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LPN INTENSIVE COURSE�� CHAPTER 3 WORKBOOK �� INTENSIVE GPHC Exam revision � programme

LONDON PHARMACIST NETWORK (LPN)

INTENSIVE REVISION FOR

GPHC EXAM.

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QUESTION 1

A 40-year-old asthmatic patient visits your clinic for an asthma review. He is currently prescribed Symbicort inhaler (formoterol/budesonide) as MART (maintenance and reliever therapy). During his review he mentions that in the last 4 months he has not experienced any exacerbations, and his inhaler completely controls his asthma as he does not wake at night anymore , not experiencing wheezing or shortness of breath in the last 1 month .

Which of the following actions would be your next line of action in this scenario?

Consider adding a SABA to his current regimen.
Make no changes. Advice him to continue with his current regimen
Consider replacing MART with montelukast.
Consider prescribing a short course of prednisolone
Step down his current treatment to AIR therapy.

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QUESTION TWO -

Mrs. Kay aged 66-years walk into your clinic for a respiratory check for COPD . You check the % of her predicted FEV1 and your required to grade her according to the GOLD assessment tool. Given that the spirometry measured 28% of predicted FEV1, which grade does Mrs. Kay fit in ? USE RESOURCE gold guidelines on previous page.
A. GOLD 1
B. GOLD 2
C. GOLD 3
D. GOLD 4
E. GOLD 5

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QUESTION THREE -

MR. Greg aged 69-years walk into your clinic for a respiratory check for COPD . He has a family history of COPD. You check his FEV1 and FVC and the results are written below.
FEV1 = 2 & FVC = 4
His mMRC score is 1, CAT score is 9 and he was hospitalized once last month due to an exacerbation of his condition. Select the COPD group this patient belongs to according to GOLD guidelines. USE resource provided
A. group A
B. group B
C. group C
D. group D
E. group E

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QUESTION FOUR -

Mrs. W. a COPD patient with chronic bronchitis is a 61-year-old patient who is trying to quit smoking but has not been successful. She was hospitalized with dyspnoea due to exacerbations of his COPD. She currently uses Tiotropium regularly to manage her condition . Her test results reveal that she has a blood eos of 300 and her FEV1 is 55% of predicted FEV1. Using the follow-up pharmacological treatment resource in GOLD guidelines 2025, select your next line of action from options below?

SEE KEY ON PREVIOUS PAGE

A. Give salmeterol only and stop Tiotropium.
B. Give both Clenil and Spiriva (Tiotropium)
C. replace Titropium with Anoro Ellipta (Umeclidinium with vilanterol)
D. Replace tiotropium with Trimbow inhaler
E. Give Fostair (beclomethasone) Inhaler only

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QUESTION FIVE -

Mr. Jay is 66-year-old patient who suffers from COPD -chronic bronchitis . He was hospitalized once last winter due to exacerbations of his COPD. He currently uses salmeterol and Tiotropium to manage his condition . His test results reveal that he has a blood eos of 250 and his FEV1 is 65% of predicted FEV1. Using the follow-up pharmacological treatment resource in GOLD guidelines 2025, select the most suitable current treatment for Mr. Jay.
A. LABA + ICS + LAMA
B. LABA + LAMA + ICS + ROFLUMILAST
C. LABA ONLY
D. LABA + LAMA + ICS + AZITHROMYCIN
E. LABA + LAMA

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QUESTION SIX -

Regarding antibiotics for Rescue pack alongside a corticosteroid such as prednisolone, antibiotics such Amoxicillin 500mg TDS for 5 days OR Doxycycline 200mg STAT then 100mg OD thereafter can be given for rescue pack. Which of the following antibiotics is used as suitable prophylaxis to reduce the risk of exacerbations in patients who are non-smokers, have had all other treatment options optimized, and who continue to either have prolonged or frequent (4 or more per year) exacerbations with sputum production, or exacerbations resulting in hospitalization.
A. Clarithromycin 500mg BD
B. Co-amoxiclav 625mg TDS for 5 days
C. Azithromycin 250mg three times a week
D. Amoxicillin 250mg three times a day
E. Azithromycin 500mg three times a week

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QUESTION SEVEN -

In 2023, Products containing pholcodine were recently withdrawn from pharmacies across the UK. What was the main reason for this ? Use resource provided

A. risk of anaphylaxis
B. risk of encephalopathy
C. Risk of respiratory depression
D. Risk of toxic megacolon
E. Risk of blood disorder
Pholcodine-containing cough and cold medicines: withdrawal from UK market as a precautionary measure - GOV.UK (www.gov.uk)

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QUESTION EIGHT -

Anna is a 19-year-old who has just been diagnosed with Chronic Asthma. She presents with symptoms such as shortness of breath, tight chest and wakes up at night quite often with worsening symptoms. Her doctor would like to prescribe a suitable medication. Choose the most appropriate option below>
A. Offer a SABA Ventolin inhaler.
B. Offer a LABA e.g. Formoterol
C. Add a LTRA e.g. Montelukast
D. Give Symbicort 100/6 inhaler
E. Give Beclomethasone inhaler e.g. Clenil

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QUESTION NINE -

SELECT a statement that is not true about spacers.
A. Use of spacers can reduce incidence of oral candidiasis
B Larger spacers with one-way valves (eg: volumatic) are more effective than smaller spacers.
C. It is advisable to dry spacers with a cloth after washing.
D. Replace every 6 -12 months.
E. Spacers should be cleaned once a month.

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QUESTION TEN-

This question relates to Mr. W a 71-year –old who suffers from COPD and diabetes type 2. Microbiology results show that he has contracted Pneumocystis pneumonia. Pneumocystis pneumonia (PCP) is an infection of the lungs caused by an organism called …………….?
A. Staphylococus Pneumonia
B. Pseudomonas Pneumonia
C. Pneumocystis jirovecii
D. Chlamydophila pneumoniae
E. Haemophilus pneumoniae

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QUESTION ELEVEN -

A 50-year-old man has just started smoking cigarettes again after quitting for 6 months. He has been newly prescribed theophylline to manage his COPD .

Select the most likely possible consequence of the drug interaction with the new drug.

Five available answer options. Select only one option
A. increased risk of theophylline toxicity
B. Hyperkaliemia
C. hypertensive crisis
D. Decrease in theophylline plasma concentration
E. Increased QT interval prolongation

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QUESTION TWELVE -

A 46-year-old female with a history of moderate persistent asthma presents to your clinic for a routine medication review. She is currently prescribed fostair 200/6 Nexhhaler twice daily for maintenance therapy. The patient mentions that she has been experiencing worsening of her symptoms despite regular appropriate use of her inhaler. Which of the following is the recommended next step of action during your assessment ?
Which of the following is the most appropriate intervention to address this issue?
A. Offer the patient salbutamol inhaler.
B. Recommend the patient is switched to AIR therapy.
C. Refer the patient to a respiratory specialist for further evaluation and management
D. Offer the patient a LAMA such as Tiotropium inhaler
E. Offer the patient an ICS such beclomethasone inhaler.

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QUESTION THIRTEEN -

Whilst administering a flu-jab to a 45-year-old female patient, She suffers an anaphylactic reaction and falls on the floor. You administer EpiPen and ask a member of staff to call the ambulance. You also need to administer cardiopulmonary resuscitation. Which of the following options below is the correct Cardiopulmonary resuscitation ratio for an Adult?
A. 15:2
B. 30:2
C. 30:1
D. 15:1
E. 30:3

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QUESTION FOURTEEN -

When supplying inhaled corticosteroids, there are several important counselling points which should be discussed with the patient and/or carer. Which of the following is the most appropriate statement regarding the use of inhaled corticosteroids?
A. A steroid card is only required to be supplied to patients taking oral corticosteroids and not those who are only on inhaled corticosteroids
B. If oral candidiasis develops, treatment should be stopped while an anti-fungal suspension or oral gel is being used as treatment.
C. Qvar and Clenil Modulite are interchangeable, as both are beclometasone dipropionate CFC-free pMDIs
D. Corticosteroids can increase the risk of hyperkaliemia.
E. Corticosteroids can increase the risk of tendon damage when given with Quinolones.

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QUESTION FIFTEEN -

Betty is a 35-year-old woman from South-Africa living in the UK. She is of Afro-Caribbean origin. She is currently 20 weeks pregnant and usually use Ventolin inhaler and clenil inhaler to manage her asthma for the past two years. Today, she was diagnosed with gestational hypertension, and the doctor would like to recommend a suitable treatment. Betty also mentions that she plans to breastfeed her child once she delivers. In light of this scenario, which of the following is the most suitable drug treatment for Betty?

A. Indapamide
B. Nifedipine M/R
C. Methyldopa
D. Labetalol
E. Enalapril

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QUESTION SIXTEEN -

You are working in a hospital ward when a 41-year-old male patient is admitted with respiratory depression after taking an overdose of codeine tablets. His symptoms include – slow and shallow breathes, confusion, difficulty breathing and fatigue. The doctor on duty would like the patient to be administered oxygen therapy. Which concentration of oxygen therapy would you recommend ? See resource
A. 94–98% oxygen saturation
B. 84–98% oxygen saturation
C. 86–92% oxygen saturation
D. 88–92% oxygen saturation
E. 80–92% oxygen saturation

Oxygen | Treatment summaries | BNF | NICE

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QUESTION 17 -

Mrs S comes to the pharmacy to have her flu vaccination, she is eligible for the vaccines she has COPD. Her records show that she is allergic to penicillin, egg, and she uses a steroid inhaler for her asthma. What is the most appropriate action you should take regarding the administration of the flu vaccine?
A. Refer her to GP as you cannot administer flu vaccination due to penicillin allergy.
B. Refer her to GP as you cannot administer flu vaccination due to her egg allergy.
C. Refer her to GP as you cannot administer flu vaccination due to asthma.
D. The flu vaccine does not contain egg so it can be administered to her
E. Administer the flu vaccine and observe her for 20 minutes.

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QUESTION 18 -

Mr. Ahmed aged 66-years walk into your clinic as a patient newly diagnosed with COPD. He would like to know which vaccinations are necessary due to his recent diagnosis. According to GOLD guidelines 2025 on COPD, which of the following is the least important for COPD patients?

A. Shingles vaccine
B. Pertussis vaccine
C. Rabies vaccine
D. Pneumococcal vaccine
E. RSV vaccine

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QUESTION 19 -

A patient has had her dose of theophylline increased from 200mg BD to 300mg BD. The prescriber is unsure of the monitoring requirements. Which of the following is the most appropriate monitoring to advise?
A. Plasma theophylline-concentration should be measured at least 2 days after a dose adjustment.
B. Plasma theophylline-concentration should be measured at least 3 days after a dose adjustment.
C. Plasma theophylline-concentration should be measured at least 4 days after a dose adjustment.
D. Plasma theophylline-concentration should be measured at least 5 days after a dose adjustment.
E. Plasma theophylline-concentration should be measured at least 6 days after a dose adjustment.

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QUESTION 20 -

A 23-year-old asthmatic female pregnant patient would like information about vaccination during pregnancy. She would like you to talk her through important vaccines in pregnancy to have and which ones to avoid. Which of the following vaccines is recommended by the NHS for women in pregnancy ?
SELECT the most appropriate option below -
BCG (vaccination against tuberculosis)
Whooping cough vaccine
MMR (measles, mumps and rubella)
oral typhoid
yellow fever vaccine

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ANSWERS -

1. Make no changes. Advice him to continue with his current regimen as he is not stabilized for 12 weeks yet.

2. D. GOLD 4 – SEE RESOURCE

3. GROUP E because mMRC score is 1, CAT score is 9 and he was hospitalized once last month due to an exacerbation of his condition. SEE RESOURCE

4. C. replace Tiotropium with Anoro Ellipta (Umeclidinium with vilanterol)

5. a. LABA +ICS + LAMA

6. C. Azithromycin 250mg three times a week.

7. A. risk of anaphylaxis

8. D. Give Symbicort 100/6 inhaler. AIR THERAPY IS FIRST LINE IN OVER 12 YEARS

9. C. It is advisable to dry spacers with a cloth after washing. Not advisable as can increase STATIC!!!

10. C. Pneumocystis jirovecii

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ANSWERS -

11. D. Decrease in theophylline plasma concentration. This is because Tobacco in cigarettes is an enzyme inducer!

D. Offer the patient a LAMA such as Tiotropium inhaler
13. B. 30:2

14. E. Corticosteroids can increase the risk of tendon damage when given with Quinolones. Both are CORRECT!!!

15. B. Nifedipine M/R as patient is Afro-Caribbean and wants to breast feed. Labetalol unsuitable in asthmatic patients and don’t give enalapril due to increased risk of angioedema in Afro-Caribbean patients. Nifedipine M/R is suitable both in pregnancy and breastfeeding.

16. D. 88–92% oxygen saturation. Lower oxygen concentration required for opioid overdose.

17. B. Refer her to GP as you cannot administer flu vaccination due to her egg allergy.

18. C. Rabies vaccine is not mandatory in COPD

19. B. Plasma theophylline-concentration should be measured at least 3 days after a dose adjustment.

20. B. Pregnant women can have Influenza, whooping cough and RSV vaccine.