Answer ALL questions. For each question, there is ONE correct answer. Use the answer grid provided for ALL your answers.

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1 OPTIMISING PATIENT CARE THROUGH PHARMACY PHA-6002Y Time allowed: 2 hours Part ONE UNIVERSITY OF EAST ANGLIA School of Pharmacy Main Series UG Examination Answer ALL questions. For each question, there is ONE correct answer. Use the answer grid provided for ALL your answers. Part TWO There is ONE question in this section. Part THREE Answer ONE of the TWO questions in this section. Use a SEPARATE answer book for EACH question from Parts TWO and THREE. Each question has the same value. The marks distribution is shown as a percentage for each section of the question. Answer ALL parts of each of the individual questions you select. The mark allocation for the paper is: Part ONE carries 50% of the total mark. Part TWO carries 25% of the total mark. Part THREE carries 25% of the total mark. You are advised to spend no more than 60 minutes on Part ONE. You are advised to spend approximately 30 minutes on Part TWO. You are advised to spend approximately 30 minutes on Part THREE. This paper consists of 14 pages in total. The following will be provided: Multiple choice answer grid. Notes are not permitted in this examination. Dictionaries are not permitted in this examination. Calculators are not permitted in this examination. Do not turn over until you are told to do so by the Invigilator. Do not take this question paper out of the examinations room. (PHA-6002Y) Module Contact: Mrs Laura Ellis, PHA Copyright of the University of East Anglia Version 2

2 PART ONE SECTION A TYPE 1 MCQs (Single Best Answer) Answer ALL questions. There are 30 questions in total in this section. For each question, there is ONE best answer. Use the answer grid provided for ALL your answers Mrs KY is 50 years old with a BMI of 32. Her recent tests have shown that she has type 2 diabetes. She has no other medical conditions, which ONE of the following would be the most suitable treatment for her? Gliclazide Insulin Metformin Ramipril Sitagliptin 2. Which ONE of the following would best describe an economic analysis which uses a QALY as an outcome? Cost-Analysis Cost-Benefit Cost-Effectiveness Cost-Minimisation Cost-Utility 3. An 8 month old child is prescribed amoxicillin oral suspension 125 mg/5 ml at a dose of 62.5 mg TDS for 10 days. What volume of suspension is required to complete the course? 7.5 ml 25 ml 75 ml 150 ml 250 ml 4. Which ONE of the following is NOT a legal requirement on a prescription for a CD POM for a pet dog? For an animal under the care of the veterinarian Name and address of the owner Quantity in words and figures RCVS registration number Withdrawal period

3 3 5. You are conducting an interview and want to assess the candidate s customer relation skills. Which ONE of the following questions is the most appropriate competency based question to assess this? Do you do any volunteer work that involves dealing with customers? Tell me about a time when you had to respond to a customer complaint What do you understand by the phrase outstanding customer service? What would you do in order to increase our customer satisfaction levels by 5%? Why do you think it is important to offer a high standard of customer service? 6. During a drug history taking session, a patient tells you that she knows that she has to take one of her medicines first thing in the morning, and not eat for half an hour after taking it. Which ONE of the following drugs is she most likely to be referring to? Alendronic acid Amoxicillin Aspirin Bendroflumethiazide Omeprazole 7. Miss HM brings in the following prescription for a CD No Reg POM on an FP10MDA. Your pharmacy is closed on Sundays. The prescription states: Subutex 2 mg S/L tablets. Take 2 tablets daily supervised. Instalments due on days when the pharmacy is closed should be dispensed on the day immediately prior to the closure Which ONE of the following is appropriate regarding Miss HMs supply? Give the tablets to the patients mother as she informs you that the patient is feeling unwell Make Miss HM take one tablet in the pharmacy and allow her to take the second tablet home Supply generic buprenorphine tablets on each occasion Supply the tablets for Sunday to Miss HM on Saturday Supervise Miss HM taking her medication if the pharmacy is not busy, but allow her to take them away if you have other patients waiting 8. Which ONE of the following patients is eligible for an annual targeted MUR? A patient who has been using the pharmacy for 2 months who is prescribed simvastatin and amlodipine A patient who has used the pharmacy for 6 months who takes furosemide A patient who has used your pharmacy for 2 years and takes levothyroxine A patient who is new to your pharmacy and presents a prescription for metformin, gliclazide, ramipril and atorvastatin A patient who has used your pharmacy for 9 months prescribed opioid analgesics TURN OVER

4 9. Which ONE of the following is NOT a cost from a NHS perspective? 4 Carer visit to administer a patients medication in their home General practitioner time during a consultation HBA1C test Hospital admission Prescribed medicine cost 10. In relation to obtaining consent from a child, which ONE of the following statements is INCORRECT? Children between 16 and 18 years of age are always considered capable of giving consent, unless demonstrated otherwise If a child is capable of giving consent a parent cannot override their decision The child must be able to understand what is involved in the service for which they are consenting The parent must decide if they believe their child has the ability to give consent There is no set minimum age at which a child is capable of giving consent 11. Which ONE of the following best describes a pharmacy near miss event? An error involving a non-oral medicine An error which does not cause harm to the patient An error discovered by a patient s carer before they administer the medicine An error discovered before the medicine is supplied to the patient An error corrected immediately by the person who made it 12. A patient returns a box of oxycodone M/R tablets (CD POM) to your pharmacy as they no longer need them. Which ONE of the following is the most appropriate course of action? Denature the drugs immediately and record the destruction in the CD register Put the tablets in the DOOP bin immediately Put the tablets in the controlled drugs cupboard, separated from other pharmacy stock, until an authorised witness is present to authorise the destruction and record in the CD register Put the tablets in the controlled drugs cupboard, separated from other pharmacy stock to denature at a later time. Record the destruction in the CD destruction record Put the tablets in a separate drawer in the pharmacy reserved for returned controlled drugs until an authorised witness is present to witness the destruction. Record the destruction in the back of the POM register

5 5 13. Mr GY calls into your pharmacy to buy something to treat a suspected case of oral thrush. He shows you a list of his regular medication. Which ONE is most likely to be associated with Mr GY s symptoms? Amlodipine Beclometasone Chlorphenamine Salbutamol Theophylline 14. Which ONE of the following tasks is the most important and urgent using Covey s time management matrix? Checking the prescriptions for a residential home order needed for delivery before the end of the day Dispensing the methadone ready for patients to collect the following morning Speaking to a drug company representative who is waiting in the pharmacy about a medicine which has just been launched Updating the weekly staff hours ahead of the payroll deadline at the end of the week Contacting the company estates department about a dripping tap in the dispensary 15. An 8 month old child is seen by her GP and is diagnosed with an upper respiratory tract infection. They have a known sensitivity to penicillin, which ONE of the following would be the most appropriate treatment choice for this patient? Amoxicillin Cefalexin Chloramphenicol Clarithromycin Doxycycline 16. Which ONE of the following response types is most appropriate when dealing with a difficult patient? Aggressive Assertive Manipulative Passive Reactive TURN OVER

6 6 17. Mrs AD calls into your pharmacy on Wednesday morning, she explains that she has run out of 1 mg warfarin tablets, which she gets regularly from your pharmacy in addition to 3 mg warfarin tablets to treat a DVT. She tells you she takes a daily dose of 4 mg and her INR is currently on target. The surgery said they will get her a new prescription ready for Friday. Which ONE of the following would be the most appropriate action? Advise Mrs AD to cut her 3 mg tablets into thirds using a knife and use that to make up the dose Advise Mrs AD that she should just take 3 mg tablets until her prescription is ready Make an emergency supply of 3 warfarin 1 mg tablets and make a record in the POM register Make an emergency supply of 28 warfarin 1 mg tablets and make a record in the POM register Tell Mrs AD that you cannot supply warfarin tablets without a prescription as the surgery is open 18. Miss GR is a new patient at the drug dependency clinic having previously been injecting heroin. Which ONE of the following would NOT be appropriate when starting her treatment with methadone? Conduct toxicological screening Inform her that if she misses more than 3 consecutive doses she will need to have her treatment reviewed Inform the patient that sedation and tooth decay are potential side effects Provide any amount as an initial dose to reflect current opiate intake Supervise her doses at the start of treatment 19. Which ONE of the following medicines would NOT be appropriate to supply to a patient in a monitored dosage system (MDS)? Amitriptyline Clopidogrel Levothyroxine Nicorandil Simvastatin 20. Which ONE of the following controlled drugs is NOT subject to safe custody requirements? Fentanyl Methadone Oxycodone Phenobarbital Temazepam

7 21. Which ONE of the following best describes why sensitivity analysis is performed when determining cost-effectiveness of a service? 7 To determine the probability of an intervention being cost-effective To determine how to best improve patient satisfaction To enhance the likelihood of the results being statistically significant To identify how costs can be minimised by purchasing the cheapest elements of the intervention To identify which elements of the intervention are likely to be most costeffective 22. Which ONE of the following would NOT be appropriate advice for a 67 year old man newly prescribed isosorbide mononitrate tablets? Patients should take tablets approximately 8 hours apart to allow for a nitrate free period Side effects include a throbbing headache The patient should avoid taking sildenafil They may experience tachycardia They should be taken when the patient experiences angina symptoms 23. Which ONE of the following best describes effective delegation? Effective delegation should NOT be used to develop staff into new roles Effective delegation is only required if you do not have time to complete the task yourself Effective delegation requires the person undertaking the task to be provided with detailed instructions Effective delegation gives someone else accountability for a task not included in their core job role Effective delegation gives someone else responsibility for a task not included in their core job role 24. Which ONE of the following statements concerning antihypertensive drugs is INCORRECT? Bendroflumethiazide is first line therapy in patients over 55 years of age in accordance with NICE guidance Bisoprolol should be used with caution in patients with a history of asthma Furosemide is reserved for use in patients unresponsive to other treatments Losartan is a suitable alternative to ramipril in patients who have developed a cough Ramipril is recommended for patients with diabetes TURN OVER

8 25. You receive a private prescription for a CD Benz POM stating: 56 Diazepam 5 mg tablets 1 BD Repeat x2 which was signed 1 week ago. Which ONE of the following concerning the supply is INCORRECT? 8 Repeats are permitted on the prescription The medication can be left on the pharmacy workbench prior to collection The prescription must be on an FP10PCD The prescription is in date The prescription should be retained in the pharmacy 26. A patient is admitted to hospital complaining of a sore throat and mouth ulcers. On conducting a drug history you find they have been taking the drugs below. Which ONE of these medicines is most likely be associated with these symptoms? Beclometasone Ibuprofen Methotrexate Naproxen Tiotropium 27. Mrs NB comes into your pharmacy, she tells you that she has been experiencing mild constipation since being prescribed co-codamol. She would like to purchase a gentle laxative to help keep her stools soft. Which ONE of the following drugs would be most appropriate for this patient? Domperidone Ispaghula Lactulose Ranitidine Senna 28. You receive a prescription for prednisolone 5 mg tablets with the following instructions, Take 40 mg daily for one week then reduce dose by 5 mg on alternate days. Which ONE of the following is the correct number of tablets to dispense?

9 29. A medicine label states Do not take milk, indigestion remedies or medicines containing iron or zinc 2 hours before or after you take this medicine. Space the doses evenly throughout the day. Keep taking this medicine until the course is finished unless you are told to stop. Swallow this medicine whole. Do not chew or crush. Which ONE of the following drugs would these warnings be applicable to? 9 Amoxicillin Cefalexin Ciprofloxacin Clarithromycin Metronidazole 30. Which ONE of the following is a SMART objective? I will complete 50 MURs in the next week I will do my smoking cessation training I will learn to do the ordering I will date check the creams and ointments section before the end of the week I will update all the stock levels for the dispensary medicines TURN OVER

10 10 SECTION 2 Type 2 MCQs (Extended Matching Questions) Answer ALL questions. There are 10 questions in this section. Use the answer grid provided for ALL your answers. Questions 31 to 34 relate to the options below, please select ONE answer per question. Gastro-intestinal Medicines (F) (G) (H) (I) Azathioprine Domperidone Ispaghula Lactulose Mesalazine Metoclopramide Omeprazole Ranitidine Senna Which drug is most appropriate for each statement? Each option may be used once, more than once, or not at all. 31. An 80 year old male with Parkinson s disease experiencing severe nausea and vomiting. 32. A patient requesting a product to treat constipation, they would prefer a sachet formulation. 33. A patient with nausea associated with migraines. 34. A 16 year old patient who presents in the community pharmacy with heartburn following eating a curry.

11 11 Questions 35 to 37 relate to the options below, please select ONE answer per question. Cardiovascular medicines (F) (G) (H) Amiodarone Amlodipine Bendroflumethiazide Bisoprolol Digoxin Diltiazem Nicorandil Ramipril For each statement select ONE answer. Each option may be used once, more than once, or not at all. 35. Is first line treatment for a patient of African origin with a new diagnosis of hypertension. 36. Is most likely to be the cause of a patient presenting at A&E with severe nausea, vomiting and blurred vision. 37. Is the most likely cause of gout developed in the big toe of a 67 year old male. TURN OVER

12 12 Questions 38 to 40 relate to the options below, please select ONE answer per question. Endocrine Medicines (F) (G) (H) Carbimazole Fludrocortisone Gliclazide Hydrocortisone Insulin Levothyroxine Metformin Sitagliptin For each statement select ONE answer. Each option may be used once, more than once, or not at all. 38. Is suitable for a patient who presents at the doctors with general malaise, and following investigation is found to have low levels of T Is a suitable choice for a 28 year old female with a new diagnosis of polycystic ovary syndrome. 40. Is first line therapy for a patient with type 1 diabetes.

13 13 PART TWO There is ONE question in this section. Use a SEPARATE answer book for this question. 41. You are the pharmacist manager of a busy community pharmacy, who employs four additional members of staff. The pharmacy is open 09:00-18:00 Monday to Friday and 09:00-13:00 on Saturdays. Name Details H Newly started trainee dispenser, works full time Monday to Friday I Senior dispensing technician, works 10:00-16:00 Monday to Friday and 09:00-13:00 Saturdays. Responsible for completing weekly paperwork on Mondays J NVQ 2 qualified dispenser. Works full time Monday to Friday, mornings in MDS room K Healthcare assistant, helps in dispensary on Mondays and whilst other staff are at lunch 13:00-14:00. Below is a copy of the pharmacy near miss log for the past two weeks which has seen a significant increase in the number of recorded events. Date Time Drug Error Code Staff Details Mon 1 st 09:15 Citalopram S H 20 mg selected not 40 mg Mon 1 st 11:20 Actrapid insulin F H Pens not penfill Mon 1 st 12:00 Ramipril F J Tabs not Caps Tues 2 nd 13:20 Co-codamol L K Incorrect strength Tues 2 nd 13:30 Paracetamol Q K Part pack selected Thur 4 th 11:15 Amoxicillin L H Incorrect strength Thur 4 th 15:30 Elocon ointment O J Expired Fri 5 th 13:45 Metronidazole L K Incorrect directions Mon 8 th 09:10 Aspirin F J Not enteric coated Mon 8 th 10:50 Citalopram S J 40 mg selected not 20 mg Mon 8 th 11:30 Oxycodone L K Incorrect directions Mon 8 th 15:40 Novomix insulin D H Incorrect selection Wed 10 th 13:10 Tramadol Q K Part pack selected Thur 11 th 11:15 Citalopram S I 10 mg selected not 20 mg Thur 11 th 12:00 Humulin insulin D H Incorrect selection Sat 13 th 11:30 Hydrocortisone cream O I Expired Error code: D=wrong drug; F= wrong form; Q= wrong quantity; S= wrong strength; O=Out of date; L=labelling error. (a) Analyse the information provided to identify any trends in the near misses recorded. Consider any factors which may have contributed to the near misses recorded in this log. [70%] (b) Describe the actions you would take as pharmacy manager to reduce the number of near misses recorded within your pharmacy. [30%] TURN OVER

14 14 PART THREE Answer ONE of the TWO questions in this section. Use a SEPARATE answer book for this question. 42. You are working in a rural community pharmacy on a Friday evening when a regular patient presents you the following prescription for a CD No Reg POM. This is a repeat of a medicine she has taken previously. The surgery is now closed and will not reopen until Monday morning. 70 Mrs Hilda French 24a Juniper Court Flatplace FP7 6TY 28 (twenty eight) Temazepam 10 mg tablets Take one at night when needed 05/06/17 Dr S Desai Flatplace Medical Practice Flatplace FP23 5TF Describe the process that you would go through when considering this request. Identify the legal, professional and clinical considerations, the options available to you and your chosen course of action. [100%] 43. You are taking the medication history of a patient who has been brought into hospital following a collapse. The patient informs you that he has been buying diazepam tablets over the internet to help with the stress he has been experiencing at work. He says he doesn t want you to tell anyone else as he doesn t want to get into trouble. Describe the process that you would go through when considering this request. Identify the legal, professional and clinical considerations, the options available to you and your chosen course of action. [100%] END OF PAPER