Open book: practice exam 3 - Chemist + Druggist

18/02/2010

References allowed for this exam

British National Formulary
Medicines, Ethics and Practice
Drug Tariff [England and Wales]
Scottish Drug Tariff

1

Assertion/Reason

Directions: The question below 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.
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

You are working in a pharmacy in a superstore in Edinburgh on a Sunday. A customer wants to buy a 500ml bottle of mineralised methylated spirits.

First statement	Second statement
You may not make the supply.	In Scotland, mineralised methylated spirits may not be sold between the hours of 10pm on Saturday and 8am on the following Monday.

Answer

2

Simple completion

Directions: The question is followed by five suggested answers. Select the best answer.

A patient who weighs 80kg has been prescribed dopamine by IV infusion at a dose of 4 micrograms/kg/min. What would be the maximum permitted infusion rate for this drug for this patient?

A.      0.1ml/min

B.     0.2 ml/min

C.     1ml/min

D.     2ml/min

E.     4ml/min

Answer

3

Multiple completion

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

For which of the following is emergency supply at the request of a patient not permitted?

1.      Nitrazepam
2.      Lormetazepam
3.      Temazepam

Answer

4

Multiple completion

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

A woman hands over a prescription to you and says: “I forgot to mention to the doctor that I’m breastfeeding my baby. Can you tell me if it’s OK to take the medicines on this prescription?” Which of the medicines on the prescription, listed below, should you contact the prescriber about?

1.      Ciprofloxacin tablets
2.      Codeine phosphate tablets
3.      Diclofenac tablets

Answer

5

Multiple completion

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

Regarding prescribing by a dentist, which of the following statements is/are correct?

1.      Amoxil capsules 500mg may be prescribed on form FP10D in England, GP14 in Scotland or WP10D in Wales, issued by a dentist providing primary care NHS services.

2.      Zinnat tablets 250mg may be prescribed on an NHS prescription that can be dispensed in a community pharmacy, issued by a dentist working in NHS secondary care.

3.      Famvir 125mg tablets may be prescribed for a patient s/he is treating privately, issued by a dentist who also provides NHS services.

Answer

6

Multiple completion

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

Out of Pocket Expenses may be claimed for the supply of medicines on NHS prescriptions, in the following circumstances:

1.      Postage costs for a medicine that must be obtained directly from the manufacturer.
2.      A minimum order charge when you have to obtain a medicine from a wholesaler that you do not normally use, because the medicine is not available from your usual wholesaler(s).
3.      Cost of telephone calls to wholesalers and manufacturers to try to obtain certain branded medicines because of problems in the supply chain.

Answer

7

Simple completion

Directions: The question is followed by five suggested answers. Select the best answer.

To reduce prescribing costs, a GP has asked you to advise him on proprietary drugs that could be prescribed generically. Which one of the following could be prescribed generically?

A.      Adalat Retard tablets

B.     Pentasa tablets

C.     Priadel tablets

D.     Tildiem tablets

E.     Uniphyllin Continus tablets

Answer

8

Assertion/Reason

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.
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

Your pharmacy participates in a local primary care cardiovascular health project involving height and weight measurements of patients. A man whose height is exactly 6ft (six feet) and weighs exactly 12 stones:

First statement	Second statement
He is considered to be overweight.	His body mass index is more than 22.

(In any calculations approximate to one place of decimals).

Answer

9

Multiple completion

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

In A&E, a three-year-old child weighing15kg is to be given an intramuscular injection of pethidine hydrochloride to relieve acute pain. Which of the following fall within the recommended dosage range?

1.    0.8ml of a 10mg/ml injection

2.    0.3ml of a 50mg/ml injection

3.    0.6ml of a 50mg/ml injection

Answer

10

Multiple completion

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 are working in a community pharmacy in England and receive a prescription for some ear drops that you are not sure can be prescribed on the NHS. The item is allowable if it is listed in any of the following sections of the Drug Tariff:

1. Part VIII

2. Part IXA

3. Part XVIIIA

Answer

________________________________________

Answers

1: E

Rationale
Reference: MEP. The regulation preventing sale of mineralised methylated spirits between the hours of 10pm on Saturday and 8am on the following Monday in Scotland was revoked from September 1, 2009.

Syllabus sections

1 Part IIa.

2: A

Rationale/calculation
Reference: BNF, section 2.7.2 and Appendix 6.
Dose for patient = 4 x 80 = 320micrograms/min = 0.32 mg/min
Maximum permitted infusion concentration = 3.2mg/ml (Appendix 6)
Therefore, infusion rate = 0.32 divided by 3.2 = 0.1ml/min


Syllabus section
2. Part IIa.

3: E

Rationale
Reference: MEP. Nitrazepam and lormetazepam are CD Schedule 4a and emergency supplies are permitted. Temazepam is CD Schedule 3, for which emergency supplies are not permitted.

Syllabus section
1. Part IIa.

4: B

Rationale
Reference: BNF, Appendix 5.
Ciprofloxacin: amount in breast milk probably too small to be harmful but manufacturer advises avoid.
Codeine: amount usually too small to be harmful, but mothers vary considerably in their capacity to metabolise codeine with possible risk of morphine overdose in the infant.
Diclofenac: amount too small to be harmful.
A pharmacist would need to contact the prescriber about the first two.

Syllabus sections
2. Part If.

5: A

Rationale
Amoxicillin capsules are included in the Dental Prescribers Formulary (DPF), which can be found in the BNF and the Drug Tariffs, and may be prescribed on the NHS.   The DPF lists products by their generic titles and dentists are strongly encouraged to prescribe generically, but a product may be prescribed by its brand name providing that the brand is not ‘blacklisted’.

Zinnat (cefuroxime) is not listed in the DPF, but NHS dentists working in secondary care are not restricted to the DPF and can prescribe any drug or medical device that would normally be allowed on an NHS prescription.

Famvir (famciclovir) is not listed in the DPF, but dentists may legally prescribe privately any medicine.

Syllabus section
3a.

6: D

Rationale
Reference: Drug Tariff, Scottish Drug Tariff. A detailed explanation of Out of Pocket Expenses also appeared in the September 2009 issue of PSNC Community Pharmacy News (England and Wales).

Syllabus section
3a.

7: D

Rationale
Reference: BNF. All, except Tildiem, are either drugs with a narrow therapeutic index and/or are modified release formulations where bioavailability may vary between brands of the same active drug. Patients should be maintained on the brand on which they have been stabilised and these drugs should not be prescribed generically.

Syllabus section:
2, Part I b).

8: D

Rationale/calculation
Reference: BNF. From conversion tables inside back cover,
6ft = 6 x 0.3 metres = 1.8 metres
12 stones = 76kg
Body mass index (BMI) = Weight in kg
                                       (Height in metres)²
                                       =       76
                                           1.8 x 1.8
                                       = 23.8

Second statement correct because BMI is more than 22.

First statement incorrect because a BMI less than 25 is not considered as overweight.

Syllabus sections
2, Part Ik); Part IIa).

9: A

Rationale/calculation
From BNF, dose range for child = 0.5-2mg/kg.
For child weighing 15kg, dose range = 15 x 0.5mg to 15x 2mg = 7.5 to 30mg.

Option 1 contains 0.8 x 10 = 8mg.
Option 2 contains 0.3 x 50 = 15mg.
Option 3 contains 0.6 x 50 = 30mg.

Therefore, all options (1,2,3) are within the recommended dosage range.

Syllabus sections

2, Part II a)

10: B

Rationale
Reference: Drug Tariff. Part VIII is the list of allowable drugs, Part IXA is the list of allowable registered medical devices, while Part XVIIIA is the list of drugs and other substances that are not allowable.

Syllabus section

3a.

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