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WorksheetsOTC / High Risk Drugs Questions
Total questions: 41
Worksheet time: 21mins
A 55-year-old male patient presents to the pharmacy requesting sildenafil 50mg (P medicine)
for the first time. During your structured consultation, he discloses he has a history of stable
angina pectoris and takes Glyceryl Trinitrate (GTN) sublingual spray only when he experiences
chest pain. He confirms he has not used the spray in the last 72 hours. He has no other medical
conditions and takes no other meds. what is the most appropriate course of action for the
pharmacist to take?
A. Supply the sildenafil 50mg, as the patient's angina is stable and he has not used GTN for over
24 hours.
B. Supply the sildenafil 50mg and counsel the patient to wait at least 7 days after the last use of
GTN before taking sildenafil
C. Do NOT supply the sildenafil 50mg and refer the patient to his GP due to the use of a
nitrate-containing medicine.
D. Contact the patient's GP immediately to confirm the stability of his angina before making a
supply.
A 27-year-old patient with an irritated right eye comes into the pharmacy for advice.
Which of the following ocular symptoms is within the red flag referral criteria for an urgent
ophthalmology assessment?
A. Abnormally watery eye
B. Eye discomfort
C. Ocular discharge
D. Red eye
E. Reduced visual acuity
You are a hospital pharmacist working in the medicine information department. You are
responding to an enquiry by a paediatric consultant on whether an unlicensed medication is
clinically effective for a rare condition. To gather evidence and formulate an answer you review
the most up-to-date and accurate literature available.
Which of the following is the most robust form of evidence?
A. Case-control
B. Cohort studies
C. Cross sectional studies
D. Randomised controlled trials
E. Systematic reviews
A 62-year-old woman with heart failure and osteoarthritis who is currently taking atorvastatin,
bisoprolol, paracetamol and ramipril. She has recently been commenced on eplerenone for heart failure. What monitoring is required?
A. Blood glucose
B. Glycosylated haemoglobin
C. Haemoglobin
D. Liver Function Test
E. Potassium
The use of NSAIDs is associated with an increased risk of Cardiovascular events.
Which of the following NSAIDs would be the least appropriate for a patient with a past history
of Stroke?
B. Ketoprofen 200mg daily
C. Ibuprofen 1.2 g daily
D. Naproxen 1g daily
E. Diclofenac 150mg daily
A 58-year-old man has been recently started on warfarin. He is aware that he needs to review his
diet now that he is on this medication.
Which of the following is least suitable juice for this patient to drink while taking warfarin?
A. Apple
B. Carrot
C. Cranberry
D. Mango
E. Orange
A mother has brought in her child to your community pharmacy for advice. The 6-year-old boy
has a circular, red patch of skin on his left arm, with a clear centre and a red, scaly outer edge. It
has been on the forearm for the past day and is very itchy. There is no discharge or crustiness of
the affected area.
Which of the following is the most appropriate treatment?
A. Clotrimazole cream
B. Hydrocortisone cream
C. Mupirocin ointment
D. Oral flucloxacillin
E. Salicylic acid
A 28-year-old man who is taking sodium valproate for migraines attends your pharmacy for some
advice. He is looking to start a family and recalls a conversation with his GP that sodium
valproate can affect his fertility. He wonders if the negative effect on his fertility can improve
once stopping.
Which of the following is a known reproductive side effect of sodium valproate in men?
A. Erectile dysfunction
B. Impaired sperm quality
C. Increased testosterone
D. Reduced libido
E. Testicular pain
2-year-old boy and has been prescribed paracetamol 120 mg/5 mL for pyrexia. What dose?
A. One 2.5 mL spoonful up to twice a day
B. One 2.5 mL spoonful up to four times a day
C. One 5 mL spoonful up to four times a day
D. One 5 mL spoonful and a one 2.5 ml spoonful up to four times a day
A 10-year-old girl and has been prescribed paracetamol 250 mg/5 mL for toothache.
What dose?
A. One 2.5 mL spoonful up to four times a day
B. One 5 mL spoonful up to four times a day
C. One 5 mL spoonful and a one 2.5 ml spoonful up to four times a day
D. Two 5 mL spoonfuls up to four times a day
A 4-months-old boy has been prescribed paracetamol 120 mg/5 mL for post-immunisation
pyrexia. What dose?
A. One 2.5 mL spoonful up to twice a day
B. One 2.5 mL spoonful up to four times a day
C. One 5 mL spoonful up to four times a day
A 50-year-old man is newly started on amiodarone in hospital for a new arrythmia that is not
responding to traditional treatments. Which of the following is a side effect that he needs to be counselled on?
A. Bleeding risk
B. Corneal microdeposits
C. Cushing’s syndrome
D. Diarrhoea
E. Osteoporosis
A 65-year-old man has been newly started on methotrexate for his rheumatoid arthritis. The
doctor asks you to counsel him when handing out the medication in the outpatient pharmacy.
Which of these is a counselling point for methotrexate?
A. Do not eat grapefruit or drink grapefruit juice
B. May cause orange discolouration of tears
C. Take on an empty stomach 1 hour before or 2 hours after a meal
D. Take the dose once a month on the same day
E. Wear suncream and avoid UV light
A 79-year-old woman, who has Parkinson’s disease, is taking the following medication:
Madopar capsule
Entacapone 200mg
Rotigotine 2mg/24 hours patches – one patch daily (started 1 month ago)
Her husband reports that the patient has frequently visited the casino recently and made large
purchases of unnecessary gadgets. These are new and unusual behaviours for her.
Which of the following is the most suitable recommended action?
A. Gradually reduce the dose of co-beneldopa
B. Gradually reduce the dose of rotigotine
C. Immediately stop co-beneldopa
D. Immediately stop entacapone
E. Offer cognitive behavioural therapy
You are working on the admissions ward of a hospital when a patient is admitted with a
suspected methotrexate overdose.
Which of the following is recommended to counteract methotrexate toxicity?
A. Cyanocobalamin
B. Folic acid
C. Leucovorin (folinic acid)
D. Pyridoxine
E. Vitamin B12
A patient on verapamil for cluster headaches needs to be prescribed a drug for treatment of
her hypertension. Which of the following will cause the most severe interction?
A. Atenolol
B. Bendroflumethiazide
C. Valsartan
Which of the following describes a primary clinical contraindication/interaction between pseudoephedrine and an hypertensive patient?
A. The pseudoephedrine may cause low blood pressure (hypotension) due to interaction with the
Lisinopril, so supply the medicine with caution.
B. Lisinopril and Bendroflumethiazide are contraindicated with pseudoephedrine; refer the
patient to her GP for an alternative prescription.
C. Pseudoephedrine has the potential to increase blood pressure and may counteract the
effects of her antihypertensive medicines; Do NOT supply and recommend a topical nasal
decongestant instead.
D. The patient's blood pressure is stable; supply the pseudoephedrine but advise her to stop
taking her Lisinopril for the 5 days she uses the decongestant.
According to current clinical guidelines (such as NICE), which one of the following over-thecounter
(OTC) medications or drug classes is recommended as the first-line oral analgesic for
managing acute non-specific low back pain?
A. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as Ibuprofen or Naproxen
B. Topical NSAID gel (e.g., Diclofenac or Ibuprofen gel)
C. Weak opioids (e.g., Codeine combinations)
D. Paracetamol (Acetaminophen)
A 28-year-old female requests Clotrimazole for thrush symptoms (white, odourless discharge);
she confirms this is her fourth episode in the last 10 months and she is otherwise well. What is
the most appropriate initial course of action for the pharmacist?
A. Supply the Clotrimazole, as she has no serious symptoms.
B. Supply Fluconazole, as it is more convenient for recurrent cases.
C. Do NOT supply the medication and refer the patient immediately to her GP for investigation.
D. Supply the medication but book her for an urgent 48-hour follow-up review.
A mother requests an antipyretic for her 10-year-old child who has a mild fever and symptoms of
influenza. Which drug must be avoided in children under 16 years old due to the risk of Reye's
syndrome?
A. Paracetamol (Acetaminophen)
B. Aspirin (Acetylsalicylic Acid)
C. Chlorphenamine
A 68-year-old patient with stable Angina Pectoris controlled by Amlodipine requests Sildenafil
50 mg (P medicine). What is the main contraindication you must screen for that would prevent
the OTC supply?
A. History of Angina Pectoris.
B. The use of the Calcium Channel Blocker (Amlodipine).
C. Patient's age (68 years old).
D. The concurrent use of any form of Nitrate or Nitric Oxide Donor.
A 5 year-old requires a first-line treatment for a cough, reporting a dry, tickly cough
that has lasted for 4 days. She takes no medication. What is the most appropriate initial
recommendation?
A. Expectorant containing Guaifenesin.
B. Cough Suppressant containing dextromethorphan
C. Simple linctus, honey, or a demulcent preparation.
D. Oral Linctus containing a sedating antihistamine (e.g., Diphenhydramine).
Your foundation trainee pharmacist is asking for your advice about OTC analgesic use in
breastfeeding. Which of the following is least appropriate to recommend in this patient group?
A. Diclofenac 1.16% gel
B. Paracetamol 500mg tablets
C. Ibuprofen 10% gel
D. Co-codamol 8/500mg tablets
E. Ibuprofen 400mg tablets
A 3-year-old has presented to the pharmacy with a yellow, crusty rash on her face. Her father
states that she has been itching at this regularly over the past two days.
A. Hydromol emollient
B. Hydrocortisone 1% cream
C. Clobetasone 0.05% cream
D. Hydrogen peroxide
Mr Q is a 42-year-old man who has undergone a renal transplant. He is currently on
Mycophenolate 720mg twice a day. He asks for advice on the use of contraception.
What is the most appropriate advice to give to Mr Q?
A. Available clinical evidence does not indicate an increased risk of malformations or
miscarriage in pregnancies where the father was taking mycophenolate medicines,
therefore, no form of contraception is required.
B. Male patients or their female partner should use effective contraception during treatment
and for 90 days after discontinuation. Mycophenolate is genotoxic.
C. Male patients or their female partner should use effective contraception during treatment
and can stop as soon as treatment is complete.
D. Mycophenolate only affects female fertility, so contraception is only necessary for female
partners
E. Mycophenolate increases the risk of infertility, so he should stop contraception to help
achieve conception
A 52-year-old man visits the pharmacy seeking advice for a new headache that started a few
days ago. He describes it as severe, constant, and located at the back of his head. He has also
noticed that his vision has become slightly blurred, and paracetamol has not provided any relief.
He denies any previous history of migraines or frequent headaches.
What is the most appropriate action for the pharmacist to take?
A. Advise the patient to monitor symptoms and keep a headache diary to identify possible
triggers.
B. Recommend an eye test, as the symptoms may be related to uncorrected vision problems.
C. Recommend switching to a stronger, over-the-counter analgesic such as ibuprofen or
paracetamol/codeine combination.
D. Refer him immediately to his GP for further investigation.
E. Suggest hydration and rest, as these symptoms could indicate tension-type headaches
A 22-year-old female patient, who is of childbearing potential, presents to the pharmacy to
collect her first prescription for oral Isotretinoin (Roaccutane) 20mg once daily for severe acne.
The prescription is for a 30-day supply and is dated within the last 7 days.
Which one of the following pieces of advice is incorrect according to the Pregnancy Prevention
Programme (PPP) requirements for dispensing this medication?
A. You must use at least one highly effective method of contraception or two
complementary effective methods for at least one month before starting Isotretinoin.
B. You must return to the clinic for a negative pregnancy test every month, and the
prescription must be collected from the pharmacy within 7 days of the prescriber signing
it.
C. You must not donate blood during treatment and for at least 1 month after stopping
Isotretinoin.
D. You should stop taking the combined oral contraceptive pill (COCP) as Isotretinoin can
reduce its effectiveness.
E. You must continue to use effective contraception for at least 1 month after stopping the
course of Isotretinoin.
A 17-year-old male patient on Isotretinoin calls the pharmacy. His mother reports he has become
unusually withdrawn, irritable, and has stopped attending football practice, which he previously
loved. What is the most appropriate initial action for the pharmacist?
A. Advise the patient to stop the Isotretinoin immediately and contact his prescriber (dermatology
team) or GP urgently.
B. Advise the patient to increase their dose of Isotretinoin, as mood changes are a sign the acne is
getting worse.
C. Recommend the patient try an over-the-counter herbal remedy like St. John's Wort to elevate his
mood.
D. Tell the mother to monitor the patient for another week, as acne itself can cause depression and
moodiness.
A 68-year-old female patient, who has been stable on Lithium for bipolar disorder for several years, calls the pharmacy. She reports a two-day history of vomiting and severe diarrhoea due
to a viral gastro-enteritis. She states she feels very drowsy, has noticed a coarse, jerky tremor
in her hands, and feels generally unsteady on her feet.
What is the most appropriate and immediate action for the pharmacist to recommend?
A. Advise her to take an over-the-counter anti-diarrhoeal medication (e.g., Loperamide)
and monitor her symptoms at home for the next 12 hours.
B. Advise her to temporarily stop her Lithium medication and contact her prescriber (GP/
specialist) immediately for an urgent blood test.
C. Advise her to take her next dose with a large glass of water and increase her salt intake
to correct any potential electrolyte imbalance.
D. Advise her to switch her dose from a modified-release tablet to a liquid formulation for
better absorption while she is unwell.
E. Advise her to take a single dose of an NSAID, such as Ibuprofen, to help with any
potential muscle aches associated with her illness.
Which of the following electrolyte abnormalities is most likely to precipitate (or worsen) Digoxin
toxicity, even if the Digoxin level is within the therapeutic range?
A. Hypernatraemia
B. Hypokalaemia
C. Hypercalcaemia
D. Hypomagnesaemia
A patient taking Digoxin reports persistent nausea, loss of appetite, and a slight green-yellow
halo around bright lights. What is the most probable cause for these symptoms?
A. Hypokalaemia, requiring potassium supplements
B. Acute-on-chronic heart failure, requiring an increase in the diuretic dose
C. Mild iron deficiency anaemia, requiring an iron supplement
D. Digoxin toxicity, requiring immediate review and withholding of the next dose
Vaginal thrush (candidiasis) can be treated with over-the-counter (P-medicine) antifungal
products (e.g., Clotrimazole) in which of the following patient age groups?
A. Females aged 16 to 60 years
B. Females aged 15 to 50 years
A customer requests two packs of a nasal decongestant containing Pseudoephedrine
hydrochloride 60mg per tablet (12 tablets per pack, total 720mg). They state one pack is for
themselves and one is for their spouse.
Which of the following is the maximum quantity (mg) of Pseudoephedrine that a pharmacist is
legally permitted to supply to a single person at any one time, without a prescription?
A. 720mg
B. 1,440mg
Chlorphenamine (e.g., Piriton Syrup/Tablets) for symptomatic relief of allergies (P-medicine) can
only be supplied to children aged:
A. 6 years and over
B. 1 year and over
Loperamide (2mg capsules/tablets) for the symptomatic treatment of acute diarrhoea as a Pmedicine
can only be sold to patients aged:
A. 12 years and over
B. 18 years and over
Tamsulosin (400 micrograms MR) for the functional symptoms of Benign Prostatic Hyperplasia
(BPH) as a P-medicine is licensed for men within which age range?
A. 45 to 75 years
B. 50 to 80 years
Sildenafil (e.g., Viagra Connect 50mg) for the treatment of erectile dysfunction (ED) as a Pmedicine
can only be sold to men aged:
A. 18 years and over
B. 25 years and over
Tranexamic Acid (500mg) for the treatment of heavy menstrual bleeding (menorrhagia) as a Pmedicine
is licensed for women aged:
A. 18 to 45 years
B. 16 to 50 years
The lower age limit for selling a standard dose of Ibuprofen (including Ibuprofen Lysine) as a Pmedicine
specifically for dysmenorrhea is:
A. 12 years old
B. 16 years old
Naproxen (250mg) for the treatment of dysmenorrhea (period pain) as a P-medicine can only be
sold to women within which age range?
A. 15 to 50 years
B. 16 to 45 years
Vaginal thrush (candidiasis) can be treated with over-the-counter (P-medicine) antifungal
products (e.g., Clotrimazole) in which of the following patient age groups?
A. Females aged 16 to 60 years
B. Females aged 15 to 50 years
