APC CAOP Practise Paper

8/10/2019 APC CAOP Practise Paper

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Australian Pharmacy Council LtdCAOP Examination

Sample Paper v1.2014

This is an official CAOP Examination sample paper produced by the AustralianPharmacy Council Ltd (APC) for practice purposes only.

All questions in this sample paper are no longer used in live or actual examinations andhave been chosen to allow candidates to gain exposure to the type of content and

layout of questions on the examination. Live or actual CAOP Examinations deliveredcontemporaneously will vary from this sample paper.

The CAOP Examination is 106-questions long (105 multiple choice questions and 1short answer question) and candidates have 3 hours to complete it.

Due to the frequent changes to the scope and content within the practice of pharmacy

in Australia, the APC does not guarantee that the information in this paper is accurateor relevant once published publicly.

The actual CAOP Examination is delivered by computer and candidates should visit theAPC website for further information, including a link to an online tutorial:

http://pharmacycouncil.org.au/content/index.php?id=11

Copyright Australian Pharmacy Council Ltd 2014.
http://pharmacycouncil.org.au/content/index.php?id=11http://pharmacycouncil.org.au/content/index.php?id=11http://pharmacycouncil.org.au/content/index.php?id=11


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Q1How much elemental calcium (MW = 40 g/mol) does a patient receive per day if takingcalcium carbonate (MW = 100 g/mol) 600 mg twice daily?

A 480 mgB 2400 mg

C 200 mg

D 600 mg

E 240 mg

Q2

A patient requires a 5- day course of a medicine the dose of which is 500mg once dailyon day 1 and 250mg once daily on day 2 to day 5. The medicine is only available as a150mg dispersible tablet and is stable after dispersion for 6 hours. What is theminimum number of dispersible tablets required for the 5-day course?

A 10

B 20

C 16

D 12E 8

Q3

Phenytoin is available as 5 mL vials at a concentration of 50 mg/mL. The dose requiredis 15mg/kg and the patient weighs 75kg. If the required rate of infusion of phenytoin is

40 mg/minute, how long will it take to complete the infusion?

A 2.8 minutes

B 28 minutes

C 6 minutes

D 18 minutes

E 1.8 minutes


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Q4

A patient who uses tramadol 200 mg SR orally mane and 50 mg orally twice dailyregularly to control breakthrough pain, is declared nil by mouth in hospital. What rateof IV morphine infusion would provide equivalent opioid analgesia if the equi-effective

analgesia dose ratio of tramadol oral to tramadol IV is 1.5:1 and the ratio of tramadolIV to morphine IV is 10:1?

A 16.6 mg/hour

B 694 micrograms/hour

C 187 mg/hour

D 833 micrograms/hour

E 69 mg/hour

Q5

What weight of an ingredient is required to produce 1000mL of a solution such that 2.5mL diluted to 50 mL gives a 0.25% (w/v) solution?

A 5 g

B 50 mg

C 50 g

D 25 mg

E 25 g

Q6

A female patient, who is 68 years old and weighs 68kg, presents with a serumcreatinine of 0.178mmol/L. What is her approximate serum creatinine clearance rate?

A 10mL/min

B 30mL/min

C 45mL/min

D 60mL/min

E 80mL/min


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Q7

A 30 year old female with a starting weight of 65 kg and a height of 160 cm has lost 10kg. What is the change in her Body Mass Index (BMI)?

A 1.6

B 2.6

C 3.9

D 1.9

E 4.5

Q8

A patient is prescribed a reducing prednisolone regimen of:

20 mg daily for 5 days, then reduce the daily dose by 5 mg every 3 days, then cease.

How many 5 mg tablets of prednisolone will the patient require for this regimen?

A 20

B 24

C 28

D 30

E 38

Q9

Which of the following conditions would prevent the use of an angiotensin-convertingenzyme inhibitor?

A bilateral renal artery stenosis

B non-insulin dependent diabetes mellitus

C Mnires disease

D hyperlipidaemia

E lupus erythematous


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Q10

Which of the following statements is CORRECT regarding paracetamol?

Paracetamol

A has significant anti-inflammatory activity

B inhibits cyclo-oxygenase

C is excreted largely unchanged by the kidneys

D can be given by intravenous infusion

E is contraindicated in pregnancy

Q11

Which of the following statements about doxycycline is INCORRECT?

Doxycycline

A can be used in the treatment of rosacea

B may decrease blood methotrexate concentration

C may be taken by children over 8 years of ageD should be taken in the morning rather than at night

E should not be taken after the first 18 weeks of pregnancy

Q12

Which of the following statements about doxycycline is CORRECT?

A it increases the metabolism of phenytoin and should be used with caution inepilepsy

B it is effective as monotherapy in treating infection with Plasmodium falciparum

C it may reduce bone growth in young children

D it should not be used in the second trimester of pregnancy, due to risk ofteratogenicity

E it is used at a dose of 100mg bd to treat acne


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Q13

A female customer misses a dose of a progesterone only pill. Within how many hoursdoes she have to take the pill, before contraceptive cover is reduced?

A one

B three

C four

D six

E twelve

Q14

A patient has been taken off fluoxetine and prescribed venlafaxine and told by thedoctor to ask the pharmacist how long to wait before starting the new medication. TheBEST advice would be to wait for

A one day

B two days

C ten to fourteen days

D four to six weeks

E one to two months

Q15

Itching is NOT a symptom of

A allergic dermatitis

B scabies

C fungal infection

D acne vulgaris

E lichen planus


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Q16

A worried father brings his 3 year old daughter into your pharmacy. She has had a badcough and mild fever spasmodically during the winter which has kept the whole familyawake at night. She has already used a whole bottle of expectorant, which had noeffect.

He asks you for a good cough mixture and describes his daughters cough as a barkingcough, which is worse at night. There is no phlegm and she gasps for air aftercoughing.

From the scenario above, you advise the father to take his daughter to the doctor, asyou suspect her cough may be caused by

A pneumoniaB bronchitis

C croup

D post nasal drip

Q17

A female customer asks you about using St Johns Wort, saying she feels a bit down.You ask what medications she is taking, as you are concerned about interactions.Which of the following medications should MOST concern you regarding itscombination with St Johns Wort?

A ibuprofen

B tramadol

C codeine

D paracetamol

E dextropropoxyphene


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Patient Profile ____________________________________________________________________

Patient Name Dick Cross

Address 49 Caffers Place, SUBIACO WA 6051Age 62 Height 170cm

Sex Male Weight 85kg

Allergies Nil known

____________________________________________________________________

DIAGNOSIS

Presenting complaint 1. Elevated blood glucose

Medical history 1. Diabetes Type II

2. Hyperlipidaemia3. Insomnia4. Constipation

LAB/DIAGNOSTIC TESTS

Date Test Reference Range

20/7 Urate 0.58 mmol/L (0.18 0.47 mmol/L)20/7 Fasting Blood Glucose 9.0 mmol/L (< 5.5 mmol/L)1/3 Creatinine 0.16 mmol/L (0.05 0.12 mmol/L)1/3 Cholesterol 6.5 mmol/L (


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Q18

The MOST appropriate option for the management of the patients hyperuricaemia is

A allopurinol started at a dose of 100 mg dailyB allopurinol started at a dose of 300 mg daily

C probenecid started at a dose of 500 mg twice a day

D no treatment be initiated

E colchicine 0.5 mg twice daily

Q19

Which of the following would be an additional risk factor for cardiovascular disease inthis patient?

A low homocysteine level

B an elevated serum albumin

C hypertension

D postural hypotension

E waist measurement 75 85 cm

Q20

Which of the following medications would be the MOST appropriate to manage MrCross diabetes?

A metforminB acarbose

C insulin

D glibenclamide

E rosiglitazone


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Q21

Which of the following tests is the BEST indicator of ongoing blood glucose control?

A random blood glucose levels

B three monthly HbA1c levels

C weekly fasting blood glucose levels

D regular serum creatine measurements

E weekly urine testing

Q22

Which of the following primary health initiatives should you strongly recommend toMr Cross?

A annual ocular examinations

B annual bone density measurement

C faecal occult blood test every 3 months

D prostate specific antigen test every 5 years

E creatine kinase levels every 3 months

END OF PATIENT PROFILE


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Patient Profile

____________________________________________________________________

Patient Name : Jack Smithers

Address : Room 22, Garren Aged Care FacilityAge : 95 years Height : 180 cm

Sex : M ale Weight : 73 kg

Allergies pencillin allergy (rash)

____________________________________________________________________

DIAGNOSIS

Presenting complaint 1. Swallowing difficulties and agitation

Medical history 1. Benign prostatic hyperplasia2. Pacemaker3. Depression4. Prostate Cancer

____________________________________________________________________


Date Test Reference Range3/2 Blood pressure 140/80

____________________________________________________________________

MEDICATION RECORDDate Medication & Strength Qty Sig

3/2 Buprenorphine 10 mcg/hour patch 2 Apply once weekly3/2 Paracetamol 500 mg 100 2 qid3/2 Docusate/senna 50 mg/8 mg 90 2 nocte3/2 Tamsulosin SR 400 mcg 30 1 daily3/2 Rabeprazole 20 mg 30 1 mane3/2 Citalopram 20 mg 30 1 mane3/2 Goserelin acetate 10.8 mg SC 1 Implant every 12 weeks3/2 Aspirin 100 mg 112 1 mane24/1 Metoclopramide 10 mg 25 1 tds prn22/1 Cephalexin 500 mg 20 1 tds course completed10/1 Roxithromycin 300 mg 5 1 daily course completed10/1 Oxycodone 5 mg tablets 20 1 qid prn12/12 Meloxicam 15 mg 30 1 daily - ceased ____________________________________________________________________

PHARMACISTS NOTES Date Comment3/2 Visual and hearing impairment. Recent falls and wheelchair bound.

Nursing staff have advised of decreased cognition in patient. 24/1GP noted no prior problems with cephalexin - cause of nausea unknown.


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Q23

Mr Smithers is becoming increasingly agitated each time tablets are given to him, dueto difficulty swallowing. Which of the following medications the patient is currentlytaking should NOT be crushed?

A paracetamol

B citalopram

C aspirin

D oxycodone

E rabeprazole

Q24

Due to the patients swallowing difficulties, changes to his medications are necessaryto alleviate this problem. Which of the following recommendations is NOT appropriate?

A oxycodone immediate release tablets, liquid, suppositories or injections can beused

B roxithromycin tablets should not be crushed, but the dispersible tablets can beused

C docusate and senna tablets may be crushed, or other options includesuppositories or lactulose

D tamsulosin tablets may be crushed, or the tablets opened and dispersed inwater

E dispersible proton-pump inhibitors should be used and include omeprazole,

pantoprazole or lansoprazol


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Q25

Mr Smithers pain is currently well managed with regular therapeutic doses ofparacetamol and a weekly buprenorphine patch. If further treatment for chronic painis required, which of the following is NOT appropriate in light of the patients currentmedication regimen?

A increased oxycodone dose

B supplementary paracetamol

C higher strength buprenorphine patch

D replace paracetamol with combination paracetamol/codeine

E replace oxycodone tablets with suppositories

Q26

Mr Smithers required metoclopramide for the treatment of nausea. Which of thefollowing statements regarding metoclopramide is INCORRECT?

A tablets may be crushed

B drowsiness is a common side effect

C oral adult dose for nausea is 0.5 mg/kg every 4-6 hours

D reduce dose in the elderly to reduce risk of extrapyramidal effects

E avoid long term use in depressed patients, as mental state may worsen



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Patient Profile ____________________________________________________________________Patient Name Beryl GroperAddress 64 Highfield Drive, Thornlie

Age 49 Height 148cmSex Female Weight 55kgAllergies Nil known ____________________________________________________________________DIAGNOSISPresenting complaint

1. Obstructive airways disease with shortness of breath Medical history

1. Congestive cardiac disease

2. Glaucoma ____________________________________________________________________

LAB/DIAGNOSTIC TESTSDate Test Reference Range16/10 Temp 37.8C; Pulse 65bpm;

BP 120/65mm Hg ____________________________________________________________________MEDICATION RECORD

Date Medication & strength Qty Sig2/1030/930/930/915/98/86/76/7

Fluticasone 250mcg and Salmeterol 25mcgSalbutamol nebules 5mg/2.5mLTiotropium 18mg capsulesPrednisolone 5mgBetaxolol eye drops 0.25%Enalapril 10mgFrusemide 40mgDocusate sodium (50mg)and senna (8mg)

1206030605ml3010090

ii puffs bd5mg 4-hourlyinhale i daily40mg maneii drops bdi dailyi maneii nocte

____________________________________________________________________PHARMACISTS NOTES Nil


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Q27

Beryl recently consulted you at the pharmacy with apparent flu symptoms, whichcleared within a few days. However, three or four weeks later she is still suffering witha persistent, dry night time cough that is disturbing her sleep pattern. She asks you fora cough suppressant. Which of the following is the MOST appropriate action for youto take?

A advise her to use the tiotropium capsule at night before bed

B advise her to use the fluticasone/ salmeterol inhaler immediately before usingthe salbutamol nebules, to increase activity of the salbutamol

C supply her with a pholcodine elixir, to be taken before bed

D contact her doctor to discuss the patients use of enalapril

E supply promethazine tablets, to be taken three times a day with the last dosebefore bed

Q28

Beryl arrives to collect her regular supply of medication and is complaining of swollenankles, so severe that she cant fit into her shoes. The MOST appropriate action wouldbe for you to

A advise her doctor and suggest Beryls frusemide and prednisolone bereassessed

B advise her to increase her frusemide dose to two tablets in the morning and totake a potassium supplement

C recommend she wear graduated support stockings and elevate her legs moreoften

D advise her to use her salbutamol more regularly to allow her to undertakegentle walking to improve her venous return

E advise her to reduce her dose of prednisolone to 5mg


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Q29

Beryl later suffers muscle cramps. The MOST likely cause is

A hypocalcaemia due to the prednisoloneB hypokalaemia due to the frusemide and prednisoloneC hyperphosphataemia due to heart failureD excessive fluid retention of feet and anklesE drug interaction between enalapril and frusemide

Q30

To improve Beryls asthma the doctor could

A change the eye drops

B change the enalapril

C increase the frusemide

D change the tiotropium to an inhaler

E reduce and cease the prednisolone

Q31

You should en sure that Beryls prednisolone dose is reduced slowly because

A stopping quickly may induce an asthma attack

B inhaled steroids need to be increased slowly

C the adrenal glands may be suppressed

D electrolytes need to return to normal slowly

E the possibility of rebound wheezing



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Patient Profile ____________________________________________________________________

Patient Name David Frost

Address 27 Christmas Parade, Wagga Wagga, NSW 2073Age 70 Height 168cm


Allergies Nil known

____________________________________________________________________

DIAGNOSIS

Presenting complaint 1. Diarrhoea

Medical History 1. Osteoarthritis2. Hypertension3. Cardiac Failure

____________________________________________________________________


Date Test Reference Range7/4 Potassium 6.0 mmol/L (3.5 5.0 mmol/L)7/4 Creatinine 0.23 mmol/L (0.05 0.12 mmol/L)7/4 Urea 36 mmol/L (3 8 mmol/L) ____________________________________________________________________

MEDICATION RECORD

Date Medication & Strength Qty Sig31/3 Paracetamol 1 gram 100 tds31/3 Celecoxib 200 mg 30 i daily31/3 Frusemide 80 mg 100 i daily6/1 Lisinopril 10 mg 30 i daily6/1 Spironolactone 25 mg 100 i daily6/1 Frusemide 40 mg 30 i daily6/1 Glucosamine 1500 mg 60 i daily ____________________________________________________________________

PHARMACISTS NOTES

Date Comment 7/4 The patient was admitted to hospital following two days of severe diarrhoea, -

one week after the patient was started on celecoxib and the dose of frusemidewas increased.


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Q35

Which of the following combinations of medication may cause acute renal failure inthis patient?

A spironolactone, frusemide, paracetamol

B frusemide, lisinopril, celecoxib

C paracetamol, frusemide, lisinopril

D celecoxib, lisinopril, glucosamine

E lisinopril, spironolactone, glucosamine

Q36

The patient is currently taking celecoxib, which is a selective inhibitor of cyclo-oxygenase type 2 (COX-2). What is the mode of action of this type of medication?

A stimulates the production of prostacyclin (PGI2)

B inhibits the production of prostacyclin (PGI2)

C stimulates the production of thromboxane (A2)

D inhibits the production of thromboxane (A2)E inhibits both prostacyclin (PGI2) and thromboxane (A2)



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Patient Profile ____________________________________________________________________

Patient Name Ms Cecily Weary

Address 17 Filamore Street, Portland, SAAge 19 Height 160cm

Sex Female Weight 58kg

Allergies Nil known

____________________________________________________________________DIAGNOSIS

Presenting complaint 1. Emergency contraceptive advice ____________________________________________________________________

MEDICATION RECORD

Date Medication & Strength Qty Sig

____________________________________________________________________

PHARMACISTS NOTES

Date CommentCurrent Patient has had unprotected sex in the last 24 hours and has consulted

her doctor for advice, as she feels at risk of falling pregnant.


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Q37

Ms Wearys doctor has recommended oral levonorgestrel. Which of the followingstatements is CORRECT regarding this method of emergency contraception?

A oral levonorgestrel must be taken within the first 72 hours after unprotectedintercourse to have a contraceptive effect

B levonorgestrel has more severe side effects when taken as emergencycontraception compared to its use as regular contraception

C levonorgestrel with ethinyloestradiol (2 doses of four tablets, 12 hours apart) isconsidered to be as effective as the oral levonorgestrel regimen

D oral levonorgestrel emergency contraception has been shown to increase therisk of ectopic pregnancy

E oral levonorgestrel does not induce a withdrawal bleed, although irregularbleeding may occur occasionally

Q38

Ms Weary is breast-feeding her seven month old month old son. Which of thefollowing is the MOST appropriate advice to give the patient?

A milk supply will significantly decrease

B the child should not be breast-fed for at least 24 hours

C emergency contraception is safe to take during breast-feeding

D emergency contraception should not be taken if breast-feeding

E emergency contraception dose should be split over twelve hours to minimise

excretion into breast milk.

Q39

Which of the following should you recommend to Ms Weary, regarding the MOST effective time to take hormonal emergency contraception?

A immediately

B immediately after the next breastfeed

C within 12 hours of unprotected sex

D 72 hours after unprotected sex

E with the evening meal to increase absorption



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Patient Profile ____________________________________________________________________

Patient Name Kay Sutton

Address 66 Argyle St HackettAge 23 Height 171 cm

Sex Female Weight 58 kg

Allergies Metoclopramide

____________________________________________________________________

DIAGNOSIS

Presenting complaint 1. Urinary tract infection

Medical history 1. Asthma

2. Type 1 diabetes

3. Bipolar Disorder ____________________________________________________________________



12/1 Lithium 0.8 micromol/L 0.5 1.2 micromol/L ____________________________________________________________________

MEDICATION RECORD

Date Medication & Strength Qty Sig12/1 Insulin glargine 20iu - bd12/1 Insulin lispro 10 iu - tds12/1 Lithium 250mg tab 100 2 tds12/1 Ethinyloestradiol/levonorgestrol 4x28 1 daily

12/1 Salbutamol 100mcg MDI 1-2 inh prn

____________________________________________________________________

PHARMACISTS NOTES

Nil


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Q40

Ms Sutton presents to your pharmacy with a script for cephalexin. Which of thefollowing is the MOST appropriate advice?

A cease taking the oral contraceptive pill when taking this antibiotic

B avoid alcohol while taking this antibiotic

C start taking acidophilus to prevent vaginal thrush

D start taking cranberry juice to treat the urinary tract infection

E use barrier contraceptive measures while taking this antibiotic

Q41

Ms Sutton requests a product containing sodium citrotartrate to relieve the burningassociated with her urinary tract infection. Which of the following statements isCORRECT?

A the increase in urinary pH will decrease the renal clearance of lithium

B the renal clearance of lithium will increase with the use of sodium citrotartrateC the antibacterial activity of cephalexin will be increased with the use of sodium

citrotartrate

D the tubular reabsorption of lithium will increase with the use of sodiumcitrotartrate

E lithium and sodium citrotartrate granules can be safely used in combination

Q42

Regarding the Ms Suttons insulin, which of the following statements is INCORRECT?

A insulin lispro should be administered 30 minutes after each meal

B the vial in use can be stored at room temperature for 28 days

C insulin lispro is injected subcutaneously

D insulin glargine is referred to as a basal release insulin

E insulin glargine should not be mixed with insulin lispro before each injection


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Q43

Ten days later Ms Sutton has been referred to your pharmacy by the doctor for atreatment for vaginal thrush. Which of the following statements regarding oralfluconazole is CORRECT?

A it must be accompanied by topical antifungal therapy

B it must be taken on three consecutive days

C it is contraindicated in diabetes

D it is not recommended for use by pregnant woman

E the course should be repeated in seven days

Q44

Ms Suttons doctor contacts you for advice regard ing her bipolar disorder therapy. Hesays that while her condition is well controlled, she is complaining of nausea and finetremor. Which of the following recommendations is the MOST appropriate?

The lithium

A should be taken one hour before food

B could be changed to a sustained release preparation

C dose should be increased by 50%

D dose should be decreased by 50%

E should be replaced with olanzapine



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Patient Profile ____________________________________________________________________

Patient Name Peter Barnard

Address Room 19, Garran WardAge 9 Height 120 cm

Sex Male Weight 25 kg

Allergies Nil Known

____________________________________________________________________

DIAGNOSIS

Presenting complaint 1. Urinary tract infection

Medical history 1. Chronic renal failure

2. Streptococcal glomerulonephritis ____________________________________________________________________


Date Test Reference Range16/11 Creatinine 0.42 mmol/l 0.02-0.06 mmol/l16/11 Calcium 2.3 mmol/l 2.1-2.6 mmol/l16/11 Phosphate 2.4 mmol/l 1.1-1.8 mmol/l

16/11 Potassium 5.8 mmol/l 3.5-5.0 mmol/l16/11 Urinalysis: Pseudomonas aeruginosa detected ____________________________________________________________________

MEDICATION RECORDDate Medication & Strength Qty Sig16/11 Calcium Carbonate 1.5g 100 i bd cc16/11 Calcitriol 0.25 mcg 100 i daily16/11 Darbopoietin 30 mcg 5 i weekly subcut16/11 Enalapril 5mg 30 i bd16/11 Sodium bicarbonate 840mg 100 i tds16/11 Ferrous sulphate 325mg 30 i daily16/11 Folic acid 0.5mg 100 i daily16/11 Nifedipine SR 30mg 30 i bd16/11 Hydralazine 25mg 100 i tds ____________________________________________________________________

PHARMACISTS NOTES Date Comment17/11 Admitted to hospital with a urinary tract infection. Patient is pyrexial with a temperature of

39 oC and looks unwell. BP is 130/90. Recently stable on peritoneal dialysis.

Patient is on transplant waiting list awaiting a renal transplant.Patient has gum hypertrophy.


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Q45

The patient has chronic kidney disease. Which of the following statements regarding

this condition is INCORRECT?

A protein starts to pass into the urine

B anaemia is a complication that must be treated or prevented

C hypercalcaemia occurs due to deficient vitamin D production

D toxins such as urea and creatinine build up and cause problems

E risk factors include diabetes mellitus, hypertension and increasing age

Q46

Which of the following medications is MOST likely to be the cause of the patients gum

hypertrophy?

A calcitriol

B enalapril

C ferrous sulphate

D nifedipine

E hydralazine


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Q47

The patient is experiencing hyperkalaemia. Which of the following statements is

CORRECTregarding the patients condition?

A the patients potassium levels indicate severe hyperkalaemia

B the patients current medications are not likely to be a contributing factor

C oral frusemide can be given to promote potassium excretion

D muscle weakness, cardiac arrhythmia and myalgia are common symptoms

E the use of NSAIDs should be avoided in this patient

Q48

Which of the following IV antibiotics is the MOST suitable treatment againstPseudomonas aeruginosa for this patient?

A amoxycillin

B vancomycin

C ceftriaxone

D ciprofloxacin

E gentamicin

Q49

The patient has hyperphosphataemia. Which medication dosage could be increased to

reduce his phosphate level?

A calcium carbonate

B calcitriol

C sodium bicarbonate

D darbepoetin

E enalapril



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Patient Profile ____________________________________________________________________

Patient Name Janine Smitters

Address 2B Nursing HomeAge72 Height 152 cm

Sex Female Weight 50 kg

Allergies Nil Known

____________________________________________________________________

DIAGNOSIS

Presenting complaint 1. Fractured neck of femur

Medical history 1. Rheumatoid arthritis

2. Hypertension ____________________________________________________________________



____________________________________________________________________

MEDICATION RECORD

Date Medication & Strength Qty Sig3/11 Enoxaparin 40mg/0.4mL 10 i daily subcut 3/11 Paracetamol 500mg/codeine 8mg 50 ii qid22/10 Oxazepam 30mg 25 i bd22/10 Diclofenac 25mg 50 i tds7/10 Prazosin 5mg 100 tds

5/9 Atenolol 50mg 30 i mane5/9 Perindopril 4 mg 30 i daily ____________________________________________________________________

PHARMACISTS NOTES

Date Comment2/11 Patient admitted to acute care hospital after a fall.

Patient has been taking diclofenac for 2 years.


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Q50

The doctor has decided to cease the oxazepam and asks for your advice. Mrs Smittershas been on this medication for 3 years. The MOST appropriate advice to give thedoctor is to

A stop the oxazepam immediately

B change to temazepam and reduce the dose over a few weeks

C reduce the oxazepam dose by 15mg a day for 4 days before ceasing

D change to an equivalent dose of diazepam and gradually reduce the dose over3 weeks

E reduce the dose of the oxazepam to one tablet on alternative nights, over a 4-6

week period

Q51

Following Mrs Smitters fall, osteoporosis is suspected. Before initiating alendronate,all of the following investigations should be undertaken EXCEPT

A bone mineral density

B vitamin D and calcium levels

C hepatic function

D renal function

E full dental assessment

Q52

Which of the following medications is LEAST likely to have contributed to Mrs Smittersfall and subsequent fractured femur?

A prazosin

B atenolol

C oxazepam

D perindopril

E paracetamol/codeine


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Q53

At a follow- up appointment, Mrs Smitters hypertension is found to have worsened.The MOST appropriate management would be to

A increase the prazosin dose

B increase prazosin and atenolol dose

C initiate frusemide and potassium supplementation

D cease prazosin and initiate verapamil

E cease prazosin and initiate ramipril



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Patient Profile ____________________________________________________________________Patient Name John ColesAddress 16 Adam Street, Hillcrest

Age 69 Height 173cmSex Male Weight 63kgAllergies Penicillin ____________________________________________________________________DIAGNOSISPresenting complaint

1. Ischaemic heart disease2. Gout

Medical History

1. Mild left sided heart failure2. Hypothyroidism3. Transient Ischaemic attacks (TIA)

____________________________________________________________________


Date Test Reference Range ____________________________________________________________________MEDICATION RECORD

Date Medication & strength Qty Sig20/620/620/615/520/420/420/416/2

Naproxen 500mgDiltiazem 180mgAspirin 100mgThyroxine 200mcgTemazepam 10mgFrusemide 40mgColchicine 0.5mgThyroxine 100mcg

50309020025100100200

bd prn1 mane1 mane1 mane1 nocte1 mane1 1 mane

2hrly until pain ceases

____________________________________________________________________PHARMACISTS NOTES Date Comment 20/6 Naproxen to be used until acute attack of gout settles.


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Q54

Which of Mr Coles medications is MOST likely to cause deterioration of his heartfailure?

A diltiazem

B thyroxine

C frusemide

D aspirin

E colchicine

Q55

The use of low dose aspirin by Mr Coles

A will reduce the effectiveness of the frusemide

B has the same gastrointestinal bleeding risk as placebo

C may mask the symptoms of hypothyroidism

D is indicated for TIA despite a possible adverse effect on his gout

E will reduce the pain associated with an acute attack of gout


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Q56

Mr Coles has been prescribed naproxen to be used when needed for acute gout.Which of the following statements is CORRECT?

A a single daily dose of naproxen would be more effective, so take two tablets at

night when necessary

B naproxen cannot be taken at the same time as aspirin in the morning, so take

two tablets at night when necessary

C naproxen should only be taken when necessary for gout pain. Continue the

aspirin regularly

D cease naproxen

E aspirin should not be taken, whilst taking naproxen for gout

Q57

Since 15 May, Mr Coles has noticed an increased incidence of chest pain. Which of thefollowing is the MOST likely cause?

A the introduction of diltiazem

B interaction between frusemide and diltiazem

C excessive use of naproxen for gout

D interaction between frusemide and naproxen

E increased dose of thyroxine

Q58

Mr Coles is prescribed cefaclor for a respiratory tract infection. The incidence of crosssensitivity to cephalosporin in patients with penicillin allergy is

A 1%

B 3%

C 10%

D 15%

E 20%


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33

Q59

Mr Coles has previously been prescribed colchicine for acute gout. The MOST likelyreason for ceasing colchicine and commencing naproxen would be

A colchicine increased the elimination of thyroxine by causing diarrhoea

B an interaction between colchicine and frusemide, causing the precipitation ofurate crystals in the kidneys

C colchicine is contraindicated in patients with heart failure due to increasedfluid retention

D for a patient with heart failure, it is more appropriate to use colchicine at lowerdoses for prophylaxis

E that nausea, vomiting and diarrhoea occurred before appropriate symptomrelief was achieved



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Medical Profile ____________________________________________________________________

Patient Name Marilyn Jones

Address 5 Backus Avenue, WESTBOURNE, TAS 7001Age 56 Height 168cm

Sex Female Weight 62kg

Allergies Nil known

____________________________________________________________________

DIAGNOSIS

Presenting complaint 1. Tremor, nausea, vomiting and blurred vision

Medical history 1. Bipolar depression 2. Heart failure3. Atrial fibrillation

____________________________________________________________________

MEDICATION RECORD

Date Medication & Strength Qty Sig7/10 Lithium Carbonate 250mg 200 i bd

Digoxin 62.5mcg 100 ii dailyPerindopril 4mg 30 i dailySpironolactone 25mg 100 i dailyFrusemide 20mg 100 i daily

____________________________________________________________________

PHARMACISTS NOTES

Date Comment 7/10 Patient reports recent bout of dehydration and diarrhoea (suffered during her

holiday last week).


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Q60

Which of the following is the MOST likely cause of Mrs Jones presenting symptoms?

A hypertension

B gastroenteritis

C urinary tract infection

D decreased lithium and digoxin clearance

E increased lithium clearance and digoxin clearance

Q61

This patient has bipolar disorder. Which of the following may be a suitable medicationto allow for a decrease in lithium dose, while maintaining control of her psychiatricillness?

A diazepam

B risperidoneC carbamazepine

D olanzapine

E chlorpromazine

Q62

Which of the following is CORRECT, with regards to using digoxin in atrial fibrillation

(AF)?

A it has a high therapeutic index

B it should not be used as monotherapy

C it is no longer indicated for the treatment of AF

D the onset of effect occurs 2 3 hours after initial dose

E is useful in achieving satisfactory resting ventricular rate control in patientswith chronic AF


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36

Q63

Mrs Jones is commenced on venlafaxine. Her other medications remain unchanged.She suffers confusion, hypermania and sweating. Which of the following may explainMrs Jones sudden deterioration?

A significant increase in lithium levels

B significant decrease in hepatic function

C decrease in synaptic adrenaline concentration

D increase in potassium concentrations

Q64

Mrs Jones also complains of an irritating cough. Which of the following options isMOST likely to address this issue without compromising the management of hermedication?

A decrease perindopril to 2mg per day

B replace perindopril with lisinopril 5mg per dayC replace perindopril with candesartan 8mg per day

D increase frusemide to 80mg per day

E add irbesartan at 300mg per day



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Patient Profile ____________________________________________________________________

Patient Name Mr Brian Furter

Address 43 Albion Way BRIGHTONAge 35 Height 174cm


Allergies Nil known

____________________________________________________________________

DIAGNOSIS

Presenting complaint 1. Red, inflamed, itchy rash on lower trunk of body

2. Slightly elevated temperature ____________________________________________________________________


____________________________________________________________________

MEDICATION RECORD

Date Medication & Strength Qty Sig ____________________________________________________________________

PHARMACISTS NOTES

Date CommentPatient indicated he first noticed the rash 24 hours ago and has just seen thedoctor and received a script for Valaciclovir for shingles .


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Q65

The recommended dose of valaciclovir for the treatment of herpes zoster is

A 500mg twice daily for 5 days

B 500mg three times a day for 7 days

C 1g daily for 7 days

D 1g three times a day for 5 days

E 1g three times a day for 7 days

Q66

Which of the following statements is CORRECTregarding the effectiveness of thepatients treatment?

Treatment must

A not be commenced until rash clears

B be commenced within 12 hours of noticing the rash

C be commenced within 24 hours of noticing the rash

D be commenced within 72 hours of noticing the rash

E be commenced within 120 hours of noticing the rash

Q67

Which of the following statements is CORRECT regarding herpes zoster?

A early treatment reduces the incidence of post-herpetic neuralgia

B dosage adjustment of guanine analogues is required in hepatic impairment

C is not contagious after three days from the appearance of a rash

D herpes zoster is activated from a latent state

E topical aciclovir must be used as an adjunct to systemic antivirals, for the

treatment of herpes zoster ophthalmicus


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39

Q68

The MOST effective topical treatment for the patients post herpetic pain is

A aqueous cream with menthol 3%

B diclofenac gel 1%

C paraffin based ointment with menthol 3%

D betamethasone gel 0.02%

E capsaicin ointment 0.05%

Q69

Which group of people in the community is MOST likely to contract herpes zoster withgreater severity?

A pregnant women

B adults > 65 years of age

C immuno-suppressed patients

D children up to the age of 14E diabetics



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Patient Profile ____________________________________________________________________

Patient Name Thomas Lipton

Address Room 9, Paediatric WardAge 7 years Height 125cm


Allergies Carbamazepine (Agranulocytosis)

____________________________________________________________________

DIAGNOSIS

Presenting complaint 1. Fever (temperature 39.2 oC)

2. Increased seizure activity3. Vomiting

Medical history 1. Cerebral Palsy

2. Epilepsy (poorly controlled seizures) ____________________________________________________________________



____________________________________________________________________

MEDICATION RECORD

Date Medication & Strength Qty Sig17/3 Diazepam 5mg 50 i tds17/3 Sodium Valproate 200mg 100 i bd17/3 Lamotrigine 50mg 100 i bd17/3 Vigabatrin 500mg 100 i daily17/3 Phenytoin 30mg 100 i bd

17/3 Phenytoin 50mg 100 I bd ____________________________________________________________________

PHARMACISTS NOTES

Nil


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41

Q70

Which of the following statements regarding epilepsy in childhood is INCORRECT?

A epilepsy is one of the commonest chronic neurological conditions of childhood

B the majority of children with a first unprovoked seizure will have a recurrence

C antiepileptic medication treatment should not be commenced routinely afterthe first unprovoked seizure

D potential adverse effects of antiepileptic medications are a major determinantin the choice of medication

E if seizure free for two or more years, withdrawal of antiepileptic treatmentshould be considered

Q71

Which of the following would NOT be an appropriate treatment for someone withacute status epilepticus?

A intranasal midazolam

B rectal diazepam

C rectal paraldehyde

D oral sodium valproate

E buccal midazolam


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42

Q72

The doctors are concerned about whether the doses of anticonvulsants areappropriate and enquire as to whether measuring blood levels of the patientsanticonvulsants would be useful. For which of the following anticonvulsants areplasma levels of MOST value in clinical practice?

A diazepam

B lamotrigine

C sodium valproate

D phenytoin

E vigabatrin

Q73

Which of the following anticonvulsants is MOST likely to be associated with visual fieldeffects?

A diazepam

B lamotrigine

C sodium valproateD phenytoin

E vigabatrin

Q74

In conversation with the medical staff, Thomas mother mentions that he has gained alot of weight recently. Weight gain is a well recognised side effect of which of thefollowing anticonvulsants?

A sodium valproate

B lamotrigine

C phenytoin

D tiagabine

E phenobarbitone



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44

Q78

One of your regular patients presents a prescription for prednisolone 25 mg orally dailyfor the treatment of asthma. What is the optimal time to take this medication?

A at lunchtime

B at bedtime

C on an empty stomach in the morning

D with or after breakfast

E anytime of the day without respect to food

Q79

Which of the following would be INAPPROPRIATE advice on caring for a pruritic rash?

A keep the area cool

B wash area with soapy water, prior to applying creamC only use cotton clothing to cover the area

D avoid shampoos on the area

E avoid hot water

Q80

Alendronate can be taken

A daily or once weekly

B with milk to enhance absorption

C at bedtime to avoid possible drowsiness

D one hour before or two hours after a meal

E in the morning with breakfast to avoid stomach upset


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45

Q81

With which of the following medications is it MOST important to maintain a high fluidintake?

A spironolactone

B ciprofloxacin

C indapamide

D cephalexin

E frusemide

Q82

Which of the following medications is MOST appropriate for the prevention of nauseaand vomiting in Parkinsons disease?

A ondansetron

B domperidone

C metoclopramide

D prochlorperazine

E hyoscine


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Q83

A male customer presents the following prescription for his recurrent urinary tractinfection

Rx Norfloxacin tablets 400 mg mitte 14 + 1 RptSig i bd

Which of the following should NOT be included in your counselling of the patient?

A maintain a good fluid intake whilst being treated with norfloxacin

B take on an empty stomach one hour before or two hours after food

C avoid taking urinary alkalinisers during treatment with norfloxacin

D see your doctor as soon as possible in the event of muscle or tendon sorenessor inflammation

E take medication for three days and stop; recommence if symptoms recurwithin 48 hours

Q84

What advice should you give when a woman on a combined oral contraceptivepresents with a prescription for doxycycline for bronchitis? She should be advised that

A there will be a decreased risk of breakthrough bleeding

B doxycycline will increase the incidence of thromboembolic disorders and sheshould take aspirin 100mg daily

C doxycycline may affect the efficacy of the pill and she should take additionalcontraceptive precautions this month

D the contraceptive pill may affect the efficacy of doxycycline and she shouldcease the pill and use barrier contraceptive methods


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47

Q85

Which of the following vitamins has antioxidant properties?

A ascorbic acid

B ergocalciferol

C pantothenic acid

D folic acid

E cyanocobalamine

Q86

A person presents with a twisted ankle which occurred an hour prior to visiting thepharmacy. What advice should you give as first-aid treatment?

A suggest aspirin or another non-steroidal anti-inflammatory medication andapply a heat pack with the foot elevated

B apply a cold pack for 15 minutes at a time, elevate the ankle and apply acompression bandage

C try some gentle exercise to prevent the joint stiffening up and give ibuprofen

D massage frequently with methyl salicylate cream, apply heat and takeparacetamol/codeine/doxylamine tablets, elevate the ankle

E rest with the ankle elevated and apply a cold pack for 5 minutes every 30minutes, for two hours following the injury


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48

Q87

A customer, who is 8 weeks pregnant, comes into the pharmacy for a worm treatmentfor her family. Her children are showing signs of infestation. Her son is 6 years of ageand her daughters are 18 months and 4 years of age. Which of the followingtreatments should you recommend?

A pyrantel embonate given to the whole family

B pyrantel embonate given to the son only

C mebendazole given to the whole family

D mebendazole given to the son only

Q88

Which of the following statements regarding oral electrolyte replacement fluids isCORRECT?

A the fluids relieve gas-related abdominal discomfort

B the fluids are first line for the treatment of diarrhoea in children

C the fluids bond toxins and bacteria and form a protective intestinal lining

D rice-based preparations reduce stool output in patients with non-choleradiarrhea, as opposed to glucose-based preparations

E higher osmolality preparations are more effective than reduced sodium hypo-osmola preparations

Q89

In what situation would the use of glucosamine plus chondroitin for osteoarthritis beconsidered INAPPROPRIATE?

A sulfonamide allergy

B penicillin allergy

C asthma

D seafood allergy

E peanut allergy


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Q90

All of the following could be used to treat motion sickness EXCEPT

A promethazine theoclate

B domperidone

C dimenhydrinate

D hyoscine hydrobromide

E pheniramine

Q91

A customer, who is six months pregnant, is concerned that she has been suffering mildconstipation over the last week. She says that she has not experienced this for a longtime and feels sure that it must be connected to her pregnancy. Which of thefollowing treatments would be INAPPROPRIATE for her constipation?

A bulk laxatives

B moderate exercise

C stimulant laxative

D high fibre diet

E increased fluid intake

Q92

With regard to maldison (malathion) head lice lotion, which of the followingstatements is CORRECT?

A hair must be wet before application

B allow hair to dry naturally after use

C the lotion must be rinsed out after 10 minutes

D the shampoo product is preferred to the lotion

E it is recommended as safe to use during pregnancy


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Q93

Which of the following statements is INCORRECT regarding scabies?

A symptoms include pimple-like irritations in skin folds

B treatment with permethrin requires 2 applications 1 week apart

C the itch generally lasts 2 3 weeks and is not a sign of ongoing infection

D a person remains infectious until 24 hours after treatment is commenced

E infestation occurs after brief contact with household items or pets

Q94

Which of the following applies to oral typhoid vaccine?

The vaccine

A can be given concurrently with antibiotics

B can be given any time before commencing antibioticsC can be given immediately after finishing a course of antibiotics

D should not be given within one week of taking antibiotics

Q95

Which of the following combinations of medications is MOST likely to causehypokalaemia?

A indomethacin/salbutamol

B insulin/salbutamol

C insulin/amlodipine

D amlodipine/indomethacin

E insulin/propranolol


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Q96

A number of medications interact with warfarin to cause life-threatening situations.Which of the following medications is MOST likely to alter the INR?

A enalapril

B hydrochlorothiazide

C sulfamethoxazole-trimethoprim

D cephalexin

E propranolol

Q97

Which of the following statements is CORRECT with regard to analgesic nephropathy?

Analgesic nephropathy is

A characterised by chronic liver failure

B a chronic kidney disease that can lead to end stage renal failure

C an acute kidney disease caused by a high doses of analgesics

D characteristic of heavy aspirin dosage and not seen in association with other

analgesicsE an easily reversible condition with little associated pathology

Q98

A regular patient in your pharmacy is stabilised on life long warfarin therapy havinghad a mitral valve replacement 6 months ago. He has just been found to have highserum triglyceride and cholesterol levels and has a prescription for nicotinic acid

250mg tds. Which of the following statements is CORRECT?

A the recommended dosage of nicotinic acid is 750mg once daily

B nicotinic acid is contraindicated in patients with mitral valve replacements

C fenofibrate is first line treatment for this patient

D nicotinic acid can increase the anticoagulant response to warfarin in somepatients, so close monitoring is required

E nicotinic acid does not interact with warfarin and is not contraindicated in thispatient


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Q99

The dosage of aciclovir should be adjusted on the basis of

A pre-existing hepatic impairment

B pre-existing renal impairment

C time since onset of symptoms

D occurrence of side effects

Q100

A 74 year old male patient has been on digoxin for heart failure for several years. Hisrecently measured digoxin plasma level was within the normal range. He presents youwith a prescription for phenytoin 200 mg bd, which is a new addition to his regulartherapy. Which of the following is CORRECT?

A phenytoin may induce the hepatic metabolism of digoxin

B phenytoin may decrease the hepatic metabolism of digoxin

C digoxin may decrease the hepatic metabolism of phenytoin

D digoxin may increase the unbound concentration of phenytoin in the blood

E phenytoin is unlikely to interact with digoxin, since digoxin is cleared largely by

renal excretion


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Q101

Which of the following is NOT an adverse effect associated with long termcorticosteroid use?

A weight gain

B increased susceptibility to infection

C rounding of the face

D osteoporosis

E hyperkalaemia

Q102

Which of the following tests should be carried out regularly for patients takingamiodarone?

A serum cholesterol and triglycerides

B ocular examination and thyroid function test

C thyroid function test and blood glucose

D thyroid function test and blood urea nitrogen

Q103

Which of the following BEST monitors the anticoagulant effect of heparin?

A the level of AST in serum

B international normalised ratio (INR)

C a complete blood examination

D the level of albumin in serum

E activated partial thromboplastin time (APTT)


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Q104

Which of the following combinations may cause a clinically significant medicationinteraction?

A phenytoin, atenolol, hydrochlorothiazide, ranitidine

B lithium, fosinopril, frusemide, thyroxine

C amiodarone, ranitidine, pravastatin, metformin

D metoprolol, ramipril, frusemide, clopidogrel

Q105

Which of the following biochemical abnormalities can predispose patients to lithiumtoxicity?

A hypernatraemia

B hyponatraemia

C hypokalaemia

D hypermagnesaemia

E hypoalbuminaemia


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Q106

A middle aged businessman, Mr Burrows, who is a fairly regular customer in the

pharmacy, drops in a prescription one morning for the following item:

Methotrexate 2.5mg 50 3 tablets weekly

The prescription is written by his Rheumatology specialist, Dr Payne.

Mr Burrows is late for a meeting and tells you he will be back later.

Your computer history indicates that this is a new medication for him. The lastmedication that you dispensed for him was for Naproxen 500mg tds 50 two weeks agoon a prescription written by Dr Burrell, his GP.

Later on that day, Mr Burrows sends his secretary, Julie, to pick up the prescription ashe is in meetings all day and cannot be disturbed. Julie also has instructions to buysome folic acid 5mg tablets.

Write a letter to Mr Burrows relaying any important information you may haveregarding his new medication, including any necessary counselling points.

End of Examination

APC CAOP Practise Paper

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