APC MAY EXAM COMPILATION

Overall, there were a lot of questions that asked for specific adverse effects or interactions.
There were too many options that I just eliminated right away so I couldn't remember those
very clearly. Calculations and ethics questions form such a small part of the exam that I barely
noticed them, but that's where the trap is, because they require a pass mark of at least 65% (or
in other words 6/8 marks), your margin of error is very limited and take particular care
answering them.

Thanks for your help and exam preparation AND the prework you gathered together! I found
that doing the prework (even though it has only been 4 sessions) has really made it easier
because you would have read the amh or therapeutic guidelines for those sections and THEY DO
appear in the exam even though they aren't the exact questions, they are "surrounding"
questions.

CALCULATIONS

1. 100kg patient takes 5ml bd iron supplement (30mg/ml). The conc is 5mg/ml which is the
same as 6mg/ml of elemental iron, what is the total daily dose of elemental iron this person
takes?
0.6mg/kg

2. 5mg of fentanyl patches which release the drug at a 50ug/hr. After 72 hours how much of the
initial drug is still present in the patches as a percentage?
-28%
-36%

3. How much of X drug is needed in 500ml if the required concentration is 1:5000?

100mg
225mg

4. How many drops question. Dropper is calibrated 0.04 mL per drop.

Answer is 8 drops.

5. Patient needs X amount of drug. Given concentration is Y mg/ml. How many drops for X
amount of drug

6. What is the volume required to make a 2% concentration of a solution with a stock solution of
10% to make 600mL
7. Had formula a solution
Something solution (6% w/v) 25 mL
To purified water 100 mL

Required to make up 15mL bottles. How much of substance is needed?

Step 1: 0.06 x 25 mL = 1.5g
Step 2: (25/100) x 15 = 3.75 mL of something solution
Step 3: 1.5/25 = unknown (g) / 3.75
Step 4: 0.225 g = 225 mg

ETHICS

1. Regular customer comes in with a script for pethidine ampoules to be used for a severe
migraine prescribed by an interstate doc while she was on holidays what should you do?
-dispense script
- refuse to dispense and offer an alternative
- dispense and ask her to bring back a replacement prescription within 7 days
- contact her local GP and ask his advice and a replacement prescription

2. Which of the following is requires a mandatory report

a) PIC has a sexual relationship with a patient
b) PIC has a mental condition which is adequately controlled by medications
c) PIC has a medical condition which is adequately controlled by medications
d) PIC is intoxicated

3. Where would you find if medications need sedation cautionary labels? Which law regulates
labelling?
-APF
-AMH
-SUSMP
--Appendix K

4. Which of the following medication is it most appropriate to put label 1

-mirtazapine
-duloxetine
-venlafaxine
- Ondansetron
- Allopurinol

5. Gentleman walks into the pharmacy and asks to identify a pill, upon questioning he tells you
he found it on his assistants desk, what do you do:
Find out and tell him
Ask questions about the assistants medical history.. then tell him what it is.
Don't tell him what it is - suggest he talks to his assistant.
Lie about what the pill is.

6. Which drug needs monitoring by pharmacists and prescribers from doctors and pharmacists? -
Clozapine
- Quetiapine
- Risperidone
- Olanzepine

7.How long does a drug of addiction prescription from its date of writing last for?
3 months
6 months
9 months
12 months
24 months

8. What medication can a doctor obtain through a doctor’s bag, that would be used for acute dystonic
reactions: Benztropine

9. Prochlorperazine approved S3 indication:

Nausea associated with migraine
Nausea associated with medication
Nausea associated with pregnancy
Nausea associated with (...)

10. In which schedule would you find esomeprazole 20mg (QTY: 14)
Unscheduled
S2
S3
S4
S8

CLINICAL
How often is loratadine dosed:
Every 4 hours
Every 6 hours
Every 8 hours
Twice Daily
Once Daily

Paracetamol:
Which of the following is FALSE:
Paracetamol is effective treatment for febrile convulsions
Paracetamol is used to treat fever.
... etc.

Antibiotics:
Which is first choice for uncomplicated cystitis in children:
Cephalexin or trimethoprim
Cephalexin or amoxycillin
Cephalexin or norfloxacin
... etc.

Which vitamin does E.Coli effect the production of?

Vitamin A
Vitamin C
Vitamin D
Vitamin E
Vitamin K

Which is NOT recommended for treatment of genital warts:

Podophyllotoxin cream
Podophyllotoxin solution (15% i think)
LPC with salicylic acid cream
Cryotherapy

Which is TRUE about mebendazole:

Safe in pregnancy
Treats ALL worms
Need to retreat after one week
Can be used to treat children >6 months

There was a case about a patient being treated for TB with isoniazid, ethambutol and
pyrazinamide.
The question was, how should these drugs be taken:
Isoniazid AND ethambutol with food in the morning, pyrazinamide at night without food.
Isoniazid AND pyrazinamide at night with dinner, ethambutol in the morning on an empty
stomach
Daily with food
Daily without food

What dose of pyridoxine is recommended to reduce the risk of peripheral neuropathy when
being treated with isoniazid:
10mg daily
25mg daily
50mg daily
100mg daily
200mg daily

Gentlemen with AF/systolic heart failure being treated with a heap of drugs (I remember
digoxin/ACE-I and a diuretic).
Which is the most appropriate to add to his therapy:
Atenolol - not indicated in HF
Bisoprolol - my answer
Carvedilol - interacts with digoxin
Metoprolol - didn't specify it was 'controlled-release' so I assumed it was incorrect.
Sotalol - not indicated in HF

Which statin is not extensively metabolised by CYP450 enzymes:

Atorvastatin
Fluvastatin
Pravastatin
Rosuvastatin
Simvastatin

What is the recommended treatment for folate deficiency in adult males:

0.5mg daily
0.5mg bd
5mg daily
5mg weekly

Which corticosteroid can be applied to the face:

Hydrocortisone 1%
Triamcinolone 0.02%
Mometasone 0.1%
Betamethasone valerate 0.02%

A mother approaches you at the pharmacy, her baby has had an ear infection for the last 3 days
- she mentions that it has improved significantly since yesterday, what do you do:
Refer to GP
Treat symptoms
Nothing
Provide topical antibacterial
How long can insulin be stored at 25°C?
One hour
One day
One week
One month
One year

Case study where a lady is taking bisphosphonates/calcium and becomes hypercalcaemic, what
do you do?
Reduce dose to 600mg daily
Increase dose to 1800mg daily
Cease calcium
Add calcitriol
Cease bisphosphonate

Which condition is not associated with dry eyes?

Glaucoma
Rheumatoid arthritis
Air-conditioning
Plane-travel
Old age

Patient with open-angle glaucoma previously on timolol - condition hasn't improved, what is the
most appropriate choice?
Betaxolol
Latanoprost
Pilocarpine
Homatropine
Tropicamide

Gold is NOT commonly associated with which side effect:

Constipation
Stomatitis
Taste disturbance
Nausea
Alopecia

Which of the following is NOT true in regards to finasteride (BPH):

Efficacy is dependent on the size of the prostate
Women should not handle tablets
Prostate specific antigen is significantly reduced after 6 months of treatment
If symptoms do not improve after 4-6 weeks, cease treatment
..something else

Vincristine/ vinblastine should be administered via which route:

Intra thecal
Intra muscular
Intra venous
Oral

Which NSAID is LEAST associated with GI complications:

Ketoprofen
Piroxicam
Indomethacin
Diclofenac
Naproxen

Chances of severe skin reactions can occur when being treated with Lamotrigine and..
Gabapentin
Levetiracetam
Valproate
Phenytoin
Pregabalin

Patient with Parkinson's is getting tremor worse of a morning, what is the most appropriate
course of action:
Start pramipexole
Start slow released levodopa + ... at night
Reduce dose
Increase levodopa + ... dose

Which of the following medicines can be re-packaged in a Dose Administration Aid:

Dabigatran
Ondansetron wafers
Montelukast chewable tablets
Fluoxetine dispersible tablets
-rifampicin

Which of the following conditions is NOT contraindicated with galantamine:

GI obstruction
Bradyarrhythmia
Seizures
Hyperlipidaemia
Parkinsons

Which of the following is TRUE about the progestogen-only pill:

It needs to be taken no more than 3 hours late - at the same time each day
Additional contraception is required until the pills have been taken for 5 consecutive days
It is more effective than COC due to strict regimen
A 7-day hormone free period is recommended after 3 weeks.

Which of the following is NOT likely to contribute to serotonin toxicity:

Phenelzine
Imipramine
Pethidine
Lithium
Quetiapine

There was a case study about an elderly gentlemen taking nitrazepam for insomnia but was
starting to feel dizzy/blurry eyed during the day.
The question was, which benzodiazepine would you recommend instead:
Clonazepam
Lorazepam
Diazepam
Temazepam
Flunitrazepam

There was a case study about a child who was previously prescribed Intal but has now swapped
to Flixotide Junior.
Which of the following is not true:
Intal should be continued for up to 4 weeks after starting Flixotide
Cromoglycates have a limited role in asthma
Cromoglycates should be recommended in children >2 years old
.. something else

Which cannot be administed at the same time as typhoid vaccine:

Paracetamol
Amoxycillin
Cholera Vaccine
Hepatitis A vaccine
.. something else

Which of the following would you recommend for a dry, red wound:
Hydrogel dressings
Foam dressings
Film dressings
Low-adherent dressing
etc.

All of these are used for treatment of MI except

- Heparin
- Aspirin
- Streptokinase

A mother comes into the pharmacy asking about their child with a fever. Select the incorrect
statement.
- Normal body temperature is 36-38˚C
- Febrile convulsions are prevented by antipyretics
- Give regular fluids

What medication used in conjunction with lamotrigine increases the risk of steven johnson
syndrome?
- Phenytoin
- Valproate
- Carbamazepine

What is taken in conjunction with TB therapy to reduce side effects?

- Pyroxidine
- Folic acid
- Thiamine

How is the oral typhoid vaccine stored?

- In the fridge
- In direct sunlight
- At room temperature

- which of the following electrolytes can be affected if excessive salbutamol is inhaled? (don't
remember the options clearly, but one of them was hypokalemia)

- Which of these vitamins should be used with great caution in pregnant woman?
-Vit A
-Vit K
-Vit C

Why would a patient be advised to use extra contraception with danozil?

Which of the following is not a symptom of hyponatraemia?

-thirst
-headache
-nausea
-irritability
-seizures

A patient comes into the pharmacy for worming medication and picks mebendazole what would
you suggest?
- treat the whole family above the age of 6months

Which of the following is best taken on an empty stomach?

-flucloxacillin

A mother brings her son into the pharmacy who had severe ear pain and discharge the night
before but this morning the pain has reduced a bit what would you suggest?
- refer to Doctor
- give ear wax removal drops

What is the storage condition for oral typhoid vaccine?

Which of the following caused increased BGL:

Codeine
Pseudoephedrine
Paracetamol
Doxycycline
amoxycillin

Which of the following medications would you not administer concurrently with oral typhoid
vaccines?
Oral cholera vaccine
omeprazole
rifampicin

A low exudate clean dry wound what would you suggest other than using saline?

A question on first aid - a patient on a cruise collapses and he is not breathing What would you
do?
- as a pharmacist it's not your responsibility and you will be left liable if something goes wrong
- administer an epipen because you suspect it is a food related allergy reaction
- administer cardiopulmonary resuscitation

there were alot of methotrexate, levodopa/benserazide and digoxin questions

- CYP enzyme interactions

Q. Timolol eye drip for glaucoma -> Appropriate counselling?

Q. Alternative treatment after failure of Timolol

- Lanatoprost
-Pilocarpine
- non-glaucoma eye drops

Eye drop counselling to decrease the systemic side effect (Glaucoma patient)
- Blinking eyes
- Press against the inner corner of the eye with finger (AMH says this one )
- 5 minutes interval between each eye drops

Question on terbuhaler technique

Question about counselling in Acne (which is wrong)

Ciprofloxain counselling point

- Taken on empty stomach

Question about symptoms of dry mouth

I chose the answer with Anticholinergic effect of Paroxetine --> It wasn't on the anticholinergic
table but dry mouth isthe common side effect of SSRI

One of the question with patient profile asked for a best diabetes treatment
- Metformin
- Gliclazide
Here I had to calculate the CrCl using the patient profile (weight, age, serum creatinine) and CrCl
was about 25mL/min so I chose Gliclazide.

What is the maintenance dose for Lithium? (TDM in APF)

Oral typhoid vaccination storage

- Freeze
- Refrigerated
- Store under 25 degrees
- Does not get affected by temperature

What shouldnt be consumed after influenza vaccination??

- Cheese
- Egg
-Peanut

Child with small metal scrap in the eye (irritating), appropriate action to be taken
- Wash on running water for 10 minutes
- Cover the eye dressing
- Use eye drop and seek for medical advice
A person falls and is unconscious and is not breathing
- CPR
- Use adrenaline as it is anaphylaxis
- call for adrenaline

what medication is least likely to cause medicine-induced neutropenia?

methotrexate
frusemide
allopurinol
clozapine
cyclophosphamide
erythromycin
cotimoxazole

The use of vitamin K in the reversal of warfarin overdose.

What tests are needed for a patient on amiodarone?

What medication will not affect renal impairment?

Prednisolone

what are the side effects of cortisone use?

The INR target with warfarin? 2-3

Patient is on paroxetine and is taking it at night, however gets insomnia what should be done?
Take it in the morning

a breastfeeding mother for a 1 week old child with back pain problems, her doctor called to ask
your opinion about paracetamol, paracetamol with codeine and naproxen
a- all 3 cannot be given as all pass in milk
b- only paracetamol or paracetamol with codeine, no naproxen as it passes in milk with
serious effects on baby
c- only paracetamol and naproxen no codeine as it has severe adverse effects on the baby
d- the metabolism of medication for very young infants is very weak and unpredictable so
no analgesia can be given to a mother before a child turns 3 months

a common side effect of alendronate is

a- osteonecrosis of the jaw

b- Osteophagititis

which medication does not affect COC

a- fluoxetine
b- st john’s wart
c- rifampicin

a case where a patient got tb from working overseas for 12 months, how long shuld she take the
tb medication for
a- 1 month
b- 2 months
c- 6 months
d- 1 year

Same case, when should she take the medication for tb

a- all at once after food
b- all at once in the morning before food
c- isoniazide in the morning and rifampicin at night
d- rifampicin in the morning and isoniazide at night

same case, which vitamin should be given to this lady

a- pyridoxine 25 mg
b- vitamin c

Lithium monitoring during prophylaxis

a- 0.4- 1 mmol/l
b- 1-4 mmol/l
 c- 0.5-2 micromol/l

which one of the following medication should be taken half an hour before food
a- metformin
b- flucloxacillin
c- norfloxacin

what is the first line treatment for a child with acute cyctitis
a- amoxicillin
b- trimethoprim or cephalexin
c- ciprofloxacin

where should oral cholera vaccine kept

a- on shelf
b- freezer
c- refrigerate 2-8

a case study where the patient congestive heart failure, which Bblocker can be used for his
hypertension
metoprolol
sotalol
atenolol
bisoprolol

a case study, question was about simvastatin, choose the appropriate answer,
a- simvastatin and a healthy controlled diet will lower the LDL of this patient by about 60%
b- eztimeb can be added to simvastatin to further lower his cholesterol if he needed that
c- both atorvastatin and simvastatin have the same lowering effect on cholesterol

carbidopa is added to levodopa to:

a- increase the peripheral dopamine production
b- reduce the metabolism of levodopa to dopamine peripherally

a case where an old patient has COPD and his doctor put him on salmeterol and ipratropium but
his COPD keeps getting worse
a- change salmeterol and ipratropium to mdi with a spacer
b- add prednisolone 5 mg daily
c- add theophylline

same case, the maximum effect of salmeterol is seen after

a- 10 min
 b- 12 hours
c- 3-4 hours

which is incorrect about whopping cough

a- its organism is bordettela pertussis
b- it can cause serious and fatal effects in infants and young children
c- it only appears as persistent cough in adults
d- it is a bacterial infection of the respiratory tract
e- its first line antibiotic is amoxcyciline

which test is not required for amiodarone:

a- thyroid
b- pulmonary
c- liver
d- renal

what is an appropriate advice to give to a patient taking the mini pill for the first time:
a- you should use an extra method of contraception for the first 7 days
b- once you stop breastfeeding you should change to COC
c- you should take the pill within 3 hours of the same time every day

which combination will not affect serotonin syndrome

a- fentanyl and dextromethorphan
b- dextromethorphan and phenlzin
c- dextromethorphan and lithium
d- fentanyl and lithium
e- dextromethorphan and codeine

Her doctor now wants to stop nitrazepam, which medication should you suggest to replace
it and help her sleep
a- temazepam
b- alprazolam

which of these factors increase the instance of tendon damage while on quinolones
a- concurrent treatment with corticosteroids
b- patient had CABG
c- liver disease

what is the INR for a patient who recently had atrial fibrillation
a- 1-2
b- 2-3
c- 3-4
How should Mr AB take these TB medication
a. Take all with regards to food
b. Take all on an empty stomach
c. Take all 1 hour after food
d. Take ritonavir and …. With breakfast and another two with dinner
How long should Mr AB take these TB medication
e. 1 month
f. 2 month
g. 4 month
h. 6 month
i. 12 months

What is affected by the long term use of salbutamol?

j. Sodium
k. Postassium
l. Chloride
m. Calcium

What is common symptom for Alendronate

- Osteonecrosis of jaw
- Oseophagitis
- Hyperkalaemia

Lamotrigine with a list of drugs and asks which one used with it most likely causes stevens-
johnson syndrome
Sodium valproate – chose this AMH 2016 page 704 (severe reactions)
Carbmaezapine

Long term corticosteroid use

- Excessive bruising – chose this
- Hypoglycaemia
- Weight loss
- Hyperkalaemia

Which cream cannot be used on the face

- lanolin
- vitamin E
- betamethasone – chose this
- miconazole
- hydrocortisone
What advice is most appropriate for a child using paracetamol?
- paracetamol use in child medically unsupervised is up to 48hrs – chose this it was in AMH

Child with ear ache and discharge, pain subsided after 24 hrs
 refer to doctor
ear ache drops consisting of ingredients
paracetamol is drug of choice for analgesia – chose this one

Drug least used for topically for acne

- isotretinoin
- Adalapene
- erythromycin
- clindamycin
- miconazole – chose this

Lercanidipine side effects and most common?

- peripheral oedema – chose this one

Rifampicin most appropriate advice

- may cause orange-red discolouration of body fluids, staining of contact lenses but don’t be
concerned – chose this answer

What is used in TB to reduce side effect of drugs

- picked pyridoxine 25mg

Which is most appropriate first line treatment for patient profile A

- chose Ramipril

What is most appropriate first line treatment of hypertenion for elderly patient with renal
impairment?
- atenolol
- frusemide
- irbesartan – chose this answer based on table 6-7 in AMH 2016 251 – drugs with favourable
effect but unsure cos elderly.

beta blocker choice for cardiac patient with renal impairment

- atenolol
- metoprolol – chose this one based on table 6-9 in AMH 2016
Question about dry mouth and had options for elderly patient asked which was least
appropriate – AMH page 414
- regular drinks such as coffee and tea
- sucking ice or lozenges
- sugarless chewing gum
- a few other options

adverse effects of MTX most common

- myelosuppression – chose this

progestogen only pill and most appropriate advice

- chose take same time each day within 3 hours

Antidepressant choice for elderly used page 787 AMH 2016

- mitrtazapine
- sertraline
- moclobemide
- venlafaxine

65. symptoms of hyponaetraemia , least appropriate

- nausea
- vomiting
- headache
- seizure
- thirst – chose this based on APF 23 page 123

66. treating a wound that had been used antiseptic, was dry and had low exudate
- dry low-adherent pads
- hydrogel
- antiseptic powder and allow to air dry
- hydrocollid
-alginate

Child 12 months, with low-mid grade fever, what is the best first line options:
1) Regular clear fluids
 2) Give paracetamol
Which is these combinations of drugs is most likely to cause RASH as a side effect?
1) Lamotrigine + valproate
2) Lamotrigine plus other drugs

Patient has diabetes, which is the first line treatment for hypertension?
1) Irbesartan
2) Other anti-hypertensives
Which of the following antidepressants would you not recommend in the elderly?
1) Doxepin
2) Other antidepressants (SSRI/SSNR)
Which of the following is incorrect about vaginal thrush?
1) Oral fluconazole is first line treatment
What is the recommended first line prophylaxis for cystitis in children?
1) Cephalexin or trimethoprim
2) Other options
Person was taking benzyamide mouthwash, (had a patient history of methotrexate), what is the
most likely reason she is using it?
1) Mouth ulcers
2) Gingival hyperplasia
Which of the following would be appropriate advice for the first time use of timolol?
1) Can cause dizziness, be careful standing up
Patient history of doxorubicin, and dexamethasone. What is the most likely reason he is taking
dexamethasone?
1) Anti-emetic
2) Immune suppressant
Which of the following can be used for neuralgia?
1) Gabapentin
Question about Danazol+extra contraception?
1) Does not prevent ovulation in all women
What is the alternative to Danazol?
1) Gestrinone
Which of the following is correct about the POP?
1) Must take it the same time every day within 3 hours
2) Some other options about when starting it, how long to use extra protection for etc