Following a medication review, you have recommended lansoprazole 15mg capsules for a 68-

year-old patient following initiation of rivaroxaban for atrial fibrillation over concerns of this

patient being high risk of bleeding. The patient has asked for information on the side effects of

this medication. Which of the following is true regarding the side effect profile of lansoprazole?

A father with asthma has brought their 3-year-old son into the pharmacy for advice. His son has

been itching his anal area over the past few days, particularly at night and has observed some

white thread-like streaks in his son’s stools. When you enquire further, you establish there is the

father, his pregnant wife, and their son in the family. What would be the most appropriate advice?

An 82-year-old male with heart failure has presented to your pharmacy to have a private

discussion. He has recently been started on a new medication for heart failure and has noticed

his breasts have started to swell and enlarge. Which of his regular medications is most likely to

have contributed to this?

A 57-year-old man attends his GP for a routine health check. The GP records a clinic blood

pressure of 164/102 mmHg after three readings in both arms. He is fit and well with no worrying

signs or symptoms. He has no previous medical conditions and is not taking any medication.

Which one of the following would be the most appropriate course of action?

A 4-year-old girl is prescribed aspirin as an antiplatelet following cardiac surgery to prevent

thrombus

formation. You check the BNF and confirm the dose is correct and it is listed as appropriate to

prescribe.

Which of the following statements regarding aspirin in paediatric patients is most accurate?

A patient has been diagnosed with hypertension after a consultation with the GP

practice-based pharmacist. The patient now requires treatment with an

antihypertensive. The patient has NKDA and takes metformin and gliclazide for type 2

diabetes. The patient is Caucasian and 70 years old.

Which of the following is the most appropriate medication to start for this

patient’s hypertension

?

A pharmacist is counselling a patient who has just started taking Lisinopril for hypertension.

Which one of the following side effects is the patient LEAST likely to experience?

Mr D is a 72-year-old gentleman who has been on a combination of Ramipril 5 mg once daily

and Bendroflumethiazide 2.5 mg once daily for over 10 years to manage his hypertension. He

presents at the community pharmacy complaining of knee pain, which he has been treating for

the past month with Ibuprofen 400 mg three times daily (purchased OTC).

Which one of the following is the MOST significant adverse effect risk associated with the

co-administration of these three medicines?

A 62-year-old patient has been diagnosed with atrial fibrillation and you have been asked to recommend a suitable anticoagulant for stroke prophylaxis. He has a history of aortic regurgitation and has mechanical heart valve.

A 67-year-old patient has presented to your pharmacy today asking for advice about a medication he has recently started, isosorbide mononitrate. He has been experiencing a mild headache and is concerned this may be associated with his new medicine.

A 67-year-old patient has been feeling increasingly short of breath over the last six months, especially when lying down in bed. He also has evident ankle oedema despite the use of furosemide. His natriuretic peptides (NT-proBNP) is 2500 ng/L (<400 ng/L) and you have referred him to cardiology for further assessment. Which will you be initiating

A 59-year-old patient has been discharged from hospital following a myocardial infarction. His discharge medications are as follows:

Ramipril 10 mg capsules 1 to be taken daily

Bisoprolol 10 mg tablets 1 to be taken daily

Atorvastatin 20 mg tablets 1 to be taken daily

Aspirin 75 mg tablets 1 to be taken daily

Ticagrelor 90 mg tablets 1 to be taken twice a day

You speak with the ward doctor regarding this patient’s atorvastatin to outline your concerns.

A 68-year-old female patient has recently been diagnosed with hypothyroidism. She has a past medical history of TIA which occurred eight years ago. Her thyroid function tests showed very low thyroid hormone and the GP therefore prescribed levothyroxine 75 mcg tablets 1 to be taken daily.

A 63-year-old man brings in a new prescription to the pharmacy for amiodarone 200mg tablets, one tablet to be taken three times daily. He mentions to the pharmacist that he has also recently been diagnosed with another medical condition and wants to know if it is safe for him to start this new prescription given his recent new diagnosis. Which of the following conditions is most likely to make it unsafe to start amiodarone tablets?

A 66-year-old man who has been diagnosed with atrial fibrillation and needs to start a medicine for the prevention of stroke in atrial fibrillation, with effectiveness measured by monitoring INR. Select the most appropriate medicine for this patient.

An active 45-year-old woman with no known allergies and no previous medical history has been diagnosed with atrial fibrillation and needs to be initiated on treatment to manage her condition. Select the most appropriate medicine for this patient.

A 68-year-old man who has completed two weeks of 300mg aspirin and now needs to start a medication for the ongoing prevention of stroke. Select the most appropriate medicine for this patient.

A 50-year-old woman taking a medication for the treatment of atrial fibrillation and has routine blood monitoring including thyroid stimulating hormone and thyroxine to ensure that she does not experience adverse effects. Select the most appropriate medicine this patient was prescribed

A 64-year-old woman has recently been diagnosed with stage two hypertension and prescribed an antihypertensive. Two weeks later, she comes to the pharmacy complaining of headaches. She mentions that the new medicine has made her feet swell and she has been struggling to walk, for this reason she has stopped taking the medicine. Which of the following antihypertensives is most likely to be the reason for non-adherence?

A 62-year-old male has recently been prescribed a beta-blocker for moderate hypertension. He comes to the pharmacy to collect his repeat prescription and tells you that he has had difficulty sleeping since starting his new medication. Which of the following beta-blockers is this patient most likely to have been prescribed?

You are working in a GP practice conducting a medication review for a 52-year-old African-Caribbean man who suffers from type II diabetes. During the course of the review, you measure his blood pressure and find that it is 147/90mmHg. Assume elevated readings are confirmed with ABPM. What would be the most appropriate action to take?

A 60-year-old woman presents with ST-elevation myocardial infarction (STEMI). She receives primary PCI and is haemodynamically stable.

Which of the following is indicated for long-term therapy post-PCI?

A patient with HFrEF is started on ACE inhibitor and MRA. Which of the following monitoring parameters is most important initially?

A 70-year-old man (weight = 58 kg, eGFR = 40 mL/min) is prescribed edoxaban for non-valvular AF.

Which starting dose is appropriate?

A 55-year-old male patient has been admitted to hospital following an NSTEMI. He has undergone coronary revascularisation and is to be discharged from hospital today. He has a high risk of bleeding as a result of a previous duodenal ulcer. Which of the following blood-thinning medications would be most appropriate for him to take alongside aspirin for 12 months?

Which of the following is not considered a risk factor for venous thromboembolism (VTE)? 

Mr. A is a 56-year-old White patient presenting with a confirmed diagnosis of Stage 1 Hypertension (average ambulatory blood pressure monitoring (ABPM) of 138/88 mmHg).What is the most appropriate initial pharmacological treatment for Mr. A according to NICE guidelines (NG136) .

A. Ramipril 2.5 mg once daily B. Amlodipine 5 mg once daily C. Bisoprolol 5 mg once daily D. Indapamide 2.5 mg once daily

Mr. F, a 48-year-old patient, is about to start Atorvastatin. He has no history of muscle problems and no known risk factors for myopathy (e.g., hypothyroidism, heavy alcohol use).

What is the correct guidance for monitoring Creatine Kinase (CK) in this patient?

A. Measure baseline CK, then repeat at 3 and 12 months.

B. Routine monitoring of CK is not required in asymptomatic patients.

C. Measure baseline CK, then repeat only if the LFTs are abnormal.

D. Measure CK every time the lipid profile is checked (e.g., every 3 months).

Mr. M, an 80-year-old patient with a history of Chronic Kidney Disease (CKD), is currently taking Simvastatin 40MG daily. His GP wants to add Amlodipine 5mg daily for new-onset hypertension.

What is the maximum recommended daily dose of Simvastatin when co-administered with Amlodipine?

Ms. P, a 35-year-old woman with a history of coronary artery disease, is taking Atorvastatin $80 \text{ mg}$ daily for secondary prevention. She is currently using reliable contraception but is planning to start trying to conceive in the near future.

What is the standard recommended period (based on the Summary of Product Characteristics, SPC, and clinical practice) for a woman to stop her statin before attempting to conceive?

A. Stop the statin at least 2 weeks before conception.

B. Stop the statin at least 1 month before conception.

C. Stop the statin at least 3 months before conception.

D. Stop the statin at least 6 months before conception.

A 72-year-old man is rushed to the emergency department after experiencing a sudden onset of weakness on his left side and slurred speech. A brain CT scan confirms an acute ischaemic stroke. His symptoms started exactly 3 hours ago. His medical history includes hypertension, for which he takes amlodipine 10mg once daily. His blood pressure on admission is 175/95 mmHg.

Assuming no contraindications, which is the most appropriate initial pharmacological treatment strategy for this patient?

A 68-year-old woman is being discharged from the hospital following an ischaemic stroke. A CT scan confirmed there was no haemorrhage. She has been stable on aspirin 300mg daily for the last 14 days while in hospital. She has no history of atrial fibrillation.

According to NICE guidelines, which is the most appropriate long-term antithrombotic regimen for her secondary prevention?

A 58-year-old woman is being discharged from the acute coronary unit following an acute ST-elevation myocardial infarction (STEMI) 5 days ago, during which she successfully underwent a percutaneous coronary intervention (PCI) with a drug-eluting stent. She has no significant past medical history, no known drug allergies, and her liver and renal functions are normal.

According to NICE guidelines, which of the following represents the most appropriate long-term antithrombotic and secondary prevention regimen for her to initiate upon discharge?

A 64-year-old gentleman with a history of stable angina attends his annual medication review at the pharmacy. He currently takes Atenolol 50mg once daily and uses a Glyceryl Trinitrate (GTN) 400mcg sublingual spray as required.

He reports that over the past month, he has had to use his GTN spray four to five times a week during his morning walks. His blood pressure today is 128/76 mmHg and his heart rate is 56 beats per minute (bpm). He has no other medical conditions.

According to NICE guidelines, which of the following is the most appropriate next step to optimize his anti-anginal treatment?

A 70-year-old Caucasian man with chronic HFrEF is already taking Sacubitril/Valsartan (ARNI) alongside his maximum doses of Bisoprolol, Spironolactone, and Dapagliflozin. He remains consistently symptomatic, is in sinus rhythm, and has a resting heart rate of 76 bpm. What is the most appropriate next step?

A. Add Digoxin 125mcg once daily

B. Add Hydralazine combined with Isosorbide Dinitrate

C. Add Ivabradine 5mg twice daily

D. Refer for urgent intravenous iron therapy (e.g., ferric derisomaltose)

E. Refer the patient to a specialist to switch the ACE inhibitor to Sacubitril/Valsartan

A 74-year-old woman presents to hospital with sudden onset facial droop and left arm weakness. CT head confirms an acute ischaemic stroke and excludes haemorrhage. She is not eligible for thrombolysis.

What is the MOST appropriate immediate treatment?