Answer ALL questions. Write/Mark the correct answer CLEARLY in the answer grid provided.

Transcription

1 PHARMACEUTICAL LEADERSHIP AND DECISION MAKING PHA-MEAY Time allowed: 2 hours UNIVERSITY OF EAST ANGLIA School of Pharmacy Main Series UG Examination Part ONE. Answer ALL questions. Write/Mark the correct answer CLEARLY in the answer grid provided. Part TWO. Answer ONE (1) question in PART A AND ONE (1) question in PART B. Use a SEPARATE answer book for EACH question in Part TWO. Each question has the same value. The marks distribution is shown for each section of each 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 50% of the total mark You are advised to spend no more than 1 hour on Part ONE and 1 hour on Part TWO This paper consists of 12 pages in total. Dictionaries are not permitted in this examination. Notes are not permitted in this examination. The British National Formulary 61 (March 2011) ONLY is allowed in this examination Do not take this question paper out of the examinations room. Do not turn over until you are told to do so by the invigilator (PHA-MEAY) Module contact: Dr Debi Bhattacharya, PHA Copyright of the University of East Anglia Version 1

2 2 Part ONE TYPE 1 MCQs For each question, there is ONE (1) correct answer. 1. Which ONE of the following is FALSE regarding Clinical Commissioning groups? A) They determine the health care needs of the local population B) They commission and manage contracts with providers C) They replaced Primary Care Groups in April 2013 D) They negotiate the pharmacy and dental contracts E) They work with the local health and wellbeing board 2. You receive a prescription for morphine sulphate tablets 10mg BD for Mrs LM. From your PMR, you know that she is currently already taking diazepam 2mg 1 TDS for muscle spasms. Which ONE of the following is the most appropriate course of action? A) Dispense the prescription promptly as there are no clinical issues B) Due to the additive pharmacodynamic interaction, counsel Mrs LM that she may feel a little more drowsy that usual C) Due to the pharmacological effect of the morphine, counsel Mrs LM that she may experience diarrhoea D) Due to the pharmacokinetic interaction, counsel Mrs LM that she should separate each dose of diazepam and morphine by at least three hours E) Due to the pharmacokinetic interaction between diazepam and morphine, refuse to supply and contact the prescriber to recommend a change in medication 3. Which ONE of the following is NOT part of Maslow s hierarchy of needs? A) The need to have standing with one s peers B) The need to ensure one s own safety C) The need to have financial security D) The need to have friends E) The need to understand everything

3 3 4. In which ONE of the following situations would the application of civil law be INAPPROPRIATE? A) A patient harmed by a dispensing error B) A pharmacist caught fraudulently endorsing prescriptions C) A person unfairly slandered by another via Twitter D) A patient harmed by slipping over in a pharmacy E) A patient harmed by a defective medicine 5. Mrs HT is a 50 year old Caucasian female with type II diabetes. She has come to your independent prescriber clinic for a medication review. Her blood pressure is 122/78. Her recent blood test results are as follows: Result egfr (ml / minute / 1.73m 2 ) 65 >90 Total Cholesterol (mmol/l) Reference range HbA1c (% and mmol/l) 8.5 (69) 6-7 or Gamma Glutamyl Transferase (IU/L) Alkaline Phosphatase (IU/L) Alanine Transaminase (IU/L) Her current medication is: Glipizide 5mg 1 OM Metformin 500mg BD Ramipril 5 mg OM Simvastatin 10mg ON Paracetamol 500mg QDS PRN Which ONE of the following is an INAPPROPRIATE response to the management of Mrs HT s medication? A) Titrate metformin up to 500mg TDS to improve glucose control B) Continue with ramipril 5mg to reduce the risk of future cardiovascular events C) Titrate simvastatin up to 40mg ON for primary prevention of cardiovascular events D) Change ramipril to atenolol as recommended in the NICE guidelines for the management of hypertension E) Consider changing glipizide to a longer acting sulphonylurea TURN OVER

4 4 6 Which ONE of the following statements regarding the destruction of schedule 2 controlled drugs by a pharmacist is TRUE? A) A pharmacist may destroy expired pharmacy stocks without the presence of an authorised person B) A pharmacist may accept and destroy stocks returned by a patient without the presence of an authorised person C) A pharmacist may accept and destroy stocks returned from a nursing home without the presence of an authorised person D) A pharmacist is legally required to record in the CD register stocks returned by a patient E) Records of destruction of stocks are legally required in the POM register 7. You have been asked to consider the development of a Patient Group Direction (PGD) to manage a potential flu pandemic. The appropriate treatment for the pandemic will include prescribing anti-viral agents, controlled drugs and in some cases unlicensed and 'off label' use of medicines? Which ONE of the following statements related to this situation is FALSE? A) The PGD must be signed by a pharmacist in addition to a doctor or dentist B) PGDs allow the supply of controlled drugs C) PGDs allow the supply of unlicensed preparations D) PGDs allow the supply of medicines for 'off label' use E) PGDs are unsuitable for complex, individualised regimens 8. Miss AB s serum concentration of drug Y is 0.8 mg/litre (therapeutic range 1-2 mg/litre). She is taking drug Y at a dose of 50mg twice daily and its half-life is 24 hours. Miss AB is demonstrating no clinical benefit from drug Y. Which ONE of the following is the best course of action? A) Change the dose to 50mg daily and retake the serum concentration in 2 days B) Change the dose to 100mg twice daily and retake the serum concentration in 2 days C) Change the dose to 50mg four times a day and retake the serum concentration in 24 hours D) Change the dose to 50mg daily and retake the serum concentration in five days E) Change the dose to 100mg twice daily and retake the serum concentration in five days

5 5 9. Which ONE of the following would be the most appropriate treatment for dermatitis on the hand which has resulted from an external irritant? A) Aqueous cream B) Hydrocortisone cream C) Calamine lotion D) Permethrin cream E) Lignocaine cream 10. A doctor asks you for advice on the administration of medicines for a baby. He would like to know about the effectiveness of different routes. Which ONE of the following statements is FALSE? A) Rectal route is similar to oral route but has great variability in absorption B) Intramuscular route is preferred in children C) Young children tend to absorb more through the transdermal route than adults D) Acidic drugs have a reduced oral bioavailability due to an alkaline gastric ph in neonates E) If a child has diarrhoea, one may need to change the route of administration 11. A parent asks you to explain the ingredients in their child s cough medicine. Which ONE of the following statements is FALSE? A) Sorbitol can cause diarrhoea B) Sugar is often absent because it can cause dental problems C) Small amounts of alcohol are often added as it is a suspending agent D) Colourings are often absent as they can cause hyperactivity in children E) Lactose is avoided due to concerns regarding intolerance 12. Which ONE of the following is NOT required on a POM-V prescription when a licensed veterinary product is to be supplied? A) Under the cascade B) Any necessary warnings C) The withdrawal period if relevant D) The prescriber s qualifications E) The date of the prescription TURN OVER

6 6 TYPE 2 MCQs Decide which of the responses to the following questions is/are correct: Then choose: A) if i, ii and iii are correct B) if i and ii only are correct C) if ii and iii only are correct D) if i only is correct E) if iii only is correct 13. Mrs CD is 72 years old and admitted to hospital with acute renal failure. Mrs CD also has a history of heart failure and osteoporosis and her medication on admission is: Bisoprolol 20mg Diclofenac 50mg Ramipril 5mg tablets 1 OM 1 TDS 1 OM Mrs CD has no known allergies, normal hepatic function and an egfr of 18 ml/minute/1.73m 2 Which of the following statements is/are (an) appropriate response(s)? i) Stop diclofenac and consider alternative pain relief ii) Reduce the bisoprolol dose to 10mg, 1 OM iii) Initiate simvastatin at 40mg ON 14. Which of the following is/are true about transactional analysis? i) Transaction between equal states creates harmony ii) In a transaction facial expression is more important than the words used iii) Adult/adult is a complementary transaction 15. A GP asks for your advice regarding one of his patients who is breast feeding her baby and suffering from significant nausea and vomiting due to migraines. She wants to know which of the following can be used safely whilst breast feeding. Which of the following is/are appropriate? i) Domperidone ii) Metoclopromide iii) Cyclizine

7 7 Decide which of the responses to the following questions is / are correct: Then choose: A) if i, ii and iii are correct B) if i and ii only are correct C) if ii and iii only are correct D) if i only is correct E) if iii only is correct 16. You run a pharmacist-led warfarin clinic and notice that Mrs EF who is prescribed warfarin after a heart valve replacement is experiencing unexpected fluctuations of her INR. On discussion with Mrs EF and reviewing her current medication you identify several recent changes. Which of the following changes may be causing her INR fluctuations? i) She has dramatically changed her diet to include more salads and vegetables ii) She was recently prescribed a course of metronidazole for a tooth infection iii) She is going through a divorce and so has started drinking heavily 17. The latest biochemistry/haematology results for Mrs GH show the following: Reference range 17/04/2013 Serum calcium (mmol/l) Which of the following factors may have caused this blood result? i) Chronic renal failure ii) Tamoxifen iii) Furosemide 18. Which of the following could legally be supplied via emergency supply at the request of a patient? i) Fluoxetine 20mg capsules ii) Temazepam 10mg tablets iii) Fentanyl 25 patch TURN OVER

8 8 Decide which of the responses to the following questions is / are correct: Then choose: A) if i, ii and iii are correct B) if i and ii only are correct C) if ii and iii only are correct D) if i only is correct E) if iii only is correct 19. The latest haematology results for Mrs PQ are shown below: Ref range 14/05/2013 PCV (packed cell volume) Which of the following conditions may cause Mrs PQ s blood result? i) Haemorrhage ii) Chronic hypoxia iii) Polycythaemia

9 9 TYPE 3 MCQs Directions: The following questions consist 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 1st 2nd statement statement A True True 2nd statement is a correct explanation of the 1st B True True 2nd statement is NOT a correct explanation of the 1st C True False D False True E False False 20. First statement Second statement Water for injection can be used as the diluent for cyclizine in a syringe driver Cyclizine can cause local irritation at the site of injection 21. First statement Second statement If someone is experiencing a tonic-clonic seizure, an attempt should be made to place something between their teeth There is a risk of a person biting their own tongue during a tonic-clonic seizure 22. First statement Second statement Patients should not take antacids and tetracyclines at the same time Tetracyclines cause increased acid production in the stomach TURN OVER

10 10 Directions summarised 1st 2 nd statement statement A True True 2nd statement is a correct explanation of the 1st B True True 2nd statement is NOT a correct explanation of the 1st C True False D False True E False False 23. First statement Second statement Once at the top of the pain ladder, diamorphine is the drug of choice for pain control in palliative care It has more pleasant psychic effects and causes less nausea and vomiting 24. First statement Second statement A prescription for morphine (CD POM) which is spelt as marphine cannot be corrected by the pharmacist and would need to be returned to the prescriber before supply The pharmacist is unable to amend minor typographical errors on CD POM prescriptions 25. Miss CD is a regular patient at your pharmacy and has a monthly prescription for 60 Rifabutin 150mg capsules. She brings into your pharmacy a prescription for 63 Ovranette tablets. First statement Second statement Miss CD should be advised to seek an Rifabutin is a potent enzyme alternative method of contraception inducing drug rendering the from her doctor Ovranette ineffective END OF PART ONE

11 11 Part TWO PART A 26. Your pre-registration student, Alma, comes to see you one morning and says that she really hates working at the pharmacy at the moment due to the way the senior assistant, Esme, treats her. She says that she treats her like a little girl and is always shouting at her and never listens to her. Whilst Alma is telling you this you remember a conversation you had with Esme a couple of days ago. Esme had described Alma as head strong and abrasive and unwilling to accept advice. Discuss how you can resolve their disputes and improve your team s effectiveness. [100%] 27. Dispensealot Ltd. owns two pharmacies in Dorchester. You manage their busiest dispensing branch and have three full time dispensers plus eight part-time assistants. One day the owner comes into your pharmacy and informs you that due to a reduction in prescription income he wants you to expand the business by now providing advanced and enhanced services whilst still maintaining the prescription volume. He also states that this has to be done with the existing staffing hours and no new staff can be taken on. Describe in detail how you will deliver your employer s objectives. [100%] TURN OVER

12 Answer BOTH parts: (a) and (b). PART B a) You are the pre-registration student and your pre-registration tutor has asked you to train Sally the new Saturday assistant so that she is familiar with what is necessary on a valid NHS prescription for a POM. Provide a brief outline of the information that should be given to Sally explaining what is legally required, what is clinically required and what is required for payment purposes. [40%] b) Later that Saturday afternoon Sally takes in a prescription and says that she is not sure whether or not it is OK. It is a handwritten hospital outpatient prescription for Jonathan Harris that reads: 28 x Tegretol Tablets BD On speaking with the Jonathan, he tells you that he has just been diagnosed with epilepsy and started on this new medication which he has never had before. On telephoning the hospital, nobody involved in the care of Mr Harris will be available until Monday. He thinks he was prescribed 200mg tablets but it could have been 100mg, he is not entirely sure. He tells you that he has to go back in 1 week for a blood test and then they will change his dose depending on the result and on the level of control of his epilepsy. Construct arguments for and against making this supply, considering criminal, civil, administrative and employment law, professional guidance and any other issues that you believe to be relevant. [60%] 29. Answer BOTH parts: (a) and (b). a) An EU registered pharmacist is working under your supervision for her first few weeks and would like some guidance on emergency supply at a prescriber s request. Provide a brief outline for her regarding the legal requirements which enable an emergency supply at the request of a prescriber including any necessary records. [40%] b) You receive a telephone call from Mrs Judith Smith who is a registered midwife. She is calling from a patient s home and urgently requires some pethidine ampoules. She says that the husband of the patient is able to come to the pharmacy to collect the pethidine. Construct arguments for and against allowing this supply, considering criminal, civil, administrative and employment law, professional guidance and any other issues that you believe to be relevant. [60%] END OF PAPER