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ICS mouth care — GPhC CRA MCQ

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HardRespiratory TherapeuticsICS mouth careGPhC CRA

A patient stable on methadone 110 mg daily presents a new fluconazole prescription. Their recent potassium is 3.1 mmol/L and QTc is 485 ms. What is the best pharmacy response?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Pause fluconazole and obtain same-day review of the interaction, potassium and QT risk

Explanation lettering: C = shown as A · D = shown as C · E = shown as D · A = shown as E

A reverses the interaction: fluconazole may reduce methadone metabolism and raise exposure, while both the prolonged QTc and hypokalaemia increase arrhythmia risk. B is correct: the new medicine should not be supplied without same-day clinical review of antimicrobial choice, potassium correction, methadone exposure and ECG risk. C makes an unauthorised 50% dose reduction without resolving the other risks. D is wrong because timing separation does not prevent enzyme inhibition. E proposes abrupt opioid substitution from an isolated threshold without specialist assessment.

Reference: Methadone 1 mg/mL oral solution SmPC. https://www.medicines.org.uk/emc/product/4905/smpc