NZREX Pharmacology & Prescribing 1 — Questions and Answers
Question 1: Which organisation in New Zealand is responsible for determining which medicines are subsidised on the Pharmaceutical Schedule?
- Medsafe
- PHARMAC (Correct answer)
- Health NZ (Te Whatu Ora)
- Ministry of Health
Correct answer: PHARMAC
PHARMAC (Pharmaceutical Management Agency) manages the NZ Pharmaceutical Schedule and decides which medicines are funded for New Zealanders.
Question 2: When prescribing a long-term NSAID for an elderly patient with osteoarthritis in New Zealand, which co-prescription is most strongly recommended to reduce gastrointestinal risk?
- A beta-blocker
- A proton pump inhibitor (PPI) (Correct answer)
- An antihistamine
- A statin
Correct answer: A proton pump inhibitor (PPI)
Proton pump inhibitors (PPIs) are co-prescribed with NSAIDs in high-risk patients (elderly, history of peptic ulcer) to protect the gastric mucosa from NSAID-induced injury.
Question 3: According to New Zealand community-acquired pneumonia guidelines, what is the recommended first-line oral antibiotic for a non-hospitalised adult without significant comorbidities?
- Ciprofloxacin
- Azithromycin
- Amoxicillin (Correct answer)
- Doxycycline
Correct answer: Amoxicillin
Amoxicillin is the first-line antibiotic for community-acquired pneumonia in ambulatory NZ adults without comorbidities, as per BPAC NZ and national guidelines targeting typical pathogens.
Question 4: In New Zealand, which of the following medications requires a Special Authority application before PHARMAC will subsidise it?
- Paracetamol 500mg
- Metformin 500mg
- Adalimumab (Humira) (Correct answer)
- Amoxicillin 500mg
Correct answer: Adalimumab (Humira)
Adalimumab requires a Special Authority application approved by PHARMAC before it is subsidised, as it is a high-cost biologic with specific indications and criteria for use.
Question 5: Under New Zealand law, when prescribing a controlled drug, which of the following is a mandatory requirement for the prescription to be legally valid?
- The prescription must be written in blue ink only
- The total quantity must be written in both words and figures (Correct answer)
- The prescription must be countersigned by a pharmacist
- A specialist referral must accompany each prescription
Correct answer: The total quantity must be written in both words and figures
NZ Misuse of Drugs Regulations require that the quantity of a controlled drug on a prescription be stated in both words and figures to prevent tampering and fraud.
Question 6: A patient on stable warfarin therapy begins taking St John's Wort for low mood. What effect would you expect on their INR?
- INR increases significantly due to enzyme inhibition
- INR decreases due to CYP450 enzyme induction (Correct answer)
- INR remains unchanged as St John's Wort has no drug interactions
- INR fluctuates unpredictably with no consistent direction
Correct answer: INR decreases due to CYP450 enzyme induction
St John's Wort is a potent inducer of CYP450 enzymes (especially CYP3A4 and CYP2C9), which accelerates warfarin metabolism and reduces anticoagulation, thereby lowering the INR.
Question 7: Which prescribing resource is specifically developed for New Zealand healthcare professionals and provides evidence-based, NZ-contextualised prescribing guidance free of charge?
- British National Formulary (BNF)
- MIMS New Zealand
- New Zealand Formulary (NZF) (Correct answer)
- Australian Medicines Handbook (AMH)
Correct answer: New Zealand Formulary (NZF)
The New Zealand Formulary (NZF) is the primary NZ-specific prescribing reference, providing evidence-based guidance tailored to NZ medicines, PHARMAC funding, and regulatory context.
NZREX Pharmacology & Prescribing 1
Which organisation in New Zealand is responsible for determining which medicines are subsidised on the Pharmaceutical Schedule?