HOSPITAL PHARMACY
Questions and Answers for Final Term Exams
Q1: ROLE OF PHARMACIST:
• Pharmacist responsibilities include a range of care for patients, from
dispensing medications to monitoring patient health.
• To maximize their response to the medication.
• Pharmacists also educate patients on the use of medicine.
• Make sure that drugs do not interact in a harmful way
• Also have a role in clinical trials
Q2: Standards require for establishment of pharmacy:
• Administration
• Facilities
• Drug distribution , inventory management and control
• Drug information
• Assuring rational use of drugs
• Research
Q3: CLASSIFICATIONS OF HOSPITALS?
A: on the basis of number of beds:
• Large hospitals
• Medium hospitals
• Small hospitals
On the basis of treatment offered:
• Specialty hospital
• Non specialty hospital
• Isolation hospital
On the basis of association with medical college:
• Teaching hospital
• Non-teaching hospitals
Q4: flow chart of organizational pattern of doctor's hospitals?
1. Directors
2. Executives
3. Service managers
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4. Patient care providers
5. Technicians
Q5: Clinical departments of hospital setup? a Internal Medicine
a Pediatrics / Neonatology
a Pulmonary and Intensive / Critical Care a Neurology
a Nephrology
a Endocrinology
a Cardiology — Invasive and non-invasive a Cardiothoracic Surgery
a Cardiac Electrophysiology
a Orthopedics and Sports Medicine a Urology
a Nephrology and Dialysis a Ophthalmology
a Ear, Nose and Throat / Audiology a Neurosurgery
a General and laparoscopic surgery a Obstetrics and Gynecology
a Clinical Nutrition Consultancy a Physical Rehabilitation
Q6: Dietetic services provided by hospital services?
Diet charts can be provided by pharmacist for diabetic patients. Weight management advices can be
given.
Instructions to take dietary supplements for mal-nutrition patients.
• Instruction to take less intake of salt for
hypertensive patients.
Q7: Diagnostic pathological tests:
• Angiography for checking blockage in heart
• Thallium test for detection of cancer
• Monteux tuberculin skin test for TB
• Magnetic resonance imaging of liver for liver diseases.
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Q8: Function of blood bank?
A: function of blood bank is to meet the emergency need of blood in emergency conditions.
It also helps to prevent deaths due to insufficiency of blood in hospitals.
Q9: Hospital formulary? And its functions?
A: A list of medicines approved for use in the healthcare system by authorized prescribers.
Functions:
• The therapeutic aspect of a formulary system that only the most efficient products are
listed.
• The economic merit also has a double benefit in that the formulary
eliminates
duplication.
• The educational benefit is also significant for the resident staff, nurses and
medical students.
Q10: Standard format of hops formulary:
A: 1. Title page
2. Names and titles of the members of the pharmacy and therapeutics committee
3. Table of contents
4. Information on hospital policies and procedures concerning drugs
5. The pharmacy and therapeutics committee of XYZ hospital
6. Objectives and operation of the formulary system
7. Products accepted for the use at hospital.
8. Appendix
Q11. Four Hospitals have their Own Blood Bank:
Shaukat Khanum Punjab Cardiology Services
Doctor's Hospital
Q12. Nutritionist in Lahore Shaukat Khanum
Defence National Hospital Sheikh Zayed
Services Jinnah Mayo
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Q13. Difference between generic names and brands names?
The chemical name of the drug is referred to as the generic of the drug while the
advertising name of the drug under which the drug is sold is referred as brand name.
Q14.Which system is best in country like Pakistan either generic or brands names?
Generic System of prescribing in developing country like Pakistan, because the running
brand name can demand high prices while the a bioequivalent product may charge less
price which will help the poor people to get the drug easily.
Q16.What are the content of written report for hospital formulary recommendations?
It must emphasize on safety of drug Cost effectiveness of the drug Economic benefits
Q17.How transparent decision making can be insured by the DTC meeting?
Decisions must not depend on single person
Positive and negative points regarding recommendations must be gathered
Meeting minutes must be compiled and if they contain more positive points than
negative ones then recommendation must be added if it contain more negative points then
it should be rejected.
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Q18.Critaria for evaluation of any medication for inclusion in formulary?
• Disease patterns
• efficacy and effectiveness
• Safety
• Quality
• Cost and cost effectiveness
• Well known medicines
• Expertise to manage the medicine
Q19. Pharmacoeconomic parameters for evaluation of drug?
1. Cost utilization analysis (CUA)
2. Cost benefit analysis (CBA)
3. Cost minimization analysis, are considered in such a way that the must lead to quality
adjusted life years of the patients (CMA)
Q20.Role of hospital pharmacist in development of hospital formulary?
Pharmacist has a potential role to develop formulary of drugs accepted for use in hospital
and provide its constant revision.
Q21.How you can keep the hospital formulary up to date?
Hospital formulary can be kept up to date by regular meeting of DTC and by contribution of the
physician and pharmacist to update the formulary according to the new and
advance knowledge.
Q22.Benefits and problems of hospital formulary?
Benefits:
These are as follows:
• Therapeutic
• Economic
• Educational
Problems of Hospital formulary:
The drug of a newly developed disease may not be available in hospital formulary
• Storage cost
• Expiry drug
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• Out dated drugs
Q23. Unit dose and its advantages:
A method of preparing medications in which individual doses of patient medications are prepar
ed by the pharmacy and delivered inindividual labeled packets to the patient's unit to be admini
stered by the nurses on an ordered schedule.
OR
A system for preparation and distribution of drugs serves in single dose and made ready to
be consumed once.
Advantages:
• Main purpose is to decrease the administration error.
• Patient safety.
• Medications ready for administration
Q24.What are various steps for dispensing of medication?
1) Reviewing a prescription (drug name, strength, dosage form etc.)
2) Primary and secondary identifiers
3) Check labeling
4) Refill
Q25) Discuss steps for dispensing to ambulatory patients?
The dispensing pattern involved to ambulatory patients in providing clinic patients as well as
those patients being discharged with "take home drugs" is identical with that carried on by a
community pharmacy.
In both instances,
A prescription is written by the physician and
The patient takes it to the pharmacy where it is compounded by a pharmacist.
If there is to be a waiting period, the pharmacist will make use of a prescription call check
which numerically identifies the patient, and the finished prescriptions
Q: 26 Difference between inpatient and outpatient?
A: Inpatient is a patient who spend more than 24 hours in hospital and require
admission in hospital for proper recovery
Outpatient is a patient who don't spend more than 24 hours in hospital and do not
require admission in hospital for recovery
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Q: 27 what is meant by controlled substances?
A: A controlled substance is generally a drug or chemical whose manufacture, possession,
or use is regulated by a government, such as illicitly used drugs or prescription
medications that are designated a Controlled Drug
Q: 28 Discuss dispensing of controlled substances?
In dispensing of controlled substances, the following requirements should Be considered with
prescriptions:
1. Drugs may be dispensed on the verbal prescription in an emergency situation.
2. Prescription shall be retained in conformity with the requirements of this law.
3. No prescription for a controlled substance in Schedule II may be refilled.
4. Controlled substances in Schedule III or IV may not be dispensed without a written
or oral prescription in conformity.
5. Such prescriptions may not be filled or refilled more than 6 months after the
date thereof or be refilled more than 5 times after the date of the prescription
unless renewed by the practitioner.
6. No controlled substance in Schedule V that is a drug may be distributed or
dispensed other than for a medical purpose.
7. Prescriptions filled with controlled substances in Schedule II may be written in
ink or indelible pencil and must be signed by the practitioner issuing them.
Prescriptions for narcotic substances in Schedules III, IV and V, must be kept in a separate
file.
Q: 29 What is meant by Medication error?
A: A medication error is any preventable event that may cause or lead to
inappropriate medication use or patient harm while the medication is in the control of
the health care professional, patient, or consumer.
Q: 30 What are various leading reasons for medication errors?
A: Incomplete patient information (not knowing about patients' allergies, other medicines
they are taking , previous diagnoses, and lab results ), Unavailable drug information (such as
lack of up-to date warnings), Miscommunication of drugs orders, which can involve poor
handwriting , confusion between drugs with similar names, misuse of zeroes and decimal points,
confusion of metric and other dosing units, and
inappropriate abbreviations. Lack of appropriate labeling as a drug is
prepared and repackaged into smaller unit's Environmental factors, such as lighting,
heat, noise, and interruptions that can distract health professionals from their medical tasks.
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Q: 31 Describe various stages at which medication error can take place?
A: Medication errors may occur at any stage of the medication process
including:
•SeIection/procurement/storage
•Prescribing
•Processing (communication related to processing and transcribing orders,
compounding, packaging, labeling, dispensing and distribution).
•Administration
•Reporting/Monitoring
Q: 32 give any example illustrating medication related problems of Sound alike drugs Aldactone (
spironolactone ) is sound alike with Aldomet (methyldopa)
Azopt is sound alike Atropt
Losec ( omeprazole magnesium ) is sound alike Lasix ( furosemide )
Q: 33 Give any example illustrating medication related problems of look-alike drugs Tropicamide
ophthalmic solution USP look alike Cyclopentolate Hydrochloride Ophthalmic
solution USP
Milrinone ( lactate inj ) look alike Neostigmine ( methylsallicylate ink ) Hydralazine
hydrochloride tablet USP look alike Hydroxyzine HCL tab USP
Q: 34 Describe various safer systems which can be utilized for reducing the tendency for
medication Related problems
• Computerized System must be utilized consisting of various software that can locate for
any medication error like drug interactions or age group dose handling etc.
• Age group calculations must be fed in computer software previously
• Unique font should be opted in order to minimize medication errors
• Full name with fathers name should be written to prevent errors
• Medication name should be written in unique font to prevent any problem
Q: 35 Human make mistakes but safer System reduce tendency of Mistakes, Justify the
statement
Humans make mistakes, but good systems design and continuous improvements utilizing the
information obtained from error analyses have been shown to decrease errors.
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Q36: How you can improve the medication safety?
A: medication safety can be improved by reducing the environmental
disturbances environment pressure , by avoiding phone calls , focusing on work , minimizing
work hours of a personnel , building sense of honesty in personnel , vigilance during
working and by using computerized filling of prescription , centralized prescription filling.
Q37: Basic rights of patients? A: Right patient
• Right medication
• Right dose
• Right route
• Right time
Q38: what sort of information should be recorded in patient admission data base? Obtain a good
patient medication history of:
• Prescription drugs and dosages
• Over-the-counter drugs and dosages
• Herbal/alternative products
• Including EVERY route.
• Last dose
Q39: “NEVER ACCEPT BLANKET” justify?
A: Never accept blanket “resume all meds” orders when transferring between levels of care
• Rewrite orders using “a medication order summary form”.
• Facilitates provision of specific orders and identifies medicines which should not be
continued
Q40: difference b/w primary and secondary identifiers?
A: primary identifier includes patient name, age, sex, occupation and address.
While secondary identifiers includes father name, husband name, bed number, date,
medical record number.
Q41: Acceptable sources of patient identifiers? A: Patient's name, MR# or account#, date of birth
• A photo ID is appropriate in some cases.
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Q42: what are verbal orders and what precautionary measures should be taken while taking it?
A: I define a verbal order as an order that the doctor gives the nurse verbally while in the
same
rOOM.
PRECAUTIONS:
• Listen carefully to avoid confusion between sound alike dugs. Q43: Dispensing of narcotic drug
on verbal orders?
A: no, narcotic drug cannot be dispensed on verbal orders because they belong to
schedule 2 class and have high potential to abuse.
Q44: Human make mistakes, but safer system reduce tendency of mistakes, justify?
A: safer systems like computerize prescriptions reduced the tendency of
mistakes as it minimizes the personnel error, problem of label mixing, confusion
between look-alike and sound-alike drugs.
Q.45: What sort of medication error can arise while receiving a verbal order, give examples along
with their solutions?
Types of Verbal Order Errors:
1) Wrong Drug:
a) Clonidine misheard as Klonopin
b) Amiodarone misheard as amrinone
2) Wrong Dose:
a) 15 mg misheard as 50 mg,
b) 2 mg misheard as 20 mg
3)Wrong Labs:
Blood glucose misheard as 257 instead of 157 patient received 6 units of insulin instead of 2.
Solutions:
Having a second person listen to a verbal order whenever possible. Recording the verbal order
directly onto an order sheet in the patient's chart. Limiting verbal orders to formulary drugs.
Limiting verbal communication of prescription or medication orders to urgent situations in
which immediate written or electronic communication is not feasible.
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Q.46: Enumerate few high risk medications?
CNS stimulants Analgesics
Anti adrenergics
Anti-anxiety Anti-histamine Antipsychotic Barbiturates
Benzodiazapines
Amphetamine, methamphetamine Indomethacine, tramadol Methyldopa, Guanabenz Meprobamate
Diphenhydramine
Thioridazine Secobarbital and others chlordiazepoxide
Q.47: Don't hesitate to ask someone to double check you, justify the statement.
Being human chances of mistakes are present so double checking is beneficial in order to reduce
or decrease errors.
Q.48: Name any two anticoagulants.
• Heparin
• Warfarin
Q.49: Name few problem prone abbreviations.
Prone abbreviations and symbols should NEVER be used when communicating medical information.
This includes internal communications, telephone/verbal prescriptions, and computer-generated
labels, labels for drug storage bins, medication administration records, as well as pharmacy and
prescriber computer order entry screens.
ISMP's (institute for safe medication practice) List of Error-Prone Abbreviations
Abbreviations Intended Meaning Misinterpretation Correction
\zg BT
IJ
Microgram Bedtime
Injection
Mistaken as “mg” Use “mcg” Mistaken as “BID” Use “bedtime” (twice daily)
Mistaken as “IV” or Use “injection” “intrajugular”
IU
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International unit Mistaken as IV
(intravenous) or 10 (ten)
Use “units”
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cc Cubic centimeters Mistaken as “u” (units)
Use “mL”
Q.50: How the line in prescription may interfere with observation of decimal po int,
give example.
Prescription should not be written on the lined page and if it is used it must be reassured, as
it make confusion and it interfere with the observation of decimal points and various
symbols.
Q.51: Enumerate various ethical principles for ensuring patient safety.
• Beneficence
• Autonomy
• Honesty
• Informed consent
• Confidentiality
• Fidelity
Q.52: What is meant by informed consent, and what sort of information must kept in mind while
getting informed consent from patient?
Informed consent means that you understand your condition and any proposed treatment. You have
a legal right to be told any information that relates to your medical condition and treatment.
Without this information, you are not able to make a fully informed choice and give valid
consent for treatment.
Informed consent forms
Verify that the patient understands procedures, outcomes, and options Patient may withdraw consent
at any time
Q.54: Case-I Edward Schizophrenia Case 1
Ms. Edward is starting on a new medication for schizophrenia. The drug has a number of side
effects, some of which are serious. She asks you several questions about the purpose of the
mediction and possible side effects. When you ask her what the physician told her about the
medication, she reports that he said “I hve got a lot of patient on this medication and they are
doing fine.” It is obvious to you that she is unclear about the purpose of this drug or any
possible problems. Your concern is that Ms. Edwards may be noncompliant if told about possible side
effects. What will you do?
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Ans) one of the most important activities done by a pharmacist is counseling. In above case of
Ms. Edward as she is unclear about the purpose of drug as the medication cause serious side
effects, so keeping in view the above scenario the pharmacist should guide in a way that minimize
the chances of patient non-compliance and at the same time also satisfy her. The patient
satisfaction is achieved by informing her side effects that are most obvious and apparent.
Q. 55) James Bentley, a 17 year old patient was diagnosed with epilepsy and
prescribed phenytoin 6 months ago. You understand that he is embarrassed by his disease and is
not convinced the doctor is right about the diagnosis. He thinks he does not need the drug. You
have tried to educate him on the med and the importance of taking it properly but it has not worked
— he still omits doses frequently. He also continues to drive, and was recently in a non-injury
accident. His father sometimes picks up his meds, but does not seem to have knowledge of
his son's denial of the disease or his non-compliance. Should you disclose to the father,
physician, or the police that the patient is not taking the medication?
ANS) There is no need to tell to the police that the patient is not taking the
medication, also there is no need to tell to the physician as James doesn*t take the
instructions of his physician seriously. First of all, there is a need to prevent the
embarrassment of James Bentley, by educating him more about the disease and telling him
the consequences of not taking proper medication. The father could also be informed about his
son's denial of disease so that he could ensure that his son is not missing any dose, but in
such case the father should pretend in front of James as if he doesn”t know anything .
Q56) Enumerate most prevalent Dispensing errors? ANS) Most prevalent dispensing errors
include;
1) Dispensing incorrect medication, dosage strength, or dosage form.
2) Dosage miscalculations.
3) Failure to identify drug interactions or contraindications.
Q57) What is meant by errors of Omission? ANS) Errors of omission includes;
• Failure to counsel the patient.
• Failure to screen for interactions and contraindications.
Q58) What is meant by errors of Commission? ANS) Errors of commission includes;
• Miscalculation of a dose.
• Dispensing the incorrect medication, dosage strength, or dosage form.
Q59 Differentiate between terms Mistakes and Slips?
ANS) Mistake
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Do things intentionally but actions are incorrect because of a knowledge or judgment
deficit
• Behavior in problem solving mode.
• Example: dose prescribed that exceeds maximum safe limit.
Slip
Do things unintentionally incorrect because of an attention deficit
• Behavior in automatic mode.
• Example: dispense chlorpromazine when prescription was clearly written for
chlorpropamide.
Q60) How the work load is responsible for dispensing errors? How u can overcome that? ANS) Work
load is responsible for dispensing error as if there is more work load pharmacist will not be
able to take rest, will become tired and will not be able to work properly.
Improving work load includes;
• Ensure adequate staffing levels.
• Eliminate dispensing time limits (quotas).
• Examples of limiting workload:
& Dispense s150 prescriptions per pharmacist per day. & Require rest breaks every 2—3 hours.
& Brief warm-up period before restarting work tasks.
& Require 30-minute meal breaks.
Q61) Distractions are leading factors for dispensing errors, how you can overcome that? ANS)
Combating dispensing errors:
• Phones:
— Fax machines, auto refill, voice mail, priority processing, trained support
personnel.
• Prohibit distractions during critical prescription-filling functions.
• Centralized filling operations.
• Train support personnel to answer the telephone.
Q62) Ensure adequate staffing level, for overcoming medication related problem, make a
strategy for it?
ANS)
• Eliminate dispensing time limits (quotas)
• Divide work load i.e. Dispense 1150 prescriptions per pharmacist per day
• Require rest breaks every 2—3 hours
• Brief warm-up period before restarting work tasks
• Require 30-minute meal breaks
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Q63) What sort of training must be provided to the personnel for receiving verbal orders at any
pharmacy setup?
ANS) Verbal drug or prescription orders should be reserved only for those situations in
which it is impossible or impractical for the prescriber to write the order or enter it in the
computer. The prescriber should dictate verbal orders slowly, clearly, and articulately to
avoid confusion. The order should be read back to the prescriber by the recipient (i.e.
pharmacist). When read back, the drug name should be spelled to the prescriber and, when
directions are repeated, no abbreviations should be used (e.g., say “three times daily”
rather than “t.i.d.”). A written copy of the verbal order should be placed in the patient's
medical record and later confirmed by the prescriber in accordance with applicable state
regulations and hospital policies.
Q64) Describe the limitations of computerized prescribing? ANS) Limitations of computerized
prescribing:
• Lower case L may look like the numeral 1.
• Letter 0 may look like the numeral 0 (zero).
• Letter Z and the numeral 2 may be misread.
• Wrong patient or wrong drug chosen from list.
Q65) Draw a label for oral medication fulfilling the minimum requirements for
its
acceptability?
ANS)
x This image cannot currently be displayed.
Q66) SAME AS Q:NO 103
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Q67) What are various errors related to dispensing methods?
• Dispensing incorrect medication, dosage strength, or dosage form
• Dosage miscalculations
• Failure to identify drug interactions or contraindications
Q68. Define the word “Addict”?
Ans. Addict: Any individual who habitually uses any narcotic drug so as to endanger the public
morals, health, safety or welfare, or who is so far addicted to the use of narcotic drugs
as to have lost the power or self-control with reference to his addiction.
Q69.What is meant by term “administer” with special reference to controlled substances?
Ans. Administer: The direct application of controlled substances to the body of a
patient or research subject by a practitioner or his agent or by the patient or
research subj ect at the direction and in the presence of the practitioner
Q70. What is meant by term “narcotic drug”?
Ans. Narcotic Drug: means any of the following, whether produced directly or indirectly
by extraction from substances of vegetable origin, or independently by means of
chemical synthesis, or by a combination of extraction and chemical synthesis.
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[A] Opium, coca leaves and opiates.
[B] A compound, manufacture, salt, derivative, or preparation of opium, coca leaves or opiates.
[C] A substance (any compound, manufacture, salt, derivative, or preparation thereof) which
is chemically identical with any substance referred to in [A] or [B] above.
Q71. Describe various schedules of controlled substances?
Ans. SCHEDULES FOR CONTROLLED SUBSTANCES
(1) SCHEDULE I
[A] The drug or other substance has a high potential for abuse.
[B] The drug or other substance has no currently accepted medical use in treatment.
[C] There is a lack of accepted safety for use of the drug or other substance under
medical supervision.
(2) SCHEDULE II
[A] The drug or other substance has a high potential for abuse.
[B] The drug or other substance has recurrently accepted medical use in treatment
or a currently accepted medical use with severe restrictions.
[C] Abuse of the drug or other substances may lead to severe psychological or
physical dependence.
(3) SCHEDULE III
[A] The drug or other substance has a potential for abuse less than the drug
or other substances in schedules I and II.
[B] The drug or other substance has a currently accepted medical use in treatment in
the (United States).
[C] Abuse of the drug or other substances may lead to moderate or low physical dependence or
high psychological dependence.
(4) SCHEDULE IV
[A] The drug or other substance has a low potential for abuse relative to the drug
or other substances in schedules III.
[B] The drug or other substance has a currently accepted medical use in treatment in
the (United States).
[C] Abuse of the drug or other substances may lead to limited physical
dependence or psychological dependence relative to the drugs or other substances in schedule
III.
(5) SCHEDULE V
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[A] The drug or other substance has a low potential for abuse relative to the drugs
or other substances in schedules IV.
[B] The drug or other substance has a currently accepted medical use in treatment in
the (United States).
[C] Abuse of the drug or other substances may lead to limited physical
dependence or psychological dependence relative to the drugs or other substances in schedule
IV.
Q72. Enumerate the information to be recorded on daily controlled drug administration
sheet?
Ans. Information on daily controlled drug administration sheet The full information required on
the Daily Controlled Drugs Administration Sheet is as follows:
1. Date.
2. Amount given.
3. Patient's full name
4. Patient's hospital number.
5. Name of doctor ordering.
6. Signature of nurse administering.
The following information is requested for auditing purposes and is not required by
Federal
1. Number of tablets or ml administered
2. Filing out inventory column (to be retained for Pharmacy).
Q73: What is the role of pharmacist in hospital pharmacy? Role of pharmacists includes
• Hospital pharmacist has more opportunity to interact closely with the prescriber and,
therefore, to promote the rational prescribing and use of drugs.
• In larger hospital and institutional pharmacies, is usually one of several pharmacists, and
thus has a greater opportunity to interact with others, to specialize and to gain greater
expertise.
Having access to medical records is in a position to influence the selection of drugs and dosage
regimens.
• Monitor patterns of drug usage and thus recommend changes where necessary.
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• Serves as a member of policy-making committees.
• is in a better position to educate other health professionals about the rational use of
drugs;
• More easily participates in studies to determine the beneficial or adverse effects of
drugs, and is involved in the analysis of drugs in body fluids.
• Can control hospital manufacture and procurement of drugs to ensure the supply of
high-quality products;
• Takes part in the planning and implementation of clinical trials.
Q74: What sort of dietetic information can be provided in any hospital pharmacy set up?
• Diet charts can be provided by pharmacist for diabetic patients.
• Weight management advices can be given.
• Instructions to take dietary supplements for mal-nutrition patients.
• Instruction to take less intake of salt for hypertensive patients.
Q75: Name any 3 hospitals in Lahore which have dietetics for dietetic services?
• Hameed latif Hospital
• Fatima memorial Hospital
• Defence national Hospital
Q76: What is the role of blood bank in hospital? Name any 4 hospitals located in Lahore which
possess their own blood bank?
• Shaukat Khanum
• Punjab Cardiology
• Services Hospital
• Doctor's Hospital
Q77: Name any 10 clinical departments of hospitals? a Internal Medicine
a Pediatrics / Neonatology
a Pulmonary and Intensive / Critical Care a Neurology
a Nephrology
a Endocrinology
a Cardiology — Invasive and non-invasive a Cardiothoracic Surgery
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a Cardial Electrophysiology
a Orthopedics and Sports Medicine a Urology
a Nephrology and Dialysis a Ophthalmology
a Ear, Nose and Throat / Audiology a Neurosurgery
a General and laparoscopic surgery a Obstetrics and Gynecology
a Clinical Nutrition Consultancy a Physical Rehabilitation
Q78: Name any 2 anticoagulants?
• Heparin
• Warfarin
Q79: What is the basic difference between inpatients and outpatients?
Inpatients are the patients admitted in the hospital & have spent more than 24 hours in it
while outpatients are out-door, they come for checkups & diagnosis or treatment. Treatment
provided to such patients is called ambulatory care.
Q80: What is meant by ambulatory patients?
The patients which are capable of walking & are not bed-ridden i.e. they are not hospitalized
for 24 hours or more but who visits a hospital, clinic, or associated facility for diagnosis or
treatment is called ambulatory patient or outpatient and treatment provided in this fashion
is called ambulatory care.
Q81: Name few categories of inpatient pharmacists?
• Staff pharmacist
• Intensive care unit (ICU) pharmacist
• Pediatrics/neonatal ICU pharmacist
• Infectious diseases pharmacist
• Operating room pharmacist
• IV room pharmacist
Q82: What are the responsibilities of inpatient pharmacists?
& Verify doctor's medication orders and monitor medication therapy of hospitalized patients
& Review medication profiles for dosage accuracy, drug-interactions, and side effects &
Monitor the distribution, dispensing, and compounding of medications
& Perform pharmacokinetic evaluations on antibiotics and anticoagulants
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Schedule and order drug levels
Formulate and provide parenteral nutrition to patients who cannot receive oral feedings
Evaluate patient's kidney function and adjust medication dosage accordingly Educate and counsel
patients being discharge.
Q 83: what sort of pharmacokinetics can be performed by Inpatient Pharmacists?
• Dose adjustment according to Creatinine clearance, BMI, Weight, Gender, Renal and Hepatic
and Renal insufficiency.
• Intravenous compatibility,
• Infusion rate.
• TPN (Total parenteral nutrition)
Q 84: What sort of dietetic services are provided by pharmacists who are unable to take meal by
oral route?
Total parenteral nutrition (TPN) is feeding a person intravenously. The person receives
nutritional formulae that contain nutrients such as glucose, amino acids, lipids and added
vitamins and dietary minerals to fulfill calorie needs. (TPN) is provided when
the gastrointestinaltract is nonfunctional, used for comatose patients, ulcerative colitis, and in
Infants and Neonates. For energy only, intravenous sugarsolutions with dextrose or glucose are
generally used.
Examples of total parenteral nutrition solution
Substance
Amino acids
Dextrose
Lipids
Na+
K+
[Q/Ans’s]
85 8
250 g
100 g
150 mEq
80 mEq
Normal patient
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Ca2+
Mg2+
Acetate
360 mg
240 mg
72 mEq
Q 85: Enlist few renal function tests?
• Urinalysis
• Renal clearance test
• Blood urea
• Serum creatinine
• Proteinuria
• Hematuria
• Insulin clearance test
• Blood urea nitrogen test
• Urine glucose
• Phenosulphonehthalein excretion test.
Q 86: What is meant by Pharmaceuticalconsultation?
The ability of a pharmacist to consult effectively is the fundamental of pharmaceutical care.
Nurturing a relationship with patient is essential to understand their medication related needs
Q 87: Enumerate few patient Consultation Behaviors?
Appropriate use of open and closed questions Respects patients
Avoids jargon
[Q/Ans’s]
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Demonstrates empathy
Deals sensitively with potentially embarrassing or sensitive issues
Q 88: Enumerate Mnemonics Used In Pharmaceutical Consultation?
What are the symptoms?
How long has it been going on? Action taken?
Medicines taken?
Self or someone else? Medicines being taken?
Exactly what do you mean by the symptom? Time and duration of the symptom?
Taken any action (medicines or seen by the doctor)?
History of any disease?
Other symptoms?
Doing anything to alleviate or worsen the symptom?
[Q/Ans’s]
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No medication is always an option
Care when dealing with specific patient groups
Observe the patient for signs of systemic disturbance and ask about the presence of fever,
loss of weight and other physiological disturbances
Refer when in doubt
Explain any course of action recommended
Q 89: Resolve the following case using the Acronyms (SIT DOWN SIR)
• Jason O'Leary is 25 and works as a barman in a local nightclub. He works
irregular antisocial hours. He is generally healthy and takes no prescribed medication. During
the winter months he gets quite a few colds and blames this on customers coughing
and sneezing near him in the nightclub.
• This winter he has had two colds in quick succession and each cold seems to start with a sore
throat. For the past four days his throat has felt quite sore, especially when he
swallows, but he has no other symptoms. He looked in the bathroom mirror this
morning and noticed that his throat was looking a little red and inflamed. He decides to go
along to the local pharmacy for some advice.
SIT DOWN SIR
S: Site or location — throat
I: Intensity or severity — quite sore
T: Type or nature — worse on swallowing D: Duration — four days
0: Onset — usually associated with cold
W: With (other symptoms) — no other symptoms N: annoyed or aggravated by — no information
S: Spread or radiation — no spread of symptoms
I: Incidence or frequency pattern — two recent colds and usually associated with sore throat
[Q/Ans’s]
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R: Relieved by — has not tried any medication, throat continually sore but worse on swallowing.
Q 90: Resolve the following case using the Acronyms (WWHAM)?
WWHAM
W: Jason O'Leary 25-year-old male works as a barman in a local nightclub. During the winter
months he gets quite a few colds and blames this on customers coughing and sneezing near him in
the nightclub
W; what are the symptoms Sore throat, especially when he swallows, usually associated with
cold.
H: How long it is has been going on — 4 days
A: Action: He looked in the bathroom mirror this morning and noticed that his throat was
looking a little red and inflamed. He decides to go along to the local pharmacy for some advice
M: Medication? — No regular medication
Q 91: Resolve the following case using the Acronyms (ASMETHOD)?
ASMETHOD
A: Age/appearance? —25-year-old male, looks generally healthy but a little run down as if he is
not taking care of himself
S: Self or someone else? — requesting information for himself M: Medication? — No regular
medication
E: Extra medicines? — has not taken anything for the sore throat T: Time persisting —4 days
H: History? — has a tendency to have sore throats associated with cold symptoms, blames this on
workplace
0: Other symptoms? — No other symptoms
D: Danger symptoms? — No symptoms to cause concern
Q 92: Resolve the following case using the Acronyms (ENCORE)?
ENCORE
E: Explore — sore throat symptoms — little information apart from throat looks a little sore N:
No medication — not taking any medication — not an adverse drug reaction
C: Care — No warning symptoms are present — for example bacterial infection such as swollen
glands or white tonsil exudate. Sore throat only of 4 days' duration.
[Q/Ans’s]
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O: Observe — 25-year-old male, looks generally healthy but a little run down as if
he is not taking care of himself
R: Refer — no need to refer in this case
E: Explain — suck a lozenge or pastille to soothe throat — could select local anesthetic lozenge
or analgesic lozenge — check on suitability; take a systemic painkiller such as paracetamol
tablets — explain dose; advise to see GP if the throat is severe/persistent lasting more
than 2 weeks or not associated with cold symptoms. The appearance of the patient is
taken into account and any symptoms that would suggest a more serious condition are eliminated.
The disadvantage of this method is that the ‘refer’ and ‘explain’ sections do not
really add to the differential diagnosis.
Q: 93 Resolve the case study by appropriate acronyms.
Q.94 Differentiate between errors of omission and commission? Ans.
Omission
1 Failure to counsel the patient
2 Failure to screen for interactions and contradictions.
Commission Miscalculation of a dose.
Dispensing the incorrect medication, dosage strength or dosage form.
Q.95 Differentiate between the terms mistakes errors and slips.
Ans. Mistakes:
Do things intentionally but actions are incorrect because of a knowledge or judgment deficit.
6 Behavior in problem solving mode.
e.g. dose prescribed that exceeds maximum safe limit. Slip:
Do things unintentionally incorrect because of an attention deficit. & Behavior in automatic
mode.
e.g. dispense chlorpromazine when prescription was clearly written for chlorpropamide.
Q.96 What are common causes of dispensing errors? Common causes:
[Q/Ans’s]
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1. Work environment: & Work load
& Distractions
& Work area
2. Use of outdated or incorrect references.
Q:97 Make a strategic plan for ensuring adequate staffing levels in any hospital pharmacy set up.
Q: 98 Make a flow chart for organizational hierarchy of any public sector hospital of Lahore.
Organizational hierarchy of Doctors hospital.
Directors
Executives
Service managers Patient care providers
Technicians
Q: 99 How you can train the personal responsible for recording verbal orders. Make a strategy for
it.
Verbal drug or prescription orders should be reserved only for those situations in which it is
impossible or impractical for the prescriber to write the order or enter it in the computer. The
prescriber should dictate verbal orders slowly, clearly, and articulately to avoid confusion. The
order should be read back to the prescriber by the recipient (i.e. pharmacist). When read back,
the drug name should be spelled to the prescriber and, when directions are repeated, no
abbreviations should be used (e.g., say "three times daily" rather than "t.i.d.”). A written
copy of the verbal order should be placed in the patient's medical record and later confirmed by
the prescriber in accordance with applicable state regulations and hospital policies.
Q.100 What are the limitations of computerized prescribing? Ans. The computerized prescribing
may have its own pitfalls,
& Lower case I may look like numeral 1.
[Q/Ans’s]
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& Letter 0 may look like the numeral 0 (zero)
& Letter Z and the numeral 2 may be misread.
& Wrong patient or wrong drug chosen from list.
Q.101 How you can overcome the limitations of computerized prescribing?
6 Corrects fonts should be selected so that misreading could not occur.
& Software design issues, poor screen design and automatic filling functions may lead to
potential errors. So therefore proper software should be there to minimize this error.
6 Some software are costly and smaller chain, independent pharmacies pay more to utilize
e-prescribing software, hence funding should be given and cost- effective software should be
designed.
Q.102 Minimum content of any oral medication label meeting the essential requirement?
Ans.
Patient Name: Patient Location:
Second patient identifier generic drug name (Brand Name)
Patient dose route (Dose=composition of dose 2x75 mg) Bar code
Pharmacist Initials Expiration Date:
Q.103 Draw label for any syringe:
Name of Patient: Bar code
Drug Name Patient dose route Pharmacist initials
Expiry
Q.104 Various dispensing errors caused by poor patient education?
& Failure to adequately educate patients.
& Lack of pharmacist involvement in direct patient education.
& Failure to provide patients with understandable written instructions.
6 Lack of involving patients in check systems.
6 Not listening to patients when therapy is questioned or concerns are expressed.
[Q/Ans’s]
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Q.105 Up to what extent dispensing errors can be corrected by proper patient counseling. Justify
with the help of any authentic source?
Ans. Up to 83% of dispensing errors can be discovered during patient counseling and
corrected before the patient leaves the pharmacy.
Source : Ukens C. Drug Topics, March 13, 1997: 100-11.