Prescribing Safety1. A 52-year-old woman with rheumatoid arthritis collects a community prescription for methotrexate 15 mg. Which counselling point is the most important safety message in UK general practice? Select TWO correct statements.Select all that apply.A. Most appropriate: Take the full methotrexate dose once weekly on the same named dayB. The following is not the most appropriate next step: Take 2.5 mg three times daily with food to reduce nauseaC. Most appropriate: Take methotrexate only on days when the joints are swollenD. Most appropriate: Double the tablets for 3 days at the start of each month as a loading courseCheck
Prescribing Safety2. A 34-year-old woman with ulcerative colitis is to start azathioprine in shared care. Bloods including FBC and LFT are normal. What must be confirmed before the first dose?A. HLA-B27 typingB. Serum amylase as a mandatory baselineC. Thiopurine methyltransferase (TPMT) activity or genotypeD. Red-cell folate onlyCheck
Prescribing Safety3. A GP starts a black-triangle (▼) medicine. The patient develops a widespread itchy rash that settles on stopping. What is the most appropriate MHRA action?A. Submit a Yellow Card because all suspected ADRs to ▼ drugs should be reportedB. Report only if the rash is biopsy-provenC. Report only if the patient is admitted to hospitalD. Do not report because the rash was not fatalCheck
Prescribing Safety4. An 78-year-old woman is on citalopram for depression. The community pharmacist queries the dose. What is the MHRA maximum daily dose in older people? Select TWO correct statements.Select all that apply.A. Most appropriate: 20 mg dailyB. The following is not the most appropriate next step: 60 mg dailyC. Most appropriate: 10 mg weeklyD. Most appropriate: 40 mg daily as for younger adultsCheck
Prescribing Safety5. A 69-year-old man takes apixaban 5 mg twice daily for AF. He asks for ibuprofen for knee OA. What is the main additional risk?A. Complete loss of anticoagulant effectB. Mandatory conversion of apixaban to warfarin within 24 hoursC. Severe serotonin syndromeD. Increased gastrointestinal bleeding riskCheck
Prescribing Safety6. A woman on leflunomide needs accelerated drug clearance because of planned pregnancy. Which washout agent is used?A. Intravenous calcium gluconateB. N-acetylcysteine 21-hour protocol as for paracetamolC. Activated charcoal every hour for 24 hours onlyD. Colestyramine (cholestyramine)Check
Prescribing Safety7. Ramipril (an established drug) is suspected of causing angioedema requiring adrenaline in a 64-year-old. Should this be Yellow Carded? Select TWO correct statements.Select all that apply.A. Most appropriate: Yes — serious suspected reactions to established drugs should be reportedB. The following is not the most appropriate next step: No — only ▼ drugs can be reportedC. Most appropriate: No — ACE-inhibitor angioedema is too well known to reportD. Most appropriate: Only if the MHRA writes to the practice firstCheck
Prescribing Safety8. A 45-year-old woman takes citalopram 40 mg daily. She needs an antibiotic for community pneumonia. Which choice most clearly adds QT risk?A. AmoxicillinB. NitrofurantoinC. Doxycycline as the dominant QT culpritD. ClarithromycinCheck
Prescribing Safety9. A 50-year-old man on lithium carbonate asks for naproxen for acute gout. What is the key interaction?A. NSAIDs can raise lithium levels and precipitate toxicityB. NSAIDs inactivate lithium completelyC. Lithium blocks all NSAID absorptionD. The combination treats mania more effectively so is encouragedCheck
Prescribing Safety10. Gabapentin is prescribed for neuropathic pain. eGFR is 25 mL/min/1.73 m². What is required?A. No change because gabapentin is hepatically cleared onlyB. Use a reduced dose (and/or extended interval) as per BNF renal tablesC. Double the usual dose to overcome reduced filtrationD. Convert immediately to morphine MR 100 mg twice dailyCheck