Consolidated pharmacy intern 13-15 exams PDF

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2013-15 AHPRA EXAMS Question 1 Sotalol Nicotine Patch 10mg/16 Hr – 1 Tds Duloxetine 60mg 1 D Codeine 30mg 2 Tds Bisacodyl 3 N

Question 2 38 yr old man asks for treatment for itchy bottom (threadworms). He actually said it looked like ‘white threads.’ turns out its for his 4 yr old son other family members – wife (not pregnant or b/f), 10 month old daughter

Question 3 Patient who knows owner wants to buy 3 nausetil packs for 10 day trip. He has taken it before after daughter suggested it and it worked for him in the past.

Question 4 new rx for metoclopramide for nausea ramipril, salbutamol, metoprolol, nexium, salbutamol, flixotide, digoxin, aspirin 100mg (has taken these for years now, all controlled). Came in a script for metoclopramide. After questioning, was prescribed nexium hp7 from another dr (usual dr wasn’t aware). Patient was on the 5th day of taking nexium hp7. Also, said asthma was controlled. They checked renal and liver function a few weeks ago, everything is fine. Patient said he was taking metoclopramide for nausea. After further questioning, he said he had blurred vision as well. Told dr – main problem – nexium hp7 + digoxin ® toxicity (due to clarithromycin in nexium hp7). Second, patient was already on nexium. Dr didn’t ask for an alternative, instead told patient to not take metoclopramide and nexium hp7 and to see the dr urgently.

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2013-15 AHPRA EXAMS Question 1 Elocon cream apply tid Endep 25mg 1 d Risedronate 35mg weekly Amiodarone 200mg 1 d Meloxicam 15mg 1 d

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Man in his 30s comes into the pharmacy with sores in his mouth. Its been a few days. He's been stressed lately. NKA, no medications, no medical conditions, new to condition. Recommended kenalog and told him how to use it. Examiner asked for other products so I suggested Cepacol mouthwash and Bonjela gel. Also recommended meditation for stress and other lifestyle changes such as avoiding spicy, hot, sharp foods. Man also said he uses listerine mouthwash and I told him to avoid all mouthwashes with alcohol. Examiner also asked when I would refer and I said medications that can cause agranulocytosis and he asked which ones and I said some antipsychotics such as clozapine. And other conditions like immunosuppression, diabetes, systemic symptoms (ie fever) etc

It is early in the morning and a woman comes into pharmacy looking very distressed and says her mother is very sick overseas and she needs to catch a plane this morning. She has no time to go see the doctor. She had diazepam prescribed 2 years ago for anxiety on flights.

Woman in her 30s comes in with alprazolam 0.5 prn. History shows perindopril and alprazolam 0.25 prn. Upon questioning, she recently increased her dose of duloxetine from 30mg daily to 60mg daily and has been sweating alot. Duloxetine is prescribed by specialist but he's away and patient could only see GP today for alprazolam. GP says her stress is causing the sweating so increased the dose of alprazolam. Called GP to discuss possibility of serotonin syndrome or sweating as a side effect of SNRI. GP said no to serotonin syndrome and agreed on it being a side effect. GP said he'll talk to specialist and to dispense 3 days of alprazolam and to get the patient to see the specialist in the next 3 days.

Examiner asked me for all my options and their consequences and finally what my decision is. I said not to dispense anything and recommended her to see a GP or hospital. I didn't recommend anything OTC because was afraid it would be off label use (some interns recommended restavit but its only indicated for sleep) and also if it fails then she could suffer an anxiety attack on the plane and I could be liable.

2013-15 AHPRA EXAMS Question 1 Digoxin 62.5mcg 1 D Risperidone 2mg 1 D Oxycontin 10mg QID Allopurinol 100mg D Nilstat oral drops 1mL QID

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Woman comes in with 6 month old baby, presents with red rosy cheeks, crying all the time, drooling, irritated because he hasn't slept well and has a rash on his face. I was quite stunned for a bit. Asked about rash - red, under the mouth/chin area and couldn't say much else to help me define if it was inflammation or fungal involvement. Asked about use of a pacifier or anything that he might use in the mouth that is perhaps causing the drooling - nil pacifier. Few minutes later, proceeds to tell me that baby keeps gnawing at his arm. Ding, ding. Looks like there's teeth coming out. Educated about the teething, rash caused by drooling. Recommended to continue panadol as its working, added teething ring, QV moisturiser and wash to cleanse and moisturise area, cold compress to sooth and refer if it doesn't resolve. Out of role-play, told them why i didn't recommend hydrocortisone as they kept pushing for something for the redness. Said i wasn't confident that it was inflammation given the information ('just red'), but would give 0.5% hydrocortisone soft cream if it was indeed inflammation. Kind of went through why i asked certain questions for Ddx. Told them when I'd refer. They asked why I chose QV moisturiser - said I was confident and comfortable with the product, contains glycerin, hypoallergenic, safe in sensitive skin, nil fragrance, etc.

You're a locum, patient wants 3 boxes of mersyndol. Assistant tells you that he came in three days ago, comes in regularly and for several months now.

Question 4 Patient comes in with new script for Xalacom. Hx - Xalatan, Ramipril, Panadol, Aspirin and Verapamil. Fish oil too. No allergies. Xalacom and verapamil C/I. Called opthamologist, recommended brimonidine. i went with brimonidine because AMH said it was an alternative in patients who beta blockers are C/I in. checked the back of the AMH for interactions and it was all clear. Did NOT check emims... Had five minutes left, doctor said he'd fax and send script in the mail hurrying me along to start counselling. Counselled on how to use it to reduce systemic absorption by pinching at the inner corner of the eye. recommended good hygiene around the eye, wash hands, don't touch eye with the tip, storage, disposal, lubricating eye drop and CMI. Found out a couple other interns went with carbonic anhydrase inhibitors. On checking the interaction on Mims, its 'cautioned- not established' but it says it would be prudent to monitor, which i didn't suggest but had checked his blood pressure fine at least a couple times. The clinical significance didn't seem like it was something to worry about, but I'm a worry wart. Hope I don't get penalised for this.

2013-15 AHPRA EXAMS Question 1 Ezetimibe 10mg tds Fentanyl 200mcg prn Ibuprofen 200mg q6h Oxazepam 15mg n Roxithromycin 150mg bd

Question 2 50 something year old male with chest pain Upon questioning, burning sensation, no arm pain, started 30 mins ago. Had alcohol and big pub meal just before. First time it's this bad. Previously had discomfort only. Has high BP and high cholesterol. On irbersartan and simvastatin.

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You are PIC. Your pharmacist refused to dispense rx for pregnant patient for sertraline because it's cat C. Patient has resulted in attempting suicide and now in hospital. Husband comes in very angry about the situation.

Patient comes in for 2 rx for wife. Oxycodone 5mg prn and OxyContin 30mg bd. been on oxycodone for 1 week as had tonsils removed in hospital. Initiated in hospital OxyContin syrup then dr dispensed OxyContin 20mg 1bd upon discharge. Been taking 4-5 breakthrough doses a day on top of CR tabs after discharge.

Other questions: who would you report to. What do you do etc.

Upon questioning everything is fine except pain is not controlled. Examiner was really stringent about giving info. Kept asking if there's anything else I need to know before preparing rx. But answered with.. Like what specifically?? You ask me and I'll tell you. Also kept insisting everything is all good.

Recommended mylanta and ranitidine. Also counselled on non drug measures. Asked why I recommended mylanta first and I said because the liquid works faster. Also asked any other drug class used for heartburn and I said ppi. Also asked for referral points and what other health professional I would refer this patient to besides GP. I said dietician.

Then I asked how is she taking her tablets? Taking CR twice daily? And then she said yeah I crush and give it to her cos she has difficulty swallowing. Then called dr to change to liquid. Dr happy and provided with dose. Relayed what dr said to patient. That's it.

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2013-15 AHPRA EXAMS Temazepam 1 m Lisinopril (I think its 20mg) Lyrica 75mg bd Rabeprazole 20mg 1 bd Ciproxin 250mg 1 bd

Woman came in saying her baby is not feeding well...something wrong with mouth. So info gathered: - NKA - had croup and was on prednisolone for 2 days, no other medical condition otherwise. - 5 months old - Described as white patches on cheek, can scrap out + red base = Oral thrush = Give Nilstat (I said 4 times a day 1 mL, and used extra 2 days after patches all gone; should see improvement in 2 days) Out of role play: Q: Other products? = Daktarin oral gel = was asked how to use = I said i will stick to Nilstat drop due to risk of choking with gel. = I said can apply on the bottle teet (Baby is bottle fed in this scenario) (Only realised here but i still mentioned it to use both products after food or meal)

You are a pharmacist at work in a small busy pharmacy and the pharmacy owner came in drunk. Discuss - Mandatory notification. - I said i give notice/warning/reason with owner first and will report if he is repeating again. I said i will ask him to stay in the tearoom (for eg) and not participate in the pharmacy activity. I could send him home if someone picking him up (i said if he gets into accident cos i sent him off unsupervised, i can be liable) - Have a meeting and tell everyone that intoxicated is forbidden and can compromise the image of professionalism in pharmacy practice. Q: What would happened to you? - I can get fired but i am doing the right thing

Q: I was asked other points of referral. = i said fever, not responding to treatment, not feeding, losing weight, spreading

Mr X brought in a script from doctor for his wife. It is Loperamide 2 stat, 1 prn. Dispensing Hx: Karvea, Reminyl 16mg cap, Doryx Info gathered: - Diarrhoea since last week, getting worse over last 2 days (5 times diarrhoea) -> see doc and was given loperamide script - Reminyl from neurologist, the rest from GP - Medical condition: high BP, Alzheimer's Disease - Had chest infection and was give Doryx but finished 2 weeks ago - Other medication: Gastrolyte (for diarrhoea), aspirin - NKA - Didnt ask pregnancy cos she is 62 years old Dig Dig... - Was restarted on Aropax 20mg for depression. (Timeline was confusing, so she was on Aropax before and stopped for a year or so...initiated with Reminyl for AZ 8mg then 16mg and now restarting Aropax again for depression) Issue: Aropax increase reminyl and side effects or reminyl => diarrhoea, i asked Mr X for other symptoms and he then said Mrx X had been feeling nauseous as well (did this to make sure side effects of reminyl) - Call doc, doc said dispense loperamide (tell how to use) and go back to doc today. He will review the depression and liase with the neurologist. 19th minute... - Counsel how to use loperamide. - BRATS - hygiene and boiled/cooked food (I mentioned without thinking so hopefully still applicable in this situation) Q: was asked the maximum dose of loperamide. = 8 tabs. Q: can still use gastrolyte? = Yes, continue

Q: What wouldnt I used? = Kenalog is for mouth ulcer so no.

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2013-15 AHPRA EXAMS Perindopril 4mg tds Paroxetine 20mg d Esomeprazole 40mg d Buprenorphine 20mcg/hr 1 weekly Norflaxacin 400mg 1 bd

Man comes into pharmacy requesting something for a blocked nose. During history taking it is discovered that is for his 5 year old daughter. Current sx: blocked nose, fever, sore throat (which was getting better already) Symptoms have been present for the last three days. No other medications, NKA

You are the intern and your pharmacy has been offered a good financial deal for the generic of a lipid-lowering agent. As a result your pharmacy manager has asked the staff to change the all patient's on the medication to the generic.

Patient presents a script for Ventolin inhalers prescribed by a doctor that wasnt her regular GP. We were given the history as well which included Ramipril, Transiderm Nitro, Aspirin 100mg and Amlodipine 5mg. Patient has never taken Ventolin before or any inhalers in the past. Patient were prescribed inhalers for shortness of breath and feeling lethargic. Patient has been taking Ramipril, Transiderm Nitro, Aspirin and Amlodipine for the last 15 years. BP is fine been stable at 125/75. Taking Transiderm Nitro and Aspirin for ischaemic heart disease. Patient was admitted to hospital 4 weeks ago for an arm fracture. Patient was commenced on amirodarone in hospital as well for ventricular arrythmias. Followed up on her amiodarone and discovered she has been taking 200mg tablets tds for the whole 4 weeks. Called doctor to inform her of the dose the patient has been taking and possible contribution to pulmonary toxicity. Dr agreed and asked the pharmacist to send the patient back to her immediately. Doctor did not want the ventolin dispensed. Told the patient what has happened and that she needs to see doctor immediately.

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2013-15 AHPRA EXAMS Methyldopa 250mg Tds (didn't know the max dose) Quetiapine 25mg bd (they kept pushing for the dose and I just said that it's meant to be higher but start off with low dose) Sildenafil 100 bd (dose is wrong. Max=100mg, also forgot to mention about the visual disturbances) Flucloxacillin 500mg qid Oxycodone 5mg qid prn

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A woman comes in for something to treat mouth ulcers. Turns out it is for her 13 year old daughter who recently had braces. I had to ask about the braces because some interns were not told this information. I recommended kenalog and bonjela and wax for braces. Out of role play they asked what was in kenalog What would be the referral points: large size ulcer, multiple lesions, treatment resistant >7 days, signs and symptoms of infection, diabetes, immunocompromised

Question 2

Dispensary assistant is sick so boss asked a friend who is a dispensary assistant to fill in. You are the pharmacist in charge. There were some expensive dispensary stock that was missing and you suspect the replacement assistant of stealing. Another pharmacist actually had a look in their bag and saw the products in there. What do you do? I said if I suspected a staff member of stealing I would look at security footage to try and confirm this. I would also speak to that staff member and ask them why they did this. Another ethical issue is the pharmacist had no right to look into someone's bag and it was breaching the persons rights. They asked if I would tell the assistant that someone had looked in their bag. I told them that I would try to talk to them first about the stealing but legally I have to tell them because the pharmacist should not have done this. They asked if I would tell the police. I said I would speak to them and because I caught them and was able to stop the burglary, firstly I would tell them that it is illegal to steal. I said I would give them a warning and that I would notify the police if it happened again. I also said I would hold a staff meeting regarding the rules of the store and that stealing would not be tolerated. I also said I would record this somewhere only managers and pharmacists are able to see so that it is confidential. Finally I said that I would also notify my boss about the behavior.

A lady brought in a prescription for esomeprazole 40mg. Had it in the past but had worsening heartburn. 155cm 55yo Med hx: Mirtazapine Panamax Esomeprazole 20mg All prescribed by the same dr. Interviewed her and she revealed she just started taking alendronate a few weeks ago because diagnosed with osteoporosis and normal dr doesn't know about this. Taking the alendronate correctly. I was stuck about trying to find an alternative because all other treatments were for postmenopausal osteo and I checked and she hadn't reached menopause yet. Called the dr and told the problem. They asked what I suggested and I said risedronate bc alendronate has the highest risk of oesophagitis. (other interns weren't told to suggest an option). The dr just said they'll speak to the hospital and to get the patient to go back to see them. Dispense the nexium and stop the alendronate.

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Spoke to the patient. Gave them the nexium and did non pharm counselling (exercise, sunlight, vitamin d, calcium in diet) Had time left at the end and wanted to counsel about heartburn but the patient just said they had it before.

2013-15 AHPRA EXAMS Hypnodorm 1n Lisinopril 10mg tds **** Gabapentin 600 mg tds omeprazole 20 mg daily Daktarin oral gel

A mum came in concerned abt getting something for her baby Upon questioning .. Baby vommiting mostly after feeds.. only breast fed I discussed abt techniques of feeding and all.. But didnt get why the problem was.. The baby was puting on weight.. not dehydrated.. no problems at all otherwise.. So told the mother not to worry...

A patient comes to get a repeat prescription filled early but asked to put it through the computer only after a week so that he can get safety net sticker, saying that he got it done in another pharmacy the same way

Then the examiner gave away saying Imagine if it was reflux then wht would u do... I said i would refer to the doctor. - WHat if baby was bottle fed??? I think i should have spoken about AR formulas. But just told to change formula thats all

Question 1 Atenolol 50mg daily,

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Question 2 55 yo came in with a haemorroid

Question 3 The owner came into your store took

Arava 20 mg script NEW MEDICATION (By rheumatologist ) ON Methotrexate 2 weekly ( by GP but rheumatologist knows) Coversyl Plus, Cephalexin for a recent infection in leg All medications were fine... regularly monitoring done every three month for methotrexate.. Problems: Talked to the patient and asked whether doctor has said anything about monitoring for the medication. She said No Then i called Dr about monitoring : Said its done every 3 months. I said since she is starting arava need more regular monitoring.. Dr asked me how regular. I checked AMH and it said every 2-4 weeks for the first 3 months then every 3 months.. But didnt check the next line properly. With Metotrexate it should be done Every Month (Forgot to mention that) REAL PROBLEM : Thinking this was the problem I started counselling the patient on ARAVA, when i told her about monitoring Said she is going away to Queensland in a week. So i Had to call the doctor again and mention that problem. Dr said he will arrange blood test in Queensland. Conveyed that to the patient... Quick counselling on Arava and monitoring and side effects... Didnt get chance to say more abt the other medications...EVEN FORGOT LABEL 8 ( Going to queensland) and CMI Hopefully i was able to pass with finding out the problem... Anoth...