Iwe practice paper 2013 and answer PDF

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Pharmacology practice notes with questions and details question answer...

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Australian Pharmacy Council Ltd Intern Written Examination Sample Paper v1.2013 This is an official Intern Written Examination sample paper produced by the Australian Pharmacy Council Ltd (APC) for practice purposes only. All questions in this sample paper are no longer used in live or actual examinations and have been chosen to allow interns to gain exposure to the type of content and layout of questions on the examination. Live or actual Intern Written Examinations delivered contemporaneously will vary from this sample paper. The Intern Written Examination is 125-questions long and candidates have 3 hours to complete it. Due to the frequent changes to the scope and content within the practice of pharmacy in Australia, the APC does not guarantee that the information in this paper is accurate or relevant once published publicly. The actual Intern Written Examination is delivered by computer and interns should visit the APC website for further information, including a link to an online tutorial: https://www.pharmacycouncil.org.au/interns/prepare-for-an-exam/ Copyright © Australian Pharmacy Council Ltd 2013. The content of this document is the property of the Australian Pharmacy Council Ltd and may not be reproduced.

Q1 How much elemental calcium (MW = 40 g/mol) does a patient receive per day if taking calcium carbonate (MW = 100 g/mol) 600 mg twice daily? A

480 mg

B

2400 mg

C

1200 mg

D

600 mg

E

240 mg

Q2 A patient requires a 5-day course of a medicine, the dose of which is 500 mg once daily on day 1 and 250mg once daily on day 2 to day 5. The medicine is only available as a 150mg dispersible tablet and is stable after dispersion for 6 hours. What is the minimum number of dispersible tablets required for the 5-day course? A 10 B 20 C 16 D 12 E

8

Q3 Phenytoin is available as 5 mL vials at a concentration of 50 mg/mL. The dose required is 15mg/kg and the patient weighs 75kg. If the required rate of infusion of phenytoin is 40 mg/minute, how long will it take to complete the infusion? A

2.8 minutes

B

28 minutes

C

56 minutes

D

18 minutes

E

1.8 minutes

Q4 A patient who uses tramadol 200 mg SR orally mane and 50 mg orally twice daily regularly to control breakthrough pain, is declared nil by mouth in hospital. What rate of IV morphine infusion would provide equivalent opioid analgesia if the equieffective analgesia ratio of tramadol oral to tramadol IV is 1.5:1 and the ratio of tramadol IV to morphine IV is 10:1? A 16.6 mg/hour B 694 micrograms/hour C 187 mg/hour D 833 micrograms/hour E

69 mg/hour

Q5 What weight of an ingredient is required to produce 1000 mL of a solution such that 2.5 mL diluted to 50 mL gives a 0.25% (w/v) solution? A 5g B 50 mg C 50 g D 25 mg E 25 g

Q6 A female patient, who is 68 years old and weighs 68kg, presents with a serum creatinine of 0.178mmol/L. What is her approximate serum creatinine clearance rate? A

10mL/min

B

30mL/min

C

45mL/min

D

60mL/min

E

80mL/min

Q7 A 30 year old female with a starting weight of 65 kg and a height of 160 cm has lost 10 kg. What is the change in her Body Mass Index (BMI)?

A

1.6

B

2.6

C

3.9

D

1.9

E

4.5

Q8 A patient is prescribed a reducing prednisolone regimen of:

20 mg daily for 5 days, then reduce the daily dose by 5 mg every 3 days, then cease.

How many 5 mg tablets of prednisolone will the patient require for this regimen? A

20

B

24

C

28

D

30

E

38

Q9 Which of the following is CORRECT, regarding the supply of Pharmaceutical Benefits Scheme (PBS) prescriptions?

A B C D E

the same PBS prescription identifying number must apply to each item on the prescription a repeat authorisation does not require endorsement by the pharmacist with his/her approved supplier number a pharmacist cannot supply an alternative brand of medicine without reference to the prescriber a pharmaceutical benefit cannot be supplied more times than specified in the PBS prescription the original PBS prescription identifying number is not duplicated on a repeat authorisation for an item

Q10 Methylphenidate is included in which of the following schedules? A

Schedule 2

B

Schedule 3

C

Schedule 4

D

Schedule 7

E

Schedule 8

Q11 For which Poisons Schedule is the following statement a general description?

“Substances with a low potential for causing harm, the extent of which can be reduced through the use of appropriate packaging with simple warnings and safety directions on the label.” A

Schedule 2

B

Schedule 3

C

Schedule 4

D

Schedule 5

E

Schedule 6

Q12 A prescription item designated as a restricted PBS benefit is BEST described as medication…

A B C D E

that has no PBS restriction on its therapeutic use with a low therapeutic index, which requires close monitoring that can only be prescribed on the PBS for specific therapeutic uses that is restricted and requires prior approval from the Medicare Australia or the Department of Veterans Affairs for a specific condition with a high chance of adverse events, which requires the prescriber to consider carefully the risk benefit ratio for each specific patient

Q13 The original supply and repeats of a pharmaceutical benefit may be supplied on the same day if the A

doctor has endorsed the prescription “Reg 19”

B

doctor has endorsed the prescription “Reg 24”

C

item is listed as an “unrestricted benefit”

D

patient is the holder of a health care card

E

patient has a safety net entitlement

Q14 For which Poisons Schedule is the following statement a general description?

“Substances, the use or supply of which should be by or on the order of persons permitted by State or Territory legislation to prescribe and should be available from a pharmacist on prescription.” A

Schedule 2

B

Schedule 3

C

Schedule 4

D

Schedule 5

E

Schedule 6

Q15 A patient enters the pharmacy wishing to fill a prescription for morphine sulphate SR 30 mg (60), having had a supply four days previously. What is the MOST appropriate action? A B C D E

dispense prescription as written ascertain why the patient needs the medication and contact the prescriber to authorise supply if necessary decline to dispense the prescription, as the patient could be misusing the medication supply the patient with an over-the-counter (OTC) paracetamol/codeine medication in the interim supply the patient with a restricted amount only

Q16 For which Poisons Schedule is the following statement a general description?

“Substances which should be available for use but require restriction of manufacture, supply, distribution, possession and use to reduce abuse, misuse and physical or psychological dependence.” A

Schedule 2

B

Schedule 3

C

Schedule 4

D

Schedule 5

E

Schedule 8

Q17 Chicken pox vaccine should be completed at A

3 months

B

6 months

C

18 months

D

5 years

Q18 Which of the following conditions would prevent the use of an angiotensinconverting enzyme inhibitor? A

bilateral renal artery stenosis

B

non-insulin dependent diabetes mellitus

C

Ménière’s disease

D

hyperlipidaemia

E

lupus erythematous

Q19 Which of the following statements is CORRECT regarding paracetamol? Paracetamol

A

has significant anti-inflammatory activity

B

induces inhibits cyclo-oxygenase

C

is excreted largely unchanged by the kidneys

D

can be given by intravenous infusion

E

is contraindicated in pregnancy

Q20 Which of the following statements about doxycycline is INCORRECT? Doxycycline

A

can be used in the treatment of rosacea

B

may decrease blood methotrexate concentration

C

may be taken by children over 8 years of age

D

should be taken in the morning rather than at night

E

should not be taken after the first 18 weeks of pregnancy

Q21 Which of the following statements about doxycycline is CORRECT? A B C D E

it increases the metabolism of phenytoin and should be used with caution in epilepsy it is effective as monotherapy in treating infection with Plasmodium falciparum it may reduce bone growth in young children it should not be used in the second trimester of pregnancy, due to risk of teratogenicity it is used at a dose of 100mg bd to treat acne

Q22 A female customer misses a dose of a progesterone only pill. Within how many hours does she have to take the pill, before contraceptive cover is reduced? A

one

B

three

C

four

D

six

E

twelve

Q23 A patient has been taken off fluoxetine and prescribed venlafaxine and told by the doctor to ask the pharmacist how long to wait before starting the new medication. The BEST advice would be to wait for A

one day

B

two days

C

ten to fourteen days

D

four to six weeks

E

one to two months

Q24 Itching is NOT a symptom of

A

allergic dermatitis

B

scabies

C

fungal infection

D

acne vulgaris

E

lichen planus

Q25 A worried father brings his 3 year old daughter into your pharmacy. She has had a bad cough and mild fever spasmodically during the winter which has kept the whole family awake at night. She has already used a whole bottle of expectorant, which had no effect. He asks you for a good cough mixture and describes his daughter’s cough as a barking cough, which is worse at night. There is no phlegm and she gasps for air after coughing. From the scenario above, you advise the father to take his daughter to the doctor, as you suspect her cough may be caused by

A

pneumonia

B

bronchitis

C

croup

D

post nasal drip

Q26 A female customer asks you about using St Johns Wort, saying she feels a bit ‘down’. You ask what medications she is taking, as you are concerned about interactions. Which of the following medications should MOST concern you regarding its combination with St Johns Wort?

A

ibuprofen

B

tramadol

C

codeine

D

paracetamol

E

dextropropoxyphene

Patient Profile ____________________________________________________________________________________

Patient Name Dick Cross Address 49 Caffers Place, SUBIACO WA 6051 Age 62 Sex Male Allergies Nil known

Height 170cm Weight 85kg

____________________________________________________________________________________

DIAGNOSIS Presenting complaint 1. Elevated blood glucose Medical history

1. Diabetes Type II 2. Hyperlipidaemia 3. Insomnia 4. Constipation

____________________________________________________________________________________

LAB/DIAGNOSTIC TESTS Date 20/7 20/7 1/3 1/3

Test Urate 0.58 mmol/L Fasting Blood Glucose 9.0 mmol/L Creatinine 0.16 mmol/L Cholesterol 6.5 mmol/L

Reference Range (0.18 – 0.47 mmol/L) (< 5.5 mmol/L) (0.05 – 0.12 mmol/L) ( 65 years of age

C

immuno-suppressed patients

D

children up to the age of 14

E

diabetics END OF PATIENT PROFILE

Patient Profile ____________________________________________________________________________________

Patient Name Thomas Lipton Address Room 9, Paediatric Ward Age 7 years Sex Male Allergies Carbamazepine (Agranulocytosis)

Height 125cm Weight 30kg

____________________________________________________________________________________

DIAGNOSIS Presenting complaint 1. Fever (temperature 39.2oC) 2. Increased seizure activity 3. Vomiting Medical history

1. Cerebral Palsy 2. Epilepsy (poorly controlled seizures)

____________________________________________________________________________________

LAB/DIAGNOSTIC TESTS Date

Test

Reference Range

____________________________________________________________________________________

MEDICATION RECORD Date Medication & Strength

Qty

Sig

17/3 Diazepam 5mg 50 i tds 17/3 Sodium Valproate 200mg 100 i bd 17/3 Lamotrigine 50mg 100 i bd 17/3 Vigabatrin 500mg 100 i daily 17/3 Phenytoin 30mg 100 i bd 17/3 Phenytoin 50mg 100 I bd ____________________________________________________________________________________

PHARMACIST’S NOTES Nil

Q79 Which of the following statements regarding epilepsy in childhood is INCORRECT?

A B C D E

epilepsy is one of the most common chronic neurological conditions of childhood the majority of children with a first unprovoked seizure will have a recurrence antiepileptic medication treatment should not be commenced routinely after the first unprovoked seizure potential adverse effects of antiepileptic medications are a major determinant in the choice of medication if seizure free for two or more years, withdrawal of antiepileptic treatment should be considered

Q80 Which of the following would NOT be an appropriate treatment for someone with acute status epilepticus?

A

intranasal midazolam

B

rectal diazepam

C

rectal paraldehyde

D

oral sodium valproate

E

buccal midazolam

Q81 The doctors are concerned about whether the doses of anticonvulsants are appropriate and enquire as to whether measuring blood levels of the patient’s anticonvulsants would be useful. For which of the following anticonvulsants are plasma levels of MOST value in clinical practice?

A

diazepam

B

lamotrigine

C

sodium valproate

D

phenytoin

E

vigabatrin

Q82 Which of the following anticonvulsants is MOST likely to be associated with visual field effects? A

diazepam

B

lamotrigine

C

sodium valproate

D

phenytoin

E

vigabatrin

Q83 In conversation with the medical staff, Thomas’ mother mentions that he has gained a lot of weight recently. Weight gain is a well recognised side effect of which of the following anticonvulsants? A

sodium valproate

B

lamotrigine

C

phenytoin

D

tiagabine

E

phenobarbitone

END OF PATIENT PROFILE

Q84 A patient with epilepsy comes into your pharmacy and tells you she is pregnant. She is concerned about the effect of her medication on the baby. Which of the following statements is the MOST appropriate advice? A

epilepsy medications should be ceased during pregnancy

B

epilepsy medications are safe to use during pregnancy

C

the dosage of current medications should be reduced to minimum levels

D

the risk to the baby is greater from uncontrolled epilepsy than from the medication

Q85 What is the recommended period (for females) for folate supplementation before conception and during pregnancy? A

one week before conception and the 1st month of pregnancy

B

one month before conception and the 1st month of pregnancy

C

three months before conception and the 1st three months of pregnancy

D

one month before conception and the 1st three months of pregnancy

E

one month before conception and the entire duration of pregnancy

Q86 Which of the following is NOT a risk factor for cardiovascular disease?

A

thyroid dysfunction

B

increased HDL

C

increased LDL

D

hypertension

E

diabetes

Q87 One of your regular patients presents a prescription for prednisolone 25 mg orally daily for the treatment of asthma. What is the optimal time to take this medication?

A

at lunchtime

B

at bedtime

C

on an empty stomach in the morning

D

with or after breakfast

E

anytime of the day without respect to food

Q88 Which of the following would be INAPPROPRIATE advice on caring for a pruritic rash? A

keep the area cool

B

wash area with soapy water, prior to applying cream

C

only use cotton clothing to cover the area

D

avoid shampoos on the area

E

avoid hot water

Q89 Alendronate can be taken

A

daily or once weekly

B

with milk to enhance absorption

C

at bedtime to avoid possible drowsiness

D

half an hour before food or one hour after a meal

E

in the morning with breakfast to avoid stomach upset

Q90 With which of the following medications is it MOST important to maintain a high fluid intake?

A

spironolactone

B

ciprofloxacin

C

indapamide

D

cephalexin

E

frusemide

Q91 Which of the following medications is MOST appropriate for the prevention of nausea and vomiting in Parkinson’s disease?

A

ondansetron

B

domperidone

C

metoclopramide

D

prochlorperazine

E

hyoscine

Q92 A male customer presents the following prescription for his recurrent urinary tract infection Rx Norfloxacin tablets 400 mg mitte 14 + 1 Rpt Sig i bd Which of the following should NOT be included in your counselling of the patient? A B C D E

maintain a good fluid intake whils...