- C
See BNF, Chapter 5 (Infections), section 5.1, Antibacterial drugs, Choice of a suitable drug, which mentions all the listed options except the need to consider formulation
- C
See BNFC, Chapter 9 (Nutrition and blood), section 9.8.2. Acute porphyria attacks are uncommon before puberty
- C
Flucloxacillin is a safe option and useful in staphylococcal skin infections. The other agents are either unsafe in acute porphyria or unsuitable for the given condition.
- E
See BNF, Chapter 5 (Infections), section 5.1.4. Gentamicin can be used for the following intravenous indications: septicaemia, neonatal sepsis, meningitis and other CNS infections, biliary-tract infection, acute pyelonephritis or prostatitis, endocarditis and pneumonia (hospital patients only), and it is used as an adjunct in listerial meningitis. It is not indicated for urinary-tract infections
- D
Ototoxicity is an irreversible side-effect of gentamicin.
- C
See BNF, Chapter 5 (Infections), section 2.12. Simvastatin is given at a maximum dose of 20 mg daily with concomitant amiodarone, verapamil, diltiazem, amlodipine, or ranolazine
- C
See BNF, Chapter 5 (Infections), section 2.12. Statins can cause myopathy (muscle pain, tenderness, and weakness) and rarely interstitial lung disease (dyspnoea, cough, and weight loss). Patients must seek medical attention immediately if they experience these symptoms
- E
See BNF, Chapter 5 (Infections), section 2.12. Thyroid function tests are necessary in order to rule out hypothyroidism. Correcting hypothyroidism may resolve any lipid abnormality
- C
See BNF, Chapter 10 (Musculoskeletal and joint diseases), section 10.1.3. Methotrexate does not need to be used with caution in those with a raised neutrophil count; however, it must be stopped immediately if there is a clinically significant drop in neutrophil count
- E
See BNF, Chapter 10 (Musculoskeletal and joint diseases), section 10.1.3. Methotrexate requires routine monitoring of full blood count, renal and liver function tests
- E
See BNF, Chapter 10 (Musculoskeletal and joint diseases), section 10.1.3. Methotrexate is not known to precipitate diabetes
- B
See BNF, Chapter 10 (Musculoskeletal and joint diseases), section 10.1.3. Co-codamol is the safest analgesic to purchase over-the-counter while on methotrexate. Use of aspirin or NSAIDs will necessitate careful monitoring, hence they are not recommended
- E
See BNF, Chapter 13 (Skin), section 13.10.4. The manufacturer recommends 2 × 30 g packs for adequate treatment. However, the table entitled ‘Suitable quantities of parascitidal preparations’ suggests 30–60 g for a single application. Thus, 60–120 g is needed for two applications (NB: 120 g is the maximum recommended quantity)
- E
See BNF, Chapter 13 (Skin), section 13.10.4. The manufacturer recommends that the product should not be applied to the head and neck
- A
See BNF, Chapter 14 (Immunological products and vaccines), section 14.1. Individuals with a previous history of anaphylactic reactions to egg should not be given tick-borne encephalitis vaccine and yellow fever vaccine. Influenza vaccines may be given but such individuals should be referred to a specialist in hospital in order to have the vaccine, with facilities available to treat anaphylaxis
- E
See BNF, Chapter 14 (Immunological products and vaccines), section 14.4. Typhoid oral vaccine is given on days 1, 3 and 5. It takes 7–10 days to confer protection following the last dose
- E
See BNF, Chapter 14 (Immunological products and vaccines), section 14.1. Contraindications to MMR include: immunosuppression; those who have received another live vaccine by injection within 4 weeks; those who have had an anaphylactic reaction to excipients such as gelatin and neomycin; if given to women, pregnancy should be avoided for 1 month
- D
See BNF, Chapter 6 (Endocrine system), section 6.4.1.1. A preparation containing oestrogen and preogestogen is recommended for women with an intact uterus
- C
See BNF, Chapter 7 (Obstetrics, gynaecology, and urinary-tract disorders), section 7.3. Hormonal contraception is the most effective method of contraception, whereas intrauterine devices are a highly effective alternative form of contraception. Barrier methods are less effective but reliable.
- E
Paracetamol is the safest analgesic in pregnancy
- B
See BNF, Chapter 2 (Cardiovascular system), section 2.5.5.1. Captopril, enalapri, and quinapril should be avoided in the first few weeks following delivery, especially in preterm infants, due to the risk of neonatal hypotension
- E
The endorsement ‘SLS’ should be on the prescription (see Drug Tariff Part VIIIA for more information on the reasoning for this)
- D
See BNF, Chapter 4 (Central nervous system), section 4.7.1. See individual drug monograph for the symbol denoting that this product is less suitable for prescribing
- B
There is one formulation of the same drug prescribed; this attracts a single NHS levy
- C
Two prescription charges as Cilest is an oral contraceptive pill
- D
See BNF, Chapter 9 (Nutrition and blood), section 9.1.5. Nitrofurantoin carries a definite risk of haemolysis
- C
See BNFC, General reference section for a list of E numbers
- C
See BNF, Chapter 4 (Central nervous system), section 4.2.1 See table entitled ‘Equivalent doses of oral antipsychotics’. 100 mg chlorpromazine is equivalent to 50 mg clozapine
- B
See BNF, Chapter 2 (Cardiovascular system), section 2.4. Diabetes is not listed as a cautioned use for beta-blockers; however, do note that beta-blockers can mask the symptoms of hypoglycaemia
- B
See BNF, Chapter 2 (Cardiovascular system), section 2.3.2. An echocardiogram is not needed when initiating amiodarone
- D
5mg prednisolone = 20mg Hydrocortisone. Therefore, 10mg prednisolone = 40mg hydrocortisone
- E
Where an ACEI is causing persistent or troublesome coughing, the alternative product is an ARB (angiotensin II receptor blocker).
- E
See BNF, Chapter 13 (Skin), section 13.4. Synalar 1 in 10 dilution is a mild corticosteroid.
- D
See BNF, Chapter 13 (Skin), section 13.4. See table entitled ‘Suitable quantities of corticosteroid preparations to be prescribed for specific areas of the body’. When used as a single application, both legs require 100 g for 2 weeks, and the trunk requires 100 g. This is equivalent to two tubes for single application; in this case it is a twice-daily application, hence 4 tubes are needed
- A
See BNF, Chapter 7 (Obstetrics, gynaecology, and urinary-tract disorders), section 7.3. Reasons to stop immediately include sudden chest pain, sudden breathlessness (or cough with blood-stained sputum), unexplained swelling or pain in calf of one leg, severe stomach pain, serious neurological effects (e.g. prolonged first presentation of a headache, sudden loss of vision, sudden loss of hearing, syncope, dysphasia, marked numbness affecting one side of the body, and unexplained first seizure), liver-related problems (e.g. hepatitis, jaundice, and hepatomegaly), raised blood pressure (above systolic 160 mmHg or diastolic 95 mmHg), prolonged immobility following leg injury or surgery, and detection of any risk factor which contraindicates treatment
- C
See BNF, Chapter 9 (Nutrition and blood), section 9.3 – Kabiven contains 4 mmol/L of magnesium ions
- D
See BNF, Chapter 2 (Cardiovascular system), section 2.3.2. Signs of breathlessness may indicate pulmonary toxicity (usually seen as pneumonitis and fibrosis) and will necessitate a review of the drug
- D
For BNF Guidance on Prescribing in palliative care, see table entitled ‘Equivalent doses of morphine sulfate and diamorphine given over 24 hours’. As a general rule the daily dose of diamorphine is ⅓the total daily oral morphine dose
- B
See BNF, Chapter 9 (Nutrition and blood), section 9.1.1. See table entitled ‘Iron content of different salts’. Ferrous sulfate contains 60 mg of ferrous iron per tablet and Fersamal contains 45 mg of ferrous iron per 5 mL spoonful. Giving a 10 mL BD dose of Fersamal provides 180 mg of ferrous iron (which is the same as taking ferrous sulfate 200 mg TDS).
- C
See BNF Appendix 4, Intravenous additives
- C
See BNF, Chapter 4 (Central nervous system), section 4.3.2. A 3-week interval is needed before starting phenelzine following discontinuation of clomipramine or imipramine. For all other antidepressants, a 2-week interval is needed before starting an MAOI (or 1–2 weeks if a TCA or related drug)
- E
Topical erythromycin has little potential for interaction with prednisolone. Options A and C have the potential to affect absorption profiles of the interacting drugs. Option B is a significant interaction. Option D carries a caution related to prolongation of QT intervals, hence affecting cardiac rhythm
- E
Patches should be folded upon themselves once the backing paper has been removed and then disposed of accordingly
- D
Using the BNF Appendix ‘Cardiovascular Risk Prediction Charts’ for primary prevention, it can be seen that Mr FZ has a >20% risk over the next 10 years based on his high blood pressure and TC:HDL ratio
- E
See BNF, Chapter 4 (Central nervous system), section 4.7.4.1. Zomig is the brand name for zolmitriptan
- A
See BNF, Chapter 5 (Infections), section 5.3.5. See drug monograph for dosing
- B
See BNF, Chapter 13 (Skin), section 13.4. Clobetasone butyrate (Eumovate) can be sold to the public in pack sizes of 15 g or less for short-term symptomatic treatment of eczema and dermatitis (but not seborrhoeic dermatitis) in adults and children over 12 years of age
- C
See BNF, Chapter 3 (Respiratory system), section 3.4.3 for the adrenaline monograph or Appendix entitled ‘Medical emergencies in the community’
- B
See BNF, Chapter 6 (Endocrine system), section 6.2.2 or a good OTC reference book. Any nonspecific illness to carbimazole must be immediately referred to a medical professional to rule out bone marrow suppression (such as neutropenia and agranulocytosis)
- A
See BNF, Chapter 8 (Malignant disease and immunosuppression), section 8.1.3. Cytarabine exists as a lipid formulation for intrathecal use. Vinca alkaloids (such as options C, D, and E) are for intravenous use only as intrathecal use can cause severe neurotoxicity, which is usually fatal
