CALCS Flashcards
1
Q
ORAL TO SC MORPHINE?
A
2 to 1
2
Q
ORAL MORPHINE TO SC DIAMORPHINE?
A
3 to 1
3
Q
HOLLIDAY SEGAR RULE 4-2-1
A
4
Q
Reducing strength vs increasing strength
90% or actuals
careful
A
reducing, use actuals
increasing, flip it!
5
Q
A female patient is due to commence a course of fludarabine phosphate at 40 mg/m2
for five
days. She is 1.68 m tall and weighs 71 kg.
How many fludarabine phosphate 10 mg tablets that should be supplied for the five day
course? Give your answer to the nearest whole tablet.
DOSE*5 day course
A
Note: Remember to convert height in m to cm (1.68m => 168cm) for the formula.
Using the formula = √([71 x 168] ÷ 3600) = √3.313333 = 1.820256 m2
Dose is 40 mg x 1.820256 m2 = 72.81024 mg
Calculate tablets for one day. You have 10 mg tablets = 70 mg = 7 tablets
So for five days: 7 X 5 = 35 tablets
TOPIC: Using provided formulae
6
Q
70-year-old man been diagnosed with pneumonia is prescribed intravenous amoxicillin. He
also suffers from chronic kidney disease and his serum creatinine is currently 182 micromol/L.
He weighs 58 kg.
The Cockcroft and Gault formula for estimating creatinine clearance is provided below:
A
Convert 1g STAT to 1000MG BOY!
7
Q
You want to find out the number needed to treat (NNT) for a valproate based migraine treatment.
You find the following information from a meta-analysis paper.
Valproate was used to treat migraine in five trials. It was found that the number of patients having
at least a 50% reduction in the number of migraine attacks over 28 days. The review of the trials
showed the following results:
• Patients treated with valproate, 241/520 (46 %) patients had the number of migraine attacks
reduced by at least half.
• With placebo, 69/341 (20 %) had the same outcome.
Use the extract about NNT provided in the resource pack
What is the NNT for valproate treatment? Give your answer to the nearest whole number.
A
sing the formula: AAR = 0.46 - 0.2= 0.26 NNT = 1/0.26 => 100/26 = 3.64615. Rounded up (all NNT rounded up) to 4.
8
Q
NNT?
A
ROUND UP
9
Q
NNH?
A
ROUND DOWN
10
Q
A patient weighing 82 kg is administered a dose of 50 mg in 2 mL levomepromazine by
intramuscular injection.
It has been calculated that the volume of distribution of levomepromazine is 15 L/kg. It is also
estimated to have a half-life of 20 hours and an effective bioavailability of 80% when given by
intramuscular injection.
Assuming the patient is not administered any further doses, what is the blood
concentration in mcg/L after 60 hours? Give your answer to one decimal place.
A
80% bioavailability means 50 x 0.8 = 40 mg (40,000 mcg) available
Volume of distribution = 15 x 82 = 1230 L
Therefore, the concentration will be 40000 mcg ÷ 1230 L
Which is 32.52 mcg/L
Then calculate half-life:
At hour 0, there will be 32.52 mcg/L
At hour 20, there will be 16.26 mcg/L
At hour 40, there will be 8.13 mcg/L
At hour 60, there will be 4.065 mcg/L
TOPIC: Pharmacokinetics
11
Q
A solution of benzalkonium chloride is available in a concentration of 1:750 w/v.
How many mL of purified water is required to be added to 30 mL of the solution to prepare
a 1:5000 solution of benzalkonium chloride for use as a wet dressing for the skin?
A
1:750 = 1g in 750mL.
Therefore there will be 40 mg in 30 mL of benzalkonium solution.
Target solution is 1:5000. This is equivalent to 1 g in 5000 mL.
We need to have 40 mg in our final solution. So the total volume needed is 200 mL
40 mg/200 mL is equivalent to a 1:5000 solution.
Started with a 30 mL volume. Need to add 170 mL of water.
TOPIC: Dilution
The correct answer is: 170
12
Q
A 29-year-old lady has been taking ferrous fumarate 210 mg tablets, three tablets daily. Oral
bioavailability is 70%. Due to an operation, she is now unable to swallow the tablets and has
been changed to Sytron Elixir® (sodium feredetate trihydrate) twice daily, which as an oral
bioavailability of 90%.
Ferrous fumarate 210 mg tablets contain the equivalent of 70 mg elemental iron.
Sytron Elixir® contains sodium feredetate trihydrate 190 mg equivalent to 27.5 mg elemental iron
in each 5 mL.
What is the equivalent single dose of Sytron Elixir® to be given? Give your answer to the
nearest 5 mL.
A
Patient has 70 mg x 3 = 210 mg of elemental iron per day.
Total bioavailable iron = 210 x 0.7 = 147 mg
Sytron bioavailability is 90%.
Therefore 147 mg = 90% of total oral dose.
100% = (147 ÷ 90) x 100 = 163.33333 mg iron needed per day of Sytron.
Sytron has 27.5 mg elemental iron per 5 mL = 5.5 mg/mL
Therefore 163.33333 ÷ 5.5 = 29.69697 mL per day
Patient will need 29.69697 ÷ 2 = 14.84848 mL of Sytron per dose
Round to nearest 5 mL => 15 mL
TOPIC: Dose and dose regime
The correct answer is: 15
13
Q
A 59-year-old female patient with heart failure and is to start maintenance dose of intravenous
digoxin, aiming for a serum digoxin concentration of 2 micrograms. The patient is not considered
to be obese.
You have the following details:
Use the extract about constant steady state concentration provided in the resource pack.
What is the daily dose of digoxin in mcg for this patient? Give your answer to the nearest
whole number.
A
Use actual body weight of 58 kg as patient is not obese.
Calculate creatinine clearance for women:
CrCl (mL/min) = (140–age) x weight x 1.04/115 µmol/L
CrCl = [(140 – 59) x 58 x 1.04] ÷ 115 = 42.48626 mL/min
Calculate digoxin clearance for heart failure:
DigCl (L/hr) = (0.053 x Creatinine Clearance (mL/min)) + (0.02 x IBW (kg))
DigCl = (0.053 x 42.48626) + (0.02 x 58) = 3.41177 L/hr
Need to rearrange Cpss equation to find D. Also, F becomes 1 (due to 100% bioavailable IV)
Thus: D = [Cpss x (DigCl x t)] ÷ F
D = [2.0 x (3.41177 x 24)] ÷ 1 = 163.76505 mcg
To nearest whole number is 164 mcg
TOPIC: Pharmacokinetics
The correct answer is: 164
14
Q
A 72-year-old male is admitted to the acute medical unit with suspected venous-catheter
infection. The medical team would like to prescribe vancomycin.
You have the following information from the patient’s admission notes:
Height: 1.9 m
Weight: 89 kg
BP: 154/95 mmHg
Serum Potassium: 5.0 mmol/L
Serum Creatinine: 2.24 mg/dL
Urea: 7.2 mmol/L
Use the extract about vancomycin provided in the resource pack
What is the patient’s estimated creatinine clearance rate in mL/min? Give your answer to
one decimal place.
A
Use the equation for adult males: eGFR = [Weight (kg) x 140 - age (years)] / 72 x serum
creatinine (mg/dL)
Take care with brackets in formula. It is: Weight x (140 – age)
Therefore, eGFR = [89 x (140 – 72)] ÷ 72 x 2.24
=> 6052 ÷ 161.28 = 37.52480
To one decimal place = 37.5 mL/min
TOPIC: Estimations of kidney function
The correct answer is: 37.5
15
Q
A 32-year-old patient is currently taking 15 ml of temazepam 10 mg/5 mL syrup each night.
There is a currently a stock issue with the syrup, so a decision is taken to transfer the patient to
diazepam tablets for 28 days.
The equivalent dose for temazepam 10 mg is diazepam 5 mg.
How many 5 mg diazepam tablets do you supply the patient?
A
10 mg/5 mL temazepam syrup = 30 mg/15 mL syrup
Patient is taking 30 mg of temazepam syrup per night
30 mg temazepam is equivalent to 15 mg diazepam
Therefore need 3 of the 5 mg tablets diazepam per night
For 28 days supply: 3 x 28 = 84 tablets
TOPIC: Quantities to supply
The correct answer is: 84
16
Q
H PYLORI TREATMENT CHOICE TAKE INTO ACCOUNT?
A
(treatment choice should take into account previous treatment with clarithromycin or metronidazole).
17
Q
A 29-year-old woman was started on fluoxetine two weeks ago for depression. At her follow up appointment with
her GP, she reports that she has felt more anxious since starting the medication and that her mood has not
improved. The GP has called you for advice on the management of this case.
Which one of the following is the most appropriate course of action in relation to the patient’s fluoxetine
therapy?
A
Treatment should be continued for at least 4 weeks (6 weeks in the elderly) before considering whether to switch
antidepressant due to lack of efficacy. In cases of partial response, continue for a further 2–4 weeks (elderly
patients may take longer to respond).
Ref: https://bnf.nice.org.uk/treatment-summary/antidepressant-drugs.html
The correct answer is: Continue fluoxetine for another 2 weeks and reassess whether there has been any
improvement
18
Q
Which ONE of the following record keeping requirements is NOT required for a supply of a POM-V and
POM-VPS?
A
The expiry date of the product
19
Q
A 57-year-old female, of African-Caribbean family origin, has just been diagnosed with Stage 1 hypertension.
She has type 2 diabetes, and a QRISK2 score of 13%. She has no known allergies and renal function tests are
within the normal range.
Which of the following drugs is the most appropriate first-line therapy according to national guidance?
A
NICE guidance NG136 recommends ACE or ARB as step 1 therapy for diabetics of any age or family origin.
NICE also recommends an angiotensin II receptor blocker (ARB), in preference to an angiotensin-converting
enzyme (ACE) inhibitor in adults of black African or African-Caribbean family origin.
The correct answer is: Candesartan
20
Q
A regular patient from your community pharmacy has been discharged from hospital following a fall associated
with hypoglycaemia. He is a 72-year-old man with Type 2 Diabetes who has recently had his medicines changed
due to poor glycaemic control.
When reviewing his prescription list, which of the following medicines would you be most concerned
about in relation to the risk of hypoglycaemia?
A
Glibenclamide is a long-acting sulphonylurea and is more prone to causing hypoglycaemia, especially overnight,
in the elderly. Gliclazide is a shorter acting sulphonylurea. Other classes of oral antidiabetic agents have a lower
risk of hypoglycaemia compared with sulphonylureas.
Ref: https://bnf.nice.org.uk/treatment-summary/type-2-diabetes.html
The correct answer is: Glibenclamide
21
Q
A 45-year-old male presents to the pharmacy complaining of redness and pain in his left eye, which started last
night. He tells you that he has used over the counter antibiotic eye drops in the past for conjunctivitis when his
eyes have been ‘uncomfortable and gritty, with sticky discharge’. He asks you about buying these eye drops
again for his current symptoms.
Which of the following is the most appropriate course of action for this patient?
A
It can cause a gritty, uncomfortable sensation but should not be painful. Patients should be referred to the GP if
it is painful. Conjunctivitis is usually viral in nature, and bacterial conjunctivitis is frequently self-limiting.
Ref: Symptoms in the pharmacy (ebook available on RPS e-library)
The correct answer is: Refer him to the GP for further investigation
22
Q
An 84-year-old woman telephones the pharmacy and explains she had the Oxford/AstraZeneca COVID-19
vaccine yesterday. She has been suffering from a headache this morning and believes it’s a side effect. She
would like you to report it to her GP.
What is the most appropriate course of action in this scenario?
A
As this is a new medicine is it important to ensure all side effects, no matter how mild are reported using in
accordance with usual reporting procedures. This includes known side effects. In this case, the vaccine is known
to cause headaches - see SmPC for more information. The Yellow Card Scheme is a national scheme for
reporting side effects with any medicine, which can be used by patients and healthcare professionals.
REF: MHRA https://yellowcard.mhra.gov.uk/ and Information about Oxford/AztraZeneca COVID-19 Vaccine
https://www.gov.uk/government/publications/regulatory-approval-of-covid-19-vaccine-astrazeneca
The correct answer is: Report the side effect using the Yellow Card Scheme
23
Q
Which of the following bronchodilators is licensed for twice daily dosing as chronic obstructive pulmonary disease (COPD) maintenance therapy?
A
A summary of licensed agents and dosing schedules for COPD can be found here: https://www.pcrsuk.org/sites/pcrs-uk.org/files/TableofInhaledDrugsFINAL.pdf
The correct answer is: Aclidinium / Formoterol (DuaKlir Genuair®)
24
Q
Standardised controlled drugs requisition forms are a legal requirement when requisitioning certain controlled
drugs in the community.
Which ONE of the following statements about standardised controlled drug requisition forms is
INCORRECT?
A
REF: MEP p 93-94.
The correct answer is: Supplies made against faxed requisitions are legally acceptable
25
A 24-year-old-woman is considering starting the combined oral contraceptive pill (COC).
Which of the following pieces of information or advice is most appropriate to give to this woman?
For women who are having natural menstrual cycles, the COC pill can be started up to and including day 5 of
the menstrual cycle
There is a possible small increase in risk of developing breast cancer, which returns to no increased risk within
10 years after stopping the COC. The estimated failure rate for typical use of COCs is 9% at 1 year. Additional
Page 6 of 46
contraceptive precautions are not required when antibiotics that do not induce enzymes are used in conjunction
with CHCs.
REF: https://www.fsrh.org/documents/fsrh-ceu-guidance-recommended-actions-after-incorrect-use-of/fsrhguidance-recommended-actions-after-incorrect-use-of-chc-march-2020.pdf
The correct answer is: For women who are having natural menstrual cycles, the COC pill can be started up to
and including day 5 of the menstrual cycle without the need for additional contraceptive protection
26
How often should this patient have their blood counts monitored when clozapine is initiated?
For the first 18 weeks, blood counts should be monitored every week.
REF: https://bnf.nice.org.uk/drug/clozapine.html#indicationsAndDoses
The correct answer is: Weekly
27
The patient is stabilised on therapy and has remained on the same dose of clozapine for one year. Now that he
is feeling an improvement in his symptoms, he decides to work on building healthy habits including regular
exercise, and quitting smoking.
Which of the following advice would be the most appropriate in relation to his clozapine?
Cigarette smoking induces metabolism of clozapine, resulting in significant increases in levels when quitting,
hence dose adjustment and increased monitoring is required. This is not related to the nicotine component,
hence the effect is not negated by NRT.
REF: https://bnf.nice.org.uk/drug/clozapine.html#interactions
The correct answer is: Refer to prescriber for a potential dose reduction and monitoring of plasma concentration
levels
28
A 21-year old woman presents to the pharmacy with a prescription for metronidazole 2 g orally as a single dose.
Which of the following is the most likely indication for her metronidazole prescription?
The recommended metronidazole doses for the above conditions can be found in the BNF.
The correct answer is: Bacterial vaginosis
29
You are dispensing a new prescription for glyceryl trinitrate patch (Transiderm Nitro®), to be applied once a day,
for a 65-year-old male for the management of his angina.
Which of the of the following would be the most appropriate advice for this patient on how to apply the
patch?
The patch should be applied to the lateral chest every 24 hours. It does not need to be removed for
showering/bathing and should be used regularly to prevent angina rather than when required.
30
Which of the following is the most likely explanation for these symptoms?
Hypokalaemia, which can be caused by potassium-depleting diuretics such as the loop diuretics, increases the
toxicity of the digitalis glycosides.
REF: Stockley’s drug interactions
The correct answer is: Hypokalemia due to furosemide
31
You are due to start work at 9am as the Responsible Pharmacist in a community pharmacy. There are delays on
the train, so you arrive 30 minutes late. The dispensing technician would like to carry out some activities before
you arrive.
Which of the following activities can the dispensing technician carry out when you are not present in the
pharmacy
In a NHS pharmacy, there must be a pharmacist present whenever pharmaceutical services are being provided.
Activities A-D can only take place when the responsible pharmacist is in charge of the pharmacy and need to
take place under the supervision of a pharmacist and the supervising pharmacist will need to be physically
present at the pharmacy. Further information also available in the RPS Responsible pharmacist toolkit,
MEP pg 137-139 and at www.psnc.org.uk
The correct answer is: Ordering stock from a wholesaler
32
A 50-year-old man with chronic kidney disease requiring haemodialysis has been discharged from hospital postfracture repair.
Which one of the following analgesics would be the most suitable choice for the short-term management
of his acute post-operative pain on discharge?
Morphine is metabolised to morphine-6-glucuronide which accumulates in renal impairment, resulting in CNS
depression. Similarly, the clearance of codeine, and its metabolites are significantly reduced in renal impairment.
The pharmacokinetics of oxycodone is also affected in renal failure, however it may be preferred to morphine in
some circumstances. The BNF recommends to avoid codeine in renal failure and to use morphine and
oxycodone with caution. The BNF also recommends to avoid ibuprofen (systemic NSAID) in severe renal
impairment. Fentanyl patches and slow release tablets are not appropriate for acute pain due to their slow onset
of action and long duration of action.
REF: https://www.sps.nhs.uk/wp-content/uploads/2018/12/SW_QA_402-4_Nov17_Final.doc
The correct answer is: Oxycodone immediate release tablets
33
She is complaining of nausea and loose stools since starting on methotrexate.
Which of the following is the most appropriate strategy to prevent the side effects that the patient is
experiencing?
Folic acid is indicated for the prevention of side effects from methotrexate however it needs to be taken on a
different day to the methotrexate, otherwise it will reduce the effectiveness of the methotrexate. The use of folinic
acid is reserved for use as a part of treatment protocols for methotrexate infusions.
The correct answer is: Folic acid 5 mg once a week, taken on a different day to methotrexate
34
A 26-year-old female has been diagnosed with microcytic anaemia.
Which one of the following nutritional deficiencies is most likely to be contributing to this diagnosis?
Microcytic Anaemia (low MCV) most commonly due to iron deficiency.
35
megaloblastic anaemia?
folic acid OR b12 deficiency
36
Summary Care Records (SCR) are an electronic record of important patient information. They can be seen and
used by authorised staff in other areas of the health and care system involved in the patient's direct care.
Which ONE of the following statements about the SCR is CORRECT?
Pharmacists currently do not have write access to SCR although this may change soon. There is a consent form
however verbal consent is also accepted. The use of SCR in the pharmacy setting is linked to quality payment
scheme in community pharmacies and is available to technicians. Must seek consent unless in emergency e.g.
unconscious patient.
See RPS guidance on SCR: http://www.rpharms.com/unsecure- support-resources/summary-care-records.asp
The correct answer is: To access the SCR consent needs to be gained for each patient, at each pharmacy, on a
need-by-need basis
37
An 18 year old man has been prescribed metronidazole 400 mg three for seven days by his dentist for a tooth
infection. He wants to know if he can drink alcohol whilst taking the medicine.
Which ONE of the following counselling points is the LEAST appropriate advice to give?
Patients should to avoid alcohol drugs while taking metronidazole and for at least 48 hours after stopping the
drug. Monitor for flushing, nausea, and vomiting if the combination is used.
REF: https://www.medicines.org.uk/emc/medicine/21216#CLINICAL_PRECAUTIONS
The correct answer is: Tell him to limit alcohol consumption
38
A 23-year-old woman presents to her GP complaining of heavy and irregular menstrual bleeding. She has a past
medical history of antiphospholipid syndrome, for which she is treated with warfarin. After conducting
investigations, the GP did not find any abnormal uterine pathology.
Use the information provided about antiphospholipid syndrome in the resource pack.
Which one of the following treatment options would be most appropriate?
Levonorgestrel-releasing intrauterine system.
This will also provide contraception which may be important for this patient as she is on warfarin.
Page 13 of 46
NSAIDs would be contra-indicated as they increase the risk of bleeding when given with warfarin. Tranexamic
acid and the combined oral contraceptive pill are also contra-indicated in antiphospholipid syndrome due to the
additive increase in thrombosis risk.
REF: BNF monographs
The correct answer is: Levonorgestrel-releasing intrauterine system
39
You are conducting a consultation with your patient, a 40-year-old-man, and he mentions he has recently been
diagnosed with diabetes. After gaining his consent you test his blood glucose levels, the result is 3.7 mmol/L.
Which ONE of the following is the most appropriate next step?
The patient requires sugar immediately as they are experiencing hypoglycaemia (any reading less than 4
mmol/L). Diabetic chocolate would not contain enough sugar required to increase the sugar level quick enough
Ref: BNF Treatment of hypoglycaemia https://bnf.nice.org.uk/treatment-summary/hypoglycaemia.html
The correct answer is: Ask him to immediately drink some of his fruit juice that he has got with him
40
A 38-year-old man presents at the pharmacy with the following symptoms: moderate; nasal itching, congestion,
sneezing and rhinorrhoea. The symptoms have lasted over a month. He has had a NEGATIVE COVID-19 test.
Which ONE of the following would be the most suitable first line over the counter treatment, to alleviate
the patient’s symptoms?
The patient is suffering from allergic rhinitis, therefore the most appropriate treatment is nasal irrigation with
saline (local treatment is recommended as first line).
Ref: BNF, Rhinitis, drugs used in nasal allergy https://bnf.nice.org.uk/treatment-summary/nose.html
The correct answer is: Nasal saline solution
41
A regular patient comes into the pharmacy and asks for some medicine to treat a wart on their hand.
Which ONE of the following statements about warts is CORRECT?
The other options are incorrect - Topical salicylic acid (15–50%) should be applied once or twice daily for up to
12 weeks
Page 14 of 46
Warts are caused by infection in the outer layer of the skin (epidermis) with a virus called the ‘human papilloma
virus’. refer to GP for facial warts. Without any treatment, warts may spontaneously resolve but may take many
months or even years
ref: BNF, Warts and Calluses https://bnf.nice.org.uk/treatment-summary/warts-and-calluses.html
The correct answer is: Cryotherapy with liquid nitrogen can be carried out to freeze a wart
42
Pharmacies can legally make a supply of adrenaline auto-injectors to schools under certain conditions.
Which ONE of the following statements about the supply of adrenaline auto-injectors to schools is
CORRECT?
Legal and professional requirements for prescriptions, to enable the safe and legal supply of medicines; see
MEP p62
The correct answer is: A written signed order signed by principal/headteacher at the school must be provided
43
A 24-year-old lady comes into the pharmacy seeking advice for an itchy, inflamed and painful external right
ear. She has just returned from a regular swimming lesson and has had similar problems before.
Which one of the following is NOT a referral point for her condition?
Temporary hearing loss is a common symptom of Otitis Externa and therefore is not a referral point.
Ref: NICE CKS, Otitis externa diagnosis https://cks.nice.org.uk/topics/otitis-externa/diagnosis/diagnosis/
The correct answer is: Some degree of temporary hearing loss
44
A father would like you to recommend how much paracetamol is required for his 4-year-old child who has cold
and flu like symptoms.
Which ONE of the following doses is MOST appropriate regarding paracetamol?
240 mg every 4-6 hours, maximum 4 times per day
Ref: https://bnfc.nice.org.uk/drug/paracetamol.html
The correct answer is: 240 mg every 6 hours
45
What weight (in milligrams) of sodium ions are in a 600 mg tablet of sodium chloride?
The molecular weights of sodium and chloride are 23 and 35.5 respectively
Give your answer to the nearest whole number.
Na + Cl = 23 + 35.5 = 58.5
Of the molecular weight, 23 out of 58.5 consists of sodium
Therefore:
23/58.5 x 600 mg = 235.9 mg
46
A 54-year-old woman comes into your pharmacy with a prescription for
chloramphenicol 0.5% minims for a severe eye infection. The instructions on the
prescription state: ‘Place ONE drop into the LEFT eye SIX times a day for 10 days’.
Chloramphenicol 0.5% minims are available in boxes of 20 dose units. Each minim
should be discarded after each use.
How many boxes of minims do you supply to this patient?
1 minim per use x 6 times daily = 6 minims per day
6 minims per day x 10 days treatment = 60 minims
60 minims / 20 doses per box = 3 boxes
47
A 6-year-old boy has been prescribed Difflam spray (benzydamine hydrochloride
0.15%) for throat pain. His mother has been told to administer the spray every 3 hours
to the affected area for five days.
He wakes up at 7am and is asleep at 7.30pm every day. The boy weighs 14 kg.
The SmPC for Difflam 0.15% w/v spray has been provided below.
https://www.medicines.org.uk/emc/product/827
Step 1 – Calculate the dose over 5 days.
The SmPC states:
Children (6-12): 4 puffs, 1½ - 3 hourly.
The patient is awake from 7am to 7.30pm each day, where he would be administered
the dose, 4 puffs at a time.
The dose received in a day is:
7am dose – 4 puffs
RPS Full Mock Exam May 2022
10am dose – 4 puffs
1pm dose – 4 puffs
4pm dose – 4 puffs
7.30pm dose – 4 puffs
Dose over five days is 20 puffs x 5 = 100 puffs
Step 2 – Calculate how much benzydamine hydrochloride will be received:
The SmPC states:
Each puff (175 microlitres) contains 262.5 micrograms benzydamine hydrochloride
(0.15% w/v)
Therefore 100 puffs x 262.5 mcg = 26250 mcg
The answer is required in mg so 26250 mcg/1000 = 26.25 mg
The answer to one decimal place is 26.3 mg
48
fluid requirements?
max. 2 litres in females, 2.5 litres in males
49
A 13-year-old girl has been prescribed intravenous fluids to restore electrolyte
imbalances following surgery. She requires two thirds of her total daily maintenance
intravenous fluids allowance. This is to be administered over 24 hours. She weighs
46kg.
Information from the BNF about fluids and electrolytes has been provided in the link
below: https://bnfc.nice.org.uk/treatment-summary/fluids-and-electrolytes.html.
How many millilitres of maintenance fluid would she receive per hour?
Give your answer to two decimal places
Step 1- Calculate the total daily dose for the patient:
The patient weighs 46 kg therefore follow guidance for those ‘over 20 kg’
Note that this table is for 24-hour fluid requirements. The question requires you to work
out fluid requirements per hour.
10 0mL/kg for the first 10 kg therefore 100 mL x 10 kg = 1000 mL
50 mL/kg for each 1kg between 10-20 kg therefore 50 mL x 10kg = 500 mL
2 0mL/kg for each 1kg body weight over 20 kg therefore 20 mL x 26kg = 52 0mL
1000 mL + 500 mL + 520 mL = 2020 mL
Note that the maximum fluid requirement for females is 2 litres so you would not use
2020 mL for the remaining steps; use 2 litres.
RPS Full Mock Exam May 2022
Step 2 - Calculate two thirds of the daily dose:
2 L / 3 x 2 = 1.33333…L = 1333.33333… mL in 24 hours
We need the dose per hour so:
1333.33333… mL / 24 hours = 55.55555 mL/hour
To two decimal places is 55.56 mL/hour
50
A patient is on your paediatric ward suffering from hypomagnesaemia. On the ward
round the consultant paediatrician would like for an infusion of 14.2 mmol of
magnesium over the next 24-hours to be commenced.
You find the following molecular masses for compounds commonly used to make up
intravenous infusions including parenteral nutrition.
How many millilitres of magnesium sulfate heptahydrate 50% w/v (MgSO4 ·7H2O) (246.47)
should be used in this infusion?
Round your answer up to the nearest whole number.
Need 14.2 mmol magnesium (Mg2+) therefore need 14.2 mmol of the MgSO4·7H2O
Convert the molecular mass off this directly from g/mol to mg/mmol, thus 246.47
mg/mmol.
Utilise and rearrange molar equation: moles = mass ÷ molar mass mass = moles x
molar mass
Therefore, mass of MgSO4·7H2O needed is 14.2 mmol x 246.47 mg/mmol = 3499.874
mg.
50% = 50 g in 100mL therefore 500 mg/mL, thus 3499.874 mg ÷ 500 mg/mL = 6.999
mL.
Rounded to the nearest whole number is 7 mL
51
What volume of water must be added to 750 mL of a 5% w/v solution to produce a 1 in
1000 solution?
Give your answer in litres to two decimal places
```
Step 1 - Calculate the target solution
Target = 1 in 1000
= 1 g in 1000 mL
0.1 g in 100 mL = 0.1% w/v
Step 2 - Calculate what we have
We have 750mL of a 5% solution
Step 3 - Use the formula C1V1=C2V2
C1 x v1 = c2 x v2
5 x 750 = 0.1 x v2
V2 = 5 x 750/0.1 = 3750/0.1= 37,500 mL
750mL of a 5 % w/v solution can make 37,500mL of a 0.1%w/v (1 in 1000) solution.
Step 4 - Take away the amount of stock!!!!! Question asks for water only!
Amount of water to be added is 37500 – 750 = 36,750 mL
= 36.75 litres
```
52
A 40-year-old man is on the intensive care unit. He is intubated and ventilated and
requires constant sedation. The dose of propofol 1 % for this patient is 4 mg/kg/hour
and he weighs 70 kg.
How much propofol in mL will this patient receive over two hours to maintain sedation?
```
1 % propofol = 1 gram in 100 mL = 10 mg in 1 mL
4 mg/kg/hour x 70 kg = 280 mg/hour
280 mg / 10 mg = 28
1 mL x 28 = 28 mL
28 mL X 2 hours = 56 mL
```
53
A 12 year-old patient weighing 40kg requires IV calcium chloride 10% w/v at a
dose of 0.2mL/kg for acute hypocalcaemia. The MW of CaCl2 is 111g (Ca2+ 40, Cl
35.5)
How many mmol of calcium will the patient receive? Give your answer to the nearest
whole number.
7 mmol
54
VIAL SINGLE USE ONLY?
DO EACH DOSE INDIVIDUALLY, COMPLETE /DOSE, NOT EVEN /DAY, THEN TOTAL
55
What amount of the drug, in micrograms, is left in the body after 36 hours? Give your answer to the nearest whole number?Q
READ THE QUESTION
DOSE UNIT CONVERSION
Etc
56
COST SAVING Qs,
BREAK DOWN EVERYTHING, STEP BY STEP
The pharmacist has identified 78 patients who are suitable to switch from apixaban 2.5 mg twice daily to edoxaban 30 mg once daily. Apixaban 2.5 mg tablets are available in 60 tablet packs costing £57.00 each. Edoxaban 30mg tablets are available in 28 tablet packs costing £49.00 each.
What is the cost saving every 12 weeks if all the suitable patients are switched from apixaban to edoxaban? Give your answer to the nearest penny.
£982.8
57
Mr D, a 57-year-old male who weighs 78 kg has Type 3 chronic neuropathic Gaucher disease. Imiglucerase intravenous infusion is being prepared to be given to Mr D at a dose of 60 units/kg once every 2 weeks. This is prepared by initially reconstituting imiglucerase in water for injection (200 units in 5.1 mL) to give 40 units/mL solution. This is then diluted with 100 mL of infusion fluid. 40 units equates to approximately 1 mg of imiglucerase.
How much imiglucerase in mg has Mr D received after 7 weeks?
Mr D receives doses at weeks 0, 2, 4 and 6. 4680 x 4 = 18,720 units total over 7 weeks.
58
DOUBLE CHECK WHAT ANSWER YOU TYPE IN!
59
A 23-year-old HIV positive woman weighing 63 kg is to receive IV zidovudine at a dose of 2 mg/kg over 1 hour, available as 200 mg in a 20 mL ampoule.
How many mL of the glucose 5% solution is needed to produce a 2 mg/mL zidovudine infusion for this patient? You will use the full contents of the vial of zidovudine. Give your answer to one decimal place.
50.4
```
Dose: 63 kg x 2 = 126 mg
Volume of drug: 200 mg/20 mL = 126 mg/X mL
X = 12.6 mL
2 mg/mL = 63 mL
Volume of glucose: 63 - 12.6 = 50.4 mL.
```
60
An ampoule of adrenaline contains 1 mL of a 1 in 1000 solution.
How many milligrams of adrenaline are contained in the ampoule?
1
A 1 in 1000 adrenaline solution contains 1 gram (1000 mg) in 1000 mL. As the ampoule contains 1 mL of solution it therefore, contains 1 mg of adrenaline.
61
Dorzolamide/Timolol eye drops contain 5 mg of timolol per mL.
How many mgs of timolol maleate are there in a 5 mL bottle of drops? Give your answer to 2 decimal places.
The SPC is provided here: https://www.medicines.org.uk/emc/product/5113/smpc
34.15
Each mL contains 6.83 mg of timolol maleate corresponding to 5 mg timolol. 6.83 x 5 = 34.15 mg.
62
Mrs Y uses magnesium trisilicate oral suspension for the treatment of dyspepsia at a dose of 20 mL three times daily, with 10 mL containing 6 mmol of Na+ and the maximum daily requirement of Na+ for an adult is 2.4 g.
What is the percentage of her daily limit of Na+ that Mrs Y is taking if Na+ = 23 g/mol. Give your answer to 1 decimal place.
34.5
12 x 3 = 36 mmol daily of Na+. 23 x (36/1000) = 0.828 g. Thus (0.828/2.4) x 100 = 34.5%.
63
Following an initial loading dose, the doctor has prescribed a continuous infusion of enoximone at a rate of 10 microgram/kg/minute for a patient weighing 80 kg. Enoximone must be diluted to a concentration of 2.5 mg/mL in sodium chloride 0.9% prior to administration.
What is the rate (mL/hr) at which this should be infused? Give your answer to 1 decimal place..
19.2
80 x 10 x 60 = 48,000 microgram/hr = 48 mg/hr. If 2.5 mg is in 1 mL then 48 mg will be in 19.2 mL.
NUMBER SENSE ANSWERS! DOUBLE CHECK
64
Mr L experienced an increase in hair growth and a "ringing in the ears" secondary to the use of diazoxide for the treatment of chronic intractable hypoglycaemia.
Hypertrichosis and tinnitus
65
Mrs R describes herself to you as "constantly active, unable to stop moving and feeling restless all the time", as well as having "involuntary movements of her face". You believe this to be side effects of fluphenazine decanoate she is currently using for schizophrenia.
Akathisia and tardive dyskinesia
66
For each of the following products sold over the counter, select the minimum age that they can be used from. Each option may be used once, more than once, or not at all.
Nurofen® for Children 100 mg/5 mL.
3 months
67
Tramadol capsules 50 mg.
Place on the shelves in the dispensary
Tramadol is a schedule 3 CD exempt from safe custody requirements.
68
Morphine sulfate oral solution 10 mg/5 mL.
Place on the shelves in the dispensary
Morphine sulfate oral solution 10 mg/5 mL is a schedule 5 CD. The requirement to record in the CD register or keep in the CD cupboard do not apply.
69
Co-codamol 8/500 mg effervescent tablets pack of 32.
Display the product behind the counter
Co-codamol 8/500 mg is a schedule 5 CD and in a pack size of 32 tablets can be sold to the public if it has a P licence.
70
A French patient on holiday requesting citalopram usually prescribed by his local doctor.
Consider making an emergency supply if it can be clarified that the item has been prescribed by a valid prescriber before
Emergency supplies at the request of an EEA or Swiss patient can be made.
71
An American mother on holiday in London requesting a salbutamol inhaler for her 18-year-old son which is usually prescribed by his local doctor. He has forgotten his inhaler but he is not currently having an asthma attack.
Advise the patient to see a local prescriber to get a prescription
Emergency supplies cannot be made to American citizens. As the patient is at no immediate risk referring them to a local prescriber (rather than A&E) would be appropriate.
72
A Scottish lady in a Scottish pharmacy who is asking for dutasteride for her husband who has taken his last tablet this morning.
Advise that you must speak to the patient themselves before considering further action
The pharmacist must speak to the patient before an emergency supply at the request of a patient is made.
73
An English patient visiting a pharmacy in the England, requesting morphine sulfate tablets because she will run out of these tomorrow.
Contact the patient's prescriber to see if you can get them to send you an electronic NHS prescription
CD prescriptions can be transferred via EPS and if the patient’s prescriber is happy to prescribe in this way, that prescription could be electronically transferred to the pharmacy.
74
Daktacort® 30 g cream.
Store at 2-8 °C
75
Ventolin accuhaler®.
Store at or below 30 °C
76
Reconstituted Augmentin® suspension.
Store at 2-8 °C
77
Daktacort® ointment.
Store at or below 25 °C
78
A 60-year-old Caucasian gentlemen with a recent blood pressure reading of 160/100 mmHg that was taken by the nurse in the surgery and a home blood pressure reading of 150/95 mmHg. He is not on any prescribed medication.
Supplement: https://www.nice.org.uk/guidance/ng136/resources/visual-summary-pdf-6899919517
Lacidipine
79
A 52-year-old Caucasian lady with a recent blood pressure reading of 160/100 mmHg that was taken in the surgery, who has been taking ramipril at the maximum dose for the past 6 weeks. She has a prior history of low potassium levels.
Lacidipine
STEPWISE! freshy!
thiazide-like hypokalaemia? :(
80
A 54-year-old Afro-Caribbean gentlemen with a recent blood pressure reading of 160/100 mmHg taken by the nurse in the surgery and a home blood pressure reading of 150/95 mmHg. He is not taking any prescribed medication.
Lacidipine
81
A 50-year-old Caucasian lady who has been taking ramipril and amlodipine for the past 4 weeks at the maximum licensed doses for hypertension. The patient has a blood pressure reading of 170/105 mmHg that was taken in the surgery.
Indapamide
82
A 65-year-old Afro-Caribbean gentlemen with type 2 diabetes and with a recent blood pressure reading of 150/100 mmHg taken in the surgery by the nurse. The patient has been taking losartan and verapamil for the past 4 weeks at the maximum doses.
Indapamide
83
A lady seeks advice regarding an unpleasant condition. The lady complains that her vaginal region is itchy, inflamed with a thick white vaginal discharge.
Which of the following would be the most likely causative organism?
Candida albicans
The patient is complaining of symptoms related to vaginal thrush. The common organism causing this kind of condition is candida albicans.
84
RATE Ml/mIN, check what infusion rate is, not every 8 horus
85
A 12 year-old patient weighing 40kg requires IV calcium chloride 10% w/v at a
dose of 0.2mL/kg for acute hypocalcaemia. The MW of CaCl2 is 111g (Ca2+ 40, Cl
35.5)
How many mmol of calcium will the patient receive? Give your answer to the nearest
whole number.
7 mmol
86
MMOL, just use the whole Mw? :|
87
glycero gelatin 1.2 DV
88
A female patient is receiving palliative care and needs her medication
administered via a syringe driver. She has been prescribed the following:
1. 20mg/mL hyoscine butylbromide solution 120mg over 24 hours
2. 25mg/mL levomepromazine solution 5mg over 24 hours
3. Diamorphine powder for reconstitution 80mg over 24 hours
4. Water for injection to 30 mL
Assume all medications are compatible and have a negligible displacement value.
What is the % w/v concentration of hyoscine butylbromide in the syringe driver? Give
your answer to 1 decimal place.
0.4% w/v
89
A dermatology consultant has prescribed a ͚special͛ topical preparation which you
need to manufacture for a patient with acne.
The formulation contains:
40g of 5% benzoyl peroxide gel
50g of Duac® Once Daily gel (3% benzoyl peroxide, 1% clindamycin gel)
10g aqueous cream
What is the й w/w of benzoyl peroxide contained in the ‘special’ preparation? Give
your answer to one decimal place
3.5% w/
90
1ML EYE SOLUTION= 20 DROPS LOL
91
A seventy four-year old patient been admitted to hospital having suffered a
cerebral vascular accident. He is given a loading dose of digoxin 800 micrograms.
His serum creatinine (Scr) is 1.2 mg/100mL.
What is a suitable maintenance dose in micrograms for this patient?
200 mcg
92
VIAL SINGLE USE ONLY?
DO EACH DOSE INDIVIDUALLY, COMPLETE /DOSE, NOT EVEN /DAY, THEN TOTAL
93
What amount of the drug, in micrograms, is left in the body after 36 hours? Give your answer to the nearest whole number?Q
READ THE QUESTION
DOSE UNIT CONVERSION
Etc
94
COST SAVING Qs,
BREAK DOWN EVERYTHING, STEP BY STEP
The pharmacist has identified 78 patients who are suitable to switch from apixaban 2.5 mg twice daily to edoxaban 30 mg once daily. Apixaban 2.5 mg tablets are available in 60 tablet packs costing £57.00 each. Edoxaban 30mg tablets are available in 28 tablet packs costing £49.00 each.
What is the cost saving every 12 weeks if all the suitable patients are switched from apixaban to edoxaban? Give your answer to the nearest penny.
£982.8
95
Dalteparin is indicated for unstable coronary artery disease at a dose of 120 units/kg every 12 hours, up to a maximum dose of 10,000
units twice daily.
What dose of dalteparin should be prescribed for a patient weighing 88 kg? Give your answer to the nearest 100 units.
10000
96
A 13-year-old boy has been taking 40 mg oxycodone modified-release tablets twice daily. Opioid therapy is well-tolerated and the
patient is clinically stable. It has been decided they will be converted to Durogesic DTrans patches.
Using the information in the resource provided, what is the recommended Durogesic DTrans dosage, in micrograms/hour, for
this patient?
25mcg/hour
97
A patient is administered a 260 mg dose of a drug by intravenous injection. The drug has an elimination half life of 6 hours.
How much drug will remain in the body 36 hours following administration? Give your answer to two decimal places.
4.06g
98
360mg
99
each tab, 438mg
Ans: 109.5%
100
A stock solution containing 500 mg in 2 mL of a drug is used to prepare an intermediary solution. When the intermediary solution is
diluted 1 in 40, a 1 in 5000 solution is obtained.
What is the strength, in % w/v, of the intermediary solution? Give your answer to one decimal place
0.8
101
A patient has advanced prostate cancer with bone metastases. Currently they take oxycodone 60 mg modified-release tablets and
oxycodone 15 mg modified-release tablets twice daily. As they are approaching the end of their life, a continuous subcutaneous
infusion of alfentanil will be set up at an equivalent dose, to run over 24 hours in a 24 mL syringe driver.
Using the information in the resource provided, what is the infusion rate, in micrograms/hour, of alfentanil in the syringe
driver? Give your answer to the nearest whole number.
417mcg/hr
102
Treatment with pregabalin is to be initiated for a 65-year-old patient according to a dose titration schedule. The patient will be given a
28 day prescription, with a review planned in one month.
Using the information in the resource provided, how many pregabalin 25 mg capsules should be supplied for the first 28 days
of treatment?
140mg
103
You are preparing a stock of glucose 5% bags by mixing the contents of a 50% glucose bag with sterile water for injection. Each
glucose 5% bag will have a volume of 475 mL.
What quantity of glucose 50% solution, in mL, will be required to produce 15 bags of glucose 5% solution? Give your answer to
the nearest 5 mL.
715 ml
104
Potassium chloride 15% concentrate must be diluted prior to administration via a central venous access device. The maximum infusion
rate is 20 mmol/hour. Potassium chloride has a molecular weight of 74.5 g/mol.
What volume of diluent, in mL, should be added to 25 mL of 15 % potassium chloride concentrate to produce a 1 mmol/mL
solution for infusion? Give your answer to the nearest whole number.
25ml
105
A patient requires 400 mL of Potassi-Wash, a potassium permanganate solution which must be diluted before use. The patient will be
given guidance on how to dilute the supplied solution 10 times so that it produces a 0.01% diluted solution before use. In order to
prepare the Potassi-Wash for the patient, a stock solution of 16% potassium permanganate will be used.
What volume of stock solution, in mL, is required to be added to water to make the Potassi-Wash solution to be supplied to the
patient? Give your answer to one decimal place.
2.5ml
106
2 g of cefotaxime has a displacement volume of 0.8 mL. A 1 g vial must be diluted to a final volume of 8 mL before administering an IV
dose to a child.
What volume of diluent, in mL, should be added to the vial to give a concentration of 125 mg/mL? Give your answer to one
decimal place.
7.6
107
Fluconazole is available as a 50 mg/5 mL powder for oral suspension. To produce 35 mL of 50 mg/5 mL oral suspension, the
pharmacist must add 23 mL of potable water and shake vigorously.
Calculate the displacement volume, in mL, for a quantity of fluconazole powder for oral suspension equivalent to 50 mg
fluconazole. Give your answer to two decimal places.
1.71
108
Basically displacement of X means X drug will displace 1g of air. I just use that logic to answer the Q (so I dont memorise formula)
Amount of base=total weight -drug/DV
109
INTERMEDIATE= DF*final conc.?
110
```
50 patients per arm minimum, 9 arms
smallest, 50 (2)
50/2= 25
25patients/arm
25*9= 225
```
50:75:100= 225
111
20,000*.1= 2000g
25% strength
2000/25 *100= 8000= 8kg
112
1 month= 28 days, assume this only!
113
114
115
116
1 month= 28 days unless otherwise stated!
117
118
119
SAVING Qs, do saving/packet, not at the end!
914.4 is £900 rounded, not £9000, blind
120
MAKE YOUR WORKING OUT NEAT, ANNOTATE, SPREAD, DON'T RUSH, DON'T OVERDOIT, RS, SAFE
MAKE YOUR WORKING OUT NEAT, SPREAD, READ
121
122
123
124
125
4G
126
84mL
127
128
129
130
don't forget weight of OG added
131
132
133
Ans 5ml
134
0.75MG/MIN
135
158G
136
34.2ML
137
33.3ML
138
139
be careful to multiply, not add
'Each gram of amino acid nitrogen is equivalent to 6.25 g of protein'
140
'5 g of magnesium sulphate infusion over at least 2 hours daily for 5 days.'
extract the key info n multiplt
141
76g
142
78.1mmol
143
98.8ml
144
SPC Qs, consider method of administration
not straight into 'IM'
'9. Konakion MM Paediatric (phytomenadione) may be given for the prophylaxis of vitamin K deficiency bleeding in neonates. For healthy neonates of 36 weeks gestation and older, this can be given orally'
145
0.5mm/hr
146
36hrs... 26hrs later
147
100ml
148
£34600
149
4500ml
150
151
172tabs
152
19g
153
immunocompromised, be careful!
https://bnfc.nice.org.uk/drug/aciclovir.html
154
64.5mg/min
155
224
156
7.4g
157
VIAL SINGLE USE ONLY?
DO EACH DOSE INDIVIDUALLY, COMPLETE /DOSE, NOT EVEN /DAY, THEN TOTAL
158
What amount of the drug, in micrograms, is left in the body after 36 hours? Give your answer to the nearest whole number?Q
READ THE QUESTION
DOSE UNIT CONVERSION
Etc
159
COST SAVING Qs,
BREAK DOWN EVERYTHING, STEP BY STEP
The pharmacist has identified 78 patients who are suitable to switch from apixaban 2.5 mg twice daily to edoxaban 30 mg once daily. Apixaban 2.5 mg tablets are available in 60 tablet packs costing £57.00 each. Edoxaban 30mg tablets are available in 28 tablet packs costing £49.00 each.
What is the cost saving every 12 weeks if all the suitable patients are switched from apixaban to edoxaban? Give your answer to the nearest penny.
£982.8
160
389
161
226
162
157
163
37
164
IBW, use the right row!
165
A 52-year-old patient weighing 63 kg has been admitted with sepsis of
unknown origin and requires intravenous gentamicin as empirical treatment.
The doctor wants to achieve a serum concentration of 8 mg/L.
What loading dose in micrograms of gentamicin should be used?
Vd = 0.25 L/kg,
Bioavailability = 1
Salt fraction = 1
126000mcg
166
ALWAYS CHECK REQUESTED UNITS
mg or micrograms?
167
168
1416
169
4.4
170
16.9
171
590mg, practicality?
172
504mg
173
0.52
174
1.2
175
6720mcg
176
3.7
177
5.6
178
CHECK THE DV
CHECK THE FINAL CONCENTRATION
FIND THE FINAL VOLUME
CALCULATE DIFFERENCE
ETC
179
5.8ML
180
Dose prescribed is 0.8 mg x 0.565 kg = 0.452 mg/hour
Product we’re using contains 125 mg in 30 mL, which is 0.452 mg in X mL
X mL = 0.10848 mL/hour i.e. this is the rate we need to set the pump at to deliver 0.452 mg/hour
– The pump is set in 0.01 mL/hour increments, therefore the hourly rate is 0.11 mL for 12 hrs
(Remember: the pump will only allow you to set either 0.10 or 0.11 mL/hour).
- 0.11 mL/hr x 12 hours = 1.32 mL
181
0.02
182
13.62 nanograms/mL = 13.62 micrograms/L (converting both ng to mcg and mL to L requires
multiplying by 1,000 then dividing by 1,000 so you get the same number at the end).
Dose from formula = 13.62 micrograms /L x 78 kg = 1,062.36 micrograms
Continuing with the formula: 1,062.36 micrograms / 100 = the dose in vials = 10.6236 vials
We are told the dose must be rounded to the nearest whole 40 mg vial, which would be 11 vials.
11 vials x 40 mg = 440 mg dose.
183
60 days total treatment, minus 14 days of IV therapy = 60 - 14 = 46 days oral treatment.
Oral dose is 500 mg BD in 250 mg tablets, i.e. 2 tablets BD = 4 tablets daily
4 tabs x 46 days = 184 tablets
184
```
Mrs K weighs 17 stone 4 lbs,
In 17 stone, there are 238 lbs (17 stone x 14 lbs) plus the extra lbs give a total weight of 242 lbs
We now need to convert lbs to kg, using the conversion given.
242 lbs ÷ 2.2 = 110 kg
From Table 1 in the SmPC section 4.2, we can see that Mrs A requires a dose of 325 mg, according to her
weight.
Table 1: Vial-based dosing scheme* for patients with body weight between 35 kg and 199 kg
Body weight
(kg)
Reslizumab total dose
(mg)
Numbers of each vial**
Vials with 10 mL concentrate
(100 mg reslizumab)
Vials with 2.5 mL
concentrate
(25 mg reslizumab)
109-116 325 3
```
185
Answer: 0.35 kg
The baby requires 5 feeds/day which is 15 feeds in 3 days.
Each feed has 5 scoops of powder, therefore 75 scoops are needed over 3 days (15 feeds x 5 scoops)
Each scoop = 4.6 g, times 75 scoops = 345 g in total.
Convert to kg = 0.345 kg = 0.35 kg to the nearest 0.05 kg
186
```
Vd = 0.7 L x 88 kg = 61.6 L
ΔCp = 15 mg/L, because this is a loading dose, so the initial concentration = 0 mg/L
ΔCp = (Dose x S)/Vd
15 mg/L = (Dose x 0.92)/61.6 L
Dose x 0.92 = 15 mg/L x 61.6 L
Dose x 0.92 = 924 mg
Dose = 924 mg/0.92
Dose = 1,004.3478 mg = 1,000 mg to nearest 100 mg
```
187
1. Calculate LEDD – [(A) + (B)] x 0.55
(A) is the total adjusted daily levodopa dose:
- co-careldopa MR 100 mg tds = 300 mg
- Total adjusted daily levodopa, due to MR preparation = 300 mg x 0.91 = 273 mg (A in the LEDD
formula)
(B) is the total adjusted daily dopamine agonist estimate levodopa equivalent:
- Bromocriptine 10 mg daily x 10 = 100 mg (B in the LEDD formula)
LEDD = [(273 mg + 100 mg)] x 0.55 = 205.15 mg
2. Calculate dosage for rotigotine patch = Adjusted LEDD/20
- 205.15 mg ÷ 20 = 10.2575 mg
- Therefore a 10 mg dose of rotigotine/24 hours would be most appropriate (6 mg + 4 mg or 2mg + 8
mg patches).
188
189
VIAL SINGLE USE ONLY?
DO EACH DOSE INDIVIDUALLY, COMPLETE /DOSE, NOT EVEN /DAY, THEN TOTAL
190
What amount of the drug, in micrograms, is left in the body after 36 hours? Give your answer to the nearest whole number?Q
READ THE QUESTION
DOSE UNIT CONVERSION
Etc
191
COST SAVING Qs,
BREAK DOWN EVERYTHING, STEP BY STEP
The pharmacist has identified 78 patients who are suitable to switch from apixaban 2.5 mg twice daily to edoxaban 30 mg once daily. Apixaban 2.5 mg tablets are available in 60 tablet packs costing £57.00 each. Edoxaban 30mg tablets are available in 28 tablet packs costing £49.00 each.
What is the cost saving every 12 weeks if all the suitable patients are switched from apixaban to edoxaban? Give your answer to the nearest penny.
£982.8
192
BOTTLES, RESCONSTITUTED?
be careful of spc, 7 days, etc
193
Total number of patients on AF register = 12,000 x 5% = 600 patients on AF register
If all AF patients treated with warfarin = 600/60 = 10 will benefit from it (NNT = 60)
If all AF patients treated with apixaban = 600/5 = 120 will benefit from it (NNT = 5)
Number of extra patients that will benefit if all patients are switched from warfarin to apixaban =
120 - 10 = 110 extra patients
194
Answer: 23.2 mg/L
| 13 mg/L/ (2.3 g/mL x 0.2) + 0.1 = 23.2142857 or 23.2 mg/L to one d.
195
Each dose for this patient is 14 FTUs.
We are told that 2 FTUs = 1g Dovobet ointment, therefore 14 FTUs = 7 g Dovobet ointment, per dose
7 g x 7 days = 49 g ointment applied in 7 days
Ointment strength is 500 mcg/g therefore X mcg in 49g
X mcg = 24,500 mcg = 24.5 mg
196
Answer: 312 units
Initial dose = 0.3 units x 40 kg = 12 units over 30 mins
Continuation dose at max. allowed = 1 unit/kg/hour → 40 units/hour → 20 units per 30 minutes
8 hours = 8 x 60 minutes = 480 minutes
Initial dose given over 30 minutes, so 480 – 30 = continuation dose given over 450 minutes at 40 units/hour
Continuation dose is 40 units/hr for 7.5 hrs = 300 units in 7.5hrs
300 units + 12 units = 312 units total administered in first 8 hours of treatment
Alternative for calculating continuation dose:
450 minutes / 30 mins = 15 half-an-hour periods
20 units x 15 = 300 units
197
5. Answer: 21.85 mL/hour
Recommended maximum dose = 1 unit/kg/hour → half this is 0.5 unit/kg/hour
Child weighs 40 kg and given over 12 hours → 0.5 units x 40 kg x 12 hrs = 240 units/12 hours
240 units from 20 unit/mL ampoules → 240 / 20 = 12 mL containing 240 units
250 mL bag + 12 mL from the ampoules = 262 mL total volume of bag
262 mL given over 12 hours = 262 mL / 12 hrs = 21.83333 mL/hour
Pump can be programmed in 0.05mL/hour increments, therefore set to 21.85 mL/hour
198
Answer: 66.4 mL
Rationale:
Dose = 2 mg/kg over 1 hour Weight = 83 kg
Dose Calculation: 2 mg/kg x 83 kg = 166 mg is the dose of zidovudine.
Each zidovudine ampoule is 200 mg in 20 mL (equivalent to 10 mg/mL)
Therefore, in terms of the dose expressed as a volume, 166 mg is in 16.6 mL of the ampoule to be used.
The final infusion bag (of glucose 5%) needs to be 2 mg/mL
So, for the dose of 166 mg it needs to be given in 166 mg/2 mL = 83 mL of fluid.
Since the zidovudine is already a liquid, this volume (16.6 mL) needs to be taken into account of the final fluid volume.
83 mL – 16.6 mL = 66.4 mL
Therefore, 66.4 mL of glucose 5% needs to be added to make the final volume
199
Answer: C - 3
Rationale: NNT is the number of patients that need to be treated for one to benefit compared with a control.
We have to treat 100/42, or 2.38 patients with the trial drug for one to benefit.
For NNT, we always round up to the next whole number.
For NNH, we always round the number down.
200
CHECK THE FINAL VOLUME!
201
202
Miss Tina Lopez, a 67-year-old female, comes to collect her prescription
medicines from a pharmacy you are locuming in. She takes the following
medications:
• Ramipril 5mg tablets
• Amlodipine 10mg tablets
• Sulfasalzaine 500mg tablets
• Hyoscine butylbromide (Buscopan®) 10mg tablets
• Tibolone 2.5mg tablets
You go through the prepared medicines with Miss Lopez prior to testing her
blood pressure and realise that baclofen 10mg tablets have been dispensed
instead of Buscopan® 10mg tablets. This error is corrected. You then
proceeded to test Miss Lopez’s blood pressure three times, of which the
average was found to be 165/98.
Which of the following is the most appropriate action to take?
STOP TIBOLONE!!
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204
You are given two concentrations and one volume – therefore the C1 x V1 formula works for this question
C1 x V1 = C2 x V2
10% x 100mL = 4% x V2
1,000mL = 4% x V2
V2 = 250 mL
250 mL – 100 mL (original volume) = 150 mL of diluent
Alternative working
10% v/v of 100 mL = 10 g
4% = 4 g/100 mL therefore how many mL for 10 g?
10 g x 100 mL = 250 mL, minus the original 100 mL leaves the answer of 150 mL
4 g
205
The diluted solution is 1 in 15,000
This has been diluted from 10 mL to 6,000 mL, which is a 600 x dilution.
The stock solution was therefore 600 x stronger i.e. before it was diluted.
The stock solution concentration would therefore have been 15,000/600 = 25 which = 1g in 25 mL.
We need 650mL, therefore if 1g in 25 mL, there are 26 g in 650 mL = 26,000mg
206
Answer: £52,200
Cost of Lamictal: £40.02/28 days x 224 patients = £8,964.48/28 days
Cost of generic lamotrigine: £1.16/28 days x 224 patients = £259.84/28 days
Total saving/28 days is £8,964.48- £259.84 = £8,704.64/28 days
Total saving/168 days £8,704.64 x 6 = £52,227.84 = £52,200 to the nearest £100
207
. Answer: £64,700
Cost of service A:
Occupational therapist cost = (£12,000 x 2) + literature/venue/catering
£24,000 + £6,000 = £30,000
Reduces 15 operations in 150,000 patients but we have 300,000 so will reduce by 30 operations,
Therefore saving is £5,600 x 30 = £168,000
Cost benefit of service A = £168,000 – £30,000 = £138,000
Cost of service B: £14,500 (physio) + £18,000 (pool hire) = £32,500
Reduces 21 operations in 150,000 patients but we have 300,000 so will stop 42.
Saving is £5,600 x 42 = £235,200
Cost benefit of service B = £235,200 – £32,500 = £202,700
ICBD = £202,700 – £138,000 = £64,700
208
Answer: 6 drops/minute
60 micrograms per kg for a 70 kg patient = 4,200 mcg or 4.2 mg per hour
The concentration of the solution is 250 mg/1,000 mL = 2.5 mg/10 mL
4.2 mg per hour = 16.8 mL/hour (4.2mg x 10mL/2.5mg) = 0.28 mL/minute
Converting to drops, if 1mL = 20 drops, 0.28 mL = 5.6 drops/minute.
6 drops/minute to the nearest whole number.
209
Answer: 63 mL
Working 1
The paediatric linctus contains 0.625% = 0.625g/100mL therefore 1.5625 g in 250 mL
The adult linctus contains 25mg/1mL, therefore 1,562.5 mg in XmL
XmL = 1,562.5mg x 1mL = 62.5 mL = 63 mL to the nearest whole number
25mg
Working 2
C1 x V1 = C2 x V2
0.625 % x 250 mL = 2.5% x V2
V2 = 0.625 % x 250 mL = 62.5mL
2.5 %
210
Answer: £1,290
Vildagliptin – dose 1 BD
2/3 x 21 patients can switch = 14 patients
Vildagliptin costs £33.35/28 days x 2 = £66.70/56 days x 14 patients x 3 repeats = £2,801.40 total cost
Sitagliptin – dose 1 OD
18 patients eligible to switch
Sitagliptin costs £33.26/28 days x 2 = £66.52/56 days x 18 patients x 3 repeats = £3,592.08 total cost
Alogliptin – dose 1 OD
Alogliptin costs £26.60/28 days x 2 = £53.20 x 3 repeats = £159.60 per patient/3 repeats
£159.60 x 14 vildagliptin patients = £2,234.40
£159.60 x 18 sitagliptin patients = £2,872.80
Saving per drug
Saving from switching patients from vildagliptin is £2,801.40 - £2,234.40 = £567
Saving from switching patients from sitagliptin is £3,592.08 - £2,872.80 = £719.28
Total Savings
£567 + £719.28 = £1,286.28 = £1,290 to nearest £10
211
Answer: 13.51 % w/v
275mL of 15% w/v = 15g/100mL therefore 41.25 g/275 mL
85mL of 27.5% w/v = 27.5g/100mL therefore 23.375 g/85 mL
145mL of 2.5% w/v = 2.5g/100mL therefore 3.625 g/145 mL
= 68.25 g/505 mL = 13.5148 g/100mL or 13.51 % w/v
212
(10 kg x 100 mL) + (10 kg x 50 mL) + (3 kg x 20 mL) = 1,560 mL/24 hours = 390 mL in 6 hours
[10 kg + 10 kg + 3 kg = 23kg]
Framework: Infusion rates, paediatrics, use of resource pack
213
214
1.2G MAX FRESHIE, 320 SOMETHING
215
93.6
216
187.5
217
72 s
218
VIAL SINGLE USE ONLY?
DO EACH DOSE INDIVIDUALLY, COMPLETE /DOSE, NOT EVEN /DAY, THEN TOTAL
219
What amount of the drug, in micrograms, is left in the body after 36 hours? Give your answer to the nearest whole number?Q
READ THE QUESTION
DOSE UNIT CONVERSION
Etc
220
COST SAVING Qs,
BREAK DOWN EVERYTHING, STEP BY STEP
The pharmacist has identified 78 patients who are suitable to switch from apixaban 2.5 mg twice daily to edoxaban 30 mg once daily. Apixaban 2.5 mg tablets are available in 60 tablet packs costing £57.00 each. Edoxaban 30mg tablets are available in 28 tablet packs costing £49.00 each.
What is the cost saving every 12 weeks if all the suitable patients are switched from apixaban to edoxaban? Give your answer to the nearest penny.
£982.8
