ppr3

1. Mr N is a 62 year old patient who is currently taking warfarin at a dose of 4mg Monday to Friday and 5mg on Saturday and Sunday. He attends the anticoagulant clinic today and is found to have an INR of 5.8. In accordance with the clinic’s protocol, Mr N is advised to stop taking warfarin for two days and recommence it, reducing the total weekly dose by 30%. 

What is the new daily dose of warfarin that Mr N should start taking?  

mg

2. You are a pharmacist working in a busy pharmacy and need to perform a controlled- drugs check on Saturday while it is quiet. The Oxycontin® 10 mg tablets you received on Tuesday evening were correctly entered and all other stock levels were correct.  The pharmacy’s SOP states “The percentage overage is the difference between the theoretical and actual volume, divided by the total volume supplied since the date of reconciliation and finally multiplied by 100”.

What is the percentage overage for the methadone 1mg/mL sugar-free solution? Give your answer to one decimal place.

%

3. Master M, a three-year-old child weighing 14kg, has been prescribed parenteral phenytoin for the management of status epilepticus. He was administered an initial loading dose of 20mg/kg given over 25 minutes and is currently receiving a maintenance dose of 3mg/kg twice daily. Phenytoin solution for injection is available as 5ml ampoules with a strength of 50mg/ml and an ethanol content of 395.75mg/5ml.  

Given that the first maintenance dose was given 24 hours after the initial loading dose,

What quantity of ethanol, in mg, would Master M have received after 96 hours treatment?

Give your answer to the nearest whole number.

mg

4. A child weighing 17.4kg requires treatment with drug X. The drug is to be given twice daily for a total of five days. Drug X is available as a powder which is reconstituted by adding 94mL of fresh water to produce a suspension with a concentration of 125mg/5mL. Drug X powder in stock has a displacement value of 6ml.

Given that the contents of the reconstituted suspension is just enough for the child to complete the five day course and no suspension remains, how much drug will the child receive per dose in mg/kg? Give your answer to two decimal places.

mg/kg

5. You receive the following prescription for Miss S, a 10 year old child weighing 34kg.

What would be the total infusion duration if it is infused at the prescribed rate? Give your answer to the nearest number of whole minutes.

minutes

6. Mr K, a 70 year old man weighing 58 Kg, with renal insufficiency, has been prescribed vancomycin for the treatment of community acquired pneumonia. He is to be administered a loading dose of 25mg/kg every 12 hours for two days followed by 20 mg/kg every 8 hours for a further 10 days. Vancomycin is available as 500mg vials and will be administered as a slow intravenous intermittent infusion at a maximum rate of 10 mg/min. Prior to administration, 10 mL Water for Injections PhEur should be added to the 500 mg vial. The reconstituted solution should then be further diluted with 5% Dextrose Intravenous Infusion BP to a maximum concentration of 5mg/ml. 

Given that each dose is to be administered at a maximum rate of 10 mg/min, what is the infusion rate in ml/min? 

mL/min

7. Mr K is a 72 year old man with Parkinson’s disease for which he takes Stalevo 150/37.5/200 tablets (levodopa/carbidopa/entacapone) at a dose of one tablet three times a day. He is currently having difficulty swallowing tablets and his doctor would like to start him on a parenteral or transdermal preparation instead. 

What would be a suitable daily dose in mg for Mr K using the alternative route of administration?

mg

8. You have in stock 250ml of a glucose 20% (w/v) solution. You receive instructions to produce a new solution by removing 150ml of the stock solution and replacing it with 150ml of a glucose 5% (w/v) solution.

What would be the percentage strength of the new solution produced?

% W/V

9. Mr M, a 47 year old man weighing 62kg is experiencing neutropenia following treatment with cytotoxic chemotherapy. He is administered subcutaneous injections of filgrastim at a dose of 5mcg/kg daily over 10 days to rectify the neutropenia. 

Given that the Filgrastim preparation administered to Mr M has a strength of 60 MU per 1ml (30million units/0.5ml), what volume of solution for injection is administered to Mr M per dose? Give your answer to two decimal places.  

mL

10.  A pharmaceutical company have developed a new drug and are in the process of conducting a phase 3 trial. The trial will include a 3-arm randomized controlled study with an allocation ratio of 1:2:2

What is the total number of patients required to participate in the study so that there at least 95 patients in each arm?

patients

11. You are working in a GP practice and receive a request from Mrs A to synchronise her medication. She has completed a form providing details of the quantity of each medication she has remaining.

How many additional omeprazole 20mg capsules should be prescribed for Mrs A so that her medication is synchronised?

capsules

12. Following a recent blood test, Master P, an 8 year old child was found to have a 25-hydroxyvitamin D3 level of 25nmol/L. The GP wishes to start him on the maximum dose of Fultium-D3 drops for the treatment of vitamin deficiency.

How many whole days will a 25ml bottle of Fultium-D3 drops last Master P?

days

13. Mr F, a 37 year old man is receiving treatment for mania. He is currently taking Li-liquid 509mg/5mL oral liquid at a dose of 20ml twice daily.  

The molecular formula for lithium citrate is Li₃C₆H₅O₇

The molecular weight of lithium is 7g/mol, carbon 12g/mol, hydrogen 1g/mol and oxygen is 16g/mol.

What quantity of lithium expressed in mg will Mr F receive per day? Give your answer to the nearest whole number.

mg

14. You are working as a practice pharmacist and have been asked to review the prescribing of tiotropium inhalers. You find that, over the last year, a total of 240 patients at the practice have been prescribed tiotropium inhalers. 50% of these prescriptions were brand prescribed as “Spiriva”. You are aware that an alternative brand of tiotropium inhaler exists and look into the cost of the brands.

Considering that all patients inhale the contents of one capsule daily, what would be the annual cost saving for the practice if 90% of patients prescribed Spiriva were prescribed Braltus instead (assume that the patients have a Spiriva handihaler and only require supplies of the capsules). Give your answer to the nearest £100.

£

15. Ms R presents you with a prescription for gabapentin 300mg capsules which she has been prescribed for neuropathic pain.  She has been provided with the following instructions:

“take 300mg once a day on day 1, then take 300mg twice a day on day 2, then take 300mg three times a day from day 3 onwards”

You currently have 30 gabapentin 300mg capsules in stock and Ms R agrees to return for the remainder.

How many gabapentin 300mg capsules are owed to Ms R to provide her with a total of 28 days’ supply?

capsules

16. You have in stock Diprosalic ointment (betamethasone 0.05%w/w / salicylic acid 3% w/w) to which you add a sufficient quantity of white soft paraffin to create an ointment with a total weight of 85g. 

Given that the strength of salicylic acid in the ointment created is 2.1%w/w, what was the initial weight of Diprosalic ointment you had in stock?  Give your answer to the nearest whole number.

g

17. Mr S is a 72 year old man currently being treated for prostate cancer. He recently started to experience low mood for which he was prescribed citalopram tablets at a dose of 20mg daily. He is no longer able to swallow tablets and you suggest switching him to an equivalent dose of citalopram 40mg/ml oral drops.  

How many whole days will a 15ml bottle of citalopram drops last Mr S?

days

18. Mr T is a 52 year old patient, weighing 160lb, with uncontrolled type 2 diabetes. During his visit to the diabetic clinic, it is decided Mr T should commence on insulin and, due to his lifestyle, he is to start taking Lantus. It is suggested that for insulin naïve patients, the starting daily dose of Lantus can be calculated using the following formula:

Units of Lantus = weight in kg x 0.2

(Units of Lantus should be rounded down to the nearest whole unit)

Given that Lantus is available as 3ml pens with a strength of 100units/ml, how many whole days would a 3ml pen last Mr T?

days

19. Mr M has been prescribed a 7 day course of norfloxacin 400mg twice daily for the treatment of a lower urinary tract infection. He also takes ferrous sulfate 200mg tablets twice daily for iron deficiency anaemia. The bioavailability of norfloxacin 400mg tablets is 40% and concomitant administration of norfloxacin with ferrous sulfate reduces the peak plasma concentration of norfloxacin by 75%.

Given that Mr M takes norfloxacin and ferrous sulfate at the same time, what percentage of the daily norfloxacin dose administered will be reaching his blood stream?

%

20. Ms P presents at your pharmacy asking for advice. She has started a fitness regime at her local gym and is eager to lose weight. She is seeking your advice regarding healthy eating. She currently weighs 13stone 2lb and has a height of 168cm.

How much weight in pounds (lb) does Mrs S need to lose in order to reach a body mass index of 24.9? Give your answer to the nearest whole pound.

lb

21. You are conducting a health check with Mr I, a 47 year old man. You are advising him on healthy eating and exercise and, as part of this are discussing his weekly alcohol intake. He informs you that, on average, in a week he enjoys a glass of red wine (13% ABV) with his evening meal daily and, on Fridays, he also drinks 2 pints of larger (5% ABV) after work.

Units of alcohol = (volume of drink (ml) x ABV (%))/1000

Where ABV is alcohol by volume

Given that each glass of wine is 175ml and 1 pint is 568ml, by how many units of alcohol should Mr I reduce his intake in order to be at the recommended weekly limit? Give your answer to one decimal place.

units

22. A patient is to be administered 1.5L of intravenous (IV) fluids over a total of 13 hours. After running for 10 hours and 25 minutes, 225ml of the fluid remains.  

Given that there are 20 drops in 1ml, what is the rate in drops/min that the remaining fluids need to be given so that the IV administration finishes in the required time? Give your answer to the nearest whole number.

drops/min

23. You have been given instructions to prepare a mixture with a final volume of 720ml using a 15.2%w/v glucose mixture and sodium chloride 0.9%w/v.  

Given that the concentration of glucose in the final mixture is 9.8%w/v, what is the percentage strength (w/v) of sodium chloride in the final mixture created? Give your answer to two decimal places.

% w/v

24. You have been asked to manufacture a batch of 5000 aminophylline hydrate tablets each containing 225mg of anhydrous aminophylline. You have available a hydrous aminophylline salt which contains 96% moisture. 

What weight in grams of the hydrous aminophylline salt will be contained in each tablet?  Round your answer to the nearest 0.05g.

g

25. Miss Z, a 9 year old girl weighing 30kg is to receive acetazolamide intravenous infusions for the management of epilepsy at a dose of 20mg/kg/day in three divided doses.  Each 250mg acetazolamide vial is to be reconstituted with 5ml water for injections and diluted further to 50ml with sodium chloride 0.9%w/v solution.  

Given that each dose is to be infused over 30 minutes, what is the infusion rate per dose in ml/min to one decimal place?

mL/min

26. Mr P, a 42 year old man is undergoing surgery under general anaesthetic. To prepare the anaesthetic infusion, the nurse reconstitutes a 5mg vial of remifentanil hydrochloride to a concentration of 1mg/ml dilutes further with glucose 5% to a total of 100ml.

What is the concentration of remifentanil hydrochloride in mcg/ml in the infusion that Mr P will receive?

mcg/mL

27. Mr K is a palliative patient who has been prescribed 30mg morphine sulphate modified release (MST Continus) tablets twice daily and 10ml morphine sulphate 10mg/5ml oral solution every 2-4 hours when required for breakthrough pain. Over the past two weeks, Mr K has been taking four 10ml doses for breakthrough pain each day in addition to the twice daily 30mg dose. The palliative team decide to increase the dose of his regular modified release morphine.

What is the maximum that Mr K’s total daily dose of modified release morphine sulphate can be increased to?

mg

28. Miss P, a 9 year old girl weighing 29kg has been prescribed Ironorm drops at a dose of 0.24ml/kg daily in two divided doses for the treatment of iron deficiency anaemia.  Ironorm contains ferrous sulphate 125mg/ml.  

Molecular formula of ferrous sulphate: FeSO4.7H2O

Molecular weight of ferrous sulphate: 278g/mol

Molecular weight of iron (Fe): 56g/mol

What weight of iron in milligrams will Miss P receive per dose?  Round your answer to the nearest 0.05mg.

mg

29. Ms S is in labour and wishes to have epidural analgesia. It has been decided that she will be provided with a continuous epidural infusion of bupivacaine hydrochloride.  Bupivacaine hydrochloride infusion solution is available as 100ml bags with a strength of 0.125%w/v. The anaesthetist sets the rate of infusion at 12.5mg/hr.

What would be the rate of infusion in ml/minute?  Give your answer to two decimal places.

mL/min

30. Mr S, a 46 year old man who weighs 92kg and is 1.75m tall has been diagnosed with a biliary-tract infection. He is to receive an intravenous infusion of gentamicin at a dose of 3mg/kg daily in three divided doses. You have the following information for calculating gentamicin doses:

When calculating gentamicin doses, the ideal body weight (IBW) should be used in all non-obese patients unless actual body weight (ABW) is lower. The corrected body weight (CBW) should be used for dosing calculations for obese patients.  

IBW Male (kg) = 50 + (2.3 x number of inches above 5ft in height)

IBW Female (kg) = 45.4 + (2.3 x number of inches above 5ft in height)

CBW = IBW + 0.4 (ABW – IBW)

What volume in ml of gentamicin 40mg/ml solution for injection will be required for each dose? Give your answer to one decimal place.

mL

31. Ms P, a 52 year old woman has just undergone surgery in her left eye. She has been instructed to apply one drop of ketorolac trometamol 0.5%w/v eye drops to the left eye every 8 hours starting 24 hours after surgery and continuing until the doctor reviews her in a few days’ time. Ms P starts using the eye drops at midday on 8th April and sees the doctor at 4pm on 11th April. Ms P is supplied with a 3ml bottle of ketorolac 0.5%w/v eye drops.

Given that there are 15 drops in 1ml of the eye drops, what volume of eye drops would be remaining in the bottle when Ms P attends her doctor’s appointment on 11th April? Give your answer to one decimal place.

mL

32. Mr T, a 42 year old man weighing 72kg is being treated for diabetic ketoacidosis. The required units of soluble insulin is diluted in sodium chloride 0.9%w/v intravenous infusion fluid to a concentration of 1 unit/ml and infused at a rate of 0.1units/kg/hour. 

At what rate in ml/minute should the infusion be administered to Mr T? Give your answer to two decimal places.

mL/min

33. Digoxin is available as an oral solution with a concentration of 50mcg/ml and a solution for injection with a concentration of 250mcg/ml.  

Given that a 2.2ml dose of oral solution is bioequivalent to 0.3ml administered intravenously, what is the bioavailability of digoxin oral solution?  Give your answer to the nearest whole number.

%

34. You are a GP practice pharmacist conducting a medication review with Mr P, a 52 year old man. He has been taking alprazolam for approximately two years for the management of anxiety and is currently on a total daily dose of 1mg. Following a discussion with you, Mr P agrees that he is ready to be weaned off the alprozalam.  You decide to switch him to an equivalent daily dose of diazepam and provide him with the following instructions:

Take the equivalent dose of diazepam daily for 1 week then, reduce the total daily dose by 2mg every 2 weeks until a daily dose of 10mg is reached.  Take 10mg daily for 1 week, then reduce the total daily dose by 1mg every 1 week until a daily dose of 5mg is reached.  Then reduce the dose by 500mcg every week until completely stopped.

Assuming Mr P follows the instructions provided, how many weeks will it take for complete withdrawal?

weeks

35. You have been asked to manufacture 25 hydrocortisone acetate suppositories with a strength of 0.75% w/w using a 2g mould and Theobroma oil as the base.   

Given that hydrocortisone acetate has a displacement value of 1.5, what is the total weight of Theobroma oil in grams required to fulfil this order? Give your answer to two decimal places.

g

36. Ms L, a 38 year old woman is to be administered parenteral nutrition. The doctors request the infusion bag contains 80ml of electrolytes, final amino acid and glucose concentrations of 5%w/v and 4.5%w/v respectively and, is made up to 1L with sterile water. You have available stock solutions of 7.5%w/v amino acid and 80%w/v glucose which you will use to make up the infusion.

What volume of sterile water in ml is needed to make the infusion? Give your answer to the nearest whole number.

mL

37. Master L, a 7 year old boy who weighs 22kg and is 1.21m tall, is receiving chemotherapy as part of his treatment for leukaemia. He has started to experience nausea and vomiting as a result of the treatment and the Paediatric Oncologist would like to initiate ondansetron to help manage his symptoms. He is to receive the initial dose by IV infusion followed by oral doses every 12 hours.  

Body surface area m2= Weight kg×Height (cm)3600

What is the total weight of ondansetron in mg that Master L would have received after 90 hours of treatment? Give your answer to one decimal place.

mg

38. Miss R, a 10 year old girl has been prescribed Difflam spray to help manage the pain associated with her mouth ulcers. She has been advised to administer 4 sprays onto the affected area every 1.5-3 hours. Difflam spray contains Benzydamine 0.15% w/v and each metered dose pump spray is 175 microlitres.  

What is the total quantity of benzydamine in mg administered if Miss R uses the spray for the maximum recommended dosage daily between 8am and 9pm for 5 days? Give your answer to two decimal places.

mg

39. Mr M, a 35 year old man weighing 77kg, has taken an overdose of carbamazepine tablets. His current serum carbamazepine concentration is 25mg/litre.  Carbamazepine has a clearance of 0.064 litres/kg/hour and a volume of distribution of 1.4L/kg.  

Assuming that carbamazepine tablets have a bioavailability of 100% and that peak plasma concentration has been reached, what quantity of carbamazepine in grams did Mr M take in overdose? Give your answer to one decimal place.

g

40. You have in stock a cream containing 2% w/w sulphur. You receive a request to use this cream as a base and to add in sufficient salicylic acid powder such that the final concentration of salicylic acid in the new cream is 4%.

What is the concentration in %w/w of sulphur in the new cream? Give your answer to two decimal place.

% w/w

41. Patient  A is  prescribed  Zarontin®  syrup  (Ethosuximide  250 mg/5ml)  with  the  following dosage regime: 

Ethosuximide  500mg daily  in  2  divided  doses  for  5  days,  then,  increase  by  250mg every 5 days to a maintenance dose of 1.5g daily in 2 divided doses. 

Supply enough for 28 days’ treatment. 

What  is  the  exact  volume  in  mL  of  Zarontin®  syrup which  is  required  for  the  28  day  treatment? 

mL

42. Miss B is prescribed oral voriconazole 400 milligrams every 12 hours for 2 doses,  then 200 milligrams every 12 hours for a total course duration of two weeks.  

Voriconazole is available as VFEND 50 mg and 200mg tablets.  

What is  the difference in cost between providing  the 50mg  tablets or  the 200mg  tablets  for the entire course?  Give your answer to two decimal places. 

£

43. C was  admitted  to  hospital  following  an  accidental  drug  overdose.    A  plasma  concentration  of  120mcg/ml was measured  at  8pm  on  the  day  of  admission.    The  drug has a half life of 4 hours. 

Assuming that the distribution is complete and that the elimination is described by a first order process, what will the plasma concentration be at 4pm in mg/L the following day?  Give your answer to two decimal places. 

mg/L

44. A  4  kg  neonate  requires  18  mg/kg of phenytoin.  A  5mL  vial  of  50  mg/mL of  phenytoin is available for dilution prior to infusion. The prescribed dose is diluted up  to  50 mL  with  sodium  chloride  0.9%  w/v.  The  infusion  rate  must  not  exceed  1  mg/kg/minute.  

What is the maximum flow rate in mL/minute for this infusion? Give your answer to one decimal place. 

mL/min

45. A 7-year-old child has been prescribed Gaviscon® suspension 5 mL after meals and at bedtime. The recommended daily allowance (RDA) of salt for a 7-year-old child is 5 grams (equivalent to 2 grams sodium) per day. 

The atomic mass of sodium is 23.  

What  percentage  of  this  child’s  recommended  daily  salt  allowance  is  contained  in the total  daily dose of Gaviscon® suspension given that he consumes three meals a day? Provide your answer to the nearest whole number.

%

46. You are required to prepare 650 mL of a potassium permanganate solution such that  when 10 mL of the solution is diluted to 2 litres, it will give a 1 in 8000 solution.   

What is the weight in grams of potassium permanganate required to prepare the original  solution? Give your answer to one decimal place. 

g

47. Mr E is 66 years old and has an ideal body weight of 70 kg. He has been prescribed  ganciclovir by  IV  infusion.  Ganciclovir is  principally  excreted  renally. The  dose  recommendations for ganciclovir are as follows:  

The formula for creatinine clearance is given below: 

Constant is 1.04 for women and 1.23 for men 

What  is  the  most  appropriate  daily  dose  in  mg  for  Mr  E if  his  creatinine  level  is  290  micromol/L? Give your answer to one decimal place.  

mg

48. Mrs  F,  a  48  year  old woman  weighing  70kg  is  being  treated  for  seizures  with  an  intravenous  infusion  of  fosphenytoin  sodium  at  a  dose  of  4mg(PE)/kg.    Fosphenytoin  sodium is available as a 10ml vial with a concentration of 75mg/ml.  The doctors request  that  the  required  dose  is diluted  to  25mg(PE)/ml  with  sodium  chloride  0.9%  prior  to  administration.   

What volume of sodium chloride 0.9% is needed to dilute the required dose for administration? Give your answer to one decimal place. 

mL

49. A  vial  containing  50  milligrams doxorubicin  powder  for  injection  is  to  be  reconstituted  to  produce  an  injection  with  a  concentration  of  2.5  mg/mL. The  displacement volume of doxorubicin is 0.03 mL/10 mg.  

What is the volume in mL of water for injection, BP that should be added to the powder?  Give your answer to two decimal places. 

mL

50. Mr  G who  weighs  81  kg  is  prescribed  acetylcysteine  following  an  overdose  of  paracetamol tablets. It is administered as three infusions. Acetylcysteine is available  as a 200 mg/mL concentrate for intravenous infusion.  

Given that the relative atomic mass of sodium is 23, how many millimoles of Na+ will Mr G receive in total after the three infusions?  Give your answer to the nearest whole number. 

mmols

51. Miss H is prescribed capecitabine at a dose of 1.25 g/m2 twice daily for 14 days, with  subsequent courses repeated after a 7-day interval. Miss H weighs 60 kg and is 1.75  metres tall. 

What  is  the  correct  number  of  500 milligrams  tablets  that  are  needed  to  provide  treatment for five weeks for Miss H? Give your answer to the nearest whole tablet. 

tablets

52. Mrs I, who weighs 55 kg, has taken an overdose of carbamazepine tablets. Her current serum carbamazepine concentration is 20 mg/litre. Carbamazepine has a  clearance of 0.064 litres/kg/hour.  

What weight in grams of carbamazepine will have been removed from Mrs I’s body after 24 hours? Give your answer to one decimal place. 

g

53. Patient J is being infused with diamorphine over 24 hours. He is currently receiving a  dose  of  150  milligrams  in  24  hours using  a  syringe  pump  that  is  calibrated  to  2 mm/hour. You increase the rate of infusion by 12 mm/24 hours.  

What dosage expressed in milligrams per hour will Patient J now receive? Give your  answer to one decimal place.  

mg/hour

54. You  are  required  to  prepare  a  45  ml  sachet  of  a  concentrated  antiseptic  solution  which contains chlorhexidine gluconate and cetrimide in the ratio of 25:1.  

If  the sachet  contains  0.015%  of  chlorhexidine  gluconate,  how  many  micrograms  of  cetrimide will it contain? 

mcg

55. Master K, a 5-year-old  child, has  been admitted  to your ward with  herpes simplex  encephalitis. He weighs 16 kg and has a body surface area of 0.6m2. The doctor has  prescribed intravenous aciclovir for 21 days.  

Given that sodium chloride 0.9% will be used for reconstitution and dilution, what volume  of sodium chloride will be required to prepare each dose?

mL

56. You  are  required  to  prepare  120  suppositories  each  weighing  2 grams.  Each  suppository is to  contain  200 milligrams  of  bismuth  subgallate.  The  displacement  value of bismuth subgallate is 2.5.  

What is the total quantity of base expressed in grams needed if 5% wastage is expected during the manufacturing process? Give your answer to the nearest whole number.

g

57. Mr L participates in a clinical trial and is given sodium nitroprusside at a dose of 4.4 nanomoles/kg/min. He weighs 70 kg and the sodium nitroprusside is supplied as a 50 milligrams in 5 mL injection.  

Given  that  the  molecular  weight  of  sodium  nitroprusside  is  298,  what  volume  in  mL  of  sodium nitroprusside will be administered in 24 hours? Give your answer  to  the nearest  whole number.

mL

58. You  are  required  to  extemporaneously  prepare  a  coal  tar  ointment.  You  have  in  stock 120 grams of a 4% coal tar ointment.  

What is the percentage  (%w/w) of coal tar in the  finished product when 8 grams of coal  tar is mixed with the ointment in stock?

%w/w

59. Patient M receives oral carbamazepine 400 milligrams twice daily for epilepsy. He is  scheduled  for  an  operation  and  is  therefore  nil  by  mouth.  The  doctor  prescribes  carbamazepine suppositories instead for this patient.   

How many 250mg carbamazepine suppositories should be administered to patient M per  dose?   

60. Mr  N is  a  35-year-old  male,  weighing  65  kg.  He  is  to  be  started  on  intravenous  phenobarbital sodium as anticonvulsant treatment.  Phenobarbital has a therapeutic  reference range of 15-40mcg/ml and a volume of distribution of  

0.7 L/kg.  

The formula for calculating the loading dose is provided below: 

Calculate  the  loading  dose  needed  to  yield  a  Cp0 of  30  mg/L. Give  your  answer  to  the  nearest 100 milligrams. 

mg

61.  Miss N, a 12 year old girl is suffering with diarrhoea for which the doctor  

recommends she takes Dioralyte rehydration therapy with the following instructions: 

Reconstitute the contents of one sachet with 200ml of water and take after every loose  bowel motion.   

Dioralyte sachets contain potassium chloride, sodium chloride, disodium hydrogen citrate  and glucose and, when reconstituted with 1 litre of water, provide Na+ 60mmol, K+ 20mmol,  Cl 60mmol, citrate 10mmol and glucose 90mmol.  Over a period of three days, Miss N uses  a total of 12 Dioralyte sachets.   

The molecular weight of sodium is 23g/mol, chlorine is 35.5g/mol and potassium is 39g/mol. 

Over the three days, what percentage of Miss N’s total sodium intake from Dioralyte is  from sodium chloride?  Give your answer to one decimal place. 

%

62. You receive a prescription  for a dexamethasone reducing schedule  for Mrs P. The  initial  dose is 6 milligrams twice a day for 5 days, reducing by a total of 2  milligrams every 3 days until the course is complete. 

What is the correct number of 2 milligrams tablets that should be supplied to Mrs P?

tablets

63. Mr Q weighs 65 kg and is prescribed dobutamine intravenous infusion at a dose of  10  micrograms/kg/minute.  You  have  available  a  dobutamine infusion  of  250mg  in  50ml dextrose 5%. 

Calculate the dose required in mL/hour for Mr Q. Give your answer to one decimal place. 

mL/hour

64. You are required to manufacture a batch of 300,000 x 150 milligram tablets. Each  tablet contains 5% w/w binder, which is added during granulation using a 20% w/v  solution.  

What is the total volume of binder solution expressed in litres required to manufacture  the batch of tablets? Give your answer to two decimal places. 

L

65. Mr  R is  switching  from  NovoRapid  vials  to  NovoRapid  FlexPen  in  line  with  NICE  guidelines. He uses 30 units three times daily immediately before meals. 

What is the correct number of FlexPen(s) will Mr R require per month?

Flexpen(s)

66. Mrs S who weighs 55 kilograms is prescribed a dose of 3 mg/kg a day of AmBisome®  to  be  given  by  intravenous infusion.  Each  vial  of  AmBisome®  (amphotericin  B  liposomal 50 milligrams) is reconstituted with 12 mL water for injection to produce a  preparation with concentration of 4 mg/mL of amphotericin B.   

What volume of AmBisome® 4 mg/mL infusion should be given for each dose? Give your  answer to one decimal place.

mL

67. You are a pharmacist involved in a clinical study comparing the treatments for otitis  media.  The study finds that standard antibiotics produced an 87% 1-week cure rate  while a new antibiotic drug A, boasted a 96% cure rate. 

Absolute  risk  reduction  (ARR)  =  difference  in  the  rate  of  an  event  between  the  two  test  groups 

ARR = (event rate with drug A) – (event rate with standard antibiotics) 

Number needed to treat (NNT) = number of people needed to be treated to achieve the  desired goal of treatment. 

NNT = 1/ARR 

What is the NNT for drug A? 

NNT

68. Baby T weighs 14 kg and requires an antibiotic suspension for a chest infection. She  has been prescribed a dose of 7.5 mg/kg/day every 8 hours for 7 days. The strength  of the suspension is 250 milligrams in 5 mL.  

How many mL of antibiotic suspension should be given to baby T for each dose? Give your  answer to one decimal place.  

mL

69. You  have  in  your  pharmacy  a  cream  containing  0.25 %  w/w  hydrocortisone.  You  receive a prescription requesting to use this cream as a base and to add in sufficient  calamine powder such that the final concentration of calamine in the new cream is 15 % w/w.  

What is the concentration of hydrocortisone in the new cream? Give your answer to two  decimal places.

% w/w

70. You receive a prescription for Master V, a 16-year-old boy who suffers with psoriasis.  The prescription is for 250g of an ointment mixture made by adding 3 parts  Cocois® ointment to 5 parts of a suitable diluent.  

What  is  the  final  concentration  of  salicylic  acid  in  the  ointment  mixture?    Give  your  answer to two decimal places. 

% w/w

71. Mrs W, who weighs 53 kg attends a pre-admission clinic at your hospital 2 weeks prior  to  having  surgery.  She  is  found  to  have  moderate  anaemia  and  her  doctor  prescribes  CosmoFer. The CosmoFer is given at a dose of 200 milligrams three times a week for the  two weeks before surgery. CosmoFer is available as a 50mg/mL injection in 2 mL vials.  

How many vials of CosmoFer should be supplied to Mrs W to complete the course?

vials

72. Miss X, a 9 year old girl weighing 32kg, is going on holiday with her  family and will  require chloroquine for malaria prophylaxis.  She will be staying in the endemic area  for two weeks and has difficulty swallowing tablets and will therefore need the oral  solution. 

What is the total volume of Malarivon oral solution that should be dispensed for Miss X?   Give your answer to the nearest whole number. 

mL

73. Mr Y presented at  the accident and emergency department with a gastrointestinal  bleed. He  has lost a  significant amount  of  blood and  there are  concerns  that  he is  becoming  haemodynamically  unstable.  The  doctor  has  decided  to  administer  one  unit of packed red blood cells (PRBC) over 2 hours via a gravity set with a drop factor  of 26.  

What is the drip rate, in drops per minute, if one unit of PRBC is 350 mL? Give your  answer to the nearest whole number.

drops/minute

74.  Master Z, a 10-year-old boy weighing 35kg is being treated for reflux oesophagitis with ranitidine at a dose  of 4mg/kg twice a day. The doctor  has prescribed  for him  ranitidine oral solution 75mg/5ml to be taken at the required dose.  Ranitidine is present as the hydrochloride salt in the oral solution. 

Molecular weights:  

Ranitidine: C13H22N4O3S = 314.4g/mol 

Ranitidine hydrochloride: C13H22N4O3S.HCl = 350.9g/mol 

How many mg of ranitidine hydrochloride will Master Z receive per day? Give your answer  to one decimal place. 

mg

75. Mr A is  being  prescribed dorzolamide  2 % eye  drops  for  his glaucoma. He  is  using  two drops into each eye every 8 hours. Assume that 50% of each dose is absorbed  and there are 20 drops in every millilitre of eye drops. 

What is the amount in milligrams of dorzolamide being provided systematically every 24  hours for Mr A? 

mg

76. Mrs B is a 70-year-old lady who has been taking fluoxetine liquid (20 mg/5 mL) at a  dose of 30 milligrams daily  for obsessive-compulsive disorder. Her doctor wants  to  stop her treatment and you receive a prescription indicating that the daily dose is to  be reduced by 5mg every 7 days until the weaning is complete. 

How many mL of fluoxetine liquid  should you  supply  to  fulfil Mrs B’s prescription? Give  your answer to the nearest whole number. 

mL

77. You  are  required  to  produce  a  copper  sulphate  solution  containing  650  ppm  of  copper  sulphate.  You  have  copper  sulphate  crystals  that  are  97  %  pure.  The  molecular  weight  of  copper  sulphate  (CuSO4)  is  159.7  g/mol  and  the  molecular  weight of copper sulphate crystals (CuSO4.5H2O) is 249.7 g/mol.  

What quantity of copper sulphate crystals in grams are  required  to produce 1.5 litres of  the desired copper sulphate solution? Give your answer to one decimal place.

g

78. A  child  weighing  16  kg  is  prescribed  metronidazole  22.5  mg/kg  a  day  to  be  given  by  intravenous infusion every 8 hours.  

What volume in mL of metronidazole 5 mg/mL infusion should be given for each dose for this child?

mL

79. The  palliative  team  have  visited  Mr  AB who  has  been  taking  60  milligrams MST Continus®  tabs  twice  daily and  10 mL Oramorph®  oral  solution  (10 mg/5mL) every  four  hours when  required. Over  the  past  week  he  has  been  taking Oramorph®  (in  addition to his MST Continus®) three times a day. The palliative team decide it would  be better if he begins to use fentanyl patches instead. 

What strength of  fentanyl patch would you suggest  to  the GP for use every 72-hours by  Mr AB? 

mcg/hour

80. You receive a call from Mr A, a regular customer of yours for advice about antimalarial medication. Mr A will be travelling to Mombasa, Kenya for a 2 week safari with his wife and son Robert.  The trip is to celebrate Robert's birthday as he will be turning 12 next month.  Mr A understands that he will require antimalarial prophylaxis for the trip and that he would need a private prescription for the medication.  He has read that some antimalarial medication may not be suitable for children and for people suffering with other health conditions.  However, he would prefer that his wife, Robert and himself all take the same medication, if possible to avoid confusion.  He would like you to advise him as to the most suitable antimalarial they could take and wants to know whether you have sufficient quantity in stock to supply as soon as he obtains a prescription tomorrow as they will be travelling in 3 days time. On further questioning Mr A informs you that Robert weighs 42kg.  Your PMR shows you that Mr A and Robert take no other regular medication while Mrs A receives a regular supply of citalopram 20mg daily. You also find that the recommended dose regimen for prophylaxis against malaria in Mombasa is by using either one of the following: malarone, doxycycline or mefloquine.

What is the minimum number of dose units of the most suitable antimalarial that should be supplied for Mr A and his family?

dose units

81. You are providing prescribing advice to a local GP practice. To assist in prescribing inhaled salbutamol cost-effectively you need to compare the cost of the preparations listed below. 

• Accuhaler 60 doses/ 200 micrograms per dose (£3.00)
• Salamol inhaler 200 doses/ 100 micrograms per dose (£2.00)
• Easi-Breathe inhaler 200 doses/ 100 micrograms per dose (£6.00)
• Novolizer 200 doses/ 100 micrograms per dose (£5.00)
• Salbutodiscs 14 x 8 dose refill/ 200 micrograms per dose (£5.60)

What is the percentage difference in cost between the least expensive and most expensive preparation per 200 microgram dose? Give your answer to the nearest whole number.

%

82. Baby B who is 1 year old and weighs 22 pounds has been prescribed aminophylline at a dose of 1mg/kg/hour. The nurse on the paediatric ward asks for your advice on the correct infusion rate. The nurse will dilute a 250mg ampoule of aminophylline in 500mL of glucose 5%. 

What is the infusion rate in mL/hour of aminophylline for Baby B? Give your answer to one decimal place.

mL/hour

83. You have been asked to extemporaneously prepare a cream with the following ingredients:

Propylene Glycol PhEur 20%

Fractionated Coconut Oil PhEur 42.5%

Sodium Hydroxide PhEur 0.01%

Purified Water PhEur to 100%

What is the quantity in kg of Fractionated Coconut Oil PhEur needed to produce 3500 kg of the cream? Give your answer to the nearest whole number.

Kg

84. Master C, an 8 year old boy, who was diagnosed with asthma 2 years ago is having problems using his inhalers despite having a spacer.  His GP has decided to initiate salbutamol syrup 2mg/5ml at a starting dose of 5ml three times a day.  Each 5ml of salbutamol syrup contains Salbutamol Sulphate BP equivalent to 2mg of Salbutamol.

Molecular weights: 

Salbutamol: C13H21NO3 = 239.3

Salbutamol sulphate: (C13H21NO3 )2H2SO4 = 576.7

How many mg of salbutamol sulphate will Master C receive per day? Give your answer to two decimal places.

mg

85. You are required to formulate 30 lidocaine suppositories for a patient using cocoa butter as the base. The suppositories will be made using a 4g mould and each suppository will contain 10 mg of lidocaine. You plan to make a surplus of 5 suppositories to allow for any losses in preparation. The displacement value of lidocaine in cocoa butter is 0.5.

How many grams of lidocaine will you require to fulfil this order? Give your answer to two decimal places.

g

86. Mr D has been admitted to the Accident and Emergency unit with severe sepsis. The consultant microbiologist has decided to initiate treatment with vancomycin. You have access to Mr D’s most recent biochemistry results.

Date of admission: 20th March 2021

Date of birth: 14th March 1950

Height: 5 feet 7 inches

The formula for calculating Ideal Body Weight (IBW) is:

IBW in kilograms = (2.3 x inches over 5 feet) + F 

F = 50 for men; 45.5 for women

The Cockcroft and Gault formula for estimating creatinine clearance is provided below:

What is the dose of vancomycin expressed in milligrams that should be administered to Mr D every 24 hours? Give your answer to the nearest whole number.

mg

87. You receive a request to provide salicylic acid ointment 7% to a patient.  However, you do not have that strength in stock.  You currently only have 3.5% salicylic acid ointment in stock in addition to salicylic acid powder.  

What weight of salicylic acid powder should be added to 250g of the 3.5% salicylic acid ointment to convert it to the 7% ointment required?  Give your answer to two decimal places.

g

88. A nurse contacts you from the ward asking for your advice.  A patient weighing 65kg

has been prescribed an intravenous infusion of AmBisome at a dose of 3mg/kg once daily for the treatment of a severe systemic fungal infection.  The doctor has requested that the patient be infused with an initial test dose of 1mg.  Each 50mg vial of AmBisome should be reconstituted with 12ml of water for injections to produce a preparation with a strength of 4mg/ml, following which the required dose should be withdrawn and added to the infusion fluid.  The nurse explains that she has accidentally reconstituted the 50mg vial with 13ml of water for injections instead of 12ml, but does not want to waste the drug vial.   

What volume of the reconstituted solution should be withdrawn and added to the infusion fluid for the initial test dose of 1mg?  Give your answer to two decimal places.

mL

89. Mr E is a 57 year old man who suffers with epilepsy for which he has been stablised on phenytoin 100mg capsules, 2 capsules twice a day.  He has recently been unable to swallow solid formulations and the doctor has requested that phenytoin suspension, equivalent to the dose he is currently taking be supplied instead.   

What is the total volume of phenytoin suspension that Mr E will require if he takes the required dose for 28 days? Give your answer to the nearest whole number.

mL

90. Mrs F, a 65 year old woman has just seen the ophthalmologist and presents you with the following prescription:

Assume that 1mL has 15 drops of dexamethasone 0.1% eye drops and that Mrs F uses the same bottle of eye drops for each eye. 

What is the minimum number of 5mL bottles that Mrs F will require?

bottle (s)

91. Mr G is receiving an intravenous dose of a drug.  The drug has an apparent volume of distribution of 6 litres and a half-life of 8 hours.  Mr G is administered with an IV bolus of 60mg.

What will the plasma concentration, in mcg/dL, of the drug be 36 hours after the dose was given? Give your answer to the nearest whole number.

mcg/dL

92. Mrs H who weighs 65kg, has severe acute asthma and requires an intravenous infusion of aminophylline. An extract from her hospital prescription is given below:

Aminophylline infusion Infusion rate: 0.5mg/kg/hour Add 3x10mL aminophylline 25mg/mL ampoules to a 500mL bag of 5% glucose

What volume in mL of the infusion fluid should Mrs H receive per hour? Give your answer to the nearest whole number.

mL

93. Miss K brings in a prescription on Monday 6th March for her 8 year old epileptic daughter who weighs 26kg. The consultant has decided to start the child on Lamotrigine with the following dose regimen as an adjunctive therapy to her existing medication:

Initially 300 micrograms/kg twice daily for 14 days then 600 micrograms/kg twice daily for a further 14 days, thereafter increased by 1.2 mg/kg every 7 days upto a maintenance dose of 15 mg/kg daily in 1–2 divided doses. 

Assuming that the treatment has been tolerated and is effective for this child, what would be the total daily dose in mg in the 8th week of treatment? Give your answer to the nearest whole number.

mg

94. You receive a request for 2% w/w calamine in emulsifying ointment, however you only have the 5% w/w ointment in stock.   

How many grams of emulsifying ointment would you need to add to 200g of 5% w/w calamine in emulsifying ointment to produce the concentration required?

g

95. You are working as a locum in your local pharmacy and you receive a call from Mrs L.  She tells you that she has just purchased Fybogel Mebeverine sachets and was advised to take one three times a day to help her with her irritable bowel syndrome symptoms. She also informs you that she has been advised to follow a low potassium diet in which she should not consume more than 1500mg of potassium/day.  

The molecular weight of potassium is 39.

What percentage of Mrs L’s recommended daily potassium is contained in the suggested daily intake of Fybogel Mebeverine sachets? Give your answer to the nearest whole number.

%

96. You are required to prepare 5L of a solution containing both sodium and potassium as chlorides, in concentration of 150mmol/L of sodium and 40mmol/L of potassium. The molecular masses of sodium chloride and potassium chloride are 58.5 and 74.5 respectively. 

What is the amount in grams of sodium chloride required? Give your answer to the nearest whole number.

g

97. You are working in your local pharmacy and are conducting a medicines use review with 75 year old Mr M who has recently undergone surgery and has been discharged from hospital. Mr M informs you that whilst in hospital, the nurses gave him 1mL of Tramadol 100mg/ml oral drops every 4-6 hours. The label on the Tramadol oral drop solution 100 mg/ml includes the directions “Take 0.75mL every 4-6 hours” and Mr M is unsure of how many drops that would be.

Given that 1 drop contains 2.5mg of tramadol, how many drops should Mr M take every 4-6 hours? 

drops

98. Mrs N is acutely unwell and is being treated in the intensive care unit for a severe head injury. She is also an epileptic patient and is on long-term phenytoin treatment. Her most recent blood test results are provided below.

Total protein : 55g/L  (64-83 g/L)

Albumin : 14g/L (35-50 g/L)

Trough phenytoin : 21 mg/L (5-20 mg/L)

The following formula is used by your hospital to give an estimated albumin corrected total phenytoin concentration. 

=  Measured phenytoin concentration (mg/L)             ((0.9 x Albumin (g/L) / 42) + 0.1)

What is the correct adjusted phenytoin concentration expressed in mg/L for Mrs N? Give your answer to one decimal place.

mg/L

99. You are the hospital pharmacist on duty and a female patient has been admitted to your ward with severe hospital acquired pneumonia. The doctor would like to start the patient on Tazocin 2.25 g (piperacillin 2 g / tazobactam 0.25 g) at a dose of 4.5 g every 8 hours via intravenous infusion to treat the infection. He informs you that she has some degree of renal impairment and her dose may need to be adjusted. The patient is 65 years old and weighs 65 kg. Her last measured serum creatinine is 150 micromol/L.

The formula for calculating creatinine clearance (CrCl) is: 

What is the maximum recommended daily dose of Tazocin expressed in grams for this patient? Give your answer to one decimal place. 

g 

100. A 10-year-old girl presents to A&E with an acute moderately severe asthma attack. The nurse on the ward administers 10 puffs of salbutamol 100 mcg metered dose inhaler via a large volume spacer device every 10 minutes for 20 minutes, then every 20 minutes, for a total of period of one hour.

What is the total dose in milligrams of salbutamol that is administered to this patient during the treatment period?

mg

101. A palliative patient is prescribed diamorphine 60 mg over 24 hours as a subcutaneous infusion via syringe driver for management of severe pain. The attending nurse mixes a 100 mg ampoule with water for injection to a length of 48 mm in the syringe. 

What rate setting in mm/hour should the syringe driver be set at? Give your answer to one decimal place.

mm/hour

102. You are working in the hospital sterile unit and have been asked to prepare a sterile solution of sodium chloride 0.9% which is to be packed into 225 x 10ml ampoules. You have available a 1 in 8000 stock solution of sodium chloride.

How many litres of the 1 in 8000 stock solution is required to prepare the requested volume of sodium chloride 0.9%?

L

103. A patient is to be initiated on Venlalic XL tablets once daily for the treatment of depression. His doctor has prescribed the following titration regimen over several months up to a total daily dose of 375mg. 

Step 1: 75mg daily for 4 weeks 

Step 2: 150mg daily for 4 weeks 

Step 3: 225mg daily for 4 weeks 

Step 4: 300mg daily for 4 weeks 

Step 5: 375mg daily for 8 weeks 

Although Venlalic XL tablets are available in strengths of 37.5mg, 75mg, 150mg and 225mg, the doctor has requested that only two strengths, 75mg and 150mg, are dispensed to avoid confusion.  The doctor further requires that instructions are provided so that the patient takes his daily dose using the fewest number of tablets possible. 

What is the total quantity of Venlalic XL 75mg tablets that this patient will require for the first five months of the titration period?

tablets

104. A patient is admitted into hospital with behavioural and psychological symptoms of dementia. The patient was previously taking memantine hydrochloride 15 mg daily which has now been increased to the maximum daily dose for 7 days followed by a review. The patient is refusing to take medication and it is decided to administer medication covertly in their best interest. The medicine is converted to oral liquid formulation for it to be given in fluids.  The consultant neurologist has prescribed memantine hydrochloride 10mg/mL oral solution with the dose to be administered using the pump device.

How much memantine in mg would the patient have received in 7 days? Give your answer to one decimal place.  

mg

105. Mr P, a 35 year old man was diagnosed with schizophrenia 2 years ago.  His condition was stabilised with long acting intramuscular injections of risperidone at a dose of 37.5mg every two weeks.  The doctors have decided to switch him over to paliperidone injections (Xeplion) at a dose of 75mg to be given every month.  Xeplion 75mg is available as a 0.75ml pre-filled disposable injection.  Each 0.75ml syringe costs £244.90.

What is the percentage annual saving in costs if Xeplion 75mg/0.75ml is administered to Mr P once per calender month rather than every four weeks?  Give your answer to two decimal places.

%

106. Mr R presents you with a prescription for a cetylpyridinium chloride solution.  He has been advised to use a 0.05%w/v cetylpyridinium chloride solution as a mouthwash.  In your pharmacy, you have a stock solution of cetylpyridinium chloride with a concentration of 15%w/v.  You are required to supply Mr R with 50ml of a solution of intermediate strength such that when he dilutes it 1 in 40, he obtains that cetylpridinium chloride concentration he is required to use.

What is the strength of the intermediate solution that you must supply to Mr R?

%w/v

107. Miss S has been prescribed 300g of an emollient that contains 12% White Soft Paraffin. You need to extemporaneously prepare this emollient in your pharmacy. You have an emollient that contains 5% White Soft Paraffin and another which contains 25% White Soft Paraffin in stock.

How many grams of the 5% White Soft Paraffin emollient will be required to mix with the 25% White Soft Paraffin emollient to provide 300g of the emollient prescribed?

g

108. Mrs T is a 55 year old woman with chronic renal failure and is receiving treatment for symptomatic anaemia. Her doctor has prescribed Arnesp (darbopoetin alfa) at a dose of 750 nanograms/kg once every 2 weeks via subcutaneous injection for 4 weeks followed by a review. Mrs T is not on dialysis and weighs 51 kg. You have available Arnesp pre-filled syringes 0.4 mL containing darbopoetin alfa 100 micrograms/mL.

How many mL of darbopoetin alfa will Mrs T receive as a single dose every fortnight? Give your answer to one decimal place.

mL

109. Miss W, an 8 year old girl has been prescribed Difflam spray to help manage the pain associated with her mouth ulcers.  She has been told to administer 4 sprays onto the affected area every 1.5 – 3 hours.  Difflam spray contains Benzydamine 0.15% w/v.  

What is the total volume of Difflam in ml that Miss W will use if she administers the spray for the maximum recommended dosage every day between 8am and 8pm for 1 week?  Give your answer to one decimal place. 

mL

110. A patient is prescribed 80 mmol of potassium, which is to be given using 2 litres of infusion fluid at a rate of 10 mmol/hr. The giving set delivers approximately 20 drops per millilitre. 

What is the drip rate in drops per minute required to administer the potassium? Give your answer to the nearest whole number.

drops/min

111. You are the locum pharmacist and you are extemporaneously preparing Methyl Salicylate Liniment for a private prescription you received earlier today.

What is the total volume in mL of arachis oil required to prepare the prescribed amount of Methyl Salicylate Liniment? 

mL

112. You receive a prescription for Miss Y, a 23 year old woman, for Betnovate RD 0.025% (betamethasone valerate) cream. The dosage instructions on the prescription state: 

Apply twice daily to the hands, face and neck for one week.

One finger tip unit (FTU) is approximately equivalent to 500mg of topical preparation.

Assuming that the patient uses the cream in accordance with the prescription, approximately how many milligrams of betamethasone would she have applied to her skin in one week? Give your answer to two decimal places.

mg

113. Mr Z aged eleven years old has developed severe tonsillitis. His doctor wishes to prescribe him phenoxymethylpenicillin 12.5mg/kg four times a day. Mr Z weighs 34kg and does not like to take tablets. Phenoxymethylpenicillin is available as a 250mg/5ml oral solution.

How many 5ml spoonful’s of phenoxymethylpenicillin is Mr Z required to take each day?

Give your answer to the nearest whole number.

spoonful(s)

114. Mr AA is a 55 year old man weighing 69kg and has a height 1.7m.  He has been prescribed Etoposide for the treatment of testicular cancer at a dose of 220mg/m2 daily for four days.  The dose is to be repeated 21 days later.  

The formula for calculating body surface area is:

What is the total number of Etoposide 50mg capsules that should be dispensed for Mr AA? 

capsules

115. You are assisting the technician in the hospital manufacturing lab to prepare 750ml of a magnesium chloride solution required for patients with hypomagnesaemia. The solution must contain 6mmol of magnesium per 10ml.

The molecular weight of magnesium chloride is 203.3.

What weight of magnesium chloride is needed to prepare 750ml of the magnesium chloride solution? Give your answer to one decimal place.

g

116. Mr AB is a 48 year old regular patient who suffers from type 1 diabetes. He takes Humulin M3 daily for the past 8 months. He takes 15 units om and 10 units on.

How many units of soluble insulin will Mr AB have taken in one week? Give your answer to one decimal place. 

units

117. RESOURCE QUESTION:

Mrs AC, a 39 year old lady weighing 69kg attends her GP appointment and informs her doctor that she has decided to quit smoking and wants medication to help her do so. She explains that she does not wish to take any nicotine replacement therapy as it has not helped her in the past and has set her quit date to be one week from today. Her doctor agrees to prescribe her Varenicline tablets.

Assuming Mrs AC is prescribed a full course of treatment, followed by another full course for the maintenance of abstinence, what is the total amount of varenicline expressed in milligrams would she receive? Give your answer to one decimal place.

mg

118. Miss R, a 7 year old girl weighing 24kg, has been admitted to hospital for surgery under anaesthetic.  During the operation she is given an initial intravenous dose of 3mcg/kg fentanyl injection followed by a supplemental dose of 1.25mcg/kg half an hour later.

Given that fentanyl injections contain 100mcg/2ml, what is the total volume of fentanyl injection that is administered to Miss R during the operation? Give your answer to two decimal places.

mL

119. Mr M, a 45 year old man who weighs 72kg, regularly takes sodium valproate tablets for the management of epilepsy. He is currently unable to take medication orally and the doctors have decided to administer the sodium valproate by intravenous injection at a dose of 9mg/kg.  Sodium valproate injection is available as a 400mg vial which is reconstituted with 4ml water for injections prior to administration to yield a concentration of 95mg/ml.

Given that the doctors have requested the dose be given over 5 minutes, at what rate in ml/min should the injection be administered? Give your answer to one decimal place.

mL/min

120. RESOURCE QUESTION

Mrs N, a 55 year old woman who weighs 67kg and is 1.69m tall is being treated for breast cancer.  As part of her chemotherapy regimen, she is to receive doxorubicin at a dose of 35mg/m2 every three weeks.  

Using the National Dose Banding table provided, calculate the volume of doxorubicin that Mrs N will receive per dose.

mL

121. Mrs S presents at your pharmacy asking for advice.  She is eager to lose weight and has started a fitness regime at her local gym.  She currently weighs 12stone 7lb and has a height of 165cm.

How much weight, in kg, does Mrs S need to lose in order to reach a body mass index of 24.9? Give your answer to two decimal places.

Kg

122. RESOURCE QUESTION

Master P, a 5 year old boy weighing 19kg is undergoing a tonsillectomy under general anaesthetic. The procedure is to last 45 minutes during which he is administered remifentanil infusion at a dose of 5mcg/kg/hour. Following reconstitution of the vial, the nurse dilutes further with glucose 5% to the minimum suggested concentration for intravenous infusion.

At what rate in ml/min should the remifentanil infusion be administered? Give your answer to two decimal places.  

mL/min

123. Miss S, a 6 year old girl weighing 23kg, is being started on carbamazepine for seizure control.  Her mother presents you with the following prescription written by the neurologist:

Initially 5mg/kg daily to be given in two divided doses, then increase total daily dose by 2.5mg/kg every 4 days, until a total daily dose of 15mg/kg is reached. Maintenance 15mg/kg daily in two divided doses.

What volume in ml of carbamazepine 100mg/5ml oral suspension do you need to dispense to provide a four week supply?

mL

124. Mr F, a 54 year old man weighing 71kg is to be given an intravenous loading dose of drug X.  The drug has a volume of distribution of 6 litres per kilogram body weight. 

What dose of drug X in mcg should be administered to Mr F to achieve a target plasma concentration of 2 nanograms per ml?  

mcg

125. RESOURCE QUESTION:

You have been asked to prepare 175g of a 1 in 5 dilution of Haelan cream in a suitable diluent.  

What weight of fludroxycortide in mg will be contained in the final cream to be prepared? Give your answer to one decimal place.

mg

126. Mr P starts receiving a 250ml infusion at 20:00 on Monday evening at rate of 4ml/hour.  At 23:30 that evening, the nurse increases the rate of infusion.

Given that the infusion is complete the following day, Tuesday at 17:30, what is the rate in ml/hour of infusion that the nurses increases it to?  Give your answer to one decimal place.

mL/hour

127. Mr R is receiving an intravenous infusion with the following formula:

• Sodium bicarbonate (NaHCO3) 125mmol/L
• Sodium chloride (NaCl) 100mmol/L
• Potassium chloride (KCl) 60mmol/L

The molecular weight of sodium is 23g/mol, hydrogen is 1g/mol, carbon is 12g/mol, oxygen 16g/mol, chlorine is 35.5g/mol and potassium is 39g/mol.

Given that the rate of infusion is 6.25ml/min, what weight of sodium in grams will Mr R have received after two hours of having the infusion? Give your answer to one decimal place.

g

128. You receive request to produce a batch of 50 morphine hydrochloride suppositories using Theobroma oil as the base.  Each suppository is to contain 25mg of morphine hydrochloride and have a final weight of 1g. The displacement value for morphine hydrochloride in Theobroma oil is 1.6.

What is the total quantity of Theobroma oil base in grams needed if a 5% wastage is expected during the manufacturing process? Give your answer to one decimal place.

g

129. At a routine blood test, a 2ml sample of Mr A’s blood is found to contain 6.4mg of sodium.

Given that the molecular weight of sodium is 23g/mol, what is Mr A’s serum sodium concentration expressed in mmol/L?  Give your answer to the nearest whole number.

mmol/L

130. RESOURCE QUESTION

Mrs M, a 55 year old woman weighing 66kg is admitted to hospital suffering with severe pneumonia. Blood tests on admission yield a creatinine level of 136 micromol/L. The doctors start Mrs M on an intravenous infusion of Tazocin.

Constant = 1.23 Men; 1.04 Women

What quantity of piperacillin in g is Mrs M receiving daily?

g

131. Mr L, a 42 year old man, is taken to hospital via ambulance following a car accident. On admission, he is found to have lost a significant amount of blood and the medical team are concerned that he is becoming haemodynamically unstable. The team decide to administer two units of packed red blood cells (PRBC) over 4 hours via a gravity set with a drop factor of 32. 

Given that one unit of PRBC is 310ml, what is the drip rate, in drops per minute? Give your answer to the nearest whole number.

drops/min

132. Miss W, a 9 year old girl weighing 31kg is receiving intravenous fluid therapy in hospital.  She begins to experience symptoms of hyponatraemia including nausea, vomiting and lethargy.  Plasma sodium levels are measured at 128mmol/L and Miss W is given an IV bolus dose of 2ml/kg sodium chloride 2.7% w/v over 10 minutes.

What weight of sodium chloride in grams does Miss W receive over 10 minutes?  Give your answer to two decimal places.

g

133. Miss W, a 9 year old girl weighing 31kg is receiving intravenous fluid therapy in hospital.  She begins to experience symptoms of hyponatraemia including nausea, vomiting and lethargy.  Plasma sodium levels are measured at 128mmol/L and Miss W is given an IV bolus dose of 2ml/kg sodium chloride 2.7% w/v over 10 minutes.

What weight of sodium chloride in grams does Miss W receive over 10 minutes?  Give your answer to two decimal places.

g

134. Mr N, a 32 year old man has been admitted to hospital with a severe respiratory tract infection.  After assessment, Mr N is prescribed an intravenous infusion of clarithromycin at a dose of 500mg every 12 hours.  Clarithromycin is available as a 500mg vial which the nurse reconstitutes with 10ml water for injections and further dilutes with sodium chloride 0.9%w/v to a concentration of 2mg/ml.  Each dose is infused over 60 minutes.

What volume in ml of sodium chloride 0.9%w/v will be used to prepare each infusion?

mL

135. Mr S, a 29 year old with type 1 diabetes is in hospital waiting to undergo major surgery.  During the procedure, Mr S will be administered a 500ml intravenous infusion of 5%w/v glucose and 0.15%w/v potassium chloride.  The infusion will be run at a rate of 100ml/hour.

Given that the molecular weight of potassium is 39g/mol and chlorine is 35.5g/mol, how many mmol of potassium chloride will Mr S receive per hour? Give your answer to the nearest whole number.

mmol

136. Ms R, a 68 year old woman weighing 66kg has been diagnosed with multiple myeloma and the doctors have decided to initiate treatment with melphalan.  Melphalan can be administered orally at a dose of 150mcg/kg daily for 4 days with the cycle repeated every 6 weeks, or it can be administered as an intravenous injection at a dose of 0.4mg/kg once every 4 weeks. Melphalan injection should be prepared immediately before use and any unused solution should be discarded after an hour.

What is the difference in cost between Ms R taking melphalan orally or by intravenous injection over a 15 week period? Give your answer to the nearest whole number.

£

137. You have in stock a 0.5% w/w hydrocortisone butyrate ointment which you dilute to a strength of 0.125%w/w using emulsifying ointment.  

If the final ointment comprises one part of the stock 0.5%w/w hydrocortisone butyrate ointment, how many parts of the final ointment is made up of emulsifying ointment?

parts

138. RESOURCE QUESTION

You have been asked to advise on a suitable dose of levetiracetam for Mrs Z, an 80 year old woman, who is suffering with partial seizures. Mrs Z weighs 60kg and has a height of 1.68m. Her latest blood test yielded a serum creatinine level of 1.32mg/dl.

What is the maximum daily dose in mg of levetiracetam that Mrs Z can take?

mg

139. Mrs R, a 45 year old woman, has just undergone surgery in her right eye and has been instructed to apply one drop of loteprednol etabonate 0.5%w/v eye drops to the right eye every 6 hours. She is to start using the drops 24 hours after surgery and continue until the doctor reviews her in a few days’ time. Mrs R starts using the eye drops at midday on 6th April and sees the doctor at 3pm on 9th April.

Given that each drop contains 0.19mg of loteprednol etabonate, what volume of eye drops would Mrs R have used by the time she attends her doctor’s appointment on 9th April?  Give your answer to one decimal place.

mL

140. Miss L, a 28 year old lady weighing 57kg is admitted to hospital 10 hours after having taken an overdose of paracetamol tablets. A blood sample taken immediately upon admission yields a plasma paracetamol concentration of 29.1mg/L.

What is the total number of paracetamol 500mg tablets that Miss L ingested? Give your answer to the nearest whole tablet.

tablets

141. Mr F has been instructed to use 1.5L of a 0.01%w/v potassium permanganate solution four times a day for 10 days to cleanse an eczematous wound. You are requested to dispense 400ml of a concentrated solution of potassium permanganate which Mr F will dilute in accordance with instructions to create the solution to use for cleansing.

How many potassium permanganate 400mg tablets do you need to use when formulating 400ml of the concentrated solution to be dispensed to Mr F?

tablets

142. Miss N, a 28 year old woman is admitted to hospital suffering with a complicated urinary tract infection.  Following assessment, the medical team decide to initiate an intravenous infusion of ceftazidime at a dose of 2g every 12 hours. To prepare the infusion, 10ml of sodium chloride 0.9% solution for injection needs to be added to 2g ceftazidime powder to create a solution with a concentration of 174mg/ml. The reconstituted solution must be further diluted with sodium chloride 0.9% solution for injection to a final concentration of 40mg/ml.

What is the total volume of sodium chloride 0.9% solution for injection that is used in the preparation of the ceftazidime infusion? Give your answer to one decimal place.

mL

143. You receive a prescription for a 5 day course of nitrofurantoin for an 8 year old child weighing 26kg. The prescriber has provided instructions that the child should take at a dose of 750mcg/kg 4 times a day.  

What volume of nitrofurantoin 25mg/5ml oral suspension should you dispense to fulfil this prescription? Give your answer to the nearest 10ml.

mL

144. Mr K, presents you with a prescription for levofloxacin 5mg/ml eye drops to be administered in accordance with the following instructions:

Instill one to two drops into the left eye every two hours up to 8 times a day for the first two days and then instill one to two drops to the left eye four times daily for 3 days.

You supply Mr K with a 5ml bottle of levofloxacin 5mg/ml labelled with the above instructions.

Considering that there are 20 drops per 1ml and that Mr K uses the eye drops at the maximum dose recommended, what volume of levofloxacin eye drops will be remaining in the bottle after Mr K completes the prescribed 5 day course? Give your answer to one decimal place.

mL

145. A 12 year old child weighing 43kg is to be given Vaminolact infusion at a dose of 1.6g amino acid/kg/day. The infusion rate is to be set at 2ml/minute.

Given that Vaminolact infusion contains 65.3g/L amino acids, what will be the total infusion time in hours.  Give your answer to the nearest hour.

hours

146.  Mr T is a 32 year old man who weighs 73kg and suffers with epilepsy for which he takes phenytoin 250mg daily.  He is admitted to hospital suffering with status epilepticus and a serum phenytoin concentration of 7mg/L is measured.  The doctors would like to administer an intravenous dose of phenytoin to help control the seizures at a rate not exceeding 1mg/kg/minute.

Phenytoin sodium = (20 - measured concentration (mg/L)) x 0.7 x weight(kg)

‘top-up’ dose (mg)

What is the minimum time in minutes in which the required intravenous phenytoin sodium dose can be infused?  Give your answer to the nearest whole minute.

minute(s)

147. RESOURCE QUESTION:

Master P, a 3 year old child weighing 15kg is prescribed furosemide at a dose of 0.5mg/kg twice a day for the management of oedema.  Master P’s mother presents you with a prescription for Frusol 20mg/5ml oral solution and explains that she has read that this solution has a high alcohol content and is rather concerned.

What volume of alcohol will Master P be consuming per day if he takes the medication as prescribed?  Give your answer to two decimal places.

mL

148. Mr P presents you with the following prescription:

Prednisolone 60mg om for 5 days, then reduce by 10mg every 5 days until 10mg for 5 days, then 5mg for 3 days, then stop.

You supply Mr P with all 120 prednisolone 5mg tablets that you have in stock and produce an owing for the remainder.  

What is the total number of prednisolone 5mg tablets that are owed to Mr P?

tablet(s)

149. Master E, a 14 year old boy who suffers with asthma, is having difficulty using his beclometasone dipropionate inhaler and does not want to use a spacer as he thinks its “childish”. He is currently taking two puffs of the beclometasone 100mcg inhaler twice a day. The GP decides to switch him over to QVAR Autohaler which he may find easier to use.

What is the difference in cost between Master E using the beclometasone dipropionate 100mcg/dose inhaler and the Qvar 100 Autohaler over a 3 month period? Give your answer to two decimal places.

£

150. You are required to produce a batch of 50,000 doxazosin 4mg tablets.  In addition to the doxazosin, each tablet is to contain 60mg of disintegrants and flow regulators, 36mg of coating and the remainder of the tablet is to be made up with lactose.  

Given that each tablet will have a final total weight of 135mg, what is the total weight in Kg of lactose required to manufacture this batch of tablets? Give your answer to two decimal places.

Kg

151. You dispense the following prescription for Miss N, an 8 year old girl weighing 28kg:

Cefalexin 50mg/ml suspension, 12.5mg/kg twice a day for 5 days

Assuming Miss N takes the medication as prescribed and that there is no wastage, what volume of suspension would you expect to be remaining in the 100ml bottle after she completes the course?

mL

152. You receive a request for lidocaine hydrochloride 3.5%w/w ointment. You currently have lidocaine hydrochloride 5%w/w ointment in stock which you can mix with a suitable diluent to prepare the desired strength. 

How much diluent do you need to mix with the stock ointment to prepare 175g of the lidocaine hydrochloride 3.5%w/w ointment? Give your answer to one decimal place.

g

153. Mr T, a 66 year old man weighing 65kg, is receiving 120mg of diamorphine in 24 hours via a syringe driver that is 10cm in length. The diamorphine hydrochloride dose has been made up to 48ml with water for injection and the syringe driver has been set at a rate of 4.2mm/hour.

What dose of diamorphine in mcg/kg/min is the patient receiving? Give your answer to one decimal place.

mcg/kg/min

154. Mr U, a 42 year old man weighing 81kg, is to receive a 7 day course of amphotericin as Fungizone intravenous infusion for a severe systemic fungal infection.  Following an initial test dose of 1mg given over 30 minutes on day 1, Mr U receives the following doses of Fungizone:

Day 1: 62.5mcg/kg/hour for four hours, given at least 30 minutes after the test dose  

Day 2:125mcg/kg/hour for four hours

Day 3: 187.5mcg/kg/hour for four hours

Day 4 onwards: 250mcg/kg/hour for four hours

What is the total amount of amphotericin in mg that Mr U would have received during the entire course of treatment?  Give your answer to one decimal place.

mg

155. You are required to dispense a solution of potassium chloride by making a 1 in 20 dilution from 50ml of a 0.5% w/v stock solution.

What is the concentration of the solution you need to dispense in parts per million?

ppm

156. A patient on your ward has been prescribed a course of erythromycin 500mg qds for 10 days for a skin infection. The patient has taken 14 doses during their stay in hospital and is now medically fit for discharge.  

How many erythromycin 250mg tablets do you need to supply to this patient on discharge so that they can complete the entire course?

tablet(s)

157. Mrs M, a 57 year old palliative care patient is finding it increasingly difficult to swallow.  She regularly takes 60mg MST tablets twice a day and 10ml Oramorph oral solution 10mg/5ml every four hours when required.  Over the past two weeks, she has been taking 10ml Oramorph three times a day.  The pain team have decided to switch Mrs M over to a transdermal preparation due to the increasing problems she is experiencing with swallowing.

Which strength of fentanyl patches should the pain team prescribe for Mrs M?

patch

158. Mr H, a 64 year old man who is a regular patient at your pharmacy, has been taking citalopram 40mg tablets once daily for the last four months. He presents you with a prescription for citalopram oral drops 40mg/ml and explains that his GP prescribed the drops for him as he was finding it difficult to swallow the tablets.  

Given that 4 oral drops (8mg) is equivalent in therapeutic effect to a 10mg tablets, how many whole days will a 15ml bottle of oral drops last Mr H?

days

159. Mr H has been assessed by ophthalmology and the following prescription was recommended:

Dexamethasone 0.1% eye drops, one drop into each eye four times a day for 7 days, then one drop into each eye three times a day for 7 days, then one drop into each eye twice a day for 7 days, then one drop into each eye once a day for 7 days then one drop into each eye on alternate days for 2 weeks, then one drop into each eye twice a week for 2 weeks then stop.

Given that there are 20 drops in 1ml, how much dexamethasone in milligrams would Mr H have administered over the treatment period? Give your answer to one decimal place.

mg

160. You are required to formulate 150 lidocaine suppositories for a patient using cocoa butter as the base. The suppositories will be made using a 4g mould and each suppository will contain 5 mg of lidocaine. You plan to make a surplus of 10 suppositories to allow for any losses in preparation. The displacement value of lidocaine in cocoa butter is 0.5.

How many grams of lidocaine will you require to fulfil this order? Give your answer to one decimal places.

g

161. Ms Z, a palliative patient has been receiving 10ml of a morphine sulphate solution with a strength of 0.55%w/v every four hours for the last 72 hours.   As her pain has been stabilised on this dose, the doctors want to switch her to an equivalent dose of MST tablets. The MST tablets are to be given twice daily.

What strength of MST tablets in mg should be prescribed for this patient for each dose?

mg

162.

Mr N, a regular customer presents at your pharmacy on a Tuesday morning asking you for advice. He is going away on Saturday for 3 weeks and wants to ensure he has enough insulin to cover the trip.  He uses Humulin I KwikPen and takes 15 units in the morning and 13 units in the evening.  He tells you that he first used his current pen on Sunday morning and has also taken his dose this morning.

Assuming each dose will be delivered from a single device, how many additional Humulin I KwikPens does Mr N require to last him the entire trip and for 5 days after he returns?

pens

163. Mrs L is prescribed 1.5 litres of sodium chloride 0.9% infusion to be given over 12 hours for the treatment of sodium depletion.

Assuming that there are 20 drops in 1 mL, what is the rate of administration in drops/minute? Give your answer to the nearest whole number.

drops per minute

164. Miss R has been prescribed drug A at a dose of 150mg daily. She takes her dose daily at 7am.  Drug A has a bioavailability of 80% and half life of 5 hours.

What percentage of the administered dose would be remaining in the body 20 hours after Miss R took the dose?

%

165. A 73-year-old male patient with a body weight of 67 kg requires an oral loading dose of digoxin. The volume of distribution (V_D) per kg body weight is 6 L, the salt factor (S) is 1 and the bioavailability (F) of the tablet formulation is 0.7.

The formula for calculating the loading dose is provided below:

What loading dose should be used to achieve a target plasma concentration (C_p) of 1.6 micrograms/L? Give your answer to the nearest whole number.

mcg

166. The label for a 15g vial says “add 20ml of diluent to create a solution with a concentration of 1.5g in 2.5ml”.

What concentration in mg/ml would you obtain if you added 30ml of diluent to the vial instead of 20ml?  Give your answer to the nearest whole number.

mg/ml

167. Miss K has been prescribed Mometasone Furoate 50microgram/dose Nasal Spray with the following instructions:

100 micrograms to be administered to each nostril once a day.  Dose to be reduced to 50 micrograms in each nostril once a day once symptoms are controlled.

Given that Miss K symptoms are controlled after 2 weeks of using the nasal spray, how many days will two 140 dose Mometasone Furoate Nasal Sprays last?

days

168.

You are the hospital pharmacist on duty and a female patient has been admitted to your ward with severe hospital acquired pneumonia. The doctor would like to start the patient on Tazocin 2.25 g (piperacillin 2 g / tazobactam 0.25 g) at a dose of 4.5 g every 8 hours via intravenous infusion to treat the infection. He informs you that she has some degree of renal impairment and her dose may need to be adjusted. The patient is 65 years old and weighs 65 kg. Her last measured serum creatinine is 150 micromol/L.

The formula for calculating creatinine clearance (CrCl) is:

Constant is 1.04 for women and 1.23 for men

Considering the patient is administered Tazocin at the maximum recommended dose, how much piperacillin in grams will she receive per day? Give your to the nearest whole number. 

g

169. Mr T is being administered a drug via a syringe driver set at 18mm/hour. The length of the syringe driver is 20cm and it holds a volume of 30ml of injection solution with a drug concentration of 15mcg/ml.

How much drug in milligrams would Mr T have received after 3 hours?  Give your answer to 2 decimal places.

mg

170. Patient J is being infused with diamorphine over 24 hours. He is currently receiving a dose of 300 milligrams in 24 hours using a syringe pump that is calibrated to 4 mm/hour. You increase the rate of infusion by 12 mm/24 hours.

What dosage expressed in milligrams per hour will Patient J now receive? Give your answer to one decimal place. 

mg/hour

171. A patient weighing 75kg is to be given an intramuscular dose of 80mg in 1.5ml of Drug X. Drug X has an estimated half-life of 14.5 hours and a volume of distribution of 15 L/kg Maximum blood levels are reached 30-90 minutes after an intramuscular dose.  Drug X has an effective bioavailability of 70%.

What would be the expected serum concentration in mcg/L after 60 minutes assuming maximum blood concentration has been achieved? Give your answer to one decimal place.

mcg/L

172. Mrs R presents at your pharmacy asking for advice regarding healthy eating and weight loss. She currently weighs 14stone 2lb and has a height of 165cm.

How much weight in kilograms does Mrs R need to lose in order to reach a body mass index of 24.9? Give your answer to the nearest kg.

Kg

173. You have in stock 500 ml of a glucose 20% (w/v) solution. You receive instructions to produce a new solution by removing 150 ml of the stock solution and replacing it with 150 ml of a glucose 5% (w/v) solution.

What would be the percentage strength of the new solution produced? Give your answer to one decimal place.

% w/v

174. You are required to extemporaneously prepare a coal tar ointment. You have in stock 150 grams of a 5% coal tar ointment.

What is the percentage (%w/w) of coal tar in the finished product when 6 grams of coal tar is mixed with the ointment in stock? Give your answer to one decimal place.

%

175. You are conducting a diabetes review with Miss S. She tells you she has been measuring her blood glucose levels at home and provides you with the following table of a week of pre-prandial readings.

Given that:

Blood glucose (mmol/L) = blood glucose (mg/dl) / 18

What is the average daily blood glucose reading for Miss S in mmol/L?  Give your answer to one decimal place.

mmol/L

176. Mr M has been instructed to take Gaviscon Advance suspension at a dose of 10ml four times a day. Each 10 ml dose of Gaviscon Advance has a sodium content of 4.6 mmol and a potassium content of 2.0 mmol.

The recommended daily allowance of salt for an adult is 6g per day (equivalent to 2.4g sodium).

The relative molecular mass of sodium is 23g/mol.

What percentage of Mr M’s recommended daily salt allowance will he obtain from the total daily dose of Gaviscon Advance suspension he has been instructed to take?  Give your answer to one decimal place.

%

177. Miss P, a 14-week old baby weighing 6.7kg was born prematurely at 34 weeks. The dietician has recommended she continues taking SMA Gold Prem 2 for nutritional support.

How many full days will 6 cans last her if she is given the feeds as per the recommended guide?

days

178. Mr D has been prescribed ipratropium bromide nebuliser solution 250 mcg/mL at a dose of 500 mcg four times a day. You dispense 60 x 2 mL vials of ipratropium nebuliser solution.

How many days treatment will the quantity of vials dispensed provide for  Mr D?

days

179. Master L, a 12-year-old boy weighing 42kg is to receive acetazolamide intravenous infusions for the management of epilepsy at a dose of 18mg/kg/day in three divided doses up to a maximum of 750mg/day. Each 500mg acetazolamide vial is to be reconstituted with 5ml water for injections and diluted further to 50ml with sodium chloride 0.9%w/v solution.

What weight in mg of acetazolamide will Master L receive per dose?

mg

180. A 24-day old neonate has been prescribed a 7-day course of flucloxacillin oral solution for the treatment of a skin infection at a dose of 25mg/kg four times a day.

Given that the neonate weighs 9.5lb and the parents have been instructed to administer the dose using a 5ml oral syringe with 0.1ml dose increments, what is the total volume of flucloxacillin 125mg/5ml oral solution that is required to complete the course?  Give your answer to one decimal place. 

1 Ib = 0.45 Kg

ml

181. A patient weighing 112kg has been prescribed an intravenous infusion of vancomycin at a dose of 20mg/kg every 12 hours for the treatment of a complicated skin infection.

What is the total daily dose of vancomycin in grams that this patient will receive?

g

182. You are requested to manufacture a stock solution of copper sulphate, so that when it is diluted 1 in 50, a final solution of 0.02% is made.

How many grams of copper sulphate is required to make 1L of the stock solution?

g

183. You are working as a practice pharmacist and have been asked to review the prescribing of tiotropium inhalers. You find that, over the last year, a total of 200 patients at the practice have been prescribed tiotropium inhalers. 45% of these prescriptions were brand prescribed as “Spiriva”. You are aware that an alternative brand of tiotropium inhaler exists and look into the cost of the brands.

Brand Pack size Cost per pack

Spiriva 10mcg inhalation powder capsules 60 £77

Braltus 10mcg inhalation powder capsules with Zhonda inhaler 30 £31.80

Considering that all patients inhale the contents of one capsule daily, what would be the annual cost saving for the practice if 90% of patients prescribed Spiriva were prescribed Braltus instead (assume that the patients have a Spiriva handihaler and only require supplies of the capsules). Give your answer to the nearest £100.

£

184. Mr L, a 68kg patient is to be commenced on infliximab infusion for fistulising active Crohn’s disease. He responds to initial treatment and is continued on the maintenance dose.

What is the total amount of infliximab in grams that Mr L receives over one year?  Give your answer to two decimal places.

g

185. You dilute a volume of a stock solution with a concentration of 15.2%w/v to produce 30ml of a solution which you dispense for a patient for use as a mouthwash.

Given that the concentration of the diluted solution that you dispense is 3.04%w/v, what is the volume of the stock solution in millilitres that was used for this dilution?

ml

186. Ms R is a 35-year-old woman who weighs 73kg and has epilepsy for which she takes phenytoin 300mg daily. She is admitted to hospital with status epilepticus and a serum phenytoin concentration of 7.5mcg/ml is measured.  The doctors would like to administer an intravenous dose of phenytoin to help control the seizures.

Phenytoin sodium 'top-up’ dose (mg) = (20 - measured concentration (mg/L)) x 0.7 x weight(kg)

What volume of phenytoin 250mg/5ml solution for injection should be administered to Ms R? Give your answer to the nearest whole ml.

ml

187. A palliative patient is prescribed diamorphine 30 mg over 24 hours as a subcutaneous infusion via a syringe driver for the management of severe pain. The attending nurse mixes a 50 mg ampoule with water for injection and uses it to fill a syringe with a length of 24 mm.

What rate setting in mm/hour should the syringe driver be set at? Give your answer to one decimal place.

mm/hour

188. You are a pharmacist involved in a clinical study comparing the treatments for otitis media.  The study finds that standard antibiotics produced a 73% 1-week cure rate while a new antibiotic drug A, had a 76% cure rate.

Absolute risk reduction (ARR) = difference in the rate of an event between the two test groups

ARR = (event rate with drug A) – (event rate with standard antibiotics)

Number needed to treat (NNT) = number of people needed to be treated to achieve the desired goal of treatment.

NNT = 1/ARR

What is the NNT for drug A?

189. Mr T is suffering from traveller’s diarrhoea. You recommend use of oral rehydration salts to treat the fluid and electrolyte depletion. You supply Mr T with Dioralyte sachets and explain how to correctly reconstitute them.

5 sachets of Dioralyte reconstituted with 1 litre of water provide Na⁺ 60 mmol, K⁺ 20 mmol, Cl^- 60 mmol, citrate 10 mmol, and glucose 90 mmol.

How many millimoles of sodium ions are contained in 350 mL of the reconstituted solution? 

millimoles

190. Mr N uses a Ventolin inhaler when required for asthma. Each canister of Ventolin contains 200 metered actuations providing 100mcg of salbutamol (as salbutamol sulfate) per dose.

The molecular weights of salbutamol and salbutamol sulfate are:

Salbutamol C₁₃H₂₁NO₃  - 239.3

Salbutamol sulfate (C₁₃H₂₁NO₃)₂H₂SO₄ – 576.7

How much salbutamol sulfate in mg does one canister of Ventolin contain?  Give your answer to the nearest whole number.

mg

191. A CCG is reviewing the prescribing of blood glucose testing strips. Over the last year, a total of 85000 packs of 50 test strips were prescribed.  30% of the packs of test strips prescribed were Aviva testing strips.

What would be the annual cost saving if 50% of the Aviva testing strips prescribed were switched to GlucoRx Nexus testing strips and 50% were switched to GlucoMen areo Sensor testing strips? Give your answer to the nearest whole number.

£

192. Mrs R has been admitted to hospital with acute pyelonephritis. She is prescribed intravenous gentamicin at a dose of 80 mg every 8 hours for 5 days.

How many 2 mL ampoules of gentamicin sulphate 40 mg/mL solution for injection will be required to complete this course of treatment?

ampoules

193. Mr R, who takes warfarin daily, has just undergone oral surgery and has been instructed to use tranexamic acid mouthwash to stop active bleeding from the wound. He is dispensed a solution that was prepared by crushing tranexamic acid 500mg tablets and dissolving them in water.  To prepare the mouthwash, Mr R has been told to dilute 5ml of this solution with an equal volume of water to create a solution with a final strength of 5%w/v.

Given that Mr R has been advised to use the mouthwash four times a day for 5 days, what is the minimum number of tranexamic 500mg tablets required to prepare the solution to be dispensed?

tablets

194. You are a Care Home pharmacist and have been approached by one of the nurses for advice regarding Mr P, an 84 year old patient, who appears to have been losing weight. Five months ago, Mr P weighed 67.1kg and, today his weight was measured as 62.1kg.  Mr P is 178cm tall.

Given that Mr P is not acutely ill and is eating some food, what is his score for the risk of malnutrition.

195. A pharmaceutical company have developed a new drug and are in the process of conducting a phase 3 trial. The trial will include a 3 arm randomised controlled study with an allocation ratio of 1:2:2.

What is the total number of patients required to participate in the study so that there at least 85 patients in arm?

patients

196. You are conducting a health check with Mr M, a 51-year-old man.  You are advising him on healthy eating and exercise and, as part of this are discussing his weekly alcohol intake.  He informs you that, on average, in a week he enjoys a glass of red wine (13% ABV) with his evening meal daily and, on Fridays, he also drinks 3 pints of larger (5% ABV) after work.

Units of alcohol = (volume of drink (ml) x ABV (%))/1000

Where ABV is alcohol by volume

Given that each glass of wine is 175ml and 1 pint is 568ml, by how many units of alcohol should Mr I reduce his intake in order to be at the recommended weekly limit?  Give your answer to one decimal place.

units

197. You have in stock Diprosalic ointment (betamethasone 0.05%w/w / salicylic acid 3% w/w) to which you add a sufficient quantity of white soft paraffin to create an ointment with a total weight of 85g.

Given that the strength of salicylic acid in the ointment created is 2.1%w/w, what was the initial weight of Diprosalic ointment you had in stock?  Give your answer to the nearest whole number.

g

198. Mrs S is 64 years old and has an ideal body weight of 65 kg. She has been prescribed ganciclovir by IV infusion. Ganciclovir is principally excreted renally. The dose recommendations for ganciclovir are as follows:

The formula for creatinine clearance is given below:

Constant is 1.04 for women and 1.23 for men

Given that Mrs S has a serum creatinine of 200 micromol/L, what is the most appropriate daily dose in mg for her?

mg

199. Mr H has been assessed by ophthalmology and the following prescription was recommended:

Dexamethasone 0.1% eye drops, one drop into each eye four times a day for 7 days, then one drop into each eye three times a day for 7 days, then one drop into each eye twice a day for 7 days, then one drop into each eye once a day for 7 days then one drop into each eye on alternate days for 2 weeks, then one drop into each eye twice a week for 2 weeks then stop.

Given that there are 20 drops in 1ml, how much dexamethasone in milligrams would Mr H have administered over the treatment period? Give your answer to one decimal place.

mg

200. You are required to formulate 150 lidocaine suppositories for a patient using cocoa butter as the base. The suppositories will be made using a 4g mould and each suppository will contain 5 mg of lidocaine. You plan to make a surplus of 10 suppositories to allow for any losses in preparation. The displacement value of lidocaine in cocoa butter is 0.5.

How many grams of lidocaine will you require to fulfil this order? Give your answer to one decimal places.

g

201. Ms Z, a palliative patient has been receiving 10ml of a morphine sulphate solution with a strength of 0.55%w/v every four hours for the last 72 hours.   As her pain has been stabilised on this dose, the doctors want to switch her to an equivalent dose of MST tablets. The MST tablets are to be given twice daily.

What strength of MST tablets in mg should be prescribed for this patient for each dose?

mg

202.

Mr N, a regular customer presents at your pharmacy on a Tuesday morning asking you for advice. He is going away on Saturday for 3 weeks and wants to ensure he has enough insulin to cover the trip.  He uses Humulin I KwikPen and takes 15 units in the morning and 13 units in the evening.  He tells you that he first used his current pen on Sunday morning and has also taken his dose this morning.

Assuming each dose will be delivered from a single device, how many additional Humulin I KwikPens does Mr N require to last him the entire trip and for 5 days after he returns?

pens

203. Mrs L is prescribed 1.5 litres of sodium chloride 0.9% infusion to be given over 12 hours for the treatment of sodium depletion.

Assuming that there are 20 drops in 1 mL, what is the rate of administration in drops/minute? Give your answer to the nearest whole number.

drops per minute

204. Miss R has been prescribed drug A at a dose of 150mg daily. She takes her dose daily at 7am.  Drug A has a bioavailability of 80% and half life of 5 hours.

What percentage of the administered dose would be remaining in the body 20 hours after Miss R took the dose?

%

205. A 73-year-old male patient with a body weight of 67 kg requires an oral loading dose of digoxin. The volume of distribution (V_D) per kg body weight is 6 L, the salt factor (S) is 1 and the bioavailability (F) of the tablet formulation is 0.7.

The formula for calculating the loading dose is provided below:

What loading dose should be used to achieve a target plasma concentration (C_p) of 1.6 micrograms/L? Give your answer to the nearest whole number.

mcg

206. The label for a 15g vial says “add 20ml of diluent to create a solution with a concentration of 1.5g in 2.5ml”.

What concentration in mg/ml would you obtain if you added 30ml of diluent to the vial instead of 20ml?  Give your answer to the nearest whole number.

mg/ml

207. Miss K has been prescribed Mometasone Furoate 50microgram/dose Nasal Spray with the following instructions:

100 micrograms to be administered to each nostril once a day.  Dose to be reduced to 50 micrograms in each nostril once a day once symptoms are controlled.

Given that Miss K symptoms are controlled after 2 weeks of using the nasal spray, how many days will two 140 dose Mometasone Furoate Nasal Sprays last?

days

208.

You are the hospital pharmacist on duty and a female patient has been admitted to your ward with severe hospital acquired pneumonia. The doctor would like to start the patient on Tazocin 2.25 g (piperacillin 2 g / tazobactam 0.25 g) at a dose of 4.5 g every 8 hours via intravenous infusion to treat the infection. He informs you that she has some degree of renal impairment and her dose may need to be adjusted. The patient is 65 years old and weighs 65 kg. Her last measured serum creatinine is 150 micromol/L.

The formula for calculating creatinine clearance (CrCl) is:

Constant is 1.04 for women and 1.23 for men

Considering the patient is administered Tazocin at the maximum recommended dose, how much piperacillin in grams will she receive per day? Give your to the nearest whole number. 

g

209. Mr T is being administered a drug via a syringe driver set at 18mm/hour. The length of the syringe driver is 20cm and it holds a volume of 30ml of injection solution with a drug concentration of 15mcg/ml.

How much drug in milligrams would Mr T have received after 3 hours?  Give your answer to 2 decimal places.

mg

210. Patient J is being infused with diamorphine over 24 hours. He is currently receiving a dose of 300 milligrams in 24 hours using a syringe pump that is calibrated to 4 mm/hour. You increase the rate of infusion by 12 mm/24 hours.

What dosage expressed in milligrams per hour will Patient J now receive? Give your answer to one decimal place. 

mg/hour

211. A patient weighing 75kg is to be given an intramuscular dose of 80mg in 1.5ml of Drug X. Drug X has an estimated half-life of 14.5 hours and a volume of distribution of 15 L/kg Maximum blood levels are reached 30-90 minutes after an intramuscular dose.  Drug X has an effective bioavailability of 70%.

What would be the expected serum concentration in mcg/L after 60 minutes assuming maximum blood concentration has been achieved? Give your answer to one decimal place.

mcg/L

212. Mrs R presents at your pharmacy asking for advice regarding healthy eating and weight loss. She currently weighs 14stone 2lb and has a height of 165cm.

How much weight in kilograms does Mrs R need to lose in order to reach a body mass index of 24.9? Give your answer to the nearest kg.

Kg

213. You have in stock 500 ml of a glucose 20% (w/v) solution. You receive instructions to produce a new solution by removing 150 ml of the stock solution and replacing it with 150 ml of a glucose 5% (w/v) solution.

What would be the percentage strength of the new solution produced? Give your answer to one decimal place.

% w/v

214. You are required to extemporaneously prepare a coal tar ointment. You have in stock 150 grams of a 5% coal tar ointment.

What is the percentage (%w/w) of coal tar in the finished product when 6 grams of coal tar is mixed with the ointment in stock? Give your answer to one decimal place.

%

215. You are conducting a diabetes review with Miss S. She tells you she has been measuring her blood glucose levels at home and provides you with the following table of a week of pre-prandial readings.

Given that:

Blood glucose (mmol/L) = blood glucose (mg/dl) / 18

What is the average daily blood glucose reading for Miss S in mmol/L?  Give your answer to one decimal place.

mmol/L

216. Mr M has been instructed to take Gaviscon Advance suspension at a dose of 10ml four times a day. Each 10 ml dose of Gaviscon Advance has a sodium content of 4.6 mmol and a potassium content of 2.0 mmol.

The recommended daily allowance of salt for an adult is 6g per day (equivalent to 2.4g sodium).

The relative molecular mass of sodium is 23g/mol.

What percentage of Mr M’s recommended daily salt allowance will he obtain from the total daily dose of Gaviscon Advance suspension he has been instructed to take?  Give your answer to one decimal place.

%

217. Miss P, a 14-week old baby weighing 6.7kg was born prematurely at 34 weeks. The dietician has recommended she continues taking SMA Gold Prem 2 for nutritional support.

How many full days will 6 cans last her if she is given the feeds as per the recommended guide?

days

218. Mr D has been prescribed ipratropium bromide nebuliser solution 250 mcg/mL at a dose of 500 mcg four times a day. You dispense 60 x 2 mL vials of ipratropium nebuliser solution.

How many days treatment will the quantity of vials dispensed provide for  Mr D?

days

219. Master L, a 12-year-old boy weighing 42kg is to receive acetazolamide intravenous infusions for the management of epilepsy at a dose of 18mg/kg/day in three divided doses up to a maximum of 750mg/day. Each 500mg acetazolamide vial is to be reconstituted with 5ml water for injections and diluted further to 50ml with sodium chloride 0.9%w/v solution.

What weight in mg of acetazolamide will Master L receive per dose?

mg

220. A 24-day old neonate has been prescribed a 7-day course of flucloxacillin oral solution for the treatment of a skin infection at a dose of 25mg/kg four times a day.

Given that the neonate weighs 9.5lb and the parents have been instructed to administer the dose using a 5ml oral syringe with 0.1ml dose increments, what is the total volume of flucloxacillin 125mg/5ml oral solution that is required to complete the course?  Give your answer to one decimal place. 

1 Ib = 0.45 Kg

ml

221. A patient weighing 112kg has been prescribed an intravenous infusion of vancomycin at a dose of 20mg/kg every 12 hours for the treatment of a complicated skin infection.

What is the total daily dose of vancomycin in grams that this patient will receive?

g

222. You are requested to manufacture a stock solution of copper sulphate, so that when it is diluted 1 in 50, a final solution of 0.02% is made.

How many grams of copper sulphate is required to make 1L of the stock solution?

g

223. You are working as a practice pharmacist and have been asked to review the prescribing of tiotropium inhalers. You find that, over the last year, a total of 200 patients at the practice have been prescribed tiotropium inhalers. 45% of these prescriptions were brand prescribed as “Spiriva”. You are aware that an alternative brand of tiotropium inhaler exists and look into the cost of the brands.

Brand Pack size Cost per pack

Spiriva 10mcg inhalation powder capsules 60 £77

Braltus 10mcg inhalation powder capsules with Zhonda inhaler 30 £31.80

Considering that all patients inhale the contents of one capsule daily, what would be the annual cost saving for the practice if 90% of patients prescribed Spiriva were prescribed Braltus instead (assume that the patients have a Spiriva handihaler and only require supplies of the capsules). Give your answer to the nearest £100.

£

224. Mr L, a 68kg patient is to be commenced on infliximab infusion for fistulising active Crohn’s disease. He responds to initial treatment and is continued on the maintenance dose.

What is the total amount of infliximab in grams that Mr L receives over one year?  Give your answer to two decimal places.

g

225. You dilute a volume of a stock solution with a concentration of 15.2%w/v to produce 30ml of a solution which you dispense for a patient for use as a mouthwash.

Given that the concentration of the diluted solution that you dispense is 3.04%w/v, what is the volume of the stock solution in millilitres that was used for this dilution?

ml

226. Ms R is a 35-year-old woman who weighs 73kg and has epilepsy for which she takes phenytoin 300mg daily. She is admitted to hospital with status epilepticus and a serum phenytoin concentration of 7.5mcg/ml is measured.  The doctors would like to administer an intravenous dose of phenytoin to help control the seizures.

Phenytoin sodium 'top-up’ dose (mg) = (20 - measured concentration (mg/L)) x 0.7 x weight(kg)

What volume of phenytoin 250mg/5ml solution for injection should be administered to Ms R? Give your answer to the nearest whole ml.

ml

227. A palliative patient is prescribed diamorphine 30 mg over 24 hours as a subcutaneous infusion via a syringe driver for the management of severe pain. The attending nurse mixes a 50 mg ampoule with water for injection and uses it to fill a syringe with a length of 24 mm.

What rate setting in mm/hour should the syringe driver be set at? Give your answer to one decimal place.

mm/hour

228. You are a pharmacist involved in a clinical study comparing the treatments for otitis media.  The study finds that standard antibiotics produced a 73% 1-week cure rate while a new antibiotic drug A, had a 76% cure rate.

Absolute risk reduction (ARR) = difference in the rate of an event between the two test groups

ARR = (event rate with drug A) – (event rate with standard antibiotics)

Number needed to treat (NNT) = number of people needed to be treated to achieve the desired goal of treatment.

NNT = 1/ARR

What is the NNT for drug A?

229. Mr T is suffering from traveller’s diarrhoea. You recommend use of oral rehydration salts to treat the fluid and electrolyte depletion. You supply Mr T with Dioralyte sachets and explain how to correctly reconstitute them.

5 sachets of Dioralyte reconstituted with 1 litre of water provide Na⁺ 60 mmol, K⁺ 20 mmol, Cl^- 60 mmol, citrate 10 mmol, and glucose 90 mmol.

How many millimoles of sodium ions are contained in 350 mL of the reconstituted solution? 

millimoles

230. Mr N uses a Ventolin inhaler when required for asthma. Each canister of Ventolin contains 200 metered actuations providing 100mcg of salbutamol (as salbutamol sulfate) per dose.

The molecular weights of salbutamol and salbutamol sulfate are:

Salbutamol C₁₃H₂₁NO₃  - 239.3

Salbutamol sulfate (C₁₃H₂₁NO₃)₂H₂SO₄ – 576.7

How much salbutamol sulfate in mg does one canister of Ventolin contain?  Give your answer to the nearest whole number.

mg

231. A CCG is reviewing the prescribing of blood glucose testing strips. Over the last year, a total of 85000 packs of 50 test strips were prescribed.  30% of the packs of test strips prescribed were Aviva testing strips.

What would be the annual cost saving if 50% of the Aviva testing strips prescribed were switched to GlucoRx Nexus testing strips and 50% were switched to GlucoMen areo Sensor testing strips? Give your answer to the nearest whole number.

£

232. Mrs R has been admitted to hospital with acute pyelonephritis. She is prescribed intravenous gentamicin at a dose of 80 mg every 8 hours for 5 days.

How many 2 mL ampoules of gentamicin sulphate 40 mg/mL solution for injection will be required to complete this course of treatment?

ampoules

233. Mr R, who takes warfarin daily, has just undergone oral surgery and has been instructed to use tranexamic acid mouthwash to stop active bleeding from the wound. He is dispensed a solution that was prepared by crushing tranexamic acid 500mg tablets and dissolving them in water.  To prepare the mouthwash, Mr R has been told to dilute 5ml of this solution with an equal volume of water to create a solution with a final strength of 5%w/v.

Given that Mr R has been advised to use the mouthwash four times a day for 5 days, what is the minimum number of tranexamic 500mg tablets required to prepare the solution to be dispensed?

tablets

234. You are a Care Home pharmacist and have been approached by one of the nurses for advice regarding Mr P, an 84 year old patient, who appears to have been losing weight. Five months ago, Mr P weighed 67.1kg and, today his weight was measured as 62.1kg.  Mr P is 178cm tall.

Given that Mr P is not acutely ill and is eating some food, what is his score for the risk of malnutrition.

235. A pharmaceutical company have developed a new drug and are in the process of conducting a phase 3 trial. The trial will include a 3 arm randomised controlled study with an allocation ratio of 1:2:2.

What is the total number of patients required to participate in the study so that there at least 85 patients in arm?

patients

236. You are conducting a health check with Mr M, a 51-year-old man.  You are advising him on healthy eating and exercise and, as part of this are discussing his weekly alcohol intake.  He informs you that, on average, in a week he enjoys a glass of red wine (13% ABV) with his evening meal daily and, on Fridays, he also drinks 3 pints of larger (5% ABV) after work.

Units of alcohol = (volume of drink (ml) x ABV (%))/1000

Where ABV is alcohol by volume

Given that each glass of wine is 175ml and 1 pint is 568ml, by how many units of alcohol should Mr I reduce his intake in order to be at the recommended weekly limit?  Give your answer to one decimal place.

units

237. You have in stock Diprosalic ointment (betamethasone 0.05%w/w / salicylic acid 3% w/w) to which you add a sufficient quantity of white soft paraffin to create an ointment with a total weight of 85g.

Given that the strength of salicylic acid in the ointment created is 2.1%w/w, what was the initial weight of Diprosalic ointment you had in stock?  Give your answer to the nearest whole number.

g

238. Mrs S is 64 years old and has an ideal body weight of 65 kg. She has been prescribed ganciclovir by IV infusion. Ganciclovir is principally excreted renally. The dose recommendations for ganciclovir are as follows:

The formula for creatinine clearance is given below:

Constant is 1.04 for women and 1.23 for men

Given that Mrs S has a serum creatinine of 200 micromol/L, what is the most appropriate daily dose in mg for her?

mg

239. A nursing home assistant wants to speak to you regarding the volume of midazolam 10mg/2mL solution for injection that should be provided to a patient who is receiving palliative care. She states that the dose written on the box is 2.5mg - 5mg every TWO hours with a maximum dose of 60mg/24 hours.

With this information, what is the minimum volume (in mL) of midazolam 10mg/2mL that would be provided per dose?

mL

240. A podiatrist has requested that a patient is provided a concentration of chlorhexidine so that when diluted by 40 times, it will produce a 1 in 5000 solution, the dosage noted on the prescription is 25mL to be applied to the affected area every 8 hours for 14 days. You currently have 0.1% chlorohexidine solution in stock

With this information, how much diluent will need to added to the stock solution to obtain the desired product?

mL