Apc Caop Practise Paper c5g6l

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 ing 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

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 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 itted 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 istered 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 s 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

itted 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 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 itted 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 t 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 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