2018

Annual Gold Questionnaire

There are 25 questions, all are compulsory.
This questionnaire has a mix of questions with ONE correct answer
in each case and 3–4 distractors.
Answers MUST be submitted online via www.psa.org.au by
30 September 2019.
How to access/enrol into the Annual Gold Questionnaire
• Go to the Pharmaceutical Society of Australia’s website –
www.psa.org.au
• Click on the login button and enter your username and
password
• Click on CPD, then CPD Catalogue
• Select Annual Gold Questionnaire under Type or Delivery Method
• Click on the Annual Gold Questionnaire tile
• Click on the enrol now button
• When you are ready to submit your answers please click on the
Launch button
• In the quiz select your 25 answers
• Submit your answers by navigating to the end of the quiz and
then click the submit all and finish button
• You will be advised of your overall mark upon the completion of
the questionnaire.
The pass mark is 75%, or 19 correct responses out of 25 questions.
Members must submit their answers by 30 September 2019.
PSA acknowledges and thanks the following PSA members for their
extensive contribution to the Annual Gold Questionnaire 2018.
Their commitment to the profession and the promotion of lifelong
learning is greatly appreciated.
Emeritus Professor Bruce Sunderland, Pascale Ng Cheong Tin, Kim
Watkins, Marcus Weidinger, Jane Carpenter, Rowland Hill, Jocelyn
Sisson, Annette Simper, Roxana Jafar, Tracy Routledge, Glenn Joyce,
Anthony Maguire, Michelle Sweeney, Fei Sim.
Learning objectives
After completing the Annual Gold Questionnaire 2018 pharmacists should be
able to:
• Use readily available information sources to access and select relevant and
up-to-date clinical and practice-based information
• Promote and contribute to the optimal use of medicines
• Address primary healthcare needs of patients
Competency Standards 2016
1.1.1, 1.1.2, 1.1.3, 1.1.4, 1.2.1, 1.2.2, 1.2.3, 1.3.1,1.5.1, 1.5.2, 1.5.4, 1.6.1, 2.1.1, 2.1.2,
3.1.1, 3.1.2, 3.2.1, 3.2.2, 3.2.3, 3.2.4, 3.2.5, 3.3.1, 3.3.2, 3.3.3, 3.4.1, 3.4.4, 3.6.1, 4.5.2
To answer these questions you may need to refer to the
following references:
• Approved Product Information and Consumer Medicines
Information – MIMS/eMIMS or www.medicines.org.au
• Australian Immunisation Handbook
– www.immunise.health.gov.au
• Australian Journal of Pharmacy
• Australian Medicines Handbook AMH 2018
• Australian Pharmaceutical Formulary and Handbook (APF) 24th
edition
• Australian Pharmacist – www.psa.org.au
• Australian Prescriber – www.australianprescriber.com
• Gastroenterological Society of Australia – www.gesa.org.au
• King Edward Memorial Hospital – www.kemh.health.wa.gov.au
• Martindale, The Complete Drug Reference 38th edition
• National Vascular Disease Prevention Alliance - cvdcheck.org.au
• National Heart Foundation – www.heartfoundation.org.au
• NPS News, Prescribing Practice Review and RADAR
– www.nps.org.au
• Pharmaceutical Benefits Schedule – www.pbs.gov.au
• Royal Children s Hospital Melbourne www.rch.org.au
• RGH Pharmacy E-Bulletin – www.auspharmlist.net.au/ebulletin.
php
• Saint John Ambulance - http://stjohn.org.au/
• State Health department guidelines
• The Pharmaceutical Society of Australia’s Essential CPE and Self
Care Fact Cards – www.psa.org.au
• The Pharmaceutical Society of Australia’s Practice support and
tools - www.psa.org.au
• The Royal Australian College of General Practitioners – www.
racgp.org.au
• Therapeutics Goods Administration – www.tga.gov.au
• Therapeutic Guidelines – www.tg.org.au
• Western Australian Therapeutic Advisory Group –
www.watag.org.au
• World Health Organisation
Accreditation number: CP18012.
This activity has been accredited for 5 hours of Group 1
CPD (or 5 CPD credits) suitable for inclusion in an individual
pharmacist’s CPD plan which can be converted to 5
hours of Group 2 CPD (or 10 CPD credits) upon successful
completion of relevant assessment activities.

PSA Committed to better health

QUESTIONS
Answer ALL 25 Questions
1. Ixekizumab is an injectable treatment for psoriasis first
listed by the Therapeutic Goods Administration (TGA) in
September 2016, under the trade name Taltz.
Which ONE of the following statements is INCORRECT?
a) Taltz is indicated for adult patients with moderate to severe
plaque psoriasis who are candidates for systemic therapy
or phototherapy.
b) The first dose is 160 mg by subcutaneous injection (two 80
mg injections), followed by 80 mg every 2 weeks to week
12, then 80 mg every 4 weeks thereafter.
c) It is recommended to be stored at 2°C to 8°C. However, the
syringes or auto-injector may be kept at a temperature not
exceeding 30°C for up to 5 days total as long as they are
then used within 5 days.
d) Patients with inflammatory bowel disease should be
treated with caution as there have been reports of
exacerbation or new cases reported in patients treated
with ixekizumab.
e) Unlike other medicines in this class, patients injected with
ixekizumab should be advised not to drive or operate
machinery for 24 hours.
2. The frail aged are an increasing cohort in the Australian
community. There is no specific definition for frail aged,
but often it is characterised by exhaustion, weakness
and unintentional weight loss. It also encompasses an
accumulation of medical, functional and social deficits.
As a community pharmacist, you are concerned about the
prescribing for this group of patients especially when you
are providing medicines to patients at residential aged care
facilities.
Which ONE of the following statements is INCORRECT with
respect to this group of patients?
a) Men categorised as frail are prescribed polypharmacy (≥
five drugs) at more than twice the rate of robust men.
b) Evidence suggests that increasing medicine load is
associated with transitioning from pre-frail to frail status
and subsequent death.
c) Frailty markedly reduces CYP3A4 and P-glycoprotein
activities.
d) Antihypertensive medicine reduces the risk of stroke or
cardiovascular events in both frail and robust patients.
e) Potential drug interactions in frail patients were seven-
fold higher compared with robust patients in a study
conducted at a tertiary referral hospital.
3. The number of Australians being diagnosed with diabetes is
increasing. Traditionally, pharmacists have concentrated on
counselling on appropriate use of medicines and monitoring
blood glucose levels plus lifestyle changes like diet and
exercise. New research has suggested a focus on injecting
technique and advice on needle size should also be included.
With regard to providing clinical best practice, which ONE of
the following statements is INCORRECT?
a) Longer pen needles such as 8 mm and 12 mm have been
associated with a greater risk of delivering insulin into the
muscle instead of the intended subcutaneous tissue.
b) Inadvertent intramuscular injection of insulin can cause
bleeding, bruising and pain as well as interfering with
blood glucose control.
c) The use of shorter 4 mm or 5 mm pen needles and correct
injecting technique can reduce unwanted outcomes and
help achieve their HbA1c targets.
d) Shorter 4 mm and 5 mm needles are suitable for both adults
and children but not for obese patients with diabetes.
e) Recommended injection sites include the abdomen, thigh,
buttock and upper arm. Rotation of the injection site is
critical for effective and comfortable injecting.
4. The demographic of the area where you work has been
changing, resulting in a larger proportion of young families
in the area. You decide to include infant health as a priority
area when developing your CPD Plan for the year.
Which ONE of the following statements is INCORRECT?
a) Lifestyle factors that may exacerbate nappy rash include
infrequent nappy changes, residual detergent or chemicals
in nappies, excessive washing with soap, use of baby
wipes, zinc deficiency.
b) Influenza and Pneumococcal conjugate (13vPCV)
immunisations are included on the National Immunisation
Program for at-risk groups between the age of 6 and 12
months, with the exception of Aboriginal and Torres Strait
Islanders.
c) Simple febrile seizures occur in about 3% of children
between 6 months and 5 years of age. Paracetamol or
ibuprofen can be administered to reduce temperature, but
they do not reduce the risk of febrile seizures.
d) Symptoms of severe dehydration as may be seen in an
infant suffering from gastroenteritis include: sunken eyes;
abnormal lethargy; a visible skin fold more than 2 seconds
after a pinch test and rapid pulse and breathing.
e) In order to reduce the risk of spreading threadworm,
patients should be advised to wear close fitting underwear
which is changed each morning, wear freshly laundered
cotton gloves to bed to reduce night time scratching and
to bath or shower immediately after waking, washing
around the anus to remove eggs laid during the night.
5. A visit to any restaurant or supermarket will demonstrate
that gluten free options are now requested by an increasing
number of people. Symptoms of gluten intolerance and
coeliac disease can remain undiagnosed for years with a
suggestion that approximately 75% of people with coeliac
disease remain undiagnosed. Pharmacists are in an ideal
position to give advice to patients about symptoms which
may be caused by an underlying condition like coeliac
disease.
Which ONE of the following statements regarding coeliac
disease is INCORRECT?
a. Coeliac disease is an autoimmune disorder that results
in an abnormal immune response to dietary gluten in
susceptible people with symptoms which include lethargy,
diarrhoea, abdominal pain, bloating and indigestion.
b. Untreated coeliac disease is associated with nutritional
deficiencies, premature osteoporosis, abnormal liver
function and other autoimmune conditions like thyroid
disease, infertility, poorer pregnancy outcomes and
lymphoma.
c. Gluten present in wheat, rye, barley and oats induce an
immune response that results in a loss of intestinal villi
(villous atrophy) and inflammation (crypt hyperplasia and
intraepithelial lymphocytosis).
d. The only treatment for coeliac disease diagnosed by
gastroscopy and duodenal biopsy is a strict gluten free diet
for life.
e. Repeat antibody testing after 1 month on a gluten free diet
can be helpful for assessing response and the patient’s
adherence to the diet.
6. You receive a request to add 15 mmol of K+ to a 100 mL bag
of glucose 5% infusion. Assuming no overage, which ONE
of the following is approximately the correct volume of 20%
potassium chloride concentrate required?
a. 11.2 mL.
b. 5.6 mL.
c. 2.9 mL.
d. 0.6 mL.
e. None of the above.
7. Functional dyspepsia is a common problem in Australia
and often impacts on quality of life and work productivity.
It affects 10% of the population and is more prevalent in
women.
Which ONE of the following statements about functional
dyspepsia is INCORRECT?
a. Postprandial distress syndrome is a more common subtype
of functional dyspepsia than epigastric pain syndrome.
b. Both syndromes above require the absence of evidence
of organic, systemic, or metabolic disease that is likely to
explain the symptoms on routine investigations.
c. Acid suppression is likely to be more efficacious in
epigastric pain syndrome whilst prokinetics are likely to be
more efficacious in postprandial distress syndrome.
d. There is new evidence that a low ‘Fermentable Oligo-,
Di-, Mono-saccharides And Polyols’ (FODMAP) diet helps
functional dyspepsia as irritable bowel syndrome often
co-exists with this condition.
e. Psychological distress is common in patients with
functional dyspepsia with anxiety being more prevalent
than depression.
8. Juliette, a 17-year-old female patient, seeks your advice as
she is concerned about commencing the combined oral
contraceptive pill (COCP) that has just been prescribed by her
regular GP. She has heard that the COCP can have side effects
and isn’t suited to every woman. During the conversation you
discover that Juliette is concerned as she has been smoking
up to 12 cigarettes a day for the last 6 months.
According to the 2016 World Health Organization (WHO)
Medical eligibility criteria for contraceptive use: quick reference
chart, which ONE of the following statements is INCORRECT?
a. Juliette’s age is not a contraindication to the use of the
COCP.
b. If Juliette suffered from migraine with aura, taking the
COCP would be contraindicated.
c. Chronic pelvic inflammatory disease would be a
contraindication to the initiation of a COCP.
d. The COCP is contraindicated for patients 35 years old or
over who smoke more than or equal to 15 cigarettes a day.
e. There would be no restriction for the use of a copper
intrauterine device if Juliette had diabetes and was over 20
years of age.
9. Despite sensational reports in the media about deaths from
snake bite and the fears of international travellers, there
are only, on average, two deaths per year and around 3,000
recorded snake bites annually in Australia. The low mortality
is attributed to good supportive care, including first aid, and
the existence of antivenoms.
Which ONE of the following statements about snake bites and
their treatment is INCORRECT?
a. Systemic effects of significant envenomation include
nausea, vomiting, headache, abdominal pain, diarrhoea,
diaphoresis and collapse. Major organ effects can also
occur including coagulopathy and, less commonly,
neuromuscular paralysis and myotoxicity.
b. When administering first aid for snake bite, the venom
should not be washed off the skin or clothes because it
may assist with identification of the type of snake. A snake
venom detection kit is used in hospitals to identify which
antivenom to use. There are five main medically important
snake immunotypes.
c. In all cases of suspected snake bite, a pressure bandage
should be applied over the whole affected limb, the limb
immobilised (splinted) and the patient kept lying down
and completely still. Bandaging pressure should be the
same as that used for a sprained ankle, preferably using an
elasticised bandage.
d. If antivenom is required, the dose for children up to 6
years of age is one quarter of the adult dose whilst 7 to 12
year olds should be treated with half the adult dose. The
usual adult dose is one vial of the appropriate antivenom,
diluted with normal saline or Hartmann’s solution and
administered by slow intravenous infusion.
e. Allergic reactions to antivenom occur in about one quarter
of patients but are only severe in around five percent.
Antivenom administration must occur in a critical care
area with readily available adrenaline and resuscitation
equipment. Due to the presence of equine protein, delayed
serum sickness can also occur at between 4 to 14 days after
treatment.
10. Epclusa (sofosbuvir 400 mg plus velpatasvir 100 mg) was the
first hepatitis C medicine shown to effectively treat all of the
six main hepatitis C genotypes with a once a day dose. It is
listed on the PBS as Authority required.
Which ONE of the following statements with regard to Epclusa
is INCORRECT?
a. Although sofosbuvir/velpatasvir treats all six genotypes
of hepatitis C, patients with hepatitis C virus genotype 3
with compensated cirrhosis are also recommended to be
prescribed ribavirin.
b. It is advisable to avoid antacids for at least 4 hours before or
after taking sofosbuvir/velpatasvir.
c. Sofosbuvir/velpatasvir is safe in pregnancy and
breastfeeding.
d. The recommended dose of sofosbuvir 400 mg/velpatasvir
100 mg is one tablet daily for 12 weeks.
e. Patients who have had hepatitis B previously may not be
suitable for treatment with sofosbuvir/velpatasvir as the
hepatitis B may become active again.
11. There are several pharmacological considerations in the
management of Parkinson’s disease (PD).
Which ONE of the following statements about PD
management is INCORRECT?
a. Levodopa is ideally administered 30-45 minutes prior to
meals, to limit competition with dietary protein/amines
(from food or supplements) for cerebral uptake.
b. Domperidone’s poor blood-brain barrier penetration
makes it a preferred oral antinauseant in PD. QT
prolongation and related signs/symptoms (e.g.
presyncope, syncope and falls) warrants monitoring in
those over 60 years of age and doses greater than 30 mg
per day.
c. Ondansetron is useful if a parenteral antiemetic is required
and does not worsen PD control. It can be given in
conjunction with all PD therapies.
d. Dopamine agonists such as pramipexole and rotigotine
can cause impulse control disorders, including
pathological shopping, eating, hoarding, gambling and
sexual preoccupation.
e. When oral administration is no longer suitable, a switch
from oral dopaminergic therapy to transdermal rotigotine
can be made using levodopa equivalent doses (LEDs).
An LED is the dose of antiparkinson drug that produces
the same symptom control as 100 mg immediate-release
levodopa combined with a dopa-decarboxylase inhibitor.
12. Guidelines on the management of migraine were recently 14. You are the local community pharmacist on duty when you
revised. are presented with a prescription for:

Which ONE of the following is INCORRECT information Lithium carbonate SR 450 mg twice daily.
regarding the management of migraine?
The patient confirms the medicine is to treat her bipolar
a. For acute migraine, opioid analgesics should only be used disorder and this is the first time she has had it prescribed.
when other drugs are not tolerated or are contraindicated. While the patient goes for a blood test, you take the
b. Limit non-opioid analgesic use to less than 15 days per opportunity to brush up on important counselling points for
month and triptan use (or medicines that contain opioid patients commencing lithium therapy.
analgesics) to less than 10 days per month. If used more
often, there is a risk of medication overuse headache. Which ONE of the following statements is INCORRECT?
c. If treatment for acute migraine is required on more than 5 a. The dosage to be taken is ONE tablet twice daily. This is
days per month consider migraine prophylaxis. Topiramate best taken 12 hours apart with food. The Quilonum SR
is a first line choice if there is a history of depression. tablets prescribed must be swallowed whole and must not
be taken with hot drinks.
d. Sedating medicines such as a tricyclic antidepressant,
pregabalin or gabapentin may be useful options for b. While undergoing treatment with lithium it is important to
prophylaxis if insomnia is also an issue. maintain a normal diet with adequate salt and fluid intake.
Fluid intake should be increased during hot weather to
e. Candesartan and topiramate may be good choices
avoid toxicity with lithium due to dehydration.
for prophylaxis where overweight or diabetes are also
considerations. c. Signs of lithium toxicity include excessive thirst and
urination, nausea and vomiting, muscle weakness and
involuntary movement. The risk of toxicity is greater during
13.You are a newly registered pharmacist who has taken a 6
illness, with excessive fluid loss (e.g. profuse sweating) and
month position in a pharmacy which offers obstructive when fluid intake is low.
sleep apnoea (OSA) services including a home sleep study, a
d. Lithium can interact with oral anti-inflammatory medicines
continuous positive airways pressure (CPAP) trial service and
such as ibuprofen and diclofenac with the potential to
the sale of CPAP equipment. In order to be better equipped increase the risk of lithium toxicity. Sodium bicarbonate
to handle enquiries regarding these services, you thought it found in certain antacids (e.g. Gaviscon) and urinary
would be best to review current literature on OSA. alkalinisers (e.g. Ural) may reduce lithium levels in the body
reducing its effectiveness.
Which ONE of the following statements regarding obstructive
sleep apnoea is INCORRECT? e. Regular blood tests are required to monitor lithium levels
to confirm the correct dose of lithium. Blood tests need to
a. OSA occurs due to repeated collapse of the upper airway. be performed immediately after taking the morning dose
This may result in a partial (hypopnoea) or complete to ascertain peak plasma concentration.
(apnoea) blockage of airflow causing hypoxaemia,
increased sympathetic activity and fragmented sleep.
b. Symptoms suggestive of OSA include daytime sleepiness,
unrefreshing sleep, snoring, dry mouth and waking up
gasping for air.
c. Risk factors for developing OSA include diabetes, obesity,
increasing age, male gender, menopause, alcohol use,
smoking and family history.
d. Apnoea-Hypopnoea Index (AHI) is a calculation of the
average number of apnoeas and hypopneas per hour
of sleep as measured by polysomnography. Along with
oxygen desaturation it is used to determine the severity of
a patient’s OSA. In adults an AHI of less than 5 is considered
normal.
e. Readily available treatments for snoring such as oral sprays
and nasal breathing strips have been found to be effective
options for some patients diagnosed with OSA. This can
avert the need for treatment with a continuous positive
airway pressure (CPAP) device.
15. Mr JP is a 59-year-old (85 kg, 175 cm) successful real estate
agent and a patient of your community pharmacy. Mr JP leads
a busy lifestyle and is often under enormous stress to reach
his sales target. Mr JP is a smoker (smokes about 12 cigarettes
a day) and enjoys one to two alcoholic beverages every night
with his evening meals.
Medical conditions:
• Hypertension
• Gout (last gout attack 6 months ago)
• Type 2 diabetes
• Hypercholesterolaemia
• Occasional heartburn
• Occasional headaches
• Allergic rhinitis (usually during spring)
Medications:
• Amlodipine 5 mg tablet – 1 mane
• Metformin 500 mg tablet – 1 tds
• Rosuvastatin 20 mg tablet – 1 d
• Allopurinol 100 mg tablet – 1 d
• Colchicine 0.5 mg tablet – Take prn
• Ranitidine 150 mg tablet – Take prn (bought over-the-
counter (OTC))
• Fexofenadine 180 mg tablet – Take prn (bought OTC)
• Paracetamol 665 mg tab – 2 tablets prn (bought OTC)
• Diclofenac 1% gel – Use prn (bought OTC)
Relevant lab and non-lab results:
• Random BSL – 6.0 mmol/L
• HbA1c – 50 mmol/mol
• BP – 159/102 mmHg
• Total cholesterol – 5.4 mmol/L
• HDL – 1.8 mmol/L
• LDL – 3.0 mmol/L
• Triglycerides – 1.5 mmol/L
• Serum creatinine – 110 micromol/L
Which ONE of the following statements is the MOST
APPROPRIATE patient-centred recommendation you can
provide?
a. Estimated creatinine clearance is 40 mL/min, hence the
dose of metformin should be reduced to 500 mg bd.
b. Absolute cardiovascular disease risk based on the National
Vascular Disease Prevention Alliance’s Australian Absolute
Cardiovascular Disease Risk calculator is 12%, indicating a
moderate risk of a cardiovascular event in the next 5 years.
c. Blood pressure is above the target range, hence an
angiotensin-converting enzyme inhibitor such as ramipril 5
mg daily should be added.
d. The use of colchicine is contraindicated in this patient,
hence a non-steroidal anti-inflammatory drug such as
naproxen 250 mg bd would be preferable for an acute flare.
16. Jason is an 8-year-old boy (26 kg, 130 cm) who has just been
diagnosed with juvenile idiopathic arthritis after a thorough
physical examination, laboratory tests and imaging. After
a 3-month trial of naproxen with little improvement in his
symptoms, the rheumatologist has written a prescription for
methotrexate injection 25 mg/0.5 mL, to be administered
subcutaneously.
Which ONE of the following volumes would be the CORRECT
recommended weekly dose of methotrexate injection 25
mg/0.5 mL?
a. 0.05 mL.
b. 0.10 mL.
c. 0.30 mL.
d. 0.50 mL.
Question 17 IBS
17. A 27-year-old woman, Li Mei, asks for your assistance with a
vitamin formula for irritable bowel syndrome (IBS). She has
just been diagnosed with the condition and doesn’t really
know what to do. Her bowel issues seemed to start after an
upsetting relationship break-up a year ago. Her symptoms
include a lot of abdominal pain, bloating and loose watery
bowel movements.
Which ONE of the following facts about IBS is INCORRECT?
a. The non-specific symptoms of IBS require extensive and
invasive investigations (e.g. colonoscopy) to exclude
differential diagnoses (e.g. bowel carcinoma) that could be
life threatening. This can often delay diagnosis for a year or
more.
b. The Rome IV criteria and Bristol stool chart are useful
diagnostic tools in confirming a diagnosis of IBS and
classifying the type of bowel pattern.
c. Visceral hypersensitivity is thought to be a key factor in IBS,
but it is not a diagnostic marker because it is not a constant
finding among all patients with the condition. A trial of
a low FODMAP diet can assist some patients by limiting
foods that aggravate the gut.
d. Loperamide is a suitable treatment to manage the
symptom of diarrhoea. Cholestyramine and sterculia are
alternative therapeutic options.
e. Mebeverine or iberogast are appropriate treatments
to trial in managing the symptom of abdominal pain.
In patients with persistent pain despite treatment with
an antispasmodic, a trial of a tricyclic antidepressant is
recommended.
18. Praxbind (idarucizumab) is indicated for the reversal of the
anticoagulant effects of Pradaxa (dabigatran).
Which ONE of the following statements is the MOST
APPROPRIATE with regard to this reversal agent?
a. Although idarucizumab is marketed for the reversal of the
anticoagulant effects of dabigatran, this specific non-
vitamin K antagonist oral anticoagulant reversal agent is
effective in reversing the anticoagulant effects of all novel
oral anticoagulants.
b. The effects of idarucizumab in reversing the anticoagulant
effects of dabigatran is more rapid if given intravenously
(within 1 minute) when compared to when it is given orally
(within 10 minutes).
c. Idarucizumab use has been associated with an increased
risk of hepatic impairment, hence patients’ liver function
should be monitored immediately after the administration
of idarucizumab and at a 4-weekly interval for a period of 6
months.
d. Anticoagulant therapy with dabigatran should be resumed
as soon as medically appropriate (can be restarted 24
hours after administration of idarucizumab) to reduce the
risk of thrombosis from the patient’s underlying disease.
19. Breast milk has many benefits to babies and the World Health
Organization recommends mothers breastfeed exclusively
for 6 months post-partum. Pharmacists need to consider the
safety of over-the-counter (OTC) medicines in breastfeeding
women when making recommendations for this group.
Which ONE of the following statements about commonly
used OTC medicines in breastfeeding is CORRECT?
a. OTC analgesics such as ibuprofen, paracetamol and aspirin
are considered safe to use for acute pain in breastfeeding
mothers.
b. Due to the risk of side effects like nausea, vomiting and
diarrhoea, anthelmintics (such as mebendazole and
pyrantel) should not be taken by breastfeeding mothers.
c. There is some risk of reduced milk production with oral
pseudoephedrine use. Short term use for nasal symptoms
associated with colds and flu is probably safe but
decongestant nasal sprays are considered a better option.
d. Ranitidine is preferable to pantoprazole for treating
gastrointestinal reflux in breastfeeding women because
less ranitidine is transferred into the breast milk.
e. Although iodine can interfere with infant thyroid function,
the amount of iodine in Betadine Sore Throat Gargle is too
low to cause problems and this product can be safely used
by breastfeeding mothers
20. In the management of heart failure, which ONE of the
following statements is CORRECT?
a. Heart failure is a clinical diagnosis. An echocardiogram may
be performed but isn’t essential for guiding treatment.
b. The percentage of blood left in the left ventricle after
each beat is the left ventricular ejection fraction. If it is
more than 70%, it is classed as heart failure with preserved
ejection fraction.
c. Angiotensin converting enzyme inhibitors and heart failure
specific beta-blockers such as atenolol reduce mortality in
heart failure with preserved ejection fraction.
d. The neprilysin inhibitor sacubitril enhances the
vasodilating and diuretic effects of natriuretic peptides.
It may benefit heart failure with reduced and preserved
ejection fraction.
e. Furosemide addresses compensatory neurohormonal
mechanisms and so improves survival. Higher doses are
required in heart failure with preserved ejection fraction.
21. Each year over 120,000 cases of shingles are reported in
Australia. Over 95% of the Australian population harbour the
latent varicella zoster virus (VZV).
The shingles vaccine Zostavax is included in the National
Immunisation Program. Pharmacists have a professional role
to inform eligible patients of this beneficial health program.
Which ONE of the following statements is INCORRECT?
a. Reactivation of the dormant VZV, which resides in the
dorsal root ganglia after primary chickenpox infection, can
cause shingles.
b. Pain and nerve damage caused by shingles can begin
before any rash is visible and there is no way of predicting
how severe or how long the pain will last.
c. Zostavax is indicated for the prevention of shingles in
individuals 50 years and over. In individuals 60 years and
over, Zostavax is also indicated for prevention of post–
herpetic neuralgia (PHN) and for reduction of acute and
chronic zoster associated pain.
d. The frequency and severity of complications of shingles
increases with age, particularly over 70 years, and PHN can
be severe and may last for months or even years.
e. Zostavax on the National Immunisation Program will be
free of charge to eligible individuals 65-79 years of age to
help protect against shingles and PHN.
22. A pharmacist receives a prescription for omeprazole 2 mg/mL
for an infant.
Standard formulations for omeprazole are capsules and
tablets containing enteric-coated granules as well as an
intravenous solution.
Which ONE of the following considerations is CORRECT when
formulating a solution for an infant?
a. Omeprazole needs to be compounded in slightly acidic
solution with appropriate thickening and flavouring
agents.
b. The sensory systems of infants are not well developed for
detecting tastes, smells and chemical irritants.
c. The paediatric dose for this solution for a 7 kg baby would
be 2.5 mL once a day.
d. The easiest way to accurately formulate a stable solution
is to use an appropriate weight of granules from capsules
containing enteric coated granules.
e. Acesulfame potassium is used in formulations as a viscosity
increasing agent.
23. Which ONE of the following statements is NOT a
recommendation from the Royal Australian College of
General Practitioners (RACGP) regarding preventive activities
prior to pregnancy?
a. Women who are considering pregnancy should take an
iodine supplement of 150 micrograms each day.
b. Women who are considered low risk for neural tube
defects should take 0.5 mg per day supplement of folic
acid for at least 1 month prior to pregnancy, and for the
first 3 months after conception.
c. Women who have closely-spaced pregnancies require
nutritional assessment and appropriate intervention in
the preconception period with an emphasis on optimising
maternal body mass index (BMI) and micronutrient
reserves.
d. Women who are considering pregnancy should be
routinely supplemented with 60 mg of elemental iron as
iron deficiency anaemia increases the risk of pre-eclampsia.
24. Mr Woods is a regular customer of yours and presents to the
pharmacy with a prescription written by a pain specialist
for pregabalin 75 mg twice daily. He has suffered from
diabetic peripheral neuropathy for a number of months and
previously trialled amitriptyline, but developed intolerable
side effects.
Which ONE of the following statements regarding the
management of neuropathic pain is INCORRECT?
a. Pharmacological treatments for neuropathic pain include
tricyclic antidepressants (TCAs), anti-epileptic drugs and
serotonin noradrenaline reuptake inhibitors (SNRIs).
b. Pregabalin may be useful in patients who require a rapid
onset of effect as TCAs, such as amitriptyline, require a trial
of at least 2 weeks before assessing response.
c. Trial data demonstrates that one in two to three patients
treated with a TCA achieves a clinically relevant outcome
(defined as a 50% reduction in pain score), compared with
one in four to five for pregabalin.
d. Combination therapy may be considered in refractory
cases; available evidence supports the combination of
pregabalin and amitriptyline in these patients.
25. A customer of your pharmacy has a Webster dose
administration aid prepared each week.
His medicines include warfarin and the INR result is
forwarded to the pharmacy after each reading and his dose is
calculated accordingly. The warfarin dose rarely changed until
recently when his readings became very erratic.
In trying to determine the reason for this you learn he has
started a vegetable garden and was growing and eating lots
of his produce, including broccoli and brussels sprouts.
You discuss with him the issue of foods containing vitamin
K (phytomenadione) to explain his INR fluctuations and to
encourage him to try to maintain a fairly constant intake of
these foods in his diet so as to regulate his warfarin dose.
Which ONE of the following statements is INCORRECT?
a. Of all the fat soluble vitamins, vitamin K has the highest
individual daily variation in both dietary intake and
corresponding plasma concentration.
b. Olive, soybean, canola and cottonseed oils are high in
vitamin K while sesame, peanut and safflower oils are low
sources of vitamin K.
c. Broccoli, spinach and brussels sprouts are amongst the
highest vitamin K content foods available.
d. Animal products, including dairy and liver, are as a general
rule poor dietary sources of vitamin K.
e. Freezing, steaming and microwaving vegetables destroys
the vitamin K content.