Sample-paper---PHR5514-paper-2-version-2023.pdf

UNIVERSITY OF MALTA FACULTY OF MEDICINE AND SURGERY DEPARTMENT OF PHARMACY SESSION OF EXAMINATIONS PHR 5514 Paper II Sample Paper...

UNIVERSITY OF MALTA FACULTY OF MEDICINE AND SURGERY DEPARTMENT OF PHARMACY SESSION OF EXAMINATIONS PHR 5514 Paper II Sample Paper 2 hours Answer all questions in this paper. Each question carries one mark. Negative marking applies as indicated in each section. Please mark your answer on the paper. Please mark your answer with a pen only, do not use a pencil. Mark only one answer for each question. If you change your mind about an answer, delete the first answer and then write down your new answer. The use of the calculator provided is permitted. Questions 1-20 Directions: Each of the questions or incomplete statements is followed by five suggested answers. Select the best answer in each case. Negative marking: For each incorrect answer 1 mark will be deducted 1. In a clinical trial a new drug met the effectiveness criteria in 742 patients out of the 1020 patients enrolled in the study. The percent patient population for which effectiveness was met is: A 0.73 B 7.42 C 73 D 278 E 742 2. The percentage strength of the resulting solution of hydrogen chloride when 5 L of a 2% solution are diluted to 20 L is: A 0.05 B 0.5 C 4 D 5 E 8 1 of 20 3. Ranitidine syrup contains 15 mg of ranitidine per mL. The amount of ranitidine in mg administered with a dose of half a teaspoon is: A 3.75 B 6 C 15 D 37.5 E 75 4. Each tablet of Deanxit contains 5 mg of flupentixol and 10 mg of melitracen. The amount in grams of melitracen administered to a patient who was taking two tablets daily for six weeks is: A 0.12 B 0.42 C 0.84 D 84 E 840 5. Nafarelin is available as a nasal spray that contains 30 doses of 200 micrograms/metered spray. The amount of nafarelin in grams that are contained in each container is: A 0.006 B 0.06 C 0.6 D 6 E 6000 2 of 20 6. The approximate weights for the ingredients contained in a mixture are 12.85 grams, 138.7 grams, 2.686 grams, 25.06 grams and 52.70 grams. The approximate total combined weight in grams of the ingredients that can validly be recorded is: A 231 B 231.9 C 231.99 D 231.996 E 232 7. Each Snip tablet contains 325 mg of paracetamol, 15 mg of pseudoephedrine hydrochloride and 1 mg of chlorphenamine maleate. The number of tablets that can be prepared with 1.5 Kg of paracetamol, 300 g of pseudoephedrine hydrochloride and an unlimited amount of chlorphenamine maleate is: A 46 B 461 C 4615 D 20 000 E 24 615 8. The maximum potential error in terms of percentage when 100 mg of morphine are weighed on a balance with a sensitivity of 6 mg is: A 0.06 B 0.6 C 6 D 10 E 100 3 of 20 9. A prescription for No Spa tablets indicates that the patient should take 2 tablets tds for 2 days, then 1 tablet tds for 5 days and then 1 tablet bd for 3 days. The total amount of tablets that the patient requires is: A 6 B 12 C 13 D 15 E 33 10. 500 mL of codeine linctus weigh 640 g. The specific gravity of codeine linctus is: A 0.78 B 0.128 C 1.28 D 12.8 E 140 11. The weight in grams of glucose in a 500 mL intravenous infusion of glucose that contains 50 g of glucose per 100 mL with a specific gravity of 1.20 is: A 25 B 208 C 250 D 300 E 2 500 12. The amount in micrograms per mL of adrenaline in a solution for injection of 1 in 200 000 is: A 0.0005 B 0.005 C 0.05 D 0.5 E 5 4 of 20 13 The amount in mL of a metronidazole 5 mg/mL intravenous infusion available in 100 mL bag that is required to be administered to a child weighing 16 Kg for a dose of 7.5 mg/Kg at induction is: A 0.2 B 1.5 C 2.4 D 24 E 37.5 14. The individual dose in mg to be administered to a newborn weighing 2.5 Kg who is prescribed ceftazidime 25 mg/Kg in 2 divided doses is: A 2.5 B 5 C 10 D 31.25 E 62.5 15. The CMF chemotherapy regimen includes cyclophosphamide 100 mg/m2 on days 1 to 14 per cycle. The total cycle dose in grams for cyclophosphamide for a patient with a body surface area of 1.4 m2 is: A 1.4 B 1.96 C 140 D 1400 E 1960 16. Somatropin is available in 1.5 mL cartridges containing 5 mg. The amount in mL to be administered to a patient receiving 400 micrograms daily is: A 0.12 B 1.2 C 12 D 120 E 1200 5 of 20 17. The concentration in mg/mL of a solution of potassium chloride containing 4 mEq/mL is: (ram: chloride = 35.5, potassium = 39) A 4 B 35.5 C 39 D 149 E 298 18. Dopamine is available as a solution for intravenous infusion containing 1.6 mg/mL. It is to be administered to a patient with a body weight of 85 Kg at a dose of 5 micrograms/Kg/minute. The number of drops to be delivered per minute using a drip set that delivers 60 drops/mL is: A 1.6 B 16 C 160 D 1 600 E 16 000 19. Heparin sodium 5 000 units/mL is administered by continuous intravenous infusion by mixing with 500 mL sodium chloride 0.9%. The amount in mL/hour to be administered to achieve a rate of 1 000 units/hour of heparin sodium is: A 1 B 10 C 100 D 500 E 1000 6 of 20 20. The daily cost differential in Euro between a product that is administered as 1 tablet four times daily costing Euro 0.07/dose and a product that is administered as 4 tablets in the morning costing Euro 0.10/dose is: A 0.03 B 0.12 C 0.18 D 0.28 E 0.40 Questions 21-30 Directions: Each group of questions below consists of five lettered headings followed by a list of numbered questions. For each numbered question select the one heading which is most closely related to it. Each heading may be used once, more than once, or not at all. Negative marking: For each incorrect answer 0.5 mark will be deducted Questions 21-23 concern the following terms: A phase I biotransformation reactions B phase II biotransformation reactions C receptor desensitisation D receptor downregulation E receptor upregulation Select from A to E, which one of the above: 21. may occur as a result of continuous exposure to agonists 22. involves the attachment to the drug of an endogenous substance 23. may be catalysed by cytochrome P450 enzymes 7 of 20 Questions 24-27 concern the following drugs: A alendronic acid B co-trimoxazole C gliclazide D senna E sildenafil Select, from A to E, which one of the above should be used with caution in: 24. cardiovascular disease 25. symptomatic oesophageal disease 26. blood disorders 27. history (within 1 year) of gastric ulcers Questions 28-30 concern the following terms: A area under the curve B clearance C first order kinetics D half life E volume of distribution Select from A to E, which one of the above is: 28. represented by a unit of measurement that is micrograms/mL 29. calculated from the amount of drug in the body divided by the plasma concentration 30. provides an indirect measure of the degree of tissue distribution 8 of 20 Questions 31-49 Directions: For each of the questions below, ONE or MORE of the responses is (are) correct. Decide which of the responses is (are) correct. Then choose: A if 1, 2 and 3 are correct B if 1 and 2 only are correct C if 2 and 3 only are correct D if 1 only is correct E if 3 only is correct Negative marking: For each incorrect answer 0.25 mark will be deducted Directions summarised A B C D E 1, 2, 3 1, 2 only 2, 3 only 1 only 3 only 31. Dissolution testing: 1. requires a dissolution medium that is at an appropriate pH 2. results are useful on a comparative basis 3. is less well developed for non-oral products than for oral products 32. Adhesion of coated tablets to mucosal surfaces is affected by: 1. film coat thickness 2. nature of the film coat 3. drug particle size 9 of 20 33. In the pharmaceutical industry, stability testing: 1. is conducted on the product in the form that is finally to be marketed 2. entails the use of the Arrhenius equation as the basis of a method for accelerating decomposition 3. results are only of value to determine expiry date of the product 34. Aspirin: 1. is absorbed rapidly from the gastrointestinal tract 2. is highly bound to plasma proteins 3. acts as an inhibitor of the enzyme cyclo-oxygenase 35. The viscosity of a polymer solution depends on: 1. polymer concentration 2. polymer-solvent interactions 3. charge interactions Questions 36-39 concern the following structure: 36. The structure represents a drug which: 1. in the hydrochloride salt is practically odourless 2. includes a tertiary amino group 3. includes two aromatic rings that are bridged 10 of 20 37. The drug: 1. is well absorbed after oral administration 2. crosses the blood-brain barrier 3. is excreted unchanged 38. The drug is useful in: 1. insomnia 2. urticaria 3. gastric ulceration 39. The drug should be used with caution in: 1. prostatic hyperthropy 2. pyloroduodenal obstruction 3. motion sickness Questions 40-44 concern the following structure: 40. The structure represents a drug which presents: 1. a methoxy-imino moiety 2. a 6 membered dihydrothiazine ring 3. a carboxylic acid moiety 41. The drug: 1. is widely distributed in the body 2. is excreted unchanged 3. acts an an ezyme inhibitor 11 of 20 42. Patients taking the oral formulation are advised: 1. to take drug at regular intervals 2. to take drug with or after food 3. that drug causes drowsiness 43. The drug may have a significant drug interaction with: 1. warfarin 2. omeprazole 3. ibuprofen 44. Side-effects associated with the use of this drug include: 1. abdominal discomfort 2. headache 3. Stevens-Johnson syndrome Questions 45-47: concern the following prescription Patient’s Name Zolmitriptan 2.5 mg tablets 1 tablet prn m 1 pack Doctor’s signature 45. Zolmitriptan: 1. is a selective serotonin agonist 2. is preferred to ergot alkaloids for the management of migraine 3. may be used for the prophylaxis of migraine 46. Zolmitriptan is contra-indicated in: 1. hypotension 2. ischaemic heart disease 3. patients with a history of myocardial infarction 12 of 20 47. Patient should be advised: 1. to take tablet at onset of migraine 2. to repeat tablet administration within 15 minutes 3. not to take any paracetamol with zolmitriptan Questions 48-49: concern the following prescription Patient’s Name Escitalopram 10 mg tablets 1 tablet daily m 1 pack Doctor’s signature 48. Escitalopram: 1. is the S-enantiomer of citalopram 2. has limited direct action at muscarinic receptors 3. is the most potent SSRI 49. Escitalopram may be used in the management of: 1. an acute manic phase 2. generalized anxiety disorder 3. obsessive-compulsive disorder Questions 50-80 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 13 of 20  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 This section carries no negative marking. Directions Summarised First Second Statement Statement A True True 2nd statement is a correct explanation of the first B True True 2nd statement is NOT a correct explanation of the first C True False D False True E False False FIRST STATEMENT SECOND STATEMENT 50. Valsartan reduces the pressor Valsartan is a selective blocker of AT1 effects of angiotensin II. receptors. 51. Valsartan should be used with Valsartan may induce hypokalaemia. caution in patients receiving high-dose diuretics. 52. Valsartan should be avoided in Valsartan lacks superiority over ACE heart failure. inhibitors in the management of heart failure. 53. Salmeterol is a direct-acting Salmeterol acts as a beta 2 antagonist. sympathomimetic.. 54. Compared to salbutamol, Plasma concentrations of salmeterol salmeterol has a quicker onset are negligible after inhalation of of action. therapeutic doses. 14 of 20 55. Salmeterol should not be used A side effect of corticosteroids is water in patients who also require retention. corticosteroids. 56. Corticosteroids that have High doses of inhaled corticosteroids reduced systemic activity are have been associated with lower preferred for inhalation therapy. respiratory tract infections, including pneumonia. 57. Inhaled corticosteroids should Growth restriction normally occurs in not be used during pregnancy. children receiving recommended doses of inhaled corticosteroid therapy. 58. Fluticasone is a synthetic Fluticasone may be used in allergic fluorinated corticosteroid. rhinitis and nasal polyps. 59. Patients using spacer devices The larger spacer devices with a one- should be advised to inhale way valve are the most effective. from the spacer device as soon as possible after actuation. 60. Diazepam may be used in the Diazepam has analgesic properties. control of muscle spasms. 61. Diazepam is used in the control Diazepam is a long-acting of symptoms of alcohol benzodiazepine which decreases the withdrawal syndrome. activity of an inhibitory neurotransmitter in the brain. 62. Impairment of consciousness Diazepam is readily and completely occurs fairly rapidly in absorbed from the gastrointestinal tract. poisoning by diazepam. 15 of 20 63. Diazepam should not be used Diazepam commonly induces a concurrently with opioid paradoxical excitation. analgesics in anaesthetic regimens. 64. Diazepam should be used with Respiratory depression due to care in patients with chronic diazepam therapy is likely to occur with pulmonary insufficiency. high dosage and parenteral use. 65. Valproate may be used in the The sodium salt of valproate is used for treatment of an acute manic oral formulations. phase of bipolar disorder. 66. Risk of occurrence of tardive Valproate may cause blood and hepatic dyskinesia with valproate is disorders. high. 67. Haloperidol possesses general Haloperidol is a phenothiazine with a properties similar to piperazine side chain. chlorpromazine. 68. Haloperidol may be After an oral dose, haloperidol has a administered as a depot very short half life. parenteral preparation. 69. Haloperidol may be preferred Haloperidol may be given to other antipsychotic drugs intramuscularly or intravenously. when rapid control of hyperactive psychotic states is required. 16 of 20 70. Zuclopenthixol is preferred to Children and young adults are at an haloperidol in children. increased risk of developing severe dystonic reactions after only a few doses of haloperidol. 71. The effect of heat on vaccines Some vaccines may be sensitive to is generally reversible loss of excessively cold temperatures. potency. 72. Fever, headache and malaise Hypersensitivity reactions are very rare may occur a few hours after the but can be fatal. injection of a vaccine and last for 1 to 2 days. 73. The seasonal influenza vaccine The vaccine is available as oral drops. is administered to adults as a single dose. 74. Coal tar may be used in Coal tar has anti-inflammatory and anti- eczema and seborrhoeic scaling properties. dermatitis. 75. Caution should be employed Coal tar should not be applied to areas with the application of coal tar which are infected. preparation to the face since acne-like eruptions may occur. 76. Choline salicylate dental gel is Frequent application of choline not recommended for use in salicylate dental gel may give rise to individuals younger than 16 salicylate poisoning. years. 17 of 20 77. Latonoprost is contra-indicated Latonoprost eye drops may produce a in raised intra-ocular pressure gradual increase in the amount of or in open-angle glaucoma. brown pigment in the iris. 78. Allopurinol should be continued Allopurinol therapy should be withdrawn indefinitely to prevent further if a rash occurs. attacks of gout by correcting hypouricaemia. 79. Ciclosporin is available for oral Nephrotoxicity is the major adverse administration as well as for effect of ciclosporin. intravenous administration. 80. Tamoxifen has a stimulant The most frequent adverse effects of effect on the endometrium. tamoxifen are hot flushes. Questions 81-100: Read the statement or patient request and follow instructions. No negative marking applies. Questions 81-83: A 62 year old patient is receiving atenolol and paroxetine. Put the following drugs in order of risk for significant drug interaction assigning 1 to the drug most likely to cause a significant drug interaction and 3 to the drug least likely to cause a significant drug interaction. 81. lorazepam 82. ranitidine 83. terazosin 18 of 20 Questions 84-87: Put the following adverse effects of telithromycin in order of occurrence assigning 1 to the side effect that occurs most commonly and 4 to the side effect that occurs least commonly. 84. diarrhoea 85. erythema multiforme 86. flushing 87. hypotension Questions 88-92: A patient presents with a prescription for tretinoin 0.01% gel to be applied twice daily. Put the following counselling points by the pharmacist in order of relevance assigning 1 to the information that is most important to be presented to the patient and 5 to the information that is least relevant to the patient. 88. apply sunscreen 89. apply thinly twice a day 90. avoid contact with eyes, nostrils and mouth 91. maximum allowed period of treatment is 16 weeks 92. some redness may occur initially but will settle with time 19 of 20 Questions 93-96: A 22 year old female with a history of chronic asthma presents with chickenpox and is complaining of severe pain. For the following drugs, place your order of preference assigning 1 to the product which should be recommended as first choice and 4 to the product which should be recommended as a last choice. 93. aciclovir cream 94. aciclovir tablets 95. calamine lotion 96. lopinavir tablets Questions 97-100: Weight gain may be a side-effect of drug therapy. Put the following in order of precipitation of weight gain assigning 1 to the drug most likely to induce weight gain and 4 to the drug least likely to induce weight gain. 97. gliclazide 98. olanzapine 99. orlistat 100. rabeprazole 20 of 20