References allowed for this exam:
BNF 56
MEP 32
Drug Tariff [England and Wales] 2008
Scottish Drug Tariff (May 2009)
1
Simple Completion
Directions: The question is followed by five suggested answers. Select the best answer.
A one year old child has been found to be anaemic. The child's mother brings in to your pharmacy a prescription issued by a hospital paediatrician for sodium feredetate elixir, 2.75mg iron/kg daily. Assuming that the child is of average weight for its age, what dosage of the elixir would you supply?
A 1.25 ml daily
B 1.25 ml twice daily
C 2.5ml daily
D 2.5ml twice daily
E 5ml twice daily
Answer
2
Simple Completion
Directions: The question is followed by five suggested answers. Select the best answer.
In your pharmacy you offer a cardiovascular risk assessment service, based on blood pressure and serum cholesterol levels. Based on NHS recommendations and assuming that they have no other risk factors for CVD (including diabetes), which one of the following would you refer to their GP for further investigation because they have a greater than 10 per cent risk of developing cardiovascular disease over the next 10 years?
A. A 45 year old male smoker with systolic blood pressure (SBP) 110 mmHg and a ratio of total serum cholesterol to HDL cholesterol (TC:HDL) of 4
B. A 45 year old male non-smoker with SBP 130mmHg and TC:HDL 5
C. A 50 year old male non-smoker with SBP 110mmHg and TC:HDL 4
D. A 55 year old female smoker with SBP 120mmHg and TC:HDL 5
E. A 60 year old female smoker with SBP 110mmHg and TC:HDL 3.5
Answer
3
The following question consists of two statements. Decide whether the first statement is true or false. And decide whether the second statement is true or false.
First statement
Lyclear SprayAway is not allowable on an NHS prescription.
Second statement
Lyclear SprayAway is not a licensed medicine but a medical device.
Then choose:
A. If both statements are true and the second statement is a correct explanation of the first statement.
B. If both statements are true but the second statement is not a correct explanation of the first statement.
C. If the first statement is true but the second statement is false.
D. If the first statement is false but the second statement is true.
E. If both statements are false.
Directions Summarised
| | First statement | Second statement | |
| A | True | True | 2nd statement is a correct explanation of the first |
| B | True | True | 2nd statement is not a correct explanation of the first |
| C | True | False | |
| D | False | True | |
| E | False | False | |
Answer
4
Simple Completion
Directions: The question is followed by five suggested answers. Select the best answer.
A patient with hypertension has been prescribed Gaviscon Advance suspension. The prescriber does not want the patient’s intake of sodium from the preparation to exceed 20mmol per day. What is the maximum dose that the patient can take?
A. 1 x 5 mL spoonful four times daily
B. 2 x 5 mL spoonfuls three times daily
C. 1 x 5mL spoonful five times daily
D. 3 x 5ml spoonfuls three times daily
E. 2 x 5mL spoonfuls four times daily
Answer
5
Simple Completion
Directions: The question is followed by five suggested answers. Select the best answer.
A 32 year old female has presented at A&E saying that she took around 20 paracetamol tablets in a suicide attempt about 6 hours ago but now regrets her action. On questioning, she says that she takes no prescribed medication but has been taking a self-prescribed St John’s wort herbal medicine for depression for several weeks. A blood sample shows a plasma-paracetamol concentration of 75mg/litre. The patient weighs 60kg.
Which one of the following statements is correct?
A. Treatment with an antidote is not necessary
B. The patient should be treated with a total of 18g of acetylcysteine by intravenous infusion
C. The treatment should be administered over a total of 24 hours
D. The total volume of intravenous infusion to be administered is 1.5 litres
E. The preferred infusion vehicle is sodium chloride 0.9% solution
Answer
6
Directions: For the question below, ONE or MORE of the responses is (are) correct. Decide which of the responses is (are) correct. Then choose:
A if 1,2 and 3 are correct
B if 1 and 2 only are correct
C if 2 and 3 only are correct
D if 1 only is correct
E if 3 only is correct
Directions Summarised |
A 1,2,3 | B 1,2 | C 2,3 | D 1 only | E 3 only |
You receive a prescription from a veterinary practitioner for latanoprost eye drops for a dog. The prescription includes the statement, “Prescribed under cascade”.
1. Latanoprost is indicated for glaucoma
2. Latanoprost eye drops are not licensed for animal use
3. You should not dispense the prescription
Answer
7
Directions: The question is followed by five suggested answers. Select the best answer.
You receive the following prescription requesting ibuprofen oral suspension, 10mg/kg tds for 10 days, for a 1 year old child of average weight. What volume needs to be dispensed?
A. 50mL
B. 100 mL
C. 150mL
D. 200mL
E. 300mL
Answer
8
Directions: The following question consists of a statement in the left hand column followed by a second statement in the right hand column.
Decide whether the first statement is true or false.
Decide whether the second statement is true or false.
A. If both statements are true and the second statement is a correct explanation of the first statement.
B. If both statements are true but the second statement is not a correct explanation of the first statement.
C. If the first statement is true but the second statement is false.
D. If the first statement is false but the second statement is true.
E. If both statements are false.
Directions Summarised |
| First statement | Second statement | |
A | True | True | 2nd statement is a correct explanation of the first |
B | True | True | 2nd statement is not a correct explanation of the first |
C | True | False | |
D | False | True | |
E | False | False | |
A patient is terminally ill with cancer and has been using fentanyl ‘25’ patches as they cannot swallow tablets. The patches have been becoming less effective and her GP has asked you to suggest a suitable modified-release oral morphine preparation, at a strength and dose equivalent to one-third higher than the daily dose the fentanyl patches are providing. Acting on your suggestion the GP provides a prescription, the relevant portion of which reads:
“MST Continus suspension 60mg. Take one every 12 hours. Supply 30 sachets.”
First statement | Second statement |
You are unable to dispense the prescription. | The strength and dose on it do not correspond to what the GP asked for, and the total quantity has not been specified in words and figures. |
Answer
9
Classification
Directions: For each of the questions below, ONE or MORE of the responses is (are) correct. Decide which of the responses is (are) correct. Then choose:
A if 1,2 and 3 are correct
B if 1 and 2 only are correct
C if 2 and 3 only are correct
D if 1 only is correct
E if 3 only is correct
Direction Summarised |
A 1,2,3 | B 1,2 | C 2,3 | D 1 only | E 3 only |
Yellow Card reports should be submitted for:
1 All serious and minor suspected adverse reactions to any medicine in children under 16 years of age
2 All serious and minor suspected adverse reactions to intensely monitored medicines
3 All serious and minor suspected adverse reactions to herbal remedies
Answer
10
Simple Completion
Directions: The question is followed by five suggested answers. Select the best answer.
What is the correct formula for 100g of a cream containing: hydrocortisone butyrate 25mg and clotrimazole 500mg, using Locoid Cream, Canesten Cream and, if required, Aqueous Cream as diluent?
A Locoid Cream 50g, Canesten Cream 50g, Aqueous Cream 0g (not required)
B Locoid Cream 25g, Canesten Cream 75g, Aqueous Cream 0g (not required)
C Locoid Cream 50g, Canesten Cream 25g, Aqueous Cream 25g
D Locoid Cream 25g, Canesten Cream 50g, Aqueous Cream 25g
E Locoid Cream 25g, Canesten Cream 25g, Aqueous Cream 50g
Answer
Answers
1: D
Rationale/Explanation
Reference: BNF. Average weight for age of children can be found on sheets inside the back cover: One year old = 10kg.
Dose of sodium feredetate elixir = 2.75 x 10 = 27.5mg daily. Sodium feredetate elixir contains 27.5mg/5ml, therefore the dosage would be 2.5ml twice daily.
Syllabus sections
2 - Clinical and pharmaceutical practice. Part I - Clinical practice. b) Action and uses of drugs; Part II - Pharmaceutical aspects of practice. a) Calculation.
2: D
Rationale/Explanation
Reference: BNF, cardiovascular risk prediction charts inside back cover. Read off risk levels from charts. E is very close to the 10-20% risk level, but C is definitely within it.
Syllabus sections
2 - Clinical and pharmaceutical practice. Part 1 - Clinical practice. j) - Interpretation of test results; k) - Health promotion and disease prevention.
3: D (False/True)
Rationale/Explanation
Lyclear SprayAway is licensed as a medical device, but it is listed in Part IXA of the Drug Tariff and Part 3 of the Scottish Drug Tariff as such and is therefore allowable.
Syllabus sections
2 – Clinical and pharmaceutical practice. Part I – Clinical practice. b) Action and uses of drugs; Part II – Pharmaceutical aspects of practice. a) Calculation.
4: E
Rationale/explanation
Reference: BNF. 5ml Gaviscon Advance suspension contains 2.3 mmol Na+. The total number of 5mL doses/day in each option is multiplied by 2.3. Option E comes the nearest to providing the maximum desired Na+ content. (18.4 mmol). (Option D provides slightly more – 20.7mmol.)
Syllabus section
2, Part II a) Calculation.
5: B
Rationale
Reference: BNF, section: Emergency treatment of poisoning/Analgesics (non-opioid)/Paracetamol.
* Plasma-paracetamol level versus time elapsed since taking overdose is read off from the chart provided.
* As the patient has been taking St John’s wort, an enzyme- inducing drug, the reading is made against the high-risk treatment line, and 75mg/litre at 6 hours comes above the line so treatment with acetylcysteine is necessary.
* From Acetylcysteine monograph:
o Calculation of the recommended adult dosage regimen: 60x150mg + 60x50 + 60x100 = 18000mg = 18g.
o Total administration time = 24 hours 15 minutes
o Total volume = 1.7 litres
o Preferred infusion vehicle is glucose 5%
RPSGB syllabus sections
2 – Clinical and pharmaceutical practice. Part I – Clinical practice. j) Interpretation of test results; Part II – Pharmaceutical aspects of practice. a) Calculation.
6 B (1 and 2 correct)
Rationale
Reference: BNF, section 11.6, Treatment of glaucoma; latanoprost is included in this section. Reference: MEP, section 1.9: List of medicines licensed for animal use; latanoprost is not listed. Section 1.8.2, Medicines for veterinary use/Prescribing cascade; a pharmacist can dispense a human licensed medicine prescribed for an animal on a veterinary prescription if s/he is satisfied that it has been prescribed under the “cascade” principle. The prescriber has indicated that this principle has been applied.
Syllabus section
1, Part II a): Sale and supply of medicines.
Rationale
Reference: BNF, section 10.1.1 Non-steroidal anti-inflammatory drugs: Strength of ibuprofen oral suspension = 100mg/5mL. From table inside back cover for mean values of weight, height and body surface area of children: weight of 1 year old child = 10kg.
Amount of ibuprofen per dose: 10 (mg) x 10 (kg) = 100mg
Total amount of ibuprofen: 3 (doses per day) x 10 (days) x 100mg = 3000mg
100mg is contained in 5ml suspension, therefore 3000mg is contained in:
3000 x 5 = 150mL
100
Syllabus sections
2 – Clinical and pharmaceutical practice. Part II – Pharmaceutical aspects of practice. a) Calculation
8: E (false/false)
The strength and dose are correct. There is a list of equivalents between fentanyl patches and oral morphine in one of the introductory sections in the BNF, Prescribing in palliative care. This equates a 24-hour dose from a fentanyl ‘25’ patch to morphine salt 90mg daily. The prescriber wants the dose increased by one-third, bringing the equivalent morphine dose to 90x4/3 = 120mg daily. Section 4.7.2 Opioid analgesics/Morphine salts/ Modified-release 12-hourly oral preparations, lists four brands providing a 60mg presentation, but only MST Continus is available as sachets for preparing a suspension. This will be the only suitable presentation for the patient, who cannot swallow tablets.
The prescription can be dispensed, because although the total quantity in words has been omitted by the prescriber, a pharmacist may correct this minor omission.
Syllabus sections
2 – Clinical and pharmaceutical practice. Part I – Clinical practice. b) Action and uses of drugs; Part II – Pharmaceutical aspects of practice. a) Calculation.
9: B (1and 2 only)
Rationale
From Yellow Cards at back of BNF. For 3, the Yellow Card states for children under 18 years old, which includes children under 16, and is therefore correct. All suspected adverse reactions should be reported for intensely monitored medicines. Only serious adverse reactions to herbal remedies should be reported.
Syllabus sections
2 – Clinical and pharmaceutical practice. Part I – Clinical practice. e) Adverse effects of medicines; 3 - Systems and procedures, e) Responding to adverse drug reactions.
10: D
Calculation
Locoid Cream contains 0.1% hydrocortisone = 0.1g = 100mg in 100g. Therefore, 25mg will be contained in 25 = 25g.
100
Canesten Cream contains 1% clotrimazole = 1g = 1000mg in 100g. Therefore, 500mg will be contained in 500 = 50g.
1000
25g Locoid Cream + 50g Canesten Cream = 75g.
Therefore, need 100-75 = 25g Aqueous Cream as diluent
Syllabus section
2 – Clinical and pharmaceutical practice, Part II – Pharmaceutical aspects of practice, a) Calculation.
