Mixed Deck — All CAOP Topics Flashcards

How many millimoles (mmol) of sodium are present in a 250 mL intravenous bag of 0.9% w/v Sodium Chloride (NaCl)? (Molar mass of Na = 23 g/mol, Cl = 35.5 g/mol)

Answer: 38.5 mmol

1. Molar mass of NaCl = 23 + 35.5 = 58.5 g/mol. 2. Calculate the mass of NaCl in the bag: 0.9% w/v = 0.9 g / 100 mL. In 250 mL, the mass is (0.9 g / 100 mL) × 250 mL = 2.25 g. 3. Calculate the moles of NaCl: Mass / Molar mass = 2.25 g / 58.5 g/mol ≈ 0.0385 mol. 4. Convert moles to millimoles: 0.0385 mol × 1000 mmol/mol = 38.5 mmol. 5. Since there is one sodium atom per molecule of NaCl, the millimoles of Na+ are equal to the millimoles of NaCl, which is 38.5 mmol.

A pharmacist is compounding an epidural solution. Which ingredient must be AVOIDED?

Answer: Preservative-containing formulations

Preservatives such as benzyl alcohol and parabens are neurotoxic and must not be used in epidural or intrathecal preparations.

Which type of drug information question requires knowledge of pharmacokinetics and individual patient factors?

Answer: Dosing in renal impairment

Dosing in renal impairment requires integrating pharmacokinetic parameters (e.g., renal clearance) with patient-specific renal function data.

A 72-year-old patient, who was started on allopurinol 100mg daily two weeks ago for gout, presents to the pharmacy complaining of a new, non-itchy rash on his torso. What is the most appropriate initial action for the pharmacist to take?

Answer: Advise the patient to immediately stop taking the allopurinol and to see their GP for an urgent assessment.

Allopurinol is associated with a risk of severe cutaneous adverse reactions (SCARs), such as Stevens-Johnson Syndrome (SJS) or Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), which can be life-threatening. Any rash, even if initially mild, that develops within the first few months of starting allopurinol should be treated as potentially serious. The safest and most critical action is to advise the patient to cease the medication immediately and seek urgent medical review to rule out a severe reaction.

A pharmacist is creating a health promotion display on healthy eating for weight management and wants to include reliable, evidence-based Australian resources for patients. Which organisation is the most appropriate source for this material?

Answer: The Australian Government Department of Health and Aged Care's 'Healthdirect' service

Healthdirect is an Australian government-funded service that provides a wide range of reliable, evidence-based health information for the public on topics including healthy eating and weight management. The TGA is the medicines regulator, the Pharmacy Board regulates pharmacists, and the AMA is a professional body for doctors; none of these are primary providers of patient-facing health promotion resources of this nature.

A pharmacist notices visible particles in a prepared IV bag. The CORRECT action is to:

Answer: Quarantine and discard the preparation, then investigate the cause

Visible particulate matter indicates contamination or incompatibility; the preparation must be discarded and the root cause investigated to prevent patient harm.

Enzyme-inducing antiepileptic drugs (e.g., phenytoin, carbamazepine) reduce the effectiveness of combined oral contraceptives because they:

Answer: Induce hepatic CYP3A4 and CYP2C9, increasing first-pass metabolism of contraceptive steroids

Enzyme-inducing antiepileptics upregulate CYP3A4 and CYP2C9, significantly increasing hepatic metabolism of ethinylestradiol and progestogens, reducing contraceptive plasma levels and risking contraceptive failure.

A patient experiences a sudden, severe, and life-threatening anaphylactic reaction immediately after receiving a dose of penicillin. According to the classification of adverse drug reactions, how is this event best categorised?

Answer: A Type B (Bizarre) reaction

This is a classic example of a Type B (Bizarre) reaction. Type B reactions are not predictable from the drug's known pharmacology, are not dose-dependent, and often involve an immunological mechanism like an allergic response. Anaphylaxis fits this description perfectly. In contrast, Type A (Augmented) reactions are predictable, dose-dependent extensions of the drug's pharmacological effects.

What is the significance of endotoxin testing (LAL test) for parenteral products?

Answer: It detects bacterial endotoxins (pyrogens) that can cause fever and septic shock

The Limulus Amebocyte Lysate (LAL) test detects gram-negative bacterial endotoxins that can cause pyrogenic reactions even if the product is sterile.

A patient presents a prescription for an urgent supply of their anti-epileptic medication. The pharmacy is unexpectedly out of stock, and the wholesaler has confirmed that they cannot deliver a new supply until the following business day. From a supply logistics and patient safety perspective, what is the pharmacist's most appropriate action?

Answer: Contact several nearby pharmacies to determine if they have the medication in stock to arrange for the patient to obtain it.

For critical medications like anti-epileptics, continuity of supply is paramount to prevent adverse outcomes such as seizures. The most effective logistical step is to source the medication from another pharmacy to ensure the patient does not miss a dose. Advising a missed dose is clinically unsafe, and asking the patient to contact the doctor introduces unnecessary delays.

Which of the following medications is most commonly associated with QT interval prolongation and torsades de pointes when combined with other QT-prolonging agents?

Answer: Domperidone

Domperidone blocks hERG potassium channels, prolonging the QT interval; combining it with other QT-prolonging drugs (e.g., azithromycin, antifungals) markedly increases the risk of torsades de pointes.

An 82-year-old female patient with a history of osteoporosis, hypertension, and urinary incontinence presents her medication list for a therapeutic review. The list includes alendronate, hydrochlorothiazide, and oxybutynin. She reports increased confusion and a recent fall. Which medication is most likely contributing to these new symptoms?

Answer: Oxybutynin

Oxybutynin has strong anticholinergic properties, which are well-known to cause central nervous system side effects like confusion, dizziness, and cognitive impairment, especially in the elderly. These effects significantly increase the risk of falls. While hydrochlorothiazide can cause dizziness and alendronate has its own side effect profile, the presentation of confusion makes oxybutynin the most probable cause due to its high anticholinergic burden.

Which type of biological safety cabinet (BSC) is used when preparing hazardous drugs?

Answer: Class II Type B2 BSC

A Class II Type B2 BSC is total-exhaust and externally vented, providing both product and personnel protection required for hazardous drug compounding.

Beta-blockers are contraindicated in patients with which of the following respiratory conditions?

Answer: Reactive airway disease / bronchial asthma

Non-selective beta-blockers block beta-2 receptors in bronchial smooth muscle, causing bronchoconstriction and potentially fatal bronchospasm in asthmatic patients.

A pharmacy receives a delivery of influenza vaccines. The enclosed temperature data logger indicates that the temperature of the shipment rose to 9.5°C for a period of 45 minutes during transit before returning to the required +2°C to +8°C range. What is the most appropriate immediate action for the pharmacist to take?

Answer: Quarantine the affected vaccines, label them 'DO NOT USE', and contact the vaccine supplier or state health department for advice.

According to the National Vaccine Storage Guidelines 'Strive for 5', any temperature deviation outside the +2°C to +8°C range is a cold chain breach. The correct protocol is to immediately isolate the affected stock to prevent use and contact the relevant authority (supplier or state health department) who can advise on the viability of the vaccines based on specific stability data.

A patient on warfarin is prescribed ibuprofen for pain. What is the primary concern with this combination?

Answer: Increased bleeding risk due to additive anticoagulation and GI mucosal damage

NSAIDs like ibuprofen inhibit platelet aggregation and damage the GI mucosa, and can also displace warfarin from protein binding, increasing bleeding risk.

Concomitant use of clopidogrel and omeprazole is clinically significant because:

Answer: Omeprazole inhibits CYP2C19, reducing conversion of clopidogrel to its active metabolite

Clopidogrel is a prodrug requiring CYP2C19 for activation; omeprazole's CYP2C19 inhibition reduces formation of the active thiol metabolite, diminishing antiplatelet efficacy.

A pharmacist is reviewing the medications of a 78-year-old patient with stable chronic heart failure (ejection fraction 35%), type 2 diabetes, and chronic kidney disease (eGFR 50 mL/min/1.73m²). The patient is on metoprolol, ramipril, and metformin. The GP is considering adding a new agent for glycemic control and cardiovascular/renal benefits. Which of the following would be the most appropriate recommendation?

Answer: Dapagliflozin, as SGLT2 inhibitors are indicated for heart failure and CKD benefits, independent of diabetes.

Sodium-glucose co-transporter 2 (SGLT2) inhibitors, such as dapagliflozin and empagliflozin, have demonstrated significant benefits in reducing hospitalizations for heart failure and slowing the progression of chronic kidney disease in patients with and without type 2 diabetes. Given this patient's comorbidities (HFrEF and CKD), an SGLT2 inhibitor is a guideline-recommended choice. Pioglitazone is generally avoided in heart failure due to the risk of fluid retention. Gliclazide does not offer the same cardiorenal benefits, and while sitagliptin is safe, it lacks the proven benefits of an SGLT2 inhibitor in this specific clinical triad.

A pharmacist receives a question about a drug not available in the US. Which resource would be MOST useful?

Answer: Martindale: The Complete Drug Reference

Martindale covers drugs available worldwide, including those not approved in the US, making it the best resource for international drug inquiries.

When implementing a medication plan that involves packing oral cytotoxic medicines into a Dose Administration Aid (DAA), which of the following is a key consideration according to the Pharmacy Board of Australia guidelines?

Answer: A risk assessment must be conducted to ensure the benefit of adherence outweighs the risk of exposure.

The Pharmacy Board of Australia's guidelines state that oral cytotoxic and other hazardous medicines should only be packed into a DAA if there is evidence that the benefit of improved patient adherence outweighs the risk of exposure during packing or administration. This requires a careful risk assessment and discussion with the patient or carer. It is not strictly prohibited, nor does it require a specific certification beyond appropriate training. While safe disposal is important, the guidelines do not mandate return to the pharmacy.