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Further MCQs in Pharmacy Practice

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London Chicago

Further MCQs in Pharmacy Practice

Edited by

Lilian M AzzopardiBPharm (Hons), MPhil, PhD

Senior LecturerDepartment of PharmacyFaculty of Medicine and SurgeryUniversity of MaltaMsida, Malta

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Published by the Pharmaceutical PressAn imprint of RPS Publishing

1 Lambeth High Street, London SE1 7JN, UK100 South Atkinson Road, Suite 206, Grayslake, IL 60030-7820, USA

Pharmaceutical Press 2006

is a trade mark of RPS Publishing

RPS Publishing is the publishing organisation of the Royal

Pharmaceutical Society of Great Britain

First published 2006

Typeset by Type Study, Scarborough, North Yorkshire

Printed in Great Britain by TJ International, Padstow, Cornwall

ISBN-10 0 85369 665 9

ISBN-13 978 0 85369 665 0

All rights reserved. No part of this publication may be reproduced, stored

in a retrieval system, or transmitted in any form or by any means,

without the prior written permission of the copyright holder.

The publisher makes no representation, express or implied, with regard to

the accuracy of the information contained in this book and cannot accept

any legal responsibility or liability for any errors or omissions that may

be made.

The editor reserves the right to be identied as the editor of the work in

accordance with sections 77 and 78 subject to section 79(6) of the

Copyright, Designs and Patents Act, 1988.

A catalogue record for this book is available from the British Library

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Contents

Foreword viiPreface ixIntroduction xiAcknowledgements xiiiAbout the editor xvContributors xviiHow to use xixRevision checklist xxi

Section 1 Open-book Questions 1Test 1 Questions 3Answers 27Test 2 Questions 51Answers 75Test 3 Questions 99Answers 123

Section 2 Closed-book Questions 147Test 4 Questions 149Answers 173Test 5 Questions 195Answers 219Test 6 Questions 241Answers 265

Section 3 Sequential Questions 287Test 7 Questions 289Answers 295

Explanatory notes 303

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Bibliography 323

Appendix A Proprietary (trade) names and equivalentgeneric names 325

Appendix B Denitions of conditions and terminology 331Appendix C Abbreviations and acronyms 341Appendix D Performance statistics 343

Proprietary names index 361Generic names index 365Conditions index 371Subject index 379

vi Contents

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Foreword

The role of the pharmacist in counselling patients, other healthprofessionals and the public on the safe, effective and proper useof medications is expanding and has never been more important.At the same time, the knowledge that a pharmacist must have toserve this role is also expanding at an ever-increasing rate.Pharmacists must know, and be able to apply to patient situations,drug and disease information that will allow them to prevent orcorrect drug overuse, misuse and underuse. The text FurtherMCQs in Pharmacy Practice is targeted towards the needs of nal-year pharmacy students and graduates sitting for registrationexaminations. The format of the text is the presentation of multiplechoice questions (MCQs) that address drug and disease knowledgeand its application. The questions also test that the pharmacist hasa command of the basic knowledge to be able to carry out theservices in an intelligent way. Questions addressing pharmaceuti-cal calculations, formulations, medicinal chemistry and pathologyare included. There is both an open-book section of questions anda closed-book section. For each answer there is an explanatorysection, indicating why the selected answer is correct or incorrect.The present text is an extension of the publication by Dr Azzopardiand colleagues entitled MCQs in Pharmacy Practice, which waspublished in 2003. The questions cover a wide range of therapeuticareas. The MCQs take different formats to challenge ones knowl-edge in a variety of ways. In my estimation, Further MCQs inPharmacy Practice should prove to be very valuable to pharmacystudents and graduates seeking registration in allowing a carefulself-assessment of their drug and disease knowledge. The infor-mation covered in the questions is comprehensive and very relevantto pharmacy practice. The open-book section and the provision ofexplanations to the answers will help the reader identify areas ofstrengths and weaknesses in pharmacy knowledge and where to

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spend additional reading and review time. Of note, practisingpharmacists would also likely benefit from a self-assessmentthrough Further MCQs in Pharmacy Practice to contribute to theircontinuing professional development. I highly recommend the textand commend the authors for providing a practical and usefuleducational tool for self-assessment of drug and disease knowledgethat is pertinent to pharmacy practice.

Peter H Vlasses, PharmD, BCPS, FCCPExecutive Director

Accreditation Council for Pharmacy Education (ACPE)Chicago, Illinois, USA

June 2006

viii Foreword

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Preface

Pharmacy educators have a responsibility towards society to ensurethat pharmacy graduates have the skills to practise the professioncompetently. During pharmacy education, assessments are carriedout over the years to develop a graduates portfolio, which demon-strates the ability of the graduates to perform the different skills.For a graduate to be able to practise the profession competently,assessments are carried out to evaluate the development of aknowledge base, the interpretation and application of knowledge,evaluation of data, mathematical skills and time management. Tobe able to achieve this, pharmacy education systems should ensurethat a programme of education and training is provided to gradu-ates who will be able to reach these goals. During the 2005 AnnualConference of the European Association of Faculties of Pharmacy(EAFP), the Malta Declaration on pharmacy education wasadopted by the Executive Committee and delegates from 68schools of pharmacy and pharmacy institutions from 29 countries.The scope of the EAFP Malta Declaration is to dene universitycourses for pharmacy education programmes so as to promoteharmonisation and cooperation among faculties of pharmacy inEurope. This will promote international student and staff mobilityand supports recognition of professional qualications betweenmember states of the European Union. EAFP holds that pharmacist education programmes should be equivalent to at least300 ECTS. A balance between theoretical, laboratory and patientcentred training is required while maintaining the universitycharacter of the curriculum. A thorough grounding in the basicsciences, including research approach, should be maintained whilecontemporary developments in pharmacy namely pharmaceuticalcare, professionalism-values, behaviours and attitudes, clinicalpharmacy and clinical analysis, prescription and non-prescriptionmedicines regulatory affairs, pharmacoeconomics, medical devices

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and industrial pharmacy should be given adequate coverage. A six-month traineeship in a pharmacy that is open to the public or in ahospital under the supervision of a pharmacist should be carriedout within the university course so as to integrate the knowledgebase and professional practice within a university milieu. Inaddition, training periods should also be considered during thecourse for other pharmacy-related areas such as industrialpharmacy. Training periods may also be offered in one or moreoptional areas, depending on the individual institution. EAFPrecommends at least a ve-year programme of university educationand training for a pharmacist to ensure that the individual hasacquired knowledge and skills in the scientic areas of chemistryand manufacture of medicines, effects, actions and use of medi-cines as well as in the practice areas of the provision of professionalservices according to good professional standards, evaluation ofinformation on medicines and pursuit of continuing professionaldevelopment programmes in the interest of patients requiringtherapeutical intervention. This declaration outlines a frameworkthat may be followed by schools of pharmacy to ensure a sounddevelopment of the graduates portfolio. The students shouldensure that they are able to demonstrate that they have developedthe necessary skills to practise the profession competently. By usingtextbooks such as Further MCQs in Pharmacy Practice, preparedby Lilian M. Azzopardi and her colleagues, the students have auseful tool, which helps them to undertake self-assessmentprocedures. Self-assessment is a healthy way to study and preparefor nal examinations and registration examinations. With theexplanations provided and the data presented in the appendices,pharmacy students should be able to use this book as a usefulrevision aid prior to assessments.

Professor Benito del Castillo GarciaDean, Faculty of Pharmacy

University Complutense, Madrid, SpainPresident, European Association of Faculties of Pharmacy

June 2006

x Preface

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Introduction

A number of pharmacy examination boards who act as the naljudges in allowing a candidate to practise unsupervised as apharmacist are using multiple choice questions (MCQs) as a usefultool to help them in making their decision. This not only appliesto pharmacy, and MCQs are now commonly used to examineseveral other healthcare professionals.

The responsibility in formulating these examination ques-tions is signicant. While there is a requirement to ensure thatcandidates who present a threat to pharmacy practice are identi-ed, thus ensuring that they should not obtain a pass mark in theexamination, the examination should also ensure that competentcandidates do make the grade.

The same principles that are used for making up questionsfor examinations were used in preparing this book. The questionsset in this book have all been analysed and considered valid andsatisfactory. The book is a continuation of a previous publicationthat was very well received. All the questions are new casescovering traditional areas while some other topics, which haverecently received greater attention in pharmacy practice, are alsoincluded. The book takes the form of test papers consisting of anumber of questions taken from actual tests undertaken bypharmacy students who have followed a ve-year course of studiesand practice. The results obtained by these students for tests 1 to6 are shown in Appendix D.

MCQ examinations frequently present a problem to prospec-tive candidates in how to prepare for them, as opposed to the moretraditional essay type or problem type exams. It is not realistic toexpect candidates to memorise whole sections of reference bookssuch as the British National Formulary, nor is it feasible forstudents to anticipate with what questions they are likely to befaced. For this reason, the examiners frequently include two types

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of questions; those that the candidates will be expected to answerfrom their own knowledge and experience without reference to anytext, the closed-book questions, and others that the candidate isexpected to answer by referring to standard sources that theprofessional would be expected to have available during practice,the open-book questions.

The profession of pharmacy is based on science and practice.The questions in a comprehensive examination aim to reect this.In practice both generic and proprietary names are encountered.Pharmacists must be familiar with both.

By going through the questions posed in this book andconsidering the rationale for the answers given at the end, thecandidate will gain a useful insight as to what might be expectedin the actual examination and thus be better prepared for it.

xii Introduction

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Acknowledgements

I would like to thank a number of colleagues who have assisted mein one way or another in the preparation of this publication. Inparticular I would like to express my thanks to Professor AnthonySerracino-Inglott, Head of Department of Pharmacy at theUniversity of Malta and Dr Maurice Zarb-Adami for theircontributions towards the book. Their knowledge and hands-onexperience in pharmacy education has added greatly to the robust-ness of the book. I also would like to thank Professor SteveHudson, University of Strathclyde, Dr Sam Salek, University ofCardiff and Professor Vincenzo Tortorella, University of Bari fortheir contributions and for the good times we shared during thediscussions we had in preparation for the book. In addition I wouldlike to thank Professor Victor Ferrito, University of Malta forreviewing material in the book.

My sincere thanks go to Professor Roger Ellul-Micallef,Rector, and Professor Godfrey LaFerla, Dean of the Faculty ofMedicine and Surgery of the University of Malta for their supportand encouragement. I would also like to thank Peter Vlasses, Exec-utive Director, Accreditation Council for Pharmacy Education,USA and Professor Benito del Castillo Garcia, UniversityComplutense Madrid for their interest in the publication.

I would like to acknowledge the support of my colleagues andthe staff at the Department of Pharmacy and the Faculty ofMedicine and Surgery of the University of Malta. I would like tomention the pharmacy students at the Department of Pharmacyand colleagues from different countries for their comments onMCQs in Pharmacy Practice. Their comments and positivefeedback gave us the encouragement to prepare this publication.Thanks also go to the staff at the Pharmaceutical Press for theirwork in the preparation and production of this publication.

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Special thanks to my sister Louise, a clinical pharmacist, forher much appreciated comments and valuable suggestions. Finally,I would like to thank my family and friends for their interest andencouragement throughout the preparation of the book.

xiv Acknowledgements

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About the editor

Lilian M Azzopardi studied pharmacy at the University of Malta,Faculty of Medicine and Surgery. In 1994 she took up a positionat the Department of Pharmacy, University of Malta as a teachingand research assistant. Dr Azzopardi began an MPhil on thedevelopment of formulary systems for community pharmacy,which was completed in 1995, and in 1999 she completed a PhDwhich led to the publication of the book Validation Instrumentsfor Community Pharmacy: Pharmaceutical Care for the ThirdMillennium published in 2000 by Pharmaceutical Products Press,USA. She worked together with Professor Anthony SerracinoInglott who was a pioneer in the introduction of clinical pharmacyin the late 60s. In 2003 Dr Azzopardi edited the book MCQs inPharmacy Practice published by the Pharmaceutical Press, UK.

Throughout her career Lilian M Azzopardi has been activelyinvolved in pharmacy practice teaching and in research inpharmacy practice. She is currently a senior lecturer in pharmacypractice at the Department of Pharmacy, University of Malta andis responsible for co-ordinating the teaching of pharmacy practice,including the planning, organisation and assessment of pharmacypractice during the undergraduate course as well as during thepreregistration period. Dr Azzopardi is an examiner in pharmacypractice and clinical pharmacy for the course of pharmacy at theUniversity of Malta.

Lilian Azzopardi was for a short period interim director ofthe European Society of Clinical Pharmacy (ESCP) and is currentlycoordinator of the ESCP newsletter. She served as a member of theWorking Group on Quality Care Standards within the CommunityPharmacy Section of the International Pharmaceutical Federation(FIP). In 1997 she received an award from the FIP Foundation forEducation and Research and in 1999 was awarded the ESCPGerman Research and Education Foundation grant.

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Lilian Azzopardi has published several papers on clinicalpharmacy and pharmaceutical care and has actively participated atcongresses organised by FIP, ESCP, the Royal PharmaceuticalSociety of Great Britain, the American Pharmaceutical Associationand the American Society of Health-System Pharmacists. In 2002Dr Azzopardi was invited to contribute to the rst sessions of com-pulsory continuing professional development programme forpharmacists in Italy.

xvi About the editor

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Contributors

Lilian M Azzopardi BPharm(Hons), MPhil, PhDSenior Lecturer, Department of Pharmacy, University of Malta,Msida, Malta

Stephen A Hudson MPharm, FRPharmSProfessor of Pharmaceutical Care, Division of PharmaceuticalSciences, Strathclyde Institute of Pharmacy and BiomedicalSciences, University of Strathclyde, Glasgow, UK

Sam Salek BPharm, PhD, RPh, MFPM(Hon)Professor and Director, Centre for Socioeconomic Research, WelshSchool of Pharmacy, Cardiff, UK

Anthony Serracino-Inglott BPharm, PharmDProfessor and Head of Department, Department of Pharmacy,University of Malta, Msida, Malta

Vincenzo Tortorella PhD, DIC(Lond)Professor and Dean, Faculty of Pharmacy, University of Bari, Bari,Italy

Maurice Zarb Adami BPharm, PhDSenior Lecturer, Department of Pharmacy, University of Malta,Msida, Malta

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How to use

The questions are divided into sets of an open-book and of aclosed-book type. Each test consists of 100 questions and there area total of six tests and therefore 600 questions. In addition another10 questions have been grouped in Test 7 to introduce readers toa format of MCQs that is becoming more popular with time. Theyare referred to as MCQs in a sequential format. In this case thecandidate is presented with a number of proposed answers whichhave a different probability of being correct. The candidate has tolist the given answers according to the relative probability of beingcorrect. The questions in Test 7 are also unique in that they dealwith the application of basic sciences to practice, an area that didnot feature prominently in Tests 1 to 6.

You should tackle all the questions in one test in one session,and write down the answer on a sheet of paper, as though underexamination conditions, namely, using or refraining from usingreference texts as the case may be.

Make a note of the time it takes to cover each test, so thatthese may be added up at the end to allow you to pace yourself.The answers for the tests can then be compared with the answersgiven in the book. You will thus start to gain some intuition orfeeling into the examiners thinking and logic in setting particularquestions. This should help in addressing the other sections, andin the end, the actual examination itself.

Keep in mind that each question carries a particular mark,and this cannot be exceeded even if you spend extra time on it. Onthe other hand, some questions are quite straightforward, andmarks allotted to such questions should not be missed.

When all the tests have been covered in the way suggestedabove, examine the explanatory notes at the end to see whetherthe difculties that you encountered are also commonly met byother students.

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Revision checklist

For each test, write the number of the question and your answeron a separate sheet of paper then, after going through all the ques-tions in the test, compare your answers with those in the book.

Refer to Appendix D for feedback on those questions thatyou did not answer correctly to be able to compare your abilitywith a cohort of students.

You can obtain information on the proprietary names listedin the book in Appendix A. Appendix B includes denitions formedical terms included in the book while Appendix C listsabbreviations and acronyms.

Recommended textbooks for the open-book section are:

Azzopardi LM (2000). Validation Instruments for CommunityPharmacy: Pharmaceutical Care for the Third Millennium, Bing-hamton, New York: Pharmaceutical Products Press.

Edwards C, Stillman P (2006). Minor Illness or Major Disease?Responding to Symptoms in the Pharmacy, 4th edn. London:Pharmaceutical Press.

Harman RJ, Mason P, eds (2002). Handbook of Pharmacy Health-care: Diseases and Patient Advice, 2nd edn. London: Pharmaceuti-cal Press.

Mehta DK, ed (2006). British National Formulary, 51st edn.London: Pharmaceutical Press.

Nathan A (2002). Non-prescription Medicines, 2nd edn. London:Pharmaceutical Press.

Royal Pharmaceutical Society of Great Britain (2005). Medicines,Ethics and Practice: a Guide for Pharmacists. London: Pharma-ceutical Press.

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Checklist

This checklist should help students identify areas that need to becovered when preparing for comprehensive nal examinations andpreregistration exams.

Action and use of drugs: classication, medicinal chemistry,mechanism of action, pharmacokinetics, dosage regimen,patient monitoring, patient counselling, cautionary labels

Responding to symptoms: presentation of conditions, diag-nosis, referrals, use of non-prescription medicines, patientcounselling

Adverse effects: common adverse effects, patient counselling,patient monitoring

Cautions and contraindications: disease states, baseline testsrequired

Special requirements: dose adjustments in liver and hepaticdisease, use of drugs during pregnancy and breast-feeding,geriatric and paediatric patients, palliative care

Diagnostics: medical devices, point-of-care tests, interpret-ation of results

Calculations: dose calculations, dilutions Health promotion and disease prevention: lifestyle and

dietary modications, prophylaxis against disease Standards of practice: evaluation methods, audit processes,

management, documentation, quality assurance, operatingprocedures

xxii Revision checklist

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Section 1

Open-book questions

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Test 1

Questions

Questions 110

Directions: Each of the questions or incomplete statements is followed byve suggested answers. Select the best answer in each case.

Q1 All the following products used in the treatment of glaucoma are appliedtopically EXCEPT:

A XalatanB DiamoxC TrusoptD TimoptolE Betoptic

Q2 Which is an alternative preparation of Lipitor?

A CozaarB LescolC ZestrilD CarduraE Trandate

Q3 Tambocor:

A may be of value in serious symptomatic ventricular arrhythmiasB is a beta-adrenoceptor blockerC is available only for parenteral administrationD cannot be administered concurrently with antibacterial agentsE is a proprietary preparation for amiodarone

3

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Q4 Terazosin:

A constricts smooth muscleB is a selective beta-blockerC increases urinary ow rateD may cause an increase in blood pressureE is indicated in urinary frequency

Q5 Legionnaires disease:

A is caused by a Gram-positive coccusB is a chronic infectious diseaseC has an incubation period of 2 days to 3 yearsD is characterised by the development of pneumoniaE may be prevented by vaccination

Q6 Trigger factors for migraine include all EXCEPT:

A use of caffeineB exposure to sunlightC missed mealsD lack of sleepE air travel

Q7 All the following products contain a local anaesthetic EXCEPT:

A DequacaineB MerocaineC BurnEzeD AnthisanE Proctosedyl

4 Test 1: Questions

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Q8 Good pharmacy practice guidelines:

A have been established by the International PharmaceuticalFederation (FIP)

B comply with ISO 9000C consist of an audit processD relate to pharmaceutical marketingE entail eld observation studies

Q9 Anti-D immunoglobulin:

A is available as oral tabletsB is a vaccination for tetanusC should be administered preferably within 72 h of a

sensitising episode

D is intended to protect the mother from haemolytic diseaseE cannot be used for prophylaxis

Q10 Which of the following products is NOT indicated for the managementof peptic ulceration?

A ZantacB GavisconC NexiumD ParietE Buscopan

Questions 1134

Directions: Each group of questions below consists of five letteredheadings followed by a list of numbered questions. For eachnumbered question select the one heading that is most closely

Questions 1134 5

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related to it. Each heading may be used once, more than onceor not at all.

Questions 1113 concern the following drugs:

A valaciclovirB griseofulvinC itraconazoleD famciclovirE terbinane

Select, from A to E, which one of the above corresponds to the brand name:

Q11 Famvir

Q12 Sporanox

Q13 Lamisil


A nalidixic acidB noroxacinC levooxacinD ooxacinE amphotericin

Select, from A to E, which one of the above:

Q14 can be used for intestinal candidiasis

Q15 has greater activity than ciprooxacin against pneumococci

Q16 is marketed as Tavanic

6 Test 1: Questions

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Q17 is only indicated in urinary tract infection


A atenololB folic acidC imipramineD carbamazepineE co-trimoxazole

Select, from A to E, during pregnancy which one of the above:

Q18 may cause intrauterine growth restriction

Q19 may increase the risk of neural tube defects

Q20 may increase the risk of tachycardia in neonate

Questions 2123 concern the following maximum oral daily doses:

A 200 mg dailyB 150 mg dailyC 100 mg dailyD 50 mg dailyE 300 mg daily

Select, from A to E, which one of the above corresponds to:

Q21 diclofenac

Q22 sildenal

Q23 sumatriptan

Questions 1134 7

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Questions 2426 concern the following cautionary labels:

A To be sucked or chewed.B With or after food.C Follow the printed instructions you have been given with this

medicine.

D Avoid exposure of skin to direct sunlight or sun lamps.E Do not stop taking this medicine except on your doctors

advice.

Select, from A to E, which one of the above corresponds to the drugs:

Q24 chlorpromazine

Q25 dapsone

Q26 warfarin

Questions 2730 concern the following products:

A AeroChamberB NuelinC AtroventD BeconaseE Alupent

Select, from A to E, which one of the above corresponds to the following presentations:

Q27 syrup

Q28 aerosol for inhalation

Q29 spacer device

Q30 nasal spray

8 Test 1: Questions

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Questions 3134 concern the following tablet descriptions:

A yellow 40 mgB brown 1 mgC yellow 250 mgD red-brown 100 mgE yellow 2.5 mg

Select, from A to E, which one of the above corresponds to the following preparations:

Q31 Klaricid

Q32 Diovan

Q33 warfarin

Q34 Zomig

Questions 3560

Directions: For each of the questions below, ONE or MORE of theresponses is (are) correct. Decide which of the responses is(are) correct. Then choose:

A if 1, 2 and 3 are correctB if 1 and 2 only are correctC if 2 and 3 only are correctD if 1 only is correctE if 3 only is correct

Directions summarised

A B C D E

1, 2, 3 1, 2 only 2, 3 only 1 only 3 only

Questions 3560 9

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Q35 When administering cisplatin powder for injection:

1 it should be reconstituted with water for injection2 it should be given over 68 h3 the infusion uid used is Ringers solution

Q36 Ceftazidime:

1 is a third-generation cephalosporin antibacterial2 is more active than cefuroxime against Gram-positive bacteria3 is available as tablets and injections

Q37 Potentially hazardous interactions could occur between:

1 ergotamine and zolmitriptan2 warfarin and gliclazide3 combined oral contraceptives and clindamycin

Q38 Examples of enzyme inducers include:

1 griseofulvin2 rifampicin3 warfarin

Q39 Which of the following drugs may be used in patients with liver diseasebut require a dose reduction?

1 Natrilix2 Nizoral3 Zyloric

Q40 Capsulitis:

1 is a disorder affecting the shoulder2 may be caused by unaccustomed movement3 is an inammatory process

10 Test 1: Questions

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Q41 Presentations of a facial lesion that warrant referral include:

1 swollen lymph glands in the neck2 buttery distribution of a rash over the nose and cheeks3 a scaly rash with mild erythema affecting the forehead and

eyebrows

Q42 Antacid preparations containing sodium bicarbonate include:

1 Gaviscon liquid2 Bisodol Heartburn Relief tablets3 Maalox Plus tablets

Q43 The agents associated with pain and inammation of a bee sting include:

1 histamine2 apamin3 hyaluronidase

Q44 Antispasmodics that could be recommended for irritable bowelsyndrome include:

1 Colofac2 Spasmonal3 Fybogel

Q45 Paradichlorobenzene:

1 has antifungal properties2 is used as a disinfectant3 is present in Cerumol drops

Questions 3560 11

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Q46 Aspirin:

1 potentiates the anticoagulant effect of warfarin2 inhibits platelet aggregation3 promotes vitamin K synthesis

Q47 Male pattern baldness:

1 is androgenetic alopecia2 is caused by the release of prostaglandins3 may be precipitated by chemical hair preparations

Q48 Finasteride:

1 is an enzyme inhibitor2 is an anti-androgen3 could be used in male-pattern baldness

Q49 Diamorphine:

1 is a controlled drug2 is more lipid soluble than morphine3 may be administered intramuscularly

Q50 Drugs that could be used in nausea and vomiting caused by palliativecancer treatment include:

1 metoclopramide2 haloperidol3 prochlorperazine


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Q51 Bacterial conjunctivitis:

1 is an infectious condition2 affects both eyes3 is associated with pain

Q52 Wet skin lesions:

1 indicate presence of a fungal infection2 always require referral3 potassium permanganate soaks may be recommended

Q53 Infant formula milk preparations:

1 may be based on cows milk2 contain no fat3 are presented as separate components to be reconstituted

before use

Q54 Staphylococcal napkin dermatitis:

1 occurs when the patient also has oral thrush2 presents as a pustular rash3 should be referred

Q55 Sialolithiasis:

1 is the inammation of a salivary gland2 presents with facial pain and swelling3 is associated with eating

Questions 3560 13

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Q56 Accompanying conditions that require referral when patients presentwith ear problems include:

1 history of perforated ear drum2 discharge3 pain

Q57 When patients present with complaints related to indigestion the phar-macist should enquire whether:

1 symptoms are related to food intake patterns2 accompanying symptoms include vomiting or constipation3 the patient is wheezing

Q58 Kaolin and Morphine Mixture:

1 is not recommended for acute diarrhoea2 contains a low concentration of morphine3 contains kaolin, which may reduce bioavailability of morphine

Q59 Meggezones pastilles:

1 contain pseudoephedrine2 provide a soothing effect through the promotion of saliva

production3 should not be recommended to diabetic patients

Q60 In migraine:

1 a soluble oral drug formulation is preferred to a solid oraldosage form

2 an analgesic should be taken at the rst sign of an attack3 Syndol may be recommended


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Questions 6180

Directions: The following questions consist of a rst statement followedby a second statement. Decide whether the rst statement istrue or false. Decide whether the second statement is true orfalse. Then choose:

A if both statements are true and the second statement is acorrect explanation of the rst statement

B if both statements are true but the second statement is NOTa correct explanation of the rst statement

C if the rst statement is true but the second statement is falseD if the rst statement is false but the second statement is trueE if both statements are false

Q61 Hydroxychloroquine is used to treat rheumatoid arthritis. Hydroxy-chloroquine is better tolerated than gold.

Q62 Acute attacks of porphyria may be precipitated by drug administration.Progestogen-containing preparations should be avoided in patients withporphyria.

Q63 Goserelin may be used in prostrate cancer. Goserelin may result in atumour are.


First statement Second statement

A True True Second statement is a correct

explanation of the rst

B True True Second statement is NOT a correct


C True False

D False True

E False False

Questions 6180 15

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Q64 Tacrolimus is chemically similar to ciclosporin. Tacrolimus has a similarmode of action to ciclosporin.

Q65 In older patients, imipramine may cause hyponatraemia. Hypo-natraemia occurs because of increased sodium re-uptake in the loop ofHenle.

Q66 Inammation of the larynx requires the administration of atropine.Atropine is a sympathomimetic agent.

Q67 Lidocaine is used in ventricular arrhythmias. Lidocaine suppressesventricular tachycardia and reduces the risk of ventricular brillationfollowing myocardial infarction.

Q68 Propranolol is preferred to atenolol in hypertensive patients withmoderate kidney damage. Propranolol is not water soluble and is notexcreted by the kidneys.

Q69 Filgrastim is used for neutropenia induced by cytotoxic chemotherapy.Filgrastim is an example of a recombinant human erythropoietin.

Q70 Intake of drugs at therapeutic doses in mothers who are breast-feedingare not likely to cause toxicity in the infant. Toxicity in the infant alwaysoccurs when the drug enters the milk.

Q71 Pemphigus is an autoimmune reaction. Immunosuppressants such asciclosporin are the rst line of treatment in pemphigus.

Q72 Ear pain during air travel occurs because of a problem in the externalear. Nasal decongestants may be used to prevent this condition.

Q73 Agranulocytosis could occur as a result of Stelazine therapy. Stelazineis trimipramine.

Q74 Tinnitus may be an adverse effect of furosemide. All diuretics may causetinnitus.


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Q75 Concomitant use of St Johns wort and sertraline should be avoided. StJohns wort is used for mild depression.

Q76 Co-codamol preparations that can be sold over-the-counter containcodeine 60 mg. Co-codamol is a combination of codeine and dextro-propoxyphene.

Q77 Varicella is a highly contagious disease. Prophylaxis for varicella is notavailable.

Q78 Graduated compression hosiery should not be used during pregnancy.Graduated compression hosiery prevents oedema.

Q79 First-line treatment of nocturnal enuresis is drug treatment. Amitriptylinemay be used in nocturnal enuresis.

Q80 Betahistine is indicated for motion sickness. Betahistine may be associ-ated with headache.

Questions 81100

Directions: These questions involve prescriptions or patient requests.Read the prescription or patient request and answer thequestions.

Questions 8185: Use the prescription below:

Patients name .........................................................................

Premarin 0.625 mg tablets1 od m 28

Doctors signature .........................................................................

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Q81 Premarin contains

A conjugated oestrogens 625 gB conjugated oestrogens 62.5 gC conjugated oestrogens 0.625 gD conjugated oestrogens 625 g and levonorgestrel 75 gE conjugated oestrogens 0.625 g and levonorgestrel 75 g

Q82 Premarin is also available as:

1 a nasal spray2 patches3 tablets in a different strength

A 1, 2, 3B 1, 2 onlyC 2, 3 onlyD 1 onlyE 3 only

Q83 Premarin:

1 is indicated in women with an intact uterus2 may be used for prophylaxis of osteoporosis3 is marketed by Wyeth



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Q84 An equivalent product to Premarin is:

A NuvelleB ProgynovaC TrisequensD Prempak-CE Femoston

Q85 The patient should:

1 take one Premarin tablet daily2 take tablets for 28 days followed by a 7-day break before

starting the next pack3 undertake regular visits to a general practitioner every 15

days



Patients name .........................................................................

Fosamax tablets70 mg once per week


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Q86 Fosamax:

A contains disodium etidronateB increases rate of bone turnoverC may cause dysphagiaD can impair bone mineralisationE acts as a posterior pituitary hormone antagonist

Q87 Fosamax:

1 a weekly treatment costs about 62 is available only as 5 mg tablets3 the patient has to take three tablets weekly



Patients name .........................................................................

Combivent2 puffs qds



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Q88 Combivent consists of:

1 ipratropium2 salbutamol3 salmeterolA 1, 2, 3B 1, 2 onlyC 2, 3 onlyD 1 onlyE 3 only

Q89 Combivent is available as:

1 dry powder for inhalation2 a nebuliser solution3 an aerosol inhalationA 1, 2, 3B 1, 2 onlyC 2, 3 onlyD 1 onlyE 3 only

Q90 Combivent is not available. Which of the following products could berecommended to replace Combivent?

1 Ventolin2 Atrovent3 BecotideA 1, 2, 3B 1, 2 onlyC 2, 3 onlyD 1 onlyE 3 only

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Q91 Depo-Medrone:

1 consists of methylprednisolone2 is used to suppress an allergic reaction3 may be used in rheumatic disease


Q92 Depo-Medrone:

1 is administered parenterally2 may be administered twice daily3 is highly likely to cause cerebral oedema


Patients name .........................................................................

Depo-Medronem 1



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Q93 Persantin Retard is an:

A anticoagulantB antiplateletC analgesicD antihypertensiveE anti-arrhythmic drug

Q94 The side-effects that could occur with Persantin Retard include:

1 gastrointestinal effects2 worsening of symptoms of coronary heart disease3 hot ushes


Patients name .........................................................................

Persantin Retard1 bd m 60Aspirin 75 mg1 daily m 60


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Q95 The pharmacist should dispense Persantin Retard in its original containerbecause:

A the pack also includes aspirinB the original pack is better labelledC such dispensing saves time in counting capsulesD the original pack contains a dessicantE it is a controlled drug

Q96 Regarding the Persantin Retard, the patient is instructed to:

A take two capsules together at breakfastB discard any capsules remaining 6 weeks after openingC double the dose before undergoing surgeryD abstain from driving when taking these medicationsE keep the medicines prescribed in a refrigerator

Questions 97100: For each question read the patient request:

Q97 A parent requests a multivitamin preparation for a 6-year-old child.Which product could be recommended?

A ForcevalB VivioptalC MaxepaD En-De-KayE Calcium-Sandoz


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Q98 A mother requests a preparation for her 5-year-old son for a chestycough. Which of the following products is the most appropriate?

A Benylin with Codeine syrupB Alupent syrupC Actifed Chesty Coughs syrupD Vicks Medinite syrupE Neoclarityn syrup

Q99 A patient asks for ibuprofen gel. The pharmacist may dispense:

A OruvailB VoltarolC DubamD BrufenE Ibutop

Q100 A patient asks for a preparation as a vaginal cream for candidiasis.Which product is the most appropriate?

A CanestenB Ortho-GynestC EuraxD BactrobanE Dermovate

Questions 81100 25

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Test 1

Answers

A1 B

Diamox contains acetazolamide, which is a carbonic anhydrase inhibitoradministered orally or by the parenteral route. Xalatan contains latanoprost,a prostaglandin analogue, and Trusopt contains dorzolamide, a carbonicanhydrase inhibitor. Timoptol and Betoptic both consist of beta-blockerscontaining timolol and betaxolol respectively.

A2 B

Lipitor contains atorvastatin. An alternative preparation is Lescol, whichcontains another statin, uvastatin. Cozaar contains losartan, an angiotensin-II receptor antagonist, Zestril contains lisinopril, an angiotensin-convertingenzyme inhibitor, Cardura contains doxazosin, an alpha-adrenoceptorblocking drug, and Trandate contains labetalol, a beta-adrenoceptor blockingdrug.

A3 A

Tambocor contains ecainide, which may be of value in serious symptomaticventricular arrhythmias. It is also indicated for junctional re-entry tachycardiasand for paroxysmal atrial brillation. It is available as tablets or injections forintravenous administration. Hazardous interactions may be expected whenecainide is administered concurrently with drugs such as amiodarone,tricyclic antidepressants, terfenadine, ritonavir, dolasetron, clozapine, vera-pamil, and with beta-blockers. Amiodarone is a drug that is also indicated inthe treatment of arrhythmias. An example of a proprietary name for amio-darone is Cordarone X.

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A4 C

Terazosin is a selective alpha-blocker that relaxes smooth muscle and is indi-cated in benign prostatic hyperplasia because it increases urinary ow rateand improves obstructive symptoms. Terazosin is also indicated in the manage-ment of mild-to-moderate hypertension. After the rst dose a rapid reductionin blood pressure may occur.

A5 D

Legionnaires disease is an acute respiratory tract infection caused by a Gram-negative bacillus of the Legionella species. It is characterised by thedevelopment of pneumonia. The incubation period is from 2 to 10 days. Thecondition is attributed to the inhalation of water droplets, such as from watergenerated in air-conditioning cooling systems and in hot-water systems, thatare contaminated with the microorganism. Prevention techniques are basedon the maintenance of air-conditioning lters and water systems.

A6 D

Trigger factors for migraine include intake of specic food such as caffeine,chocolate, cheese and alcoholic drinks, exposure to light, hunger and missedmeals, and air travel.

A7 D

Anthisan contains mepyramine, an antihistamine. Dequacaine contains benzo-caine and dequalinium, Merocaine contains benzocaine and cetylpyridinium,BurnEze contains benzocaine, and Proctosedyl contains cinchocaine andhydrocortisone. Benzocaine and cinchocaine are anaesthetics.

A8 A

During the FIP congress in Japan in 1993 the international guidelines for GoodPharmacy Practice (GPP) were adopted. A revised version of these guidelines,

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Standards for Quality of Pharmacy Services, was endorsed during the 35thmeeting of the World Health Organizations Expert Committee on Specica-tions for Pharmaceutical Preparations in April 1997 and this was approvedby the FIP Congress in Vancouver in 1997.

A9 C

Anti-D(Rh0) immunoglobulin should be administered immediately or within72 h of any sensitising episode during abortion, miscarriage or giving birthto a rhesus-positive foetus. It prevents a rhesus-negative mother from formingantibodies to rhesus-positive cells that may pass into the maternal circulation.It is intended to protect any subsequent child from haemolytic disease. It isavailable as an injection.

A10 E

Buscopan contains hyoscine, which is a quaternary ammonium compoundhaving antimuscarinic activity. It is indicated for symptomatic relief of gastro-intestinal or genitourinary disorders characterised by smooth muscle spasm.Zantac contains ranitidine, which is an H2-receptor antagonist that promoteshealing of peptic ulcers by reducing gastric output as a result of histamine H2-receptor blockade. Nexium contains esomeprazole and Pariet containsrabeprazole, both of which are proton pump inhibitors. The proton pumpinhibitors inhibit gastric acid output by blocking the hydrogenpotassiumadenosine triphosphatase enzyme system of the gastric parietal cells. Gavisconis an antacid preparation that can be used for the management of symptomsof peptic ulceration. The constitution of Gaviscon preparations varies accord-ing to dosage forms. Gaviscon tablets contain alginic acid, dried aluminiumhydroxide, magnesium trisilicate and sodium bicarbonate, whereas Gavisconliquid contains sodium alginate, sodium bicarbonate and calcium carbonate.

A11 D

Famvir is a proprietary preparation of famciclovir (used for the treatment ofherpes virus infections).

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A12 C

Sporanox is a proprietary preparation of itraconazole (triazole antifungal).

A13 E

Lamisil is a proprietary preparation of terbinane (antifungal).

A14 E

Amphotericin is active against most fungi and yeasts. It can be used for intes-tinal candidiasis.

A15 C

Both levooxacin and ciprooxacin are quinolones. Levooxacin has greateractivity against pneumococci than ciprooxacin.

A16 C

Tavanic is a proprietary preparation of levooxacin.

A17 A

Nalidixic acid is a quinolone that is indicated only for urinary tract infections.

A18 A

Atenolol is a beta-adrenoceptor blocker that, when administered duringpregnancy, may cause intrauterine growth restriction, neonatal hypoglycaemiaand bradycardia.

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A19 D

Carbamazepine is an anti-epileptic drug that, when administered during therst trimester of pregnancy, increases the risk of teratogenesis, including anincreased risk of neural tube defects. To counteract the risk of neural tubedefects, adequate folate supplements are advised before and duringpregnancy. Administration of carbamazepine during the third trimester maycause vitamin K deciency and increase the risk of neonatal bleeding.

A20 C

Imipramine is a tricyclic antidepressant that, when administered during thethird trimester, may cause tachycardia, irritability and muscle spasms in theneonate.

A21 B

The maximum daily dose for diclofenac, a non-steroidal anti-inammatorydrug, is 150 mg.

A22 C

The maximum daily dose for sildenal, a phosphodiesterase type-5 inhibitor,is 100 mg.

A23 E

The maximum daily dose for sumatriptan, a 5HT1-agonist, is 300 mg.

A24 D

Chlorpromazine is an antipsychotic drug, specically a phenothiazine deriva-tive, that is characterised by pronounced sedative effects. Cautionary labels

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recommended are to avoid exposure of skin to direct sunlight or sun lampsand a warning that it may cause drowsiness and, if affected, not to drive oroperate machinery and to avoid alcoholic drinks.

A25 E

Dapsone is an anti-leprotic drug. It is also used in malaria prophylaxis and indermatitis herpetiformis. The cautionary label Do not stop taking this medicineexcept on your doctors advice is recommended. This label is recommendedfor use on preparations that contain a drug which has to be taken over longperiods without the patient perceiving any benet, or for a drug where with-drawal is likely to present a particular hazard. In the management of leprosy,dapsone may be used in combination with other drugs and treatment is usuallyfor a few months. Withdrawal of dapsone therapy in skin conditions may beassociated with sudden are-ups.

A26 C

Warfarin is an oral anticoagulant. The cautionary label Follow the printedinstructions you have been given with this medicine is recommended. Anappropriate treatment card should be given to the patient where advice onanticoagulant therapy, necessity of monitoring and precautions are presented.

A27 E

Alupent, which contains orciprenaline, an adrenoceptor agonist, is availableas a syrup.

A28 C

Atrovent, which contains ipratropium, an antimuscarinic bronchodilator, isavailable as an aerosol for inhalation, as a nebuliser solution, and as drypowder for inhalation.

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A29 A

AeroChamber is a proprietary name for a spacer device. It is a large spacerwith a one-way valve. Spacer devices eliminate the disadvantage associatedwith metered-dose inhalers, where drug administration may be compromiseddue to lack of coordination between actuation of the inhaler and inhalation.

A30 D

Beconase, which contains beclometasone, a corticosteroid, is available as anasal spray.

A31 C

Klaricid, which contains clarithromycin, a macrolide antibacterial agent, isavailable as yellow tablets in 250 mg and 500 mg strengths.

A32 A

Diovan, which contains valsartan, an angiotensin-II receptor antagonist, isavailable as yellow tablets 40 mg.

A33 B

Warfarin, an oral anticoagulant, is available as brown tablets at 1 mgstrength. Warfarin is also available as tablets in other colours in the 0.5 mg,3 mg and 5 mg strengths.

A34 E

Zomig, which contains zolmitriptan, a 5HT1-agonist, is available as yellowtablets of 2.5 mg.

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A35 B

Cisplatin is a platinum compound that is used alone or in combination therapyfor the treatment of testicular, lung, cervical, bladder, head and neck andovarian cancer. It is administered intravenously and is available as powderfor injection. The powder formulation should be reconstituted with water forinjections to produce a 1 mg/mL solution. Subsequently it is diluted into 2 Lsodium chloride 0.9% or sodium chloride and glucose solution. The infusionis given over 68 h.

A36 D

Ceftazidime is a third-generation cephalosporin antibacterial agent. It hasgreater activity than cefuroxime against certain Gram-negative bacteria andless activity against Gram-positive bacteria. Ceftazidime is administered bydeep intramuscular injection or intravenous injection or infusion. It is not avail-able as tablets.

A37 B

Both ergotamine and zolmitriptan are indicated for migraine attacks. Whenergotamine and zolmitriptan are administered concurrently there is anincreased risk of vasospasm. Use of ergotamine should be avoided for 6 hafter administration of zolmitriptan, and use of zolmitriptan should be avoidedfor 24 h after administration of ergotamine. This reaction could be potentiallyhazardous. When warfarin is administered to a patient receiving a sulphonyl-urea such as gliclazide, this could enhance the hypoglycaemic effect and mayalso result in changes in the anticoagulant effect. There is no evidence of apotentially hazardous interaction when clindamycin is administered to patientsreceiving combined oral contraceptives.

A38 B

Griseofulvin and rifampicin are enzyme inducers. They can increase the rateof synthesis of cytochrome P450 enzymes, resulting in enhanced clearance of

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other drugs. When enzyme inducers are administered to patients receivingwarfarin, a decreased effect of warfarin results. However, warfarin itself is notknown to be an enzyme inducer.

A39 E

Zyloric contains allopurinol, which requires dose-reduction in patients with liverdisease. Natrilix contains indapamide, a thiazide diuretic that should beavoided in severe liver disease. Nizoral contains ketoconazole, an antifungalagent that should be avoided in liver disease.

A40 A

Capsulitis is a disorder affecting the shoulder joint. It may be caused by un-accustomed movement or overuse. The condition is characterised by inamma-tion of the brous tissue surrounding the shoulder joint.

A41 B

Any facial lesion that is accompanied by swollen lymph glands in the neckrequires referral as this suggests systemic disease or an infection. A rash thatpresents as a buttery distribution over the nose and cheeks requires referralas this could be caused by systemic lupus erythematosus. This is a rarecondition that is associated with auto-antibody formation. A buttery rashcovering the nose and cheeks is a very characteristic symptom. A scaly rashwith mild erythema affecting the forehead and eyebrows indicates seborrhoeiceczema. This condition can extend to the nose and pinna of ears. Emollientcreams and ointments are useful in the management of this condition as theyhydrate the skin.

A42 B

Gaviscon liquid and Bisodol Heartburn Relief tablets contain sodium bicarbon-ate. Gaviscon liquid also contains sodium alginate and calcium carbonate.

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Bisodol Heartburn Relief tablets contain alginic acid and magaldrate inaddition to the sodium bicarbonate. Maalox Plus tablets contain aluminiumhydroxide, magnesium hydroxide and simeticone.

A43 A

The pain and inammation associated with a bee sting are caused by agentsthat include histamine, apamin, which is neurotoxic, and the enzymehyaluronidase, which breaks down the intercellular tissue structure, promotingthe penetration of the venom into the human tissues.

A44 B

Colofac (mebeverine) and Spasmonal (alverine) contain an antispasmodicagent, whereas Fybogel (ispaghula husk) presents a bulk-forming laxative.Alverine and mebeverine are direct relaxants of intestinal smooth muscle,which may relieve pain in irritable bowel syndrome.

A45 E

Paradichlorobenzene is an organic compound that is included in products,such as Cerumol drops, which are intended for ear wax removal. The rationalefor its inclusion is based on the ability of paradichlorobenzene to penetratethe ear wax plugs. In Cerumol it is available with chlorobutanol and arachisoil.

A46 B

Because of its antiplatelet effect, the administration of aspirin to patients receiv-ing warfarin is associated with a potentiated anticoagulant effect leading toan increased risk of bleeding. Aspirin decreases platelet aggregation byinactivating cyclo-oxygenase, an enzyme involved in the platelet aggregation

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pathway through the interference with thromboxane A2. Vitamin K is requiredfor the procoagulation activity. Aspirin does not interfere with vitamin K synthe-sis. However warfarin, which is an oral anticoagulant, acts as a vitamin Kantagonist.

A47 D

Male-pattern baldness is also referred to as androgenetic alopecia. It occurswhen genetically predisposed hair follicles in the scalp respond to stimulationby circulating androgens.

A48 A

Finasteride is an inhibitor of the enzyme 5-reductase, which is responsiblefor the metabolism of testosterone into the androgen dihydrotestosterone.Finasteride is used in benign prostatic hyperplasia and at a lower dose inmale-pattern baldness.

A49 A

Diamorphine is an opioid drug, which in many countries is classied as acontrolled drug, indicating that special prescription and dispensing require-ments are necessary. Diamorphine is more lipid soluble than morphine andthis allows for effective doses to be injected in smaller volumes. Diamorphinemay be administered by mouth, subcutaneously, intramuscularly or by intra-venous injection.

A50 A

The three drugs are used in the management of nausea and vomiting causedby palliative cancer treatment, which commonly features cytotoxics and opioiddrugs. The three drugs are useful in counteracting nausea and vomiting

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induced by opioids and cytotoxic agents. Haloperidol is also used in pallia-tive care to counteract nausea and vomiting attributable to chemical causessuch as hypercalcaemia and renal failure.

A51 D

Bacterial conjunctivitis is an eye disorder characterised by inammation of theconjunctiva caused by a bacterial infection. A common microorganism associ-ated with this condition is Staphylococcus aureus. The condition does notnecessarily affect both eyes. However, infection can be spread from one eyeto the other. The patient complains of itchiness or grittiness on the surface ofthe eye but this is differentiated from pain.

A52 E

Wet skin lesions or weeping lesions may or may not be infected. Referral isnot always warranted. It is recommended to refer when the lesion is present-ing purulent discharge, which indicates an infective component. When theexudate is clear and watery, the patient may be advised to undertake potas-sium permanganate soaks to cleanse the lesion.

A53 D

Infant formula milk preparations are manufactured to mimic as much aspossible the composition of the mothers milk. Most preparations are basedon cows milk, and modications, such as the addition of carbohydrates, aremade to achieve the formula. The fat content of infant formula milk is adjustedto be similar to mothers milk. Some preparations may substitute cows milk fatwith vegetable and animal fats that are more easily digested. Infant formulamilk preparations may be presented as ready-to-use preparations or aspowders for reconstitution. Dried milk formulations should be reconstitutedaccording to the manufacturers instructions and involve adding water to thepowder formulation.

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A54 C

Staphylococcal napkin dermatitis is a condition where a rash develops in thenapkin area. A rash that has a pustular appearance, as opposed to a con-uent red rash, which is associated with napkin dermatitis, indicates abacterial infection caused by the Staphylococcus species. A patient present-ing such symptoms should be referred as antibacterial treatment may be indi-cated. Candidal napkin dermatitis, where infection of the napkin area withCandida species occurs, is associated with oral thrush (candidiasis).

A55 C

Sialolithiasis is a condition characterised by the formation of calculi (salivarystones) in the salivary ducts or salivary glands. This leads to obstruction andhence accumulation of saliva within the gland especially when eating. Thepatient presents with facial pain and swelling, which may last for a few hours.

A56 A

A history or suspicion of a perforated ear drum requires referral for assess-ment of the damage and treatment of the condition through systemic drugadministration. Discharge may reect an infective component such as in otitismedia and infective dermatitis. Earache generally occurs with otitis media andrequires referral for diagnosis.

A57 B

Enquiry whether the symptoms are related to food intake patterns conrms thatthe origin of discomfort is in the gastrointestinal tract. Vomiting or constipationwith indigestion warrant referral because the clinical presentation mayindicate obstruction in the gastrointestinal tract.

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A58 A

Products containing adsorbents such as kaolin are not recommended for acutediarrhoea. Adsorption may interfere with the absorption of other drugs fromthe intestine. Oral rehydration therapy should be considered to be the rst-linetreatment in acute diarrhoea. Kaolin and Morphine Mixture is an oral suspen-sion that contains 4% chloroform and morphine tincture. Absorption ofmorphine after oral administration of Kaolin and Morphine may be reducedbecause it may become adsorbed to the kaolin.

A59 C

Meggezones pastilles contain menthol. They provide a soothing effect for sorethroats through the promotion of saliva secretion. The preparation containsglucose as excipients and therefore should not be recommended to diabeticpatients.

A60 A

In migraine gastric motility is reduced and this may compromise drug absorp-tion. Soluble oral drug formulations are preferred to solid oral dosage formsbecause absorption is faster. Analgesics should be taken at the rst sign ofan attack. Syndol contains paracetamol (non-opioid drug), caffeine, codeine(opioid drug) and doxylamine (antihistamine). Syndol presents a compoundanalgesic that also contains caffeine, which is a weak stimulant claimed toenhance the analgesic effect, and a sedating antihistamine that confers anti-emetic activity.

A61 B

Hydroxychloroquine and gold are examples of disease-modifyingantirheumatic drugs that can be used in the management of rheumatoid arthri-tis. Hydroxychloroquine is better tolerated than gold. Gold is associated withsevere skin reactions and blood disorders, which could be sudden and fatal.

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A62 B

Porphyrias are a group of rare disorders that are characterised by a disturbedmetabolism of porphyrin, which contributes to the formation of the iron-containing complex, haem. Attacks may be precipitated by drug adminis-tration. Progestogens are porphyrinogenic and should be avoided in patientswith porphyria.

A63 B

Goserelin is a gonadorelin analogue that can be used in prostate cancer.During the initial weeks of treatment with gonadorelin analogues, increasedproduction of testosterone may result in the progression of prostate cancer(tumour are). This stage may present with increased bone pain, back paincaused by spinal cord compression, and ureteric obstruction.

A64 D

Tacrolimus and ciclosporin are immunosuppressants. Tacrolimus is a fungalmacrolide and has a different chemical structure to ciclosporin. However, ithas a similar mode of action.

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Tacrolimus

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A65 C

Imipramine is a tricylic antidepressant and, as with all types of antidepres-sants, hyponatraemia may occur in older people. This is possibly due toinappropriate secretion of antidiuretic hormone.

A66 E

Inammation of the larynx (laryngitis) is usually due to a bacterial or viral infec-tion and is a very common condition after a common cold. When the causeof laryngitis is a bacterial infection, an antibacterial agent may be appropri-ate. Atropine is an antimuscarinic drug that can be used in the symptomaticrelief of gastrointestinal disorders characterised by smooth muscle spasm, inmydriasis and cycloplegia, for the reversal of bradycardia, and in cardio-pulmonary resuscitation.

42 Test 1: Answers

Ciclosporin

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A67 A

Lidocaine is indicated for ventricular arrhythmias, especially after myocardialinfarction, because it suppresses ventricular tachycardia and reduces the riskof ventricular brillation.

A68 A

In moderate kidney damage, the dose of atenolol should be reduced. Atenololis a highly water-soluble drug that is excreted by the kidneys. Hence it mayaccumulate in the body to a greater extent than propranolol, which is predomi-nantly excreted by the liver.

A69 C

Filgrastim is indicated for the reduction in duration of neutropenia as a resultof cytotoxic chemotherapy. Filgrastim is a recombinant human granulocyte-colony stimulating factor (G-CSF).

A70 E

When drugs are administered to breast-feeding mothers, the concentration ofsome drugs in milk may exceed the concentration in maternal plasma. Thera-peutic doses in the mother may result in toxic doses in the milk. Toxicity in theinfant depends on the drug and on the amount of drug in the milk.

A71 C

Pemphigus is a skin condition characterised by severe and chronic blistering,which is attributed to an autoimmune reaction. Oral corticosteroids are therst-line treatment. Immunosuppressants are considered either when optimummanagement is not achieved with oral corticosteroids or when corticosteroidsare not tolerated or the dose has to be decreased.

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A72 D

Ear pain during air travel when the aircraft is descending occurs when theeustachian tube, which normally equalises the pressure, is blocked andpressure inside the middle ear is less than on the outside (barotrauma). Thetympanic membrane is sucked and may rupture. Nasal decongestants may beused to prevent eustachian tube blockage hence preventing barotrauma.

A73 C

Stelazine contains triuoperazine, a phenothiazine. It may cause pancyto-penia, which includes agranulocytosis. Agranulocytosis is a condition result-ing in a marked decrease in the number of granulocytes.

A74 C

Tinnitus is an adverse effect of furosemide, especially when it is administeredin large parenteral doses, as a rapid administration and in renal impairment.Not all diuretics are associated with tinnitus.

A75 B

Increased serotonergic effects have been reported when St Johns wort is givenwith selective serotonin re-uptake inhibitors (SSRIs). Concomitant use shouldbe avoided. Sertraline is an SSRI. St Johns wort is a herbal remedy that canbe used for mild depression.

A76 E

Co-codamol preparations, which may be sold to the public as over-the-countermedicines, contain codeine 8 mg. Co-codamol is a combination of codeine(opioid drug) and paracetamol.

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A77 C

Varicella (chickenpox) is an infection caused by the varicella zoster virus,which in the acute phase is highly contagious. It is transmitted via airbornedroplets or by contact with active lesions. Varicella zoster immunoglobulin isavailable for prophylaxis for individuals who are at increased risk of severevaricella or who have signicant exposure to chickenpox or herpes zoster.

A78 D

Graduated compression hosiery is in some cases recommended during preg-nancy against the varicosis that may result. Compression with graduatedhosiery allows haemostasis to occur and therefore reduces oedema andswelling.

A79 D

Nocturnal enuresis is persistent involuntary urination during sleep and it is acommon condition in young children. Drug treatment is not appropriate inchildren under 5 years of age and it is usually not needed in those under 7years. Psychotherapy and enuresis alarms may be used. Enuresis alarmsshould be rst-line treatment for well-motivated children aged over 7 yearsbecause their use may achieve a more sustained reduction of enuresis thanthe use of drugs. Tricyclic antidepressants such as amitriptyline, imipramineand less often, nortriptyline may be used in nocturnal enuresis. However,relapse is common after drug withdrawal.

A80 D

Betahistine is an analogue of histamine and is indicated for vertigo, tinnitusand hearing loss associated with Mnires disease. Side-effects of betahistineinclude gastrointestinal disturbances, headache, rashes and pruritus.

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A81 A

Premarin is an example of a product that presents hormone replacementtherapy and contains conjugated oestrogens 625 g.

A82 E

Premarin is also available as tablets of 1.25 mg conjugated oestrogens andas a vaginal cream, which contains 625 g/g conjugated oestrogens.

A83 C

Premarin is not indicated in women with intact uterus because it does notpresent cyclical or continuous administration of progestogen. In women withintact uterus, the administration of progestogen for at least 12 days per monthreduces the risk of endometrial cancer. Hormone replacement therapy (HRT)is an option for the prophylaxis of osteoporosis and Premarin may be usedfor this purpose. However, guidelines in a number of countries advise that HRTshould not be considered as rst-line therapy for the long-term prevention ofosteoporosis in women over 50 years of age. Premarin is marketed by Wyeth.

A84 B

Progynova is another product that presents an oestrogen component only andtherefore is indicated in women without intact uterus. It contains estradiolvalerate. Nuvelle, Trisequens and Femoston are examples of products contain-ing estradiol with progestogen, whereas Prempak-C is an example of aproduct that contains conjugated oestrogens with progestogen.

A85 D

Patient should take one Premarin tablet daily and start a new pack once the28-day pack has nished. The therapy is continuous and there is no 7-day

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break. Patient should be advised to maintain regular visits to a generalpractitioner every 12 months but should be advised to seek advice from thepharmacist or the general practitioner should any symptoms that warrant with-drawal of the HRT occur. Such symptoms include sudden, severe chest pain,sudden breathlessness or cough with blood-stained sputum, unexplainedsevere pain in the calf of one leg, severe stomach pain, serious neurologicaleffects including unusually severe, prolonged headache and blood pressureabove systolic 160 mmHg and diastolic 100 mmHg.

A86 C

Fosamax contains alendronic acid, a biphosphonate that is adsorbed ontohydroxyapatite crystals in the bone resulting in a deceleration in the rate ofgrowth and dissolution of the bone. Use of alendronic acid therefore resultsin a decreased rate of bone turnover. Alendronic acid may cause oesophagealreactions and patients should be advised to seek advice if they developsymptoms of oesophageal irritation such as dysphagia.

A87 D

Fosamax Once Weekly is available as a pack containing four tablets of 70 mgstrength at a price of 22.80. At this dosage regimen, weekly treatment costsabout 6. Fosamax tablets are available in 5 mg, 10 mg and 70 mgstrengths. The patient has been prescribed one 70 mg tablet once a week.

A88 B

Combivent contains ipratropium (antimuscarinic bronchodilator) and salbuta-mol (selective beta2 agonist).

A89 C

Combivent is available as an aerosol inhalation and as a nebuliser solution.

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A90 B

Ventolin contains salbutamol and Atrovent contains ipratropium. The twoproducts can be used together to replace the combination product Combivent.Becotide contains beclometasone (corticosteroid).

A91 A

Depo-Medrone consists of methylprednisolone (corticosteroid), which is usedfor the suppression of inammatory and allergic disorders and in rheumaticdisease.

A92 D

Depo-Medrone is presented as an aqueous suspension that can be adminis-tered either by deep intramuscular injection into the gluteal muscle or by intra-articular or intrasynovial injection for rheumatic disease. Administration canbe repeated after 23 weeks or, for rheumatic disease, at intervals of 735days. Corticosteroids, including methylprednisolone, can be used in themanagement of raised intracranial pressure or in cerebral oedema resultingfrom malignancy.

A93 B

Persantin Retard contains dipyridamole which, like aspirin, is an antiplateletdrug.

A94 A

Side-effects of dipyridamole include gastrointestinal effects, worsening ofsymptoms of coronary heart disease and hot ushes.

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A95 D

The original pack of Persantin Retard contains a dessicant that protects themodied-release capsules.

A96 B

The patient should be advised to take one capsule of Persantin Retard twicedaily with food and to take one tablet of aspirin daily. Persantin Retardcapsules are unstable in humid conditions, so the patient should be advisedto open one pack and to use the capsules before opening another pack. Ifany capsules remain 6 weeks after opening a pack, they should be discarded.

A97 A

Forceval is a multivitamin preparation, which is available as adult and paedi-atric formulations (Forceval Junior capsules). Vivioptal is also a multivitaminpreparation. It is presented for children over 12 years of age and for adults.Maxepa consists of a sh-oil preparation rich in omega-3-marine triglycerides,En-De-Kay presents a uoride supplement whereas Calcium-Sandoz containscalcium salts.

A98 C

Actifed Chesty Coughs syrup contains guaifenesin (expectorant), pseudo-ephedrine (decongestant) and triprolidine (antihistamine). Benylin withCodeine syrup contains codeine (antitussive), diphenhydramine (antihistamine)and menthol. Alupent syrup contains orciprenaline, an adrenoceptor agonistindicated for reversible airways obstruction. Vicks Medinite syrup containsdextromethorphan (antitussive), doxylamine (antihistamine), ephedrine (decon-gestant) and paracetamol (analgesic and anti-pyretic). Vicks Medinite is notrecommended for children under 10 years of age. Neoclarityn syrup containsdesloratidine, a non-sedating antihistamine.

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A99 E

Ibutop gel contains ibuprofen. Brufen contains ibuprofen but the dosage formsavailable are tablets, syrup and effervescent granules. Voltarol (diclofenac)and Oruvail (ketoprofen) present other non-steroidal anti-inammatory drugsin the form of gels. Dubam products contain rubefacients.

A100 A

Canesten is presented as a vaginal cream, which contains clotrimazole, animidazole antifungal agent that is indicated in vaginal candidiasis. Ortho-Gynest is presented as an intravaginal cream that contains estriol and whichis indicated as a topical hormone replacement therapy. Eurax contains crotami-ton, an anti-pruritic, Bactroban contains mupirocin, an antibacterial agent, andDermovate contains clobetasol, a corticosteroid.

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Test 2

Questions

Questions 110

Directions: Each of the questions or incomplete statements is followed byve suggested answers. Select the best answer in each case.

Q1 All the following products are selective inhibitors of cyclo-oxygenase-2EXCEPT:

A CelebrexB ArcoxiaC MobicD FeldeneE Prexige

Q2 What is an appropriate therapeutic alternative for Pulmicort?

A ZaditenB BecotideC IntalD AtroventE Serevent

Q3 Raynauds phenomenon:

A is characterised by vasodilationB causes hot, red feetC starts as white patches of skinD is caused by a bacterial infectionE may require vasodilator treatment

51

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Q4 Leunomide:

A its therapeutic effect starts after 46 weeksB is given as an initial dose of 7.5 mgC is administered once a weekD is available only for parenteral administrationE no washout procedures are required when changing to

another product

Q5 Zanamivir:

A reduces replication of inuenza A and B virusesB reduces duration of inuenza symptoms by 3 daysC is licensed for prophylaxis of inuenzaD is available as capsulesE is licensed for use within 72 h of the rst symptoms

Q6 Diabetic retinopathy:

A is reversible changes in the lens shapeB indicates long-standing uncontrolled diabetesC presents with impaired drainage of the aqueous humourD is an example of corneal injuryE is characterised by proteolytic enzymes affecting the lens

Q7 Metolazone:

A profound diuresis may occurB is a loop diureticC is marketed as NatrilixD maximum daily dose is 20 mgE antagonises aldosterone


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Q8 All the following products contain codeine EXCEPT:

A SyndolB Solpadeine MaxC MigraleveD UniuE Panadol Extra

Q9 A signicant clinical interaction may occur if St Johns wort is adminis-tered concomitantly with:

A gliclazideB simvastatinC sertralineD amoxicillinE salbutamol

Q10 Basal cell carcinoma:

A forms metastases rapidlyB arises from a moleC may occur in scar tissueD general malaise is the presenting symptomE is associated with poor prognosis

Questions 1134

Directions: Each group of questions below consists of five letteredheadings followed by a list of numbered questions. For eachnumbered question select the one heading that is most closelyrelated to it. Each heading may be used once, more than onceor not at all.

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A losartanB valsartanC candesartanD telmisartanE lisinopril

Select, from A to E, which one of the above corresponds to the brand name:

Q11 Micardis

Q12 Cozaar

Q13 Diovan


A tramadolB dihydrocodeineC dextropropoxypheneD remifentanilE diamorphine


Q14 has fewer of the typical opioid side-effects

Q15 is preferred for use during intra-operative analgesia

Q16 enhances serotonergic and adrenergic pathways

Q17 requires smaller volumes for an equivalent effective dose of morphine


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A alfuzosinB dinoprostoneC tadalalD indometacinE ritodrine


Q18 may cause drowsiness

Q19 may cause hypokalaemia

Q20 may cause severe uterine contractions

Questions 2123 concern the following dosage regimens:

A 5 mg at nightB 20 mg in the morningC 400 g twice dailyD 150 mg twice dailyE 30 mg at night

Select, from A to E, which one of the above corresponds to the following products:

Q21 Dulco-lax tablets

Q22 Zantac tablets

Q23 Pariet tablets

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A Proctosedyl suppositoriesB rifampicin tabletsC Slow-K tabletsD isoniazid tabletsE glycerin suppositories

Select, from A to E, which one of the above corresponds to the following advice:

Q24 swallow whole with uid during meals

Q25 store between 2C and 8C

Q26 advise patient to avoid soft contact lens wear


A Gaviscon Advance suspensionB Dentinox dropsC Eno saltsD Actonorm gelE Rennie tablets

Select, from A to E, which of the above:

Q27 contains sodium bicarbonate

Q28 is suitable for a patient with symptoms of mild gastro-oesophageal reuxdisease

Q29 contains calcium salts

Q30 is a preparation that contains simeticone only as active ingredient


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Questions 3134 concern the following tablet descriptions:

A greyish-red 25 mgB m/r pink 10 mgC m/r grey-red 75 mgD orange scored 100 mgE white scored 5 mg

Select, from A to E, which one of the above corresponds to the following proprietarypreparation:

Q31 Adalat

Q32 Tenormin

Q33 Anafranil

Q34 Ludiomil

Questions 3560

Directions: For each of the questions below, ONE or MORE of theresponses is (are) correct. Decide which of the responses is(are) correct. Then choose:

A if 1, 2 and 3 are correctB if 1 and 2 only are correctC if 2 and 3 only are correctD if 1 only is correctE if 3 only is correct


A B C D E

1, 2, 3 1, 2 only 2, 3 only 1 only 3 only

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Q35 According to good practice, when dispensing a medication thepharmacist is required to:

1 provide written instructions2 provide verbal advice3 ask whether the patient has any problems with the medication

Q36 When a patient presents with symptoms of a musculoskeletal disorderin the neck and arms, which of the following points should be givenpriority by the pharmacist when assessing the symptoms?

1 stiffness and numbness2 sustained injury3 itchiness

Q37 In a community pharmacy, the managing pharmacist should ensure thatthe dispensing equipment:

1 is stored in a clean place2 is cleaned after use3 is securely locked and accessible only to pharmacists

Q38 A female patient presents with uncomplicated symptoms of painful,frequent and urgent urination. When recommending management of thecondition, the pharmacist should prioritise:

1 explaining to the patient about personal hygiene2 recommending medications that alkalinise the urine3 advising the patient to drink large volumes of uid

Q39 Which of the following agents is (are) used in fungating growth in pallia-tive care?

1 metronidazole2 amoxicillin3 nitrofurantoin


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Q40 Paracetamol overdose:

1 occurs with the ingestion within 24 h of 4 g2 early features are hyperventilation and sweating3 liver damage is maximal 34 days after ingestion

Q41 Which of the following drugs require a dose-reduction in patients withsevere renal impairment?

1 cefaclor2 amoxicillin3 insulin

Q42 Follitropin alfa:

1 may be administered by subcutaneous injection2 is used in the treatment of infertility in women3 infertility caused by thyroid disorders should be ruled out

before administration

Q43 Potentially hazardous interactions could occur between:

1 memantine and Night Nurse2 tacrolimus and grapefruit juice3 carbamazepine and co-proxamol

Q44 Remicade:

1 inhibits activity of tumour necrosis factor2 is used in rheumatoid arthritis when the patient has not

responded to other disease-modifying antirheumatic drugs3 the patient should be instructed to seek advice if symptoms

suggestive of tuberculosis occur

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Q45 Varicella-zoster vaccine:

1 is a live attenuated vaccine2 is indicated for routine immunisation in children3 is available in two strengths

Q46 Liver function should be monitored when treatment is started with whichof the following drugs?

1 rosiglitazone2 carvedilol3 insulin

Q47 Cough preparations that can be used in a patient with hyperthyroidismcomplaining of a chesty cough include:

1 Mucodyne2 Actifed Chesty Coughs3 Day Nurse

Q48 Locabiotal:

1 is an anti-infective preparation2 may be administered nasally or in the oral cavity3 is indicated for rst-line treatment of bacterial sinusitis

Q49 Which of the following drugs should be avoided with statins?

1 gembrozil2 digoxin3 co-amoxiclav


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Q50 Propofol:

1 is administered by inhalation2 may be used for the induction of anaesthesia in paediatric

patients3 is associated with minimal hangover effects

Q51 Pyridoxine:

1 deciency may occur during isoniazid therapy2 may be used daily for the management of premenstrual

syndrome3 is a precursor of prostaglandin E1

Q52 Effective product(s) for the prophylaxis of motion sickness that can betaken 30 minutes before travelling is (are):

1 cetirizine2 cinnarizine3 hyoscine

Q53 Witch hazel

1 contains avonoids and tannins2 has astringent and anti-inammatory properties3 is indicated for the management of psoriasis

Q54 Leptospirosis:

1 is caused by a parasitic microorganism found on dogs2 onset is sudden3 symptoms are similar to inuenza but may include abdominal

pain and vomiting

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Q55 Venous ulcers:

1 generally occur on the lower leg2 patients should be encouraged to exercise3 patients should be advised not to use compression bandages

Q56 Cushings syndrome:

1 hypersecretion of hydrocortisone occurs2 may be caused by long-term systemic administration of

prednisolone at high doses3 is characterised by loss of weight

Q57 Juvenile rheumatoid arthritis:

1 has a poor prognosis2 affects predominantly lower limbs3 bladder function may be impaired

Q58 Dorzolamide:

1 may be used in conjunction with timolol2 may cause eyelid inammation and crusting3 blood count should be monitored

Q59 Aerodiol:

1 contains an oestrogen component only2 may be used with cyclical progestogen3 is presented as a nasal spray


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Q60 Imatinib:

1 may cause nephrotoxicity2 is given intravenously3 is used in chronic myeloid leukaemia

Questions 6180

Directions: The following questions consist of a rst statement followedby a second statement. Decide whether the rst statement istrue or false. Decide whether the second statement is true orfalse. Then choose:

A if both statements are true and the second statement is acorrect explanation of the rst statement

B if both statements are true but the second statement is NOTa correct explanation of the rst statement

C if the rst statement is true but the second statement is falseD if the rst statement is false but the second statement is trueE if both statements are false


First statement Second statement

A True True Second statement is a correct


B True True Second statement is NOT a correct


C True False

D False True

E False False

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Q61 No important differences have been found between the major classes ofantihypertensive drugs in terms of efcacy. The choice of antihyperten-sive drugs depends on contraindications.

Q62 Citalopram should not be use

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