OPTIMISING PATIENT CARE THROUGH PHARMACY PHA-6002Y Time allowed: 2 hours Part ONE UNIVERSITY OF EAST ANGLIA School of Pharmacy Main series UG Examination 2015-2016 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
PART ONE SECTION A TYPE 1 MCQs (Single Best Answer) Answer ALL questions. Use the answer grid provided for ALL your answers. 1. With regards to medicines for animal use which ONE of the following is INCORRECT? 2 POM V medicines must be supplied in accordance to a prescription from a veterinary surgeon Pharmacists can prescribe POM VPS medicines Suitably qualified persons can prescribe POM VPS medicines Pharmacists can supply a human medicine for an animal provided it is categorised as a GSL Any retailer may supply AMV GSL medicines 2. Mr LS is a 45 year old male with a BMI of 30. He has just been diagnosed with type 2 diabetes. Which ONE of the following would be the most suitable treatment for him? Gliclazide Insulin Metformin Ramipril Sitagliptin 3. A patient is prescribed prednisolone 5mg tablets, with a dose of 40mg for two days, 30mg for two days, 20mg for two days, 10 mg for two days, 5mg for five days then stop. How many 5mg tablets should you supply? 16 28 41 45 84 4. Which ONE of the following is NOT a feature of an addictive drug? The individual experiences the need to sleep when a dose wears off The individual taking the drug craves another dose when the previous dose is wearing off The individual experiences withdrawal symptoms when the drug wears off Withdrawal symptoms are relieved by a subsequent dose of the drug The individual requires increasingly higher doses to obtain the same effect of the drug
3 5. Which ONE of the following statements about a curriculum vitae (CV) is most accurate? When applying for several jobs applicants should produce a generic CV to save time Applicants should not ask anyone to proof read their CV as this amounts to collusion Applicants should include both positive and negative information in their CV to present a balanced view Most recruiters will spend an average of 10 seconds reading a CV before deciding whether to shortlist Inclusion of a detailed personal statement removes the requirement for a covering letter 6. Which ONE of the following is a SMART objective? I will produce a health promotion leaflet I will help 10 people quit smoking in the by the end of June I will run a health promotion campaign on weight loss within the pharmacy in June I will counsel patients newly prescribed statins on diet to ensure they all eat 2 portions of oily fish per week I will train the healthcare assistants on health promotion 7. In order for a patient to make an informed decision which ONE of the following is INCORRECT? They should be able to understand the information provided They should remember the information provided They should have a written copy of all the information as reference They should use and weigh up the information to make a decision The patient must be able to communicate their decision 8. A patient is admitted to hospital complaining of nausea and vomiting, diarrhoea and blurred vision. Which ONE of the drugs below is most likely to be the cause? Diazepam Digoxin Diltiazem Domperidone Doxycycline TURN OVER
9. Which ONE of the following statements concerning mesalazine is INCORRECT? 4 Its primary indication is for the treatment of inflammatory bowel disease It is an aminosalicylate which has a systemic effect Side effects include exacerbation of colitis Patients require monitoring of renal function Formulations include suppositories and enemas 10. Which ONE of the following statements concerning sildenafil for the treatment of erectile dysfunction is INCORRECT? It works by increasing blood flow to the penis It is contraindicated in patients receiving nitrates It has an immediate action Patients can take a maximum of one dose in a 24 hour period Side effects include priapism and night sweats 11. Which ONE of the following is NOT indicated for Asthma? Beclomethasone Fludrocortisone Monteleulast Salbutamol Theophylline 12. Which ONE of the following best describes effective delegation? Delegation gives someone else accountability for a task which is not included in their core job description Delegation requires the person undertaking the task to follow step by step instructions Delegation gives someone else responsibility for a task which is not included in their core job role Delegation should only include tasks a person has undertaken previously Delegation is only required when you are too busy to complete a task yourself 13. Which ONE of the following statements concerning lipid lowering drugs is INCORRECT? Simvastatin is first line treatment for hypercholesteroleamia Ezetamibe can be taken in combination with Simvastatin Ezetamibe inhibits intestinal absorption of cholesterol Simvastatin competitively inhibits HMG-CoA reductase Grapefruit juice should be avoided in patients taking Ezetamibe
14. Which ONE of the following statements concerning the supply of nonmedicinal poisons and explosive precursors is CORRECT? 5 Part 1 contains regulated non-medicinal poisons In order to purchase a reportable substance the purchaser requires a Home Office licence Supplies of regulated substances can be made to a third party provided they provide the purchasers license and passport Supplies of regulated explosive precursors must be recorded in the poisons register All supplies must be labelled with the words Acquisition, possession or use by the general public is restricted 15. Which ONE of the drugs below should have Warning: Do not drink alcohol included on its dispensing label? Amoxicillin Clarithromycin Doxycycline Metronidazole Trimethoprim 16. Which ONE of the following is NOT legally required on a prescription for a CD POM issued by a veterinary surgeon? Prescribers RCVS number Dose must include a number For an animal under my care Total quantity in words and figures Telephone number of veterinary practice 17. Which ONE of the following tasks would be the most important and urgent task according to Covey s time management matrix? Checking the weekly cashing up Denaturing patient return controlled drugs Speaking to a member of the local CCG who has just come into pharmacy to discuss potential health promotion campaigns for the upcoming year Speaking to the local GP on the telephone concerning an issue with a patients prescription Packing up the previous months prescriptions to send to the NHS BSA TURN OVER
6 18. Mr TY brings in the following prescription for a CD POM on an FP10MDA into your pharmacy which opens Monday to Saturday Methadone mixture 1 mg/ml 30 ml 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 supply to Mr TY? Supply sugar free methadone on each occasion Take half the dose in the pharmacy and take the remainder home Take Sunday s dose home on Saturday Supply the methadone after he has missed five days supply Take methadone home on days when the pharmacy is busy 19. You are working on a hospital ward and conduct a medication history with Mr FG who tells you that he uses latanoprost eye drops but cannot remember what it is used for. Which ONE of the following is the usual indication of latanoprost? Allergic conjunctivitis Bacterial conjunctivitis Blephoritis Glaucoma Inflammation 20. Mrs CF comes into your pharmacy for an MUR, and explains that she has not been feeling tired and had very cold hands recently. Which ONE of the following medicines on her PMR is most likely to be associated with these side effects? Atenolol Bendroflumethiazide Chlorphenamine Nicorandil Temazepam
7 21. You are working in medicines information when you get a call from an FY1 doctor working on an elderly ward. He has a patient with Parkinson s Disease who requires an anti-emetic. Which ONE of the following is the most appropriate? Amitriptyline Domperidone Metoclopramide Ranitidine Sumatriptan 22. A 5 year old child is prescribed paracetamol oral suspension 120mg/5mL at a dose of 240mg QDS for 4 days. Which ONE of the following is the correct volume to supply? 80 ml 100 ml 160 ml 200 ml 240 ml 23. Miss KL telephones your pharmacy for advice, she explains that she usually takes Cerazette a progesterone only oral contraceptive pill containing desogestrol at 10 pm. Last night she forgot to take her pill and had sexual intercourse. She took her missed pill at 8 am once she remembered. Which ONE of the following is the most appropriate recommendation? Seek emergency contraception Take a double dose of Cerezette at 10 pm tonight to ensure contraceptive cover is maintained Continue to take your Cerazette as usual, but use condoms for the next seven days Nothing, continue as usual as contraceptive cover is maintained if the pill is taken within 24 hours of its usual time Nothing, continue as usual as contraceptive cover is maintained if the pill is taken within 12 hours of its usual time 24. Mr TG is newly prescribed Warfarin following a deep vein thrombosis, which ONE of the following over the counter preparations should Mr TG avoid whilst on his treatment? Chlorphenamine Co-codamol Ibuprofen Loratidine Senna TURN OVER
25. Which ONE of the following verbal responses is most appropriate when dealing with a difficult patient? 8 Passive Manipulative Aggressive Assertive Reactive 26 Miss TY calls into your pharmacy and asks you to recommend something for her as she is feeling run down and has a sore throat and mouth ulcers. She hands you a list of her regular medicines. Which ONE of the following drugs is most likely to be associated with Miss TY s symptoms? Carbimazole Metformin Paracetamol Prednisolone Ramipril 27. Which ONE of the following statements regarding the destruction of Schedule 2 controlled drugs by a pharmacist is CORRECT? A pharmacist may destroy expired pharmacy stocks without the presence of an authorised person A pharmacist may accept and destroy stocks returned by a patient without the presence of an authorised person A pharmacist may accept and destroy stocks returned from a nursing home without the presence of an authorised person A pharmacist is legally required to record in the CD register stocks returned by a patient Records of destruction of stocks are legally required in the POM register 28. A medicine label states: swallow whole, with a full glass of water. Take on an empty stomach and remain sitting or standing for at least 30 minutes after taking. Which ONE of the following drugs is this applicable to? Alendronic acid Ferrous sulphate Levothyroxine Phenoxymethylpenicillin Tamsulosin
29. You receive the following prescription for a CD No Reg POM in your pharmacy: 9 28 Temazepam 10mg tablets 1 PRN Which ONE of the following concerning the supply is INCORRECT? The prescription is valid for 28 days The total quantity must be in words and figures A dose of 1 PRN is NOT acceptable You should recognise the prescribers signature NFA as an address is acceptable 30. You receive the following prescription for a CD POM in your community pharmacy: 10(ten) Fentanyl transdermal patches Apply one every three days You notice that the strength is missing from the prescription. Which ONE is the most appropriate course of action? Supply the prescription based on the PMR Contact the prescriber to confirm the strength, then endorse the prescription PC and the strength and endorse the amendment with your initials and date Contact the prescriber to confirm the strength, supply the patient then return to the surgery for amendment Return the prescription to the prescriber for amendment prior to supply Send the patient to another pharmacy TURN OVER
10 SECTION 2 Type 2 MCQs (Extended Matching Questions) Answer ALL questions. Use the answer grid provided for ALL your answers. Questions 31 to 34 relate to the options below, please select ONE answer per question. Anti-infective Medicines (F) (G) (H) (I) (J) Aciclovir Amoxicillin Cefalexin Chloramphenicol Clarithromycin Fluconazole Mebendazole Mefloquine Metronidazole Trimethoprim For each statement select ONE answer. Each option may be used once, more than once, or not at all. 31. Is the most appropriate drug to treat a patient with upper respiratory tract infection who has previously developed an itchy rash whilst taking phenoxymethylpenicillin. 32. Is available as a single dose tablet to treat vaginal candidiasis. 33. Is contra-indicated in patients with a history of psychiatric disease. 34. Is associated with grey baby syndrome.
11 Questions 35 to 37 relate to the options below, please select ONE answer per question. Cardiovascular medicines (F) (G) (H) (I) (J) Amiodarone Amlodipine Bendroflumethiazide Bisoprolol Digoxin Diltiazem Furosemide Isosorbide mononitrate Losartan Ramipril For each statement select ONE answer. Each option may be used once, more than once, or not at all. 35. Is most appropriate for a 58 year old who has blood pressure of 150/95 and no other medical conditions. 36. May lead to tolerance if taken long term, which can be avoided by asymmetric dosing. 37. Is a suitable alternative for a patient who had developed a cough whilst taking Lisinopril. TURN OVER
12 Questions 38 to 40 relate to the options below, please select ONE answer per question. Formulary Medicines (F) (G) (H) (I) (J) Amitriptyline Codeine Diazepam Fentanyl Ibuprofen Paracetamol Morphine Naproxen Sumatriptan Temazepam For each statement select ONE answer. Each option may be used once, more than once, or not at all. 38. Is a 5-HT receptor agonist. 39. Is indicated for migraine prophylaxis. 40. Is indicated in patients with muscle spasms.
13 PART TWO There is ONE question in this section. Use a SEPARATE answer book for this question. 41. Answer BOTH questions. You are the pharmacist manager of a busy community pharmacy, who employs four additional members of staff. Name Details L Experienced NVQ level 3 dispenser works part time 10-3 on Mondays, Tuesdays, Thursdays and Fridays. Most time on Mondays and Tuesdays is spent dispensing MDS for local care homes. A Just completed NVQ level 3, works full time, but has Wednesday afternoons off in lieu of Saturday morning. Mainly works in the dispensary but covers MDS on a Wednesday morning. P Completed level 2 in pharmacy services, keen to progress onto level 3. Works full time Monday to Friday. Works in dispensary and helps on the counter when it s busy. K Medicines counter assistant, just started level DAC. Works Monday to Thursday and Saturday mornings, mainly responsible for front of shop and medicines counter but works in dispensary on a Wednesday. 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 09:30 Amoxicillin L A Incorrect directions Tues 2 nd 14:30 Betnesol eye drops O L Expired Wed 3 rd 11:00 Nifedipine D K Nicorandil selected Wed 3 rd 14:15 Trimethoprim Q K Part pack Wed 3 rd 15:00 Ramipril L/F K/P Tablets not Capsules Thur 4 th 14:00 Furosemide Q L Part Pack Thur 4 th 16:45 Seretide D P Serevent selected Fri 5th 17:50 Simvastatin S A 40mg not 20mg Sat 6 th 11:30 Timolol eye drops O A Expired Mon 8 th 09:15 Salmeterol F P Accuhaler not evohaler Tues 9 th 13:30 Co-codamol Q L Part Pack Wed 10 th 10:15 Budesonide D/F K Symbicort selected Wed 10 th 14:00 Erythromycin L K Incorrect directions Wed 10 th 15:40 Bendroflumethiazide L K Incorrect directions Fri 12 th 09:50 Metronidazole Q P Part Pack Sat 13 th 12:50 Simvastatin S A 20mg not 40mg 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 and identify any factors which may have contributed to the near misses recorded in the 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 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 community pharmacy on a Saturday afternoon when you receive a telephone call from Mrs Francis, she explains that her husband has run out of his MST 30mg tablets, she thought that he had another packet. He is a regular patient and an extract of his PMR is given below. Mr Edward Francis 15 Home Avenue Flatplace 16/02/1946 (70 years) Dr Thompson Flatplace medical practice Date Quantity Drug Dose 20/05/16 300mL Morphine Sulphate Oral 5-10 ml PRN solution 10mg/5mL 20/05/16 500mL Lactulose solution 15 ml BD 19/04/16 60 MST 30mg tabs 1 BD 19/04/16 14 Temazepam 10mg tabs 1 ON PRN 19/04/16 300mL Morphine Sulphate Oral 5-10 ml PRN solution 10mg/5mL 19/04/16 56 Amlodipine 10mg tabs 1 OD 19/04/16 56 Atorvastatin 20mg tabs 1 OD Describe the process that you would go through when considering this request, differentiating between legal, professional and clinical considerations and your course of action. [100%] 43. During an MUR with a patient with Cardiovascular disease the patient confides in you that they are buying Viagra on-line and doesn t want to tell their GP. Describe the process that you would go through when considering this request, differentiating between legal, professional and clinical considerations and your course of action [100%] END OF PAPER