APC Intern Written Examination Practice Paper v1.2013

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: http://pharmacycouncil.org.au/content/index.php?id=9 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 B C D E 480 mg 2400 mg 1200 mg 600 mg 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 B C D E 2.8 minutes 28 minutes 56 minutes 18 minutes 1.8 minutes
Australian Pharmacy Council Ltd, 2013
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 B C D E 10mL/min 30mL/min 45mL/min 60mL/min 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 B C D E
1.6 2.6 3.9 1.9 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 B C D E 20 24 28 30 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 B C D E Schedule 2 Schedule 3 Schedule 4 Schedule 7 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 B C D E Schedule 2 Schedule 3 Schedule 4 Schedule 5 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 B C D E doctor has endorsed the prescription Reg 19 doctor has endorsed the prescription Reg 24 item is listed as an unrestricted benefit patient is the holder of a health care card patient has a safety net entitlement
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 B C D E Schedule 2 Schedule 3 Schedule 4 Schedule 5 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
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 B C D E Schedule 2 Schedule 3 Schedule 4 Schedule 5 Schedule 8
Q17 Chicken pox vaccine should be completed at A B C D 3 months 6 months 18 months 5 years
Q18 Which of the following conditions would prevent the use of an angiotensinconverting enzyme inhibitor? A B C D E bilateral renal artery stenosis non-insulin dependent diabetes mellitus Mnires disease hyperlipidaemia lupus erythematous 9
Q19 Which of the following statements is CORRECT regarding paracetamol? Paracetamol
A B C D E
has significant anti-inflammatory activity induces inhibits cyclo-oxygenase is excreted largely unchanged by the kidneys can be given by intravenous infusion is contraindicated in pregnancy
Q20 Which of the following statements about doxycycline is INCORRECT? Doxycycline A B C D E can be used in the treatment of rosacea may decrease blood methotrexate concentration may be taken by children over 8 years of age should be taken in the morning rather than at night 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 10
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 B C D E one three four six 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 B C D E one day two days ten to fourteen days four to six weeks one to two months
Q24 Itching is NOT a symptom of
A B C D E
allergic dermatitis scabies fungal infection acne vulgaris lichen planus 11
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 daughters 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 B C D
pneumonia bronchitis croup 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 B C D E
ibuprofen tramadol codeine paracetamol dextropropoxyphene
12
Patient Profile
____________________________________________________________________________________
Patient Name Dick Cross Address 49 Caffers Place, SUBIACO WA 6051 Age 62 Sex Male Allergies Nil known DIAGNOSIS
Height 170cm Weight 85kg
____________________________________________________________________________________
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) (<5 mmol/L)
____________________________________________________________________________________
MEDICATION RECORD
Date 1/3 16/1 16/1 Medication & Strength Atorvastatin 20 mg Docusate 50 mg with Senna 8 mg Aspirin 100 mg Qty 30 90 28 Sig i daily prn i daily
____________________________________________________________________________________
PHARMACISTS NOTES
Date 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
20/7
13
Q27 The MOST appropriate option for the management of the patients hyperuricaemia is A B C D E allopurinol started at a dose of 100 mg daily allopurinol started at a dose of 300 mg daily probenecid started at a dose of 500 mg twice a day no treatment be initiated colchicine 0.5 mg twice daily
Q28 Which of the following would be an additional risk factor for cardiovascular disease in this patient?
A B C D E
low homocysteine level an elevated serum albumin hypertension postural hypotension waist measurement 75 85 cm
Q29 Which of the following medications would be the MOST appropriate to manage Mr Cross diabetes?
A B C D E
metformin acarbose insulin glibenclamide rosiglitazone
14
Q30 Which of the following tests is the BEST indicator of ongoing blood glucose control?
A B C D E
random blood glucose levels three monthly HbA1c levels weekly fasting blood glucose levels regular serum creatine measurements weekly urine testing
Q31 Which of the following primary health initiatives should you strongly recommend to Mr Cross?
A B C D E
annual ocular examinations annual bone density measurement faecal occult blood test every 3 months prostate specific antigen test every 5 years creatine kinase levels every 3 months
END OF PATIENT PROFILE
15
Patient Profile
____________________________________________________________________________________
Patient Name : Jack Smithers Address : Room 22, Garren Aged Care Facility Age : 95 years Sex : Male Allergies pencillin allergy (rash)
Height : 180 cm Weight : 73 kg
____________________________________________________________________________________
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 3/2 Blood pressure 140/80 MEDICATION RECORD Date Medication & Strength
Reference Range
____________________________________________________________________________________
Qty
Sig
3/2 Buprenorphine 10 mcg/hour patch 2 Apply once weekly 3/2 Paracetamol 500 mg 100 2 qid 3/2 Docusate/senna 50 mg/8 mg 90 2 nocte 3/2 Tamsulosin SR 400 mcg 30 1 daily 3/2 Rabeprazole 20 mg 30 1 mane 3/2 Citalopram 20 mg 30 1 mane 3/2 Goserelin acetate 10.8 mg SC 1 Implant every 12 weeks 3/2 Aspirin 100 mg 112 1 mane 24/1 Metoclopramide 10 mg 25 1 tds prn 22/1 Cephalexin 500 mg 20 1 tds course completed 10/1 Roxithromycin 300 mg 5 1 daily course completed 10/1 Oxycodone 5 mg tablets 20 1 qid prn 12/12 Meloxicam 15 mg 30 1 daily - ceased ____________________________________________________________________________________
PHARMACISTS NOTES
Date 3/2 24/1 Comment Visual and hearing impairment. Recent falls and wheelchair bound. Nursing staff have advised of decreased cognition in patient. GP noted no prior problems with cephalexin - cause of nausea unknown.
16
Q32 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 B C D E
paracetamol citalopram aspirin oxycodone rabeprazole
Q33 Due to the patients swallowing difficulties, changes to his medications are necessary to alleviate this problem. Which of the following recommendations is NOT appropriate?
A B C D E
oxycodone immediate release tablets, liquid, suppositories or injections can be used roxithromycin tablets should not be crushed, but the dispersible tablets can be used docusate and senna tablets may be crushed, or other options include suppositories or lactulose tamsulosin tablets may be crushed, or the tablets opened and dispersed in water dispersible proton-pump inhibitors should be used and include omeprazole, pantoprazole or lansoprazole
17
Q34 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 patients current medication regimen?
A B C D E
increased oxycodone dose supplementary paracetamol higher strength buprenorphine patch replace paracetamol with combination paracetamol/codeine replace oxycodone tablets with suppositories
Q35 Mr Smithers required metoclopramide for the treatment of nausea. Which of the following statements regarding metoclopramide is INCORRECT?
A B C D E
tablets may be crushed drowsiness is a common side effect oral adult dose for nausea is 0.5 mg/kg every 4-6 hours reduce dose in the elderly to reduce risk of extrapyramidal effects avoid long term use in depressed patients, as mental state may worsen
18
Patient Profile
____________________________________________________________________________________
Patient Name Address Age
Beryl Groper 64 Highfield Drive, Thornlie 148cm Weight 55kg

Height
49 Sex Female Allergies Nil known DIAGNOSIS Presenting complaint
____________________________________________________________________________________
1. Obstructive airways disease with shortness of breath Medical history 1. Congestive cardiac disease 2. Glaucoma
____________________________________________________________________________________
Date 16/10 Test Reference Range Temp 37.8C; Pulse 65bpm; BP 120/65mm Hg ____________________________________________________________________________________ Medication & strength
Fluticasone 250mcg and Salmeterol 25mcg Salbutamol nebules 5mg/2.5mL Tiotropium 18mg capsules Prednisolone 5mg Betaxolol eye drops 0.25% Enalapril 10mg Frusemide 40mg Docusate sodium (50mg)and senna (8mg)
MEDICATION RECORD
Date
2/10 30/9 30/9 30/9 15/9 8/8 6/7 6/7
Qty
120 60 30 60 5ml 30 100 90
Sig
ii puffs bd 5mg 4-hourly inhale i daily 40mg mane ii drops bd i daily i mane ii nocte
____________________________________________________________________________________
PHARMACISTS NOTES Nil
19
Q36 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 B C D E advise her to use the tiotropium capsule at night before bed advise her to use the fluticasone/ salmeterol inhaler immediately before using the salbutamol nebules, to increase activity of the salbutamol supply her with a pholcodine elixir, to be taken before bed contact her doctor to discuss the patients use of enalapril supply promethazine tablets, to be taken three times a day with the last dose before bed
Q37 Beryl arrives to collect her regular supply of medication and is complaining of swollen ankles, so severe that she cant fit into her shoes. The MOST appropriate action would be for you to A B C D E advise her doctor and suggest Beryls 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
20
Q38 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
Q39 To improve Beryls asthma the doctor could A B C D E change the eye drops change the enalapril increase the frusemide change the tiotropium to an inhaler reduce and cease the prednisolone
Q40 You should ensure that Beryls prednisolone dose is reduced slowly because A B C D E stopping quickly may induce an asthma attack inhaled steroids need to be increased slowly the adrenal glands may be suppressed electrolytes need to return to normal slowly the possibility of rebound wheezing
21
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 Medical History
1. Diarrhoea 1. Osteoarthritis 2. Hypertension 3. Cardiac Failure
____________________________________________________________________________________
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 ____________________________________________________________________________________
PHARMACISTS NOTES
Date 7/4 Comment 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.
22
Q41 The MOST likely cause of the results of the laboratory tests that have been provided for this patient is
A B C D E
liver failure acute renal failure respiratory distress hyperkalaemia worsening cardiac failure
Q42 Which of the following medications is MOST likely to cause gynecomastia in Mr Frost?
A B C D E
lisinopril celecoxib frusemide glucosamine spironolactone
Q43 Mr Frost is on spironolactone for his cardiac failure. What is the usual recommended dose of this medication in patients with cardiac failure?
A B C D E
400 mg daily 100 mg daily 25 mg twice a day 25 mg once a week 25 mg once a day
23
Q44 Which of the following combinations of medications is MOST LIKELY to cause acute renal failure in this patient?
A B C D E
spironolactone, frusemide, paracetamol frusemide, lisinopril, celecoxib paracetamol, frusemide, lisinopril celecoxib, lisinopril, glucosamine lisinopril, spironolactone, glucosamine
Q45 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 B C D E
stimulates the production of prostacyclin (PGI2) inhibits the production of prostacyclin (PGI2) stimulates the production of thromboxane (A2) inhibits the production of thromboxane (A2) inhibits both prostacyclin (PGI2) and thromboxane (A2)
24
Patient Profile
____________________________________________________________________________________
Patient Name Ms Cecily Weary Address 17 Filamore Street, Portland, SA Age 19 Sex Female Allergies Nil known
____________________________________________________________________________________
DIAGNOSIS Presenting complaint 1. Emergency contraceptive advice
____________________________________________________________________________________
MEDICATION RECORD
Date Medication & Strength Qty Sig
_____________________________________________________________________ PHARMACISTS 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.
25
Q46 Ms Wearys doctor has recommended oral levonorgestrel. Which of the following statements is CORRECT regarding this method of emergency contraception?
A B C D E
oral levonorgestrel must be taken within the first 72 hours after unprotected intercourse to have a contraceptive effect levonorgestrel has more severe side effects when taken as emergency contraception compared to its use as regular contraception levonorgestrel with ethinyloestradiol (2 doses of four tablets, 12 hours apart) is considered to be as effective as the oral levonorgestrel regimen oral levonorgestrel emergency contraception has been shown to increase the risk of ectopic pregnancy oral levonorgestrel does not induce a withdrawal bleed, although irregular bleeding may occur occasionally
Q47 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 B C D E
milk supply will significantly decrease the child should not be breast-fed for at least 24 hours emergency contraception is safe to take during breast-feeding emergency contraception should not be taken if breast-feeding emergency contraception dose should be split over twelve hours to minimise excretion into breast milk
26
Q48 Which of the following should you recommend to Ms Weary, regarding the MOST effective time to take hormonal emergency contraception?
A B C D E
immediately immediately after the next breastfeed within 12 hours of unprotected sex 72 hours after unprotected sex with the evening meal to increase absorption
27
Patient Profile
____________________________________________________________________________________
Patient Name Kay Sutton Address 66 Argyle St Hackett Age 23 Sex Female Allergies Metoclopramide DIAGNOSIS
Height 171 cm Weight 58 kg
____________________________________________________________________________________
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 Medication & Strength

12/1 12/1 12/1 12/1 12/1 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
____________________________________________________________________________________
28
Q49 Ms Sutton presents to your pharmacy with a script for cephalexin. Which of the following is the MOST appropriate advice?
A B C D E
cease taking the oral contraceptive pill when taking this antibiotic avoid alcohol while taking this antibiotic start taking acidophilus to prevent vaginal thrush start taking cranberry juice to treat the urinary tract infection use barrier contraceptive measures while taking this antibiotic
Q50 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 B C D E
the increase in urinary pH will decrease the renal clearance of lithium the renal clearance of lithium will increase with the use of sodium citrotartrate the antibacterial activity of cephalexin will be increased with the use of sodium citrotartrate the tubular reabsorption of lithium will increase with the use of sodium citrotartrate lithium and sodium citrotartrate granules can be safely used in combination
29
Q51 Regarding the Ms Suttons insulin, which of the following statements is INCORRECT?
A B C D E
insulin lispro should be administered 30 minutes after each meal the vial in use can be stored at room temperature for 28 days insulin lispro is injected subcutaneously insulin glargine is referred to as a basal release insulin insulin glargine should not be mixed with insulin lispro before each injection
Q52 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 B C D E
it must be accompanied by topical antifungal therapy it must be taken on three consecutive days it is contraindicated in diabetes it is not recommended for use by pregnant woman the course should be repeated in seven days
30
Q53 Ms Suttons 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 B C D E should be taken one hour before food could be changed to a sustained release preparation dose should be increased by 50% dose should be decreased by 50% should be replaced with olanzapine
31
Patient Profile
____________________________________________________________________________________
Patient Name Peter Barnard Address Room 19, Garran Ward Age 9 Sex Male Allergies Nil Known DIAGNOSIS
____________________________________________________________________________________
Presenting complaint 1. Urinary tract infection Medical history 1. Chronic renal failure 2. Streptococcal glomerulonephritis
____________________________________________________________________________________
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 ____________________________________________________________________________________
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 ____________________________________________________________________________________
PHARMACISTS 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 renal transplant. Patient has gum hypertrophy.
32
Q54 The patient has chronic kidney disease. Which of the following statements regarding this condition is INCORRECT?
A B C D E
protein starts to pass into the urine anaemia is a complication that must be treated or prevented hypercalcaemia occurs due to deficient vitamin D production toxins such as urea and creatinine build up and cause problems risk factors include diabetes mellitus, hypertension and increasing age
Q55 Which of the following medications is MOST likely to be the cause of the patients gum hypertrophy? A B C D E calcitriol enalapril ferrous sulphate nifedipine hydralazine
Q56 The patient is experiencing hyperkalaemia. Which of the following statements is CORRECT regarding the patients condition? A B C D E the patients potassium levels indicate severe hyperkalaemia the patients current medications are not likely to be a contributi ng factor oral frusemide can be given to promote potassium excretion muscle weakness, cardiac arrhythmia and myalgia are common symptoms the use of NSAIDs should be avoided in this patient
33
Q57 Which of the following IV antibiotics is the MOST suitable treatment against Pseudomonas aeruginosa for this patient? A B C D E amoxycillin vancomycin ceftriaxone ciprofloxacin gentamicin
Q58 The patient has hyperphosphataemia. Which medication dosage could be increased to reduce his phosphate level? A B C D E calcium carbonate calcitriol sodium bicarbonate darbepoetin enalapril
34
Patient Profile
____________________________________________________________________________________
Patient Name Janine Smitters Address 2B Nursing Home Age72 Sex Female Allergies Nil Known DIAGNOSIS
____________________________________________________________________________________
Presenting complaint 1. Fractured neck of femur
Medical history
1. Rheumatoid arthritis 2. Hypertension
____________________________________________________________________________________
Reference Range
____________________________________________________________________________________
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 tds 5/9 Atenolol 50mg 30 i mane 5/9 Perindopril 4 mg 30 i daily ____________________________________________________________________________________
PHARMACISTS NOTES Date Comment

2/11 Patient admitted to acute care hospital after a fall. Patient has been taking diclofenac for 2 years.
35
Q59 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 B C D E stop the oxazepam immediately change to temazepam and reduce the dose over a few weeks reduce the oxazepam dose by 15mg a day for 4 days before ceasing change to an equivalent dose of diazepam and gradually reduce the dose over 3 weeks reduce the dose of the oxazepam to one tablet on alternative nights, over a 4-6 week period
Q60 Following Mrs Smitters fall, osteoporosis is suspected. Before initiating alendronate, all of the following investigations should be undertaken EXCEPT
A B C D E
bone mineral density vitamin D and calcium levels hepatic function renal function full dental assessment
Q61 Which of the following medications is LEAST likely to have contributed to Mrs Smitters fall and subsequent fractured femur? A B C D E prazosin atenolol diclofenac perindopril paracetamol/codeine
36
Q62 At a follow-up appointment, Mrs Smitters hypertension is found to have worsened. The MOST appropriate management would be to
A B C D E
increase the prazosin dose increase prazosin and atenolol dose initiate frusemide and potassium supplementation cease prazosin and initiate verapamil cease perindopril and initiate irbesarten
37
Patient Profile
____________________________________________________________________________________
John Coles Address 16 Adam Street, Hillcrest Age 69 Sex Male Allergies Penicillin
Patient Name
173cm Weight 63kg

Height
____________________________________________________________________________________
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 MEDICATION RECORD

Date 20/6 20/6 20/6 15/5 20/4 20/4 20/4 Medication & strength Naproxen 500mg Diltiazem 180mg Aspirin 100mg Thyroxine 200mcg Temazepam 10mg Frusemide 40mg Colchicine 0.5mg Qty 50 30 90 200 25 100 100
Reference Range
Sig bd prn 1 mane 1 mane 1 mane 1 nocte 1 mane 1
____________________________________________________________________________________
2hrly until pain ceases
16/2 Thyroxine 100mcg 200 1 mane ____________________________________________________________________________________
PHARMACISTS NOTES
Date 20/6 Comment Naproxen to be used until acute attack of gout settles.
38
Q63 Which of Mr Coles medications is MOST likely to cause deterioration of his heart failure?
A B C D E
diltiazem thyroxine frusemide aspirin colchicine
Q64 The use of low dose aspirin by Mr Coles A B C D E will reduce the effectiveness of the frusemide has the same gastrointestinal bleeding risk as placebo may mask the symptoms of hypothyroidism is indicated for TIA despite a possible adverse effect on his gout
will be sufficient to reverse an acute attack of gout
Q65 Mr Coles has been prescribed naproxen to be used when needed for acute gout. Which of the following statements is CORRECT? A B C D E a single daily dose of naproxen would be more effective, so take two tablets at night when necessary naproxen cannot be taken at the same time as aspirin in the morning, so take two tablets at night when necessary naproxen should only be taken when necessary for gout pain. Continue the aspirin regularly cease naproxen aspirin should not be taken, whilst taking naproxen for gout
39
Q66 Since 15 May, Mr Coles has noticed an increased incidence of chest pain. Which of the following is the MOST likely cause?
A B C D E
the introduction of diltiazem interaction between frusemide and diltiazem excessive use of naproxen for gout interaction between frusemide and naproxen increased dose of thyroxine
Q67 Mr Coles is prescribed cefaclor for a respiratory tract infection. The incidence of cross sensitivity to cephalosporin in patients with penicillin allergy is A B C D E 1% 3% 10% 15% 20%
40
Q68 Mr Coles has previously been prescribed colchicine for acute gout. The MOST likely reason for ceasing colchicine and commencing naproxen would be A B C D E colchicine increased the elimination of thyroxine by causing diarrhoea an interaction between colchicine and frusemide, causing the precipitation of urate crystals in the kidneys colchicine is contraindicated in patients with heart failure due to increased fluid retention for a patient with heart failure, it is more appropriate to use colchicine at lower doses for prophylaxis that nausea, vomiting and diarrhoea occurred before appropriate symptom relief was achieved
41
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 Medical history 1. Tremor, nausea, vomiting and blurred vision 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 ____________________________________________________________________________________
PHARMACISTS NOTES
Date 7/10 Comment Patient reports recent bout of dehydration and diarrhoea (suffered during her holiday last week).
42
Q69 Which of the following is the MOST likely cause of Mrs Jones presenting symptoms?
A B C D E
hypertension gastroenteritis urinary tract infection decreased lithium and digoxin clearance increased lithium clearance and digoxin clearance
Q70 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 B C D E Q71
diazepam oxazepam carbamazepine phenelzine chlorpromazine
Which of the following is CORRECT, with regards to using digoxin in atrial fibrillation (AF)? A B C D E it has a high therapeutic index it should not be used as monotherapy it is no longer indicated for the treatment of AF the onset of effect occurs 2 3 hours after initial dose is useful in achieving satisfactory resting ventricular rate control in patients with chronic AF
43
Q72 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 B C D E 'significant decrease in synaptic lithium concentration significant decrease in hepatic function decrease in synaptic adrenaline concentration increase in potassium concentrations 'precipitation of serotonin syndrome
Q73 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 B C D E decrease perindopril to 2mg per day replace perindopril with lisinopril 5mg per day replace perindopril with candesartan 8mg per day increase frusemide to 80mg per day add irbesartan at 300mg per day
44
Patient Profile
____________________________________________________________________________________
Patient Name Mr Brian Furter Address 43 Albion Way BRIGHTON Age 35 Sex Male Allergies Nil known DIAGNOSIS
____________________________________________________________________________________
Presenting complaint 1. Red, inflamed, itchy rash on lower trunk of body 2. Slightly elevated temperature
____________________________________________________________________________________
___________________________________________________________________________
MEDICATION RECORD Date Medication & Strength PHARMACISTS NOTES Date Comment
Qty
Sig
____________________________________________________________________________________
Patient indicated he first noticed the rash 24 hours ago and has just seen the doctor and received a script for Valaciclovir for shingles.
45
Q74 The recommended dose of valaciclovir for the treatment of herpes zoster is
A B C D E
500mg twice daily for 5 days 500mg three times a day for 7 days 1g daily for 7 days 1g three times a day for 5 days 1g three times a day for 7 days
Q75 Which of the following statements is CORRECT regarding the effectiveness of the patients treatment? Treatment must
A B C D E
not be commenced until rash clears be commenced within 12 hours of noticing the rash be commenced within 24 hours of noticing the rash be commenced within 72 hours of noticing the rash be commenced within 120 hours of noticing the rash
46
Q76 Which of the following statements is CORRECT regarding herpes zoster?
A B C D E
early treatment reduces the incidence of post-herpetic neuralgia dosage adjustment of guanine analogues is required in hepatic impairment is not contagious after three days from the appearance of a rash herpes zoster is activated from a latent state topical aciclovir must be used as an adjunct to systemic antivirals, for the treatment of herpes zoster ophthalmicus
Q77 The MOST effective topical treatment for the patients post herpetic pain is
A B C D E
aqueous cream with menthol 3% diclofenac gel 1% paraffin based ointment with menthol 3% betamethasone gel 0.02% capsaicin ointment 0.05%
Q78 Which group of people in the community is MOST likely to contract herpes zoster with greater severity?
A B C D E
pregnant women adults > 65 years of age immuno-suppressed patients children up to the age of 14 diabetics
47
Patient Profile
____________________________________________________________________________________
Patient Name Thomas Lipton Address Room 9, Paediatric Ward Age 7 years Sex Male 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 MEDICATION RECORD Date Medication & Strength
Reference Range
____________________________________________________________________________________
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 ____________________________________________________________________________________
48
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 B C D E
intranasal midazolam rectal diazepam rectal paraldehyde oral sodium valproate buccal midazolam
49
Q81 The doctors are concerned about whether the doses of anticonvulsants are appropriate and enquire as to whether measuring blood levels of the patients anticonvulsants would be useful. For which of the following anticonvulsants are plasma levels of MOST value in clinical practice?
A B C D E
diazepam lamotrigine sodium valproate phenytoin vigabatrin
Q82 Which of the following anticonvulsants is MOST likely to be associated with visual field effects? A B C D E diazepam lamotrigine sodium valproate phenytoin vigabatrin
50
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 B C D E sodium valproate lamotrigine phenytoin tiagabine phenobarbitone
51
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 B C D epilepsy medications should be ceased during pregnancy epilepsy medications are safe to use during pregnancy the dosage of current medications should be reduced to minimum levels 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 B C D E one week before conception and the 1st month of pregnancy one month before conception and the 1st month of pregnancy three months before conception and the 1st three months of pregnancy one month before conception and the 1st three months of pregnancy one month before conception and the entire duration of pregnancy
Q86 Which of the following is NOT a risk factor for cardiovascular disease?
A B C D E
thyroid dysfunction increased HDL increased LDL hypertension diabetes
52
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 B C D E
at lunchtime at bedtime on an empty stomach in the morning with or after breakfast anytime of the day without respect to food
Q88 Which of the following would be INAPPROPRIATE advice on caring for a pruritic rash? A B C D E keep the area cool wash area with soapy water, prior to applying cream only use cotton clothing to cover the area avoid shampoos on the area avoid hot water
Q89 Alendronate can be taken
A B C D E
daily or once weekly with milk to enhance absorption at bedtime to avoid possible drowsiness half an hour before food or one hour after a meal in the morning with breakfast to avoid stomach upset
53
Q90 With which of the following medications is it MOST important to maintain a high fluid intake?
A B C D E
spironolactone ciprofloxacin indapamide cephalexin frusemide
Q91 Which of the following medications is MOST appropriate for the prevention of nausea and vomiting in Parkinsons disease?
A B C D E
ondansetron domperidone metoclopramide prochlorperazine hyoscine
54
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 whilst being treated with norfloxacin take on an empty stomach one hour before or two hours after food avoid taking urinary alkalinisers during treatment with norfloxacin see your doctor as soon as possible in the event of muscle or tendon soreness or inflammation take medication for three days and stop; recommence if symptoms recur within 48 hours
Q93 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 B C D there will be a decreased risk of breakthrough bleeding doxycycline will increase the incidence of thromboembolic disorders and she should take aspirin 100mg daily doxycycline may affect the efficacy of the pill and she should take additional contraceptive precautions this month the contraceptive pill may affect the efficacy of doxycycline and she should cease the pill and use barrier contraceptive methods
55
Q94 Which of the following vitamins has antioxidant properties?
A B C D E
ascorbic acid ergocalciferol pantothenic acid folic acid cyanocobalamine
Q95 A customer comes into your pharmacy complaining of a headache. You elicit other symptoms nausea, stiff neck, sensitivity to light and fever. Which of the following is MOST consistent with this patients symptoms? A B C D E tension headache cluster headache meningitis migraine sinusitis
56
Q96 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 B C D E suggest aspirin or another non-steroidal anti-inflammatory medication and apply a heat pack with the foot elevated apply a cold pack for 15 minutes at a time, elevate the ankle and apply a compression bandage try some gentle exercise to prevent the joint stiffening up and give ibuprofen massage frequently with methyl salicylate cream, apply heat and take paracetamol/codeine/doxylamine tablets, elevate the ankle rest with the ankle elevated and apply a cold pack for 5 minutes every 30 minutes, for two hours following the injury
Q97 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 B C D
pyrantel embonate given to the whole family pyrantel embonate given to the son only mebendazole given to the whole family mebendazole given to the son only
57
Q98 Which of the following statements regarding oral electrolyte replacement fluids is CORRECT?
A B C D E
the fluids relieve gas-related abdominal discomfort the fluids are first line for the treatment of diarrhoea in children the fluids bond toxins and bacteria and form a protective intestinal lining rice-based preparations reduce stool output in patients with non-cholera diarrhea, as opposed to glucose-based preparations higher osmolality preparations are more effective than reduced sodium hypo- osmola preparations
Q99 In what situation would the use of glucosamine plus chondroitin for osteoarthritis be considered INAPPROPRIATE?
A B C D E
sulfonamide allergy penicillin allergy asthma seafood allergy peanut allergy
Q100 All of the following could be used to treat motion sickness EXCEPT
A B C D E
promethazine theoclate domperidone dimenhydrinate hyoscine hydrobromide pheniramine
58
Q101 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 B C D E bulk laxatives moderate exercise stimulant laxative high fibre diet increased fluid intake
Q102 With regard to maldison (malathion) head lice lotion, which of the following statements is CORRECT? A B C D E hair must be wet before application allow hair to dry naturally after use the lotion must be rinsed out after 10 minutes the shampoo product is preferred to the lotion it is recommended as safe to use during pregnancy
59
Q103 In treating methotrexate overdose, what is the agent of choice? A B C D E sodium bicarbonate acetylcysteine filgrastim folinic acid folic acid
Q104 A customer asks for your advice when purchasing a laxative for her husband who is taking morphine for cancer pain. Which of the following would be the LEAST appropriate? A B C D E docusate sodium 50 mg, total sennosides 8 mg bisacodyl docusate sodium 50 mg ispaghula husk in an effervescent base glycerin suppositories
Q105 What advice should you give to a customer requesting a decongestant nasal spray for a stuffy nose, due to a head cold? A B C D E use twice a day until nose is clear use once daily for 5 days do not use continuously for more than five days use three times a day for a minimum of one week until clear use on alternate days only until nose is clear
60
Q106 Which of the following statements is INCORRECT regarding scabies?
A B C D E
symptoms include pimple-like irritations in skin folds treatment with permethrin requires 2 applications 1 week apart the itch generally lasts 23 weeks and is not a sign of ongoing infection a person remains infectious until 24 hours after treatment is commenced infestation occurs after brief contact with household items or pets
Q107 Which of the following is NOT a risk factor for Chronic Obstructive Pulmonary Disease?
A B C D E
genetics smoking occupational pollutants (smoke, fumes) obesity alpha-1 antitrypsin (enzyme) deficiency
Q108 The local doctor phones your pharmacy for advice on treatment for his patient, who works as a fireman and is suffering from his annual bout of seasonal allergic rhinitis. The patient is 6 weeks into a 3 month course of ketoconazole. Which of the following treatments should you recommend as the MOST appropriate, to manage his acute symptoms? A B C D pseudoephedrine 60mg three times daily promethazine 25 mg twice daily fexofenadine 60 mg twice daily prednisolone 5mg daily for 10 days
61
Q109 All of the following medications have been used for the treatment of attention deficit hyperactivity disorder (ADHD) EXCEPT A B C D E methylphenidate clonidine imipramine sertraline dexamphetamine
Q110 Which of the following statements regarding psoriasis is INCORRECT?
A B C D E
treatment with dithranol is more feasible when plaques are large coal tar is photosensitising and may be irritating to the face, genitals and skin folds calcipotriol is useful in the treatment of resistant plaque psoriasis, as tolerance does not occur salicylic acid assists in the removal accumulated scale to allow topical agents to penetrate lesions topical corticosteroids have a slower onset of action than other topical treatments, but prolong the period between relapses
Q111 Which of the following applies to oral typhoid vaccine? The vaccine
A B C D
can be given concurrently with antibiotics can be given any time before commencing antibiotics can be given immediately after finishing a course of antibiotics should not be given within one week of taking antibiotics
62
Q112 Which of the following combinations of medications is MOST likely to cause hypokalaemia? A B C D E indomethacin/salbutamol insulin/salbutamol insulin/amlodipine amlodipine/indomethacin insulin/propranolol
Q113 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 B C D E enalapril hydrochlorothiazide sulfamethoxazole-trimethoprim cephalexin propranolol
Q114 Which of the following statements is CORRECT with regard to analgesic nephropathy? Analgesic nephropathy is A B C D E characterised by chronic liver failure a chronic kidney disease that can lead to end stage renal failure an acute kidney disease caused by a high doses of analgesics characteristic of heavy aspirin dosage and not seen in association with other analgesics an easily reversible condition with little associated pathology 63
Q115 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 B C D E the recommended dosage of nicotinic acid is 750mg once daily nicotinic acid is contraindicated in patients with mitral valve replacements fenofibrate is first line treatment for this patient nicotinic acid can increase the anticoagulant response to warfarin in some patients, so close monitoring is required nicotinic acid does not interact with warfarin and is not contraindicated in this patient
Q116 The dosage of aciclovir should be adjusted on the basis of
A B C D
pre-existing hepatic impairment pre-existing renal impairment time since onset of symptoms occurrence of side effects
Q117 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 B C D E phenytoin may induce the hepatic metabolism of digoxin phenytoin may decrease the hepatic metabolism of digoxin digoxin may decrease the hepatic metabolism of phenytoin digoxin may increase the unbound concentration of phenytoin in the blood phenytoin is unlikely to interact with digoxin, since digoxin is cleared largely by renal excretion
64
Q118 Which of the following is NOT an adverse effect associated with long term corticosteroid use?
A B C D E
weight gain increased susceptibility to infection rounding of the face osteoporosis hyperkalaemia
Q119 Which of the following tests should be carried out regularly for patients taking amiodarone? A B C D serum cholesterol and triglycerides ocular examination and thyroid function test thyroid function test and blood glucose thyroid function test and blood urea nitrogen
Q120 Which of the following BEST monitors the anticoagulant effect of heparin? A B C D E the level of AST in serum international normalised ratio (INR) a complete blood examination the level of albumin in serum activated partial thromboplastin time (APTT)
65
Q121 Which of the following combinations may cause a clinically significant medication interaction?
A B C D
phenytoin, atenolol, hydrochlorothiazide, ranitidine lithium, fosinopril, frusemide, thyroxine amiodarone, ranitidine, pravastatin, metformin metoprolol, ramipril, frusemide, clopidogrel
Q122 Which of the following biochemical abnormalities can predispose patients to lithium toxicity? A B C D E hypernatraemia hyponatraemia hypokalaemia hypermagnesaemia hypoalbuminaemia
Q123 Which of the following medications would NOT be used in the management of atrial fibrillation?
A B C D E
warfarin verapamil digoxin amiodarone perhexiline (use ivabradine for CAOP)
66
Q124 Which ONE of the medication combinations could NOT account for symptoms of muscle pain, weakness and/or dark coloured urine? A B C D E gemfibrozil / glibenclamide pravastatin / metoprolol gemfibrozil / pravastatin glibenclamide / metoprolol glibenclamide / pravastatin
Q125 A female patient, 48, has just been prescribed oestradiol patches 37.5 mcg/24hour. In your counselling to her, you should advise her to place a new patch
A B C D
on her chest every Monday morning and Thursday evening in a different place every day on her upper buttocks every three to four days in the same place twice a week
END OF EXAMINATION
67

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Australian Pharmacy Council Ltd Intern Written Examination Sample Paper v1.

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1.6 2.6 3.9 1.9 4.5

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Q8 A patient is prescribed a reducing prednisolone regimen of:

Australian Pharmacy Council Ltd, 2013

Australian Pharmacy Council Ltd, 2013

Australian Pharmacy Council Ltd, 2013

Australian Pharmacy Council Ltd, 2013

Australian Pharmacy Council Ltd, 2013

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

Australian Pharmacy Council Ltd, 2013

Q24 Itching is NOT a symptom of

allergic dermatitis scabies fungal infection acne vulgaris lichen planus 11

Australian Pharmacy Council Ltd, 2013

pneumonia bronchitis croup post nasal drip

ibuprofen tramadol codeine paracetamol dextropropoxyphene

Australian Pharmacy Council Ltd, 2013

Height 170cm Weight 85kg

Australian Pharmacy Council Ltd, 2013

metformin acarbose insulin glibenclamide rosiglitazone

Australian Pharmacy Council Ltd, 2013

END OF PATIENT PROFILE

Australian Pharmacy Council Ltd, 2013

Height : 180 cm Weight : 73 kg

Australian Pharmacy Council Ltd, 2013

paracetamol citalopram aspirin oxycodone rabeprazole

Australian Pharmacy Council Ltd, 2013

END OF PATIENT PROFILE

Australian Pharmacy Council Ltd, 2013

Beryl Groper 64 Highfield Drive, Thornlie 148cm Weight 55kg

49 Sex Female Allergies Nil known DIAGNOSIS Presenting complaint

PHARMACISTS NOTES Nil

Australian Pharmacy Council Ltd, 2013

END OF PATIENT PROFILE

DIAGNOSIS Presenting complaint Medical History

1. Diarrhoea 1. Osteoarthritis 2. Hypertension 3. Cardiac Failure

Australian Pharmacy Council Ltd, 2013

lisinopril celecoxib frusemide glucosamine spironolactone

Australian Pharmacy Council Ltd, 2013

END OF PATIENT PROFILE

Australian Pharmacy Council Ltd, 2013

Height 160cm Weight 58kg

DIAGNOSIS Presenting complaint 1. Emergency contraceptive advice

_____________________________________________________________________ PHARMACISTS NOTES

Australian Pharmacy Council Ltd, 2013

Australian Pharmacy Council Ltd, 2013

Australian Pharmacy Council Ltd, 2013

Height 171 cm Weight 58 kg

LAB/DIAGNOSTIC TESTS Date Test

12/1 Lithium 0.8 micromol/L 0.5 1.2 micromol/L ____________________________________________________________________________________

MEDICATION RECORD Date Medication & Strength

PHARMACISTS NOTES Nil

Australian Pharmacy Council Ltd, 2013

Australian Pharmacy Council Ltd, 2013

Australian Pharmacy Council Ltd, 2013

END OF PATIENT PROFILE

Australian Pharmacy Council Ltd, 2013

Height 120 cm Weight 25 kg

LAB/DIAGNOSTIC TESTS Date Test

MEDICATION RECORD Date Medication & Strength

PHARMACISTS NOTES Date Comment

Australian Pharmacy Council Ltd, 2013