Thu, 03/05/2009 - 10:39 -- CDPulse Admin

Test your knowledge ahead of the pre-reg exam with C+D's Pre-reg Exam Q&A.Every week we will publish a quick question. All you need to do is think about your response before scrolling down to the answer and explanation. Why not see if you can beat your tutor?The Pre-reg Exam Q&A will feature in the C+D email newsletter each week. To ensure you get your weekly reminder sign up at www.chemistanddruggist.co.uk/register





The Questions

 Latest questions



1

Closed  Book (No references allowed)


Multiple Completion 

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


A if 1,2 and 3 are correct

B if 1 and 2 only are correct

C if 2 and 3 only are correct

D if 1 only is correct

E if 3 only is correct


Directions Summarised

A

1,2,3

B

1,2

C

2,3

D

1 only

E

3 only

 

The Responsible Pharmacist Regulations 2008, which come into force on 1 October this year, will replace the following provisions in the Medicines Act 1968.

 

1.      Personal control

2.      Supervision

3.      Superintendent pharmacist

 

Answer


2

Open Book (References allowed: BNF 56; MEP 32; Drug Tariff [England and Wales] Feb 2008)

 

Simple Completion

Directions: The question is followed by five suggested answers. Select the best answer.


A one year old child has been found to be anaemic. The child's mother brings in to your pharmacy a prescription issued by a hospital paediatrician for sodium feredetate elixir, 2.75mg iron/kg daily. Assuming that the child is of average weight for its age, what dosage of the elixir would you supply?


A 1.25 ml daily

B 1.25 ml twice daily

C 2.5ml daily

D 2.5ml twice daily

E 5ml twice daily


Answer


3

Open Book (References allowed: BNF 56; MEP 32; Drug Tariff [England and Wales] Feb 2008)

 

Simple Completion

Directions: The question is followed by five suggested answers. Select the best answer.


In your pharmacy you offer a cardiovascular risk assessment service, based on blood pressure and serum cholesterol levels. Based on NHS recommendations and assuming that they have no other risk factors for CVD (including diabetes), which one of the following would you refer to their GP for further investigation because they have a greater than 10 per cent risk of developing cardiovascular disease over the next 10 years?


A. A 45 year old male smoker with systolic blood pressure (SBP) 110 mmHg and a ratio of total serum cholesterol to HDL cholesterol (TC:HDL) of 4

B. A 45 year old male non-smoker with SBP 130mmHg and TC:HDL 5

C. A 50 year old male non-smoker with SBP 110mmHg and TC:HDL 4

D. A 55 year old female smoker with SBP 120mmHg and TC:HDL 5

E. A 60 year old female smoker with SBP 110mmHg and TC:HDL 3.5


Answer


4

Closed Book (No references allowed)

 

Simple Completion

Directions: The question is followed by five suggested answers. Select the best answer.


The supply of which one of the following would be unlawful? Select the best answer.


A. A prescription for six weeks supply of a Schedule 2 Controlled Drug issued three weeks previously (and not forward dated).

B. A prescription for 28 days supply of a Schedule 3 Controlled Drug issued six weeks previously (and not forward dated).

C. A  prescription for 28 days supply of a Schedule 2 Controlled Drug issued three weeks previously (and not forward dated), with the total quantity written only in figures.

D. A  repeat supply, made six weeks after the original dispensing, of a Schedule 4 Controlled Drug for which repeats are allowed, on a private prescription requesting one repeat but with no specification, either of the date or length of time after the initial supply, as to when the repeat is to be made.

E. A repeat supply, made one year after the original dispensing, of a Schedule 5 Controlled Drug on a private prescription requesting one repeat, but with no specification, either of the date or length of time after the initial supply, as to when the repeat is to be made.


Answer


5

The following question consists of two statements. Decide whether the first statement is true or false. And decide whether the second statement is true or false.

 

First statement

Lyclear SprayAway is not allowable on an NHS prescription.


Second statement

Lyclear SprayAway is not a licensed medicine but a medical device.


Then choose:

 

A.         If both statements are true and the second statement is a correct explanation of the first statement.

B.         If both statements are true but the second statement is not a correct explanation of the first statement.

C.         If the first statement is true but the second statement is false.

D.         If the first statement is false but the second statement is true.

E.         If both statements are false.

 

Directions Summarised


 First statement Second statement    
ATrue True 2nd statement is a correct explanation of the first 
BTrue True 2nd statement is not a correct explanation of the first
CTrue False    
DFalse   True  
EFalse   False    


This is an open book question (references allowed: BNF 56; MEP 32; Drug Tariff [England and Wales] Feb 2009; Scottish Drug Tariff Feb 2009)


Answer


6

In order to make 200ml of Gentian Mixture Alkaline BP, which contains 50 per cent double strength chloroform water, you would need to use:


1. 0.25ml of chloroform

2. 2.5ml of concentrated chloroform water, which contains 10 per cent chloroform

3. 10ml of chloroform spirit, which contains chloroform 1 part in 20


One or more of the responses below is (are) correct. Decide which of the responses is (are) correct. Then choose:


A if 1, 2 and 3 are correct

B if 1 and 2 only are correct

C if 2 and 3 only are correct

D if 1 only is correct

E if 3 only is correct

 

Directions Summarised

A

1,2,3

B

1,2

C

2,3

D

1 only

E

3 only


This is a closed book question and no references are allowed


Answer


7

The question consists of four lettered headings followed by a list of numbered questions. For each numbered question select the one heading which is most closely related to it. Each heading may be used once, more than once, or not at all.


Which one of the over-the counter medicines (select from A to D) should not be sold to a patient who is taking one of the prescription medicines below:


A Dulcolax tablets (bisacodyl)

B Imodium capsules (loperamide)

C Nurofen tablets (ibuprofen)

D Sudafed tablets (pseudoephedrine)


1. Lithium carbonate

2. Phenelzine


This is a closed book question and no references are allowed


Answer

 

8

Open Book (References allowed: BNF 56; MEP 32; Drug Tariff [England and Wales] Feb 2009, Scottish Drug Tariff Feb 2009)

 

Simple Completion

Directions: The question is followed by five suggested answers. Select the best answer.


A patient with hypertension has been prescribed Gaviscon Advance suspension. The prescriber does not want the patient’s intake of sodium from the preparation to exceed 20mmol per day.  What is the maximum dose that the patient can take?


 A. 1 x 5 mL spoonful four times daily

B. 2 x 5 mL spoonfuls three times daily

C. 1 x 5mL spoonful five times daily

D. 3 x 5ml spoonfuls three times daily

E. 2 x 5mL spoonfuls four times daily


Answer 


9

Closed  Book (No references allowed)

 

Multiple Completion 

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


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


A if 1,2 and 3 are correct

B if 1 and 2 only are correct

C if 2 and 3 only are correct

D if 1 only is correct

E if 3 only is correct


Directions Summarised

A

1,2,3

B

1,2

C

2,3

D

1 only

E

3 only


Which of the following symptoms might indicate that a patient who is taking levothyroxine is on too high a dose?

 

1. Diarrhoea

2. Sweating

3. Weight gain

 

Answer


10



Open Book (References allowed: BNF 57; MEP 32; Drug Tariff [England and Wales] Feb 2009, Scottish Drug Tariff Feb 2009)

 

Simple Completion

Directions: The question is followed by five suggested answers. Select the best answer.


A 32 year old female has presented at A&E saying that she took around 20 paracetamol tablets in a suicide attempt about 6 hours ago but now regrets her action. On questioning, she says that she takes no prescribed medication but has been taking a self-prescribed St John’s wort herbal medicine for depression for several weeks. A blood sample shows a plasma-paracetamol concentration of 75mg/litre. The patient weighs 60kg.


Which one of the following statements is correct?


A. Treatment with an antidote is not necessary

B. The patient should be treated with a total of 18g of acetylcysteine by intravenous infusion

C. The treatment should be administered over a total of 24 hours

D. The total volume of intravenous infusion to be administered is 1.5 litres

E. The preferred infusion vehicle is sodium chloride 0.9% solution


Answer



11



Open Book (References allowed: BNF 57; MEP 32; Drug Tariff [England and Wales] and Scottish Drug Tariff, April 2008)

Multiple Completion
Directions:  For the question below, ONE or MORE of the responses is (are) correct. Decide which of the responses is (are) correct. Then choose:

A if 1,2 and 3 are correct
B if 1 and 2 only are correct
C if 2 and 3 only are correct
D if 1 only is correct
E if 3 only is correct

Directions Summarised
A
1,2,3
B
1,2
C
2,3
D
1 only
E
3 only

You receive a prescription from a veterinary practitioner for latanoprost eye drops for a dog. The prescription includes the statement, “Prescribed under cascade”.

1.      Latanoprost is indicated for glaucoma
2.      Latanoprost eye drops are not licensed for animal use
3.      You should not dispense the prescription

Answer



12

Open Book (References allowed: BNF 57; MEP 32; Drug Tariff [England and Wales] April 2009, Scottish Drug Tariff April 2009)

Simple Completion
Directions: The question is followed by five suggested answers. Select the best answer.

You receive the following prescription requesting ibuprofen oral suspension, 10mg/kg tds for 10 days, for a 1 year old child of average weight. What volume needs to be dispensed?

A.      50mL

B.     100 mL

C.     150mL

D.     200mL

E.     300mL




Answer



13


Open Book (References allowed: BNF 56; MEP 32; Drug Tariff [England and Wales] Feb 2008)

Assertion/Reason


Directions. The following question consists of a statement in the left hand column followed by a second statement in the right hand column.


Decide whether the first statement is true or false.


Decide whether the second statement is true or false.


Then choose:


A.         If both statements are true and the second statement is a correct explanation of the first statement.


B.        If both statements are true but the second statement is not a correct explanation of the first statement.


C.        If the first statement is true but the second statement is false.


D.        If the first statement is false but the second statement is true.


E.         If both statements are false.


Directions Summarised

First statement
Second statement

A
True
True
2nd statement is a correct explanation of the first
B
True
True
2nd statement is not a correct explanation of the first
C
True
False

D
False
True

E
False
False


A patient is terminally ill with cancer and has been using fentanyl ‘25’ patches as they cannot swallow tablets. The patches have been becoming less effective and her GP has asked you to suggest a suitable modified-release oral morphine preparation, at a strength and dose equivalent to one-third higher than the daily dose the fentanyl patches are providing. Acting on your suggestion the GP provides a prescription, the relevant portion of which reads:
“MST Continus suspension 60mg. Take one every 12 hours. Supply 30 sachets.”
 
First statement
Second statement
You are unable to dispense the prescription.
The strength and dose on it do not correspond to what the GP asked for, and the total quantity has not been specified in words and figures.




Answer



14


Open Book (References allowed: BNF 57; MEP 32; Drug Tariff [England and Wales], Scottish Drug Tariff (May 2009)


Classification

 

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

 

A if 1,2 and 3 are correct

B if 1 and 2 only are correct

C if 2 and 3 only are correct

D if 1 only is correct

E if 3 only is correct

 

Direction Summarised

A

1,2,3

B

1,2

C

2,3

D

1 only

E

3 only

 

 

Yellow Card reports should be submitted for:

 

1        All serious and minor suspected adverse reactions to any medicine in children under 16 years of age

 

2        All serious and minor suspected adverse reactions to intensely monitored medicines

 

3    All serious and minor suspected adverse reactions to herbal remedies


Answer



15.


Closed  Book (No references allowed)

Simple Completion

Directions: The question is followed by five suggested answers. Select the best answer.


A pregnant woman taking medication for which one of the following conditions is at increased risk of giving birth to a baby with spina bifida?


A.        Asthma


B.        Crohn’s disease


C.        Diabetes


D.        Epilepsy


E.        Hypertension


Answer




16


Closed Book (No references allowed)
Multiple Completion
Directions:  For the question below, ONE or MORE of the responses is (are) correct. Decide which of the responses is (are) correct. Then choose:

A if 1,2 and 3 are correct
B if 1 and 2 only are correct
C if 2 and 3 only are correct
D if 1 only is correct
E if 3 only is correct

Directions Summarised
A
1,2,3
B
1,2
C
2,3
D
1 only
E
3 only

For which of the following could you lawfully make an emergency supply of a prescription only medicine at the request of a patient?

1.      A person who has previously been prescribed the medicine by a doctor in France

2.      A person who has previously been prescribed the medicine by a dentist in Germany

3.      A person who has previously been prescribed the medicine by a dentist in the United Kingdom



Answer



17


Closed Book (No references allowed)

Your pharmacy participates in a ‘Heart Health’ scheme run by your local PCT, in which you measure patients’ height, weight, blood pressure and, depending on results, offer lifestyle advice or refer them to their GP. A 40 year old male patient weighs 70 kg and is 1.8 metres in height. His blood pressure is 160/110mmHg.

Assertion/Reason
Directions. The following question consists of a statement in the left hand column followed by a second statement in the right hand column.
Decide whether the first statement is true or false.
Decide whether the second statement is true or false.
Then choose:
A.         If both statements are true and the second statement is a correct      explanation of the first statement.
B.        If both statements are true but the second statement is not a correct            explanation of the first statement.
C.        If the first statement is true but the second statement is false.
D.        If the first statement is false but the second statement is true.
E.         If both statements are false. 
First statement
Second statement
He should be referred to his GP.
 
He is overweight.

Directions Summarised

First statement
Second statement

A
True
True
2nd statement is a correct explanation of the first
B
True
True
2nd statement is not a correct explanation of the first
C
True
False

D
False
True

E
False
False



Answer



18


Open Book (References allowed: BNF 57; MEP 32; Drug Tariff [England and Wales] April 2008)

Simple Completion
Directions: The question is followed by five suggested answers. Select the best answer.

What is the correct formula for 100g of a cream containing: hydrocortisone butyrate 25mg and clotrimazole 500mg, using Locoid Cream, Canesten Cream and, if required, Aqueous Cream as diluent?
      A    Locoid Cream 50g, Canesten Cream 50g, Aqueous Cream 0g (not required)
      B    Locoid Cream 25g, Canesten Cream 75g, Aqueous Cream 0g (not required)
C   Locoid Cream 50g, Canesten Cream 25g, Aqueous Cream 25g
D   Locoid Cream 25g, Canesten Cream 50g, Aqueous Cream 25g

E    Locoid Cream 25g, Canesten Cream 25g, Aqueous Cream 50g

Answer


19


Open Book (References allowed: BNF 57; MEP 32; Drug Tariff [England and Wales], Scottish Drug Tariff, June 2009)



Multiple Completion


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


A if 1,2 and 3 are correct


B if 1 and 2 only are correct


C if 2 and 3 only are correct


D if 1 only is correct


E if 3 only is correct


Directions Summarised
A
1,2,3
B
1,2
C
2,3
D
1 only
E
3 only

A local GP wants to prescribe a fluoride supplement for a seven year old child, and asks you to recommend a preparation. You have contacted the local water company and have been told that the water supply contains 0.5 parts fluoride per million. Which of the following preparations could you recommend to the GP?

1        En-De Kay Fluotabs 6+ years


2        Fluor-a day Tablets 1.1mg


3      Fluorigard Tablets 0.5


Answer


20.


Open Book (References allowed: BNF 57; MEP 32; Drug Tariff [England and Wales], Scottish Drug Tariff, June 2009)Assertion/Reason

Directions. The following question consists of a statement in the left hand column followed by a second statement in the right hand column.

Decide whether the first statement is true or false.

Decide whether the second statement is true or false.

Then choose:

A. If both statements are true and the second statement is a correct   explanation of the first statement.

B. If both statements are true but the second statement is not a correct          explanation of the first statement.

C. If the first statement is true but the second statement is false.

D. If the first statement is false but the second statement is true.

E. If both statements are false.

 

Directions Summarised


First statement

Second statement


A

True

True

2nd statement is a correct explanation of the first

B

True

True

2nd statement is not a correct explanation of the first

C

True

False


D

False

True


E

False

False

 

 

Question

One of your regular customers, who runs a small local factory, wishes to buy from your pharmacy some carbon tetrachloride to use as an industrial solvent.

 

First statement

You may supply the carbon tetrachloride.

 

Second statement

Carbon tetrachloride is a chemical that you can sell so long as you know the purchaser to be a person to whom it may properly be sold.


Answer


21


Closed Book (No references allowed)

Simple Completion
Directions: The question is followed by five suggested answers. Select the best answer.

Question
Which one of the of the following side-effects of antipsychotic drugs relates exclusively to males?

A    Akathisia

B    Dystonia

C   Galactorrhoea

D   Gynaecomastia

E    Tardive dyskinesia

Answer



22.


Closed  book (No references allowed)Classification Directions:  There are four headings below, followed by three questions relating to charges for private prescriptions. For each question select the one heading which is the most closely related to it. Each heading may be used once, more than once, or not at all.

            A          £9.20

 

            B          £9.50  

 

C         £10.90

 

D         £11.20

 

For private prescriptions, a community pharmacy charges 25 per cent on the net cost of the item plus a £2 dispensing fee. If the net cost of an item is £6, which one of the above prices should be charged for: 1.      A private prescription for a 66 year old man2.      A private prescription for an 8 year old girl 3.      A veterinary prescription for a dog

 



Answer



23


Closed book (No references allowed)

Simple completion                           
The question is followed by five suggested answers. Select the best answer.

1.      A patient with non-insulin dependent diabetes has been admitted to the ward for which you are the clinical pharmacist, to investigate the cause of his poor blood glucose control. He takes gliclazide tablets to control his blood glucose levels. Which one of the other medicines he takes, listed below, is the most likely to have adversely affected his blood glucose levels?

A    aspirin 75mg tablets, i om

B    bendroflumethiazide 5mg tablets, i om

C   prazosin 1mg tablets, i tds

D   simvastatin 20mg tablets, i on

E    tramadol 100mg tablets, i qds

Answer



24


Closed book (No references allowed)


Simple completion                           


The question is followed by five suggested answers. Select the best answer.


The following is an extract from a prescription:

Norethisterone 5 mg tablets, one tds from day 5 to 24 of menstrual cycle, supply 4 cycles.

 How many tablets should you supply?

A.      168

B.     252

C.     320

D.     228

E.     240

Answer



25


Open book (References allowed: BNF 57; MEP 33; Drug Tariff [England and Wales], Scottish Drug Tariff, July 2009)

Assertion/Reason
Directions. The following question consists of a statement in the left hand column followed by a second statement in the right hand column.
Decide whether the first statement is true or false.
Decide whether the second statement is true or false.
Then choose:
A.         If both statements are true and the second statement is a correct      explanation of the first statement.
B.        If both statements are true but the second statement is not a correct            explanation of the first statement.
C.        If the first statement is true but the second statement is false.
D.        If the first statement is false but the second statement is true.
E.         If both statements are false.


Directions summarised

First statement
Second statement

A
True
True
2nd statement is a correct explanation of the first
B
True
True
2nd statement is not a correct explanation of the first
C
True
False

D
False
True

E
False
False


You receive a prescription for 60 Tasmar 100mg tablets. You have not had a prescription for this drug before and, as it is issued by a GP for a patient who are both quite distant from your pharmacy, you think it is unlikely that you will receive another and make a ‘broken bulk’ claim for a complete pack of 100 tablets. Three months later you receive another prescription for 60 Tasmar 100mg tablets and, as you think it unlikely that you will receive another prescription, you make another ‘broken bulk’ claim for 100 tablets.  

First statement
Second statement
For the second claim you will be paid for 60 tablets only. 
A contractor is reimbursed for the full pack against the first broken bulk claim but, for any subsequent prescription for that drug within the following six months, will only be reimbursed for the actual quantity supplied against that prescription.



Answer


 26


Closed book (No references allowed)
Multiple completion
Directions:  For the question below, ONE or MORE of the responses is (are) correct. Decide which of the responses is (are) correct. Then choose:
A if 1, 2 and 3 are correct
B if 1 and 2 only are correct
C if 2 and 3 only are correct
D if 1 only is correct
E if 3 only is correct

Directions summarised
A
1,2,3
B
1,2
C
2,3
D
1 only
E
3 only

You have been requested to prepare, for an eight year old child with juvenile myxoedema, a suspension of levothyroxine at a dose of 45 micrograms daily. Because of stability considerations you will only prepare 10 days’ supply at a time. The formula you are going to use includes Concentrated Chloroform Water 2.5ml per 100ml suspension, but you only have available either chloroform or Chloroform Water Double Strength. You are going to make the suspension using levothyroxine 0.05mg tablets, with the daily dose in 5ml of suspension. For each 10 day batch:

  • 90 levothyroxine 0.05mg tablets are required.
  • If Chloroform Water Double Strength was used, the amount required would be 25ml.
  • If chloroform was used, 0.125ml would be required.

  •  Answer


    27


    Closed book (No references allowed)


    Multiple completion
    Directions:  For the question below, ONE or MORE of the responses is (are) correct. Decide which of the responses is (are) correct. Then choose:
    A if 1, 2 and 3 are correct
    B if 1 and 2 only are correct
    C if 2 and 3 only are correct
    D if 1 only is correct
    E if 3 only is correct

    Directions summarised
    A
    1,2,3
    B
    1,2
    C
    2,3
    D
    1 only
    E
    3 only

    A locum pharmacist has been reported to the Royal Pharmaceutical Society for being drunk on duty. No other misconduct has been reported. The Society would normally:

    1.      Suspend him from practice immediately

    2.     Refer his case to the Disciplinary Committee

    3.      Remove his name from the Register of Pharmacists if the allegation of drunkenness was proven



    Answer


    28


    Open book (References allowed: BNF 58; MEP 33; Drug Tariff [England and Wales], Scottish Drug Tariff, October 2009)


    Multiple completion


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


    A if 1, 2 and 3 are correct


    B if 1 and 2 only are correct


    C if 2 and 3 only are correct


    D if 1 only is correct


    E if 3 only is correct

    Directions summarised
    A
    1,2,3
    B
    1,2
    C
    2,3
    D
    1 only
    E
    3 only

    Which of the following is a Prescription Only Medicine?

    1.      A pack of 100 aspirin 325mg tablets (non-effervescent)
    2.      A pack of 100 paracetamol 500mg tablets (non-effervescent)
    3.      A pack of 100 co-codamol (8/500) tablets (effervescent)

    Answer 


    29.


    Closed book (No references allowed)

    Simple completion


    Directions: The question is followed by five suggested answers. Select the best answer.


    Which one of the following would not be entitled to free NHS prescriptions?

     

    A: A woman with a two year-old child, in Wales


    B: A 55 year-old man with diabetes which is being treated by diet alone but is receiving medication for hypertension, in Scotland


    C: A 20 year-old full-time university undergraduate, in Wales


    D: An 18 year-old full-time university undergraduate, in England


    E: A 60 year-old woman with diabetes which is being treated by diet alone but is receiving medication for hypertension, in England



    Answer


    30


    Closed book (No references allowed)

    Assertion/Reason
    Directions. The following question consists of a statement in the left hand column followed by a second statement in the right hand column.
    Decide whether the first statement is true or false.
    Decide whether the second statement is true or false.
    Then choose:
    A.         If both statements are true and the second statement is a correct             explanation of the first statement.
    B.        If both statements are true but the second statement is not a correct            explanation of the first statement.
    C.        If the first statement is true but the second statement is false.
    D.        If the first statement is false but the second statement is true.
    E.         If both statements are false.


    Directions Summarised

    First statement
    Second statement

    A
    True
    True
    2nd statement is a correct explanation of the first
    B
    True
    True
    2nd statement is not a correct explanation of the first
    C
    True
    False

    D
    False
    True

    E
    False
    False


    You have to supply 5 litres of a solution containing 150 mmol/l of sodium chloride. You have been told that you can supply physiological (normal) saline if it is within 5 per cent of the required concentration, otherwise you will have to prepare the solution extemporaneously. (Molecular weight of sodium chloride = 58.5) 

    First statement
    Second statement
    You could supply physiological (normal) saline
    Physiological (normal) saline contains within 5 per cent of 0.15 mol sodium chloride per litre. 



    Answer


    31


    Closed book (No references allowed)

    Multiple completion
    Directions:  For the question below, ONE or MORE of the responses is (are) correct. Decide which of the responses is (are) correct. Then choose:
    A if 1, 2 and 3 are correct
    B if 1 and 2 only are correct
    C if 2 and 3 only are correct
    D if 1 only is correct
    E if 3 only is correct

    Directions summarised
    A
    1,2,3
    B
    1,2
    C
    2,3
    D
    1 only
    E
    3 only

    Which of the following must be kept in safe custody?

    1.      Buprenorphine ‘5’ transdermal patches

    2.      Temazepam oral solution 10mg/5ml

    3.      Phenobarbital 60mg tablets 


    Answer


    32


    Open book (References allowed: BNF 58; MEP 33; Drug Tariff [England and Wales]; Scottish Drug Tariff, August 2009).
    Multiple completion
    Directions:  For the question below, ONE or MORE of the responses is (are) correct. Decide which of the responses is (are) correct. Then choose:
    A if 1, 2 and 3 are correct
    B if 1 and 2 only are correct
    C if 2 and 3 only are correct
    D if 1 only is correct
    E if 3 only is correct

    Directions summarised
    A
    1,2,3
    B
    1,2
    C
    2,3
    D
    1 only
    E
    3 only

    A patient’s asthma has been well controlled for the past year with inhaled salbutamol and salmeterol and theophylline tabets. He was also a long-term smoker but has given up, without any therapeutic aid, in the last few days. He comes to you complaining that he is suffering some unpleasant symptoms. Which of the symptoms below are likely to be due to nicotine withdrawal?

    1.      Dizziness
    2.      Chesty cough
    3.      Nausea

    Answer 



    33
    Open book (References allowed: BNF 58; MEP 33; Drug Tariff [England and Wales], Scottish Drug Tariff, August 2009)
    Simple completion

    Directions: The question is followed by five suggested answers. Select the best answer.

    A 1 year-old child of average size for her age is prescribed zidovudine oral solution 400mg/m2 daily, given in four doses. A 10ml oral syringe is supplied with the solution, and you are allowed to approximate the dose to the nearest millilitre. What volume would you need for a 30 day supply?   


    A.      900ml

    B.     600ml

    C.     450ml

    D.     300ml

    E.     150ml 

    Answer


    34:




    Closed book (No references allowed)
    Multiple completion
    Directions:  For the question below, ONE or MORE of the responses is (are) correct. Decide which of the responses is (are) correct. Then choose:
    A if 1, 2 and 3 are correct
    B if 1 and 2 only are correct
    C if 2 and 3 only are correct
    D if 1 only is correct
    E if 3 only is correct

    Directions summarised
    A
    1,2,3
    B
    1,2
    C
    2,3
    D
    1 only
    E
    3 only

    The legal provisions of the Responsible Pharmacist Regulations:

    1.      Require the responsible pharmacist to display in the pharmacy his or her registration certificate.
    2.      Permit the responsible pharmacist to be absent from the pharmacy for up to two hours per day, for professional duties only.
    3.      Require the responsible pharmacist to maintain and review pharmacy procedures (standard operating procedures) relating to professional aspects of the running of the pharmacy.


    Answer


    35


    Closed book (No references allowed)

    Simple completion

    Directions: The question is followed by five suggested answers. Select the best answer.

    What is the infusion rate per hour of an intravenous infusion containing dopexamine 400 micrograms/ml in 0.9 per cent sodium chloride, for a patient weighing 72kg who is prescribed a dose of dopexamine of 500 nanograms/kg/minute?  

    A.      2.7 ml

    B.     5.4 ml

    C.     10.8ml

    D.     27 ml

    E.     54 ml

    Answer


    36


    Closed book (No references allowed)

    Classification

    Directions: The questions below consist of four lettered headings followed by a list of numbered questions. For each numbered question select the one heading which is most closely related to it. Each heading may be used once, more than once, or not at all.


                A          Alendronic acid tablets

                B          Amiodarone tablets    

    C         Naproxen tablets

                D         Phenytoin tablets

               
    Select from A to D, for which of the above drugs the advice below should be given to a patient:

    1.      Take at least 30minutes before a meal

    2.      Swallow whole with plenty of water

    Answer


    37


    Closed book (No references allowed)


    Simple completion


    Directions: The question is followed by five suggested answers. Select the best answer.


    For which one of the following patients could you recommend sodium citrate sachets for the treatment of cystitis symptoms? (Assume that these patients are taking no medication other than that mentioned).


    A.      A woman of 45 who is taking bendroflumethiazide

    B.     A man of 30 who is taking diclofenac

    C.     A woman of 60 who is taking carbamazepine

    D.     A woman of 45 who is taking lithium carbonate

    E.     A pregnant woman of 25 who is taking no medication

    Answer


    38: 


    Open book* (References allowed: BNF 58; MEP 33; Drug Tariff [England and Wales], Scottish Drug Tariff, October 2009)

    Simple completion
    Directions: The question is followed by five suggested answers. Select the best answer.

    You are required to prepare 20 litres of a 0.2 per cent solution of chlorhexidine from a 1 in 20 solution. The volume of the 1 in 20 solution you will require is:

    A.      80ml

    B.     200ml

    C.     400ml

    D.     800ml

    E.     1200ml

    Answer



    39:

    Open Book (References allowed: BNF 58; MEP 33; Drug Tariff [England and Wales], Scottish Drug Tariff, October 2009)

    Assertion/Reason
    Directions: The following question consists of a statement in the left hand column followed by a second statement in the right hand column.
    Decide whether the first statement is true or false.
    Decide whether the second statement is true or false.
    Then choose:
    A.         If both statements are true and the second statement is a correct      explanation of the first statement.
    B.        If both statements are true but the second statement is not a correct            explanation of the first statement.
    C.        If the first statement is true but the second statement is false.
    D.        If the first statement is false but the second statement is true.
    E.         If both statements are false.


    Directions summarised

    First statement
    Second statement

    A
    True
    True
    2nd statement is a correct explanation of the first
    B
    True
    True
    2nd statement is not a correct explanation of the first
    C
    True
    False

    D
    False
    True

    E
    False
    False


    In your community pharmacy you receive an NHS prescription for “omeprazole 20mg capsules (Teva)”. The brand of generic omeprazole 20mg capsules that your pharmacy currently stocks is Actavis.
    First statement
    Second statement
    You may not supply the Actavis brand against this prescription. 
    Where a prescription for a generic product specifies the name of a manufacturer or supplier, it is a legal and ethical requirement that that specific product must be supplied.


    Answer


    40:


    Closed book (No references allowed)
    Simple completion
    Directions: The question is followed by five suggested answers. Select the best answer.

    Which one of the following statements about supply of non-prescription medicines is correct?

    A.      Hydrocortisone 1 per cent cream is licensed for use in children of six years and over.

    B.     Naproxen 250mg tablets are licensed for the treatment of dysmenorrhoea only.

    C.     Chloramphenicol 1 per cent eye ointment is licensed for the treatment of conjunctivitis and styes.

    D.     Diclofenac 12.5mg tablets are licensed for the treatment of muscular and rheumatic pain only.

    E.     Trimethoprim 100mg tablets are licensed for the treatment of cystitis.

    Answer




    The Answers1. D (1 only)

    Rationale/Explanation 

    The Health Act 2006 replaced the term “personal control” in the Medicines Act 1968 with the concept of a “responsible pharmacist”; the Responsible Pharmacist Regulations 2008 will bring that into effect. These will underpin any changes to supervision, proposals for which are likely to be published later this year, although they would not come into force until at least 2010. There are currently no proposals to amend the superintendent pharmacist provisions.Notes

    1. RPSGB registration exam syllabus, sections 1a: Sale and supply of medicines; 1b: Conditions for operating a registered pharmacy.  

    2. Closed book: Questions that pre-registration trainees are expected to answer without recourse to a reference. 

    One of the requirements for trainees is that they keep up to date with important developments in pharmacy. Information on this topic has appeared in the pharmacy press and a consultation on the proposals has been issued by the RPSGB.



    2: D


    Rationale/Explanation

    Reference: BNF. Average weight for age of children can be found on sheets inside the back cover: One year old = 10kg.Dose of sodium feredetate elixir = 2.75 x 10 = 27.5mg daily. Sodium feredetate elixir contains 27.5mg/5ml, therefore the dosage would be 2.5ml twice daily.



    Notes


    RPSGB registration exam syllabus sections: 2 - Clinical and pharmaceutical practice. Part I - Clinical practice. b) Action and uses of drugs; Part II - Pharmaceutical aspects of practice. a) Calculation.


     3: D

    Rationale/Explanation


    Reference: BNF, cardiovascular risk prediction charts inside back cover. Read off risk levels from charts. E is very close to the 10-20% risk level, but C is definitely within it.


    Notes


    RPSGB registration exam syllabus sections: 2 - Clinical and pharmaceutical practice. Part 1 - Clinical practice. j) - Interpretation of test results; k) - Health promotion and disease prevention.


    4: B

    Rationale/Explanation

    Only B is prohibited by the Misuse of Drugs Regulations: prescribers have been advised by the Department of Health and the Scottish Executive not to prescribe more than 30 days supply of a Controlled Drug in Schedule 2, 3 or 4, but it is not unlawful to do so or for pharmacists to supply more than 30 days if prescribed.

     

    Pharmacists can correct minor technical errors or omissions on CD scripts, and this applies to C. So long as the initial supply of a Schedule 4 CD is made within 28 days of being prescribed, and for a Schedule 5 CD within six months, there is no restriction on when repeats can be supplied. The question is closed book because pharmacists are expected to be conversant with the rules for supply of CDs and not have to look them up. 

     

    Notes

     

    RPSGB registration exam syllabus sections: 1 – Professional and legal practice. Part II – Legal aspects of providing a pharmaceutical service. a) – Sale and supply of medicines. 



    5: D (False/True]


    Rationale/Explanation

     

    Lyclear SprayAway is licensed as a medical device, but it is listed in Part IXA of the Drug Tariff and Part 3 of the Scottish Drug Tariff as such and is therefore allowable.

     

    Notes

     

    RPSGB registration exam syllabus sections: 2 – Clinical and pharmaceutical practice. Part I – Clinical practice. b) Action and uses of drugs; Part II – Pharmaceutical aspects of practice. a) Calculation.

     

     6: E (3 only)


    Rationale/Explanation


    Chloroform water contains 1 part chloroform in 400 (0.25 per cent). The question asks for the quantities required to prepare 100ml of double strength chloroform water. 


    Using the concentrations given in the question, it can be calculated that 0.5ml of chloroform, 5ml of concentrated chloroform water, or 10ml of chloroform spirit would be required to prepare 100ml of double strength chloroform water. Thus, only answer 3 is correct.


    Notes 


    1. RPSGB registration exam syllabus, sections 2, Part II a): Calculation and b) Dilution


    2. The question requires an understanding of concentration as expressed in percentages and as 'parts in', and the ability to manipulate them. The question is Closed Book because pharmacists and trainees should know the concentration of chloroform in chloroform water without having to look it up.





     7: 1.C, 2.D

    Rationale/Explanation


    Lithium interacts with ibuprofen, an NSAID, reducing lithium excretion and increasing the risk of toxicity.


    Phenelzine, a MAOI, interacts with pseudoephedrine, a sympathomimetic decongestant, causing blood pressure to rise with a risk of hypertensive crisis


    Notes


    RPSGB registration exam syllabus sections: 2 - Clinical and pharmaceutical practice. Part I - Clinical practice. g) Drug interactions.



    8: E


    Rationale/explanationReference: BNF.  5ml Gaviscon Advance suspension contains 2.3 mmol Na+. The total number of 5mL doses/day in each option is multiplied by 2.3. Option E comes the nearest to providing the maximum desired Na+ content. (18.4 mmol). (Option D provides slightly more – 20.7mmol.)


    RPSGB syllabus sections: 2, Part II a) Calculation.




    9 B (1 and 2 only)



    Rationale/Explanation


    Diarrhoea and sweating are symptoms of a hyperthyroid state; weight gain indicates a hypothyroid state.


    Notes


    1. RPSGB registration exam syllabus, section 2, Part 1 e): Adverse effects of medicines.





    10: B


    Rationale


    Reference: BNF, section: Emergency treatment of poisoning/Analgesics (non-opioid)/Paracetamol.

    * Plasma-paracetamol level versus time elapsed since taking overdose is read off from the chart provided.

    * As the patient has been taking St John’s wort, an enzyme- inducing drug, the reading is made against the high-risk treatment line, and 75mg/litre at 6 hours comes above the line so treatment with acetylcysteine is necessary.

    * From Acetylcysteine monograph:

    o Calculation of the recommended adult dosage regimen: 60x150mg + 60x50 + 60x100 = 18000mg = 18g.

    o Total administration time = 24 hours 15 minutes

    o Total volume = 1.7 litres

    o Preferred infusion vehicle is glucose 5%



    Notes


    RPSGB syllabus sections: 2 – Clinical and pharmaceutical practice. Part I – Clinical practice. j) Interpretation of test results; Part II – Pharmaceutical aspects of practice. a) Calculation.


     11 B (1 and 2 correct)


    Rationale
    Reference: BNF, section 11.6, Treatment of glaucoma; latanoprost is included in this section. Reference: MEP, section 1.9: List of medicines licensed for animal use; latanoprost is not listed. Section 1.8.2, Medicines for veterinary use/Prescribing cascade; a pharmacist can dispense a human licensed medicine prescribed for an animal on a veterinary prescription if s/he is satisfied that it has been prescribed under the “cascade” principle. The prescriber has indicated that this principle has been applied.  

    Syllabus section: 1, Part II a): Sale and supply of medicines.


    12: C

    Rationale


    Reference: BNF, section 10.1.1 Non-steroidal anti-inflammatory drugs: Strength of ibuprofen oral suspension = 100mg/5mL. From table inside back cover for mean values of weight, height and body surface area of children: weight of 1 year old child = 10kg.


    Amount of ibuprofen per dose: 10 (mg) x 10 (kg) = 100mg


    Total amount of ibuprofen: 3 (doses per day) x 10 (days) x 100mg = 3000mg

    100mg is contained in 5ml suspension, therefore 3000mg is contained in: 3000 x 5 = 150mL100


     Syllabus sections: 2 – Clinical and pharmaceutical practice. Part II – Pharmaceutical aspects of practice. a) Calculation


    13: E (false/false)


    Rationale


    References: BNF and MEP. 


    The strength and dose are correct. There is a list of equivalents between fentanyl patches and oral morphine in one of the introductory sections in the BNF, Prescribing in palliative care. This equates a 24-hour dose from a fentanyl ‘25’ patch to morphine salt 90mg daily. The prescriber wants the dose increased by one-third, bringing the equivalent morphine dose to 90x4/3 = 120mg daily. Section 4.7.2 Opioid analgesics/Morphine salts/ Modified-release 12-hourly oral preparations, lists four brands providing a 60mg presentation, but only MST Continus is available as sachets for preparing a suspension. This will be the only suitable presentation for the patient, who cannot swallow tablets.


    The prescription can be dispensed, because although the total quantity in words has been omitted by the prescriber, a pharmacist may correct this minor omission. 


    Syllabus sections: 2 – Clinical and pharmaceutical practice. Part I – Clinical practice. b) Action and uses of drugs; Part II – Pharmaceutical aspects of practice. a) Calculation.


    14: B (1and 2 only)


    Rationale: From Yellow Cards at back of BNF. For 3, the Yellow Card states for children under 18 years old, which includes children under 16, and is therefore correct. All suspected adverse reactions should be reported for intensely monitored medicines. Only serious adverse reactions to herbal remedies should be reported.


    Syllabus sections: 2 – Clinical and pharmaceutical practice. Part I – Clinical practice. e) Adverse effects of medicines; 3 - Systems and procedures, e) Responding to adverse drug reactions.



    15: D




    Rationale

    There is an increased risk of neural tube defects in babies associated with the use of antiepileptic drugs during pregnancy. Spina bifida is a neural tube defect.   


    Syllabus sections: 2 – Clinical and pharmaceutical practice. Part I – Clinical practice. e) Adverse effects of medicines.


    16: A (All three correct)


    Rationale


    Since November 2008, as result of an EU directive, pharmacists can make emergency supplies of prescription only medicines that have been previously prescribed by a practising doctor or dentist in Switzerland and the European Economic Area, which includes all EU states plus Norway, Iceland and Liechtenstein.In May 2009, the Medicines Act 1968 regulations were amended to allow emergency supplies of POMs previously prescribed by a UK dentist. 


    Syllabus sections: 1, Part II – Legal aspects of providing a pharmaceutical service, a) Sale and supply of medicines.



    17: C (true/false)


    Rationale/calculation
    Calculate his body mass index (BMI) using the formula: BMI = Weight (in kilograms) divided by height (in metres)2
    Calculation:     70 / 1.8x1.8 = 70 / 3.24 = 21.6A BMI between 18.5 and 24.9 is considered normal, so the patient is not overweight. However, he should be referred to his GP because his blood pressure is above the generally accepted target level of 140/90mmHg. 

    Syllabus sections: 2 – Clinical and pharmaceutical practice, Part 1 – Clinical practice, j) Interpretation of test results, k) Health promotion and disease prevention; Part 2- a) Calculation.


    18: D


    Calculation
    Locoid Cream contains 0.1% hydrocortisone = 0.1g = 100mg in 100g. Therefore, 25mg will be contained in 25 = 25g.
                            100
    Canesten Cream contains 1% clotrimazole = 1g = 1000mg in 100g. Therefore, 500mg will be contained in 500 = 50g.
                       1000
    25g Locoid Cream + 50g Canesten Cream = 75g.

    Therefore, need 100-75 = 25g Aqueous Cream as diluent

    Reference: BNF. 

    Syllabus section: 2 – Clinical and pharmaceutical practice, Part II – Pharmaceutical aspects of practice, a) Calculation.



    19 C (2 and 3)   


    Reference: BNF:


    Rationale/explanation


    BNF section 9.5.3, Fluorides, Dose states, for water content between F- 0.3-0.7 ppm, for child of over 6 years, provide supplement of F- 500mcg daily. En-De Kay Fluotabs 6+ years provides F- 1mg, which is too much, but other two options provide F- 500mcg daily. 


    Syllabus section: 2 – Clinical and pharmaceutical practice. Part I – Clinical practice. b) Action and uses of drugs.


    20: E (False/False)                 

     

    Reference: MEP

     

    Rationale

    Carbon tetrachloride is a POM.

     

    Syllabus section: 1, Part II a) Sale and supply of medicines.


    21: D


    Rationale: Akathisia (uncontrollable motor restlessness), dystonia (involuntary jerking movements of the trunk and limbs) and tardive dyskinesia (twitching, mainly of the face and tongue) can be experienced by both men and women. Galactorrhoea (spontaneous flow of breast milk) is exclusive to women. Gynaecomastia is excessive breast development in males. 

    Syllabus section: 2, Part 1, e) Adverse effects of medicines.

    Note: Pharmacists are expected to be familiar with medical terminology.

    22:  1 B, 2 B, 3 C

     

    Rationale/calculation: Private prescriptions for humans are zero rated for VAT; veterinary prescriptions are subject to VAT at the standard rate (currently 15 per cent).

    Q 1 and 2: Cost of item: £6, plus 25 per cent (£1.50) = £7.50 + £2 = £9.50. (Age and gender of patients are irrelevant).

    Q3: As for 1 and 2, plus VAT (£9.50 + 15 per cent [£1.43]) = £10.93 (nearest suggested answer = £10.90).

     

    Syllabus sections: 1, Professional and legal practice. Part IIa) Sale and supply of medicines.  2. Clinical and pharmaceutical practice. Part IIa) Calculation.


     

    23: B


    Rationale: Hypoglycaemic effect of antidiabetics is antagonised by thiazides.



    Syllabus sections: 2 Clinical and pharmaceutical practice. Part I Clinical practice g) Drug interactions.


    Note: The RPSGB board of examiners has commented in the past that questions on diabetes are generally not well answered.


    24: E


    Calculation:


    Day 5 to 24 = 20 days@3/day = 60 x 4 (cycles) = 240


    Syllabus section: 2. Clinical and pharmaceutical practice. Part IIa) Calculation.


    25: E


    Rationale/explanation: For the second claim you will be paid for 20 tablets only, because subsequent prescriptions, received during the next six months, will be deemed to have been supplied in full or part from the remainder of the first pack. Only the additional tablets supplied from the second pack will be paid for.  



    Syllabus section: 3a)Systems and procedures; NHS funding for pharmacy services.


    26: C


    Calculation
    Total volume of a batch of suspension = 10 x 5ml = 50ml.

    Total quantity of levothyroxine 0.05mg (= 50 microgram) tablets =

    45 x 10 = 9 tablets.50Concentrated Chloroform Water is 20 times more concentrated than Chloroform Water Double Strength.

    Therefore, for 50ml suspension, require:
    2.5 x 20 = 25ml Chloroform Water Double Strength.
     2

    Chloroform Water Double Strength contains chloroform 1 in 200 (0.5 per cent).
    Therefore, 25ml Chloroform Water Double Strength contains:
     1    x 25 = 0.125ml chloroform
    200


    Syllabus section: 2. Clinical and pharmaceutical practice. Part IIa) Calculation.

    (Note: This question is probably more complex than would normally appear in the registration exam, but it emphasises the importance of knowing the relationship between mg and micrograms and knowing the different strengths of chloroform preparations, which can be found at http://www.pharmj.com/noticeboard/info/pip/water.html).



    27: D

    Rationale
    Normally, he would be suspended from practice immediately. His case would be referred to the Health Committee and he would be offered the chance to undertake rehabilitation. When the committee was satisfied that he had done so, was fully rehabilitated and safe to resume practice, it would lift the suspension.   

    Syllabus sections: 1. Professional and legal practice; Part Ia) RPSGB Code of Ethics; Part IId) Health and safety. 



    28: B

    Rationale
    Packs greater than 32 of non-effervescent aspirin 325mg and paracetamol 500mg tablets are POM. Packs of 100 co-codamol (8/500) effervescent tablets are currently P, although they are labelled for dispensing only and pharmacists are requested by the RPSGB to restrict sales without prescription to a maximum of a single pack of 32. Packs of 100 co-codamol (8/500) effervescent tablets will become POM from January 2010.

    Syllabus section: 1. Part IIa).


    29. B

    Rationale

    Exemptions to payment, which are the same in England and Scotland, are set out in the Drug Tariff for England and Wales and the Scottish Drug Tariff.  Pharmacists and pre-reg trainees are expected to know these exemptions without having to look them up.  All NHS prescriptions are free in Wales.

     

    Syllabus sections: Section 3a). NHS funding for pharmacy services.


    30: A


    Calculation/rationale:
    A mole (mol) is the molecular weight of a substance expressed as grams.
    Therefore, a solution of NaCl containing 0.15 mol/l (150mmol/l) contains:
    0.15 x 58.5g in 1 litre = 8.8g = 0.88g in 100ml = 0.88 per cent.
    Physiological (normal) saline contains 0.9 per cent w/v NaCl.
    The concentration of this solution is 2.2 per cent less than that of physiological (normal) saline.
    So, both statements are correct and the second statement is a consequence of the first (they can be linked by the word ‘because’).

    Syllabus section: 2a)Calculation.

    31: B


    Rationale
    All are CD Schedule 3 drugs. Buprenorphine is subject to prescription requirements and safe custody; temazepam is subject to safe custody only; phenobarbital is subject to prescription requirements only.  

    Syllabus sections: 1. Part IIa) Sale and supply of medicines.


    32: B (1 and 2 only)


    Rationale


    Reference BNF. Nausea is not a normal effect of nicotine withdrawal; it is more likely to be a symptom of theophylline toxicity. Theophylline has a narrow therapeutic index; tobacco smoke reduces plasma theophylline and when smoking ceases it can rise to a toxic level.


    Syllabus sections


    2. Part 1b) Actions and uses of drugs; e) Adverse effects of medicines.


    33: B


    Rationale/Calculation
    Reference: BNF. From conversion table of weight, height and body surface area (BSA) of children, average BSA of a 1 year-old child = 0.49m2. Approximation in dosage allowed is up to 5 per cent (up to 0.5ml up or down to nearest ml on syringe). The BSA figure given is 2 per cent less (49/50) than 0.5m2, ie within the 5 per cent approximation allowed, so you can approximate the calculation to this figure.

    Zidovudine dose = 400mg/m2 daily, so for a child with BSA 0.5m2  this equals 200mg daily.
    Zidovudine oral solution contains 50mg/5ml.
    Volume required/day = 200 x 5 = 20ml.
                                            50
    For 30 days = 20 x30 = 600ml.


    Syllabus section
     2. Calculation.



    34:  E (3 only)


    Rationale
    1.      False. The Regulations require a notice to be displayed giving the name and registration number of the responsible pharmacist and stating that they are in charge of the pharmacy at that time, but does not require the pharmacist’s registration certificate to be displayed.
    2.      False. The Regulations place no restrictions on the reasons for absence.
    3.      True. The Regulations specify these.

    Syllabus sections

    1. Part II b) Conditions for operating a registered pharmacy.


    35: B


    Calculation
    1000 nanograms = 1 microgram
    Dose per minute: 0.5 x 72 = 36 micrograms
    Volume per minute: 36 = 0.09 ml
                                    400 
    Volume/hour = 0.09 x 60 = 5.4 ml

    Syllabus section

    2. Part IIa) Calculation.


    36: 1. A; 2. A (In the registration examination this would count as two questions.)


    Rationale:
    Alendronic acid tablets should be taken on an empty stomach at least 30 minutes before breakfast, and swallowed whole with plenty of water. These requirements do not apply to any of the other drugs listed.

    Syllabus section: 2. Part 1h.


    37: C


    Rationale
    OTC treatments for cystitis containing sodium citrate should not be sold for patients with: hypertension (A); men under any circumstances (B); patients taking lithium because sodium is preferentially absorbed by the kidney, increasing the excretion of lithium and resulting in reduced plasma lithium concentrations (D); pregnant women (E). There is no contra-indication or interaction with carbamazepine, and no upper age limit for recommendation, given the usual precautions.


    Syllabus sections: 2. Part I, sub-sections c, f, g.


    38: D


    Rationale/calculation
    1in 20 solution = 5 per cent
    Dilution of 5 per cent solution to 0.2 per cent = 5 divided by 0.2 = 25 fold

    Therefore, 20 litres of 0.2 per cent would require: 20,000ml divided by 25 = 800ml

    Syllabus section: 2. Part IIa.

    *In the registration examination all calculation questions are included in a section at the end of the open book paper, although many of them do not require any looking up. 


    39: A


    Rationale
    The correct explanation is given in the second statement. Reference: MEP33, Code of Ethics Professional Standards 3.8 (p119). Substitution is also prohibited through patent and trademark laws as the specification of the manufacturer makes this a prescription for, in effect, a branded product. A pharmacist could contact the prescriber and ask him or her to alter the script and either delete ‘Teva’ or specify ‘Actavis’.  

    Syllabus section: 3a.


    40: B


    Rationale
    Hydrocortisone cream is licensed for use in children of 10 years and over; chloramphenicol eye ointment is licensed only for the treatment of acute bacterial conjunctivitis; diclofenac is licensed for other types of pain as well as muscular and rheumatic, as well as for colds, influenza and fever; trimethoprim is currently not licensed for non-prescription sale. (Exam technique point: There is no need to get distracted by wondering whether the strengths of the medicines given are the licensed non-prescription strengths, as B is clearly the only correct answer).    

    Syllabus sections: 1. Part IIa; 2. Part Ic.