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Continuing Professional DeveloPment
1. which one of the following
statements about the efficacy of
codeine is correct?
a) Codeine’s analgesic effect is due to
its almost complete metabolism to
morphine by Cyp2d6 enzymes.
b) ultrarapid codeine metabolisers derive
no detectable analgesic effect from
c) increasing the dose of codeine in a
poor metaboliser can increase the risk
of adverse effects without providing
d) approximately 10% of people of
southern european ancestry are poor
2. which one of the following
statements regarding otc codeine-
containing analgesics is correct?
a) otC codeine-containing analgesics
have been shown to be more effective
than simple analgesics alone.
b) pharmacists should make an effort
to discuss the issue of codeine
dependence with all customers
requesting otC codeine-containing
c) the serious harms resulting from
over-use of otC codeine-containing
analgesics are mainly due to the
codeine in these preparations.
d) ‘autoprotection’ is the term used for the
tolerance that people who over-use
codeine-containing analgesics develop
to the adverse effects of codeine.
3. medication over-use headache:
a) develops as a result of taking
paracetamol or nsaids on 10 or more
days per month for more than 3 months.
b) is usually accompanied by symptoms
such as nausea, vomiting and
c) Can be prevented with amitriptyline.
d) does not seem to develop in people
who regularly take analgesics for cluster
4. when counselling customers
about the appropriate use of otc
analgesics, which one of the
following is correct?
a) to reduce nsaid requirements, patients
with rheumatoid arthritis can take fish
oil in doses sufficient to provide at least
2.7 g of omega-3 fatty acids per day.
b) paracetamol should be used only for
acute symptom relief, at the lowest
possible dose for the shortest possible
c) the use of nsaids is contraindicated in
people taking lithium or methotrexate.
d) in people whose pain does not respond
adequately to paracetamol and/or an
nsaid, addition of 8 mg codeine is likely
to be effective.
5. a customer requests some Panamax
Co (paracetamol 500 mg, codeine
phosphate 8 mg), telling you that she
takes it for tension headaches, which
she has been getting more and more
frequently over the past few months.
which one of the following would
be the most appropriate response?
a) tell her that she should preferably be
taking preventive treatment such as
pizotifen or sodium valproate.
b) supply Panamax (paracetamol 500 mg)
instead, telling her that Panamax Co is
no more effective than paracetamol
c) tell her you cannot supply it, as it is
likely that she has developed codeine
d) advise her to see her doctor, as it is likely
that she has developed medication
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