You are working as the on-call pharmacist at a hospital. You receive a call from a doctor who would like some advice on what antibiotic to prescribe for a patient who is 15 weeks pregnant with an upper respiratory tract infection. He informs you this patient is going on holiday tomorrow for 4 weeks and has a penicillin allergy. What is the most appropriate antibiotic to prescribe?

Mrs P has recently been diagnosed with type 2 diabetes. She has tried managing it by modifying her lifestyle with a balanced diet and increased exercise. The diabetic nurse has now decided to commence with medication treatment. Mrs P is currently not taking any other medication and has a BMI of 35kg/m. What is the first line treatment for Mrs P?

Mrs P has recently been diagnosed with type 2 diabetes. She has tried managing it by modifying her lifestyle with a balanced diet and increased exercise. The diabetic nurse has now decided to commence with medication treatment. Mrs P is currently not taking any other medication and has a BMI of 35kg/m.
A week later, Mrs P comes into the pharmacy asking to speak to the pharmacist in private. In the consultation room, she explains that sinceshe has started the metformin, she has been experiencing really bad side effects such as an upset tummy and diarrhoea. What is the least appropriate action to take to give to the patient?

Mr G comes into the pharmacy asking to buy a laxative. He explains he has not been able to go to the toilet for a couple of days and is now starting to feel uncomfortable. He mentions he started a new tablet a few days ago and wonders if it is a side effect of it. Which of the following medications has most likely caused the side effect Mr G is experiencing?

A regular patient comes into the pharmacy asking to buy cystitis relief sachets. After speaking to the patient, they mention they’ve been going to the bathroom more often than usual and a burning sensation when passing urine. He also mentions he has seen some blood in his urine yesterday. You check the PMR and he is on the following medication: Aspirin 75mg tablets – take one daily Atorvastatin 20mg tablets – take one in the evening

Lansoprazole 15mg GR capsules – take one daily

Pioglitazone 15mg tablets – take once daily

Metformin 500mg tablets – take one three times a day with food

Ramipril 2.5mg capsules – take one daily. What is the most appropriate action to take?

Miss E, a pregnant lady comes into the pharmacy asking for some advice. She is currently in her last trimester and would like to buy a soothing haemorrhoid cream over the counter. She explains that she is experiencing perianal itching and blood in her stools. Which of the following is not a reason to refer patients?

A regular patient comes into the pharmacy asking for advice. She has been prescribed leflunomide for rheumatoid arthritis. Miss F explains that her and her partner are planning on starting a family and is wondering if she can take this medication. Which of the following statements is correct?

A mother comes into the pharmacy with a prescription for her daughter. She has recently been diagnosed with asthma and has been prescribed a new spacer to be used with her blue and brown inhalers. Which of the following statements regarding spacers is false?

A regular patient has recently been switched from fluoxetine capsules to liquid as they cannot swallow capsules. You receive their new prescription for fluoxetine liquid. Assume 1 month = 28 days. What quantity of fluoxetine would need to be supplied for one month's supply?

You are the on-call pharmacist working in a hospital pharmacy. You receive a call on the weekend from the palliative care doctor who would like to switch a patient from fentanyl 25microgram patches to the equivalent intravenous morphine dose. What is the most appropriate dose to recommend?

You receive a call from one of your regular patients, Mr F aged 69. He has been feeling unwell with abdominal cramps over the last couple of days and asks if you have anything he can buy over the counter to help with sickness. Upon further questioning, he mentions his vomit yesterday resembled ‘ground coffee’. You check the PMR and he is on the following medication:Amlodipine 10mg tablets – take one daily, Indapamide 2.5mg tablets – take one daily, Naproxen 500mg tablets – take one twice daily, Omeprazole 20mg capsules – take one daily, Beclometasone 50mcg nasal spray – 1-2 sprays in each nostril daily, Atorvastatin 20mg tablets – take one daily.

Which of the following drugs most likely have caused Mr F’s symptoms?

A patient comes into the pharmacy requesting to buy hydrocortisone 1% cream for a rash. Your dispenser asks for some advice as she isunsure whether she can sell hydrocortisone to this patient. Which of the following patients would you be able to sell hydrocortisone 1% cream over the counter?

You are working in a community pharmacy when you receive a call from a regular patient. He asks if you could recommend a suitable painkiller over the counter as they have recently sprained their ankle in a football match over the weekend. The patient explains that his ankle is swollen and painful even after using ice. You check the PMR and he is on the following medication: Amlodipine 10mg tablets – take one daily, Citalopram 20mg tablets – take one daily, Fexofenadine 180mg tablets – take one daily, Pregabalin 50mg capsules – take one three times a day, Sodium valproate 300mg MR tablets – take one twice a day, Ramipril 5mg capsules – take one daily. What is the least appropriate choice of analgesic over the counter for this patient?

A mother comes into the pharmacy with her 10-year-old daughter seeking advice from the pharmacist. You go into the consultation roomwhere the mother explains she has recently noticed dry, itchy, flaky patches on her daughter’s skin around her neck and has now startedbehind her knees. She explains it can also look like a red rash with darker red spots. Which of the following is the most likely diagnosis?

A patient comes into the pharmacy to ask for a suitable mouthwash. He has noticed whilst brushing his teeth, that his gums are sore andoften bleed. He thinks he could be brushing too hard as he has recently replaced his old toothbrush. You check the PMR and he is on the following medication: Aspirin 75mg dispersible tablets – take one daily Amlodipine 10mg tablets – take one daily Gabapentin 100mg tablets – take one three times a day Phenytoin 300mg tablets – take one twice daily Ramipril 2.5mg capsules – take one daily Simvastatin 20mg tablets – take one daily. Which of the following is the most appropriate action to take?

A patient brings you a private prescription for gabapentin 100mg capsules. You are aware that private prescriptions for controlled drugsand prescriptions for non controlled drugs have different legal requirements. You check the legality of the prescription in the MEP beforedispensing it. What prescription form must this medicine be on for it to be a legally valid private prescription?

A father brings his son aged 12 to your pharmacy as he was stung by a bee 5 minutes ago, you notice his lips have swelled and he is struggling to breathe normally. You believe he is experiencing an anaphylaxis reaction and decide to inject him with a pre-filled adrenaline pen that is kept in your pharmacy. What strength of adrenaline would be the most appropriate for him?

A mother comes into your pharmacy to buy Calpol for her 4-year-old son. She explains that her son has developed a fever this morning and would like to purchase paracetamol for him. He uses a salbutamol 100mcg inhaler - when required and has recently been prescribed a course of amoxicillin 250mg/5ml oral solution. What is the maximum amount of Calpol she can give him per dose?