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How I can be ready for
Pharmacy Lisensure Exam?
Study Smart Not Hard
• Identify the main domain of Licensure Exam.
• Study from questions rather than study to questions.
pharmacy exam preparation for undergradute students.pptx
Questions
1) A pharmacist received numerous packs of
medicines as part of previous order. Upon
inspection of the delivery, the pharmacist saw that
one of the medicines was labeled as: “protect
from moisture”. What is the most appropriate
storage for the condition for the medicine?
A. Exactly 60% relative humidity
B. 60-80% relative humidity
C. Less than 60% relative humidity
D. 60%-75% relative humidity
2) A tertiary care hospital pharmacy uses fluid
location system to stoke pharmaceuticals. A junior
pharmacist was assigned to organize the
medicines, so the pharmacist asked the store
manager for guidance on how to properly classify
the stock. What is the most recommended
method of stock classification?
A. Alphabetical order
B. Commodity code
C. Random bin
D. Dosage form
Zoning stock within the store
• Medicines and essential medical supplies must be located in a
part of the store with the correct combination of temperature
and security. This initial zoning process is the most basic way
in which supplies are arranged.
• A zone can be a separate building or room.
• If no specific storage instruction are given ”normal storage
conditions ” apply.
• normal storage conditions for medicines have been defined as
“storage in dry, well-ventilated premises at temperatures of
15°C- 30 °C”
• Each storage zone should have at least one thermometer, and
temperatures should be recorded daily at the hottest time of
day.
Different Storage Conditions
1. Storage at uncontrolled room temperature.
• 15°C-30 °C
2. Storage at controlled temperature and humidity
• By using air conditioned, Dehumidifiers to control temperature
and humidity
3. Cold Storage: Any temperature not exceeding 8°C and usually
between 2°C to 8°C.
• Refrigerator is a cold place in which the temperature is
maintained thermostatically between 2°C to 8°C E.g-
Ceftazidime Inj, Vaccines, Insulin
4. Secure Storage: For Narcotic and other controlled substance
• The door must be locked. No more than two assigned officers
should have access. Typically, one should be the director of the
store, the most senior pharmacist, or the most senior store
keeper.
5. Flammables
- They should be stored in special(separated room
recommended)
- Must be well ventilated and fuels should never be stores in or
near medical store.
Some other considerations
• Store latex products away from electric motors and fluorescent
lights
• Liquid and heavy products kept at the lower shelves
• Damaged/expired products stored separately
pharmacy exam preparation for undergradute students.pptx
pharmacy exam preparation for undergradute students.pptx
Stock location with in zone
A. Fixed location
- Simplest to manage (each stock item is always stored in the
same place)
- Like a house which each family member has his own room.
Room is empty if a person is not at home.
- The store should be large enough and stock administration is
relatively easy.
Disadvantage
- Inflexibility
- If a new item is ordered, there may be no place to store it.
- Storage space may be wasted
- Theft may increase.
B. Fluid location system
- The store is divided into many designated locations. Each
location is assigned a code.
- Individual items are stored wherever space is available at the
time of delivery.
- It’s like a hotel rooms are assigned only when guests arrive.
- Uses space efficiently, but requires sophisticated stock
administration.
- The procurement unit provides information on type, volume, and
weight of goods arriving.
- The storekeeper assesses which location will be empty and assign
an appropriate location. These data are recorded in the stock
control system.
- It requires a classification system that allocates a unique
identifier code to each stock item and to each location. And,
the stock record for each batch of item must always indicate
the physical location of item in the store.
C. Semifluid location system
- Combination of the fixed and fluid systems.
- It is like hotel that has regular guests. Regular guests are
always given the same room. Casual guests are given any
room that is available.
- Isn’t as space-efficient as a fluid location system.
Stock Classification
• Items should be clearly organized within each zone of the
store.
A. Therapeutic/Pharmacological
- Keeping medicine according to there function and uses
- E.g Arrange all antibiotics together
- Used in smaller stores and dispensaries of smaller clinic.
B. Alphabetical order
- Attractive way to order drug by alphabetical order.
- Used in small stores that keep small number of items.
- Doesn’t result in optimal use of available space.
- Requires reorganization when there is a change in essential
medicines.
C. Dosage form
- Used in smaller warehouses.
- The drugs are arranged based on dosage form
- With in each dosage form area product may be stored in fixed,
fluid or semi fluid manner.
- The main advantages are dosage form are easy to recognize
when receiving goods and this system allows optimal use of
space.
D. Random Bin
- Is unique storage space identified by code
- Random bin can be combined with the previously described
methods.
E. Commodity code
- Abstract organizational system offering maximum flexibility.
- Can be used in small and large stores.
- Use unique location code (derived from WHO and UNICEF
specifications)
- The Location code is similar to random bin principle.
- Storekeeping staff donot need to have specific knowledge of
drug and its Use
- The code can be designed to incorporate any number of
characteristics.
- Correct storage To
- Whether or not the product is flammable
- The building where the product is located
- Pack size
- Pharmaceutical form
Answer???
3) A junior pharmacist was ordered by head of a
hospital pharmacy to identify materials to be used
as primary packaging containers. In the process,
the pharmacist referred manuals of the national
regulatory authority.
What is the least valuable primary packaging
material for medicines?
A. Glass
B. Paper
C. Plastic
D.Aluminum
Packaging of Pharmaceuticals
pharmacy exam preparation for undergradute students.pptx
pharmacy exam preparation for undergradute students.pptx
Answer???
4) An inpatient dispensary unit is planning to
design a dispensing technique for a high patient
flow setting that can be applied with low material,
supply and labor cost.
What is the most applicable dispensing technique
for this setting?
A. Individual medication
B. Unit-dose system
C. Automated medication
D. Bulk ward stock
Inpatient/ ward dispensing practice
• There are four types of dispensing practice for inpatient pharmacy.
• Bulk distribution (ward stock system)
• The pharmacy function as a warehouse
• Is dispensing bulks on requisition without reviewing individual drugs for
appropriateness
• Full course dispensing/Individual medication/
• Resembles to dispensing to outpatients
• The pharmacist can review the appropriateness of therapy
• Daily dose dispensing
• The amount which is enough for one day is dispensed
• Is more practical and preferable (considering the availability of personnel
and other facilities
• Single dose dispensing (unit dose dispensing)
• Is the preferred method from patient care perspective
• Medication profile can be closely monitored
• Increases interaction
• It minimizes unnecessary expense if treatment is changed
• But it needs more time and staff
• Automated medication-
???
5) A medical equipment supplier delivered a magnetic
resonance imaging (MRI) machine to tertiary care hospital.
A pharmacist was assigned to receive the machine and
apply the routine inventory management process.
What appropriate details should be included in the
inventory records?
A. Supplier company name, routs of transport,
arrival date and expiry dates
B. Manufacturer name ,model, identification
number, power requirements
C. Order date, list of MRI operators manufacturer
and supplier company profile
D. Installation date, name of technician who
installed the MRI, physician address
pharmacy exam preparation for undergradute students.pptx
6) A community pharmacy stocked a large amount of
dextromethorphan syrup in anticipation of common cold
and cough cases due to a long duration of cold weather
What is the most likely type of stock used by the
pharmacy?
A.Safety stock
B.Quarantine stock
C.Pipe line stock
D.Seasonal stock
Definition of terms
• Safety stock- Level of extra stock that is maintained to
mitigate risk of stock outs caused by uncertainties in
supply and demand
• Quarantine stock- is an inventory of specific items
kept for specific use.
• Pipe line stock- is an inventory items in the company’s
shipping chain that have yet to reach their final
destination
• Seasonal stock- is stock which is in high demand
during particular times of the year
Answer???
7) It is noted that Clopidogrel is more effective
than aspirin in preventing vascular vents of
ischemic stroke. In addition, aspirin is an over the
counter while Clopidogrel remains by- prescription
only medication.
What is the best reason of Clopidogrel to be a by-
prescription only medication?
A. High cost
B. Clinical effectiveness
C. Adverse event
D.Therapeutic class
ASA
- Antiplatelet Agent by Irreversibly inhibits cyclooxygenase-1
and 2 (COX-1 and 2) enzymes
- Analgesic and antipyretic dose; 325-650 mg
- ADR; Bleeding
Clopidogrel
- Antiplatelet Agent
- ADR; high risk of bleeding
8) A store pharmacist at specialized mental
hospital was suspected by the medical director for
involvement in fraudulent activities of stocking
expired phenobarbital. The director forwarded the
issue for the internal audit committee for the
investigation.
What stock record system could be most likely
manipulated by the store pharmacist?
A. Stock card
B. Bin card
C. Ledger card
D. Vertical file card
• Stock cards:
• As the base for requisition and issuing of products
• To know fluctuation of price of drugs
• Bin cards
• Remain with each item in the store
• Filled by the store keeper
• Are used as an easy reference on stock levels and
expiry dates
• Ledger Card; where the history of charges, credits. . .for
each family recorded.
9) A pharmacist working in a hospital with high transaction
of narcotic drugs keeps the prescription for five years and
disposes the paper by himself. In addition, the pharmacist
regularly reported the consumption and prescribing
patterns.
What good dispensing practice was breached by the
pharmacist?
A. Keeping the prescription paper for fewer years
B. Assessing the prescribing pattern of physicians
C. Making unnecessary report of drug
consumption
D. Disposing the prescription paper by him self
10) A senior clinical pharmacist in a tertiary
hospital frequently encounters an order
sheet that states “resume pre- op meds”.
What is the most likely problem the
pharmacist might recognize in these orders?
A. Omission of information
B. Poor prescription writing
C. Illegal prescription paper
D.Inappropriate drug selection
pharmacy exam preparation for undergradute students.pptx
Answer???
11) A 34- years-old patient who is taking warfarin for the
treatment of deep vein thrombosis came to the pharmacy
and complained about heartburn for last two days. The
pharmacist, in consolation with the physicians, wanted to
avoid a medicine that could interact with warfarin.
Which drug would most likely increase the toxicity of
warfarin?
A. Famotidine
B. Ranitidine
C. Cimetidine
D. Omeprazole
Common enzyme inhibitors
• S. . .Sodium Valporate
• I. . .Isoniazid
• C. . .Cimetidine
• K. . .Ketoconazole
• F. . .Fluconazole
• A. . .Alcohol(small)
• C. . .Chloramphenicol
• E. . .Erythromycine
• S. . .Sulfonamide
• C. . .Ciprofloxacin
• O. . .Omeprazole
• M. . .Metronidazole
12) A 38-years-old patient diagnosed with oropharyngeal
candidiasis was taking ketoconazole tablet twice a day for the
last three days. The patient used to take the medicine at 8:00
AM and 8:00 PM and complained heart burn after meals for
the last two days. As a result, the physician prescribed
omeprazole 20mg every day and the patient came to the
pharmacy to collect the medicine.
What is the most appropriate instruction to be given for this
patient?
A. Take omeprazole 30 minutes before meal at 8:00 AM and
take ketoconazole after meal
B. Take omeprazole 30 minutes before meal and at least two
hours before ketoconazole
C. Take both omeprazole and ketoconazole 30 minutes
before meal at 8:00 PM
D. Take both omeprazole and ketoconazole after meal at 8:00
AM
• Administer ketoconazole oral tablets 2 hours
prior to antacids to prevent decreased
absorption due to the high pH of gastric
contents.
14) A mother of 10- years- old child with mild pain
came to the dispensary with a prescription stating
80mg of aspirin tab P.O. BID.
What is the problem of this prescription paper?
A. Higher dose
B. Wrong indication
C. Route of administration
D.Frequency of administrations
Aspirin dose and indications
• Pain and Fever
• Immediate release: 325- 650 mg PO q4hr PRN or 975 mg PO
q6hr PRN or 500-1,000 mg PO q4-6hr for no more than 10
days; not to exceed 4 g/day
• Cardiovascular disorders
• <325 mg
15) A physician has diagnosed a patient with
enterotoxigenic (cholera-like) diarrhea and prescribed
400mg mg sulfamethoxazole and 160mg trimethoprim
(co- trimoxazole) twice daily P.O. for three days.
What prescription error could be identified by the
pharmacist?
A. Inappropriate strength of the medication
B. In appropriate frequency of treatment
C. Inappropriate duration of therapy
D. Inappropriate route of administration
• trimethoprim/sulfamethoxazole Tablet dose
• 80mg/400mg
• 160mg/800mg
16) A pharmacist who was assigned to mentor and monitor
pharmacy students, observed one of the students about to
dispense a prescribed medication. The prescription states a
drug for gastro-esophageal reflux disease which is started
as “rabeprazol 20mg cap qd for 10 days, use after meal “.
The pharmacist politely approached the student and made
some corrections.
What possible modification could be made on the
prescription?
A. Dose of the drug
B. Frequency of administration
C. Duration of therapy
D. Direction to use
• Rabeprazol is Proton pump inhibitor.
• it should be taken 30 minutes before a meal.
• PPIs The timing of taking the medication 30 to 60 minutes
before eating a meal permits the maximum effect of the
medication in the inhibiting of the production of gastric acid.
41) A prescriber, consulted a pharmacist that
client who is on phenytoin therapy which is very
effective medicine wanted to use combined oral
contraceptive. The prescriber suspected drug-drug
interaction and thus wanted to know the
appropriate recommendation.
What is the most appropriate recommendation of
this client?
A. Change phenytoin with valporic acid.
B. Decrease the dose of contraceptive
C. Increase the dose of contraceptive
D. Decrease the dose of phenytoin
Common Enzyme Inducer
• S. . .sulphonyl urea
• C. . .Carbamazepine
• R. . .Rifampine
• A. . .Alcohol(high)
• P. . .Phenytoin
• G. . .Grisofulvin
• P. . .Phenobarbital
42) A client came with the prescription containing
carbidopa/levodopa. The pharmacist dispensed
the drug with the necessary information. The
client came back two weeks later with the
compliant of no improvement.
What was the most likely message the pharmacist
missed during counseling?
A. Avoid high fatty meal
B. Avoid high carbohydrate meal
C. Avoid high protein meal
D.Avoid high fiber meals
• Avoid high protein diets (>2 g/kg) which may decrease the
efficacy of levodopa via competition with amino acids in
crossing the blood-brain barrier.
43) A 35-years –old HIV patient, who is well treated with
TDF+3TC+SQV/RTV before one month took garlic three
weeks ago without consulting the physician or pharmacist.
Now, the patient came with the compliant of fever,
headache, tiredness and fatigue. The patient’s CD4
+ count
was reduced significantly and the viral load was elevated.
What was the most likely possible cause of these signs and
symptoms?
A. Garlic decreases serum concentration of ritonavir
B. Garlic decreases serum concentration of lamivudine
C. Garlic decreases serum concentration of tenofovir
D. Garlic decreases serum concentration of saquinavir
• Garlic may decrease the serum concentration of ritonavir.
• Management: Garlic supplementation is not recommended.
44) A 68- years-old man developed aspiration pneumonia
and was put on ceftriaxone 1 g I.V. BID for 14 days and
clindamycin 600 mg I.V. TID for 14 days. After two days,
the patient complained diarrhea and colitis.
What should be recommended to avoid the cause of the
above conditions?
A. Replace ceftriaxone by benzyl penicillin
B. Replace ceftriaxone by amoxicillin-clavulanic acid
C. Increase the dose of clindamycin and ceftriaxone
D. Replace clindamycin by metronidazole
• Oral Metronidazole 500mg TID for 10days
45) a nurse from neonatal intensive care unit
came with an internal facility report and re
supplies containing alcohol for infection
preventation activities and requested storage
condition for the supply.
What should be the most appropriate storage
condition for this tablet?
A. Deep freezer
B. Cool area
C. Refrigerator
D. Moist area
46) A 45- years-old male patient came to the
dispensary unit with a prescription of
nitroglycerine sublingual tablet.
What should be the appropriate storage condition
for this tablet?
A. In tightly closed with plastic container
B. In tightly closed glass container
C. In refrigerator
D. In deep freezer
17) A patient diagnosed with severe pneumonia
came with a prescription which states 25mg/kg/
BID for five days. The drug is available in
500mg/2ml formulation and the patient weight
was 35kg. What quantity of drug should be
administrated at a time?
A. 1.75 ml
B. 3.5 ml
C. 5.25 ml
D. 7 ml
18) The physician prescribed naltrexone 25 mg PO initially
and then tapered doses to 100mg PO every other day, if no
withdrawal signs appear. The formulation hand is
naltrexone 50 mg tablet.
How much dose the pharmacist should dispense as initial
dose?
A. 1/2 tablet
B. 1/3 tablet
C. 1/4 tablet
D. 1/5 tablet
21) A 3 years-old child diagnosed with acute upper
respiratory tract infection was prescribed amoxicillin
250mg/5ml PO TID for 7 days. The drug is reconstituted to
a solution of 10mg/1ml. a pharmacist advised the parents
to use teaspoon for drug administration.
How much amoxicillin solution would one teaspoon
contain?
A. 150mg
B. 75mg
C. 100mg
D. 50mg
22) A primary health care provider prescribed
400mg of levofloxacin tablet PO daily for seven
days. But the drug was available in 200 mg tablet
formulation.
How many tablets should the patient take each
day?
A. 2 tablets
B. 3 tablets
C. 4 tablets
D. 5 tablets
27) A newly hired pharmacist started working in dispensary
outlets. The pharmacist was guided by the seniors on how to
dispense medications including labeling and packaging.
What important issues should be told during packaging of
medicines?
A. Suppositories should be packaged in paper made
containers
B. Tablets should be packaged with collapsible tubes
C. Ointments should be packaged with paper made
containers
D. Liquid should be packaged in light resistance glasses
pharmacy exam preparation for undergradute students.pptx
pharmacy exam preparation for undergradute students.pptx
24) A 40- years-old man came to a primary hospital
pharmacy with a prescription of simple ointment BP. The
drug has the following details
• Patient: M.K
• Direction: MDU
• Mitte: 30g
What is the most appropriate container to dispense this
medication?
A. Amber fluted bottle
B. Amber table bottle
C. Cardboard carton
D. Collapsible tube
28) A 14- years-old patient diagnosed with tonsillitis and
the physicians prescribed amoxicillin 500 mg BID. The
pharmacist in charge dispensed the medications with due
counseling. One week later, the patient came to the
dispensary again with a prescription indicating the same
disease.
What was the most likely reason for the treatment failure
A. The dose was lower than recommended one
B. The frequency of medication was wrongly prescribed
C. The frequency of taking medication should be once a
day
D. The pharmacist might have wrongly dispensed
amoxicillin plus clavulanate
29) A 30- years-old male patient came to a
dispensary with a prescription of metronidazole 500
mg P.O. TID for 7 days. In the dispensary unit,
metronidazole was available in 250 mg strength.
How should the medicine be labeled before
dispensing?
A. Take three capsule at a time with eight hour
difference
B. Take two capsule at a time with eight hour
difference
C. Take six capsule a day every twelve hour difference
D. Take three capsule a day every twelve hour
difference
30) A 42- year old male patient was diagnosed with
psoriasis and prescribed betamethasone dipropionate
cream 0.05%. The pharmacist labeled and provided the
drug to the patient. What information the pharmacist
include to minimize side effect?
A. For external use only
B. To be applied thinly
C. Keep out of the reach of children
D. Discard if lasted more than 4-month
• betamethasone
• Corticosteroid
• Apply topical sparingly to areas. Not for use on broken skin or in
areas of infection. Do not apply to wet skin unless directed; do
not cover with occlusive dressing.
31) A 60- years-old female patient was diagnosed with
Parkinson’s disease and taking the combination of carbidopa,
levodopa and benztropine. Several months later, the patient
came back with a compliant of difficulty of passing stool. Her
physician prescribed liquid paraffin emulsion 10ml P.O. TID
again and the pharmacist dispensed the drug with adequate
counseling. Three days later, the patient came back saying “I
have taken 10ml every eight hours but I still have the same
bowel problem”
What was the most likely missed labeling for this prescription?
A. For internal use only
B. Keep in dry and cool place
C. Discard if lasted more than 4- months
D. Shake the bottle well before use
32) A patient was diagnosed with acute coronary
syndrome and took prescription of :
• Nitroglycerin, sublingual, 0.4mg every 05 minute
• Morphine PO 4mg
• Aspirin 300mg stat P.O. then 75 mg P.O daily
• Clopidogrel 300mg followed by 75mg/d P.O
Which medication should be packaged with a tightly fit
glass?
A. Aspirin
B. Nitroglycerin
C. Clopidogrel
D. Morphine
36) A 28- years-old asthmatic patient on
theophylline therapy came to dispensary in orded
to take cimetidine 400mg tablet PO BID for ten
days as per the physician’s prescription. What is
the most appropriate recommendation for this
case?
A. Reduce the dose of theophylline
B. Increase the dose of theophylline
C. Lower the dose of cimetidine
D. Replace cimetidine with famotidine
48) A pharmacist in charge of stock management
wanted to update records in order to timely
monitor flow of stock.
What should be avoided while recording on stock
card?
A. Using pencils
B. Using pen
C. Using inerasable ink
D. Using permanent markers
73) A 40-years-old woman was brought to the emergency
department with fever and severe headache. Her history
was significant for Hodgkin lymphoma, which is remission.
Upon further investigation. She was diagnosed with
Cryptococcal meningitis. She is also taking ranitidine as a
treatment for her dyspepsia. The physician planned to give
fluconazole to treat cryptococcal meningitis as treatment
option. What is the most pertinent cause of drug therapy
problem?
A. Ranitidine decreases absorption of fluconazole
B. Ranitidine increases absorption of fluconazole
C. Fluconazole induces metabolism of ranitidine
D. Fluconazole decreases absorption of ranitidine
86)A 10-years-old boy has been taking anti-epileptic
medication for the treatment of generalized tonic-clonic
seizures that he had developed a year ago. After starting
anti-epileptic medication, he exhibited moderate gingival
hyperplasia resulting in a poor oral hygiene.
Which anti-epileptic medication was responsible for
gingival hyperplasia?
A. Carbamazepine
B. Phenobarbital
C. Lamotrigine
D. Phenytoin
87) A 55-years old, 55kg (BMI: 22 m2) man with a history of
type II diabetes mellitus came to a hospital. His behavioral
measure is significant for smoking. His present chief compliant
is right upper thigh pain while walking around the block. The
pain has gradually increased during the past 12 months, but
only recently has become intolerable. The pain is relieved
within minutes after he stopped walking. The attending
physician suspected peripheral arterial disease. Pertinent
laboratory values include: total cholesterol, 180mg/dL LDL,
80mg/dl, Hdl, 44mg/DL and fasting glucose, 190mg/dl.
What is the most related risk factors for peripheral arterial
disease in this patient?
A. Smoking and type 2 diabetes
B. Type 2 diabetes and over weight
C. Type 2 diabetes and hyperlipidemia
D. Smoking and hyperlipidemia
16) A quality control company wants to
inspect the manufacturing quality of the
drug manufacturer. What the inspector
inspects?
A. Good laboratory practice
B. Good dispensing practice
C. Good manufacturing practice
D. Good procurement practice
37. A physician prescribes enteric coated
tablet for the treatment of constipation.
What is the drug?
A. Amoxicillin
B. Bisacodyle
C. Cloxacillin
D. Gentamycine
60. A quality control department wants to inspect
community pharmacies randomly beyond the
inspection program. What types of inspection is
done?
A. Programmed inspection
B. Sudden inspection
C. Scheduled inspection
D. Annual inspection
33) A store pharmacist was conducting annual
inventory. After finishing the inventory, the
pharmacy auditor found out a gap between the
expected and actually counted inventory and
requested the pharmacist to reconcile the
difference. However, the pharmacist couldn’t
settle the difference. What was the most likely
factor that the pharmacy missed?
A. Billing
B. Ordering
C. Double-counting
D. Documentation
79) A 35 old patient prescribed to take antifungal
drug for his topical nail infection for 3 months
duration. The absorption of this drug is increase
by fatty food. Which is the drug?
A. Ketoconazole
B. Itraconazole
C. Grisofulvine
D. Terbinafine
43) All of the following are examples of
irrational use of drugs except
A. Non-compliance with prescriptions
B. Self-medication with prescription drugs
C. Over use and misuse of antibiotics
D. High adherence with medication
48) A 50-year-patient with edema of the
ankles develops gynecomastia and erectile
dysfunction while being treated with which
of the following agents?
A. Hydrochlorothiazide
B. Spironolactone
C. Verapamil
D. Enalapril
28) A pharmaceutical company needs to
manufacture Aspirin tablets. It is known that
aspirin is moisture sensitive and has poor flow and
compression property. The company has no
directly compressible diluents. What method
would you recommend the company to use?
A. Wet granulation
B. Dry granulation
C. Direct compression
D. A & B could be used

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pharmacy exam preparation for undergradute students.pptx

  • 1. How I can be ready for Pharmacy Lisensure Exam?
  • 2. Study Smart Not Hard • Identify the main domain of Licensure Exam. • Study from questions rather than study to questions.
  • 5. 1) A pharmacist received numerous packs of medicines as part of previous order. Upon inspection of the delivery, the pharmacist saw that one of the medicines was labeled as: “protect from moisture”. What is the most appropriate storage for the condition for the medicine? A. Exactly 60% relative humidity B. 60-80% relative humidity C. Less than 60% relative humidity D. 60%-75% relative humidity
  • 6. 2) A tertiary care hospital pharmacy uses fluid location system to stoke pharmaceuticals. A junior pharmacist was assigned to organize the medicines, so the pharmacist asked the store manager for guidance on how to properly classify the stock. What is the most recommended method of stock classification? A. Alphabetical order B. Commodity code C. Random bin D. Dosage form
  • 7. Zoning stock within the store • Medicines and essential medical supplies must be located in a part of the store with the correct combination of temperature and security. This initial zoning process is the most basic way in which supplies are arranged. • A zone can be a separate building or room. • If no specific storage instruction are given ”normal storage conditions ” apply. • normal storage conditions for medicines have been defined as “storage in dry, well-ventilated premises at temperatures of 15°C- 30 °C” • Each storage zone should have at least one thermometer, and temperatures should be recorded daily at the hottest time of day.
  • 8. Different Storage Conditions 1. Storage at uncontrolled room temperature. • 15°C-30 °C 2. Storage at controlled temperature and humidity • By using air conditioned, Dehumidifiers to control temperature and humidity 3. Cold Storage: Any temperature not exceeding 8°C and usually between 2°C to 8°C. • Refrigerator is a cold place in which the temperature is maintained thermostatically between 2°C to 8°C E.g- Ceftazidime Inj, Vaccines, Insulin 4. Secure Storage: For Narcotic and other controlled substance • The door must be locked. No more than two assigned officers should have access. Typically, one should be the director of the store, the most senior pharmacist, or the most senior store keeper.
  • 9. 5. Flammables - They should be stored in special(separated room recommended) - Must be well ventilated and fuels should never be stores in or near medical store. Some other considerations • Store latex products away from electric motors and fluorescent lights • Liquid and heavy products kept at the lower shelves • Damaged/expired products stored separately
  • 12. Stock location with in zone A. Fixed location - Simplest to manage (each stock item is always stored in the same place) - Like a house which each family member has his own room. Room is empty if a person is not at home. - The store should be large enough and stock administration is relatively easy. Disadvantage - Inflexibility - If a new item is ordered, there may be no place to store it. - Storage space may be wasted - Theft may increase.
  • 13. B. Fluid location system - The store is divided into many designated locations. Each location is assigned a code. - Individual items are stored wherever space is available at the time of delivery. - It’s like a hotel rooms are assigned only when guests arrive. - Uses space efficiently, but requires sophisticated stock administration. - The procurement unit provides information on type, volume, and weight of goods arriving. - The storekeeper assesses which location will be empty and assign an appropriate location. These data are recorded in the stock control system. - It requires a classification system that allocates a unique identifier code to each stock item and to each location. And, the stock record for each batch of item must always indicate the physical location of item in the store.
  • 14. C. Semifluid location system - Combination of the fixed and fluid systems. - It is like hotel that has regular guests. Regular guests are always given the same room. Casual guests are given any room that is available. - Isn’t as space-efficient as a fluid location system.
  • 15. Stock Classification • Items should be clearly organized within each zone of the store. A. Therapeutic/Pharmacological - Keeping medicine according to there function and uses - E.g Arrange all antibiotics together - Used in smaller stores and dispensaries of smaller clinic. B. Alphabetical order - Attractive way to order drug by alphabetical order. - Used in small stores that keep small number of items. - Doesn’t result in optimal use of available space. - Requires reorganization when there is a change in essential medicines.
  • 16. C. Dosage form - Used in smaller warehouses. - The drugs are arranged based on dosage form - With in each dosage form area product may be stored in fixed, fluid or semi fluid manner. - The main advantages are dosage form are easy to recognize when receiving goods and this system allows optimal use of space. D. Random Bin - Is unique storage space identified by code - Random bin can be combined with the previously described methods.
  • 17. E. Commodity code - Abstract organizational system offering maximum flexibility. - Can be used in small and large stores. - Use unique location code (derived from WHO and UNICEF specifications) - The Location code is similar to random bin principle. - Storekeeping staff donot need to have specific knowledge of drug and its Use - The code can be designed to incorporate any number of characteristics. - Correct storage To - Whether or not the product is flammable - The building where the product is located - Pack size - Pharmaceutical form
  • 19. 3) A junior pharmacist was ordered by head of a hospital pharmacy to identify materials to be used as primary packaging containers. In the process, the pharmacist referred manuals of the national regulatory authority. What is the least valuable primary packaging material for medicines? A. Glass B. Paper C. Plastic D.Aluminum
  • 24. 4) An inpatient dispensary unit is planning to design a dispensing technique for a high patient flow setting that can be applied with low material, supply and labor cost. What is the most applicable dispensing technique for this setting? A. Individual medication B. Unit-dose system C. Automated medication D. Bulk ward stock
  • 25. Inpatient/ ward dispensing practice • There are four types of dispensing practice for inpatient pharmacy. • Bulk distribution (ward stock system) • The pharmacy function as a warehouse • Is dispensing bulks on requisition without reviewing individual drugs for appropriateness • Full course dispensing/Individual medication/ • Resembles to dispensing to outpatients • The pharmacist can review the appropriateness of therapy • Daily dose dispensing • The amount which is enough for one day is dispensed • Is more practical and preferable (considering the availability of personnel and other facilities • Single dose dispensing (unit dose dispensing) • Is the preferred method from patient care perspective • Medication profile can be closely monitored • Increases interaction • It minimizes unnecessary expense if treatment is changed • But it needs more time and staff • Automated medication-
  • 26. ???
  • 27. 5) A medical equipment supplier delivered a magnetic resonance imaging (MRI) machine to tertiary care hospital. A pharmacist was assigned to receive the machine and apply the routine inventory management process. What appropriate details should be included in the inventory records? A. Supplier company name, routs of transport, arrival date and expiry dates B. Manufacturer name ,model, identification number, power requirements C. Order date, list of MRI operators manufacturer and supplier company profile D. Installation date, name of technician who installed the MRI, physician address
  • 29. 6) A community pharmacy stocked a large amount of dextromethorphan syrup in anticipation of common cold and cough cases due to a long duration of cold weather What is the most likely type of stock used by the pharmacy? A.Safety stock B.Quarantine stock C.Pipe line stock D.Seasonal stock
  • 30. Definition of terms • Safety stock- Level of extra stock that is maintained to mitigate risk of stock outs caused by uncertainties in supply and demand • Quarantine stock- is an inventory of specific items kept for specific use. • Pipe line stock- is an inventory items in the company’s shipping chain that have yet to reach their final destination • Seasonal stock- is stock which is in high demand during particular times of the year
  • 32. 7) It is noted that Clopidogrel is more effective than aspirin in preventing vascular vents of ischemic stroke. In addition, aspirin is an over the counter while Clopidogrel remains by- prescription only medication. What is the best reason of Clopidogrel to be a by- prescription only medication? A. High cost B. Clinical effectiveness C. Adverse event D.Therapeutic class
  • 33. ASA - Antiplatelet Agent by Irreversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes - Analgesic and antipyretic dose; 325-650 mg - ADR; Bleeding Clopidogrel - Antiplatelet Agent - ADR; high risk of bleeding
  • 34. 8) A store pharmacist at specialized mental hospital was suspected by the medical director for involvement in fraudulent activities of stocking expired phenobarbital. The director forwarded the issue for the internal audit committee for the investigation. What stock record system could be most likely manipulated by the store pharmacist? A. Stock card B. Bin card C. Ledger card D. Vertical file card
  • 35. • Stock cards: • As the base for requisition and issuing of products • To know fluctuation of price of drugs • Bin cards • Remain with each item in the store • Filled by the store keeper • Are used as an easy reference on stock levels and expiry dates • Ledger Card; where the history of charges, credits. . .for each family recorded.
  • 36. 9) A pharmacist working in a hospital with high transaction of narcotic drugs keeps the prescription for five years and disposes the paper by himself. In addition, the pharmacist regularly reported the consumption and prescribing patterns. What good dispensing practice was breached by the pharmacist? A. Keeping the prescription paper for fewer years B. Assessing the prescribing pattern of physicians C. Making unnecessary report of drug consumption D. Disposing the prescription paper by him self
  • 37. 10) A senior clinical pharmacist in a tertiary hospital frequently encounters an order sheet that states “resume pre- op meds”. What is the most likely problem the pharmacist might recognize in these orders? A. Omission of information B. Poor prescription writing C. Illegal prescription paper D.Inappropriate drug selection
  • 40. 11) A 34- years-old patient who is taking warfarin for the treatment of deep vein thrombosis came to the pharmacy and complained about heartburn for last two days. The pharmacist, in consolation with the physicians, wanted to avoid a medicine that could interact with warfarin. Which drug would most likely increase the toxicity of warfarin? A. Famotidine B. Ranitidine C. Cimetidine D. Omeprazole
  • 41. Common enzyme inhibitors • S. . .Sodium Valporate • I. . .Isoniazid • C. . .Cimetidine • K. . .Ketoconazole • F. . .Fluconazole • A. . .Alcohol(small) • C. . .Chloramphenicol • E. . .Erythromycine • S. . .Sulfonamide • C. . .Ciprofloxacin • O. . .Omeprazole • M. . .Metronidazole
  • 42. 12) A 38-years-old patient diagnosed with oropharyngeal candidiasis was taking ketoconazole tablet twice a day for the last three days. The patient used to take the medicine at 8:00 AM and 8:00 PM and complained heart burn after meals for the last two days. As a result, the physician prescribed omeprazole 20mg every day and the patient came to the pharmacy to collect the medicine. What is the most appropriate instruction to be given for this patient? A. Take omeprazole 30 minutes before meal at 8:00 AM and take ketoconazole after meal B. Take omeprazole 30 minutes before meal and at least two hours before ketoconazole C. Take both omeprazole and ketoconazole 30 minutes before meal at 8:00 PM D. Take both omeprazole and ketoconazole after meal at 8:00 AM
  • 43. • Administer ketoconazole oral tablets 2 hours prior to antacids to prevent decreased absorption due to the high pH of gastric contents.
  • 44. 14) A mother of 10- years- old child with mild pain came to the dispensary with a prescription stating 80mg of aspirin tab P.O. BID. What is the problem of this prescription paper? A. Higher dose B. Wrong indication C. Route of administration D.Frequency of administrations
  • 45. Aspirin dose and indications • Pain and Fever • Immediate release: 325- 650 mg PO q4hr PRN or 975 mg PO q6hr PRN or 500-1,000 mg PO q4-6hr for no more than 10 days; not to exceed 4 g/day • Cardiovascular disorders • <325 mg
  • 46. 15) A physician has diagnosed a patient with enterotoxigenic (cholera-like) diarrhea and prescribed 400mg mg sulfamethoxazole and 160mg trimethoprim (co- trimoxazole) twice daily P.O. for three days. What prescription error could be identified by the pharmacist? A. Inappropriate strength of the medication B. In appropriate frequency of treatment C. Inappropriate duration of therapy D. Inappropriate route of administration
  • 47. • trimethoprim/sulfamethoxazole Tablet dose • 80mg/400mg • 160mg/800mg
  • 48. 16) A pharmacist who was assigned to mentor and monitor pharmacy students, observed one of the students about to dispense a prescribed medication. The prescription states a drug for gastro-esophageal reflux disease which is started as “rabeprazol 20mg cap qd for 10 days, use after meal “. The pharmacist politely approached the student and made some corrections. What possible modification could be made on the prescription? A. Dose of the drug B. Frequency of administration C. Duration of therapy D. Direction to use
  • 49. • Rabeprazol is Proton pump inhibitor. • it should be taken 30 minutes before a meal. • PPIs The timing of taking the medication 30 to 60 minutes before eating a meal permits the maximum effect of the medication in the inhibiting of the production of gastric acid.
  • 50. 41) A prescriber, consulted a pharmacist that client who is on phenytoin therapy which is very effective medicine wanted to use combined oral contraceptive. The prescriber suspected drug-drug interaction and thus wanted to know the appropriate recommendation. What is the most appropriate recommendation of this client? A. Change phenytoin with valporic acid. B. Decrease the dose of contraceptive C. Increase the dose of contraceptive D. Decrease the dose of phenytoin
  • 51. Common Enzyme Inducer • S. . .sulphonyl urea • C. . .Carbamazepine • R. . .Rifampine • A. . .Alcohol(high) • P. . .Phenytoin • G. . .Grisofulvin • P. . .Phenobarbital
  • 52. 42) A client came with the prescription containing carbidopa/levodopa. The pharmacist dispensed the drug with the necessary information. The client came back two weeks later with the compliant of no improvement. What was the most likely message the pharmacist missed during counseling? A. Avoid high fatty meal B. Avoid high carbohydrate meal C. Avoid high protein meal D.Avoid high fiber meals
  • 53. • Avoid high protein diets (>2 g/kg) which may decrease the efficacy of levodopa via competition with amino acids in crossing the blood-brain barrier.
  • 54. 43) A 35-years –old HIV patient, who is well treated with TDF+3TC+SQV/RTV before one month took garlic three weeks ago without consulting the physician or pharmacist. Now, the patient came with the compliant of fever, headache, tiredness and fatigue. The patient’s CD4 + count was reduced significantly and the viral load was elevated. What was the most likely possible cause of these signs and symptoms? A. Garlic decreases serum concentration of ritonavir B. Garlic decreases serum concentration of lamivudine C. Garlic decreases serum concentration of tenofovir D. Garlic decreases serum concentration of saquinavir
  • 55. • Garlic may decrease the serum concentration of ritonavir. • Management: Garlic supplementation is not recommended.
  • 56. 44) A 68- years-old man developed aspiration pneumonia and was put on ceftriaxone 1 g I.V. BID for 14 days and clindamycin 600 mg I.V. TID for 14 days. After two days, the patient complained diarrhea and colitis. What should be recommended to avoid the cause of the above conditions? A. Replace ceftriaxone by benzyl penicillin B. Replace ceftriaxone by amoxicillin-clavulanic acid C. Increase the dose of clindamycin and ceftriaxone D. Replace clindamycin by metronidazole
  • 57. • Oral Metronidazole 500mg TID for 10days
  • 58. 45) a nurse from neonatal intensive care unit came with an internal facility report and re supplies containing alcohol for infection preventation activities and requested storage condition for the supply. What should be the most appropriate storage condition for this tablet? A. Deep freezer B. Cool area C. Refrigerator D. Moist area
  • 59. 46) A 45- years-old male patient came to the dispensary unit with a prescription of nitroglycerine sublingual tablet. What should be the appropriate storage condition for this tablet? A. In tightly closed with plastic container B. In tightly closed glass container C. In refrigerator D. In deep freezer
  • 60. 17) A patient diagnosed with severe pneumonia came with a prescription which states 25mg/kg/ BID for five days. The drug is available in 500mg/2ml formulation and the patient weight was 35kg. What quantity of drug should be administrated at a time? A. 1.75 ml B. 3.5 ml C. 5.25 ml D. 7 ml
  • 61. 18) The physician prescribed naltrexone 25 mg PO initially and then tapered doses to 100mg PO every other day, if no withdrawal signs appear. The formulation hand is naltrexone 50 mg tablet. How much dose the pharmacist should dispense as initial dose? A. 1/2 tablet B. 1/3 tablet C. 1/4 tablet D. 1/5 tablet
  • 62. 21) A 3 years-old child diagnosed with acute upper respiratory tract infection was prescribed amoxicillin 250mg/5ml PO TID for 7 days. The drug is reconstituted to a solution of 10mg/1ml. a pharmacist advised the parents to use teaspoon for drug administration. How much amoxicillin solution would one teaspoon contain? A. 150mg B. 75mg C. 100mg D. 50mg
  • 63. 22) A primary health care provider prescribed 400mg of levofloxacin tablet PO daily for seven days. But the drug was available in 200 mg tablet formulation. How many tablets should the patient take each day? A. 2 tablets B. 3 tablets C. 4 tablets D. 5 tablets
  • 64. 27) A newly hired pharmacist started working in dispensary outlets. The pharmacist was guided by the seniors on how to dispense medications including labeling and packaging. What important issues should be told during packaging of medicines? A. Suppositories should be packaged in paper made containers B. Tablets should be packaged with collapsible tubes C. Ointments should be packaged with paper made containers D. Liquid should be packaged in light resistance glasses
  • 67. 24) A 40- years-old man came to a primary hospital pharmacy with a prescription of simple ointment BP. The drug has the following details • Patient: M.K • Direction: MDU • Mitte: 30g What is the most appropriate container to dispense this medication? A. Amber fluted bottle B. Amber table bottle C. Cardboard carton D. Collapsible tube
  • 68. 28) A 14- years-old patient diagnosed with tonsillitis and the physicians prescribed amoxicillin 500 mg BID. The pharmacist in charge dispensed the medications with due counseling. One week later, the patient came to the dispensary again with a prescription indicating the same disease. What was the most likely reason for the treatment failure A. The dose was lower than recommended one B. The frequency of medication was wrongly prescribed C. The frequency of taking medication should be once a day D. The pharmacist might have wrongly dispensed amoxicillin plus clavulanate
  • 69. 29) A 30- years-old male patient came to a dispensary with a prescription of metronidazole 500 mg P.O. TID for 7 days. In the dispensary unit, metronidazole was available in 250 mg strength. How should the medicine be labeled before dispensing? A. Take three capsule at a time with eight hour difference B. Take two capsule at a time with eight hour difference C. Take six capsule a day every twelve hour difference D. Take three capsule a day every twelve hour difference
  • 70. 30) A 42- year old male patient was diagnosed with psoriasis and prescribed betamethasone dipropionate cream 0.05%. The pharmacist labeled and provided the drug to the patient. What information the pharmacist include to minimize side effect? A. For external use only B. To be applied thinly C. Keep out of the reach of children D. Discard if lasted more than 4-month
  • 71. • betamethasone • Corticosteroid • Apply topical sparingly to areas. Not for use on broken skin or in areas of infection. Do not apply to wet skin unless directed; do not cover with occlusive dressing.
  • 72. 31) A 60- years-old female patient was diagnosed with Parkinson’s disease and taking the combination of carbidopa, levodopa and benztropine. Several months later, the patient came back with a compliant of difficulty of passing stool. Her physician prescribed liquid paraffin emulsion 10ml P.O. TID again and the pharmacist dispensed the drug with adequate counseling. Three days later, the patient came back saying “I have taken 10ml every eight hours but I still have the same bowel problem” What was the most likely missed labeling for this prescription? A. For internal use only B. Keep in dry and cool place C. Discard if lasted more than 4- months D. Shake the bottle well before use
  • 73. 32) A patient was diagnosed with acute coronary syndrome and took prescription of : • Nitroglycerin, sublingual, 0.4mg every 05 minute • Morphine PO 4mg • Aspirin 300mg stat P.O. then 75 mg P.O daily • Clopidogrel 300mg followed by 75mg/d P.O Which medication should be packaged with a tightly fit glass? A. Aspirin B. Nitroglycerin C. Clopidogrel D. Morphine
  • 74. 36) A 28- years-old asthmatic patient on theophylline therapy came to dispensary in orded to take cimetidine 400mg tablet PO BID for ten days as per the physician’s prescription. What is the most appropriate recommendation for this case? A. Reduce the dose of theophylline B. Increase the dose of theophylline C. Lower the dose of cimetidine D. Replace cimetidine with famotidine
  • 75. 48) A pharmacist in charge of stock management wanted to update records in order to timely monitor flow of stock. What should be avoided while recording on stock card? A. Using pencils B. Using pen C. Using inerasable ink D. Using permanent markers
  • 76. 73) A 40-years-old woman was brought to the emergency department with fever and severe headache. Her history was significant for Hodgkin lymphoma, which is remission. Upon further investigation. She was diagnosed with Cryptococcal meningitis. She is also taking ranitidine as a treatment for her dyspepsia. The physician planned to give fluconazole to treat cryptococcal meningitis as treatment option. What is the most pertinent cause of drug therapy problem? A. Ranitidine decreases absorption of fluconazole B. Ranitidine increases absorption of fluconazole C. Fluconazole induces metabolism of ranitidine D. Fluconazole decreases absorption of ranitidine
  • 77. 86)A 10-years-old boy has been taking anti-epileptic medication for the treatment of generalized tonic-clonic seizures that he had developed a year ago. After starting anti-epileptic medication, he exhibited moderate gingival hyperplasia resulting in a poor oral hygiene. Which anti-epileptic medication was responsible for gingival hyperplasia? A. Carbamazepine B. Phenobarbital C. Lamotrigine D. Phenytoin
  • 78. 87) A 55-years old, 55kg (BMI: 22 m2) man with a history of type II diabetes mellitus came to a hospital. His behavioral measure is significant for smoking. His present chief compliant is right upper thigh pain while walking around the block. The pain has gradually increased during the past 12 months, but only recently has become intolerable. The pain is relieved within minutes after he stopped walking. The attending physician suspected peripheral arterial disease. Pertinent laboratory values include: total cholesterol, 180mg/dL LDL, 80mg/dl, Hdl, 44mg/DL and fasting glucose, 190mg/dl. What is the most related risk factors for peripheral arterial disease in this patient? A. Smoking and type 2 diabetes B. Type 2 diabetes and over weight C. Type 2 diabetes and hyperlipidemia D. Smoking and hyperlipidemia
  • 79. 16) A quality control company wants to inspect the manufacturing quality of the drug manufacturer. What the inspector inspects? A. Good laboratory practice B. Good dispensing practice C. Good manufacturing practice D. Good procurement practice
  • 80. 37. A physician prescribes enteric coated tablet for the treatment of constipation. What is the drug? A. Amoxicillin B. Bisacodyle C. Cloxacillin D. Gentamycine
  • 81. 60. A quality control department wants to inspect community pharmacies randomly beyond the inspection program. What types of inspection is done? A. Programmed inspection B. Sudden inspection C. Scheduled inspection D. Annual inspection
  • 82. 33) A store pharmacist was conducting annual inventory. After finishing the inventory, the pharmacy auditor found out a gap between the expected and actually counted inventory and requested the pharmacist to reconcile the difference. However, the pharmacist couldn’t settle the difference. What was the most likely factor that the pharmacy missed? A. Billing B. Ordering C. Double-counting D. Documentation
  • 83. 79) A 35 old patient prescribed to take antifungal drug for his topical nail infection for 3 months duration. The absorption of this drug is increase by fatty food. Which is the drug? A. Ketoconazole B. Itraconazole C. Grisofulvine D. Terbinafine
  • 84. 43) All of the following are examples of irrational use of drugs except A. Non-compliance with prescriptions B. Self-medication with prescription drugs C. Over use and misuse of antibiotics D. High adherence with medication
  • 85. 48) A 50-year-patient with edema of the ankles develops gynecomastia and erectile dysfunction while being treated with which of the following agents? A. Hydrochlorothiazide B. Spironolactone C. Verapamil D. Enalapril
  • 86. 28) A pharmaceutical company needs to manufacture Aspirin tablets. It is known that aspirin is moisture sensitive and has poor flow and compression property. The company has no directly compressible diluents. What method would you recommend the company to use? A. Wet granulation B. Dry granulation C. Direct compression D. A & B could be used