1. A 24-year-old woman with epilepsy is taking sodium valproate. She tells you she is sexually active, not using reliable contraception and is considering pregnancy in the next year.
Which ONE of the following is the most appropriate pharmacist action?
A. Reassure because valproate is safe if seizures are controlled.
B. Advise stopping valproate immediately without specialist input.
C. Urgently signpost for specialist review and discuss Pregnancy Prevention Programme requirements and pregnancy risks.
D. Recommend folic acid only and continue valproate unchanged.
E. Advise contraception is only needed after pregnancy is confirmed.
2. A 30-year-old woman takes topiramate for migraine prevention. She is not pregnant but is not using highly effective contraception.
Which ONE of the following is the most appropriate pharmacist intervention?
A. Reassure because topiramate is safe in pregnancy for migraine.
B. Advise stopping all migraine treatment permanently.
C. Recommend taking topiramate only during the luteal phase.
D. Suggest taking folic acid alone and continuing unchanged.
E. Escalate for review because topiramate has pregnancy safety restrictions and Pregnancy Prevention Programme requirements.
3. A 34-year-old man takes valproate for epilepsy. He and his partner are planning to conceive. He asks whether recent MHRA warnings apply to men.
Which ONE of the following is the most appropriate advice?
A. Discuss the possible reproductive risks, advise effective contraception as recommended and signpost to specialist review before conception planning.
B. Reassure that valproate warnings apply only to women.
C. Advise stopping valproate immediately.
D. Recommend doubling the valproate dose before conception.
E. Tell him contraception is unnecessary if his partner is using folic acid.
4. A 17-year-old with severe acne is being considered for isotretinoin. The patient has a history of low mood and asks whether mental health monitoring is relevant.
Which ONE of the following is the most appropriate response?
A. Isotretinoin has no mental health warnings.
B. Mental health review is needed only after treatment finishes.
C. Isotretinoin can be started without counselling if acne is severe.
D. Mental health and sexual function effects should be discussed and monitored as part of safe isotretinoin prescribing.
E. Isotretinoin is available OTC if topical treatment fails.
5. A 72-year-old woman is prescribed ciprofloxacin for uncomplicated cystitis despite culture results showing nitrofurantoin sensitivity. She has a history of Achilles tendon rupture.
Which ONE of the following is the most appropriate pharmacist action?
A. Supply ciprofloxacin and advise strenuous exercise to maintain tendon strength.
B. Query the prescription because fluoroquinolones should be reserved for when other commonly recommended antibiotics are inappropriate and tendon risks are relevant.
C. Add prednisolone to prevent tendon pain.
D. Reassure that fluoroquinolone tendon effects occur only in athletes.
E. Advise taking ciprofloxacin with calcium tablets to reduce adverse effects.
6. A 64-year-old man taking levofloxacin for prostatitis develops new tendon pain, tingling in his feet, insomnia and anxiety after 3 days.
Which ONE of the following is the most appropriate advice?
A. Continue treatment because these symptoms show infection is resolving.
B. Double the dose to shorten treatment.
C. Add ibuprofen and continue without review.
D. Delay seeking help until the end of the course.
E. Stop taking the fluoroquinolone and seek medical advice urgently because serious disabling adverse effects may occur.
7. A 9-year-old child taking montelukast for asthma develops nightmares, aggression and anxiety shortly after starting treatment. Asthma symptoms are otherwise stable.
Which ONE of the following is the most appropriate pharmacist action?
A. Advise prompt medical review because montelukast can be associated with neuropsychiatric reactions.
B. Reassure that behavioural changes are unrelated to montelukast.
C. Double the montelukast dose.
D. Stop all asthma medicines permanently.
E. Add another leukotriene receptor antagonist.
8. A 51-year-old man with severe uncontrolled hypertension asks to buy pseudoephedrine for nasal congestion. He has recently had severe headaches and visual disturbance.
Which ONE of the following is the most appropriate pharmacist action?
A. Supply pseudoephedrine and advise checking blood pressure next month.
B. Recommend taking two doses initially.
C. Supply pseudoephedrine only with caffeine avoided.
D. Avoid pseudoephedrine and advise clinical assessment because of cardiovascular risk and rare PRES/RCVS warning symptoms.
E. Reassure that pseudoephedrine has no systemic effects.
9. A 70-year-old woman has been taking nitrofurantoin prophylaxis for recurrent UTI for 8 months. She reports new persistent cough and breathlessness.
Which ONE of the following is the most appropriate pharmacist concern?
A. Nitrofurantoin prevents all respiratory symptoms.
B. Nitrofurantoin-associated pulmonary adverse reaction should be considered and reviewed urgently.
C. Symptoms are expected with recurrent UTI prophylaxis.
D. Increase nitrofurantoin dose.
E. Add codeine linctus and continue nitrofurantoin.
10. A 67-year-old woman on long-term nitrofurantoin develops jaundice, dark urine and right upper quadrant discomfort.
Which ONE of the following is the most appropriate action?
A. Reassure that nitrofurantoin commonly stains the skin yellow.
B. Increase fluid intake and continue treatment.
C. Escalate for urgent review because nitrofurantoin can cause hepatic adverse reactions.
D. Add paracetamol at maximum dose.
E. Treat as uncomplicated cystitis.
11. A 29-year-old man taking finasteride 1 mg for hair loss reports new low mood, reduced libido and erectile dysfunction. He asks whether these could be medicine-related.
Which ONE of the following is the most appropriate response?
A. Reassure because finasteride affects only hair follicles.
B. Advise increasing the dose to 5 mg.
C. Stop all medicines permanently.
D. Discuss possible psychiatric and sexual side effects and advise medical review.
E. Recommend adding dutasteride without review.
12. A 76-year-old man with COPD and chronic kidney disease is prescribed pregabalin. He also takes modified-release morphine and zopiclone.
Which ONE of the following is the most appropriate pharmacist contribution?
A. Review respiratory depression risk, dose suitability and additive CNS depressant effects.
B. Reassure because pregabalin has no respiratory effects.
C. Recommend alcohol to improve sleep.
D. Advise doubling morphine if pregabalin causes drowsiness.
E. Stop COPD inhalers because pregabalin treats breathlessness.
13. A 58-year-old woman taking gabapentin and oxycodone becomes unusually drowsy and her partner notices slow, shallow breathing.
Which ONE of the following is the most appropriate action?
A. Reassure because drowsiness is expected.
B. Give the next oxycodone dose early.
C. Treat as mild anxiety.
D. Advise taking gabapentin with alcohol to reduce symptoms.
E. Arrange urgent assessment for possible additive CNS and respiratory depression.
14. A 35-year-old woman using domperidone regularly for nausea asks to buy another supply. She has a history of prolonged QT interval and is currently taking clarithromycin.
Which ONE of the following is the most appropriate pharmacist action?
A. Supply domperidone and advise taking it with grapefruit juice.
B. Increase the dose to improve nausea control.
C. Avoid supply and refer for review because of cardiac arrhythmia and interaction risk.
D. Reassure that QT prolongation is unrelated to antiemetics.
E. Recommend combining domperidone with erythromycin.
15. A 62-year-old man is prescribed diclofenac for osteoarthritis. He has ischaemic heart disease, heart failure and uncontrolled hypertension.
Which ONE of the following is the most appropriate pharmacist concern?
A. Diclofenac reduces cardiovascular risk.
B. Diclofenac has cardiovascular risk and may be unsuitable in this patient.
C. NSAIDs are always safer than topical analgesics.
D. Diclofenac prevents heart failure exacerbations.
E. Cardiovascular history does not affect NSAID choice.
16. A 38-year-old woman taking carbamazepine develops fever, sore throat, bruising and a widespread rash. She started treatment 3 weeks ago.
Which ONE of the following is the most appropriate action?
A. Continue carbamazepine and review at the next annual check.
B. Treat as hay fever.
C. Recommend topical hydrocortisone only.
D. Arrange urgent medical assessment because serious blood, skin or hypersensitivity reactions may occur.
E. Increase the carbamazepine dose.
17. A 46-year-old man of Han Chinese ancestry is being considered for carbamazepine. He has never taken it before.
Which ONE of the following is the most appropriate safety consideration?
A. HLA-B*1502 testing should be considered before carbamazepine because of severe skin reaction risk in some Asian ancestry groups.
B. Carbamazepine is contraindicated in all patients of Asian ancestry.
C. Skin reaction risk occurs only after 10 years of treatment.
D. Genetic risk is removed by taking antihistamines.
E. Carbamazepine should be started at double dose.
18. A patient taking clozapine presents with fever, sore throat and flu-like symptoms. He missed his scheduled blood test last week.
Which ONE of the following is the most appropriate pharmacist action?
A. Reassure because clozapine prevents infection.
B. Supply chlorphenamine and continue clozapine without review.
C. Advise taking an extra clozapine dose.
D. Delay review until the next clinic.
E. Arrange urgent assessment and blood count review for possible neutropenia or agranulocytosis.
19. A 40-year-old woman taking lamotrigine for epilepsy develops a painful widespread rash with fever and mouth ulcers 4 weeks after starting treatment.
Which ONE of the following is the most appropriate action?
A. Add a potent topical corticosteroid and continue lamotrigine.
B. Reassure because lamotrigine rashes are always mild.
C. Stop lamotrigine and arrange urgent assessment for possible serious skin reaction.
D. Increase lamotrigine more slowly but continue current tablets.
E. Treat as uncomplicated acne.
20. A 73-year-old woman is taking trimethoprim for UTI. She also takes ramipril and spironolactone. She reports muscle weakness and palpitations.
Which ONE of the following is the most appropriate pharmacist concern?
A. Trimethoprim prevents electrolyte disturbance.
B. Hyperkalaemia risk is increased with trimethoprim, ACE inhibitors and potassium-sparing diuretics.
C. Spironolactone lowers potassium in all patients.
D. Ramipril prevents trimethoprim interactions.
E. Muscle weakness excludes electrolyte disturbance.
21. A 34-year-old woman taking warfarin is prescribed miconazole oral gel for suspected oral thrush.
Which ONE of the following is the most appropriate pharmacist action?
A. Supply because topical oral products cannot interact.
B. Increase warfarin dose.
C. Advise applying extra gel to improve absorption.
D. Reassure because miconazole reduces INR.
E. Query and seek an alternative because miconazole oral gel can significantly increase warfarin effect.
22. A 61-year-old man taking citalopram 40 mg daily is prescribed erythromycin. He has a history of prolonged QT interval.
Which ONE of the following is the most appropriate pharmacist concern?
A. Erythromycin shortens QT interval.
B. Citalopram prevents arrhythmias.
C. The combination may increase QT prolongation risk and should be reviewed.
D. QT risk is relevant only to injectable medicines.
E. No monitoring is required if the patient is asymptomatic.
23. A patient asks what the black triangle symbol next to a new medicine means in the BNF.
Which ONE of the following is the most appropriate explanation?
A. It means the medicine is under additional monitoring and suspected adverse reactions should be reported.
B. It means the medicine is banned.
C. It means the medicine is only for hospital use.
D. It means the medicine cannot be used in pregnancy.
E. It means the medicine has no known adverse effects.
24. A pharmacist suspects a patient has experienced a serious adverse reaction to a medicine, but the causal link is not certain.
Which ONE of the following is the most appropriate action?
A. Do not report unless causality is proven.
B. Report only if the manufacturer requests it.
C. Report only if the medicine is new.
D. Submit a Yellow Card report because suspected serious adverse reactions should be reported.
E. Wait until another healthcare professional reports it.
25. A 69-year-old man with type 2 diabetes takes empagliflozin. He is acutely unwell with vomiting, abdominal pain and rapid breathing. His blood glucose is 9 mmol/L.
Which ONE of the following is the most appropriate safety concern?
A. SGLT2 inhibitors prevent ketoacidosis if glucose is below 11 mmol/L.
B. Euglycaemic diabetic ketoacidosis should be considered and urgent assessment is needed.
C. The symptoms prove uncomplicated gastroenteritis.
D. Empagliflozin should be doubled during vomiting illness.
E. Ketone testing is unnecessary if glucose is not very high.
Drug and Safety Alerts Questions
Answers and Rationale
1. C
Valproate has major reproductive risks and strict prescribing safeguards. A woman of childbearing potential who is not using reliable contraception should be urgently signposted for specialist review and Pregnancy Prevention Programme counselling.
2. E
Topiramate has strengthened pregnancy safety restrictions and should not be used in women of childbearing potential unless Pregnancy Prevention Programme conditions are met. Migraine prophylaxis in pregnancy is particularly restricted.
3. A
MHRA advice includes precautionary counselling for men taking valproate who may father children. They should be informed of possible reproductive risks and advised to use effective contraception while specialist review is arranged.
4. D
Isotretinoin requires specialist prescribing and careful counselling. Patients should be informed about possible psychiatric and sexual function adverse effects, and monitoring should be part of safe treatment.
5. B
Fluoroquinolones should be reserved for situations where other commonly recommended antibiotics are inappropriate. Previous tendon rupture increases concern because fluoroquinolones can cause serious tendon adverse effects.
6. E
New tendon pain, neuropathic symptoms, insomnia or mood symptoms during fluoroquinolone treatment are warning signs of potentially disabling adverse effects. The medicine should be stopped and medical advice sought.
7. A
Montelukast can be associated with neuropsychiatric reactions, including nightmares, anxiety, aggression, depression and mood changes. New behavioural symptoms should prompt review.
8. D
Pseudoephedrine can raise blood pressure and has MHRA warnings about very rare PRES and RCVS. Severe headache or visual disturbance in a patient with uncontrolled hypertension requires caution and clinical assessment.
9. B
Long-term nitrofurantoin can rarely cause pulmonary adverse reactions, including persistent cough and breathlessness. These symptoms should be reviewed urgently rather than treated as a minor respiratory illness.
10. C
Nitrofurantoin can rarely cause hepatic adverse reactions. Jaundice, dark urine and right upper quadrant discomfort require prompt clinical review and liver function assessment.
11. D
Finasteride has MHRA warnings about psychiatric adverse effects and sexual dysfunction, which may persist after stopping. Patients reporting these symptoms should receive counselling and medical review.
12. A
Pregabalin can cause respiratory depression, particularly in older adults, renal impairment, respiratory disease and with other CNS depressants such as opioids and zopiclone. Dose and risk should be reviewed.
13. E
Gabapentin and opioids can have additive CNS depressant effects, increasing risk of sedation and respiratory depression. Slow shallow breathing requires urgent assessment.
14. C
Domperidone can prolong QT interval and is risky with QT-prolonging or CYP3A4-inhibiting medicines such as clarithromycin. It should be avoided or reviewed in high-risk patients.
15. B
Diclofenac has recognised cardiovascular risk and may be unsuitable in patients with established ischaemic heart disease, heart failure or uncontrolled hypertension. Safer alternatives should be considered.
16. D
Carbamazepine can cause serious skin reactions, blood disorders and hypersensitivity. Fever, sore throat, bruising and rash soon after initiation require urgent assessment.
17. A
HLA-B*1502 is associated with severe carbamazepine-related skin reactions in some Asian ancestry groups. Testing should be considered before starting in relevant patients.
18. E
Clozapine can cause neutropenia and agranulocytosis. Fever or sore throat with missed blood monitoring requires urgent assessment and full blood count review.
19. C
Lamotrigine can cause serious skin reactions including Stevens–Johnson syndrome. A painful rash with fever and mouth ulcers requires stopping treatment and urgent assessment.
20. B
Trimethoprim can increase potassium, especially with ACE inhibitors and spironolactone. Muscle weakness and palpitations may indicate clinically significant hyperkalaemia.
21. E
Miconazole oral gel can significantly increase warfarin anticoagulant effect and bleeding risk. An alternative antifungal or anticoagulation review is usually needed.
22. C
Citalopram and erythromycin can both contribute to QT prolongation. The combination is concerning in a patient with known prolonged QT interval and should be reviewed.
23. A
A black triangle means a medicine is under additional monitoring. Healthcare professionals and patients are encouraged to report suspected adverse reactions, even if not serious.
24. D
Yellow Card reports are based on suspicion, not proven causality. Serious suspected adverse drug reactions and reactions to black triangle medicines should be reported.
25. B
SGLT2 inhibitors can be associated with euglycaemic diabetic ketoacidosis, where glucose may not be markedly raised. Vomiting, abdominal pain and rapid breathing require urgent assessment and ketone testing.
Here are 25 multiple-choice questions designed to mimic the GPHC exam itself. At the bottom of the page you will find answers and rationale for each question.