PSI Pharmacy Registration Assessment Ireland — Questions and Answers

Question 1: What monitoring is required for a patient on Direct Oral Anticoagulants (DOACs) such as apixaban or rivarelbane?

Renal function (eGFR) should be monitored at least annually (more frequently if impaired), along with hepatic function and haemoglobin; no routine INR monitoring is needed (Correct answer)
DOACs require weekly INR monitoring like warfarin
Only blood pressure monitoring is required
No monitoring is needed for DOACs

Correct answer: Renal function (eGFR) should be monitored at least annually (more frequently if impaired), along with hepatic function and haemoglobin; no routine INR monitoring is needed

Unlike warfarin, DOACs do not require routine INR monitoring. However, renal function must be monitored (at least annually, more frequently if eGFR <60) as renal impairment affects drug clearance. Hepatic function and haemoglobin should also be checked. Dose adjustments may be needed based on renal function.

Question 2: A patient taking isotretinoin for severe acne must be counselled about which mandatory precaution?

Strict contraception throughout treatment and for one month after — severe teratogen (Correct answer)
No alcohol for 2 weeks only
Take at bedtime only
Avoid sunlight only

Correct answer: Strict contraception throughout treatment and for one month after — severe teratogen

Isotretinoin is teratogenic. In Ireland, the HPRA-mandated iPLEDGE-equivalent (Roaccutane/Accutane REMS) requires two forms of contraception, monthly pregnancy testing and patient agreement form.

Question 3: What is the ethical importance of continuing professional development (CPD) for pharmacists?

CPD is an ethical obligation to maintain and develop competence throughout a pharmacist's career, ensuring patients receive care based on current knowledge and best practice (Correct answer)
CPD is the employer's responsibility, not the individual pharmacist's
CPD is optional and only for career advancement
CPD is only required for the first five years after qualification

Correct answer: CPD is an ethical obligation to maintain and develop competence throughout a pharmacist's career, ensuring patients receive care based on current knowledge and best practice

CPD is both a regulatory requirement and an ethical imperative. The rapid pace of pharmaceutical science means knowledge quickly becomes outdated. Pharmacists have an ethical duty to maintain competence through lifelong learning, ensuring their practice reflects current evidence and best practice.

Question 4: Blister packaging for dispensed medicines is preferable to loose tablets in a bottle for which reason?

Blisters are cheaper to produce
Each tablet is individually protected from moisture, air and light — improving stability and aiding compliance (Correct answer)
Bottles are legally prohibited
Loose tablets improve dose accuracy

Correct answer: Each tablet is individually protected from moisture, air and light — improving stability and aiding compliance

Blister packs protect each unit individually and the date-sequencing aids patient adherence (knowing which tablet to take each day). Bottles expose all tablets to humidity and air each time they are opened.

Question 5: What ethical principle requires pharmacists to act in the best interest of the patient?

Beneficence — the duty to act in the patient's best interest and promote their welfare (Correct answer)
Justice — the fair distribution of resources
Non-maleficence — the duty to do no harm
Autonomy — the right to make decisions independently

Correct answer: Beneficence — the duty to act in the patient's best interest and promote their welfare

Beneficence is the ethical principle requiring healthcare professionals to act in the patient's best interest. For pharmacists, this means providing optimal pharmaceutical care, advocating for patients, and always prioritising patient welfare over commercial interests.

Question 6: Which piece of information is NOT required on a controlled drug prescription under Irish Misuse of Drugs Regulations?

Prescriber's signature
Total quantity in words and figures
The patient's occupation (Correct answer)
Patient's full name and address

Correct answer: The patient's occupation

Irish CD prescription requirements include patient name/address, drug/strength/form, dose instructions, total quantity in words AND figures, date, and prescriber's signature and address. Occupation is not required.

Question 7: Which OTC topical preparation is used to treat cold sores (herpes labialis) and should be applied at the first sign of tingling?

Hydrocortisone 1% cream
Zinc oxide cream
Fusidic acid cream
Aciclovir 5% cream (Correct answer)

Correct answer: Aciclovir 5% cream

Topical aciclovir 5% cream inhibits herpes simplex virus DNA polymerase. Application at the prodromal tingling/itching stage (before vesicles form) is most effective in limiting lesion size and duration.

Question 8: How should a pharmacist handle a conflict of interest between commercial pressures and patient care?

Balance equally between commercial and patient interests
Let the pharmacy owner decide which takes priority
Commercial success should be the primary priority
Patient care and safety must always take priority over commercial or business interests (Correct answer)

Correct answer: Patient care and safety must always take priority over commercial or business interests

The PSI Code of Conduct is clear: patient care must always come first. Pharmacists must not allow commercial pressures to compromise the quality of care, recommend unnecessary products, or dispense inappropriately. Professional judgement must prioritise patient safety above business interests.

Question 9: A drug with a narrow therapeutic index requires:

No dose adjustments
Therapeutic drug monitoring (Correct answer)
Higher loading doses
Less frequent dosing

Correct answer: Therapeutic drug monitoring

Narrow therapeutic index drugs (e.g., digoxin, warfarin, lithium) have small differences between effective and toxic concentrations, necessitating regular plasma level monitoring.

Question 10: The 'yellow card' equivalent for adverse drug reaction reporting in Ireland is submitted to:

The patient's GP
The HPRA (Correct answer)
The manufacturer directly
The PSI

Correct answer: The HPRA

ADRs in Ireland are reported to the HPRA (Health Products Regulatory Authority) via the online reporting system. Healthcare professionals and patients can both report. The HPRA feeds data to EudraVigilance.

Question 11: The 'right drug, right patient, right dose, right route, right time' is known as the:

WHO Surgical Safety Checklist
Five Rights of Medicines Administration (Correct answer)
PSI Dispensing Protocol
Seven Rights of Dispensing

Correct answer: Five Rights of Medicines Administration

The Five Rights (or expanded Seven Rights) is a fundamental patient safety framework for medicines administration and dispensing, minimising errors across prescribing, dispensing and administration.

Question 12: Which dosage form is designed to release drug in the small intestine rather than the stomach?

Effervescent tablet
Enteric-coated tablet (Correct answer)
Buccal film
Sublingual tablet

Correct answer: Enteric-coated tablet

Enteric coatings (e.g., HPMC phthalate) resist acidic gastric pH but dissolve at the higher pH of the small intestine, protecting acid-labile drugs or preventing gastric irritation.

Question 13: What is the LASA (Look-Alike, Sound-Alike) issue in pharmacy?

The risk of medication errors caused by medicines with similar names, similar packaging, or both, leading to potential selection errors during dispensing (Correct answer)
A patient classification system
A quality assessment tool for pharmacy labels
An inventory management system

Correct answer: The risk of medication errors caused by medicines with similar names, similar packaging, or both, leading to potential selection errors during dispensing

LASA medicines pose a significant safety risk because their similar names (e.g., hydroxyzine/hydralazine) or packaging can lead to wrong drug selection errors. Pharmacies should implement strategies such as tall-man lettering, physical separation of LASA products, and electronic alerts.

Question 14: A patient asks if they can crush their slow-release diltiazem tablet. The pharmacist should advise:

No — crushing destroys the controlled-release mechanism and may cause dose-dumping toxicity (Correct answer)
Yes — food makes it easier to swallow
Yes — crushing is always safe
Only half the tablet can be crushed

Correct answer: No — crushing destroys the controlled-release mechanism and may cause dose-dumping toxicity

Modified-release (MR/SR/XL) tablets must NEVER be crushed. Destruction of the release mechanism releases the entire dose immediately, causing toxicity (dose-dumping). A different formulation should be considered.

Question 15: What is the importance of medication reconciliation when a patient is discharged from hospital?

It is the hospital's sole responsibility
Medication reconciliation is only needed on admission
The community pharmacist has no role in discharge reconciliation
To ensure continuity of care by comparing the discharge prescription with the patient's pre-admission medications, identifying any intentional changes, and preventing unintended omissions or duplications (Correct answer)

Correct answer: To ensure continuity of care by comparing the discharge prescription with the patient's pre-admission medications, identifying any intentional changes, and preventing unintended omissions or duplications

Community pharmacists play a vital role in discharge reconciliation. They should compare the discharge prescription with the patient's previous medication record, identify any changes (new medicines, stopped medicines, dose changes), verify these changes were intentional, and counsel the patient on the updated regimen.

Question 16: Which OTC product is recommended for the management of mild allergic contact dermatitis on the skin?

Betamethasone 0.1% cream OTC
Antifungal cream
Antihistamine cream (topical diphenhydramine)
Hydrocortisone 1% cream applied sparingly for up to 7 days (Correct answer)

Correct answer: Hydrocortisone 1% cream applied sparingly for up to 7 days

Hydrocortisone 1% is the only topical corticosteroid available OTC in Ireland. It is appropriate for mild, localised inflammation (dermatitis, insect bites) for up to 7 days. Stronger steroids require prescription.

Question 17: What is the pharmacist's role in pharmacovigilance?

Pharmacists have no role in pharmacovigilance
To monitor the safety of medicines in everyday use, detect new or changing safety signals, report adverse events, and contribute to the ongoing assessment of medicine benefit-risk profiles (Correct answer)
Pharmacovigilance is only the manufacturer's responsibility
It only applies during clinical trials

Correct answer: To monitor the safety of medicines in everyday use, detect new or changing safety signals, report adverse events, and contribute to the ongoing assessment of medicine benefit-risk profiles

Pharmacovigilance (the science of monitoring drug safety) is a responsibility shared by all healthcare professionals. Pharmacists contribute by reporting ADRs to the HPRA, monitoring patients for drug safety issues, educating patients about potential adverse effects, and staying informed about drug safety alerts.

Question 18: What is the 'high alert medications' concept and which medicines fall into this category?

Medicines that bear a heightened risk of causing significant patient harm when used in error, including anticoagulants, insulin, opioids, and chemotherapy agents (Correct answer)
Only medicines administered by injection
Any medicine that costs over €100
Medicines that have been recalled

Correct answer: Medicines that bear a heightened risk of causing significant patient harm when used in error, including anticoagulants, insulin, opioids, and chemotherapy agents

High-alert medications carry an elevated risk of harm when errors occur. The ISMP (Institute for Safe Medication Practices) list includes anticoagulants, insulin, opioids, neuromuscular blocking agents, and concentrated electrolytes. Extra safeguards (independent double-checks, dose limits) should be applied.

Question 19: Which question is most useful when assessing if a patient has understood their new antibiotic prescription?

'Did you read the patient information leaflet?'
'Can you tell me in your own words how you'll take this antibiotic and what to watch for?' (Correct answer)
'Have you taken antibiotics before?'
'Do you have any allergies?'

Correct answer: 'Can you tell me in your own words how you'll take this antibiotic and what to watch for?'

The 'teach-back' method — asking the patient to explain in their own words — is the most effective way to confirm comprehension, identifying gaps before the patient leaves the pharmacy.

Question 20: In which scenario should a pharmacist decline to dispense a prescription without contacting the prescriber?

The drug has an unusual colour
Prescription is handwritten
Patient is known to the pharmacy
Dose prescribed is 10 times the normal maximum — potential prescribing error (Correct answer)

Correct answer: Dose prescribed is 10 times the normal maximum — potential prescribing error

A dramatically supra-therapeutic dose (10× normal maximum) constitutes a clinical red flag requiring pharmacist-prescriber communication before dispensing to rule out error and ensure patient safety.

Question 21: A topical preparation contains a drug at 0.1% w/v. How many milligrams of drug are present in 20 mL of the preparation?

200 mg
2 mg
20 mg (Correct answer)
0.2 mg

Correct answer: 20 mg

0.1% w/v = 0.1 g/100 mL = 1 mg/mL; 1 mg/mL × 20 mL = 20 mg.

Question 22: A patient asks why they must avoid grapefruit juice with their simvastatin. The pharmacist explains:

Grapefruit increases renal excretion of simvastatin
Grapefruit inhibits CYP3A4 in the intestinal wall, raising simvastatin plasma levels and increasing myopathy risk (Correct answer)
Grapefruit causes a taste interaction only
Grapefruit reduces simvastatin absorption

Correct answer: Grapefruit inhibits CYP3A4 in the intestinal wall, raising simvastatin plasma levels and increasing myopathy risk

Grapefruit contains furanocoumarins that irreversibly inhibit intestinal CYP3A4, increasing oral bioavailability of simvastatin. This raises plasma levels, increasing the risk of myopathy and rhabdomyolysis.

Question 23: A mother asks for cough medicine for her 18-month-old child with a wet cough. The pharmacist should advise:

OTC cough medicines should not be used in children under 6 years — advise honey (over 12 months) and fluids instead (Correct answer)
Antihistamine cough preparation is appropriate
Give adult cough linctus at a reduced dose
Codeine linctus is safe for toddlers

Correct answer: OTC cough medicines should not be used in children under 6 years — advise honey (over 12 months) and fluids instead

In Ireland/UK, OTC cough and cold medicines are not recommended for children under 6 (some say under 12). Honey (not before 12 months) and adequate hydration are safe, evidence-supported alternatives.

Question 24: What is the first-line treatment for mild-to-moderate community-acquired pneumonia in adults in Ireland?

Metronidazole
Flucloxacillin
Amoxicillin (Correct answer)
Ciprofloxacin

Correct answer: Amoxicillin

According to Irish antibiotic prescribing guidelines, amoxicillin is the first-line treatment for community-acquired pneumonia in adults. For penicillin-allergic patients, doxycycline or clarithromycin are alternatives. This follows antimicrobial stewardship principles.

Question 25: What is the pharmacist's responsibility regarding cold chain management for medicines requiring refrigeration?

Medicines can be returned to the fridge after being left out overnight
To maintain the cold chain (2-8°C) throughout storage and supply, monitor and record temperatures daily, investigate any breaches, and not supply medicines that have been compromised (Correct answer)
Temperature monitoring is optional
Only the wholesaler is responsible for cold chain

Correct answer: To maintain the cold chain (2-8°C) throughout storage and supply, monitor and record temperatures daily, investigate any breaches, and not supply medicines that have been compromised

Cold chain management ensures temperature-sensitive medicines (vaccines, insulin, biologics) remain within 2-8°C from receipt to supply. Daily temperature monitoring, calibrated equipment, breach protocols, and patient counselling on home storage are all pharmacist responsibilities.

Question 26: What ethical considerations apply when a pharmacist suspects a patient is being abused or neglected?

The pharmacist has an ethical duty to safeguard vulnerable patients, which may require breaking confidentiality to report concerns to appropriate authorities such as the HSE or Tusla (Correct answer)
Pharmacists should only act if the patient explicitly asks for help
Patient confidentiality prevents any reporting
Abuse is a matter only for the Gardaí, not pharmacists

Correct answer: The pharmacist has an ethical duty to safeguard vulnerable patients, which may require breaking confidentiality to report concerns to appropriate authorities such as the HSE or Tusla

Pharmacists have a duty of care that extends to safeguarding vulnerable patients. When abuse or neglect is suspected, confidentiality may be broken to protect the patient. The pharmacist should document concerns, report to appropriate authorities (HSE, Tusla for children), and follow safeguarding protocols.

Question 27: What ethical principles should guide a pharmacist when dealing with a patient's request for information about their medication that may cause anxiety?

Withhold negative information to avoid causing distress
Give all information regardless of the patient's emotional state
Refuse to provide any information and refer to the prescriber
Provide truthful, balanced information about benefits and risks, using appropriate language, while being sensitive to the patient's emotional state and level of understanding (Correct answer)

Correct answer: Provide truthful, balanced information about benefits and risks, using appropriate language, while being sensitive to the patient's emotional state and level of understanding

The ethical principles of veracity (truthfulness), beneficence, and autonomy require pharmacists to provide honest, complete information while being sensitive to the patient's needs. Information should be tailored to the patient's level of understanding, delivered with empathy, and balanced between risks and benefits.

Question 28: Which excipient acts as a disintegrant in tablet formulations?

Magnesium stearate
Povidone
Lactose monohydrate
Croscarmellose sodium (Correct answer)

Correct answer: Croscarmellose sodium

Croscarmellose sodium is a superdisintegrant that swells rapidly on contact with water, breaking the tablet apart to aid drug dissolution and absorption.

Question 29: What should a pharmacist do if they identify a drug recall notice?

Wait until the stock runs out
Only act if a patient complains
Continue dispensing the product until a replacement is available
Immediately quarantine the affected stock, check dispensing records for patients who received the recalled product, notify affected patients and their prescribers, and arrange returns (Correct answer)

Correct answer: Immediately quarantine the affected stock, check dispensing records for patients who received the recalled product, notify affected patients and their prescribers, and arrange returns

Upon receiving a drug recall notice from the HPRA, the pharmacist must immediately quarantine affected stock, check records to identify patients who received the product, contact those patients and their prescribers, arrange for returns to the supplier, and document all actions taken.

Question 30: Proton pump inhibitors (PPIs) like omeprazole work by:

Neutralising gastric acid
Irreversibly inhibiting H+/K+ ATPase in gastric parietal cells (Correct answer)
Coating the stomach lining
Blocking H2 histamine receptors

Correct answer: Irreversibly inhibiting H+/K+ ATPase in gastric parietal cells

PPIs are prodrugs activated in the acidic canaliculi of parietal cells. Active drug covalently binds and irreversibly inhibits H+/K+ ATPase (the proton pump), suppressing acid secretion.

Question 31: Which interaction is the basis for advising patients not to take tetracycline within 2 hours of taking a calcium supplement?

Tetracycline blocks calcium absorption
Calcium chelates tetracycline in the GI tract, forming insoluble complexes that reduce tetracycline absorption by 80% (Correct answer)
Calcium raises gastric pH, destroying tetracycline
Competition for the same renal transporter

Correct answer: Calcium chelates tetracycline in the GI tract, forming insoluble complexes that reduce tetracycline absorption by 80%

Divalent cations (Ca2+, Mg2+, Fe2+, Al3+) form stable, insoluble chelates with tetracycline molecules in the GI tract, preventing absorption. A 2-hour separation (before) or 4-hour separation (after) is required.

Question 32: Under the PSI Code of Conduct, which principle requires pharmacists to treat all patients with equal respect regardless of background?

Beneficence only
Professional competence only
Autonomy only
Justice and non-discrimination (Correct answer)

Correct answer: Justice and non-discrimination

The justice principle requires pharmacists to distribute care fairly and without discrimination. The PSI Code explicitly requires equal respect for all patients regardless of age, race, religion, disability or other characteristics.

Question 33: How many millilitres of a 1 in 1000 adrenaline solution are required to obtain a dose of 0.5 mg?

2.0 mL
5.0 mL
0.5 mL (Correct answer)
1.0 mL

Correct answer: 0.5 mL

A 1 in 1000 solution contains 1 g per 1000 mL = 1 mg/mL; therefore 0.5 mg requires 0.5 mL.

Question 34: A 500 mL bag of 5% dextrose for infusion contains how many grams of dextrose?

25 g (Correct answer)
10 g
5 g
50 g

Correct answer: 25 g

5% w/v = 5 g per 100 mL; 500 mL contains 5 × 5 = 25 g of dextrose.

Question 35: A patient on an SSRI antidepressant wants to buy an OTC product containing ibuprofen. What should the pharmacist consider?

Recommend a higher dose of ibuprofen
SSRIs increase the risk of GI bleeding, which is further increased by concurrent NSAID use; recommend paracetamol as an alternative or advise use of gastroprotection if an NSAID is essential (Correct answer)
There is no interaction between SSRIs and NSAIDs
SSRIs make NSAIDs more effective

Correct answer: SSRIs increase the risk of GI bleeding, which is further increased by concurrent NSAID use; recommend paracetamol as an alternative or advise use of gastroprotection if an NSAID is essential

SSRIs affect platelet function by depleting serotonin in platelets, increasing bleeding risk. Combined with NSAIDs (which also impair platelet function and cause GI mucosal damage), the risk of GI bleeding is significantly increased. Paracetamol is a safer analgesic alternative.

Question 36: Which schedule of the Misuse of Drugs Regulations 1988 (as amended) covers morphine?

Schedule 3
Schedule 1
Schedule 2 (Correct answer)
Schedule 5

Correct answer: Schedule 2

Morphine is a Schedule 2 controlled drug. Schedule 2 CDs have the highest level of control for medicinal use — requiring full CD prescription requirements, CD register entries and safe custody.

Question 37: What is a medication error and how should it be managed in a pharmacy?

Medication errors should be hidden to protect the pharmacy's reputation
An error only counts if the patient is harmed
Any preventable event that may cause or lead to inappropriate medication use or patient harm; it should be documented, reported, the patient assessed, and a root cause analysis conducted (Correct answer)
Only dispensing the wrong drug counts as a medication error

Correct answer: Any preventable event that may cause or lead to inappropriate medication use or patient harm; it should be documented, reported, the patient assessed, and a root cause analysis conducted

Medication errors include any preventable event at any stage: prescribing, dispensing, administration, or monitoring. When discovered, the patient must be assessed for harm, the prescriber informed, an incident report completed, the error documented, and a root cause analysis conducted to prevent recurrence.

Question 38: A prescription states 'paracetamol 0.5 g'. Tablets available are 500 mg. How many tablets should be dispensed per dose?

5 tablets
0.5 tablet
1 tablet (Correct answer)
2 tablets

Correct answer: 1 tablet

0.5 g equals 500 mg, which is exactly one 500 mg tablet.

Question 39: A patient requires 250 mg of amoxicillin. The suspension contains 125 mg/5 mL. What volume should be dispensed per dose?

5 mL
10 mL (Correct answer)
20 mL
2.5 mL

Correct answer: 10 mL

125 mg = 5 mL, therefore 250 mg = 10 mL. Using the formula: required dose / stock strength × volume = 250/125 × 5 = 10 mL.

Question 40: Michaelis-Menten kinetics apply when enzyme-mediated metabolism is:

Only seen with CYP3A4
Linear at all concentrations
Independent of substrate concentration
Saturated at high drug concentrations (Correct answer)

Correct answer: Saturated at high drug concentrations

At high concentrations, metabolic enzymes become saturated and elimination shifts from first-order to zero-order kinetics — described by Michaelis-Menten equations.

Question 41: Which class of drug is a GLP-1 receptor agonist used in type 2 diabetes?

Empagliflozin
Semaglutide (Correct answer)
Sitagliptin
Glibenclamide

Correct answer: Semaglutide

Semaglutide is a GLP-1 receptor agonist that stimulates glucose-dependent insulin secretion, suppresses glucagon, slows gastric emptying and reduces appetite.

Question 42: What counselling points should a pharmacist provide to a patient starting a statin (e.g., atorvastatin)?

No counselling is needed for statins
Only tell them to take it with food
Tell them to stop taking it if they feel fine after a month
Take at the recommended time, report unexplained muscle pain, have liver function monitored, avoid grapefruit juice in large quantities, and understand it is for long-term use (Correct answer)

Correct answer: Take at the recommended time, report unexplained muscle pain, have liver function monitored, avoid grapefruit juice in large quantities, and understand it is for long-term use

Key counselling points include: take consistently (some statins are best taken at night), report muscle pain/weakness (risk of rhabdomyolysis), baseline and follow-up liver function tests, avoid excessive grapefruit juice (CYP3A4 interaction with some statins), and emphasise long-term adherence.

Question 43: Which vitamin supplement is recommended by Irish health authorities for all adults during autumn and winter?

Vitamin D 400–1000 IU daily (Correct answer)
Zinc 15 mg daily
Vitamin B12 daily
Vitamin C 1000 mg daily

Correct answer: Vitamin D 400–1000 IU daily

Due to Ireland's northern latitude, sunlight is insufficient for cutaneous vitamin D synthesis from October to March. HSE and FSAI recommend vitamin D supplementation for all adults during this period.

Question 44: Which counselling point is most important for a patient starting a new SSRI for depression?

Take double dose if you miss a day
SSRIs work immediately
Stop the medication if side effects occur in week 1
Antidepressant effect takes 2–4 weeks — continue even if no immediate improvement (Correct answer)

Correct answer: Antidepressant effect takes 2–4 weeks — continue even if no immediate improvement

SSRIs take 2–4 weeks for full antidepressant effect. Early discontinuation is a major cause of treatment failure. Patients must be counselled to persist through initial side effects and not expect immediate results.

Question 45: Which OTC nicotine replacement therapy formulation has the fastest onset of action for craving relief?

Nicotine mouth spray (reaches peak levels in 10–15 minutes) (Correct answer)
Nicotine inhaler
Nicotine lozenge
Nicotine patch

Correct answer: Nicotine mouth spray (reaches peak levels in 10–15 minutes)

Nicotine mouth spray (e.g., Nicorette Quickmist) provides rapid buccal absorption, achieving peak nicotine levels in 10–15 minutes. Patches provide slow sustained release.

Question 46: What is 'conscientious objection' in pharmacy practice?

The right to refuse to stock any product the pharmacist disagrees with
The right to refuse to serve any customer for any reason
A pharmacist's right to decline providing certain services based on personal moral or religious beliefs, provided the patient is referred to another provider without delay (Correct answer)
An objection to working on certain days of the week

Correct answer: A pharmacist's right to decline providing certain services based on personal moral or religious beliefs, provided the patient is referred to another provider without delay

Pharmacists may exercise conscientious objection to certain services (e.g., emergency contraception) based on genuine moral or religious beliefs. However, they must not impose their beliefs on patients, must inform the patient and refer them to another pharmacist who can provide the service without delay.

Question 47: Which drug is used to reverse opioid overdose?

Naloxone (Correct answer)
Flumazenil
Protamine
Neostigmine

Correct answer: Naloxone

Naloxone is a competitive opioid receptor antagonist with high affinity for mu-receptors. IV/IM/intranasal naloxone rapidly reverses respiratory depression, sedation and miosis of opioid overdose.

Question 48: What are the key principles of health promotion that pharmacists should apply?

Focusing exclusively on medication-related issues
Empowerment, accessibility, evidence-based practice, equity, and a whole-population approach combining individual and community health interventions (Correct answer)
Only providing information to patients who ask for it
Only promoting health during specific awareness weeks

Correct answer: Empowerment, accessibility, evidence-based practice, equity, and a whole-population approach combining individual and community health interventions

Health promotion in pharmacy involves empowering patients with knowledge and skills, ensuring accessibility of services, using evidence-based approaches, addressing health inequalities, and taking opportunities for brief interventions during every patient interaction — not just during awareness campaigns.

Question 49: The Noyes-Whitney equation describes the rate of:

Drug distribution
Drug excretion
Drug absorption
Drug dissolution (Correct answer)

Correct answer: Drug dissolution

The Noyes-Whitney equation describes how dissolution rate depends on surface area, diffusion coefficient, solubility, and boundary layer thickness.

Question 50: Ibuprofen is contraindicated OTC in patients with:

Mild seasonal allergy
Age over 60 with no other issues
Controlled hypertension only
Active peptic ulcer, third trimester of pregnancy, or severe renal impairment (Correct answer)

Correct answer: Active peptic ulcer, third trimester of pregnancy, or severe renal impairment

NSAIDs including ibuprofen are contraindicated in active GI ulceration (risk of bleeding), third trimester pregnancy (premature ductus arteriosus closure), and severe renal impairment (risk of acute kidney injury).

Question 51: What is the pharmacist's ethical responsibility regarding counterfeit medicines?

Check medicines only if a patient complains
To source medicines only from authorised suppliers, be vigilant for counterfeit products, report any suspicious products to the HPRA, and protect patients from potentially dangerous fake medicines (Correct answer)
Only customs officials deal with counterfeit medicines
Counterfeit medicines are not a concern in Ireland

Correct answer: To source medicines only from authorised suppliers, be vigilant for counterfeit products, report any suspicious products to the HPRA, and protect patients from potentially dangerous fake medicines

Pharmacists have an ethical and legal responsibility to maintain the integrity of the medicine supply chain. This includes sourcing only from authorised wholesalers, checking deliveries for signs of counterfeiting, using the FMD (Falsified Medicines Directive) verification system, and reporting any suspicious products.

Question 52: Hygroscopic drug substances require which type of packaging?

Moisture-barrier packaging (Correct answer)
Amber glass bottles
PET containers
Strip foil only

Correct answer: Moisture-barrier packaging

Hygroscopic substances absorb moisture from the environment, leading to degradation. Moisture-barrier packaging (e.g., blister with aluminium foil) protects product stability.

Question 53: What is the difference between a generic medicine and a branded medicine?

Generic medicines contain different active ingredients
There is no difference — the terms are interchangeable
A generic contains the same active ingredient, dose, and dosage form as the brand but is marketed under the non-proprietary (generic) name, usually at a lower cost (Correct answer)
Generic medicines are less effective than branded medicines

Correct answer: A generic contains the same active ingredient, dose, and dosage form as the brand but is marketed under the non-proprietary (generic) name, usually at a lower cost

Generic medicines must contain the same active ingredient in the same dose and dosage form as the reference (branded) product and must demonstrate bioequivalence. They are approved by the HPRA and meet the same quality standards but are typically less expensive as they do not carry development costs.

Question 54: A patient on a statin reports new onset muscle pain. The pharmacist should advise:

Stop the statin, seek GP review — report any dark urine urgently as this may indicate rhabdomyolysis (Correct answer)
Continue and take ibuprofen for pain
The pain is unrelated to the statin
Reduce the dose independently

Correct answer: Stop the statin, seek GP review — report any dark urine urgently as this may indicate rhabdomyolysis

Statin-induced myopathy ranges from mild myalgia to severe rhabdomyolysis. Dark urine (myoglobinuria) is a red flag for rhabdomyolysis — a medical emergency causing acute kidney injury. The statin must be stopped.

Question 55: What is antimicrobial stewardship and why is it important for pharmacists?

Only prescribing the newest antibiotics available
Keeping antibiotics in stock at all times
Selling as many antibiotics as possible
A systematic approach to optimising antibiotic use by ensuring the right drug, dose, and duration to improve outcomes and reduce antimicrobial resistance (Correct answer)

Correct answer: A systematic approach to optimising antibiotic use by ensuring the right drug, dose, and duration to improve outcomes and reduce antimicrobial resistance

Antimicrobial stewardship involves selecting the optimal antibiotic, dose, and duration of therapy to maximise clinical cure while minimising side effects and the development of antimicrobial resistance. Pharmacists play a key role in reviewing prescriptions, advising prescribers, and educating patients.

Question 56: Renal clearance of a drug is increased when the drug is:

Ionised at urinary pH (Correct answer)
Metabolised to inactive metabolites
Highly protein bound
Lipophilic

Correct answer: Ionised at urinary pH

Ionised drugs cannot readily be reabsorbed through tubular epithelium, so they remain in urine and are excreted. Manipulating urinary pH to increase ionisation is used in poisoning management.

Question 57: What is the correct sequence of steps in the dispensing process?

Dispense immediately → check → label
Receive prescription → clinical check → label → dispense → accuracy check → counsel patient (Correct answer)
Label first → clinical check → dispense
Clinical check → label → dispense → skip counselling

Correct answer: Receive prescription → clinical check → label → dispense → accuracy check → counsel patient

The standard dispensing process: receive and validate the prescription, perform a clinical check, generate a label, select and dispense the product, accuracy check, then counsel the patient on proper use.

Question 58: Which storage temperature range is considered 'refrigerated' for medicinal products?

2°C to 8°C (Correct answer)
-20°C to -10°C
8°C to 15°C
15°C to 25°C

Correct answer: 2°C to 8°C

Refrigerated storage (2–8°C) is required for vaccines, insulin, some eye drops and many biologics. Temperatures outside this range can irreversibly damage the product.

Question 59: A patient receiving intramuscular methotrexate for psoriasis asks about taking folic acid supplements. The pharmacist advises:

Folic acid is irrelevant with IM methotrexate
Only if mouth ulcers develop
Yes — folic acid 5 mg once weekly (on a different day) is routinely co-prescribed to reduce methotrexate side effects without reducing efficacy (Correct answer)
No — folic acid completely blocks methotrexate

Correct answer: Yes — folic acid 5 mg once weekly (on a different day) is routinely co-prescribed to reduce methotrexate side effects without reducing efficacy

Folic acid supplementation with methotrexate reduces toxicity (mouth ulcers, GI side effects, liver toxicity, cytopenias) without significantly compromising its anti-inflammatory effect. It is routinely co-prescribed.

Question 60: What are the key considerations when dispensing methotrexate for a patient?

Methotrexate can be taken daily without concern
Methotrexate has no serious side effects
No special counselling is needed
Ensure the correct WEEKLY dose (not daily), counsel on folate supplementation, warn about teratogenicity, and advise on monitoring requirements (blood tests) (Correct answer)

Correct answer: Ensure the correct WEEKLY dose (not daily), counsel on folate supplementation, warn about teratogenicity, and advise on monitoring requirements (blood tests)

Methotrexate is a HIGH-RISK medication. The most critical safety point is ensuring it is taken WEEKLY (not daily — daily dosing has caused fatalities). Patients need folic acid supplementation, regular blood monitoring (FBC, LFTs, renal function), and pregnancy prevention counselling.

Question 61: The STOPP/START criteria in Ireland are used to:

Score pain severity in older patients
Assess cognitive function in dementia
Identify potentially inappropriate prescribing and prescribing omissions in older adults (Correct answer)
Guide antibiotic selection in elderly patients

Correct answer: Identify potentially inappropriate prescribing and prescribing omissions in older adults

STOPP (Screening Tool of Older Persons' Prescriptions) and START (Screening Tool to Alert to Right Treatment) help identify potentially harmful medicines and missing beneficial ones in older patients.

Question 62: A drug has a half-life of 6 hours. What fraction of the original dose remains in the body after 24 hours?

1/8
1/12
1/4
1/16 (Correct answer)

Correct answer: 1/16

24 hours equals 4 half-lives; (1/2)^4 = 1/16 of the original dose remains.

Question 63: Which NSAID is most COX-2 selective and associated with increased cardiovascular risk?

Diclofenac
Celecoxib (Correct answer)
Ibuprofen
Naproxen

Correct answer: Celecoxib

Celecoxib selectively inhibits COX-2, reducing GI side effects compared to non-selective NSAIDs, but COX-2 selectivity shifts the prostanoid balance towards thrombosis, increasing CV risk.

Question 64: Which process converts a prodrug to its active form?

Protein binding
Bioactivation (Correct answer)
Glucuronidation
Renal filtration

Correct answer: Bioactivation

Bioactivation is metabolic conversion of an inactive prodrug to its pharmacologically active metabolite. Example: enalapril → enalaprilat; codeine → morphine (via CYP2D6).

Question 65: Which anti-asthma drug is a long-acting muscarinic antagonist (LAMA)?

Salbutamol
Tiotropium (Correct answer)
Salmeterol
Montelukast

Correct answer: Tiotropium

Tiotropium blocks muscarinic M3 receptors in airway smooth muscle, causing bronchodilation. It is a LAMA used for COPD and add-on therapy in uncontrolled asthma.

Question 66: What safety checks should a pharmacist perform when dispensing a new prescription for a patient already on other medications?

No additional checks are needed
Only check the patient's name matches the prescription
Only check the expiry date of the medicine
Check for drug-drug interactions, therapeutic duplication, contraindications based on the patient's medical history, appropriate dose for age/weight/renal function, and allergies (Correct answer)

Correct answer: Check for drug-drug interactions, therapeutic duplication, contraindications based on the patient's medical history, appropriate dose for age/weight/renal function, and allergies

A comprehensive clinical check includes: drug-drug interactions with current medications, therapeutic duplication, contraindications (medical history, pregnancy), dose appropriateness (age, weight, renal/hepatic function), allergy status, and whether the new medicine is consistent with the patient's conditions.

Question 67: A patient taking spironolactone asks to buy a potassium supplement. The pharmacist should advise:

Potassium supplements are safe with spironolactone
Take a half-dose of the supplement
Only relevant if the patient is over 70
Avoid routine potassium supplementation — spironolactone already raises potassium, and additional potassium risks hyperkalaemia (Correct answer)

Correct answer: Avoid routine potassium supplementation — spironolactone already raises potassium, and additional potassium risks hyperkalaemia

Spironolactone is a potassium-sparing diuretic — it retains potassium. Additional supplementation risks serious hyperkalaemia (cardiac arrhythmia, cardiac arrest). The combination is contraindicated unless medically directed.

Question 68: A patient is prescribed warfarin. Which of the following interactions should the pharmacist be most concerned about?

Taking warfarin in the morning versus evening
Concurrent use of NSAIDs such as ibuprofen, which increases the risk of bleeding (Correct answer)
Drinking water with the medication
Taking the warfarin with food

Correct answer: Concurrent use of NSAIDs such as ibuprofen, which increases the risk of bleeding

NSAIDs increase bleeding risk with warfarin through multiple mechanisms: they inhibit platelet function, can cause GI erosion, and some (like fluconazole) inhibit CYP2C9, which metabolises warfarin. Pharmacists should counsel patients about avoiding OTC NSAIDs and reporting any signs of bleeding.

Question 69: What is the pharmacist's role in adverse drug reaction (ADR) reporting in Ireland?

ADRs do not need to be reported
ADR reporting is only the doctor's responsibility
Only report ADRs that cause hospitalisation
To identify, document, and report suspected ADRs to the HPRA through the national ADR reporting system, especially for new medicines and serious reactions (Correct answer)

Correct answer: To identify, document, and report suspected ADRs to the HPRA through the national ADR reporting system, especially for new medicines and serious reactions

Pharmacists have a professional duty to report suspected ADRs to the HPRA (Health Products Regulatory Authority). Reports should be made for all suspected ADRs to medicines, vaccines, herbal products, and devices, particularly for new medicines (marked with a black triangle ▼) and serious reactions.

Question 70: Which drug interaction causes 'serotonin syndrome' when tramadol is co-prescribed with an SSRI?

Additive serotonergic effect — tramadol inhibits serotonin reuptake in addition to opioid activity (Correct answer)
Tramadol induces CYP2D6 raising SSRI levels
Reduced tramadol absorption by SSRIs
Physical precipitation in the GI tract

Correct answer: Additive serotonergic effect — tramadol inhibits serotonin reuptake in addition to opioid activity

Tramadol is both a mu-opioid agonist and a serotonin/noradrenaline reuptake inhibitor. Combined with SSRIs, the serotonergic burden increases risk of serotonin syndrome (hyperthermia, clonus, agitation, autonomic instability).

Question 71: How can pharmacists contribute to reducing health inequalities in Ireland?

By only serving patients with medical cards
By providing accessible healthcare services in all communities, offering health literacy support, promoting uptake of screening and vaccination, and adapting services for disadvantaged groups (Correct answer)
Only by offering discounts on medicines
Health inequalities are not a pharmacy concern

Correct answer: By providing accessible healthcare services in all communities, offering health literacy support, promoting uptake of screening and vaccination, and adapting services for disadvantaged groups

Pharmacies are often the most accessible healthcare setting in communities, particularly in disadvantaged areas. Pharmacists can reduce health inequalities through accessible services, culturally sensitive care, health literacy support, targeted health promotion, and advocacy for equitable healthcare access.

Question 72: Which combination of antibiotics produces significant risk of QT interval prolongation and ventricular arrhythmia?

Co-amoxiclav combined with cefalexin
Amoxicillin combined with metronidazole
Azithromycin combined with moxifloxacin (Correct answer)
Doxycycline combined with nitrofurantoin

Correct answer: Azithromycin combined with moxifloxacin

Both azithromycin and moxifloxacin individually prolong QT interval. Co-administration significantly increases risk of torsades de pointes — a potentially fatal ventricular arrhythmia. Avoid combining QT-prolonging agents.

Question 73: Serotonin syndrome is most likely when combining an SSRI with which other drug?

Linezolid (MAO inhibitor) (Correct answer)
Atenolol
Amlodipine
Metformin

Correct answer: Linezolid (MAO inhibitor)

Linezolid inhibits monoamine oxidase (MAO), reducing serotonin breakdown. Combined with an SSRI, serotonin accumulates, causing hyperthermia, clonus, agitation and autonomic instability.

Question 74: A 2% w/v solution contains how many grams of solute in 250 mL?

2 g
5 g (Correct answer)
8 g
0.5 g

Correct answer: 5 g

2% w/v = 2 g per 100 mL; therefore 250 mL contains 2 × 2.5 = 5 g.

Question 75: What is the importance of patient counselling at the point of dispensing?

Patient counselling is a waste of time
Written labels are sufficient — no verbal counselling is needed
It improves medication adherence, helps patients understand their treatment, reduces errors in self-administration, and identifies potential problems before they cause harm (Correct answer)
Counselling should only be provided if the patient asks for it

Correct answer: It improves medication adherence, helps patients understand their treatment, reduces errors in self-administration, and identifies potential problems before they cause harm

Patient counselling is a core pharmacy activity that significantly impacts treatment outcomes. It should cover: how to take the medicine, expected effects, potential side effects, storage, what to do if a dose is missed, and when to seek medical attention. Counselling improves adherence by up to 50%.

Question 76: What is the pharmacist's role in promoting public health during a pandemic?

Providing reliable health information, maintaining medicine supply, administering vaccines, conducting testing, supplying PPE, and serving as accessible healthcare professionals (Correct answer)
Only dispensing prescriptions with no other involvement
Pandemics have no impact on pharmacy practice
Closing the pharmacy until the pandemic ends

Correct answer: Providing reliable health information, maintaining medicine supply, administering vaccines, conducting testing, supplying PPE, and serving as accessible healthcare professionals

The COVID-19 pandemic demonstrated pharmacists' critical public health role: they maintained essential medicine supplies, provided reliable health information, administered vaccines, supported testing, supplied PPE, and served as a vital point of healthcare access when other services were restricted.

Question 77: A patient presents a forged prescription. The pharmacist's immediate obligation is to:

Dispense but note the forgery
Only document the incident internally
Retain the prescription, refuse to dispense and notify the relevant authorities (Correct answer)
Return the prescription to the patient

Correct answer: Retain the prescription, refuse to dispense and notify the relevant authorities

Prescription fraud is a criminal offence. The pharmacist should retain the prescription (do not return it), refuse to dispense, and report to Garda and the prescribing practice if appropriate.

Question 78: What is the pharmacist's ethical obligation regarding pharmaceutical company interactions?

To promote whatever products pharmaceutical companies recommend
To maintain professional independence, not allow commercial relationships to influence clinical decisions, and be transparent about any conflicts of interest (Correct answer)
Pharmacists have no restrictions on interactions with pharmaceutical companies
To only stock products from companies that offer the best incentives

Correct answer: To maintain professional independence, not allow commercial relationships to influence clinical decisions, and be transparent about any conflicts of interest

Pharmacists must maintain clinical independence from pharmaceutical industry influence. They should not accept gifts or inducements that could influence prescribing or recommendations, must make clinical decisions based on evidence and patient need, and should declare any potential conflicts of interest.

Question 79: What is a 'near miss' in the pharmacy context?

A prescription that was nearly written incorrectly
A delivery of medicines that nearly arrived late
A dispensing error that is detected and corrected before the medicine reaches the patient (Correct answer)
A patient who nearly missed collecting their prescription

Correct answer: A dispensing error that is detected and corrected before the medicine reaches the patient

A pharmacy near miss is an error caught during the checking process before the medicine is handed to the patient. Recording and analysing near misses is crucial for patient safety as they reveal system weaknesses that could lead to actual errors reaching patients.

Question 80: Which drug is the antidote for paracetamol (acetaminophen) overdose?

Activated charcoal alone
Naloxone
N-acetylcysteine (NAC) (Correct answer)
Flumazenil

Correct answer: N-acetylcysteine (NAC)

NAC replenishes hepatic glutathione, which conjugates the toxic metabolite NAPQI (produced by CYP2E1 during paracetamol overdose), preventing liver damage.

Question 81: What is the pharmacist's role in managing minor ailments in the community?

Telling all patients to see their GP
Assessing symptoms, recommending appropriate OTC treatments, providing self-care advice, and referring to a GP when symptoms suggest a more serious condition (Correct answer)
Only selling products without any assessment
Diagnosing diseases and prescribing medications

Correct answer: Assessing symptoms, recommending appropriate OTC treatments, providing self-care advice, and referring to a GP when symptoms suggest a more serious condition

Pharmacists manage common minor ailments (colds, headaches, hayfever, mild skin conditions) by assessing symptoms, recommending appropriate OTC treatments, providing lifestyle and self-care advice, and making appropriate referrals. This reduces pressure on GP services and provides convenient healthcare access.

Question 82: What is the pharmacist's obligation regarding the notification of infectious diseases in Ireland?

Pharmacists must directly report all infectious diseases
Infectious disease notification has nothing to do with pharmacy
Pharmacists should be aware of notifiable diseases and facilitate the notification process, though the primary reporting obligation lies with the attending medical practitioner (Correct answer)
Only hospital pharmacists need to know about notifiable diseases

Correct answer: Pharmacists should be aware of notifiable diseases and facilitate the notification process, though the primary reporting obligation lies with the attending medical practitioner

While the legal obligation to notify lies primarily with the medical practitioner, pharmacists play a supporting role by being aware of notifiable diseases, recognising unusual patterns in OTC sales that might indicate outbreaks, and facilitating the public health response through medicine supply and public information.

Question 83: What is the pharmacist's role in managing substance misuse in Ireland?

Pharmacists have no role in substance misuse services
Supervising methadone consumption for opioid-dependent patients, providing needle exchange services, supplying naloxone, and supporting patients in recovery (Correct answer)
Only dispensing methadone without any supervision
Refusing to serve patients with addiction issues

Correct answer: Supervising methadone consumption for opioid-dependent patients, providing needle exchange services, supplying naloxone, and supporting patients in recovery

Community pharmacists are central to substance misuse services in Ireland through the Methadone Treatment Protocol Scheme (supervised consumption), needle and syringe programmes, naloxone (Nyxoid) provision for opioid overdose reversal, and providing accessible, non-judgemental healthcare to this vulnerable population.

Question 84: Emergency supply of prescription-only medicines without a prescription is permitted in Ireland when:

A CD is requested for a known patient
The patient has a repeat prescription from abroad only
The patient requests any prescription medicine urgently
A pharmacist is satisfied immediate treatment is necessary and the patient has previously been prescribed the medicine (Correct answer)

Correct answer: A pharmacist is satisfied immediate treatment is necessary and the patient has previously been prescribed the medicine

Irish pharmacy law allows pharmacist-initiated emergency supply for POMs (not Schedule 1/2 CDs) when the pharmacist judges it is immediately necessary, the patient has had it prescribed before, and a follow-up prescription will be obtained.

Question 85: What is the pharmacist's role in smoking cessation in Ireland?

Pharmacists have no role in smoking cessation
Providing advice, support, and nicotine replacement therapy (NRT) to patients who wish to quit smoking, including behavioural counselling and follow-up (Correct answer)
Referring all smokers to their GP without any intervention
Only selling nicotine patches without advice

Correct answer: Providing advice, support, and nicotine replacement therapy (NRT) to patients who wish to quit smoking, including behavioural counselling and follow-up

Pharmacists are ideally placed for smoking cessation support through brief interventions, motivational counselling, supply of NRT products (patches, gum, lozenges, inhalers), and follow-up. The HSE QUIT programme works with community pharmacies to provide structured cessation services.

Question 86: What is the pharmacist's role in addressing the opioid crisis and promoting safe use of pain medications?

Pharmacists should refuse to dispense opioids entirely
Screening for opioid misuse risk, counselling on safe use and storage, promoting non-opioid alternatives, dispensing naloxone for overdose reversal, and supporting patients transitioning off opioids (Correct answer)
Opioid management is entirely the prescriber's responsibility
Pharmacists should simply dispense whatever is prescribed without question

Correct answer: Screening for opioid misuse risk, counselling on safe use and storage, promoting non-opioid alternatives, dispensing naloxone for overdose reversal, and supporting patients transitioning off opioids

Pharmacists play a critical role in the opioid crisis by assessing prescriptions for appropriateness, counselling patients on safe use/storage/disposal, promoting non-opioid and non-pharmacological pain management, providing naloxone, identifying signs of misuse or diversion, and supporting patients in opioid tapering programmes.

Question 87: What is the mechanism of action of proton pump inhibitors (PPIs) such as omeprazole?

They neutralise existing stomach acid
They speed up gastric emptying
They irreversibly inhibit the hydrogen-potassium ATPase enzyme (proton pump) in gastric parietal cells, reducing gastric acid secretion (Correct answer)
They coat the stomach lining to protect it

Correct answer: They irreversibly inhibit the hydrogen-potassium ATPase enzyme (proton pump) in gastric parietal cells, reducing gastric acid secretion

PPIs work by irreversibly binding to the H+/K+-ATPase enzyme system (the proton pump) on the surface of gastric parietal cells. This blocks the final step of acid production, providing potent and long-lasting suppression of gastric acid secretion.

Question 88: Which solid dosage form release mechanism uses an osmotic pump?

OROS (Osmotic Release Oral System) (Correct answer)
Matrix tablet
Enteric coating
Immediate release capsule

Correct answer: OROS (Osmotic Release Oral System)

OROS uses osmotic pressure to drive water into a core compartment, pushing drug through a laser-drilled orifice at a controlled, constant rate.

Question 89: Which type of isomerism involves non-superimposable mirror image molecules?

Diastereomerism
Structural isomerism
Geometric isomerism
Enantiomerism (Correct answer)

Correct answer: Enantiomerism

Enantiomers are mirror images that cannot be superimposed. They have identical physical properties but can differ in pharmacological activity, toxicity and metabolism.

Question 90: Which drug class inhibits neuraminidase and is used to treat influenza?

Oseltamivir (Tamiflu) (Correct answer)
Interferon alfa
Aciclovir
Amantadine

Correct answer: Oseltamivir (Tamiflu)

Oseltamivir inhibits viral neuraminidase, preventing release of new viral particles from infected cells and limiting spread of influenza A and B.

Question 91: What is the pharmacist's duty of confidentiality regarding patient information?

Confidentiality does not apply in community pharmacies
Patient information can be discussed freely with anyone
Confidentiality only applies to medical records, not verbal information
To protect all patient information and only disclose it with consent or when legally required, in accordance with GDPR and professional standards (Correct answer)

Correct answer: To protect all patient information and only disclose it with consent or when legally required, in accordance with GDPR and professional standards

Pharmacists have both a professional and legal duty to maintain patient confidentiality. Under GDPR and the Data Protection Act 2018, patient data must be processed lawfully, stored securely, and only shared with authorised persons for legitimate purposes. Breaches have serious professional and legal consequences.

Question 92: Which preservative is commonly used in multi-dose eye drop formulations?

Benzyl alcohol
Chlorhexidine
Phenol
Benzalkonium chloride (Correct answer)

Correct answer: Benzalkonium chloride

Benzalkonium chloride (BAK) is the most widely used preservative in ophthalmic preparations. It disrupts bacterial cell membranes but can cause ocular surface toxicity with prolonged use.

Question 93: Which blood pressure reading is classified as hypertensive crisis requiring immediate referral?

Systolic ≥180 mmHg and/or diastolic ≥120 mmHg, especially with symptoms (Correct answer)
150/95 mmHg
140/90 mmHg
130/85 mmHg

Correct answer: Systolic ≥180 mmHg and/or diastolic ≥120 mmHg, especially with symptoms

A reading of ≥180/120 mmHg, especially with symptoms (headache, visual disturbance, chest pain), represents hypertensive crisis or emergency, requiring same-day emergency assessment.

Question 94: Which drug is a selective oestrogen receptor modulator (SERM) used to prevent post-menopausal osteoporosis?

Clomifene
Raloxifene (Correct answer)
Letrozole
Tamoxifen

Correct answer: Raloxifene

Raloxifene acts as an oestrogen agonist in bone (maintaining bone density) but as an antagonist in breast and uterine tissue. It is used for osteoporosis and has added benefit of reducing breast cancer risk.

Question 95: Under Irish legislation, who can legally own a pharmacy (retail pharmacy business)?

Only Irish citizens
The HSE only
Any registered company
A registered pharmacist or pharmacy body corporate meeting PSI requirements (Correct answer)

Correct answer: A registered pharmacist or pharmacy body corporate meeting PSI requirements

The Pharmacy Act 2007 requires pharmacy owners to be registered pharmacists or a body corporate meeting specified ownership criteria. This is known as registering as a 'retail pharmacy business' with the PSI.

Question 96: Reconstituted amoxicillin oral suspension should be stored in the refrigerator and discarded after:

3 months
28 days
14 days (Correct answer)
7 days

Correct answer: 14 days

Once reconstituted, amoxicillin suspension is stable for 14 days when refrigerated. Beyond this, bacterial contamination and drug degradation are concerns.

Question 97: What is the principle of patient autonomy and how does it apply to pharmacy practice?

Autonomy only applies to patients in hospitals
Patients must always follow the pharmacist's recommendations
The right of a competent patient to make informed decisions about their own healthcare, including the right to refuse treatment; pharmacists must respect these decisions while providing full information (Correct answer)
The pharmacist always knows what is best for the patient

Correct answer: The right of a competent patient to make informed decisions about their own healthcare, including the right to refuse treatment; pharmacists must respect these decisions while providing full information

Patient autonomy is a fundamental ethical principle. Pharmacists must provide patients with the information they need to make informed decisions, respect their right to refuse or choose treatments, and support shared decision-making. Pharmacists should advise but never coerce.

Question 98: Polypharmacy is most commonly defined as the concurrent regular use of:

5 or more medicines simultaneously (Correct answer)
10 or more medicines only
2 or more medicines
Any combination of prescription and OTC medicines

Correct answer: 5 or more medicines simultaneously

Polypharmacy is conventionally defined as ≥5 regular medicines. It is associated with increased adverse drug reactions, drug interactions, adherence problems and inappropriate prescribing.

Question 99: A liquid medicine with a measured dose of 5 mL BID for 10 days — what total volume should be dispensed?

100 mL (5 mL × 2 × 10) (Correct answer)
200 mL
150 mL
50 mL

Correct answer: 100 mL (5 mL × 2 × 10)

5 mL per dose × 2 doses per day (BID) = 10 mL/day × 10 days = 100 mL total. Accurate volume calculation ensures the correct supply with no shortfall during the treatment course.

Question 100: What measures should a pharmacy implement to prevent dispensing errors?

Only rely on the pharmacist's memory and experience
Speed up dispensing to reduce waiting times
Remove all safety checks to improve efficiency
Separate LASA products, use barcode scanning, implement independent double-checking, maintain adequate staffing, reduce interruptions during dispensing, and report all near misses (Correct answer)

Correct answer: Separate LASA products, use barcode scanning, implement independent double-checking, maintain adequate staffing, reduce interruptions during dispensing, and report all near misses

Error prevention requires multiple strategies: physical separation of similar products, barcode verification technology, mandatory independent final checks, appropriate staffing levels, a quiet dispensing environment, standard operating procedures, near-miss reporting, and a positive safety culture.

Question 101: What are the rules regarding prescription repeats and validity in Ireland?

Prescriptions never expire
A standard prescription is valid for 6 months from the date of issue; repeat prescriptions can be specified by the prescriber for up to 6 months of supplies; controlled drug prescriptions have more restrictive validity (Correct answer)
All prescriptions are valid for 12 months
Repeat prescriptions are not allowed in Ireland

Correct answer: A standard prescription is valid for 6 months from the date of issue; repeat prescriptions can be specified by the prescriber for up to 6 months of supplies; controlled drug prescriptions have more restrictive validity

Standard prescriptions are valid for 6 months. Prescribers can indicate repeat dispensing. Controlled drug prescriptions (Schedule 2) are valid for only 14 days from the appropriate date and must specify the total quantity to be supplied. High-tech medicines may have different arrangements.

Question 102: Which interaction should a pharmacist counsel a patient about when dispensing sildenafil for erectile dysfunction?

Avoid with statins
Absolute contraindication with organic nitrates (GTN, isosorbide) — risk of fatal hypotension (Correct answer)
Do not take with antacids
Avoid with paracetamol

Correct answer: Absolute contraindication with organic nitrates (GTN, isosorbide) — risk of fatal hypotension

Both sildenafil (PDE-5 inhibition) and nitrates (cGMP elevation via guanylate cyclase) cause vasodilation. Combined, they produce profound, potentially fatal hypotension. Nitrates are an absolute contraindication.

Question 103: What is the purpose of the batch number on a dispensed medicine?

It is only relevant for hospital pharmacies
It indicates the price band
It confirms the prescriber's authorisation code
It allows the product to be traced and recalled if a safety issue is identified (Correct answer)

Correct answer: It allows the product to be traced and recalled if a safety issue is identified

Batch numbers link a product to its manufacturing record. If a quality defect or contamination is found, the HPRA/manufacturer can identify and recall all packs from the same batch.

Question 104: Medicines reconciliation at hospital discharge involves:

Having the patient bring in their medicines
Checking allergies only
Only supplying 28-day TTOs
Comparing the patient's pre-admission medicines with discharge medicines to identify unintended discrepancies (Correct answer)

Correct answer: Comparing the patient's pre-admission medicines with discharge medicines to identify unintended discrepancies

Medicines reconciliation compares the complete pre-admission medication list with newly prescribed medicines at each care transition, identifying omissions, duplications and changes requiring communication.

Question 105: Reconstitution of an oral antibiotic suspension requires adding which liquid?

Orange juice to improve taste
Freshly boiled and cooled water to the specified volume (Correct answer)
Tap water directly to the bottle mark
Saline solution

Correct answer: Freshly boiled and cooled water to the specified volume

Oral antibiotic suspensions (e.g., amoxicillin) are reconstituted with freshly boiled and cooled water to the volume indicated on the bottle label, then shaken well. Tap water may contain bacteria.

Question 106: The British Pharmacopoeia (BP) is a legally recognised standard for medicinal product quality in:

All WHO member states
The United Kingdom and Ireland (Correct answer)
The USA only
The EU only

Correct answer: The United Kingdom and Ireland

The BP is the official pharmacopoeia for the UK and Republic of Ireland. Medicinal products must comply with BP standards unless otherwise stated in a marketing authorisation.

Question 107: What does the term 'polymorphism' refer to in pharmaceutical sciences?

Different salts of the same drug
Different crystal structures of the same compound (Correct answer)
Variation in patient metabolism
Multiple dosage forms of one drug

Correct answer: Different crystal structures of the same compound

Polymorphism describes the ability of a solid material to exist in more than one crystal form. Different polymorphs can have different solubility and bioavailability.

Question 108: What is the role of inhaler technique review in managing asthma and COPD?

Only doctors should review inhaler technique
Technique review is only needed when first prescribed
Poor inhaler technique is a major cause of treatment failure; pharmacists should assess and correct technique at every opportunity, as up to 90% of patients use inhalers incorrectly (Correct answer)
Inhaler technique does not affect treatment outcomes

Correct answer: Poor inhaler technique is a major cause of treatment failure; pharmacists should assess and correct technique at every opportunity, as up to 90% of patients use inhalers incorrectly

Studies show that 50-90% of patients use their inhalers incorrectly, leading to poor disease control. Pharmacists should review inhaler technique at every dispensing opportunity, demonstrate correct use, observe the patient's technique, and correct any errors. A change of device may be needed.

Question 109: The target INR range for a patient with a mechanical heart valve on warfarin therapy is typically:

4.0–5.0
1.0–1.5
1.5–2.0
2.5–3.5 (Correct answer)

Correct answer: 2.5–3.5

Mechanical heart valves require a higher target INR (2.5–3.5, or 3.0–4.0 for high-risk valves) compared to AF (2.0–3.0) due to greater thrombogenicity of the prosthetic material.

Question 110: What is the pharmacist's role in managing chronic disease conditions like diabetes or hypertension?

Only dispensing medications without any further input
Providing medication counselling, monitoring adherence, reviewing medication appropriateness, conducting health screenings, and supporting self-management education (Correct answer)
Pharmacists have no role in chronic disease management
Referring all queries to the GP without comment

Correct answer: Providing medication counselling, monitoring adherence, reviewing medication appropriateness, conducting health screenings, and supporting self-management education

Pharmacists play an increasingly important role in chronic disease management through medication therapy reviews, adherence support, health screenings (blood pressure, blood glucose), lifestyle counselling, identifying drug-related problems, and working collaboratively with GPs and other healthcare professionals.

Question 111: A patient requests advice on taking iron supplements. The pharmacist should advise taking iron:

With antacids to reduce GI side effects
With a glass of milk
At bedtime
On an empty stomach with vitamin C (orange juice) to maximise absorption — if GI upset occurs, take with food (Correct answer)

Correct answer: On an empty stomach with vitamin C (orange juice) to maximise absorption — if GI upset occurs, take with food

Ferrous iron absorption is maximised on an empty stomach. Vitamin C (ascorbic acid) reduces Fe3+ to Fe2+ and forms soluble chelates, enhancing absorption. Antacids, milk and tannins (tea) all reduce iron absorption.

Question 112: Digoxin toxicity is worsened by hypokalaemia because:

Digoxin shifts potassium out of cells
Hypokalaemia reduces digoxin protein binding
Low potassium increases renal digoxin excretion
Potassium competes with digoxin for the same binding site on Na+/K+ ATPase (Correct answer)

Correct answer: Potassium competes with digoxin for the same binding site on Na+/K+ ATPase

Potassium and digoxin bind competitively to Na+/K+ ATPase. When potassium is low, more binding sites are available for digoxin, increasing its inhibitory effect and risk of toxicity.

Question 113: A patient presents with symptoms of an uncomplicated urinary tract infection (UTI). What is the first-line recommended antibiotic treatment in Ireland?

Amoxicillin for 5 days
Ciprofloxacin for 7 days
Nitrofurantoin (modified release) for 3 days in non-pregnant women (Correct answer)
Co-amoxiclav for 14 days

Correct answer: Nitrofurantoin (modified release) for 3 days in non-pregnant women

Irish antibiotic prescribing guidelines recommend nitrofurantoin MR 100mg twice daily for 3 days as first-line treatment for uncomplicated UTIs in non-pregnant women. Trimethoprim is an alternative. Fluoroquinolones should be reserved for complicated infections due to resistance concerns.

Question 114: Which OTC product is recommended for treating head lice in children?

Dimeticone 4% lotion (physical insecticide) applied for 8 hours (Correct answer)
Permethrin 1% cream rinse only
Oral ivermectin OTC
Lindane shampoo

Correct answer: Dimeticone 4% lotion (physical insecticide) applied for 8 hours

Dimeticone is a physical agent that coats and suffocates lice — resistance does not develop. It is preferred first-line in Ireland and the UK. Two applications 7 days apart are needed to kill newly hatched lice.

Question 115: Which patient counselling approach best ensures medication adherence in a patient with low health literacy?

Only verbal instructions in a loud, clear voice
Providing a detailed written clinical summary
Referring all low-literacy patients to a specialist
Simple verbal instructions with demonstrate-and-return demonstration, written pictogram leaflets (Correct answer)

Correct answer: Simple verbal instructions with demonstrate-and-return demonstration, written pictogram leaflets

Low health literacy requires plain language, demonstration, teach-back and visual aids. Complex written materials are ineffective. Combination verbal and pictogram approaches significantly improve comprehension.

Question 116: What is the role of the Pharmaceutical Society of Ireland (PSI)?

To manufacture and distribute medicines
To regulate the pharmacy profession, register pharmacists and pharmacies, set education standards, investigate complaints, and protect public health (Correct answer)
To run the national pharmacy chain
To represent pharmacists in pay negotiations

Correct answer: To regulate the pharmacy profession, register pharmacists and pharmacies, set education standards, investigate complaints, and protect public health

The PSI is the independent statutory regulator of pharmacy in Ireland. Its functions include maintaining the register of pharmacists and pharmacies, setting standards for education and practice, conducting inspections, investigating fitness to practise concerns, and advising the Minister for Health.

Question 117: A patient has a creatinine clearance of 30 mL/min (normal = 100 mL/min). A renally cleared drug is normally dosed every 8 hours. What is the appropriate adjusted dosing interval?

Every 12 hours
Every 8 hours
Approximately every 27 hours (Correct answer)
Every 48 hours

Correct answer: Approximately every 27 hours

Adjusted interval = normal interval × (normal CrCl ÷ patient CrCl) = 8 × (100/30) ≈ 27 hours.

Question 118: A patient requests their prescription be returned after it has been dispensed. Under Irish law:

Prescriptions must be returned on request
Pharmacists must retain dispensed prescriptions and cannot return them (Correct answer)
The patient has a GDPR right to have the prescription returned
Only GMS prescriptions are retained

Correct answer: Pharmacists must retain dispensed prescriptions and cannot return them

Under Irish pharmacy regulations, dispensed prescriptions must be retained by the pharmacy for the required period. They form part of the legal dispensing record and cannot be returned to patients.

Question 119: Which class of antihypertensives is the first-line treatment in patients with heart failure with reduced ejection fraction (HFrEF)?

Alpha-1 blockers
Direct vasodilators
ACE inhibitors (Correct answer)
Calcium channel blockers

Correct answer: ACE inhibitors

ACE inhibitors (e.g., ramipril, lisinopril) reduce mortality and morbidity in HFrEF by blocking angiotensin II production, reducing cardiac afterload and preload.

Question 120: Which drug is used as prophylaxis for Pneumocystis jirovecii pneumonia (PCP) in HIV patients?

Aciclovir
Co-trimoxazole (trimethoprim/sulfamethoxazole) (Correct answer)
Fluconazole
Azithromycin

Correct answer: Co-trimoxazole (trimethoprim/sulfamethoxazole)

Co-trimoxazole is first-line PCP prophylaxis in HIV patients with CD4 count <200 cells/μL. It inhibits folate synthesis in the fungus, preventing pneumocystis pneumonia.

PSI Pharmacy Registration Assessment Ireland

The PSI (Pharmaceutical Society of Ireland) Registration Assessment is the qualifying exam for pharmacists seeking registration in Ireland. It covers Irish pharmacy law and ethics, clinical therapeutics, dispensing practice, patient safety, public health, pharmaceutical sciences, pharmacology, and patient counselling. Candidates must demonstrate competency in both clinical and legal aspects of pharmacy practice in Ireland.

120

Questions

180 min

Time Limit

65%

To Pass

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