APC Clinical Procedures and Protocols 3 — Questions and Answers
Question 1: A pharmacist in a community setting is asked to supply an S8 opioid under an emergency verbal order. Which condition must be met before supply?
- The pharmacist personally knows the prescriber
- The prescriber must provide a written follow-up prescription within 24 hours
- A statutory declaration from the patient is obtained
- The prescriber faxes confirmation within 72 hours and the pharmacist records the supply (Correct answer)
Correct answer: The prescriber faxes confirmation within 72 hours and the pharmacist records the supply
Under most Australian state/territory S8 regulations, emergency verbal supply is permitted if the prescriber faxes confirmation within 72 hours and full records are kept.
Question 2: Which clinical parameter is the primary guide for adjusting vancomycin dosing in current Australian practice guidelines?
- Peak serum concentration
- Trough serum concentration alone
- Area under the curve to minimum inhibitory concentration ratio (AUC/MIC) (Correct answer)
- Creatinine clearance alone
Correct answer: Area under the curve to minimum inhibitory concentration ratio (AUC/MIC)
Current guidelines recommend AUC/MIC-guided vancomycin dosing (target AUC 400–600 mg·h/L) rather than trough-only monitoring.
Question 3: A 70 kg adult patient is to receive a stat IV phenytoin dose of 15 mg/kg for status epilepticus. What is the maximum recommended infusion rate?
- 25 mg/min
- 50 mg/min (Correct answer)
- 100 mg/min
- 150 mg/min
Correct answer: 50 mg/min
IV phenytoin must not be infused faster than 50 mg/min in adults to prevent cardiac arrhythmias and hypotension.
Question 4: What is the recommended action when a patient's subcutaneous insulin injection site shows lipohypertrophy?
- Increase the insulin dose at that site to overcome absorption issues
- Continue using the site but apply warm compresses before injection
- Rotate injections away from the affected site and educate the patient on rotation technique (Correct answer)
- Switch from subcutaneous to intramuscular injections
Correct answer: Rotate injections away from the affected site and educate the patient on rotation technique
Lipohypertrophy impairs insulin absorption; the site must be avoided and the patient educated on proper rotation to all recommended anatomical areas.
Question 5: Under the Australian Poisons Standard, which schedule applies to medications that require a prescription and may be supplied by a pharmacist with specific record-keeping requirements but are not as tightly controlled as S8?
- Schedule 3
- Schedule 4 (Correct answer)
- Schedule 7
- Schedule 8
Correct answer: Schedule 4
Schedule 4 (prescription-only) medicines require a valid prescription and standard prescription records, with less stringent controls than S8 drugs of dependence.
Question 6: Which sign is an early indicator of local anaesthetic systemic toxicity (LAST) requiring immediate intervention?
- Mild drowsiness and metallic taste (Correct answer)
- Complete cardiovascular collapse
- Tonic-clonic seizure
- Severe hypotension
Correct answer: Mild drowsiness and metallic taste
Perioral tingling, metallic taste, and mild drowsiness are early neurological warning signs of LAST that demand immediate cessation of injection and preparation of lipid emulsion.
Question 7: A patient receiving warfarin has an INR of 9.2 with no active bleeding. According to Therapeutic Guidelines: Anticoagulation, the most appropriate management is:
- Withhold warfarin and give vitamin K 10 mg IV immediately
- Withhold warfarin, give oral vitamin K 1–2 mg, and recheck INR in 24 hours (Correct answer)
- Continue warfarin at the same dose and recheck INR in 48 hours
- Administer prothrombin complex concentrate (PCC) immediately
Correct answer: Withhold warfarin, give oral vitamin K 1–2 mg, and recheck INR in 24 hours
For an INR 5–10 with no bleeding, withholding warfarin and administering low-dose oral vitamin K (1–2 mg) with next-day INR recheck is the recommended approach.
APC Clinical Procedures and Protocols 3
A pharmacist in a community setting is asked to supply an S8 opioid under an emergency verbal order.
Which condition must be met before supply?