Module 3 RATIONALIZATION Practice of Pharmacy Clinical Pharmacy

Module 3: RATIONALIZATION Practice of Pharmacy (Clinical Pharmacy, Hospital Pharmacy, Dispensing, Incompatibilities, ADR, Pharmaceutical Calculations)

1. It refers to the responsible provision of drug therapy to achieve definite outcomes that are intended to improve a patient’s quality of life: a. Drug therapy assessment b. Therapeutic drug monitoring c. Pharmaceutical care d. Professional-patient relationship e. Formal documentation Components of Pharmaceutical care: • Equal responsibility (to patient and prescriber) • Professional-patient relationship • Formal documentation ( clinical interventions and therapeutic outcomes )

2. A way of summarizing the health benefits and resources used by competing health care programs so that policy makers can choose among them: a. Cost-of-Illness Evaluation b. Cost-Minimization Analysis c. Cost-Utility Analysis d. Cost-Effectiveness Analysis e. Cost-Benefit Analysis

3. Any noxious, unintended, and undesired effect of a drug that occurs at doses used in humans for prophylaxis, diagnosis or therapy: a. Allergy b. Adverse drug reaction c. Adverse drug event d. Hypersensitivity e. idiosyncracy -adverse drug event is used to describe an injury resulting from administration of drug

4. Patient R. S. had bone marrow transplant 5 years ago. This information belong in which section of the patient’s medical chart: a. ROS – Review of Systems b. FH – Family History c. HPI – History of Present Illness d. PMH – Past Medical History e. PMP – Patient Medication Profile

Insulin Duration of Action 5. Which of the following insulins exert the A. longest duration of action Short-acting 1. Insulin Lispro 3 -5 h a. Humalog – Insulin Lispro 2. Insulin Aspart 3 -5 h b. Lantus – Insulin Glargine 3. Regular 5 -8 h c. Intermediate-acting Humulin R – regular Insulin B. 1. NPH >14 h d. Novo rapid – Insulin Aspart C. e. Long-acting Insulin NPH 1. Glargine 2. Detemir D. Pre mixed 1. Lispro mix 75/25 2. Aspart mix 70/30 24 h 6 -23 h 14 -24 h 18 -24 h

6. Which of the following is not an objective parameter: a. Bilirubin b. Creatinine c. Urine output d. Vertigo e. CBG – Capillary Blood Glucose

7. When blood urea nitrogen (BUN) is above the normal values, it indicates the following conditions except: a. Dehydration b. GI bleeding c. Liver disease d. Renal disease -BUN is the measure of the amount of nitrogen in the blood in the form of urea, and a measurement of renal function. Urea is a by- product from metabolism of proteins by the liver, and therefore removed from the blood by the kidneys.

8. The clinical pharmacist functions focus on the: a. b. c. d. e. Product Hospital Diagnosis Patient Income

9. Which of the following provides the greatest number of calories per gram: a. Dextrose b. Proteins c. Fats d. Ethanol Fat: 1 gram = 9 calories Protein: 1 gram = 4 calories Carbohydrates: 1 gram = 4 calories Alcohol: 1 gram = 7 calories

10. Exforge ® is an anti hypertensive agent which is a combination of: a. b. c. d. Amlodipine & valsartan Telmisartan & HCTZ Valsartan & HCTZ Enalapril & amlodipine

11. Which of the following dosages of dopamine is selected for its positive inotropic effects in treating the patient with Heart Failure: a. 40 mg/kg/min b. 40 ug/kg/min c. 10 -20 ug/kg/min d. 5 -10 ug/kg/min e. 2 ug/kg/min

12. Measures the electrical activity of the brain, and helps to identify functional cerebral changes underlying structural abnormalities: a. CBG – Capillary Blood Glucose b. EEG – Electroencephalogram c. MRI – Magnetic Resonance Imaging d. PET – Positron Emitting Tomography e. CSF – Cerebro Spinal Fluid - EEG serves as diagnostic tool in classifying seizures.

13. Agent/s that inhibit smooth muscle contractions in asthmatic patients is/are: I. III. IV. a. b. c. d. e. Beta adrenergic agonists Methylxanthines Glucocorticoids Anticholinergics I and IV I, II and IV II, III and IV AOTA I, II and III Drugs that inhibit smooth muscle contraction are often called “quick relief medications” ex. Beta adrenergic agonists, methylxanthines, anticholinergics Glucocorticoids are considered “long term control medications”

Insulin Onset of Action 14. It is a rapid-acting insulin preparation: A. Short-acting a. Humalog – Insulin Lispro 1. Insulin Lispro Within 15 mins b. Lantus – Insulin Glargine 2. Insulin Aspart Within 15 mins 3. Regular 30 – 60 mins c. Levemir – Insulin Detemir B. d. Intermediate-acting Humulin N – Insulin NPH 1. NPH 2. 5 – 3 h e. Insulin NPH C. Long-acting 1. Glargine 1. 5 h 2. Detemir 3. 4 h D. Pre mixed 1. Lispro mix 75/25 0. 25 – 5 h 2. Aspart mix 70/30 0. 1 – 0. 2 h

15. It is the hypermetabolic syndrome that occurs from excessive production of thyroid hormone with classic symptoms of weight loss despite increases appetite, nervousness, palpitations, heat tolerance and insomnia: a. Thyrotoxicosis or “Hyperthyroidism” b. Hypothyroidism c. Graves disease – autoimmune disorder causing hyperthyroidism. d. Cushing syndrome e. Hashimoto’s disease

16. Which of the following types of questions should be avoided while interviewing the patient: a. b. c. d. e. Leading questions Multiple questions Excessive yes/no questions AOTA NOTA

17. The following are clinical functions of pharmacists except: a. b. c. d. Prepare medications Taking inventories Participate in patient education program Assess drug interactions and ADRs

18. In hospital abbreviations, Pt. means: a. b. c. d. Prothrombin Time Pro. Time Patient Pint

19. Tx means: a. b. c. d. Treatment Therapeutics Therapy

20. Patient N. H. has a BMI of 27 kg/m 2, patient N. H. is considered to be: a. Underweight b. Normal weight c. Overweight d. Obese -BMI = weight in kg / (Height in meters)2 Interpretation: Underweight < 18. 5 Normal weight = 18. 5 - 24. 9 Overweight = 25. 0 - 29. 9 Obese > 30. 0

21. The successor of the first hospital pharmacist that revolutionize the practice of pharmacy and medicine in the hospital setting: a. Jonathan Roberts b. John Morgan c. Jason Bourne d. Jonathan Morgan

22. First hospital pharmacy practice was observed in which hospital? a. b. c. d. Pennsylvania Plymouth San Antonio Washington

23. The first hospital pharmacist: a. b. c. d. Jonathan Roberts John Morgan Jason Bourne Jonathan Morgan

24. A form of therapy offered as a substitute for drug therapy that follows the biochemical effects derived from essential oils: a. Acupuncture b. Aromatherapy c. Massage d. Chiropratic medicine

25. Patients who can walk and not bedridden: a. b. c. d. Institutionalized Inpatient Ambulatory Outpatient

26. A facility where patients who are not confined are treated by a set of physician practicing together: a. b. c. d. Hospital In-house facility ER Clinic

27. Which is not a fundamental function of a hospital? a. b. c. d. Research Wellness Education NOTA

28. ASHP stand for: a. b. c. d. American Society of Hospital Pharmacist American Society for Hospital Practitioners Asian Society of Hospital Pharmacist American Society of Health-system Pharmacists - New meaning of ASHP

29. Hospitals function in assisting their communities the incidence of illness and improve quality of life, is under what fundamental function? a. Research b. Education c. Patient Care d. Wellness

30. The Hospital Pharmacist holds what position in the P&T Committee? a. b. c. d. Chair Secretary Treasurer NOTA

31. The degradation reaction of ASA involves: a. hydrolysis b. racemization c. oxidation d. photolysis e. Reduction - in presence of moisture or water, ASA will hydrolyze into acetic acid and salicylic acid.

32. The most serious drug-induced blood disorder: a. aplastic anemia b. leukemia c. agranulocytosis d. Thrombocytopenia - This is also referred to as pancytopenia resulting from damaged pluripotent stem cells. - It is characterized by acellular or hypocellular bone marrow

33. Which is NOT true for camphor? I. forms a eutectic mixture with menthol II. can be powdered by rubbing with a small amount of alcohol or ether III. dissolves readily in water a. b. c. d. e. I only III only I and II only II and III only I, II, and III -Camphor is soluble in alcohol and organic solvents but is only slightly soluble in water (1 g in 800 ml)

34. Which one of the following diluents is LEAST suitable for reconstituting single-dose vials? a. Bacteriostatic Sterile Water for Injection (BSWFI) BSWFI should not be used for reconstituting b. D 5 W injection single-dose units because the preservative c. N/S injection present would serve no useful purpose, and large d. 0. 5 N/S injection amounts of the preservative could increase the incidence or severity of toxicity. e. Sterile Water for Injection (SWFI) The use of BSWFI may be appropriate if a powder in a multidose vial is being reconstituted.

35. Methysalicylate is also known as: a. camphorated oil -Methyl salicylate can be used in small b. peppermint oil quantities as flavoring c. salicylamide or perfuming agent. d. oil of wintergreen -It is also included in e. sweet oil many topical products such as rubbing alcohol, gels and liniments

36. Alcohol is suitable as a solvent for menthol and salicylic acid when preparing which of the following dosage forms? I. lotions II. ointments III. Suppositories a. I only b. III only c. I and II only d. II and III only e. I, II, and III

37. The ideal weight for a vaginal suppository will be approximately: a. b. c. d. e. 1 g 2 g 5 g 10 g 15 g - rectal suppositories: 2 grams

38. The most practical method for sterilizing the ophthalmic solution is: a. autoclaving for 15 minutes b. autoclaving for 30 minutes c. membrane filtration through 0. 2 -micron filter d. membrane filtration through 5 -micron filter e. use of ethylene oxide gas - Membrane filtration involves the passing of solutions through a 0. 2 micron filter using one of the commercially available sterile filter units such as Millipore's Millex or Swinnex units.

39. Boric acid is present in the formula as a (an) : I. antioxidant II. antimicrobial preservative III. buffering agent a. b. c. d. e. I only III only I and II only II and III only I, II, and III

40. Ondansetron is available under the trade name of : a. Kytril - Granisetron b. Marinol - Dronabinol c. Reglan - Metoclopramide d. Zofran e. Zoloft – Sertraline (Antidepressant) -all except Zoloft are used for nausea and vomiting during chemotherapy

41 -42. 41. How many mg of codeine base is in each dose of the cough product? (mol. wt. : codeine = 299; codeine phosphate = 406) a. 6 mg b. 8 mg c. 11 mg d. 16 mg e. 24 mg

42. How many mg of codeine phosphate are being consumed daily by a patient taking the prescription as directed? a. 6. 25 mg b. 8. 25 mg c. 19 mg d. 25 mg e. 33 mg

(E) Because the volume of a standard teaspoon is considered to be 5 m. L, the patient in this prescription is receiving four daily doses for a total of 20 m. L.

43. A hospital pharmacy technician has written the following formula for inclusion into the master manufacturing formula book. Codeine sulfate Aspirin Hydrocortisone Lactose Mix and make 30 capsules 0. 5 gr 1. 6 gr 120 mg qs 6 grams

(cont. . ) When reviewing this formula, the pharmacist should comment upon which of the following expressions? I. 0. 5 II. gr III. qs a. b. c. d. e. I only III only I and II only II and III only I, II, and III

44. Alcohol has many pharmaceutical uses and is available in several concentrations. What is the concentration (% v/v) of diluted alcohol? a. 49% b. 70% c. 92% d. 95% e. 100%

45. How many grams of glacial acetic acid (99. 9% w/w) must be added to 1 gal purified water to prepare an irrigation solution containing 0. 25% wt. /vol. acetic acid? a. 1. 2 g One gallon contains 3, 785 m. L; thus b. 9. 5 g 3, 785 m. L × 0. 25% = 9. 46 or 9. 5 g. c. 12 g Because the volume contributed by the acetic acid is insignificant when d. 20 g compared to 3, 785 m. L, it does not e. 95 g enter into the calculation of the final volume.

46. A nurse adds a 4 -m. L Tubex unit containing 2. 4 M units penicillin suspension to a 20 -m. L vial containing 10 m. L of normal saline. What is the new concentration of penicillin expressed as units/m. L? 2. 4 megaunits is 2. 4 million a. 170 units or a total of 2, 400, 000 b. 240 units. The final dilution will c. 170, 000 have a volume of 14 m. L. d. 240, 000 e. 600, 000

47. A hospital pharmacy needs 1 qt of an antibacterial solution containing 92% v/v alcohol. How many m. L of alcohol USP will be needed? a. 458 m. L [Q 1][C 1]= [Q 2[C 2] b. 870 m. L [x m. L][95% vol. /vol. ]= [946 m. L][92% vol. /vol. ] c. 916 m. L 95 x = 92, 000 d. 920 m. L x = 916 m. L e. 968 m. L

Rx Sodium thiosulfate 1. 2% Sodium chloride qs Purified water qs 100 m. L 48. How much sodium chloride is needed to adjust the following prescription to isotonicity? (E value for sodium thiosulfate is 0. 31. ) a. 0. 37 g b. 0. 45 g c. 0. 53 g d. 0. 31 g e. 0. 90 g

Step 1—Determine amount of sodium thiosulfate in the Rx: 100 m. L × 1. 2% = 1. 2 g or 1, 200 mg Step 2—Multiply the amount of chemical by its “E” value: 1, 200 mg × 0. 31 = 372 mg (equivalent amount of Na. Cl) Step 3—Determine amount of Na. Cl needed as if no other chemical was present: 100 m. L × 0. 9% = 900 mg Step 4—Subtract contribution by chemical (Step 2) from amount of Na. Cl (Step 3): 900 mg – 372 mg = 528 mg = 0. 53 g (The amount of Na. Cl needed to render the solution isotonic. )

49. How many grams of pure hydrocortisone powder must be mixed with 60 g of 0. 5% hydrocortisone cream if one wishes to prepare a 2. 0% w/w preparation? a. 0. 90 g b. 0. 92 g c. 0. 30 g d. 1. 2 g e. 1. 53 g

Because the amount of 0. 5% hydrocortisone cream is exactly 60 g, the final weight of the cream will be greater when hydrocortisone powder is added. Therefore, the problem may be solved by the allegation alternate method or by simple algebra: 100% HC 1. 5 parts 2% 0. 5% HC 98 parts

OR. . by algebra, let x = weight of 100% HC powder, then (x g) (100%) + (60 g) (0. 5%)= (60 g + x g) (2%) x + 0. 3 = 1. 2 + 0. 02 x x = 0. 92 g

50. A pharmacist adds 2 g of potassium chloride to 1 L of D 5 W/1/2 normal saline. Estimate the osmolarity (m. Osm/L) of this solution assuming the final volume is 1 L. (Atomic wt. : sodium = 23, potassium = 39, chloride = 35. 5, dextrose = 198. ) a. 54 m. Osm/L b. 300 m. Osm/L c. 405 m. Osm/L d. 460 m. Osm/L e. 477 m. Osm/L

Three chemicals are contributing to the osmolarity. Potassium chloride 2 g ÷ 74. 5 = 0. 0268 mol or 26. 8 m. M × i value of 2 = 53. 6 m. Osm Dextrose 50 g ÷ 198 = 0. 253 mol or 253 m. M × i value of 1 = 253 m. Osm Sodium chloride 1, 000 m. L � 0. 45% = 4. 5 g ÷ 58. 5 = 0. 0769 mol or 76. 9 m. M × i value of 2 = 153. 8 m. Osm Total in 1 L = 53. 6 + 253 + 153. 8 = 460 m. Osm/L

51. Primary function of P&T Committee: a. b. c. d. Policy Development Education AOTA NOTA

52. A type of drug distribution system that makes medication available at nursing units of hospitals and for which a charge is made to the patient. a. Charged Floor Stock b. Free Floor Stock c. Unit Dose Delivery d. Complete Floor Stock

53. Focus of all Physician-Pharmacist-Nurse interactions: a. b. c. d. Hospital Policy Implementation Patient AOTA

54. Function of P&T Committee, except: a. Disseminate information on its action to all healthcare staff b. Establish program for safe and efficient drug usage c. Develop a formulary of drug d. AOTA e. NOTA

55. ABG stands for: a. b. c. d. Arterial blood gradient Arterial Blood gasses C. Abdominal Bend Gauge Acid-Base Gap

56. D &C stands for: a. b. c. d. Discontinue Dye and Color Dilatation and Curettage AOTA

57. HOPI stands for: a. b. c. d. History of Present Illness History of Past Illness History of Patient Illness AOTA

58. Drugs with indicated use together with a “p. c” note should be taken when? a. b. c. d. After meal Before sleeping After waking-up

59. A type of hospital where all professional services, private and charity are provided and controlled by the active medical staff: a. Closed Staff b. Open Staff c. Honorary Medical Staff d. Consulting Staff

60. A private or public organization that provides comprehensive healthcare services to individuals enrolled to the organization: a. Hospital b. Health Management Organization c. Health Maintenance Organization d. Health Care Organization

61. 5%D/LR means: a. b. c. d. 5% Dextrose or Lactated Ringers 5% Dextrose and Lactated Ringers 5% Dextrose in Lactated Ringers NOTA

62. PICU stand for what hospital department? a. b. c. d. Pulmonary Intensive Care Unit Patient Information and Concern Unit Patient Information and Care Unit NOTA

63. Which hospital in the Philippines is the second hospital in Asia to be accredited by JCIA, and is considered as a tertiary hospital with a 650 bed capacity: a. UST Hospital b. St. Luke’s Medical Center c. Manila Doctor’s General Hospital d. Philippine General Hospital

64. A type of hospital that provides specific services to specific and selected type of patient or cases: a. b. c. d. General Hospital Special Hospital BOTH NOTA

65. Hospital Pharmacy was said to evolve from the early practice dated back in the times of Hippocrates. Where did Hippocrates practice Medicine and Pharmacy? a. Temple of Kas b. Temple of Kros c. Temple of Kos d. Temple of Kratos

66. When preparing a liquid dosage form, elixirs may be preferred over syrups because elixirs have better solvent properties for: I. weak organic acids II. weak organic bases -Elixirs are clear, III. flavoring oils sweetened, a. I only usually flavored b. III only hydroalcoholic solutions c. I and II only intended for oral d. II and III only use e. I, II, and III

67. The process of wetting and smoothing zinc oxide with mineral oil in preparation for incorporation into an ointment base is: a. attrition b. levigation c. milling d. pulverization e. trituration

68. Before placing a patient on IV fatty oil emulsions, the clinical pharmacist should confirm that the patient does NOT have: a. egg allergies b. sensitivities to bisulfite c. milk intolerance d. lactose intolerance e. sensitivities to tartrazine - Fatty oil emulsions are stabilized by the presence of egg phospholipids. As such they are usually contraindicated in those patients with serious allergies to eggs.

69. The incompatibility between _____ is a potential problem a. potassium chloride and calcium gluconate b. potassium chloride and insulin c. potassium phosphate and calcium gluconate d. potassium phosphate and zinc chloride e. insulin and zinc chloride

70. Which of the following antacid cannot be used by patients with heart failure? a. b. c. d. sodium bicarbonate Aluminum hydroxide calcium carbonate magnesium hydroxide -This cannot be used because of sodium content

71. Potential adverse effects of Aspirin include: I. GI ulceration II. hypersensitivity asthma III. cardiac arrhythmias a. b. c. d. e. I only I and II II and III I, II, and III - Cardiac arrhythmia is not induced by ASA

72. Which of the chemotherapeutic agents is most likely associated with pulmonary toxicity? a. Vincristine b. Doxurubicin c. Paclitaxel d. Bleomycin

73. Which of the following mood stabilizers would be most appropriate in a patient with liver disease? a. Lithium b. Valproic acid c. carbamazepine d. AOTA - Lithium is not known to cause hepatic dysfunction nor is metabolized via the liver. However both valproic acid and carbamazepine can impair liver function

74. Levodopa is associated with which of the following problems? a. GI disturbances b. Postural hypotension c. Dystonia d. Depression e. AOTA -Adverse effects of levodopa include GI disturbances, cardiovascular, musculoskeletal, CNS and haematological effects

75. This anti-parkinsonian agent may cause a first dose phenomenon that can trigger sudden cardiovascular collapse: a. Bromocriptine b. Selegiline c. Pergolide d. Amantadine e. NOTA - Bromocriptine should be used with caution in patients with a history of MI and arrhythmias

76. Substances which absorb moisture from the air but do not dissolve are called: a. hygroscopic powders b. effervescent powders c. deliquescent powders d. anhydrous powders e. efflorescent powders

77. This contains the conditions to which the use of the product is known to be associated to an unacceptable risk: a. warning b. precaution c. contraindication d. indication e. NOTA

78. These medications decrease the levels of phenytoin, carbamazepine, Phenobarbital, and primidoneby enhancing their metabolism: a. oral contraceptives b. oral hypoglycemics c. glucocorticoids d. TCAs e. AOTA -Other drugs that have same effect are azathioprine, cyclosporine, quinidine, theophylline, warfarin, doxycycline, and levodopa

79. Characterizes the first exposure of the fraction of the drug metabolized in the liver: a. first pass effect b. drug-receptor interaction c. biotransformation d. pharmacokinetics e. clearance

80. Aminophylline is indicated for bronchial asthma and for reversible bronchospasm associated with chronic bronchitis and emphysema. It is approximately 80 % theophylline. Which of the following can cause precipitation of theophylline from aminophylline solution? a. HCl -Aqueos solutions are alkaline and b. Na. OH display the incompatibilities of the c. Na. Cl alkalies. Acid cause a precipitation d. Water of theophylline. e. Na 2 SO 4

81. A patient’s serum cholesterol value is reported as 4 m. M/L. What is this concentration expressed in terms of mg/d. L? (mol. wt. of cholesterol = 386) a. 0. 154 mg/d. L b. 1. 54 mg/d. L c. 154 mg/d. L d. 596 mg/d. L e. 1, 540 mg/d. L

In this problem, the m. M/L concentration is converted by recognizing that 1 mol of cholesterol weighs 386 g and 4 mmol equals 0. 004 mol. 386 x 0. 004 mol = 1. 544 g or 1, 540 mg/L = 154 mg/d. L

82. The adult dose of a drug is 250 mg. What would be the approximate dose for a 6 -yearold child weighing 60 lb? (Use Young’s rule. ) a. 60 mg b. 85 mg c. 100 mg d. 125 mg e. 180 mg

83. A physician requests 1 av. lb of bacitracin ointment containing 200 U of bacitracin per gram. How many grams of bacitracin ointment (500 U/g) must be used to make this ointment? a. 182 g b. 200 g c. 227 g d. 362 g e. 400 g

84. Calcium chloride (Ca. Cl 2· 2 H 2 O) has a formula weight of 147. What weight of the chemical is needed to obtain 40 m. Eq of calcium? (Ca = 40. 1; Cl = 35. 5; H 2 O = 18) a. 0. 80 g b. 1. 47 g c. 2. 22 g d. 2. 94 g e. 5. 88 g

One equivalent of calcium chloride = 147 (mol. wt. ) divided by 2 (valence of calcium) = 73. 5 g and 1 m. Eq = 73. 5 mg. Therefore, 40 m. Eq is 40 × 73. 5 mg = 2, 940 mg, which is 2. 94 g. Or, the problem can be solved by the following equation:

85. A 250 -m. L infusion container contains 5. 86 g of potassium chloride (KCl). How many milliequivalents (m. Eq) of KCl are present? (mol. wt. of KCl = 74. 6) a. 12. 7 m. Eq b. 20 m. Eq c. 78. 5 m. Eq d. 150 m. Eq e. 157 m. Eq

86. The hospital protocol calls for additional dosing when the trough level of tobramycin (mol. wt. = 470) approaches 2 �g/m. L. The concentration may also be expressed as how many �mol/L? a. 2. 1 b. 4. 2 c. 6. 4 d. 8. 5 e. 0. 04

87. -89 87. What flow rate must be programmed into the PCA unit to obtain the desired amount of morphine per minute? a. 0. 01 m. L/min b. 0. 05 m. L/min c. 0. 1 m. L/min d. 0. 1 m. L/h e. 1. 0 m. L/min

88. Upon consultation, the prescriber decides to allow bolus PRN dosing of 2 mg with a lockout of 1 h intervals. Assuming that the patient uses all bolus -dosing intervals, approximately how long will the PCA last? The maximum volume used per hour will be a. <2. 5 days 0. 01 m. L/min � 60 min = 0. 6 m. L plus bolus b. 4 days dosing of 2 mg (0. 4 m. L) = 1 m. L total. Since c. 7 days the total volume in the PCA is 100 m. L, it d. 10 days should last at least 100 h or 4. 2 days. e. >14 days

89. How many m. L of a commercial morphine sulfate vial (25 mg/m. L) is needed to fill this order? a. 10 m. L b. 20 m. L c. 25 m. L d. 30 m. L e. 50 m. L

90. Alcohol has many pharmaceutical uses and is available in several concentrations. What is the concentration (% v/v) of full strength alcohol? a. 49% Alcohol USP, sometimes known as b. 70% grain alcohol, contains 94. 9% v/v or 92. 3% w/w of C 2 H 5 OH. The c. 92% remaining portion is water. It may d. 95% be used as a solvent and as a e. 100 source of alcohol for oral dosage forms.

91. A prescription calls for the dispensing of a 4% Pilocar solution with the directions of “gtt i OU TID. ” How many mg of pilocarpine hydrochloride is being used per day? Assume that the dropper is calibrated to deliver 20 drops to the m. L. a. 4 mg b. 6 mg c. 12 mg d. 24 mg e. 60 mg

92. A nurse in a nursing home setting mixes 240 m. L of a dietary supplement formula (400 m. Osm/L) with 250 m. L of D 10 W and 200 m. L of water containing 5 g calcium chloride (mol. wt. = 111; mol. wt. of dextrose = 180). What is the osmolarity of this solution? a. 280 m. Osm/L b. 370 m. Osm/L c. 410 m. Osm/L d. 470 m. Osm/L e. 540 m. Osm/L

93. How many mg of sodium chloride should be added to the following medication order to maintain isotonicity? “Atrovent Inhalation Solution 0. 02% 5 m. L + SWF Injection 25 m. L. Place in nebulizer ut dict” (Note: Atrovent inhalation solution is isotonic. ) a. 45 mg b. 225 mg c. 270 mg d. 900 mg e. 0 (since sterile water for injection is already isotonic)

Since the 5 m. L of Atrovent inhalation solution is already isotonic, the pharmacist has to render the remaining volume of solution (diluent) isotonic. 30 m. L – 5 m. L= 25 m. L × 0. 9% sodium chloride= 225 mg

94. A hospital clinic requests 2 lb of 2% hydrocortisone ointment. How many grams of 5% hydrocortisone ointment should be diluted with white petrolatum to prepare this order? a. 18. 2 g b. 27. 5 g c. 45. 4 g d. 363 g e. 545 g

95. How many m. L of isopropyl rubbing alcohol (70% v/v) will be needed to prepare 1 pt of 50% isopropyl alcohol? a. 70 m. L b. 170 m. L c. 342 m. L d. 400 m. L e. 480 m. L

96. Tuberculin syringe can measure up to: a. b. c. d. 1 m. L 5 m. L 10 m. L 20 m. L

97. Drug of Choice for Status Epilepticus: a. Lamotrigine b. Phenobarbital c. Diazepam d. Ethosuximide e. Carbamazepine -1 st line of treatment, Diazepam 0. 20. 3 mg/kg/dose then may repeat up to 3 doses until seizure stops

98. All are criteria for classification of Systemic Lupus Erythematosus (SLE), except: a. b. c. d. e. Malar rash Neurologic disorder Arthritis GI ulcerations Oral ulcers Criteria: Mnemonic S - erositis O -ral ulcer A- rthritis P- hotosensitivity B-lood disorder R- enal disorder A- ntinuclear Antibodies I- mmunologic disorder N- eurologic disorder M-alar rash D-iscoid rash

99. It is a genetically determined abnormal response to ordinary doses of a drug: a. b. c. d. Anaphylaxis Idiosyncracy Sensitization Drug Interaction

100. Vascor® is an anti hypertensive medication classified as: a. b. c. d. ACEIs – “prils” ARBs – “sartans” CCB – “dipines” , verapamil, diltiazem Beta blockers – “olols” -Vascor is imida. PRIL