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Warfarin patient-held record — GPhC CRA MCQ

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HardPatient Counselling and Pharmaceutical CareWarfarin patient-held recordGPhC CRA

A first cycle of capecitabine is due to start tomorrow, but the oncology prescription has no pretreatment DPD result. The patient reports that a sibling had life-threatening fluoropyrimidine toxicity. What should happen?

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Correct answer: D — Await DPD status before initiating any systemic fluoropyrimidine

Option D is correct: all patients require DPD assessment before systemic capecitabine, intravenous fluorouracil or tegafur. Known complete deficiency contraindicates treatment; partial deficiency generally requires a reduced starting dose determined by the oncology team. Option B ignores both mandatory testing and a concerning family history. Option E guesses a dose before status is known. Option A does not validate safe systemic exposure. Option C is wrong because tegafur is also a systemic fluoropyrimidine covered by the same DPD precautions.

Reference: MHRA DPD testing guidance: https://www.gov.uk/drug-safety-update/5-fluorouracil-intravenous-capecitabine-tegafur-dpd-testing-recommended-before-initiation-to-identify-patients-at-increased-risk-of-severe-and-fatal-toxicity