Download Australian Pharmacy Council Ltd CAOP Examination Sample Paper v1.2014

Australian Pharmacy Council Ltd
CAOP Examination
Sample Paper v1.2014
This is an official CAOP 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 candidates to gain exposure to the type of content and
layout of questions on the examination. Live or actual CAOP Examinations delivered
contemporaneously will vary from this sample paper.
The CAOP Examination is 106-questions long (105 multiple choice questions and 1
short answer question) 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 CAOP Examination is delivered by computer and candidates should visit the
APC website for further information, including a link to an online tutorial:
http://pharmacycouncil.org.au/content/index.php?id=11
Copyright © Australian Pharmacy Council Ltd 2014.
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
200 mg
D
600 mg
E
240 mg
Q2
A patient requires a 5-day course of a medicine’ the dose of which is 500mg 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
6 minutes
D
18 minutes
E
1.8 minutes
1
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 equi-effective
analgesia dose 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 1000mL 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
2
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 conditions would prevent the use of an angiotensin-converting
enzyme inhibitor?
A
bilateral renal artery stenosis
B
non-insulin dependent diabetes mellitus
C
Ménière’s disease
D
hyperlipidaemia
E
lupus erythematous
3
Q10
Which of the following statements is CORRECT regarding paracetamol?
Paracetamol
A
has significant anti-inflammatory activity
B
inhibits cyclo-oxygenase
C
is excreted largely unchanged by the kidneys
D
can be given by intravenous infusion
E
is contraindicated in pregnancy
Q11
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
Q12
Which of the following statements about doxycycline is CORRECT?
A
it increases the metabolism of phenytoin and should be used with caution in
epilepsy
B
it is effective as monotherapy in treating infection with Plasmodium falciparum
C
it may reduce bone growth in young children
D
it should not be used in the second trimester of pregnancy, due to risk of
teratogenicity
E
it is used at a dose of 100mg bd to treat acne
4
Q13
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
Q14
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
Q15
Itching is NOT a symptom of
A
allergic dermatitis
B
scabies
C
fungal infection
D
acne vulgaris
E
lichen planus
5
Q16
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
Q17
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
6
Patient Profile
____________________________________________________________________
Patient Name Dick Cross
Address 49 Caffers Place, SUBIACO WA 6051
Age 62
Height 170cm
Sex Male
Weight 85kg
Allergies Nil known
____________________________________________________________________
DIAGNOSIS
Presenting complaint 1. Elevated blood glucose
Medical history
1. Diabetes Type II
2. Hyperlipidaemia
3. Insomnia
4. Constipation
LAB/DIAGNOSTIC TESTS
Date Test
20/7
Urate 0.58 mmol/L
20/7
Fasting Blood Glucose 9.0 mmol/L
1/3
Creatinine 0.16 mmol/L
1/3
Cholesterol 6.5 mmol/L
Reference Range
(0.18 – 0.47 mmol/L)
(< 5.5 mmol/L)
(0.05 – 0.12 mmol/L)
(<5 mmol/L)
____________________________________________________________________
MEDICATION RECORD
Date
Medication & Strength
Qty
Sig
1/3
Atorvastatin 20 mg
30
i daily
16/1
Docusate 50 mg with Senna 8 mg
90
prn
16/1
Aspirin 100 mg
28
i daily
____________________________________________________________________
PHARMACIST’S NOTES
Date
20/7
20/7
Comment
Patient has been placed on dietary restriction for his elevated blood glucose in
the past 2 years. His most recent blood glucose indicates that dietary control
alone has not been adequate.
Asymptomatic elevated urate
7
Q18
The MOST appropriate option for the management of the patient’s hyperuricaemia is
A
allopurinol started at a dose of 100 mg daily
B
allopurinol started at a dose of 300 mg daily
C
probenecid started at a dose of 500 mg twice a day
D
no treatment be initiated
E
colchicine 0.5 mg twice daily
Q19
Which of the following would be an additional risk factor for cardiovascular disease in
this patient?
A
low homocysteine level
B
an elevated serum albumin
C
hypertension
D
postural hypotension
E
waist measurement 75 – 85 cm
Q20
Which of the following medications would be the MOST appropriate to manage Mr
Cross’ diabetes?
A
metformin
B
acarbose
C
insulin
D
glibenclamide
E
rosiglitazone
8
Q21
Which of the following tests is the BEST indicator of ongoing blood glucose control?
A
random blood glucose levels
B
three monthly HbA1c levels
C
weekly fasting blood glucose levels
D
regular serum creatine measurements
E
weekly urine testing
Q22
Which of the following primary health initiatives should you strongly recommend to
Mr Cross?
A
annual ocular examinations
B
annual bone density measurement
C
faecal occult blood test every 3 months
D
prostate specific antigen test every 5 years
E
creatine kinase levels every 3 months
END OF PATIENT PROFILE
9
Patient Profile
____________________________________________________________________
Patient Name : Jack Smithers
Address : Room 22, Garren Aged Care Facility
Age : 95 years
Height : 180 cm
Sex : Male
Weight : 73 kg
Allergies pencillin allergy (rash)
____________________________________________________________________
DIAGNOSIS
Presenting complaint 1. Swallowing difficulties and agitation
Medical history
1. Benign prostatic hyperplasia
2. Pacemaker
3. Depression
4. Prostate Cancer
____________________________________________________________________
LAB/DIAGNOSTIC TESTS
Date
Test
Reference Range
3/2
Blood pressure 140/80
____________________________________________________________________
MEDICATION RECORD
Date Medication & Strength
Qty
Sig
3/2
3/2
3/2
3/2
3/2
3/2
3/2
3/2
24/1
22/1
10/1
10/1
12/12
2
100
90
30
30
30
1
112
25
20
5
20
30
Apply once weekly
2 qid
2 nocte
1 daily
1 mane
1 mane
Implant every 12 weeks
1 mane
1 tds prn
1 tds course completed
1 daily course completed
1 qid prn
1 daily - ceased
Buprenorphine 10 mcg/hour patch
Paracetamol 500 mg
Docusate/senna 50 mg/8 mg
Tamsulosin SR 400 mcg
Rabeprazole 20 mg
Citalopram 20 mg
Goserelin acetate 10.8 mg SC
Aspirin 100 mg
Metoclopramide 10 mg
Cephalexin 500 mg
Roxithromycin 300 mg
Oxycodone 5 mg tablets
Meloxicam 15 mg
____________________________________________________________________
PHARMACIST’S NOTES
Date
Comment
3/2
Visual and hearing impairment. Recent falls and wheelchair bound.
Nursing staff have advised of decreased cognition in patient. 24/1
GP noted no prior problems with cephalexin - cause of nausea unknown.
10
Q23
Mr Smithers is becoming increasingly agitated each time tablets are given to him, due
to difficulty swallowing. Which of the following medications the patient is currently
taking should NOT be crushed?
A
paracetamol
B
citalopram
C
aspirin
D
oxycodone
E
rabeprazole
Q24
Due to the patient’s swallowing difficulties, changes to his medications are necessary
to alleviate this problem. Which of the following recommendations is NOT
appropriate?
A
oxycodone immediate release tablets, liquid, suppositories or injections can be
used
B
roxithromycin tablets should not be crushed, but the dispersible tablets can be
used
C
docusate and senna tablets may be crushed, or other options include
suppositories or lactulose
D
tamsulosin tablets may be crushed, or the tablets opened and dispersed in
water
E
dispersible proton-pump inhibitors should be used and include omeprazole,
pantoprazole or lansoprazol
11
Q25
Mr Smithers’ pain is currently well managed with regular therapeutic doses of
paracetamol and a weekly buprenorphine patch. If further treatment for chronic pain
is required, which of the following is NOT appropriate in light of the patient’s current
medication regimen?
A
increased oxycodone dose
B
supplementary paracetamol
C
higher strength buprenorphine patch
D
replace paracetamol with combination paracetamol/codeine
E
replace oxycodone tablets with suppositories
Q26
Mr Smithers required metoclopramide for the treatment of nausea. Which of the
following statements regarding metoclopramide is INCORRECT?
A
tablets may be crushed
B
drowsiness is a common side effect
C
oral adult dose for nausea is 0.5 mg/kg every 4-6 hours
D
reduce dose in the elderly to reduce risk of extrapyramidal effects
E
avoid long term use in depressed patients, as mental state may worsen
END OF PATIENT PROFILE
12
Patient Profile
____________________________________________________________________
Patient Name Beryl Groper
Address 64 Highfield Drive, Thornlie
Age 49
Height 148cm
Sex Female
Weight 55kg
Allergies Nil known
____________________________________________________________________
DIAGNOSIS
Presenting complaint
1. Obstructive airways disease with shortness of breath
Medical history
1. Congestive cardiac disease
2. Glaucoma
____________________________________________________________________
LAB/DIAGNOSTIC TESTS
Date
Test
Reference Range
16/10
Temp 37.8°C; Pulse 65bpm;
BP 120/65mm Hg
____________________________________________________________________
MEDICATION RECORD
Date
Medication & strength
Qty
Sig
2/10
Fluticasone 250mcg and Salmeterol 25mcg 120
ii puffs bd
30/9
Salbutamol nebules 5mg/2.5mL
60
5mg 4-hourly
30/9
Tiotropium 18mg capsules
30
inhale i daily
30/9
Prednisolone 5mg
60
40mg mane
15/9
Betaxolol eye drops 0.25%
5ml
ii drops bd
8/8
Enalapril 10mg
30
i daily
6/7
Frusemide 40mg
100
i mane
6/7
Docusate sodium (50mg)and senna (8mg) 90
ii nocte
____________________________________________________________________
PHARMACIST’S NOTES
Nil
13
Q27
Beryl recently consulted you at the pharmacy with apparent flu symptoms, which
cleared within a few days. However, three or four weeks later she is still suffering with
a persistent, dry night time cough that is disturbing her sleep pattern. She asks you for
a cough suppressant. Which of the following is the MOST appropriate action for you
to take?
A
advise her to use the tiotropium capsule at night before bed
B
advise her to use the fluticasone/ salmeterol inhaler immediately before using
the salbutamol nebules, to increase activity of the salbutamol
C
supply her with a pholcodine elixir, to be taken before bed
D
contact her doctor to discuss the patient’s use of enalapril
E
supply promethazine tablets, to be taken three times a day with the last dose
before bed
Q28
Beryl arrives to collect her regular supply of medication and is complaining of swollen
ankles, so severe that she can’t fit into her shoes. The MOST appropriate action would
be for you to
A
B
C
D
E
advise her doctor and suggest Beryl’s frusemide and prednisolone be
reassessed
advise her to increase her frusemide dose to two tablets in the morning and to
take a potassium supplement
recommend she wear graduated support stockings and elevate her legs more
often
advise her to use her salbutamol more regularly to allow her to undertake
gentle walking to improve her venous return
advise her to reduce her dose of prednisolone to 5mg
14
Q29
Beryl later suffers muscle cramps. The MOST likely cause is
A
B
C
D
E
hypocalcaemia due to the prednisolone
hypokalaemia due to the frusemide and prednisolone
hyperphosphataemia due to heart failure
excessive fluid retention of feet and ankles
drug interaction between enalapril and frusemide
Q30
To improve Beryl’s asthma the doctor could
A
change the eye drops
B
change the enalapril
C
increase the frusemide
D
change the tiotropium to an inhaler
E
reduce and cease the prednisolone
Q31
You should ensure that Beryl’s prednisolone dose is reduced slowly because
A
stopping quickly may induce an asthma attack
B
inhaled steroids need to be increased slowly
C
the adrenal glands may be suppressed
D
electrolytes need to return to normal slowly
E
the possibility of rebound wheezing
END OF PATIENT PROFILE
15
Patient Profile
____________________________________________________________________
Patient Name David Frost
Address 27 Christmas Parade, Wagga Wagga, NSW 2073
Age 70
Height 168cm
Sex Male
Weight 75kg
Allergies Nil known
____________________________________________________________________
DIAGNOSIS
Presenting complaint
1. Diarrhoea
Medical History
1. Osteoarthritis
2. Hypertension
3. Cardiac Failure
____________________________________________________________________
LAB/DIAGNOSTIC TESTS
Date
Test
Reference Range
7/4
Potassium 6.0 mmol/L
(3.5 – 5.0 mmol/L)
7/4
Creatinine 0.23 mmol/L
(0.05 – 0.12 mmol/L)
7/4
Urea 36 mmol/L
(3 – 8 mmol/L)
____________________________________________________________________
MEDICATION RECORD
Date
Medication & Strength
Qty
Sig
31/3
Paracetamol 1 gram
100
tds
31/3
Celecoxib 200 mg
30
i daily
31/3
Frusemide 80 mg
100
i daily
6/1
Lisinopril 10 mg
30
i daily
6/1
Spironolactone 25 mg
100
i daily
6/1
Frusemide 40 mg
30
i daily
6/1
Glucosamine 1500 mg
60
i daily
____________________________________________________________________
PHARMACIST’S NOTES
Date Comment
7/4
The patient was admitted to hospital following two days of severe diarrhoea, one week after the patient was started on celecoxib and the dose of frusemide
was increased.
16
Q32
The MOST likely cause of the results of the laboratory tests that have been provided
for this patient is
A
liver failure
B
acute renal failure
C
fluid overload
D
hyperkalaemia
E
worsening cardiac failure
Q33
Which of the following medications is MOST likely to cause gynecomastia in Mr Frost?
A
lisinopril
B
celecoxib
C
frusemide
D
glucosamine
E
spironolactone
Q34
Mr Frost is on spironolactone for his cardiac failure. What is the usual recommended
dose of this medication in patients with cardiac failure?
A
400 mg daily
B
100 mg daily
C
25 mg twice a day
D
25 mg once a week
E
25 mg once a day
17
Q35
Which of the following combinations of medication may cause acute renal failure in
this patient?
A
spironolactone, frusemide, paracetamol
B
frusemide, lisinopril, celecoxib
C
paracetamol, frusemide, lisinopril
D
celecoxib, lisinopril, glucosamine
E
lisinopril, spironolactone, glucosamine
Q36
The patient is currently taking celecoxib, which is a selective inhibitor of cyclooxygenase type 2 (COX-2). What is the mode of action of this type of medication?
A
stimulates the production of prostacyclin (PGI2)
B
inhibits the production of prostacyclin (PGI2)
C
stimulates the production of thromboxane (A2)
D
inhibits the production of thromboxane (A2)
E
inhibits both prostacyclin (PGI2) and thromboxane (A2)
END OF PATIENT PROFILE
18
Patient Profile
____________________________________________________________________
Patient Name Ms Cecily Weary
Address 17 Filamore Street, Portland, SA
Age 19
Height 160cm
Sex Female
Weight 58kg
Allergies Nil known
____________________________________________________________________
DIAGNOSIS
Presenting complaint
1. Emergency contraceptive advice
____________________________________________________________________
MEDICATION RECORD
Date
Medication & Strength
Qty
Sig
____________________________________________________________________
PHARMACIST’S NOTES
Date
Current
Comment
Patient has had unprotected sex in the last 24 hours and has consulted
her doctor for advice, as she feels at risk of falling pregnant.
19
Q37
Ms Weary’s doctor has recommended oral levonorgestrel. Which of the following
statements is CORRECT regarding this method of emergency contraception?
A
oral levonorgestrel must be taken within the first 72 hours after unprotected
intercourse to have a contraceptive effect
B
levonorgestrel has more severe side effects when taken as emergency
contraception compared to its use as regular contraception
C
levonorgestrel with ethinyloestradiol (2 doses of four tablets, 12 hours apart) is
considered to be as effective as the oral levonorgestrel regimen
D
oral levonorgestrel emergency contraception has been shown to increase the
risk of ectopic pregnancy
E
oral levonorgestrel does not induce a withdrawal bleed, although irregular
bleeding may occur occasionally
Q38
Ms Weary is breast-feeding her seven month old month old son. Which of the
following is the MOST appropriate advice to give the patient?
A
milk supply will significantly decrease
B
the child should not be breast-fed for at least 24 hours
C
emergency contraception is safe to take during breast-feeding
D
emergency contraception should not be taken if breast-feeding
E
emergency contraception dose should be split over twelve hours to minimise
excretion into breast milk.
Q39
Which of the following should you recommend to Ms Weary, regarding the MOST
effective time to take hormonal emergency contraception?
A
immediately
B
immediately after the next breastfeed
C
within 12 hours of unprotected sex
D
72 hours after unprotected sex
E
with the evening meal to increase absorption
END OF PATIENT PROFILE
20
Patient Profile
____________________________________________________________________
Patient Name Kay Sutton
Address 66 Argyle St Hackett
Age 23
Height 171 cm
Sex Female
Weight 58 kg
Allergies Metoclopramide
____________________________________________________________________
DIAGNOSIS
Presenting complaint 1. Urinary tract infection
Medical history
1. Asthma
2. Type 1 diabetes
3. Bipolar Disorder
____________________________________________________________________
LAB/DIAGNOSTIC TESTS
Date
Test
Reference Range
12/1
Lithium 0.8 micromol/L
0.5 – 1.2 micromol/L
____________________________________________________________________
MEDICATION RECORD
Date
12/1
12/1
12/1
12/1
12/1
Medication & Strength
Insulin glargine 20iu
Insulin lispro 10 iu
Lithium 250mg tab
Ethinyloestradiol/levonorgestrol
Salbutamol 100mcg
Qty
100
4x28
MDI
Sig
bd
tds
2 tds
1 daily
1-2 inh prn
____________________________________________________________________
PHARMACIST’S NOTES
Nil
21
Q40
Ms Sutton presents to your pharmacy with a script for cephalexin. Which of the
following is the MOST appropriate advice?
A
cease taking the oral contraceptive pill when taking this antibiotic
B
avoid alcohol while taking this antibiotic
C
start taking acidophilus to prevent vaginal thrush
D
start taking cranberry juice to treat the urinary tract infection
E
use barrier contraceptive measures while taking this antibiotic
Q41
Ms Sutton requests a product containing sodium citrotartrate to relieve the burning
associated with her urinary tract infection. Which of the following statements is
CORRECT?
A
the increase in urinary pH will decrease the renal clearance of lithium
B
the renal clearance of lithium will increase with the use of sodium citrotartrate
C
the antibacterial activity of cephalexin will be increased with the use of sodium
citrotartrate
D
the tubular reabsorption of lithium will increase with the use of sodium
citrotartrate
E
lithium and sodium citrotartrate granules can be safely used in combination
Q42
Regarding the Ms Sutton’s insulin, which of the following statements is INCORRECT?
A
insulin lispro should be administered 30 minutes after each meal
B
the vial in use can be stored at room temperature for 28 days
C
insulin lispro is injected subcutaneously
D
insulin glargine is referred to as a basal release insulin
E
insulin glargine should not be mixed with insulin lispro before each injection
22
Q43
Ten days later Ms Sutton has been referred to your pharmacy by the doctor for a
treatment for vaginal thrush. Which of the following statements regarding oral
fluconazole is CORRECT?
A
it must be accompanied by topical antifungal therapy
B
it must be taken on three consecutive days
C
it is contraindicated in diabetes
D
it is not recommended for use by pregnant woman
E
the course should be repeated in seven days
Q44
Ms Sutton’s doctor contacts you for advice regarding her bipolar disorder therapy. He
says that while her condition is well controlled, she is complaining of nausea and fine
tremor. Which of the following recommendations is the MOST appropriate?
The lithium
A
should be taken one hour before food
B
could be changed to a sustained release preparation
C
dose should be increased by 50%
D
dose should be decreased by 50%
E
should be replaced with olanzapine
END OF PATIENT PROFILE
23
Patient Profile
____________________________________________________________________
Patient Name Peter Barnard
Address Room 19, Garran Ward
Age 9
Height 120 cm
Sex Male
Weight 25 kg
Allergies Nil Known
____________________________________________________________________
DIAGNOSIS
Presenting complaint 1. Urinary tract infection
Medical history
1. Chronic renal failure
2. Streptococcal glomerulonephritis
____________________________________________________________________
LAB/DIAGNOSTIC TESTS
Date
Test
Reference Range
16/11
Creatinine 0.42 mmol/l
0.02-0.06 mmol/l
16/11
Calcium 2.3 mmol/l
2.1-2.6 mmol/l
16/11
Phosphate 2.4 mmol/l
1.1-1.8 mmol/l
16/11
Potassium 5.8 mmol/l
3.5-5.0 mmol/l
16/11
Urinalysis: Pseudomonas aeruginosa detected
____________________________________________________________________
MEDICATION RECORD
Date
Medication & Strength
Qty
Sig
16/11
Calcium Carbonate 1.5g
100
i bd cc
16/11
Calcitriol 0.25 mcg
100
i daily
16/11
Darbopoietin 30 mcg
5
i weekly subcut
16/11
Enalapril 5mg
30
i bd
16/11
Sodium bicarbonate 840mg
100
i tds
16/11
Ferrous sulphate 325mg
30
i daily
16/11
Folic acid 0.5mg
100
i daily
16/11
Nifedipine SR 30mg
30
i bd
16/11
Hydralazine 25mg
100
i tds
____________________________________________________________________
PHARMACIST’S NOTES
Date Comment
17/11
Admitted to hospital with a urinary tract infection. Patient is pyrexial with a temperature of
o
39 C and looks “unwell”. BP is 130/90. Recently stable on peritoneal dialysis.
Patient is on transplant waiting list awaiting a renal transplant.
Patient has gum hypertrophy.
24
Q45
The patient has chronic kidney disease. Which of the following statements regarding
this condition is INCORRECT?
A
protein starts to pass into the urine
B
anaemia is a complication that must be treated or prevented
C
hypercalcaemia occurs due to deficient vitamin D production
D
toxins such as urea and creatinine build up and cause problems
E
risk factors include diabetes mellitus, hypertension and increasing age
Q46
Which of the following medications is MOST likely to be the cause of the patient’s gum
hypertrophy?
A
calcitriol
B
enalapril
C
ferrous sulphate
D
nifedipine
E
hydralazine
25
Q47
The patient is experiencing hyperkalaemia. Which of the following statements is
CORRECT regarding the patient’s condition?
A
the patient’s potassium levels indicate severe hyperkalaemia
B
the patient’s current medications are not likely to be a contributing factor
C
oral frusemide can be given to promote potassium excretion
D
muscle weakness, cardiac arrhythmia and myalgia are common symptoms
E
the use of NSAIDs should be avoided in this patient
Q48
Which of the following IV antibiotics is the MOST suitable treatment against
Pseudomonas aeruginosa for this patient?
A
amoxycillin
B
vancomycin
C
ceftriaxone
D
ciprofloxacin
E
gentamicin
Q49
The patient has hyperphosphataemia. Which medication dosage could be increased to
reduce his phosphate level?
A
calcium carbonate
B
calcitriol
C
sodium bicarbonate
D
darbepoetin
E
enalapril
END OF PATIENT PROFILE
26
Patient Profile
____________________________________________________________________
Patient Name Janine Smitters
Address 2B Nursing Home
Age72
Height 152 cm
Sex Female
Weight 50 kg
Allergies Nil Known
____________________________________________________________________
DIAGNOSIS
Presenting complaint 1. Fractured neck of femur
Medical history
1. Rheumatoid arthritis
2. Hypertension
____________________________________________________________________
LAB/DIAGNOSTIC TESTS
Date
Test
Reference Range
____________________________________________________________________
MEDICATION RECORD
Date
Medication & Strength
Qty
Sig
3/11
Enoxaparin 40mg/0.4mL
10
i daily subcut
3/11
Paracetamol 500mg/codeine 8mg
50
ii qid
22/10
Oxazepam 30mg
25
i bd
22/10
Diclofenac 25mg
50
i tds
7/10
Prazosin 5mg
100
½ tds
5/9
Atenolol 50mg
30
i mane
5/9
Perindopril 4 mg
30
i daily
____________________________________________________________________
PHARMACIST’S NOTES
Date
2/11
Comment
Patient admitted to acute care hospital after a fall.
Patient has been taking diclofenac for 2 years.
27
Q50
The doctor has decided to cease the oxazepam and asks for your advice. Mrs Smitters
has been on this medication for 3 years. The MOST appropriate advice to give the
doctor is to
A
stop the oxazepam immediately
B
change to temazepam and reduce the dose over a few weeks
C
reduce the oxazepam dose by 15mg a day for 4 days before ceasing
D
change to an equivalent dose of diazepam and gradually reduce the dose over
3 weeks
E
reduce the dose of the oxazepam to one tablet on alternative nights, over a 4-6
week period
Q51
Following Mrs Smitters’ fall, osteoporosis is suspected. Before initiating alendronate,
all of the following investigations should be undertaken EXCEPT
A
bone mineral density
B
vitamin D and calcium levels
C
hepatic function
D
renal function
E
full dental assessment
Q52
Which of the following medications is LEAST likely to have contributed to Mrs Smitters’
fall and subsequent fractured femur?
A
prazosin
B
atenolol
C
oxazepam
D
perindopril
E
paracetamol/codeine
28
Q53
At a follow-up appointment, Mrs Smitters’ hypertension is found to have worsened.
The MOST appropriate management would be to
A
increase the prazosin dose
B
increase prazosin and atenolol dose
C
initiate frusemide and potassium supplementation
D
cease prazosin and initiate verapamil
E
cease prazosin and initiate ramipril
END OF PATIENT PROFILE
29
Patient Profile
____________________________________________________________________
Patient Name John Coles
Address 16 Adam Street, Hillcrest
Age 69
Height 173cm
Sex Male
Weight 63kg
Allergies Penicillin
____________________________________________________________________
DIAGNOSIS
Presenting complaint
1. Ischaemic heart disease
2. Gout
Medical History
1. Mild left sided heart failure
2. Hypothyroidism
3. Transient Ischaemic attacks (TIA)
____________________________________________________________________
LAB/DIAGNOSTIC TESTS
Date
Test
Reference Range
____________________________________________________________________
MEDICATION RECORD
Date
Medication & strength
Qty
Sig
20/6
Naproxen 500mg
50
bd prn
20/6
Diltiazem 180mg
30
1 mane
20/6
Aspirin 100mg
90
1 mane
15/5
Thyroxine 200mcg
200
1 mane
20/4
Temazepam 10mg
25
1 nocte
20/4
Frusemide 40mg
100
1 mane
20/4
Colchicine 0.5mg
100
1–
2hrly until pain ceases
16/2
Thyroxine 100mcg
200
1 mane
____________________________________________________________________
PHARMACIST’S NOTES
Date
Comment
20/6
Naproxen to be used until acute attack of gout settles.
30
Q54
Which of Mr Coles’ medications is MOST likely to cause deterioration of his heart
failure?
A
diltiazem
B
thyroxine
C
frusemide
D
aspirin
E
colchicine
Q55
The use of low dose aspirin by Mr Coles
A
will reduce the effectiveness of the frusemide
B
has the same gastrointestinal bleeding risk as placebo
C
may mask the symptoms of hypothyroidism
D
is indicated for TIA despite a possible adverse effect on his gout
E
will reduce the pain associated with an acute attack of gout
31
Q56
Mr Coles has been prescribed naproxen to be used when needed for acute gout.
Which of the following statements is CORRECT?
A
a single daily dose of naproxen would be more effective, so take two tablets at
night when necessary
B
naproxen cannot be taken at the same time as aspirin in the morning, so take
two tablets at night when necessary
C
naproxen should only be taken when necessary for gout pain. Continue the
aspirin regularly
D
cease naproxen
E
aspirin should not be taken, whilst taking naproxen for gout
Q57
Since 15 May, Mr Coles has noticed an increased incidence of chest pain. Which of the
following is the MOST likely cause?
A
the introduction of diltiazem
B
interaction between frusemide and diltiazem
C
excessive use of naproxen for gout
D
interaction between frusemide and naproxen
E
increased dose of thyroxine
Q58
Mr Coles is prescribed cefaclor for a respiratory tract infection. The incidence of cross
sensitivity to cephalosporin in patients with penicillin allergy is
A
1%
B
3%
C
10%
D
15%
E
20%
32
Q59
Mr Coles has previously been prescribed colchicine for acute gout. The MOST likely
reason for ceasing colchicine and commencing naproxen would be
A
colchicine increased the elimination of thyroxine by causing diarrhoea
B
an interaction between colchicine and frusemide, causing the precipitation of
urate crystals in the kidneys
C
colchicine is contraindicated in patients with heart failure due to increased
fluid retention
D
for a patient with heart failure, it is more appropriate to use colchicine at lower
doses for prophylaxis
E
that nausea, vomiting and diarrhoea occurred before appropriate symptom
relief was achieved
END OF PATIENT PROFILE
33
Medical Profile
____________________________________________________________________
Patient Name Marilyn Jones
Address 5 Backus Avenue, WESTBOURNE, TAS 7001
Age 56
Height 168cm
Sex Female
Weight 62kg
Allergies Nil known
____________________________________________________________________
DIAGNOSIS
Presenting complaint
1. Tremor, nausea, vomiting and blurred vision
Medical history
1. Bipolar depression
2. Heart failure
3. Atrial fibrillation
____________________________________________________________________
MEDICATION RECORD
Date
7/10
Medication & Strength
Qty
Sig
Lithium Carbonate 250mg
200
i bd
Digoxin 62.5mcg
100
ii daily
Perindopril 4mg
30
i daily
Spironolactone 25mg
100
i daily
Frusemide 20mg
100
i daily
____________________________________________________________________
PHARMACIST’S NOTES
Date
7/10
Comment
Patient reports recent bout of dehydration and diarrhoea (suffered during her
holiday last week).
34
Q60
Which of the following is the MOST likely cause of Mrs Jones’ presenting symptoms?
A
hypertension
B
gastroenteritis
C
urinary tract infection
D
decreased lithium and digoxin clearance
E
increased lithium clearance and digoxin clearance
Q61
This patient has bipolar disorder. Which of the following may be a suitable medication
to allow for a decrease in lithium dose, while maintaining control of her psychiatric
illness?
A
diazepam
B
risperidone
C
carbamazepine
D
olanzapine
E
chlorpromazine
Q62
Which of the following is CORRECT, with regards to using digoxin in atrial fibrillation
(AF)?
A
it has a high therapeutic index
B
it should not be used as monotherapy
C
it is no longer indicated for the treatment of AF
D
the onset of effect occurs 2 – 3 hours after initial dose
E
is useful in achieving satisfactory resting ventricular rate control in patients
with chronic AF
35
Q63
Mrs Jones is commenced on venlafaxine. Her other medications remain unchanged.
She suffers confusion, hypermania and sweating. Which of the following may explain
Mrs Jones sudden deterioration?
A
significant increase in lithium levels
B
significant decrease in hepatic function
C
decrease in synaptic adrenaline concentration
D
increase in potassium concentrations
Q64
Mrs Jones also complains of an irritating cough. Which of the following options is
MOST likely to address this issue without compromising the management of her
medication?
A
decrease perindopril to 2mg per day
B
replace perindopril with lisinopril 5mg per day
C
replace perindopril with candesartan 8mg per day
D
increase frusemide to 80mg per day
E
add irbesartan at 300mg per day
END OF PATIENT PROFILE
36
Patient Profile
____________________________________________________________________
Patient Name Mr Brian Furter
Address 43 Albion Way BRIGHTON
Age 35
Height 174cm
Sex Male
Weight 78kg
Allergies Nil known
____________________________________________________________________
DIAGNOSIS
Presenting complaint 1. Red, inflamed, itchy rash on lower trunk of body
2. Slightly elevated temperature
____________________________________________________________________
LAB/DIAGNOSTIC TESTS
____________________________________________________________________
MEDICATION RECORD
Date
Medication & Strength
Qty
Sig
____________________________________________________________________
PHARMACIST’S NOTES
Date
Comment
Patient indicated he first noticed the rash 24 hours ago and has just seen the
doctor and received a script for Valaciclovir for shingles.
37
Q65
The recommended dose of valaciclovir for the treatment of herpes zoster is
A
500mg twice daily for 5 days
B
500mg three times a day for 7 days
C
1g daily for 7 days
D
1g three times a day for 5 days
E
1g three times a day for 7 days
Q66
Which of the following statements is CORRECT regarding the effectiveness of the
patient’s treatment?
Treatment must
A
not be commenced until rash clears
B
be commenced within 12 hours of noticing the rash
C
be commenced within 24 hours of noticing the rash
D
be commenced within 72 hours of noticing the rash
E
be commenced within 120 hours of noticing the rash
Q67
Which of the following statements is CORRECT regarding herpes zoster?
A
early treatment reduces the incidence of post-herpetic neuralgia
B
dosage adjustment of guanine analogues is required in hepatic impairment
C
is not contagious after three days from the appearance of a rash
D
herpes zoster is activated from a latent state
E
topical aciclovir must be used as an adjunct to systemic antivirals, for the
treatment of herpes zoster ophthalmicus
38
Q68
The MOST effective topical treatment for the patient’s post herpetic pain is
A
aqueous cream with menthol 3%
B
diclofenac gel 1%
C
paraffin based ointment with menthol 3%
D
betamethasone gel 0.02%
E
capsaicin ointment 0.05%
Q69
Which group of people in the community is MOST likely to contract herpes zoster with
greater severity?
A
pregnant women
B
adults > 65 years of age
C
immuno-suppressed patients
D
children up to the age of 14
E
diabetics
END OF PATIENT PROFILE
39
Patient Profile
____________________________________________________________________
Patient Name Thomas Lipton
Address Room 9, Paediatric Ward
Age 7 years
Height 125cm
Sex Male
Weight 30kg
Allergies Carbamazepine (Agranulocytosis)
____________________________________________________________________
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
40
Q70
Which of the following statements regarding epilepsy in childhood is INCORRECT?
A
epilepsy is one of the commonest chronic neurological conditions of childhood
B
the majority of children with a first unprovoked seizure will have a recurrence
C
antiepileptic medication treatment should not be commenced routinely after
the first unprovoked seizure
D
potential adverse effects of antiepileptic medications are a major determinant
in the choice of medication
E
if seizure free for two or more years, withdrawal of antiepileptic treatment
should be considered
Q71
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
41
Q72
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
Q73
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
Q74
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
42
Q75
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
Q76
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
Q77
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
43
Q78
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
Q79
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
Q80
Alendronate can be taken
A
daily or once weekly
B
with milk to enhance absorption
C
at bedtime to avoid possible drowsiness
D
one hour before or two hours after a meal
E
in the morning with breakfast to avoid stomach upset
44
Q81
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
Q82
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
45
Q83
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
maintain a good fluid intake whilst being treated with norfloxacin
B
take on an empty stomach one hour before or two hours after food
C
avoid taking urinary alkalinisers during treatment with norfloxacin
D
see your doctor as soon as possible in the event of muscle or tendon soreness
or inflammation
E
take medication for three days and stop; recommence if symptoms recur
within 48 hours
Q84
What advice should you give when a woman on a combined oral contraceptive
presents with a prescription for doxycycline for bronchitis? She should be advised that
A
there will be a decreased risk of breakthrough bleeding
B
doxycycline will increase the incidence of thromboembolic disorders and she
should take aspirin 100mg daily
C
doxycycline may affect the efficacy of the ‘pill’ and she should take additional
contraceptive precautions this month
D
the contraceptive pill may affect the efficacy of doxycycline and she should
cease the pill and use barrier contraceptive methods
46
Q85
Which of the following vitamins has antioxidant properties?
A
ascorbic acid
B
ergocalciferol
C
pantothenic acid
D
folic acid
E
cyanocobalamine
Q86
A person presents with a twisted ankle which occurred an hour prior to visiting the
pharmacy. What advice should you give as first-aid treatment?
A
suggest aspirin or another non-steroidal anti-inflammatory medication and
apply a heat pack with the foot elevated
B
apply a cold pack for 15 minutes at a time, elevate the ankle and apply a
compression bandage
C
try some gentle exercise to prevent the joint stiffening up and give ibuprofen
D
massage frequently with methyl salicylate cream, apply heat and take
paracetamol/codeine/doxylamine tablets, elevate the ankle
E
rest with the ankle elevated and apply a cold pack for 5 minutes every 30
minutes, for two hours following the injury
47
Q87
A customer, who is 8 weeks pregnant, comes into the pharmacy for a worm treatment
for her family. Her children are showing signs of infestation. Her son is 6 years of age
and her daughters are 18 months and 4 years of age. Which of the following
treatments should you recommend?
A
pyrantel embonate given to the whole family
B
pyrantel embonate given to the son only
C
mebendazole given to the whole family
D
mebendazole given to the son only
Q88
Which of the following statements regarding oral electrolyte replacement fluids is
CORRECT?
A
the fluids relieve gas-related abdominal discomfort
B
the fluids are first line for the treatment of diarrhoea in children
C
the fluids bond toxins and bacteria and form a protective intestinal lining
D
rice-based preparations reduce stool output in patients with non-cholera
diarrhea, as opposed to glucose-based preparations
E
higher osmolality preparations are more effective than reduced sodium hypoosmola preparations
Q89
In what situation would the use of glucosamine plus chondroitin for osteoarthritis be
considered INAPPROPRIATE?
A
sulfonamide allergy
B
penicillin allergy
C
asthma
D
seafood allergy
E
peanut allergy
48
Q90
All of the following could be used to treat motion sickness EXCEPT
A
promethazine theoclate
B
domperidone
C
dimenhydrinate
D
hyoscine hydrobromide
E
pheniramine
Q91
A customer, who is six months pregnant, is concerned that she has been suffering mild
constipation over the last week. She says that she has not experienced this for a long
time and feels sure that it must be connected to her pregnancy. Which of the
following treatments would be INAPPROPRIATE for her constipation?
A
bulk laxatives
B
moderate exercise
C
stimulant laxative
D
high fibre diet
E
increased fluid intake
Q92
With regard to maldison (malathion) head lice lotion, which of the following
statements is CORRECT?
A
hair must be wet before application
B
allow hair to dry naturally after use
C
the lotion must be rinsed out after 10 minutes
D
the shampoo product is preferred to the lotion
E
it is recommended as safe to use during pregnancy
49
Q93
Which of the following statements is INCORRECT regarding scabies?
A
symptoms include pimple-like irritations in skin folds
B
treatment with permethrin requires 2 applications 1 week apart
C
the itch generally lasts 2–3 weeks and is not a sign of ongoing infection
D
a person remains infectious until 24 hours after treatment is commenced
E
infestation occurs after brief contact with household items or pets
Q94
Which of the following applies to oral typhoid vaccine?
The vaccine
A
can be given concurrently with antibiotics
B
can be given any time before commencing antibiotics
C
can be given immediately after finishing a course of antibiotics
D
should not be given within one week of taking antibiotics
Q95
Which of the following combinations of medications is MOST likely to cause
hypokalaemia?
A
indomethacin/salbutamol
B
insulin/salbutamol
C
insulin/amlodipine
D
amlodipine/indomethacin
E
insulin/propranolol
50
Q96
A number of medications interact with warfarin to cause life-threatening situations.
Which of the following medications is MOST likely to alter the INR?
A
enalapril
B
hydrochlorothiazide
C
sulfamethoxazole-trimethoprim
D
cephalexin
E
propranolol
Q97
Which of the following statements is CORRECT with regard to analgesic nephropathy?
Analgesic nephropathy is
A
characterised by chronic liver failure
B
a chronic kidney disease that can lead to end stage renal failure
C
an acute kidney disease caused by a high doses of analgesics
D
characteristic of heavy aspirin dosage and not seen in association with other
analgesics
E
an easily reversible condition with little associated pathology
Q98
A regular patient in your pharmacy is stabilised on life long warfarin therapy having
had a mitral valve replacement 6 months ago. He has just been found to have high
serum triglyceride and cholesterol levels and has a prescription for nicotinic acid
250mg tds. Which of the following statements is CORRECT?
A
the recommended dosage of nicotinic acid is 750mg once daily
B
nicotinic acid is contraindicated in patients with mitral valve replacements
C
fenofibrate is first line treatment for this patient
D
nicotinic acid can increase the anticoagulant response to warfarin in some
patients, so close monitoring is required
E
nicotinic acid does not interact with warfarin and is not contraindicated in this
patient
51
Q99
The dosage of aciclovir should be adjusted on the basis of
A
pre-existing hepatic impairment
B
pre-existing renal impairment
C
time since onset of symptoms
D
occurrence of side effects
Q100
A 74 year old male patient has been on digoxin for heart failure for several years. His
recently measured digoxin plasma level was within the normal range. He presents you
with a prescription for phenytoin 200 mg bd, which is a new addition to his regular
therapy. Which of the following is CORRECT?
A
phenytoin may induce the hepatic metabolism of digoxin
B
phenytoin may decrease the hepatic metabolism of digoxin
C
digoxin may decrease the hepatic metabolism of phenytoin
D
digoxin may increase the unbound concentration of phenytoin in the blood
E
phenytoin is unlikely to interact with digoxin, since digoxin is cleared largely by
renal excretion
52
Q101
Which of the following is NOT an adverse effect associated with long term
corticosteroid use?
A
weight gain
B
increased susceptibility to infection
C
rounding of the face
D
osteoporosis
E
hyperkalaemia
Q102
Which of the following tests should be carried out regularly for patients taking
amiodarone?
A
serum cholesterol and triglycerides
B
ocular examination and thyroid function test
C
thyroid function test and blood glucose
D
thyroid function test and blood urea nitrogen
Q103
Which of the following BEST monitors the anticoagulant effect of heparin?
A
the level of AST in serum
B
international normalised ratio (INR)
C
a complete blood examination
D
the level of albumin in serum
E
activated partial thromboplastin time (APTT)
53
Q104
Which of the following combinations may cause a clinically significant medication
interaction?
A
phenytoin, atenolol, hydrochlorothiazide, ranitidine
B
lithium, fosinopril, frusemide, thyroxine
C
amiodarone, ranitidine, pravastatin, metformin
D
metoprolol, ramipril, frusemide, clopidogrel
Q105
Which of the following biochemical abnormalities can predispose patients to lithium
toxicity?
A
hypernatraemia
B
hyponatraemia
C
hypokalaemia
D
hypermagnesaemia
E
hypoalbuminaemia
54
Q106
A middle aged businessman, Mr Burrows, who is a fairly regular customer in the
pharmacy, drops in a prescription one morning for the following item:
Methotrexate 2.5mg 50 3 tablets weekly
The prescription is written by his Rheumatology specialist, Dr Payne.
Mr Burrows is late for a meeting and tells you he will be back later.
Your computer history indicates that this is a new medication for him. The last
medication that you dispensed for him was for Naproxen 500mg tds 50 two weeks ago
on a prescription written by Dr Burrell, his GP.
Later on that day, Mr Burrows sends his secretary, Julie, to pick up the prescription as
he is in meetings all day and cannot be disturbed. Julie also has instructions to buy
some folic acid 5mg tablets.
Write a letter to Mr Burrows relaying any important information you may have
regarding his new medication, including any necessary counselling points.
End of Examination
55