riro#en%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%44 "lucloxacillin%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 "luconazole%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;4 "luoxetine%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9? "olate%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%: "olic acid%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%: Gastrointestinal 1isorders%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4< Gastrointestinal !$stem%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 Ginger%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;4 Gingko Bil(ao%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;; Ginseng%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;; Gliclazide%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9 Golden crust%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% :; Gout%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 GPhC Exam%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%; GPhC s$lla(us%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% :: G!&%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Guidance 1ocuments%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ?> Gut mucosa%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:?? G$naecolog$%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9> DAB:C%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:4 Daem%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 5
Daemorrhoids%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4> Da$#e.er%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4; Deart(urn%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4 Deart(urn .s Angina%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4 Dearin%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9? Der(al Medicines%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;;/ :?? Deres la(ialis%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;: Domeoathic%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;; Dormone Relacement%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9> DRT%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9> D$oscine (ut$l(romide %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 D$oscine h$dro(romide%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 -B!%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 4 -mmunit$ to malaria%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:; -metigo%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% :; -ncontinence%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 4 -ndigestion%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4 -n#ections%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 -*R%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9? -nsect (ites%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;: -nsomnia%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;? -ntroduction%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 -ron%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%5/ 9 -rrita(le (o'el s$ndrome%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4 -saghula husk%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 ,ourne$ lanner%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:5 &a(elling%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ?5 &actulose%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% :4/ 9/ 4< &atin a((re.iations%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:?: &earning disa(ilit$%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:: &egal re0uirements%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% &e.onelle%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9> &e.onorgestrel%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;; &ice%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:< &i#est$le%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;; &imited !ta(ilit$%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4: &inking MC8s%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% &i0uid ara##in%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 &oeramide%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 4< &oratidine%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% : Magnesium%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 Malarone%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% :; Malathion%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% :< Measured and "itted%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4: Me(endazole%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% : Medicines #or human use%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Me#lo0uine%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9 MEP%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Met#ormin%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9 Methotrexate%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:> Meth$ldoa%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9 Metronidazole%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9?/ 9 MDRA%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%: Microg$non%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9>
Midazolam%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%94 Migraine%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 94 Minerals%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9 MMR%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:?5 Mnemonic%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%94/ 9 *D! 1irect %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:?9 *iacin%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 5% *icorandil%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 *icotine%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9; *o alcohol%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9 *otes on Charges%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%4? *RT%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;< *!A-1s%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% :>/ 4< *utrition%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 5 3n The 1a$%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:5 3en Book Ans'ers%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:: 3en Book Exam%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%< 3en (ook exam timing%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%< 3en Book MC8s%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 3rlistat%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;< 3smotic laxati.es%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 P medicines%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Pain%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%; Pain &adder%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9; Palliati.e care %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:> Pailloma .irus%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;: Paracetamol o.erdose%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:?9 Pass rate%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:5 Patients to look out #or%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% :? PC3!%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:4 Pediculus humanus caitis%%%%%%%%%%%%%%%%%%%%%%%%%%%%:< Penciclo.ir%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;: Permethrin%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:< Pharmac$ Record %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% > Pharmac$CPA%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:: Pheno(ar(itone%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%?9 Phenothiazines%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%94 Phenothrin%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% :< Pholcodeine%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%44 Phoshorous%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9 Piles%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4> Pierazine%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%: Piroxicam%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 94 Poisoning%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:> Poisons%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ?
P3M%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Porh$rias%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 5 Potassium citrate%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9> Pre+reg Tis%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% :: Pregnant 'omen%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:? Prescri(a(le aliances %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 4 Pro#essional #ees %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4 Promethazine%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;? Ps$chosis%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9; 8uestion !tructure%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%< 8unial(ar(itone%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%?9 8@AR%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:/ 94 Ranitidine%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 4 Rashes%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% :; R1%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% :? Reasoning MC8s%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%< Red Clo.er %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;; Reim(ursement%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%45 Remuneration%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 45 Re0uirements%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:5 Resirator$ conditions%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%44 Resirator$ !$stem%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%94 Resonding to !$mtoms%%%%%%%%%%%%%%%%%%%%%%%%%%%%%44 Retinol%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%: Rhinitis%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4; Ri(o#la.in%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%5 R-CE%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%; Ring'orm%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;: Risk%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% :4: Rosu.astatin%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9 RP!GB !$lla(us%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ; Ru(e#acients%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%; !a#e custod$%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ?9 !ca(ies%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;5 !cale o# #ees %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 4 !chedule 9H%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%?9 !chool%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:< !ection ?) Central *er.ous !$stem%%%%%%%%%%%%%%94 !elenium%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%9 !ide e##ect%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:> !,W%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;; !kin Conditions%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;5 !lee h$giene%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;? !&!%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:? !moking%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ;< !odium%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 9 !odium cromogl$cate%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4; !ore throat%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%44 !acers%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 94 !!R-s%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%94% !t ,ohns Wort%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%;; !tandard MC8s%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% < !tah$lococcus aureus%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%:; !teroid license%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%;5
