Download September 2015 - General Pharmaceutical Council

Learning points from the September 2015 registration assessment
About this document
This document contains learning points drawn from candidate performance in the General Pharmaceutical
Council’s (GPhC’s) September 2015 registration assessment. It has been released by the Board of Assessors,
the independent body that sets and moderates the registration assessment. It is aimed at pre-registration
trainee pharmacists, pre-registration tutors and anyone involved in pharmacist education and training.
The questions were used in September 2015 and have not been altered. Now that the questions have
been released they will not be used again, but the topics covered in them may be tested in future papers
using differentquestions.
The learning points from previous sittings are available at
www.pharmacyregulation.org/51-registration-assessment-preparation
The registration assessment is changing in 2016. The question types will be
different and the syllabus has been replaced by the registration assessment framework.
Details are available at www.pharmacyregulation.org/2016changes. Even though the
question types used in 2016 will be different from the questions in this document, the
topics in these questions can still be tested because they are relevant to the new
registration assessment framework.
1
Format of the document
The first part of the document includes the questions themselves and the second part shows how candidates
answered those questions and includes the learning points.
The questions
1. Questions 1 to 11 are from the Closed Book paper. No reference sources were
allowed in the sitting.
2. Questions 12 to 23 are from the Open Book paper. The reference sources allowed in the sitting were:
 British National Formulary 69 March 2015 to September 2015;
 BNFfor Children 2014-2015; and the
 Summary of Product Characteristics (SPC) for Versatis 5% medicated plaster (provided
by the GPhC). This was provided for use in questions 12 to 14 below.
2
There are examples of all four question types used in the September
2015 Registration Assessment.
Part 1: Questions
(A) Questions 1 to 11 – Closed Book paper
Directions for questions 1 to 4. Each of the questions or incomplete statements in this section
is followed by five suggested answers. Select the best answer in each case.
1.
You receive a prescription for haloperidol depot injections for Mrs B. Your patient
medication record system shows that Mrs B usually takes haloperidol tablets. Which one
of the following is the most likely reason that the haloperidol has been changed from
tablets to a depot injection?
A
to reduce the risk of extrapyramidal side-effects
B
to reduce the risk of neuroleptic malignant syndrome
C
to provide a more rapid response
D
to improve efficacy
E
to improve adherence
3
2.
Which one of the following patients, with symptoms of a chest infection, is at
greatest risk of complications as a result of the infection and is in most need of immediate
intravenous antibiotics?
A
a 35-year-old woman with an exacerbation of her asthma. She has symptoms of
wheezing and shortness of breath but is able to talk in full sentences. Her respiratory
rate is 20 bpm and her BP is 120/70 mmHg
B
a 60-year-old man with no past medical history who has a heavy cold and now has a
cough and pleuritic chest pain. His respiratory rate is 15 bpm and his BP is 140/80
mmHg
C
a 76-year-old woman with new signs of confusion and a fever. She also has
osteoporosis and osteoarthritis. Her respiratory rate is 32 bpm and her BP is 85/55
mmHg
D
a 58-year-old woman with an exacerbation of her COPD. Her main symptom is
increased sputum. Her respiratory rate is 25 bpm and her BP is 120/80 mmHg
E
a 78-year-old man who has a cough, sore throat and nasal congestion. He also has
Parkinson's disease. His respiratory rate is 22 bpm and his BP is 100/70 mmHg
4
3.
4.
In which one of the following drug combinations, each for a different adult patient,
would referral to the prescriber be most important?
Current treatment
Newly prescribed drug
A
warfarin tablets as directed
according to INR
flucloxacillin capsules 500 mg four
times a day
B
Microgynon 30 tablets take one daily as
directed
co-amoxiclav tablets 625 mg three
times a day
C
quetiapine tablets 200 mg twice a day
clarithromycin tablets 500 mg twice a
day
D
lithium carbonate (Priadel) tablets 400
mg once a day
co-codamol 8/500 mg tablets two
every six hours
E
rosuvastatin tablets 20 mg at night
digoxin tablets 250 micrograms once a
day
Which one of the following is the most appropriate dose of paracetamol to be
administered every six hours to a 3-year-old child for the treatment of pyrexia
associated with flu-like symptoms?
A
60 mg
B
120 mg
C
180 mg
D
240 mg
E
360 mg
5
Directions for question 5. Select from the list above it the one lettered option which is most closely
related to it.
5.
Question 5 concerns the following cardiovascular medicines:
A
ramipril capsules
B
bendroflumethiazide tablets
C
atenolol tablets
D
digoxin tablets
E
aspirin tablets
Select, from A to E, which one of the above medicines:
5.
should be avoided in patients with severe bilateral renal artery stenosis
6
Directions for questions 6 to 9. Each of the questions or incomplete statements in this section is
followed by three responses. For each question 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
6.
7.
B
1, 2
only
C
2, 3
only
D
1
only
E
3
only
Pharmacists are required to apply evidence to their practice. Often the results of a
clinical trial are analysed statistically. Which of the following p values indicates a result that
is statistically significant?
1
p = 0.002
2
p = 0.044
3
p = 0.678
Miss A is 27 years old and has type 1 diabetes. Her PMR shows that she uses
NovoRapid (insulin aspart) and Lantus (insulin glargine). Which of the following is/are
appropriate if she experiences severe diarrhoea and is unable to eat solid foods? She should:
1
stop injecting her insulin
2
increase the frequency of blood glucose monitoring
3
take oral rehydration therapy
7
Directions Summarised
A
1, 2, 3
8.
9.
B
1, 2
only
C
2, 3
only
D
1
only
E
3
only
Which of the following is/are true of meta-analysis?
1
it is a statistical technique for combining the findings from independent
studies
2
randomised, controlled trials are likely to be included in a meta-analysis
3
most useful data in a meta-analysis is likely to come from observational
studies
Which of the following values would you not expect to find in an adult patient who
has normal kidney function?
1
2
eGFR 15 mL/minute/1.73m
2
eGFR 50 mL/minute/1.73m2
3
2
eGFR 95 mL/minute/1.73m
8
Directions for questions 10 and 11. The following questions consist of a first statement in the lefthand 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 and 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
A
B
C
D
E
First
Statement
True
True
True
False
False
Second
Statement
True
True
False
True
False
2nd statement is a correct explanation of the first
2nd statement is NOT a correct explanation of the first
Questions 10 and 11 concern Mrs Q who comes into your pharmacy to seek advice. She uses Durogesic
DTrans 50 microgram/hour patches (fentanyl). About an hour ago, she discovered that her 3-year-old son
had found a used patch and managed to stick it to his own arm. Mrs Q has removed the patch but does not
know how long it was stuck to the child’s arm. The child has no medical conditions and does not take any
regular medication. According to Mrs Q the child is behaving normally.
10.
FIRST STATEMENT
SECOND STATEMENT
Mrs Q can be reassured that used
patches are unlikely to contain active
ingredient
When worn for 72 hours, all the active
ingredient in the patch is likely to have
been absorbed by the user
9
Directions Summarised
A
B
C
D
E
First
Statement
True
True
True
False
False
Second
Statement
True
True
False
True
False
2nd statement is a correct explanation of the first
2nd statement is NOT a correct explanation of the first
11.
FIRST STATEMENT
SECOND STATEMENT
Since the child is behaving normally, no
further action is necessary
Once a patch is removed, serum
fentanyl concentrations fall very
rapidly
10
(B) Questions 12 to 23 – Open Book paper
Directions for questions 12 to 17. Each of the questions or incomplete statements in this section is
followed by three responses. For each question 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
only
C
2, 3
only
D
1
only
E
3
only
Questions 12 to 14 concern Mrs H, a 59-year-old woman who has residual pain from having
had shingles 3 weeks previously and has been prescribed Versatis 5% medicated plaster. Mrs H has
rheumatoid arthritis and normally uses ibuprofen 400 mg tablets three times a day and
esomeprazole 20 mg daily. Mrs H’s renal and hepatic function are normal and she has no other
medical conditions.
The Summary of Product Characteristics for Versatis 5% medicated plaster was provided in the
assessment and can be accessed here www.medicines.org.uk/emc/medicine/19291
12.
Which of the following is/are true?
1
Mrs H has been prescribed Versatis 5% medicated plaster for a licensed
indication
2
Mrs H should be reviewed in 2 to 4 weeks to evaluate if the plasters are
effective
3
Versatis 5% medicated plasters should be used for no longer than 8 weeks because of
their potential to be addictive
11
Directions Summarised
A
1, 2, 3
13.
14.
B
1, 2
only
C
2, 3
only
D
1
only
E
3
only
Mrs H asks for your advice on how to use the plasters. Which of the following is/are
true?
1
Mrs H should be advised that if there are any hairs present on the area where the
plaster is to be applied that these must be shaved off prior to application
2
the plaster must be applied during the night and should be removed after 12 hours
3
after removal, a used plaster should be folded in half, adhesive side inwards so that
the self-adhesive layer is not exposed, and the plaster should then be discarded
Mrs H is worried about side-effects from Versatis 5% medicated plasters. Which of
the following is/are true?
1
the plasters can cause drowsiness and Mrs H should be advised not to drive or
perform skilled tasks whilst using the plasters
2
Mrs H should be advised to remove the plaster and seek immediate medical advice
if she develops pruritus when using the plasters
3
less than 20% of patients can be expected to experience adverse reactions
12
Directions Summarised
A
1, 2, 3
15.
16.
17.
B
1, 2
only
C
2, 3
only
D
1
only
E
3
only
Which of the following laboratory test results would not be expected in a healthy
adult?
1
a blood glucose level of 1 mmol/litre
2
a plasma potassium level of 6.5 mmol/litre
3
a plasma sodium level of 150 mmol/litre
Mrs K, a regular customer in your pharmacy, asks you for some advice. She is feeling
very anxious because her sister has just been diagnosed with breast cancer and she wants
to know what she can do to reduce her risk of having breast cancer. Which of the following
is/are modifiable risk factors for breast cancer?
1
drinking 3 medium glasses of red wine each day with dinner
2
using combined hormone replacement therapy
3
having a family history of breast cancer
Which of the following drugs can be given intrathecally?
1
baclofen
2
methotrexate
3
vincristine sulfate
13
Designated calculation questions
Directions for questions 18(Calc) to 20(Calc). Each of the questions or incomplete statements in this
section is followed by five suggested answers. Select the best answer in each case.
18
(Calc).
19
(Calc).
A man weighing 60 kg requires an intravenous infusion of dopamine hydrochloride
to be given at a rate of 2 micrograms/kg/minute. A standard 250 mL pack of dopamine
hydrochloride solution 1.6 mg/mL is available. The nurse on the ward asks you to
calculate the rate of infusion required in order to provide the prescribed dosage.
Which one of the following should you recommend?
A
0.75 mL/minute
B
1.15 mL/minute
C
0.45 mL/hour
D
4.5 mL/hour
E
11.5 mL/hour
A 43-year-old woman is on citalopram tablets 40 mg once daily. She has developed
swallowing difficulties and is prescribed the equivalent dose of citalopram as oral drops.
Which one of the following is the correct number of bottles of citalopram 40 mg/mL oral
drops that need to be supplied for eight weeks of treatment?
A
1 bottle
B
2 bottles
C
3 bottles
D
4 bottles
E
5 bottles
14
20
(Calc).
The route of opiate administration for a patient with terminal illness needs to be
changed from oral morphine to sub-cutaneous morphine via a syringe driver. The patient is
taking 75 mg morphine sulfate m/r tablets twice daily and in the previous 48 hours has also
taken 7.5 mL of Oramorph oral solution daily for breakthrough pain.
Which one of the following daily doses of subcutaneous morphine sulfate provides the
closest equivalent daily dose for this patient?
A
45 mg
B
55 mg
C
80 mg
D
150 mg
E
165 mg
15
Directions for questions 21(Calc) to 23(Calc). For each numbered question select from the list above
it the one lettered option which is most closely related to it. Within each group of questions each
lettered option may be used once, more than once, or not at all.
Questions 21(Calc) to 23(Calc) concern the following quantities:
A
6 micrograms
B
60 micrograms
C
0.6 mg
D
6 mg
E
60 mg
Select from A to E, which one of the above is:
21(Calc).
the weight of drug present in 20 mL of a 0.3 % w/v solution
22(Calc).
the weight of dopamine that will be given to a patient weighing 75 kg over 20
minutes when given at a rate of 4 micrograms/kg/minute
23(Calc).
the amount of drug remaining in each mL of a solution where the original product
contained 405 mg/20 mL and where one third has been lost through photo- degradation
each week for the last three weeks
16
Part 2: Candidate answers and learning points
Note: Candidates select one answer from five for each question – ‘A’, ‘B’, ‘C’, ‘D’ or ‘E’.
For example, looking at the spread of answers for question 1 below, 8% answered ‘A’, 3%
answered ‘B’, 17% answered ‘C’, 4% answered ‘D’ and 68% answered ‘E’. The correct answer was
E and this is indicated by ‘*’and bold font.
Table 1
Question
% of candidates choosing each
answer in the September 2015 sitting
Notes and learning points from the
Board of Assessors
A
B
C
D
E
1
8
3
17
4
68*
2
2
16
63*
14
4
Candidates are expected to be able to assess
the severity of the symptoms of common
conditions.
3
26
6
45*
10
12
Candidates are expected to know significant
drug interactions and be able to decide
when a prescriber should be contacted.
4
12
38
43*
7
1
Candidates are expected to know the most
appropriate dose for patients of different
ages when recommending common nonprescription medicines. For example,
trainees should know what dose of
paracetamol to recommend in children of all
ages.
5
37*
28
7
25
3
Candidates are expected to know the
contraindications to commonly used
medicines and to understand medical
terminology.
6
5
48*
7
16
25
Candidates are expected to understand basic
statistics so that they can assess the
significance of research evidence.
7
22
4
71*
1
3
Candidates are expected to know how to
advise a patient with type 1 diabetes to
manage their condition during a concurrent
acute illness; otherwise known as ‘sick day
rules’.
8
19
67*
6
6
2
Candidates are expected to understand
the terminology used to categorise different
types of evidence.
17
Candidates are expected to know how the
formulation of a medicine will affect its
release profile and how this can affect
medicine choice for a patient.
Question
% of candidates choosing each
answer in the September 2015 sitting
Notes and learning points from the
Board of Assessors
A
B
C
D
E
9
3
68*
5
15
8
Candidates are expected to recognise
laboratory values representative of normal
kidney function.
10
39
1
2
18
39*
Candidates are expected to understand how
the formulation of a medicine affects how
the medicine is released.
11
4
9
17
27
43*
As above.
12
7
75*
10
4
2
13
17
6
19
10
47*
As above.
14
7
9
22
9
52*
As above.
15
56*
22
5
12
4
Candidates are expected to know the
reference ranges for common clinical
investigations.
16
11
60*
20
6
2
Candidates are expected to know the
modifiable risk factors for serious diseases
and be able to advise patients and the public
how to reduce their risks appropriately.
17
3
64*
3
23
6
Candidates are expected to know that vinca
alkaloids must never be administered
intrathecally. Information on the
administration of both baclofen and
methotrexate by the intrathecal route is
available in the BNF.
18
23
2
7
65*
2
The steps in the calculation are:
Candidates must be aware of the structure
of an SPC so that they can identify the
answers to questions effectively in the
assessment.
Candidates should read the section of the
SPC relevant to the question, not the whole
document.
Candidates must be able to extract
information from reference sources and
apply it to individual patients.
The man requires dopamine at a dose of 2
micrograms/kg/minute = 2 x 60 x 60 = 7200
micrograms/hour
Infusion pack = 1600 micrograms/mL
Therefore need 7200/1600 = 4.5 mL/hour
18
Question
19
% of candidates choosing each
answer in the September 2015 sitting
Notes and learning points from the
Board of Assessors
A
B
C
D
E
4
4
40*
47
5
The steps in the calculation are:
From the BNF, 10 mg tablet is equivalent in
therapeutic effect to 8 mg oral drops.
This patient is on 40 mg citalopram daily in
tablet formulation which is equivalent to 32 mg
daily in oral drops.
For 8 weeks treatment, the patient will need 32
x 7 x 8 = 1792 mg
Oral drops available as 15 mL bottle containing
40 mg/mL
So the patient will need 1792/40 = 44.8 mL = 3
bottles
It is possible that candidates who answered ‘D’
did not take account of the dose equivalence
between citalopram tablets and liquid
formulations.
20
2
5
83*
5
5
The steps in the calculation are:
The patient is taking 75 mg morphine sulfate
m/r tablets twice daily which totals 150 mg
daily. Also taking 7.5 ml Oramorph daily which
equals 15 mg per day. Total daily dose of oral
morphine sulfate is 165 mg.
From the BNF, the approximate equivalent
dose of parenteral morphine is about half of
the oral dose.
Therefore this patient will need 165/2 = 82.5
mg subcutaneous morphine daily.
21
0
2
0
1
96*
The steps in the calculation are:
0.3% w/v solution = 0.3 g in 100 mL
Therefore 0.3/100 in 1mL, therefore 0.3/100 x
20 in 20 mL = 0.06 g = 60 milligrams
22
1
1
3
95*
1
The steps in the calculation are:
4 micrograms/kg/minute = 4 x 75 x 20 =
6000 micrograms = 6 mg
19
Question
23
% of candidates choosing each
answer in the September 2015 sitting
Notes and learning points from the
Board of Assessors
A
B
C
D
E
5
11
19
46*
17
GPhC November 2015
20
The steps in the calculation are:
Start with 405 mg in 20 mL. One third lost in
week 1 = 405 – 135 = 270 mg in 20 mL left
One third lost in week 2 = 270 – 90 = 180 mg in
20 mL left
One third lost in week 3 = 180 – 60 = 120 mg in
20 mL left
120 mg/20 mL = 6 mg/mL