Pharmacy Prep QE 2006 Summer MOCK

TEST 1 PartA Answers

1. MM’s daughter reports that her 85-year old, 49 kg. mother has been experiencing

continuous nausea and her memory dementia has not improved in the 2 months that she has been on donepizil (Aricept) 5 mg. She asks you for advice on what to do. You would: A. Consult with the physician to add vitamin E to her therapy B. Consult with the physician to discontinue donezipil (Aricept) therapy C. Consult with the physician to increase the dose of donezipil (Aricept) to 10 mg daily D. Tell MM’s daughter to leave her mother on the same dose for another 2

months, then reassess E. Tell MM’s daughter to leave her mother on the same dose for another 2

months, then reassess and to take dimenhydrinate (Gravol) for the nausea

Ans.: B

2. MD, a 17 year old, presents with a purpuric skin rash. She wonders if she is having another flare-up of her eczema, but this rash looks different. Her patient record is as follows: Allergies: penicillin History: eczema x 2.5 years

epilepsy x 1 month

Current medications: betamethasone (Betnovate) Cr 0.05% bid prn x 2.5 years ethinyl estradiol/ levonorgestrel (Min-Ovral) x 10 months phenytoin (Dilantin) 200mg qhs x 1 month What is the most probable cause of her skin rash?

A. An acute flare-up of her eczema B. A reaction to phenytoin C. A reaction to oral contraceptives D. An interaction between ethinyl estradiol/ levonorgestrel (Min-Ovral) and

phenytoin (Dilantin)

Ans.: B

3. Ms BB presents the following prescription for her 8 year-old daughter, who weights 30 kg and has an acute urinary tract infection:

Ciproflaxin (Cipro) 500 mg Sig: i po bid until finished

M: 14 You would: A. Call the doctor to clarify the dosage. B. Call the doctor and recommend sulfamethoxazole/ trimethoprim (Septra)

suspension, 2.5 mL po bid C. Call the doctor regarding the appropriateness of the medication for this

patient. D. Dispense the prescription as written, instructing the mother to give the drug

with meals to reduce stomach upset. Ans.: C

4. JL approaches you confidentially stating that she had a “problem” every month for the last 5 months and has tried Miconazole (Monistat-3) and Clotrimazole (Canesten) ovules, 3 day therapy. Both were effective, but the problem recurs. This time her symptoms include frequent urination and thirst. She had her menstrual period ten days ago, but it is unpredictable. She has not been to her doctor for almost a year. Based on this information, you would be most concerned that she could be:

A. Diabetic and the sugar spilling into her urine may be causing the recurrent

yeast infections B. Diabetic, but the yeast infections could not be associated with the sugar in her

urine C. Using the incorrect product. Recurrent infections respond better to 6-day

therapy D. Undergoing pre-menopausal symptoms and the fluctuation in vaginal pH is

contributing to her recurrent yeast infections E. Overusing non-prescription antifungals and the subsequent bacterial

overgrowth is contributing to her recurrent bacterial infections

Ans.: A 5. HB, a 76-year old, 40 kg patient wishes to purchase the following herbal products. Which would you NOT sell based on the following patient record information?

Allergies: No known allergies Current medications: Warfarin (Coumadin) 2.5mg daily x 2 years

Donepezil (Aricept) 5 mg daily x 2 months I-Ginkgo biloba II-Evening primrose oil III-Vitamin B complex A-I only B-III only

C-I and II D-II and III E-All of the above Ans: A

6. Which of the following medications may require dose adjustment if being taken

by a patient just starting on thyroid hormone for hypothyroidism? I- Digoxin (Lanoxin) II-Insulin III-Phenobarbital A-I only B-III only C-I and II D-II and III E-All of the above Ans.: C

7. Case study for next two questions: Patient Name: EF Age: 58 years old Allergies: No known allergies History: Asthma Hypercholesterolemia

Current medications: salbutamol (Ventolin) 100 mcg/puff HFA inhaler 2 puffs qid prn fluticasone (Flovent) 125 mcg/puff HFA inhaler 2 puffs bid atorvastatin (Lipitor) 20 mg once daily Alprazolam (Xanax) 0.25 mg bid and hs prn

Lovastatin (Mevacor) counseling includes: I do not give during pregnancy II take with food III do not take with grape fruit juice

a. I only b. III only c. I and II d. II and III e. I, II and III

Ans: E 8. EF’s doctor wants to prescribe an antibiotic for an upper respiratory tract

infection. Based on his patient record, any of the following antibiotics could be recommended, EXCEPT: A. Amoxicillin 250mg tid x 10 days B. Ciprofloxacin (Cipro) 500mg bid x 10 days C. Doxycycline (Vibra-Tabs) 100mg 2 tablets on the first day then 1 tablet daily x 10 days D. Erythromycin (EryC) 333 mg tid x 10 days E. Sulfamethoxazole/ trimethoprim (Septra DS) bid x 10 days

Ans.: D

9. Case study for next two questions:

Patient Name: JB Age: 60 years old Allergies: Sulfonamides History: Deep Vein thrombosis (DVT)

Urinary Tract Infection (UTI) Lab reports: CrCl 19 mL/min (normal CrCl = 100mL/min)

Culture and Sensitivity Test: * Resistant to ampicillin * Sensitive to sulfa, ciprofloxacin, cephalosporins INR 2.5 (normal range 2-3) Current Medications: warfarin (Coumadin) 1mg daily

JB presents a new prescriptions for ciprofloxacin (Cipro) 500mg bid x 7 days for recurrent urinary tract infections. Based on the patient record above,

you would: A. Dispense the ciprofloxacin as ordered with a note to monitor INRs B. Call the physician and recommend decreasing ciprofloxacin (Cipro) dose to

250 mg bid x 7 days with a note to monitor INRs C. Call the physician and recommend sulfamethoxazole/ trimethoprim (Septra)

i bid x 7 days with a note to monitor INRs D. Call the doctor and recommend ampicillin 250 mg qid x 7 days with a note to

monitor INRs

E. Do B, C, or D above

Ans: B 10. Two weeks later, JB complains of heart burn especially at night. JB has already

tried antacids and wonders if there is anything else that would help. Which of the following drugs would you NOT recommend? A. Alginic acid/ aluminum hydroxide (Gaviscon) B. Cimetidine (Tagamet) C. Famotidine (Pepcid AC) D. Ranitidine (Zantac) E. B, C, and D

Ans.: B

11. A patient of yours, CE, asks what she could do to decrease her risk of osteoporosis. You would suggest all of the following options, EXCEPT:

A. Elemental calcium 1000 – 1500 mg per day B. Vitamin D 400 IU daily C. Regular swimming D. Regular weight lifting E. Drinking milk

Ans.: C

12. Case study for next two questions:

Patient Name: FJ Age: 40 years old Allergies: No known allergies History: Smoker Current medications: Zopiclone (Imovane) 7.5 mg qhs prn x 30 FJ presents the following new prescriptions:

clarithromycin (Biaxin) 500mg bid x 7 days metronidazole (Flagyl) 500 mg bid x 7 days bismuth subsalicylate (Pepto Bismol) ii tabs qid x 7 days

What is the most likely diagnosis according to this new prescription drug regimen?

A. Escherichia coli intestinal infection B. Helicobacter pylori infection induced peptic ulcer C. Salmonella intestinal infection D. Intestinal amoebiasis E. Gardnerella vaginitis

Ans.: B

13. You would include the following recommendations in counseling FJ about the medication EXCEPT: A. Take with food or milk B. Avoid alcohol C. Bismuth subsalicylate (Pepto Bismol) must be taken 2 hours after

clarithromycin and metronidazole D. Bismuth subsalicylate (Pepto Bismol) may take the tongue and stool black

Ans.: C

14. Case study for next 4 questions: Patient Name: FG

Age: 54-year old male

Past medical history: non-insulin dependent (Type 2 diabetes x 5 years)

Allergies: No known allergies

Current medications: glyburide (Diabeta) 10mg daily

FG comes into the pharmacy to pick up some over-the-counter medications for his medicine cabinet. Which of the following medications should NOT be recommended because they may adversely affect FG’s blood glucose levels? A. Pseudoephedrine B. Acetaminophen C. Diphenhydramine D. Dextromethorphan

Ans.: A

15. FG asks you what the most common side effects of his glyburide (DiaBeta) are, in particular, he is wondering if it can cause a dry cough. You advise him that the most common side effects of his glyburide (DiaBeta) is: A. Lactic acidosis B. Hyperglycemia C. Cough D. Hypoglycemia

Ans.: D

16. FG tells you he has a current fasting blood glucose reading of 10 mmol/L. He is

wondering if it is too low. The most appropriate advice for FG is that his blood glucose level is: A. Within normal range – his diabetes appears well controlled

B. High – refer patient to his physician C. Low – recommend carrying glucose tablets to prevent hypoglycemia D. High – suggest switching to insulin

Ans.: B

17. FG is concerned about his alcohol use because he has diabetes. You counsel FG

that individuals with diabetes should limit alcohol consumption for a number of reasons. All of the following are appropriate reasons, EXCEPT: A. Alcohol may interact with certain oral hypoglycemic agents B. Alcohol may impair the body’s ability to recover from hypoglycemia C. Alcohol may cause weight loss D. Alcohol may aggravate peripheral neuropathy Ans.: C

18. Case study for next 4 questions: Patient Name: PK Age: 69 years old Gender: Male Allergies: No known allergies Past medical history: Parkinson’s disease x 3 years

Benign prostatic hypertrophy Non-insulin dependent (Type 2) diabetes – diet controlled

Current medications: levodopa/ carbidopa (Sinemet 100/25) Presentation: Dyskinesia, sudden periods of “freezing”

PK approaches you complaining about his “freezing” episodes. He is wondering if there is something he can take to get rid of them. You will recommend that his doctor: A. Switch his levodopa/carbidopa (Sinemet) to the sustained-release formulation B. Restrict the protein in his diet C. Add selegiline (Eldepryl) to Sinemet D. Initiate a drug holiday Ans.: A

19. PK wants to purchase some diphenhydramine (Nytol) as he is having trouble

sleeping at night. You advise him that he should not use diphenhydramine (Nytol) because of his:

A. Calorie restricted diet B. Benign prostatic hypertrophy

C. Diabetic nephropathy D. Rigidity

Ans.: B

20. PK approaches you wondering why he isn’t on levodopa. You explain that he is on a levodopa/ carbidopa (Sinemet 100/25) combination which is better than taking levodopa alone. You go on to explain that carbidopa:

A. Prevents peripheral neuropathy B. Delays the progression of the disease C. Controls symptoms of hypertension D. Reduces the levodopa dose requirement

Ans.: D

21. What is the best advice you can give PK regarding how he should take his

levodopa/ carbidopa (Sinemet 100/25)? A. Discontinue the drug for one week to avoid “on-off” phenomenon B. Crush the tablets and dissolve in soft food or fruit juice C. Supplement with vitamin B6 100 mg po daily D. Take with a light snack E. Take with high protein snacks

Ans.: D

22. Case study for next 4 questions: Patient Name: TR Age: 75-year old, nursing home patient Past medical history: Alzheimers’ disease

Raynauds disease Stroke at age 70, partial disability on left side Hypercholesterolemia

Allergies: Penicillin Current medications: donepezil (Aricept) 5 mg daily

nifedipine (Adalat XL) 30 mg daily ASA 325 mg daily lorazepam (Ativan) 1 mg qhs prn Pravastatin (Pravachol) 20 mg qhs

You participate in the bi-monthly review of TR’s medical progress and medication review with the physician, nurse, nutritionist, and physiotherapist. The physiotherapist asks you how donepezil (Aricept) works. You reply that donepezil’s (Aricept’s) main pharmacological action is to: A. Inhibit the breakdown of serotonin in the brain B. Increase acetylcholine levels in the brain C. Decrease dopamine levels in the CNS D. Acts as a gamma aminobutyric acid agonist

Ans.: B

23. The nutritionist reports that grapefruit juice is a regular breakfast beverage for

TR. You advise the nutritionist that grapefruit juice should be avoided because it interacts with TR’s: A. ASA B. Donepezil C. Lorazepam D. Nifedepine

Ans.: D

24. Which recommendation would you suggest to best manage the grapefruit juice? A. Space apart the grapefruit juice and the interacting medication by at least 2

hours B. Discontinue the interacting medication since risks outweigh the benefits C. Monitor for increased levels and response of the interacting medication D. Discontinue the grapefruit juice Ans.: D

25. One month later, you receive the following prescriptions for TR for community-

acquired pneumonia. Amoxicillin 500 mg tid x 10 days

Upon review of the patient’s record you determine the prescription is inappropriate. When calling the doctor, he asks you to recommend the best alternative for this patient. You would recommend: A. clarithromycin (Biaxin) 500 mg bid x 10 days B. erythromycin (Eryc) 333 mg tid x 10 days C. cefuroxime (Ceftin) 500 mg bid x 10 days D. doxycycline (Vibra Tabs) 100 mg tid x 10 days E. sulfamethoxazole/ trimethorprim DS (Septra DS) i bid x 10 days Ans.: D

26. Case study for next 3 questions:

Patient Name: VJ Age: 56 years old Gender: Female Past medical history: Gastroesophageal reflux disease

Atrial fibrillation Allergies: No known allergies

Current medications: rabeprazole (Pariet) 10 mg daily ramipril (Altace) 10 mg daily amiodarone (Cordarone) 200 mg daily Midsummer, VJ appears at the dispensary counter to refill her rabeprazole (Pariet) prescription and is also looking for a cold preparation to relieve her cold symptoms. After interviewing VJ, you decide she has allergic rhinitis, not a cold. Which one of the following symptoms is more characteristic of seasonal allergic rhinitis?

A. Congestion B. Nasal discharge C. Sore throat

D. Itchy eyes

Ans: D 27. VJ presents the following prescription: erythromycin base (Eryc) 333 mg tid x 10 days

What are your concerns? A. Amiodarone and erythromycin interaction B. Decreased gastric acidity reduces erythromycin absorption C. Erythromycin aggravates gastroesophageal reflux disease D. Erythromycin inhibits metabolism of ramipril E. Erythromycin and rabeprazole interaction Ans.: A

28. VJ returns to the pharmacy two weeks later with a prescription for an intranasal corticosteroid.

fluticasone (Flonase) 50 mcg I puff each nostril bid

Which of the following statements would you include when counseling VJ? A. Therapy should only be used for three months B. Beneficial effects require regular usage C. Discontinue a few days after symptoms resolve D. Therapy should be initiated at the maximum recommended dose E. See your physician if no relief within 3 days

Ans.: B

29. Case study for next 2 questions: Patient Name: NE

Age: 72 years old

Gender: Male

Past medical history: Non-insulin dependent (Type 2) diabetes x 20 years

Allergies: No known allergies

Current medications: enteric Coated ASA (Entrophen) 325 mg daily

nitroglycerin patch (Nitro-Dur) 0.2 mg, Apply in the morning; Remove at night

Glyburide (Diabeta) 10 mg daily Nitroglycerin (Nitrolingual Pumpsray) prn

NE’s angina has been poorly controlled. He is using the nitroglycerin spray 3 to 4 times a day. What would you give NE regarding his nitroglycerin spray? A. Shake the nitroglycerin pumpspray prior to use B. See your doctor immediately to reevaluate your nitroglycerin therapy C. It is necessary to prime the spray prior to each use

D. Doses may be repeated as many times as needed until complete relief is achieved

Ans.: B

30. On further questioning, you discover that NE has been having angina at night, so

he has been leaving the patch on for 24 hours. You tell him that he can prevent or lessen the degree of nitrate tolerance from developing by having a daily nitrate free interval of at least: A. 6 hours B. 8 hours C. 10 hours D. 24 hours Ans.: C

31. Case study for next 2 questions:

Patient Name: JT

Age: 41 years old

Gender: Male

Allergies: No known allergies

Past medical history: Anxiety Difficulty sleeping (starting 3 years ago)

Current medications: triazolam (Halcion) 0.5 mg qhs x 3 years acetaminophen/ caffeine/ codeine (Tylenol#1) – ii prn headache

You notice that JT has been coming in early for refills for triazolam and has received extra prescriptions for this medication from many walk-in clinics.

JT approaches you and states that he is concerned about his triazolam (Halcion) usage, so he stopped using it 24 hours ago. He asks you what the most common withdrawal symptoms will be: A. Diarrhea, shakes and chills B. Insomnia, muscle spasms and irritability C. Increased headache, fatigue and nausea D. Seizures, delirium, and hallucinations Ans.: B

32. You offer to call JT’s doctor to suggest an effective triazolam withdrawal

strategy. You would recommend:

A. Giving the equivalent dose of diazepam, then gradually decrease the dose over

several months B. Go to the hospital emergency department for a flumazenil (Anexate) injection C. Gradually tapering (25% per day) triazolam (Halcion) dose over one week D. Giving an equivalent dose of lorazepam (Ativan) Ans.: A

33. Case study for next 2 questions: Patient Name: MT

Age: 23 years old

Gender: Male

Past medical history: Hepatitis C with liver dysfunction

Allergies: No known allergies

Current medications: None

MT was diagnosed with a fungal infection of the fingernail for which he was prescribed terbinafine (Lamisil) 250 mg daily orally. Which of the following statements would you include when counseling MT?

A. Do not take with food as this reduces drug bioavailability B. Contact doctor to decrease the terbinafine prescribed dose C. Limit sun exposure as terbinafine causes photosensitivity D. Terbinafine is not effective against dermatophyte fungi

Ans.: B

34. MT should continue taking his terbinafine for:

A. 2 weeks B. 4 weeks C. 3 months D. 12 months Ans.: C

35. Another effective treatment for MT’s fingernail infection would be:

A. Oral itraconazole (Sporanox) B. Topical clotrimaxole (Canesten) C. Topical terbinafine (Lamisil) D. Oral nystatin (Nilstat)

Ans: A

36. Which of the following is least likely to contribute to fungal fingernail infections?

A. HIV infection B. Cancer chemotherapy C. Systemic cortiscosteroids D. Oral antibiotic therapy Ans.: D

37. Patient Name: MJ Age: 50 years old Allergies: No known allergies Past medical history: Severe gastrointestinal cramps when on acetaminophen/ codeine (Emtec-30) Current medications: ibuprofen (Motrin) 400 mg qid You receive the following prescriptions for MJ: Tylenol #3 Sig: I – ii q4h prn pain Mitte: 24 Upon review of the patient record, you would: A. Call the doctor and discuss the possible intolerance to codeine B. Call the doctor regarding duplicate therapy; recommend discontinuing the

ibuprofen (Motrin) C. Call the doctor to discuss the potential interaction between Tylenol #3 and

ibuprofen (Motrin) D. Dispense 24 Tylenol #3 and counsel the patient to be aware of drowsiness E. Dispense 24 Tylenol #3 and counsel patient t discontinue ibuprofen while on

Tylenol #3 Ans: A

38. Patient Name: HR Age: 79 years old Allergies: Allopurinol Current medications: zopiclone (Imovane) 7.5 mg hs prn hydrochlorothiazide 25 mg daily

potassium chloride 600 mg (slow K) ii bid digoxin (Lanoxin) 0.25 mg daily HR presents with a prescription for: verapamil SR ( Isoptin SR) 240 mg daily Upon reviewing the patient record, you would: A. Call the doctor regarding a potential digoxin (Lanoxin) interaction B. Call the doctor regarding a potential verapamil (Isoptin) hypersensitivity C. Call the doctor regarding a possible hydrochlorothiazide interaction D. Dispense as written; warn the patient to notify you of any new gastrointestinal symptoms E. Call the doctor to decrease the dose of verapamil (Isoptin) Ans.: A 39. Patient Name: JB

Age: 62 years old Allergies: Sulfonamides, ciprofloxacin (rash) Current medications: naproxen 250 mg tid Medical conditions: Urinary tract infection

Arthritis You receive the following prescription for JB: norfloxacin (Noroxin) 400 mg Sig: I bid x 10 days

Upon review of the patient record, you would: A. Call the doctor and recommend that the prescription be changed to

Nitrofurantoin (MacroBID) 100 mg bid B. Call the doctor to recommend a 5-day course of therapy and dispense 10 norfloxacin (Noroxin) 400 mg tablets C. Call the doctor and recommend that the prescription be changed to sulfamethoxazole/ trimethorprim (Septra) ii bid

D. Dispense 20 norfloxacin (Noroxin) 400 mg tablets as prescribed Ans.: A

40. Patient Name: DF Age: 51 years old

Allergies: Penicilllin

History: Epilepsy Current medications: carbamazepine CR (Tegretol CR) 400 mg bid

oxazepam (Serax) 15 mg qhs prn insomnia You receive a prescription for DF for: erythromycin 250 mg Sig: i q6h Mitte: 40 Upon review of the patient record, you would: A. Call the doctor about a possible drug-drug interaction B. Call the doctor about a possible drug-disease interaction C. Call the doctor about a possible intolerance to erythromycin D. Dispense 40 erythromycin base (EryC) 250 mg capsules and instruct the patient to take one capsule four times daily. Ans.: A 41. The patient record indicates the following:

Patient Name: AJ Age: 58 years old Gender: Male

Allergies: Sulfamethoxazole/ trimethoprim (Septra) Cephalosporins

Current medications: salbutamol(Ventolin) HFA 100mcg/puff inhaler 1-2 puffs qid prn salmeterol/fluticasone (Advair-250) diskus 1 puff bid You receive the following prescription for AJ: silver sulfadiazine (Flamazine) Cream: Apply qid x 7 days to the burn Upon review of the patient record, you would: A. Call the doctor and recommend one application per day. B. Call the doctor and recommend mupirocin (Bactroban) topical cream C. Call the doctor to recommend nystatin (Nyaderm) topical cream D. Dispense silver sulfadiazine as ordered Ans.: B 42. JS’s doctor instructed him to start taking niacin tablets 500 mg tid. He asks you what this therapy is used to treat? You would tell him that it is used to treat:

A. Hypercholesterolemia B. Coronary insufficiency C. Gout D. Anemia E. Alcoholism Ans.: A

43. Two months later, JS approaches you to purchase a box of nicotine (Nicoderm) patches and asks, “where is the best place on the body to apply the patch?” You would indicate:

A. Upper arm B. Back C. Lower rib cage D. Buttocks E. All of the above Ans.: E

44. A young woman purchases loperamide (Imodium) 2 mg to take to Mexico and asks what dose she should take. You would recommend:

A. One caplet three times daily prophylactically starting on the day of arrival in Mexico

B. One caplet after each loose bowel movement to a maximum of 6 caplets daily C. One caplet every 4 hours after diarrhea starts and continue until stools are formed D. Two caplets at onset of diarrhea, then one after each loose bowel movement, up to

a maximum of 8 caplets a daily E. Two caplets after each loose bowel movement, to a maximum of 4 caplets daily Ans.: D

45. Patient name: JF Age: 70 years old Allergies: Sulfonamides History: Congestive heart failure Current medications: digoxin (Lanoxin) 0.25 mg qam Maalox 15 mL qid pc & hs You receive the following prescription for JF: sucralfate (Sulcrate) 1 g Sig: 1 qid ac and hs Mitte: 30 days

Upon review of the patient prescription for JF, you would:

A. Dispense as written, instructing the patient to take the digoxin (Lanoxin) two hours after the morning dose of sucralfate (Sulcrate)

B. Dispense as written, instructing the patient to take the digoxin (Lanoxin) with his noon meal

C. Dispense as written , instructing the patient to take the digoxin (Lanoxin) before one of his meals

D. Call the doctor to discuss a potential cross-sensitivity and recommend sucralfate (Sulcrate) be changed to ranitidine (Zantac) 150 mg bid

E. Call the doctor to discuss a potential cross-sensitivity and recommend sucralfate (Sulcrate) be changed to misoprostol (Cytotec) 200 mcg qid

Ans.: A

46. A woman tells you that her friend told her she should be taking potassium chloride(Slow K) because she is on blood pressure medications. The medications she asks are spironolactone (Aldactone) 100 mg daily and captopril (Capoten) 25 mg bid. You would:

A. Sell her 100 potassium chloride (Slow-K) tablets B. Sell her 100 slow release potassium chloride tablets of a generic brand C. Sell her potassium chloride in the brand of her choice and instruct her to see her

doctor for a potassium blood level check D. Not sell her anything and instruct her to consult her doctor first E. Not sell her anything and instruct her to supplement her diet with potassium rich

foods such as orange juice, bananas, etc. Ans.: D

47. TL, a 70-year old patient is currently taking phenytoin (Dilantin) 100 mg three capsules daily at bedtime. TL can no longer swallow these capsules so the doctor requests an equivalent dose of Dilantin suspension 125 mg/5 mL. In order to maintain similar blood levels, you would give: A. 5.5 mL in the morning and at bedtime B. 6 mL in the morning and at bedtime C. 7.5 mL in the morning and at bedtime D. 11 mL daily at bedtime E. 12 mL daily at bedtime Ans: A 48. Case study for next two questions:

Patient name: AB Age: 50years old

Gender: Female Past medical history: Borderline hypertension, diet controlled x 4 years Lactose intolerant Allergies: Codeine

Penicillin Peanuts Medications: Calcium 500 mg bid Vitamin D 1000 IU daily

AB calls you for some information about menopause and hormone replacement therapy (HRT). In response to her complaints of irritability, hot flushes, and difficulty sleeping, her doctor has told her that she is in menopause and needs an estrogen supplement. When discussing the benefits of estrogen with AB, you include that it: A. Increases calcium resorption from bone

B. Decreases vasomotor flushing within two weeks C. Decreases risk of hypertension D. Decreases frequency of migraine headache

Ans.: B 49. AB calls you several days later, after doing some research on her own. She has decided to give HRT a try. She does not wish to resume her menses. Which regimen is most suitable for AB?

A. Conjugated estrogen (Premarin) 0.625 mg daily and medroxyprogesterone (Provera) 2.5 mg daily

B. Estradiol (Estrace) 1 mg daily and medroxyprogesterone (Provera) 5 mg days on

days 14-25 of each month

C. Conjugated estrogen (Premarin) 0.625 mg daily and micronized progesterone (Prometrium) 100 mg daily

D. Estradiol (Estracel) 1 mg daily and micronized progesterone (Prometrium) 100mg daily

Ans.: A

50. Patient name: LT

Age: 43 years old

Gender: male Allergies: polymixin sulfate/ neomycin/ gramicidin (Neosporin) Past medical history: Ileostomy Medications: loperamide (Imodium) 2 mg bid Attapulgite (Kaopectate) 10 mL qid You receive the following prescription for LT: mupirocin (Bactroban) ointment sig: Apply to stomal area bid for fungal infection

Mitte: 15 g Upon review of the patient record, you would:

A. Dispense mupirocin (Bactroban) counseling the patient to apply thinly bid B. Instruct the patient to apply the Bactroban more frequently if removed with

washing C. Recommend clotrimazole (Canesten) topical cream D. Call the doctor and recommend fusidic acid (Fucidin) ointment E. Call the doctor regarding a possible cross-sensitivity between Bactroban and

Neosporin ointment Ans.: C

51. Case study for next 3 questions:

Patient name: SK Age: 32 years old

Gender: Female Past medical history: Hypethyroidism (Graves’ disease) Migraines Allergies: Sulfonamides Medications: propylthiouracil (Propyl-Thyracil) 100 mg tid propranolol (Inderal) 40 mg bid acetaminophen/ codeine/ caffeine (Tlenol No.2) 1-2 tid prn

SK arrives at your pharmacy after being discharged from hospital with the diagnosis of Graves’ disease. Which of the following is NOT a symptom of Graves Disease? A. Sweating, palpitations B. Insomnia, palpitations C. Diarrhea, palpitations D. Constipation, palpitations Ans.: D

52.Which of the following statements concerning propylthiouracil (Propyl-Tyracil)is true? A. It decreases the thyroid’s ability to synthesize thyroid hormone B. It is contraindicated in pregnancy C. It is used to control symptoms until spontaneous remission occurs D. The most frequent adverse effect is osteoporosis

Ans.: A 53. With regard to the use of a beta blocker in the management of hyperthyroidism, which one of the following is TRUE?

A. Aggravates migraine B. Controls tremor C. Causes neutropenia D. Synergistic with iodide

Ans.: B 54. Case study for next 4 questions:

Patient name: RB Age: 81 years old

Gender: Female Weight: 100 kg Past medical history: Osteoarthritis in fingers and legs x 10 years Mild leg edema Allergies: No known allergies Current medications: fluticasone (Flovent) 125 mcg/puff HFA inhaler 1 puff bid hydrochlorothiazide 25 mg daily for ankle swelling docusate sodium (Colace) 100 mg daily acetaminophen/ codeine/ caffeine (Tyleol No. 2) 1 q4h prn

RB was admitted to hospital with complaint of increased swelling in ankles and severe pain in her left leg. She was diagnosed with deep vein thrombosis (DVT). What factor most likely aggravated RB’s condition leading to her admission to the hospital? A. Obesity B. Laxative abuse C. Insufficient diuretic therapy D. Gender Ans.: A

55. Which of the following drugs would most often be used as initial therapy for acute treatment of deep vein thrombosis in the hospital?

A. Heparin

B. ASA C. Streptokinase D. Warfarin Ans: A

56. What would be the best prophylaxis for RB’s deep vein thrombosis when he is discharged from the hospital?

A. Measuring international normalized ratio (INR) B. Measuring prothrombin time (PT) C. Measuring factor III and X D. No monitoring required Ans.: A

58. Case study for next 3 questions: While dispensing HIV/AIDS medications for RH, who is dating your best friend, you begin to worry that your friend isn’t aware of RH’s diagnosis. You are also aware that it is a breach of confidentiality to inform your friend about RH’s condition and you are wondering how to handle this situation. Which three (3) of the following actions would be most appropriate?

A. Call RH’s doctor to discuss your concerns and ask her/him to follow-up with RH B. Counsel RH on preventive measures to prevent the spread of the virus and to

inform all sexual partners about his condition C. Disclose to RH that you are a friend of the woman he is dating and urge him to

inform her about his diagnosis D. Disclose to our friend that RH is being treated for HIV/AIDS and urge her to see

her doctor if they have had unprotected sex E. Refrain from telling your friend about RH’s condition, but urge her to always use

safe sex measures and to be checked for HIV/AIDS is she had unprotected sex Ans.: A, B, E

59. Based on the case above regarding RH, which action (of the same responses) would you take first?

A. Call RH’s doctor to discuss your concerns and ask her/him to follow-up with RH and your friend

B. Counsel RH on preventive measures to prevent the spread of the virus and to inform all sexual partners about his condition

C. Disclose to RH that you are a friend of the woman he is dating and urge him to inform her about his diagnosis

D. Disclose to your friend that RH is being treated for HIV/AIDS and urge her to see her doctor if they have had unprotected sex.

E. Refrain from telling your friend about RH’s condition, but urge her to always use safe sex measures and to be checked for HIV/AIDS if she has had unprotected sex Ans: B

60. Which of the following ratios is the best indicator of a pharmacy’s profitability?

a) Net profit to net sales b) Net profit to net worth c) Net profit to total assets d) Net profit to inventory e) Net profit to annual turnover

Ans: B

61. Patient name: JS Age: 6 years old

Gender: male Weight: 27 kg Allergies: No known allergies Medications: Gentamicin (Garamycin) ear drops 3 drops in affected ear TID – initated 3 days ago After 3 days of gentamicin ear drops, JS’s mother presents a new prescription for JS for: Amoxicillin 250 mg TID x 5 days She states that his ear infection has worsened and he now has a perforated eardrum. She asks if she should continue to give JS the gentamicin ear drops. How would you respond?

A. Continue the gentamicin ear drops along with the amoxicillin suspension B. Stop the gentamicin ear drops and start the amoxicillin prescription C. Call Doctor to decrease dose of gentamicin (Garamycin) ear drops to 2 drops TID D. Call Doctor to change ear drops to Ciprofloxacin/ Hydrocortisone (Cipro HC)

Otic 2 drops TID

Ans.: B

62. Patient name: KG Age: 55 years old

Gender: Female Allergies: No known allergies Medical conditions: Migraine headaches Medications: ASA/ butalbital/ caffeine/ codeine (Fiorinal C ½) 1 q3-4h prn – filled 1 week ago Ergotamine/ caffeine (Cafergot) 2 stat then 1 q30min up to 6 per day A family member presents the following prescription for KG who is at home with an acute migraine: Sumatriptan (Imitrex DF) 100 mg

Sig: 1 stat for migraine, to maximum of 1 per attack or 2 per day Based on the patient record (above) you would:

A. Fill the prescription and caution the patient not to start taking Sumatriptan (Imitrex DF) within 24 hours of taking ergotamine/ caffeine (Cafergot) B. Fill the prescription and caution the patient not to start taking Sumatriptan (Imitrex DF) within 24 hours of taking Fiorinal C ½ C. Fill the prescription and counsel the patient about appropriate dosing of

Sumatriptan (Imitrex DF) D. Call the physician about a possible drug interaction between Sumatriptan (Imitrex DF) and Fiorinal C ½ E. Call the physician about a possible drug interaction between Sumatriptan (Imitex DF) and ergotamine/ caffeine (Cafergot)

Ans.: A Comments: All triptans do not used with Ergotamine and MAO except Naratriptan Tc

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63. Patient name: JC Age: 30 years old

Gender: male Allergies: Penicillin ASA JC wants to know how to prevent or treat diarrhea while in Mexico. You would recommend all of the following EXCEPT:

A. Drink only bottled water/ soft drinks without ice B. Eat food from reliable sources C. Eat only fruit cut and peeled by yourself D. Take bismuth subsalicylate (Pepto-Bismol), 2 tablets every 30 minutes (max 8

doses per day) E. Take loperamide (Imodium) 2 mg. 2 tablets at onset of diarrhea, then 1 tablet after

each loose bowel movement (maximum 8 tablets per day) F. See your doctor for a prescription for ciprofloxacin, to take if severe diarrhea

occurs Ans.: D

64. Patient name: PS

Age: 55 years old Gender: male Allergies: sulfonamides (no allergy to glyburide) Medical conditions: Type 2 diabetes Medications: Glyburide (Diabeta) 10 mg daily x 3 years

PS comes into your pharmacy with a prescription for atenolol (Tenormin) 50 mg daily You are most concerned that atenolol (Tenormin) may:

A. mask signs of hypoglycemia B. increase blood sugar C. increase glyburide level D. decrease glyburide level Ans.: A

65. Which of the following counseling points is NOT appropriate when counseling genetic a patient on emergency contraceptive pills (ECP)?

A. Take dimenhydrinate (Gravol) 50 mg 1 hour before ECP to decrease nausea and vomiting

B. Taking ECP can result in transient side effects such as abdominal cramps, headaches, and breast tenderness

C. If you do not experience withdrawal bleeding within 3 weeks after taking ECP, you should see your family doctor

D. Once ECP is taken, it provides protection against pregnancy for 6 – 7 days Ans.: D

66. Patient name: EM

Age: 59 years old

Gender: male Allergies: Sulfonamides Molds Pollen Medical conditions: Arthritis x 2 years Asthma x 1 year

Medications: Salbutamol (Ventolin) 100 mcg HFA inhaler 2 puffs QID prn – initiated 1 year ago

Fluticasone (flovent0 125 mcg HFA inhaler 2 puffs BID – initiated 1 year ago

Naproxen (Naprosyn) 500 mg BID – initiated 2 years ago

EM presents a prescription for celecoxib (Celebrex) 100 mg BID x 60 capsules. He tells you his doctor wants to stop the naproxen because he has been taking his naproxen on an empty stomach and has developed an upset stomach.

You would be concerned that celecoxib:

A. has not been proven to be as effective as naproxen in arthritis B. is contraindicated in patients with asthma C. is contraindicated in patients with a sulfonamide allergy D. is expensive; adding misoprostol (Cytotec) to naproxen is cheaper

Ans.: C

67. Patient name: DC Age: 46 years old

Gender: male Allergies: Penicillin (anaphylaxis) Medical conditions: Hypertension x 18 months Medications: Hydrochlorothiazide (Apo-Hydro) 12.5 mg qam x 18 months Multivitamins (Centrum forte) one daily x 6 months

Upon picking up his prescriptions, DC asks you if you can recommend some other eyedrops for his extremely itchy/ watery eyes. He has used tetrahydrozoline (Visine Original Formula) for 1 week and it is not working.

Your recommendation would be: A. naphazoline (Albalon) 2 drops each eye QID B. naphazoline/ antazoline (Vasocon A) 2 drops each eye QID C. sodium cromoglycate (opticrom) 2 drops each eye QID D. tetrahydrozoline zinc sulphate (Visine allergy) 1-2 drops each eye TID – QID E. any of the above

Ans.: C

68. Patient name: JS

Age: 67 years old Gender: Female Allergies: Diclofenac

Medical conditions: Insomnia Nerve pain Medications: Tryptophan (tryptan) 500 mg 2 qhs for sleep x 6 months Amitriptyline 50 mg 1-2 qhs nerve pain x 3 days

JS’s daughter asks you to recommend something for her mother’s flu. She explains that her mother is extremely agitated and tremulous, is sweating a lot, has a high fever and is really confused. She’s in bed with muscle spasms.

What would you recommend?

A. Methocarbamol/ASA (Robaxisal) 2 QID with food and see her doctor if symptoms don’t improve in 48 hours B. Methocarbamol/ acetaminophen (Robaxacet) 2 tablets QID and see her doctor if symptoms don’t improve in 48 hours C. Discontinue amitriptyline and see her doctor within 48 hours D. Discontinue amitriptyline and tryptophan and see her doctor within 48 hours E. Take JS to the closest emergency department as soon as possible Ans.: E

69. Patient name: WB Age: 28 years old

Gender: Female Allergies: No known allergies Medical conditions: Acne Medications: Minocycline (Minocin) 100 mg daily x 2 weeks Benzoyl peroxide/ erythromycin (Benzamycin)Gel; Apply qhs x 2 weeks Benzoyl peroxide (PanOxyl) 5% Gel Apply qhs x 6 months-now discontinued

WB’s doctor calls you for advice. WB has been on minocycline (Minocin) and benzoyl peroxide/ erythpmycin (Benzamycin) for 2 weeks now, but has not seen any improvement in her acne.

What would you recommend? A. Continue minocycline (Minocin) and benzoyl peroxide/ erythromycin

(Benzamycin) for 2 months B. Start tazarotene (Tazorac) discontinue other medications C. Start cyproterone/ ethinyl estradiol (Diane 35), discontinue other medications D. Start isotretinoin (Accutane), discontinue other medications E. Start norgestimate/ ethinyl estradiol (Tricyclen), discontinue other medications Ans.: A

70. Patient name: SE

Age: 55 years old Gender: male Allergies: Penicillin ASA Medical conditions: Arrhythmia Hypertension

Hypercholesterolemia Medications: Digoxin (Lanoxin) 0.125 mg daily x 1 year Nitroglycerin (Nitro-dur) 0.4 mg patch Apply at 8 am; Remove at 8 pm daily x 1 year Ramipril (Altace) 5 mg daily x 1 year Furosemide (Lasix) 40 mg daily x 1 year Simvastatin (Zocor) 20 mg daily x 1 year You receive the following prescription for SE for community-acquired pneumonia: Amoxicillin 500 mg TID x 10 days When calling the doctor to change the prescription which alternate antibiotic, would you recommend?

A. amoxicillin/ clavulanate (clavulanate (Clavulin 500 F) 500 mg TID B. cefixime (Suprax) 400 mg daily C. clarithromycin (Biaxin) 500 mg BID D. doxycycline (Vibra Tabs) 100 mg BID E. norfloxacin (Noroxin) 400 mg BID

Ans.: D 71. Patient name: MN

Age: 8 years old Weight: 50 kg

Gender: male Allergies: Captopril Codeine Mentoclopramide

Penicillin Medical conditions: Displastic multicystic kidneys; paraplegic, unable to communicate Other: CrCl 110 mL/min (Normal CrCl = 125 mL/min) Medications: Sulfamethoxazole/ trimethoprim (Septra) Susp. 5 mL daily for UTI Prophylaxis x 2 months Salbutamol (ventolin) 1 mg/ml nebulas 2.5 mL QID prn x 2 years Budesonide (Pulmicort) 250 mcg nebule BID x 2 years MN has been coughing up yellowish-green sputum. The doctor calls you with a prescription for amoxicillin/ clavulanate (Clavulin 250 F) 250 mg TID x 10 days What would you do?

A. Fill the prescription as written B. Suggest reducing the dose to amoxicillin/ clavulanate (Clavulin 125 F) 125 mg

TID x 10 days C. Suggest changing to doxycycline (Vibra tabs) 100 mg daily x 10 days D. Suggest changing to erythromycin 250 mg QID x 10 days E. Suggest changing to erythromycin 125 mg QID x 10 days Ans.: D

72.Patient name: DA

Age: 60 years old Gender: male Allergies: No known allergies Medical conditions: Type 2 Diabetes Hypercholesterolemia Occasional angina Other: Half-marathon walker, eats grapefruit Medications: Atorvastatin (Lipitor) 20 mg qhs – initiated 2 years ago Metformin (Glucophage) 500 mg TID – initiated 2 years ago Sildenafil (Viagra) 100 mg hs prn – initiated 2 months ago Nitroglycerin (Nitrolingual) 0.4 mg Spray 1-2 sprays sl prn – initiated 3 weeks ago DA requests a refill of his sildenafil (Viagra) prescription. You would be concerned about all of the following EXCEPT:

A. Atorvastatin with grapefruit B. Metformin with attorvastatin C. Sildenafil with nitroglycerin D. Sildenafil with grapefruit

Ans.: B

73. Case study for next 2 questions DC brings in a prescription for triamcinolone (Nasacort Aqueous) 1 spray in each nostril TID PRN

A. Call the doctor to change the directions to 1 spray in each nostril three times daily B. Call the doctor to change the directions to 2 sprays in each nostril once daily

C. Dispense as written and explain that the patient may not see results for at least 3 weeks D. Dispense as written and explain that the medication should be used regularly, not prn, to receive the maximum benefit Ans.: B

74. When counseling on the triamcinolone (Nasocort Aqueous), you would include the following EXCEPT:

A. Blow your nose if necessary prior to use and avoid blowing your nose after use B. Contact your doctor if you experience severe nose bleeds C. Contact your doctor if you are experiencing yellow or green discharge D. Do not take OTC antihistamines while on triamcinolone (Nasocort Agueous) E. Do not use decongestant nasal sprays while on triamcinolone (Nasocort Aqueous) Ans.: D

75. Case Study for next two questions: Patient name: RK

Age: 9 years old Weight: 30 kg

Gender: male Allergies: peanuts (anaphylaxis) Medical conditions: shortness of breath on exertion (asthma)

Medications: Epipen (filled every year)

RK has just been diagnosed with asthma. His mother brings in a new prescription for: ipratropium/ salbutamol (Combivent) inhaler 2 puffs before exercising and 2 puffs 3-4 times daily prn shortness of breath

What would you do?

A. Recommend adding theophylline syrup to the ipratropium/ salbutamol (Combivent) therapy

B. Recommend adding a corticosteroid to the ipratropium/ salbutamol (Combivent) therapy

C. Recommend adding salbutamol (Ventolin) inhaler to the ipratropium therapy D. Recommend changing the prescription to salbutamol (Ventolin) inhaler E. Dispense the prescription as written and counsel the mother on its proper use,

asking that the son bring the inhaler in for a review of how to use it. Ans.: D

76. Two weeks later, RK’s mother returns stating that RK is frequently waking up at night with shortness of breath. She asks you if there is anything that can help. You would advise RK’s mother to take RK to see the doctor to get a prescription for:

A. cromoglycate (Intal) inhaler. B. ipratropium/ salbutamol (Combivent) inhaler

80. Patient name: JC

Age: 54 years old

Gender: male Allergies: no known allergies Medical conditions: Bone Cancer, severe pain Other: Low-income patient

Medications: Hydromorphone (Dilaudid) 2 mg TID x 3 months Tylenol No.3, 2 QID prn pain x 5 months In the past, JC has trouble paying for his medications and sometimes has not picked them up because of their high cost. His condition is deteriorating and he is in intense pain. Today, JC presents a new prescription for hydromorphone (HydromorphContin) 6 mg BID x 100 capsules. JC shows your pharmacy intern a vial of medication, labeled for a deceased patient, which he received from the doctor. He wants to know if it is the same as what was prescribed for him. The pharmacy intern confirms that the vial contains hydromorphone 3 mg capsules. The pharmacy intern tells JC it is the same medication as the doctor prescribed, but to take 2 of the capsules twice daily to get the right dose. What are the three (3) most important factors to be considered in this case?

I-Dosing information on the vials is inaccurate for JC

II-The integrity (storage, expiry, tampering) of the medication is unknown III-JC needs pain medication Ans-E

A. JC’s PharmaNet record would be incomplete B. Dosing information on the vials is inaccurate for JC C. The other patient’s right to confidentiality has been breached D. The integrity (storage, expiry, tampering) of the medication is unknown E. JC needs pain medication F. The doctor is dispensing and not following appropriate dispensing procedures G. JC’s relationship with the doctor should be respected H. The pharmacy intern should respect the doctor’s professional judgment

Ans.: B, D, E

ETHICS 81. A pharmacist wants to leave on a weekend, but the pharmacy manager does not grant leaves on a Sunday. He calls the pharmacy and say that that he is sick. A-Pharmacy manager will ask when he will come back to work B-Give disciplinary notice and let college know about his absence C-It is the right of the pharmacist utilize his holidays D-It is manager choice, if he wants he can stop him from his vacation. E-It is college of pharmacy decision, what to do Ans: C 82. A manufacturer of a new drug is trying to convince a pharmacist to buy a stock. What is the least important information the pharmacist will consider? a. Minimum order for stock and shelf capacity b. The patient need for the drug c. It is frequently written by the physician d. The cost of the medicine Ans:B 83. A pharmacist is working as a reliever in another pharmacy. A patient came with a prescription of Ativan 1mg. The pharmacist remembered that the same patient came with another prescription of the same drug two days ago in another pharmacy where

he worked. What should the pharmacist do? a. call the police b. refuse to fill the new prescription c. discuss the matter with the patient d. call the doctor and tell him that the patient is addictive Ans:C 83. A woman phoned the pharmacist and told him that her husband has swallowed 30tabs of acetaminophen 325mg. What is the proper advice? a. he will be ok b. induce emesis-using ipecac c. call the poison center to ask for advice d. take him to the emergency department Ans:D 84. How would you dispense a prescription for imipramine for two months for a woman who has attempted suicide? a. it is a safe drug b. do not fill it c. refer to another pharmacy d. counsell her not to take too much of it Ans: D 85. If a hospital Pharmacist contacts a community Pharmacist requesting a fax of an adult patient’s drug profile because the admitting physician is unable to obtain a complete medial history from the patient and the patient’s family cannot be contacted I-. It would be all right to transfer patient information from one pharmacist to another for the benefit of the patient. II-Name of the pharmacist transferring the prescription should not be given III-Medication error occur in information transfer therefore should not transfer information. A I only B III only C I and II D II and III I, II and III

Ans-A 86. A lady pharmacist returned from a maternity leave. She is not coming on time, making more mistakes in dispensing medicine, leaving early in the evening (before the time). What should the manager do? a. hire one more pharmacist to cover up b. warn her regarding disciplinary action c. appoint a tech for a close watch Ans: B 87. A pharmacist noticed that a technician is giving Tylenol #1 to a customer. What action should he take? A-Tell the technician to counsel about Tylenol # 1, constipation side effect B-Tell the patient about hepatotoxicity if acetaminophen dose exceed 4g per day C- Technician cannot release exempted narcotics, need pharmacist intervention D-Train technician on counselling tips for over the counter medications. Ans-C 88-If a Father comes into the pharmacy requesting official receipts for his family’s prescription for an entire year. Family members include a teenage daughter of 17 year age and a small son of 8 year old. I-Due to confidentiality purposes these documented cannot be released to the father unless each family member is contacted and permission is taken by each member of the family to release this information to the father for tax purposes. II-Care of confidentiality should be taken in case of there daughter who is on birth control as the father may not be aware that the daughter is on birth control and she may not want her father to know this information. III- She should be called on the phone in a confidential area and asked if it would be all right if her medical profile were given to her father for tax peruses. A I only B III only C I and II D II and III E I, II and III Ans-E 89-A person comes into the pharmacy and asks for some syringes the syringes are kept behind the counter to monitor the sales of the syringes to patients. A patient who looks a little bit confused and not too sure what to ask for comes in and asks you in a lower voice if you have syringes. When you ask the patient what size he needs he is not quite sure and shows you how long using his fingers. You then ask the patient what she is using for and the patient pauses and then says she needs it for her

grandmother diabetes. You then offer to call his grandmother to see what exact size she needs. The patient refuses and then finally says that he needs it for illicit drugs. Which of the following are appropriate actions: I. counsel the patient on the side affects of illicit drug and that it would be a good idea

to see his doctor regarding the use of such drugs, and what could be done to help him get off them..

II. The pharmacist at this point may chose to give the patient the syringes in order to avoid driving the patient to share syringes with other and get a transmitted disease.

III. The pharmacist may chose to not sell the patient the syringes, because the pharmacist believes that this would benefit the patient and would be against the pharmacist own personal morals

A I only B III only C I and II D II and III E I, II and III

Ans-C

90. ABC pharmacy has following figures appearing on its balance sheet.

Cost of goods sold $500,000 Beginning inventory $200,000 Ending inventory $220,000 Total current assets $150,000 Total fixed assets $40,000 Total liabilities $75,000

Inventory turnover rate for ABC pharmacy is

a) 4.3 b) 2.38 c) 3.5 d) 6.0 e) 8.0

Ans: B 91. Net worth of ABC pharmacy is

a) $195,000 b) $225,000 c) $115,000 d) $75,000 e) $110,000

Ans: C

Comments: Total assets – total liabilities ($150,000+$40,000) - $75,000 = $150,000 93. Patient was using albuterol 2 puffs qid prn, budesonide (Pulmicort) 100 microgram 1 puff BID. What should the pharmacist do if the patient increased his frequency of using albuterol a. see profile to check dose b. advise doctor to increase dose of budesonide (pulmicort) c. tell the patient to contact the doctor d. all of the above Ans :D (The maintenance dose of budesonide is 200-400 microgram twice daily and a higher dose may be necessary in some cases. Also, do not exceed the dose of albuterol prescribed by the physician. If difficulty of breathing persists, contact your physician) 94. Patient comes for refill of ibuprofen and salbutamol prn. Increasing frequency of use of salbutamol is noted, what should the pharmacist recommend? a. do not exceed the dose prescribed by the doctor; if difficulty of breathing persists, contact your physician. b. advise Dr. to give mefenamic acid instead of ibuprofen c. tell the patient to see the doctor for further assessment d. all of the above Ans: D 95-A local family physician phones the pharmacy to inquire whether omalizumab is available in Canada. The pharmacist learns that the doctor read about the drug in a medical journal. He wants to treat a patient with allergic asthma, and is interested in its availability and cost. The pharmacist asks you to gather information on omalizumab for her to review so she can respond to the doctor later. Which of the following information source is an appropriate I-Pharmacist Letter II-Canadian Pharmacist Journal III-Pharmacy Practice

a. I only b. III only c. I and II only d. II and III only e. All of the above

Ans-E 96. A doctor wants to give infusion of proton pump inhibitor and ask the pharmacist what is the source of information?

I CPS II Medline III manufacturer leaflet

A. I only B. III only C. I and II only D. II and III only E. All of the above

Ans :D 97. What are the primary sources of information? a. Canadian hospital journal b. American hospital journal c. CPS d. A, b and E e. New England medical journal Ans.: D 98-One of your regular patients comes to the pharmacy in search of Dogmatil® for her brother. He has just arrived from Hong Kong for a visit, but his medication was lost with his luggage. She says her brother needs the medication for a mental condition and shouldn’t go without it. She wants to know if he can get Dogmatil® here. Which of the following appropriate a. Canadian hospital journal b. American hospital journal c. CPS d. Martindale, The complete drug reference e. National formulary Ans-D 99. When a manager wants to hire a pharmacist, what is the least important question he will ask about?

A. pharmacist qualifications B. experience C. professional colleagues D. communication skills

Ans.: C

100-A diabetes teaching nurse knows that inhaled insulin will not be available in Canada in the immediate future, but asks you to help her source information for a lecture. A logical initial choice to use would be: A. CPS B. E-CPS C. PubMed D. Health Canada website E. Therapeutic choice Ans-C 101. Which one should be written down in the narcotic and controlled drug register

I. Darvon N II. Dextroamphetamine sulfate (Dexidine)

III. Methylphenidate (Ritalin) A. I only B. III only C. I and II D. II and III E. All of the above Ans: E 102.Which factor would reduce the effectiveness of print materials?

a. unbiased and accurate b. written at the grade 6-8 level c. used in conjunction with verbal counseling d. include numbered lists e. customized for patients

Ans E 103.What advantage does the pharmacist have when using counseling aids with J.J.?

a. saves time b. no need to verbally counsel J.J. c. no need to use a private counseling area d. no need to review or adjust materials e. no need to assess skills

104. A physician has prescribed 60 g of 0.01% fluocinolone acetonide cream. You have available the commercially prepared cream containing 0.2% fluocinolone acetonine

(Synalar ® cream) and cream base (Dermabase ®) for dilution. To prepare the Rx you would require:

a) 1.2 g Synalar and 58.8 g Dermabase b) 3 g Synalar and 60 g Dermabase c) 0.3 g Synalar and 59.7 g Dermabase d) 3 g Synalar and 5 7 g Dermabase e) 12 g Synalar and 48 g Dermabase

Ans-D Working:

i. 60 g of 0.01% fluocinolone acetonide (required in the Rx) contains 0.01/100 x 60 = 0.006 g fluocinolone acetonide)

ii. You have 0.2% fluocinolone acetonide (0.2 g per 100 g = 0.002 g fluocinolone per gramme of cream)

iii. Therefore, for the Rx you need 0.006 / 0.003 = 3 g Synalar cream Ans: D B is wrong, because 3 g Synalar and 60 g of Dermabase will give 63 g of total cream, with a concentration of 0.0095% (0.006 / 63 x 100) 105- The package information enclosed with a vial containing 5,000,000 units penicillin G potassium specifies that when 23mL of a sterile solvent are added to dry powder the resultant concentration is 200,000 units/mL. On the basis of this information, how many mL of sterile water injection should be used to prepare a solution containing penicillin G potassium 500,000 units/mL? A. 8 B. 9.2 C. 10 D. 18.4 E. 25 Ans-A Working:

i. vial contains 5,000,000 units of penicillin G ii. 23 mL are used to prepare a solution of concentration of 200,000

units/mL. Since no drug is removed from the vial (and it therefore still contains a total of 5,000,000 units), the total volume inside the vial is 5,000,000 / 200,000 = 25 mL. This means that the volume of powder occupies 25-23 = 2 mL.

iii. to dilute the vial to produce a solution whose concentrations is 500,000 units/mL I need to be diluted to 5,000,000/500,000 = 10 mL

iv. From (ii) we know that the powder occupies 2 mL of volume. Therefore the amount of sterile solvent requested is 10-2 = 8 mL

Ans: A

106. You are receiving a prescription for 150 percocet tablets and when you checked, you realized that there is only 100 tablets with you. The patient needs it right now, you called the other pharmacy and they are ready to loan the tablets. Which of the following procedure should you follow for the loan? I-Write percocet prescription for 50 tabs and record in your green narcotic book II- Loan a 500 tablet full bottle and give back the unopened bottle within 48 hours III-Ask for 50 tabs and give back within 48 hours, no recording is required A. I only B. III only C. I and II D. II and III E. All of the above Ans : A 107- Drug utilization review, it is the process of quantitatively and systematically reviewing prescription claims data to evaluate the appropriateness of drug therapy. Drug utilization effectiveness is

I. retrospective II. prospective

III. reactive A. I only B. III only C. I and II D. II and III E. I, II and III

Ans: E

108.A baby had fever of viral origin, all of the following should be done, Except: a. give him acetaminophen five doses/day b. give him acetaminophen not more than eight doses/day c. avoid too much clothes d. do not wake him up during the night to give him acetaminophen doses except if he had febrile seizures before Ans: B 109. In order to protect a baby from UV radiation, do all except: a. avoid exposure to sunlight between 10am and 3 pm b. use hat to protect his nose and ears from sunburns c. use lotion SPF 15 d. no effect of UV radiation in cloudy skies Ans: D 110. A baby swallowed a 15g tube of nystatin. What should you do to remedy the over dosage? a. rush to emergency b. too low dose to get any serious side effects c. do stomach wash d. give activated charcoal Ans: B TIPS: If more than 15g nystatin proper action should be refer to emergency 111. A patient is treated with Gentamycin through IV infusion every 12h, it was found that the Gentamycin is always below desired levels before infusion ends by half an hour. How can you manage the situation. a. keep the dose the decrease the interval b. increase the dose keep the same interval c. increase the dose and decrease the interval d. increase the dose twice Ans: A 112.. What should the pharmacist consider in using interchangeable drugs? a. high therapeutic index b. low therapeutic index c. high AUC d. T max

Ans: A 113. When 3.5 mL of water is added to 1 g of penicillin powder, the concentration of the resulting injectable is 250 mg/mL. How much water should be added to give a concentration of 100 mg/mL?

a) 9.0 mL b) 9.5 mL c) 10 mL d) 10.5 mL e) 12 mL

Working:

i. Vial contains 1 g of penicillin powder. Since none was removed, and the resulting concentration is 250 mg/mL, then the vial contains 1,000/250 = 4 mL (total penicillin is unchanged).

ii. Therefore, since only 3.5 mL water was added to produce 4 mL of solution, we assume that the powder occpies (4-3.5) = 0.5 mL of volume.

iii. To dilute to 100 mg/mL, you need to have 1,000/100 = 10 mL of final solution. But we know from above that the powder occupies 0.5 mL of volume. Therefore, the amount of water to be used to dilute is 10-0.5 = 9.5 mL

Ans: B 114. How many grams of boric acid should be used to compound the following Rx (NaCl equivalents: phenacetin 0.2; chlorbutanol 0.24; boric acid 0.52) Phenacetin 1% Chlorbutanol ½% Boric acid q.s. Water 60 mL Make isosotonic solution Sig. for the eye A-0.52g B-0.66g C-0.33g D-348g E-0.072g Ans-B Working:

i. Calculate number of NaCl equivalents required: (0.9 / 100) x 60 mL = 0.54

ii. Calculate NaCl equivalents of each component as follows: Phenacetin: [(1/100) x 60] x 0.2 = 0.6 g x 0.2 = 0.12 Chlorbutanol: [(0.5/100) x 60) x 0.24] = 0.3 g x 0.24 = 0.072 Boric acid: Eq. Required – [Eq phenacetin + Eq chlorbutanol]

= 0.54 – (0.12 + 0.072) = 0.54 – 0.912 = 348 NaCl eg of boric acid are required

iii. Convert the above to grammes of boric acid: 348 NaCl Equivalents / 0.52 = 0.669 g are required 115. A father of a teenaged girl phones the pharmacy and asked him whether his daughter is taking birth control pills or not? What are the contradicting ethics pressing the pharmacist?

a) Non-maleficence and confidentiality b) Beneficence and confidentiality c) Autonomy and confidentiality d) Veracity and confidentiality e) Justice and confidentiality

Ans: D 116.All should be included in the lifestyle of an osteoporosis patient, except: A. Avoid alcohol B. Avoid smoking C. Weight bearing exercise D. Calcium diet E. Vitamin D 10,000 IU Ans: E 117.What will you recommend to a man with a swollen toe and has an allergy to NSAIDs? a. Colchicin b. Tylenol c. allopurinol d. indomethacin e. ibuprofen Ans: A

118.How do you apply methyl salicylates ointment for arthritis? I not to big areas II not to broken skin III use with wet compresses or hot pads

a. I only b. III only c. I and II d. II and III e. I, II and III

Ans: C 119-All of the following are important fundamental principles of marketing EXCEPT:

a) Product b) Price c) Profession d) Promotion e) Place

Ans: C 120. A pharmacist needs to choose a brand of warfarin to give to a patient who has already started warfarin in the hospital. Which of the following are correct?

I. Choose the brand used by hospital II. Choose the one with the quickest onset of action III. Choose the one with higher Cmax

a) I only b) III only c) I and II only d) II and III only e) All of the above

Ans: A

121.In motion sickness, which one is correct? I pills should be used 10-15 minutes before travel II pills should be used at least 30 minutes before travel III dimenhydrinate Gravol can cause drowsiness

a. I only b. III only c. I and II d. II and III e. I, II and III

Ans: D 122.A vertical laminar flow hood should be the best choice to used for which of these medications? a. aminophylline b. nitroglycerin c. doxorubicine d. magnesium sulfate e. penicillin Ans : C 123. What is the treatment goal of psoriatic therapy? I reduce underlying inflammation II increase epidermal proliferation III eradicate the condition completely

a. I only b. III only c. I and II d. II and III e. I, II and III

Ans : A 124.Which one is true regarding minocycline 100mg BID and Minocycline 50 QID? I Css average is the same II Cmax is lower in 560mg QID III Tmax in 50mg QID is less than 100mg BID

a. I only b. III only c. I and II d. II and III e. I, II and III

Ans: E

125.A woman needs a sleeping pill and we have two brands of diazepam. How do we decide which one has faster onset of action? I by comparing the two Tmax I by comparing the rate of absorption III by comparing two AUC

a. I only b. III only c. I and II d. II and III e. I, II and III

Ans: A 126. Which one should be written down in the narcotic and controlled drug register

I Darvon N II Dextroamphetamine sulfate (Dexidine) III methylphenidate (Ritalin)

A I only B III only C I and II D II and III E I, II and III

Ans: E 127. A patient got treatment from USA for cancer. He got medicine from the States. He needs a refill. What is appropriate/ a. Get from States under special access program if need same drug b. Canadian doctor has to countersign Rx c. Canadian Dr should write substitutes ans :B 128. A woman phoned the pharmacist and told him that her husband has swallowed 30tabs of acetaminophen 325mg. What is the proper advice? A. He will be all right, he should not worry and this not a serious concern B. Induce emesis-using ipecac C. Call the poison center to ask for advice D. Refer him to the emergency department E. Call drug information center for help Ans: D

129.A pianist woman comes to the doctor and complains of pain and she says she can’t do her regular job. What is the goal in arthritis therapy? a. to allow the patient to function as normally as possible in the short term b. to ensure that therapy is as effective as possible in arresting or delaying joint

damage and destruction c. three types of drugs are used to achieve the above target, NSAIDs, DMARDs (methotrexate, chloroquine, gold) and corticosteroids (prednisolone, intraarticular cortisone injection)

D-All of the above Ans : all of the above 130.Counselling on PABA products includes: I stains cloths II it absorbs the UV III it blocks the UV rays

a. I only b. III only c. I and II d. II and III e. I, II and III

Ans.: C 131. Alcohol abuse patient with liver failure has headache what to give a. Tylenol b. ibuprofen c. coated ASA d. robaxacet e. mersendol Ans: B 132.Which one is true in the elderly? I-the hepatic metabolism (first pass effect) is decreased II. the protein binding of acidic drug is decreased III. volume of distribution (Vd) of lipid-soluble drug is increased Ans-E Ans: all of the above

132.Counselling on Hydrochlorthiazide (HCTZ) includes: a. do not wear contact lenses b. take it in the morning c. take with a glass of orange juice or banana (K-supplement) d. all of the above e. B and C Ans: D 133.Which one is true in treating a person who has been overdosed by meperidine? I- use naloxone as antidote II. if naloxone does not work in the first shot it can be repeated III-. naloxone will prevent the respiratory depression caused by meperidine Ans-E Ans: all of the above 134.Which one should be recorded in the narcotic sales book a. Phenobarbital b. meperidine c. Tylenol #3 d. all of the above e. A and B Ans: B 135.A woman started birth control 2 days ago. She is sexually active and has vaginitis with discharge. Which one is not related to her problem? a. Trichomonas infection b. candidiasis c. having sex often d. none of the above Ans: C

136. A pharmacist needs to choose a brand of warfarin to give to a patient who has already started warfarin in the hospital. Which of the following are correct?

IV. Choose the brand used by hospital V. Choose the one with the quickest onset of action VI. Choose the one with higher Cmax

a) I only b) III only c) I and II only d) II and III only e) All of the above Ans: A 137. A doctor and nurse start frantically looking for naloxone for a female patient is suspected of overdosing of IV narcotics. What basic principle in the treatment of poisoning are the overlooking

a) Gastric lavage b) Syrup of ipecac c) Control of vital functions d) Electrolytes e) Blood analysis

Ans-c 138. The following parameters would provide the best estimate of relative bioavailability for a drug ingested orally

a) onset of drug action b) duration of drug action c) maximum plasma concentration d) area under the AUC e) serum half life

Ans: D 139.You get a phone call from a life insurance company asking about a patient’s current medication. What should you do? A-Give the information without telling the patient B-Give the information and tell the patient later C-Do not give the information unless you have patient’s consent in writing D-Pharmacist have right to share information with physician and insurance companies E-Insurance company have right to get information from pharmacist. Ans: C

140.An alcoholic patient is being attended to in the emergency ward. Which action should be taken? I infusion of multivitamin thiamine (pyridoxine 100mg IV q day) for

neurological symptoms II diazepam for withdrawal symptoms III phenytoin for convulsions

a. I only b. III only c. I and II d. II and III e. I, II and III

Ans: E 141-A patient weighs 70 kg with normal renal function is injected with an IV drug for 10 hours. The desired plasma concentration is 15 mg/dl. T half of drugs is 1 hr and an apparent volume of distribution is 9Litres. What is the rate of infusion for this patient?

a) 936.0 mg/hr b) 1350.0 mg/hr c) 468.0 mg/hr d) 93.6 mg/hr e) 135.0 mg/hr

Ans: A Comment: Vd = 9 L → 90 dL k = .693/ t1/2 T ½ = 1 hr = .693/ 1 Css = 15 mg/dL = .693 R = Css x Vd x Kel = 15mg/dl x 90 dl x kel = 935.55mg/hr

142. The physician called your pharmacy and asked you to prepare him 10 g of 2.5% of benzocaine ointment. In stock you have 20% benzocaine ointment. How much benzocaine and ointment base will you need for this prescription?

a) 1 g of benzocaine and 9 g of ointment base b) 1.20 g benzocaine and 8.75 g of ointment base c) 1.25 g of benzocaine and 8.6 g of ointment base d) 1.30 of benzocaine and 8.7 g of ointment base e) 1.35 of benzocaine and 8.6 g of ointment base

Ans: C 143. Patient is being treated with ampicillin and gentamycin. Useful monitoring parameter/s is/are

I. temperature II. serum creatinine III. partial thromboplastin time

a) I only b) III only c) I and II only d) II and III only e) All of the above Ans-C 144-AZ is a 42-year old female who has a five-year history of major depressive disorder (MDD) without psychotic features. In the past, her depression was treated with clomipramine, Venlafaxine, and the combination of paroxetine and lithium, each with little or no effect. She has been somewhat controlled for the past six months with escitalopram (Lexapro) 10 mg daily, but went to her doctor because she still has no interest in doing things she used to enjoy, has trouble sleeping, and continuous to lose weight. She presents with a prescription for olanzapine 5 mg daily, and tells you her doctor is giving her another antidepressant. When she reads in the patient information leaflet that the medication is used for schizophrenia, she becomes concerned that she is not receiving the correct medication. Which of the following appropriate counselling olanzapine: I- Explain that increased appetite and weight gain may be beneficial side effects. II- Suggest that she let her doctor know if she is gaining too much weight. III- Olanzapine may cause extrapyramidal symptoms

A. I only B. III only C. I and II D. II and III E. I, II and III

Ans-E

145. The information that you can give to the patient when dispensing ketoconazole may include which of the following

I. give antacids to reduce GI upset II. take until finished III. take with food to decrease GI upsest

a) I only b) III only c) I and II only d) II and III only e) All of the above Ans-D 146.Primary sources of information include which of the following? I-Canadian hospital journal II-American hospital journal III-Pharmacoeconomics Ans-E 147.Which one does not need the label “shake well” I AEROSOLS II flonase III nitroglycerin pump (nitro lingual pump)

a. I only b. III only c. I and II d. II and III e. I, II and III

Ans: B

149.A patient with shortness of breath, swollen ankle, high blood pressure and exercise- induced angina comes to the pharmacy with a Rx for digoxin 0.20mg/day. He is already taking HCTZ, verapamil and nitro lingual spray prn. What will be your conversation with the doctor? I fill the prescription the way it is II changing HCTZ to furosemide III decrease the dosage of digoxin

A. I only B. III only C. I and II D. II and III E. All of the above

Ans: D 150.A 74 year old female in a nursing home with osteoporosis is taking ibuprofen 300mg BID and ranitidine 150 mg BID. Which one is the better therapy for this woman? a. didrocall etidronate b. fosamax alendronate c. hormone replacement therapy d. Calcitonin Ans :D