Australian Pharmacy Council Ltd

CAOP Examination
Sample Paper v1.2014
This is an official CAOP Examination sample paper produced by the Australian
Pharmacy Council Ltd (APC) for practice purposes only.
All questions in this sample paper are no longer used in live or actual examinations and
have 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 delivered
contemporaneously will vary from this sample paper.
The CAOP Examination is 106-questions long (105 multiple choice questions and 1
short 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 accurate
or relevant once published publicly.
The actual CAOP Examination is delivered by computer and candidates should visit the
APC 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.

Q1
How much elemental calcium (MW = 40 g/mol) does a patient receive per day if taking
calcium carbonate (MW = 100 g/mol) 600 mg twice daily?
A

480 mg

2400 mg

200 mg

600 mg

240 mg

Q2
A patient requires a 5-day course of a medicine the dose of which is 500mg once daily
on day 1 and 250mg once daily on day 2 to day 5. The medicine is only available as a
150mg dispersible tablet and is stable after dispersion for 6 hours. What is the
minimum number of dispersible tablets required for the 5-day course?
A

10

20

16

12

Q3

Phenytoin is available as 5 mL vials at a concentration of 50 mg/mL. The dose required

is 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

28 minutes

6 minutes

18 minutes

1.8 minutes

Q4
A patient who uses tramadol 200 mg SR orally mane and 50 mg orally twice daily
regularly to control breakthrough pain, is declared nil by mouth in hospital. What rate
of 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 tramadol
IV to morphine IV is 10:1?

16.6 mg/hour

694 micrograms/hour

187 mg/hour

833 micrograms/hour

69 mg/hour

Q5
What weight of an ingredient is required to produce 1000mL of a solution such that 2.5
mL diluted to 50 mL gives a 0.25% (w/v) solution?
A

5g

50 mg

50 g

25 mg

25 g

Q6
A female patient, who is 68 years old and weighs 68kg, presents with a serum
creatinine of 0.178mmol/L. What is her approximate serum creatinine clearance rate?

10mL/min

30mL/min

45mL/min

60mL/min

80mL/min

Q7
A 30 year old female with a starting weight of 65 kg and a height of 160 cm has lost 10
kg. What is the change in her Body Mass Index (BMI)?

1.6

2.6

3.9

1.9

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?

20

24

28

30

38

Q9
Which of the following conditions would prevent the use of an angiotensin-converting
enzyme inhibitor?

bilateral renal artery stenosis

non-insulin dependent diabetes mellitus

Mnires disease

hyperlipidaemia

lupus erythematous

Q10
Which of the following statements is CORRECT regarding paracetamol?
Paracetamol

has significant anti-inflammatory activity

inhibits cyclo-oxygenase

is excreted largely unchanged by the kidneys

can be given by intravenous infusion

is contraindicated in pregnancy

Q11
Which of the following statements about doxycycline is INCORRECT?
Doxycycline

can be used in the treatment of rosacea

may decrease blood methotrexate concentration

may be taken by children over 8 years of age

should be taken in the morning rather than at night

should not be taken after the first 18 weeks of pregnancy

Q12
Which of the following statements about doxycycline is CORRECT?

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

epilepsy

it is effective as monotherapy in treating infection with Plasmodium falciparum

it may reduce bone growth in young children

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

teratogenicity

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

Q13
A female customer misses a dose of a progesterone only pill. Within how many hours
does she have to take the pill, before contraceptive cover is reduced?

one

three

four

six

twelve

Q14
A patient has been taken off fluoxetine and prescribed venlafaxine and told by the
doctor to ask the pharmacist how long to wait before starting the new medication. The
BEST advice would be to wait for

one day

two days

ten to fourteen days

four to six weeks

one to two months

Q15
Itching is NOT a symptom of

allergic dermatitis

scabies

fungal infection

acne vulgaris

lichen planus

Q16
A worried father brings his 3 year old daughter into your pharmacy. She has had a bad
cough and mild fever spasmodically during the winter which has kept the whole family
awake at night. She has already used a whole bottle of expectorant, which had no
effect.
He asks you for a good cough mixture and describes his daughters cough as a barking
cough, which is worse at night. There is no phlegm and she gasps for air after
coughing.
From the scenario above, you advise the father to take his daughter to the doctor, as
you suspect her cough may be caused by
A

pneumonia

bronchitis

croup

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 its
combination with St Johns Wort?

ibuprofen

tramadol

codeine

paracetamol

dextropropoxyphene

Patient Profile
____________________________________________________________________
Patient Name Dick Cross
Address 49 Caffers Place, SUBIACO WA 6051
Age 62

Height 170cm

Sex Male

Weight 85kg

Allergies Nil known

____________________________________________________________________
DIAGNOSIS
Presenting complaint 1. Elevated blood glucose
Medical history

1. Diabetes Type II
2. Hyperlipidaemia
3. Insomnia
4. Constipation

LAB/DIAGNOSTIC TESTS
Date Test
20/7
Urate 0.58 mmol/L
20/7
Fasting Blood Glucose 9.0 mmol/L
1/3
Creatinine 0.16 mmol/L
1/3
Cholesterol 6.5 mmol/L

Reference Range
(0.18 0.47 mmol/L)
(< 5.5 mmol/L)
(0.05 0.12 mmol/L)
(<5 mmol/L)

____________________________________________________________________
MEDICATION RECORD
Date
Medication & Strength
Qty
Sig
1/3
Atorvastatin 20 mg
30
i daily
16/1
Docusate 50 mg with Senna 8 mg
90
prn
16/1
Aspirin 100 mg
28
i daily
____________________________________________________________________
PHARMACISTS NOTES
Date
20/7

20/7

Comment
Patient has been placed on dietary restriction for his elevated blood glucose in
the past 2 years. His most recent blood glucose indicates that dietary control
alone has not been adequate.
Asymptomatic elevated urate
7

Q18
The MOST appropriate option for the management of the patients hyperuricaemia is
A

allopurinol started at a dose of 100 mg daily

allopurinol started at a dose of 300 mg daily

probenecid started at a dose of 500 mg twice a day

no treatment be initiated

colchicine 0.5 mg twice daily

Q19
Which of the following would be an additional risk factor for cardiovascular disease in
this patient?

low homocysteine level

an elevated serum albumin

hypertension

postural hypotension

waist measurement 75 85 cm

Q20
Which of the following medications would be the MOST appropriate to manage Mr
Cross diabetes?

metformin

acarbose

insulin

glibenclamide

rosiglitazone

Q21
Which of the following tests is the BEST indicator of ongoing blood glucose control?

random blood glucose levels

three monthly HbA1c levels

weekly fasting blood glucose levels

regular serum creatine measurements

weekly urine testing

Q22
Which of the following primary health initiatives should you strongly recommend to
Mr Cross?

annual ocular examinations

annual bone density measurement

faecal occult blood test every 3 months

prostate specific antigen test every 5 years

creatine kinase levels every 3 months

END OF PATIENT PROFILE

Patient Profile
____________________________________________________________________
Patient Name : Jack Smithers
Address : Room 22, Garren Aged Care Facility
Age : 95 years

Height : 180 cm

Sex : Male

Weight : 73 kg

Allergies pencillin allergy (rash)

____________________________________________________________________
DIAGNOSIS
Presenting complaint 1. Swallowing difficulties and agitation
Medical history

1. Benign prostatic hyperplasia

2. Pacemaker
3. Depression
4. Prostate Cancer
____________________________________________________________________
LAB/DIAGNOSTIC TESTS
Date
Test
Reference Range
3/2
Blood pressure 140/80
____________________________________________________________________
MEDICATION RECORD
Date Medication & Strength

Qty

Sig

3/2
3/2
3/2
3/2
3/2
3/2
3/2
3/2
24/1
22/1
10/1
10/1
12/12

2
100
90
30
30
30
1
112
25
20
5
20
30

Apply once weekly

2 qid
2 nocte
1 daily
1 mane
1 mane
Implant every 12 weeks
1 mane
1 tds prn
1 tds course completed
1 daily course completed
1 qid prn
1 daily - ceased

Buprenorphine 10 mcg/hour patch

Paracetamol 500 mg
Docusate/senna 50 mg/8 mg
Tamsulosin SR 400 mcg
Rabeprazole 20 mg
Citalopram 20 mg
Goserelin acetate 10.8 mg SC
Aspirin 100 mg
Metoclopramide 10 mg
Cephalexin 500 mg
Roxithromycin 300 mg
Oxycodone 5 mg tablets
Meloxicam 15 mg

____________________________________________________________________
PHARMACISTS NOTES
Date
Comment
3/2

Visual and hearing impairment. Recent falls and wheelchair bound.

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

10

Q23
Mr Smithers is becoming increasingly agitated each time tablets are given to him, due
to difficulty swallowing. Which of the following medications the patient is currently
taking should NOT be crushed?

paracetamol

citalopram

aspirin

oxycodone

rabeprazole

Q24
Due to the patients swallowing difficulties, changes to his medications are necessary
to alleviate this problem. Which of the following recommendations is NOT
appropriate?

oxycodone immediate release tablets, liquid, suppositories or injections can be

used

roxithromycin tablets should not be crushed, but the dispersible tablets can be
used

docusate and senna tablets may be crushed, or other options include

suppositories or lactulose

tamsulosin tablets may be crushed, or the tablets opened and dispersed in

water

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

pantoprazole or lansoprazol

11

Q25
Mr Smithers pain is currently well managed with regular therapeutic doses of
paracetamol and a weekly buprenorphine patch. If further treatment for chronic pain
is required, which of the following is NOT appropriate in light of the patients current
medication regimen?

increased oxycodone dose

supplementary paracetamol

higher strength buprenorphine patch

replace paracetamol with combination paracetamol/codeine

replace oxycodone tablets with suppositories

Q26
Mr Smithers required metoclopramide for the treatment of nausea. Which of the
following statements regarding metoclopramide is INCORRECT?

tablets may be crushed

drowsiness is a common side effect

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

reduce dose in the elderly to reduce risk of extrapyramidal effects

avoid long term use in depressed patients, as mental state may worsen
END OF PATIENT PROFILE

12

Patient Profile
____________________________________________________________________
Patient Name Beryl Groper
Address 64 Highfield Drive, Thornlie
Age 49
Height 148cm
Sex Female
Weight 55kg
Allergies Nil known
____________________________________________________________________
DIAGNOSIS
Presenting complaint
1. Obstructive airways disease with shortness of breath
Medical history
1. Congestive cardiac disease
2. Glaucoma
____________________________________________________________________
LAB/DIAGNOSTIC TESTS
Date
Test
Reference Range
16/10
Temp 37.8C; Pulse 65bpm;
BP 120/65mm Hg
____________________________________________________________________
MEDICATION RECORD
Date
Medication & strength
Qty
Sig
2/10
Fluticasone 250mcg and Salmeterol 25mcg 120
ii puffs bd
30/9
Salbutamol nebules 5mg/2.5mL
60
5mg 4-hourly
30/9
Tiotropium 18mg capsules
30
inhale i daily
30/9
Prednisolone 5mg
60
40mg mane
15/9
Betaxolol eye drops 0.25%
5ml
ii drops bd
8/8
Enalapril 10mg
30
i daily
6/7
Frusemide 40mg
100
i mane
6/7
Docusate sodium (50mg)and senna (8mg) 90
ii nocte
____________________________________________________________________
PHARMACISTS NOTES
Nil

13

Q27
Beryl recently consulted you at the pharmacy with apparent flu symptoms, which
cleared within a few days. However, three or four weeks later she is still suffering with
a persistent, dry night time cough that is disturbing her sleep pattern. She asks you for
a cough suppressant. Which of the following is the MOST appropriate action for you
to take?

advise her to use the tiotropium capsule at night before bed

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

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

contact her doctor to discuss the patients use of enalapril

supply promethazine tablets, to be taken three times a day with the last dose
before bed

Q28
Beryl arrives to collect her regular supply of medication and is complaining of swollen
ankles, so severe that she cant fit into her shoes. The MOST appropriate action would
be for you to
A
B
C
D
E

advise her doctor and suggest Beryls frusemide and prednisolone be

reassessed
advise her to increase her frusemide dose to two tablets in the morning and to
take a potassium supplement
recommend she wear graduated support stockings and elevate her legs more
often
advise her to use her salbutamol more regularly to allow her to undertake
gentle walking to improve her venous return
advise her to reduce her dose of prednisolone to 5mg

14

Q29
Beryl later suffers muscle cramps. The MOST likely cause is
A
B
C
D
E

hypocalcaemia due to the prednisolone

hypokalaemia due to the frusemide and prednisolone
hyperphosphataemia due to heart failure
excessive fluid retention of feet and ankles
drug interaction between enalapril and frusemide

Q30
To improve Beryls asthma the doctor could

change the eye drops

change the enalapril

increase the frusemide

change the tiotropium to an inhaler

reduce and cease the prednisolone

Q31
You should ensure that Beryls prednisolone dose is reduced slowly because

stopping quickly may induce an asthma attack

inhaled steroids need to be increased slowly

the adrenal glands may be suppressed

electrolytes need to return to normal slowly

the possibility of rebound wheezing

END OF PATIENT PROFILE

15

Patient Profile
____________________________________________________________________
Patient Name David Frost
Address 27 Christmas Parade, Wagga Wagga, NSW 2073
Age 70

Height 168cm

Sex Male

Weight 75kg

Allergies Nil known

____________________________________________________________________
DIAGNOSIS
Presenting complaint

1. Diarrhoea

Medical History

1. Osteoarthritis
2. Hypertension
3. Cardiac Failure
____________________________________________________________________
LAB/DIAGNOSTIC TESTS
Date
Test
Reference Range
7/4
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
Sig
31/3
Paracetamol 1 gram
100
tds
31/3
Celecoxib 200 mg
30
i daily
31/3
Frusemide 80 mg
100
i daily
6/1
Lisinopril 10 mg
30
i daily
6/1
Spironolactone 25 mg
100
i daily
6/1
Frusemide 40 mg
30
i daily
6/1
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 frusemide
was increased.

16

Q32
The MOST likely cause of the results of the laboratory tests that have been provided
for this patient is

liver failure

acute renal failure

fluid overload

hyperkalaemia

worsening cardiac failure

Q33
Which of the following medications is MOST likely to cause gynecomastia in Mr Frost?

lisinopril

celecoxib

frusemide

glucosamine

spironolactone

Q34
Mr Frost is on spironolactone for his cardiac failure. What is the usual recommended
dose of this medication in patients with cardiac failure?

400 mg daily

100 mg daily

25 mg twice a day

25 mg once a week

25 mg once a day

17

Q35
Which of the following combinations of medication may cause acute renal failure in
this patient?

spironolactone, frusemide, paracetamol

frusemide, lisinopril, celecoxib

paracetamol, frusemide, lisinopril

celecoxib, lisinopril, glucosamine

lisinopril, spironolactone, glucosamine

Q36
The patient is currently taking celecoxib, which is a selective inhibitor of cyclooxygenase type 2 (COX-2). What is the mode of action of this type of medication?

stimulates the production of prostacyclin (PGI2)

inhibits the production of prostacyclin (PGI2)

stimulates the production of thromboxane (A2)

inhibits the production of thromboxane (A2)

inhibits both prostacyclin (PGI2) and thromboxane (A2)

END OF PATIENT PROFILE

18

Patient Profile
____________________________________________________________________
Patient Name Ms Cecily Weary
Address 17 Filamore Street, Portland, SA
Age 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
Current

Comment
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.

19

Q37
Ms Wearys doctor has recommended oral levonorgestrel. Which of the following
statements is CORRECT regarding this method of emergency contraception?
A

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

levonorgestrel has more severe side effects when taken as emergency

contraception compared to its use as regular contraception

levonorgestrel with ethinyloestradiol (2 doses of four tablets, 12 hours apart) is

considered to be as effective as the oral levonorgestrel regimen

oral levonorgestrel emergency contraception has been shown to increase the

risk of ectopic pregnancy

oral levonorgestrel does not induce a withdrawal bleed, although irregular

bleeding may occur occasionally

Q38
Ms Weary is breast-feeding her seven month old month old son. Which of the
following is the MOST appropriate advice to give the patient?

milk supply will significantly decrease

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

emergency contraception is safe to take during breast-feeding

emergency contraception should not be taken if breast-feeding

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?

immediately

immediately after the next breastfeed

within 12 hours of unprotected sex

72 hours after unprotected sex

with the evening meal to increase absorption

END OF PATIENT PROFILE
20

Patient Profile
____________________________________________________________________
Patient Name Kay Sutton
Address 66 Argyle St Hackett
Age 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
____________________________________________________________________
LAB/DIAGNOSTIC TESTS
Date
Test
Reference Range
12/1
Lithium 0.8 micromol/L
0.5 1.2 micromol/L
____________________________________________________________________
MEDICATION RECORD
Date
12/1
12/1
12/1
12/1
12/1

Medication & Strength

Insulin glargine 20iu
Insulin lispro 10 iu
Lithium 250mg tab
Ethinyloestradiol/levonorgestrol
Salbutamol 100mcg

Qty
100
4x28
MDI

Sig
bd
tds
2 tds
1 daily
1-2 inh prn

____________________________________________________________________
PHARMACISTS NOTES
Nil

21

Q40
Ms Sutton presents to your pharmacy with a script for cephalexin. Which of the
following is the MOST appropriate advice?

cease taking the oral contraceptive pill when taking this antibiotic

avoid alcohol while taking this antibiotic

start taking acidophilus to prevent vaginal thrush

start taking cranberry juice to treat the urinary tract infection

use barrier contraceptive measures while taking this antibiotic

Q41
Ms Sutton requests a product containing sodium citrotartrate to relieve the burning
associated with her urinary tract infection. Which of the following statements is
CORRECT?

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

the renal clearance of lithium will increase with the use of sodium citrotartrate

the antibacterial activity of cephalexin will be increased with the use of sodium
citrotartrate

the tubular reabsorption of lithium will increase with the use of sodium
citrotartrate

lithium and sodium citrotartrate granules can be safely used in combination

Q42
Regarding the Ms Suttons insulin, which of the following statements is INCORRECT?

insulin lispro should be administered 30 minutes after each meal

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

insulin lispro is injected subcutaneously

insulin glargine is referred to as a basal release insulin

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

22

Q43
Ten days later Ms Sutton has been referred to your pharmacy by the doctor for a
treatment for vaginal thrush. Which of the following statements regarding oral
fluconazole is CORRECT?

it must be accompanied by topical antifungal therapy

it must be taken on three consecutive days

it is contraindicated in diabetes

it is not recommended for use by pregnant woman

the course should be repeated in seven days

Q44
Ms Suttons doctor contacts you for advice regarding her bipolar disorder therapy. He
says that while her condition is well controlled, she is complaining of nausea and fine
tremor. Which of the following recommendations is the MOST appropriate?
The lithium

should be taken one hour before food

could be changed to a sustained release preparation

dose should be increased by 50%

dose should be decreased by 50%

should be replaced with olanzapine

END OF PATIENT PROFILE

23

Patient Profile
____________________________________________________________________
Patient Name Peter Barnard
Address Room 19, Garran Ward
Age 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
____________________________________________________________________
LAB/DIAGNOSTIC TESTS
Date
Test
Reference Range
16/11
Creatinine 0.42 mmol/l
0.02-0.06 mmol/l
16/11
Calcium 2.3 mmol/l
2.1-2.6 mmol/l
16/11
Phosphate 2.4 mmol/l
1.1-1.8 mmol/l
16/11
Potassium 5.8 mmol/l
3.5-5.0 mmol/l
16/11
Urinalysis: Pseudomonas aeruginosa detected
____________________________________________________________________
MEDICATION RECORD
Date
Medication & Strength
Qty
Sig
16/11
Calcium Carbonate 1.5g
100
i bd cc
16/11
Calcitriol 0.25 mcg
100
i daily
16/11
Darbopoietin 30 mcg
5
i weekly subcut
16/11
Enalapril 5mg
30
i bd
16/11
Sodium bicarbonate 840mg
100
i tds
16/11
Ferrous sulphate 325mg
30
i daily
16/11
Folic acid 0.5mg
100
i daily
16/11
Nifedipine SR 30mg
30
i bd
16/11
Hydralazine 25mg
100
i tds
____________________________________________________________________
PHARMACISTS NOTES
Date Comment
17/11

Admitted to hospital with a urinary tract infection. Patient is pyrexial with a temperature of
o
39 C 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.

24

Q45
The patient has chronic kidney disease. Which of the following statements regarding
this condition is INCORRECT?

protein starts to pass into the urine

anaemia is a complication that must be treated or prevented

hypercalcaemia occurs due to deficient vitamin D production

toxins such as urea and creatinine build up and cause problems

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?

calcitriol

enalapril

ferrous sulphate

nifedipine

hydralazine

25

Q47
The patient is experiencing hyperkalaemia. Which of the following statements is
CORRECT regarding the patients condition?

the patients potassium levels indicate severe hyperkalaemia

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

oral frusemide can be given to promote potassium excretion

muscle weakness, cardiac arrhythmia and myalgia are common symptoms

the use of NSAIDs should be avoided in this patient

Q48
Which of the following IV antibiotics is the MOST suitable treatment against
Pseudomonas aeruginosa for this patient?

amoxycillin

vancomycin

ceftriaxone

ciprofloxacin

gentamicin

Q49
The patient has hyperphosphataemia. Which medication dosage could be increased to
reduce his phosphate level?

calcium carbonate

calcitriol

sodium bicarbonate

darbepoetin

enalapril
END OF PATIENT PROFILE

26

Patient Profile
____________________________________________________________________
Patient Name Janine Smitters
Address 2B Nursing Home
Age72

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
____________________________________________________________________
LAB/DIAGNOSTIC TESTS
Date

Test

Reference Range

____________________________________________________________________
MEDICATION RECORD
Date
Medication & Strength
Qty
Sig
3/11
Enoxaparin 40mg/0.4mL
10
i daily subcut
3/11
Paracetamol 500mg/codeine 8mg
50
ii qid
22/10
Oxazepam 30mg
25
i bd
22/10
Diclofenac 25mg
50
i tds
7/10
Prazosin 5mg
100
tds
5/9
Atenolol 50mg
30
i mane
5/9
Perindopril 4 mg
30
i daily
____________________________________________________________________
PHARMACISTS NOTES
Date
2/11

Comment
Patient admitted to acute care hospital after a fall.
Patient has been taking diclofenac for 2 years.

27

Q50
The doctor has decided to cease the oxazepam and asks for your advice. Mrs Smitters
has been on this medication for 3 years. The MOST appropriate advice to give the
doctor is to

stop the oxazepam immediately

change to temazepam and reduce the dose over a few weeks

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

change to an equivalent dose of diazepam and gradually reduce the dose over
3 weeks

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

bone mineral density

vitamin D and calcium levels

hepatic function

renal function

full dental assessment

Q52
Which of the following medications is LEAST likely to have contributed to Mrs Smitters
fall and subsequent fractured femur?
A

prazosin

atenolol

oxazepam

perindopril

paracetamol/codeine

28

Q53
At a follow-up appointment, Mrs Smitters hypertension is found to have worsened.
The MOST appropriate management would be to

increase the prazosin dose

increase prazosin and atenolol dose

initiate frusemide and potassium supplementation

cease prazosin and initiate verapamil

cease prazosin and initiate ramipril

END OF PATIENT PROFILE

29

Patient Profile
____________________________________________________________________
Patient Name John Coles
Address 16 Adam Street, Hillcrest
Age 69
Height 173cm
Sex Male
Weight 63kg
Allergies Penicillin
____________________________________________________________________
DIAGNOSIS
Presenting complaint
1. Ischaemic heart disease
2. Gout
Medical History
1. Mild left sided heart failure
2. Hypothyroidism
3. Transient Ischaemic attacks (TIA)
____________________________________________________________________
LAB/DIAGNOSTIC TESTS
Date
Test
Reference Range
____________________________________________________________________
MEDICATION RECORD
Date
Medication & strength
Qty
Sig
20/6
Naproxen 500mg
50
bd prn
20/6
Diltiazem 180mg
30
1 mane
20/6
Aspirin 100mg
90
1 mane
15/5
Thyroxine 200mcg
200
1 mane
20/4
Temazepam 10mg
25
1 nocte
20/4
Frusemide 40mg
100
1 mane
20/4
Colchicine 0.5mg
100
1
2hrly until pain ceases
16/2
Thyroxine 100mcg
200
1 mane
____________________________________________________________________
PHARMACISTS NOTES
Date
Comment
20/6
Naproxen to be used until acute attack of gout settles.

30

Q54
Which of Mr Coles medications is MOST likely to cause deterioration of his heart
failure?

diltiazem

thyroxine

frusemide

aspirin

colchicine

Q55
The use of low dose aspirin by Mr Coles

will reduce the effectiveness of the frusemide

has the same gastrointestinal bleeding risk as placebo

may mask the symptoms of hypothyroidism

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

will reduce the pain associated with an acute attack of gout

31

Q56
Mr Coles has been prescribed naproxen to be used when needed for acute gout.
Which of the following statements is CORRECT?

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

naproxen cannot be taken at the same time as aspirin in the morning, so take
two tablets at night when necessary

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

cease naproxen

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 the
following is the MOST likely cause?

the introduction of diltiazem

interaction between frusemide and diltiazem

excessive use of naproxen for gout

interaction between frusemide and naproxen

increased dose of thyroxine

Q58
Mr Coles is prescribed cefaclor for a respiratory tract infection. The incidence of cross
sensitivity to cephalosporin in patients with penicillin allergy is

1%

3%

10%

15%

20%

32

Q59
Mr Coles has previously been prescribed colchicine for acute gout. The MOST likely
reason for ceasing colchicine and commencing naproxen would be

colchicine increased the elimination of thyroxine by causing diarrhoea

an interaction between colchicine and frusemide, causing the precipitation of

urate crystals in the kidneys

colchicine is contraindicated in patients with heart failure due to increased

fluid retention

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

that nausea, vomiting and diarrhoea occurred before appropriate symptom

relief was achieved
END OF PATIENT PROFILE

33

Medical Profile
____________________________________________________________________
Patient Name Marilyn Jones
Address 5 Backus Avenue, WESTBOURNE, TAS 7001
Age 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 failure
3. Atrial fibrillation
____________________________________________________________________
MEDICATION RECORD
Date
7/10

Medication & Strength

Qty
Sig
Lithium Carbonate 250mg
200
i bd
Digoxin 62.5mcg
100
ii daily
Perindopril 4mg
30
i daily
Spironolactone 25mg
100
i daily
Frusemide 20mg
100
i daily
____________________________________________________________________

PHARMACISTS NOTES
Date
7/10

Comment
Patient reports recent bout of dehydration and diarrhoea (suffered during her
holiday last week).

34

Q60
Which of the following is the MOST likely cause of Mrs Jones presenting symptoms?

hypertension

gastroenteritis

urinary tract infection

decreased lithium and digoxin clearance

increased lithium clearance and digoxin clearance

Q61
This patient has bipolar disorder. Which of the following may be a suitable medication
to allow for a decrease in lithium dose, while maintaining control of her psychiatric
illness?

diazepam

risperidone

carbamazepine

olanzapine

chlorpromazine

Q62
Which of the following is CORRECT, with regards to using digoxin in atrial fibrillation
(AF)?

it has a high therapeutic index

it should not be used as monotherapy

it is no longer indicated for the treatment of AF

the onset of effect occurs 2 3 hours after initial dose

is useful in achieving satisfactory resting ventricular rate control in patients

with chronic AF

35

Q63
Mrs Jones is commenced on venlafaxine. Her other medications remain unchanged.
She suffers confusion, hypermania and sweating. Which of the following may explain
Mrs Jones sudden deterioration?

significant increase in lithium levels

significant decrease in hepatic function

decrease in synaptic adrenaline concentration

increase in potassium concentrations

Q64
Mrs Jones also complains of an irritating cough. Which of the following options is
MOST likely to address this issue without compromising the management of her
medication?

decrease perindopril to 2mg per day

replace perindopril with lisinopril 5mg per day

replace perindopril with candesartan 8mg per day

increase frusemide to 80mg per day

add irbesartan at 300mg per day

END OF PATIENT PROFILE

36

Patient Profile
____________________________________________________________________
Patient Name Mr Brian Furter
Address 43 Albion Way BRIGHTON
Age 35

Height 174cm

Sex Male

Weight 78kg

Allergies Nil known

____________________________________________________________________
DIAGNOSIS
Presenting complaint 1. Red, inflamed, itchy rash on lower trunk of body
2. Slightly elevated temperature
____________________________________________________________________
LAB/DIAGNOSTIC TESTS
____________________________________________________________________
MEDICATION RECORD
Date
Medication & Strength
Qty
Sig
____________________________________________________________________
PHARMACISTS NOTES
Date

Comment
Patient indicated he first noticed the rash 24 hours ago and has just seen the
doctor and received a script for Valaciclovir for shingles.

37

Q65
The recommended dose of valaciclovir for the treatment of herpes zoster is

500mg twice daily for 5 days

500mg three times a day for 7 days

1g daily for 7 days

1g three times a day for 5 days

1g three times a day for 7 days

Q66
Which of the following statements is CORRECT regarding the effectiveness of the
patients treatment?
Treatment must

not be commenced until rash clears

be commenced within 12 hours of noticing the rash

be commenced within 24 hours of noticing the rash

be commenced within 72 hours of noticing the rash

be commenced within 120 hours of noticing the rash

Q67
Which of the following statements is CORRECT regarding herpes zoster?

early treatment reduces the incidence of post-herpetic neuralgia

dosage adjustment of guanine analogues is required in hepatic impairment

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

herpes zoster is activated from a latent state

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

treatment of herpes zoster ophthalmicus

38

Q68
The MOST effective topical treatment for the patients post herpetic pain is

aqueous cream with menthol 3%

diclofenac gel 1%

paraffin based ointment with menthol 3%

betamethasone gel 0.02%

capsaicin ointment 0.05%

Q69
Which group of people in the community is MOST likely to contract herpes zoster with
greater severity?

pregnant women

adults > 65 years of age

immuno-suppressed patients

children up to the age of 14

diabetics
END OF PATIENT PROFILE

39

Patient Profile
____________________________________________________________________
Patient Name Thomas Lipton
Address Room 9, Paediatric Ward
Age 7 years

Height 125cm

Sex Male

Weight 30kg

Allergies Carbamazepine (Agranulocytosis)

____________________________________________________________________
DIAGNOSIS
Presenting complaint 1. Fever (temperature 39.2oC)
2. Increased seizure activity
3. Vomiting
Medical history

1. Cerebral Palsy

2. Epilepsy (poorly controlled seizures)

____________________________________________________________________
LAB/DIAGNOSTIC TESTS
Date
Test
Reference Range
____________________________________________________________________
MEDICATION RECORD
Date
Medication & Strength
Qty
Sig
17/3
Diazepam 5mg
50
i tds
17/3
Sodium Valproate 200mg
100
i bd
17/3
Lamotrigine 50mg
100
i bd
17/3
Vigabatrin 500mg
100
i daily
17/3
Phenytoin 30mg
100
i bd
17/3
Phenytoin 50mg
100
I bd
____________________________________________________________________
PHARMACISTS NOTES
Nil

40

Q70
Which of the following statements regarding epilepsy in childhood is INCORRECT?

epilepsy is one of the commonest chronic neurological conditions of childhood

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

antiepileptic medication treatment should not be commenced routinely after

the first unprovoked seizure

potential adverse effects of antiepileptic medications are a major determinant

in the choice of medication

if seizure free for two or more years, withdrawal of antiepileptic treatment

should be considered

Q71
Which of the following would NOT be an appropriate treatment for someone with
acute status epilepticus?

intranasal midazolam

rectal diazepam

rectal paraldehyde

oral sodium valproate

buccal midazolam

41

Q72
The doctors are concerned about whether the doses of anticonvulsants are
appropriate and enquire as to whether measuring blood levels of the patients
anticonvulsants would be useful. For which of the following anticonvulsants are
plasma levels of MOST value in clinical practice?

diazepam

lamotrigine

sodium valproate

phenytoin

vigabatrin

Q73
Which of the following anticonvulsants is MOST likely to be associated with visual field
effects?

diazepam

lamotrigine

sodium valproate

phenytoin

vigabatrin

Q74
In conversation with the medical staff, Thomas mother mentions that he has gained a
lot of weight recently. Weight gain is a well recognised side effect of which of the
following anticonvulsants?

sodium valproate

lamotrigine

phenytoin

tiagabine

phenobarbitone
END OF PATIENT PROFILE

42

Q75
A patient with epilepsy comes into your pharmacy and tells you she is pregnant. She is
concerned about the effect of her medication on the baby. Which of the following
statements is the MOST appropriate advice?

epilepsy medications should be ceased during pregnancy

epilepsy medications are safe to use during pregnancy

the dosage of current medications should be reduced to minimum levels

the risk to the baby is greater from uncontrolled epilepsy than from the
medication

Q76
What is the recommended period (for females) for folate supplementation before
conception and during pregnancy?

one week before conception and the 1st month of pregnancy

one month before conception and the 1st month of pregnancy

three months before conception and the 1st three months of pregnancy

one month before conception and the 1st three months of pregnancy

one month before conception and the entire duration of pregnancy

Q77
Which of the following is NOT a risk factor for cardiovascular disease?

thyroid dysfunction

increased HDL

increased LDL

hypertension

diabetes

43

Q78
One of your regular patients presents a prescription for prednisolone 25 mg orally daily
for the treatment of asthma. What is the optimal time to take this medication?

at lunchtime

at bedtime

on an empty stomach in the morning

with or after breakfast

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

wash area with soapy water, prior to applying cream

only use cotton clothing to cover the area

avoid shampoos on the area

avoid hot water

Q80
Alendronate can be taken

daily or once weekly

with milk to enhance absorption

at bedtime to avoid possible drowsiness

one hour before or two hours after a meal

in the morning with breakfast to avoid stomach upset

44

Q81
With which of the following medications is it MOST important to maintain a high fluid
intake?

spironolactone

ciprofloxacin

indapamide

cephalexin

frusemide

Q82
Which of the following medications is MOST appropriate for the prevention of nausea
and vomiting in Parkinsons disease?
A
ondansetron
B

domperidone

metoclopramide

prochlorperazine

hyoscine

45

Q83
A male customer presents the following prescription for his recurrent urinary tract
infection

Rx Norfloxacin tablets 400 mg mitte 14 + 1 Rpt

Sig i bd

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

maintain a good fluid intake whilst being treated with norfloxacin

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

avoid taking urinary alkalinisers during treatment with norfloxacin

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

take medication for three days and stop; recommence if symptoms recur
within 48 hours

Q84
What advice should you give when a woman on a combined oral contraceptive
presents with a prescription for doxycycline for bronchitis? She should be advised that

there will be a decreased risk of breakthrough bleeding

doxycycline will increase the incidence of thromboembolic disorders and she

should take aspirin 100mg daily

doxycycline may affect the efficacy of the pill and she should take additional
contraceptive precautions this month

the contraceptive pill may affect the efficacy of doxycycline and she should
cease the pill and use barrier contraceptive methods

46

Q85
Which of the following vitamins has antioxidant properties?

ascorbic acid

ergocalciferol

pantothenic acid

folic acid

cyanocobalamine

Q86
A person presents with a twisted ankle which occurred an hour prior to visiting the
pharmacy. What advice should you give as first-aid treatment?

suggest aspirin or another non-steroidal anti-inflammatory medication and

apply a heat pack with the foot elevated

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

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

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

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

47

Q87
A customer, who is 8 weeks pregnant, comes into the pharmacy for a worm treatment
for her family. Her children are showing signs of infestation. Her son is 6 years of age
and her daughters are 18 months and 4 years of age. Which of the following
treatments should you recommend?

pyrantel embonate given to the whole family

pyrantel embonate given to the son only

mebendazole given to the whole family

mebendazole given to the son only

Q88
Which of the following statements regarding oral electrolyte replacement fluids is
CORRECT?

the fluids relieve gas-related abdominal discomfort

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

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

rice-based preparations reduce stool output in patients with non-cholera

diarrhea, as opposed to glucose-based preparations

higher osmolality preparations are more effective than reduced sodium hypoosmola preparations

Q89
In what situation would the use of glucosamine plus chondroitin for osteoarthritis be
considered INAPPROPRIATE?

sulfonamide allergy

penicillin allergy

asthma

seafood allergy

peanut allergy

48

Q90
All of the following could be used to treat motion sickness EXCEPT

promethazine theoclate

domperidone

dimenhydrinate

hyoscine hydrobromide

pheniramine

Q91
A customer, who is six months pregnant, is concerned that she has been suffering mild
constipation over the last week. She says that she has not experienced this for a long
time and feels sure that it must be connected to her pregnancy. Which of the
following treatments would be INAPPROPRIATE for her constipation?
A

bulk laxatives

moderate exercise

stimulant laxative

high fibre diet

increased fluid intake

Q92
With regard to maldison (malathion) head lice lotion, which of the following
statements is CORRECT?

hair must be wet before application

allow hair to dry naturally after use

the lotion must be rinsed out after 10 minutes

the shampoo product is preferred to the lotion

it is recommended as safe to use during pregnancy

49

Q93
Which of the following statements is INCORRECT regarding scabies?
A

symptoms include pimple-like irritations in skin folds

treatment with permethrin requires 2 applications 1 week apart

the itch generally lasts 23 weeks and is not a sign of ongoing infection

a person remains infectious until 24 hours after treatment is commenced

infestation occurs after brief contact with household items or pets

Q94
Which of the following applies to oral typhoid vaccine?
The vaccine

can be given concurrently with antibiotics

can be given any time before commencing antibiotics

can be given immediately after finishing a course of antibiotics

should not be given within one week of taking antibiotics

Q95
Which of the following combinations of medications is MOST likely to cause
hypokalaemia?

indomethacin/salbutamol

insulin/salbutamol

insulin/amlodipine

amlodipine/indomethacin

insulin/propranolol
50

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?

enalapril

hydrochlorothiazide

sulfamethoxazole-trimethoprim

cephalexin

propranolol

Q97
Which of the following statements is CORRECT with regard to analgesic nephropathy?
Analgesic nephropathy is

characterised by chronic liver failure

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

an acute kidney disease caused by a high doses of analgesics

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

an easily reversible condition with little associated pathology

Q98
A regular patient in your pharmacy is stabilised on life long warfarin therapy having
had a mitral valve replacement 6 months ago. He has just been found to have high
serum triglyceride and cholesterol levels and has a prescription for nicotinic acid
250mg tds. Which of the following statements is CORRECT?

the recommended dosage of nicotinic acid is 750mg once daily

nicotinic acid is contraindicated in patients with mitral valve replacements

fenofibrate is first line treatment for this patient

nicotinic acid can increase the anticoagulant response to warfarin in some

patients, so close monitoring is required

nicotinic acid does not interact with warfarin and is not contraindicated in this
patient

51

Q99
The dosage of aciclovir should be adjusted on the basis of

pre-existing hepatic impairment

pre-existing renal impairment

time since onset of symptoms

occurrence of side effects

Q100
A 74 year old male patient has been on digoxin for heart failure for several years. His
recently measured digoxin plasma level was within the normal range. He presents you
with a prescription for phenytoin 200 mg bd, which is a new addition to his regular
therapy. Which of the following is CORRECT?

phenytoin may induce the hepatic metabolism of digoxin

phenytoin may decrease the hepatic metabolism of digoxin

digoxin may decrease the hepatic metabolism of phenytoin

digoxin may increase the unbound concentration of phenytoin in the blood

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

renal excretion

52

Q101
Which of the following is NOT an adverse effect associated with long term
corticosteroid use?

weight gain

increased susceptibility to infection

rounding of the face

osteoporosis

hyperkalaemia

Q102
Which of the following tests should be carried out regularly for patients taking
amiodarone?

serum cholesterol and triglycerides

ocular examination and thyroid function test

thyroid function test and blood glucose

thyroid function test and blood urea nitrogen

Q103
Which of the following BEST monitors the anticoagulant effect of heparin?

the level of AST in serum

international normalised ratio (INR)

a complete blood examination

the level of albumin in serum

activated partial thromboplastin time (APTT)

53

Q104
Which of the following combinations may cause a clinically significant medication
interaction?

phenytoin, atenolol, hydrochlorothiazide, ranitidine

lithium, fosinopril, frusemide, thyroxine

amiodarone, ranitidine, pravastatin, metformin

metoprolol, ramipril, frusemide, clopidogrel

Q105
Which of the following biochemical abnormalities can predispose patients to lithium
toxicity?
A

hypernatraemia

hyponatraemia

hypokalaemia

hypermagnesaemia

hypoalbuminaemia

54

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 last
medication that you dispensed for him was for Naproxen 500mg tds 50 two weeks ago
on a prescription written by Dr Burrell, his GP.

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

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

End of Examination

55