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Reference Guide for Foreign Pharmacy Licensing Exam KrismanQuestions and Answers- Part-I

www.pharmacyexam.com 1

REFERENCE GUIDEFOR FOREIGNPHARMACYLICENSING EXAM

2008-2009

Manan H. Shroff

(Questions and Answers-Part I)

Reference Guide for Foreign Pharmacy Licensing Exam KrismanQuestions and Answers- Part I


REFERENCE GUIDE FORFOREIGN PHARMACY

LICENSING EXAM(Questions and Answers-Part I)

2008-2009

DEDICATED

TO

KRISHNA



This reference guide is not intended as a substitute for the advice of a physician. Studentsor readers must consult their physician about any existing problem. Do not use any informationin this reference guide for any kind of self-treatment. Do not administer any dose of mentioneddrugs in this reference guide without consulting your physician. This is only a review guide forpreparation for the Foreign Pharmacy Licensing board exam.

The author of this reference guide is not responsible for any kind of misinterpreted, incorrect ormisleading information or any typographical errors in this guide. Any doubtful or questionableanswers should be checked in other available reference sources.

All rights reserved.

No part of this guide may be reproduced or transmitted in any form or by any means, electroni-cally photocopyed, recorded or otherwise , without prior written permission of the publisher.

RXEXAM is a registered trademark of Pharmacy Exam of Krishna Publication Inc. Anyunauthorized use of this trademark will be considered a violation of law.

NAPLEX and FPGEE are federally registered trademarks owned by the National Associa-tion of Boards of Pharmacy (NABP) and this reference guide is in no way authorized or spon-sored by NABP.



REFERENCE GUIDE FOR FOREIGN PHARMACY LICENSING EXAM

Questions and Answers

SECOND REVISED EDITION

2003-2004



PREFACE

Reference Guide For Foreign Pharmacy Licensing Exam Questions and Answers(Part-I) is specifically written for students preparing for the FPGEE exam. It has approximately 1000FPGEE TYPE questions with answers and complete explanations. The FPGEE exam puts moreemphasis on pharmacy management, statistics, immunology, pharmacology, kinetics and biopharmaceutics,therefore an effort was made to include all of these topics in a review guide. To prepare for pharmacology,I would highly recommend that you take advantage of the Reference Guide For Pharmacy LicensingExam-Theory.

Our preparation guide covers all the important topics you need to be familiar with to passthe FPGEE. I would recommend that you to go through the FPGEE review guide sample ques-tions provided by the NABP (you will get one when your approval from the FPGEE arrives) toevaluate the importance of our review materials.

Each answer is explained thoroughly to refresh your memory on specific topics. Please donot go through only the questions and answers. Try to understand and learn the answer’s explana-tions. It is the best way to get the most out of this review guide.

I hope my efforts will help you to pass your key exam. I wish you the very best of luck, andany questions or comments are always welcome.

Good Luck,

MANAN H SHROFF



TABLE OF CONTENTS

SECTION-I

QUESTIONS 7

SECTION-II

ANSWERS 121

SECTION-III

TABLES 243



1 Benzyl alcohol is classified as:

a. Emulsifying agentb. Preservativec. Diluentd. Suspending agent

2. Cold cream is an example of:

a. Suspensionb. O/W emulsionc. W/O emulsiond. O/W/O emulsion

3. Egg yolk or egg white is used as:

a. Emulsifying agentb. Suspending agentc. Binderd. Preservative

4. The transfer of a drug from high con-centrated areas to low concentrated areas isgenerally defined as:

a. Infusionb. Levigationc. Diffusiond. Dissolution

5. Which of the following is the mostsuitable route for administration of insulin ?

a. IMb. SCc. IVd. IV bolus

6. Noyes Whitney equation is helpful topredict the rate of:

a. Drug diffusionb. Drug dissolution

c. Drug degradationd. Drug oxidation

7. Polymorphism is generally defined asa:

a. Substance that may exist in more thanone crystalline form.

b. Substance that may exist only in meta-stable form.

c. Substance that has different viscositytime to time.

d. Substance that reduces interfacial ten-sion.

8. The minimum concentration of a drugat the receptor site to initiate pharmacologi-cal action is defined as:

a. T max

b. MECc. MTCd. Cmax

9. The area under curve gives useful in-formation about :

a. The amount of drug systematically ab-sorbed.

b. The time to reach peak concentration.

c. The time to reach minimum toxicconcentration.

d. The concentration at which pharma-cological actions of drug would beinitiated.

10. Which of the following is the majorplasma protein involved in drug binding?



a. Globulinb. Creatininec. Albumind. Glycoprotein

11. Which of the following equations maybe useful to find out the plasma concentrationof a drug ?

a. Vd x P = Cp

b. P x Cp = Vd

c. Vd = P/Cp

d. Vd = Cp/P

12. The initial dose of a drug through IVbolus to achieve desirable plasma concentra-tion at once is known as:

a. Loading doseb. Maintenance dosec. Replacement dosed. Degradation dose

13. Which of the following is/are usefulto measure glomerular filtration rate?

I. CreatinineII. InulinIII. Albumin

a. I onlyb. I and II onlyc. II and III onlyd. All

14. The rapid degradation of a drug byliver enzymes in a liver is defined as:

a. Third pass effect of metabolismb. First pass effect of metabolismc. Rapid degradationd. Liver elimination

15. The normal renal creatinine clearancevalue lies between:

a. 200 to 300 ml/minb. 80 to 120 ml/minc. 30 to 60 ml/mind. 10 to 20 ml/min

16. Which of the following is an exampleof an oligosaccharide?

a. Glucoseb. Sucrosec. Starchd. Glycogen

17. Which pyrimidine base is found only inRNA?

a. Cytosineb. Thyminec. Uracild. Adenine

18. Heparin is classified as a(n):

a. Heteropolysacharideb. Oligosaccharidec. Homopolysacharided. Monosaccharide

19. Ribonucleic acid exists in all of thefollowing forms EXCEPT :

a. r RNAb. m RNAc. q RNAd. t RNA

20. Which of the following structures is ahost for Kreb’s cycle ?

a. Mitochondriab. Golgi bodies



c. Cytoplasmic membraned. Ribosome

21. The synthesis of glucose from sourcesother than carbohydrates is generally knownas:

a. Glycolysisb. Gluconeogenesisc. Glycogenolysisd. Glucogenesis

22. Which of the following amino acidsshould be considered an essential aminoacid(s) for the body ?

I. PhenylalanineII. LeucineIII. Tryptophan


23. Which of the following enzymes ca-talyses the coupling of two molecules ofnucleotides to form DNA ?

a. Transferaseb. Ligasec. Isomerased. Aldehyde dehydrogenase

24. A nucleotide is a building block of:

a. Sphingomideb. Nucleic acidc. Amino acidd. Starch

25. Which of the following cells are in-volved with immune responses of the body?

I. B lymphocytesII. T lymphocytesIII. Neutrophils


26. Which of the following immunoglo-bulin levels are elevated during asthma ?

a. IgMb. IgDc. IgEd. IgA

27 All of the following tests are requiredto check sensitivity of class A weighing pre-scription balance EXCEPT :

a. Arm ratio testb. Rider graduated beam testc. Shift testd. U test

28. The ratio of the mass of an objectmeasured in a vacuum at specific tempera-ture to volume (in ml) of an object at the sametemperature is defined as:

a. Absolute densityb. Specific gravityc. Relative densityd. Apparent density

29. The mean blood pressure of Mr. Hamis:

01/01/00 80 mm hg 04/04/00 90 mm hg01/02/00 82 mm hg 01/05/00 85 mm hg01/03/00 81.5 mm hg 01/06/00 83 mm hg



a. 81.5b. 85.6c. 83.58d. 84.20

30. The deviation of data from its mean isgenerally described by:

a. The averageb. The standard deviationc. The precisiond. The accuracy

31. The reproducibility of results of anumber of experiments is generally known as:

a. Precisionb. Biasc. Accuracyd. Closelessness

32. If the value of p = 0.6 in binomial dis-tribution, what is the probability of failure ?

a. 0.2b. 0.4c. 0.3d. 1.0

33. The ααααα error is generally consideredsignificant at:

a. 1%b. 3%c. 5%d. 10%

34. When the hypothetical value of a pa-rameter is the same as the observed value of aparameter, the error should be considered:

a. Alfa-errorb. Beta-errorc. Gema-errord. Infinitive

35. Find out the degrees of freedom in aChi-square test in a 2x2 contingency table (as-sume tests are independent).

a. 1b. 2c. 3d. 4

36 The F distribution generally compares:

a. Two meansb. Two variancesc. Three meansd. Three variances

37. Which of the following elements hasthe highest electronegativity?

a. Clb. Fc. Brd. I

38. Which of the following molecules hasthe largest dipole movement?

CH3 CI

C C

CH3 Cl

FIGURE - I



CH3 H

C C

H CH3

FIGURE-2

H F

C C

F H

FIGURE-3

CH3 F

C C

CH3 F

FIGURE-4

a. Fig Ib. Fig IIc. Fig IIId. Fig IV

39. Which of the following molecules hasthe highest boiling point?

a. H2Ob. H2Sc. H2Sed. HCN

40. The bond between NH3 and CO2 is bestdescribed as a:

H ON C

HH.....................O

a. Hydrophobic interaction forceb. Ion dipole or ion induced dipole forcec. London forced. Van der walls force

41. The process of transforming a soliddirectly to a vapor state is generally definedas:

a. Evaporationb. Meltingc. Sublimationd. Levigation

42. The characteristic of solid substancesto exhibit more than one crystalline or amor-phous form is defined as:

a. Isomerismb. Polymorphismc. Zwitter iond. Coupling

43. Which of the following molecules rep-resents CIS form ?

H Cl

C C

H Cl

FIGURE - I



H H

C C

H ClFIGURE - 2

H Cl

C C

Cl Cl

FIGURE - 3

H H

C C

H H

FIGURE - 4

a. Fig Ib. Fig IIc. Fig IIId. Fig IV

44. Which of the following drugs is anangiotensin receptor antagonist ?

a. Lisinoprilb. Losartanc. Methyldopad. Captopril

45. According to Fick’s law of diffusion,which of the following is inversely propor-tionate to the rate of diffusion ?

a. The area of the solid.

b. The difference between the concentra-tion of solute to concentration ofsolute in stagnant layer.

c. Diffusion coefficient.

d. The length of the stagnant layer.

46. Acetone is classified as a:

a. Polar solventb. Nonpolar solventc. Semipolar solventd. Dipolar solvent

47 The process of degradation of ioniccompounds into cations and anions in a pres-ence of water is defined as:

a. Solvationb. Hydrationc. Activationd. Degradation

48. What happens to the solubility of al-cohol as the molecular weight of alcohol in-creases ?

a. Reducesb. Increasesc. Remain unchangedd. Insoluble in water

49. The degradation of Riboflavin bylight is classified as:

a. Oxidationb. Reductionc. Photochemical degradationd. Racemization

50. The degradation of Penicillin GProcaine is highest in:

a. Solutionb. Suspensionc. Elixird. Tablet



51 The rate of oxidation is influenced by allof the following EXCEPT :

a. Temperatureb. Radiationc. Presence of catalystd. Hydrolysis

52. Which of the following are character-istics of pseudoplastic flow?

I Viscosity of the flow generally de-creases with an increase in the rate ofshears.

II No yield value has been found withflow.

III. Suspension of tragacanth follows thepseudoplastic’s flow.

a. I onlyb. I and II onlyc. II and III onlyd. I, II and III only

53. Which of the following is NOT trueabout microemulsion?

a. The mean diameter of a droplet gener-ally lies between 10 to 200 nm.

b It is a thermodynamically stablesystem.

c It requires a cosurfactant.d. It is intermediate in property between

solution and emulsion.

54. A system with considerable interactionbetween dispersed phase and dispersion me-dium is known as:

a. Lyophilicb. Lipophyliticc. Lyophobicd. Radioactive colloids

55. To balance the following equation, howmany molecules of NH4Cl would be required?

(NH4)2S+NICl2—— NIS + NH4CL

a. 1b. 2c. 3d. 4

56. The random motion of solute particlesin colloidal dispersion is known as:

a. Newtonian flowb. Brownian motionc. Stoke’s lawd. Non-Newtonian flow

57. Which of the following about floccu-lated suspension is NOT true?

a. Particles of suspension form loose ag-gregates.

b. Rate of sedimentation is very low.c. The time to form sediment is less.d. The sedimentation is easy to redis-

perse.

58. The rate of sedimentation is indepen-dent of :

a. The viscosity of dispersion medium.b. The diameter of suspended particles.c. The difference in densities between

dispersed medium and dispersedphase.

d. The lipophilic nature of particles.

59. Which of the following compounds isan acetanilide?

a CH3CONHC6H5

b. CH3CHOc. C6H5CH=N.C6H5

d. C6H5N=NC6H5



387. Which of the following ratios is the bestindicator of a pharmacy’s profitability ?

a. Net profit to net salesb. Net profit to net worthc. Net profit to total assetd. Net profit to inventory

388. Which of the following ratios generallyindicates the efficiency of a pharmacy ?

a. Net profit to total assets.b. Inventory turnover ratec. Capitalization of net profitd. Net profit to net sales

389. All of the following indicate the ratiothat measures the efficiency of a pharmacyEXCEPT:

a. Inventory turnover rateb. Net sales to inventoryc. Acid testd. Net sales to net working capital

390. The acceptable ratio for net profit tonet sales would be:

a. Less than 1%b. 1 to 2 %c. 2 to 3 %d. 5 to 7%

391. What would be the acceptable ratio for10 year old pharmacy’s net profit to net worth?

a. 1%b. 5%c. 15%d. 50%

392. Which of the following is true about netprofit to inventory ratio?

I. It indicates profitability as well as theefficiency of pharmacy.

II. It can be used for new and old phar-macies.

III. It increases with an increase in salesof the pharmacy.

a. I onlyb. I and II onlyc. II and III onlyd. I, II, and III only

393. Manan Pharmacy’s net profit to total as-sets ratio is found to be 15%. This will indicatethe pharmacy’s profitability is :

a. Goodb. Excellentc. Outperformd. Worst

394. Manan’s Pharmacy’s part of the finan-cial balance sheet is as follows:

YEAR 2000 SALES

RX $600,000Merchandise $150,000Total $750,000Cost of goods sold $500,000Beginning inventory $200,000Ending inventory $220,000

What would be the inventory turnoverrate for Manan’s Pharmacy?

a. 4.3b. 2.38c. 3.5d. 6.0



395. The inventory turnover rate of the abovepharmacy would :

a. Meet the expectationb. Below the expectationc. Exceed the expectationd. Cannot calculate

396. The net sales of the above pharmacy are840,000. Find out the ratio of net sales to inven-tory of the above pharmacy. [assume inventoryof above pharmacy at time of calculation is$210,000]

a. 8b. 4c. 10d. 12

397. Find out the net worth of Manan’sPharmacy?

Total current assets = $150,000Total fixed assets = $40,000Total liabilities = $75,000

a. 2.55b. 115,000c. 35,000d. 1.3

398. Which of the following ratios best de-scribes the account receivable collectiontimes?

a. year end account receivablemean credit sales per day

b. annual credit salestotal account receivable

c. total account receivable 365

d. annual credit sales 24

399. Which of the following classes of recallsshould be considered a potential hazard to health?

a. Class Ib. Class IIc. Class IIId. Class IV

400. Which of the following categories indi-cates the use of a drug is restricted during preg-nancy ?

a. Ab. Bc. Xd. C

401. Liquidity generally expresses apharmacy’s ability to meet its:

a. Assetsb. Current liabilityc. Inventoryd. Prepaid expenses

402. The acid test generally measures apharmacy’s :

a. Financial positionb. Liquidityc. Profitabilityd. Inventory

403. Which of the following is generally NOTincluded in current assets ?

a. Cashb. Accounts payablec. Accounts receivabled. Inventory

404. Which of the following would generallybe considered the fixed assets of a pharmacy?



a. Inventoryb. Fixtures and equipmentc. Cashd. Accounts receivable

405. All of the following can be considered thecurrent liability of a pharmacy EXCEPT

a. Accounts payable.b. Notes payable within 1 year.c. Accrued expenses.d. Notes payable beyond 1 year.

406. Find out the Acid test (quick ratio) ofManancare Pharmacy from Table 1?

a. 202/1b. 1.47/1c. 13/1d. 1/1

TABLE 1

A CURRENT ASSETS

Cash $ 50,000A/C receivable $ 75,000Inventory $ 100,000Prepaid expenses $ 10,000Total current assets $ 235,000

B FIXED ASSETS

Fixtures and equipment $ 30,000Deposits $ 5000Total fixed assets $ 35,000

TOTAL ASSETS $ 270,000

C CURRENT LIABILITIES

A/C payable $ 70,000Notes payable (1 yr) $ 5,000Accrued expenses $ 10,000Total current liabilities $ 85,000

D LONG TERM LIABILITY

Notes payable (>1 yr) $ 20,000Total liabilities $ 105,000Net worth $ 165,000Cost of goods sold $ 490,000

407. Which of the following does NOTmeasure the pharmacy’s liquidity ?

a. Acid test ratiob. Current ratioc. Net sales to inventoryd. Inventory to its net working capital

408. Total liabilities to net worth ratio ofManancare Pharmacy is :

a. Acceptableb. Below expectationc. Exceeds the expectationd. Cannot be calculated

409. The investment in fixed assets ofMananCare Pharmacy :

a. Exceeds the requirementb. Is below the requirementc. Meet’s the requirementd. Cannot be calculated

410. Manancare Pharmacy wants to sell its pre-scription files. The Manancare Pharmacy own-ers asks $350,000 for the existing prescriptionfile.

The Manancare Pharmacy provides the follow-ing data upon request.

Total new RX dispensed in $ 80,000past 2 years.

The % of Rx that has one 40%or more refill left



The average RX price $ 50

Net profit % % 15

What would be your answer to the owner of thepharmacy?

a Price is okay.b. Price is too high.c. Price is breaking even.d Cannot be calculated.

411. “Manancare Pharmacy” marksdownthe price of analgesic balm from $3 to $2. Ifthe mark down of the price increases the sales ofanalgesic balm from 60 tubes to 80 tubes, whatwould be the coefficient of elasticity of this prod-uct ?

a. 1b. 2c. 0.25d. 0.5

412. When relative change in revenue is sameas the relative change in price, it is known as:

I. Unitary elasticityII. Inelastic demandIII. Elastic demand


413. Find out the retail price of a box of insulinsyringes if the cost complement of the product is55% and the cost of one box of insulin is $9.00.

a. $4.95b. $16.30c. $15.11d. $13.95

414. Find out the % markup of Vasotec pre-scription if 30 tablets of Vasotec 5 mg retail priceis $75 and the cost of the drug is $45.

a. 55%b. 75%c. 66%d. 10%

415. Find out the retail price of one box ofinsulin syringes if :

The cost of complement = 55%The known retail markup = 45%The cost of syringes = $9.00

a. 4.95b. 13.95c. 16.30d. 15.11

416. For Manancare Pharmacy, the totalrent for the whole store including the Phar-macy department is $10,000. The size of the phar-macy is 600 ft2 and the size of the whole store is5000 ft2 . On the basis of above figures, whatwould be the rent of the pharmacy alone?

a. $ 1000b. $ 2000c. $ 1200d. $ 800

417. The funding for Medicare programs isgenerally obtained from:

I. Social security taxesII. Premiums paid by participantIII. State government




418. In a patient cost sharing plan, when apatient has to pay a specified amount of thecost of prescriptions and a third party will pay theremainding cost of prescriptions, it is known as:

a. Copaymentb. Coinsurancec. Deductibled. Retrospective payment

419. A person who works for an insurancecompany, provides the statistical data that in-dicates the risk associated with serving the popu-lation, and determines the premiums to cover allthe estimated expenses is known as:

a. Pharmacy managerb. Actuaryc. Sponsord. Vendor

420. The maximum amount that will be paidby a third party to a pharmacy when the drugis available from more than one source is definedas:

a. Maximum allowable cost (MAC)b. Estimated acquisition cost (EAC)c. Actual acquisition cost (AAC)d. Average wholesale price (AWC)

421. When a patient pays a full predeter-mined amount to the provider at the begin-ning of each month it is known as:

a. Concurrent reimbursementb. Prospective reimbursementc. Retrospective reimbursementd. Cash reimbursement

422. The increase in the number of taking theforeign pharmacy exam is as follows:

Year Students taking the exam.

1981 3501982 4201983 5301984 6001985 6201986 6351987 7001988 850

Find out the mean of the above data:

a. 601b. 588c. 720d. 520

423. What would be the median of theabove example?

a. 350b. 850c. 610d. 635

424. A random sample of the blood glucoseconcentration of 100 patients has a mean of130 and a median of 155. The frequency dis-tribution of the sample is:

a. Normally distributedb. Positively skewedc. Negatively skewedd. Cannot be calculated

425. All of the following can be a shape offrequency of distribution EXCEPT:

a. Bell shaped distributionb. Skewed shape distributionc. U shape distributiond. T shape distribution



426. What would be the Pearsonian coefficientof skewness if a sample has a mean of 55 and amedian of 45. The standard deviation of thesample is 35.

a. 0.90b. 1.0c. 0.85d. 0.35

427. Which of the following about a Bino-mial experiment is NOT true?

a. Each trial results in an outcome that isclassified as success or failure.

b. The repeated trials are dependent uponprevious experiment.

c. The experiment generally consists ofn-repeated trials.

d. The probability of success remainsconstant from trial to trial.

428. What is the mean binomial distribution ifthe probability of success is 0.60 in 50 trials ?

a. 5b. 3c. 8d. 4

429. If the blood pressure measurement of5 people is 110, 135, 140, 125 and 115 re-spectively . What would be the range of the set ofthe above observations?

a. 110b. 30c. 125d. 140

430. When plotting t distribution curves, ifsample size of 20 is taken from a normal popula-tion, what would be the degree of freedom in thet distribution?

a. 40b. 19c. 10d. 2

431. Find out the degree of freedom in a 2 x 3contingency table Chi-square test when it isapplied to test the hypothesis of independence oftwo variables?

a. 3b. 2c. 4d. 1

432. The average length of time it takes stu-dents to finish an exam is 180 minutes, with astandard deviation of 36 minutes. A new ex-amination procedure using modern comput-ers is being tested. A random sample of 50students had an average examination time of 150minutes, with a standard deviation of 40 minutesunder the new system. Test the hypothesis thatthe population mean is now less than 180 minutes.This hypothesis would result in ?

a. One sidedb. Two sidedc. Three sidedd. Cannot be calculated

433. In protein, Amino acids are joined co-valently by :

a. Hydrogen bondb. Peptide bondc. Oxygen bondd. Disulfide bond

434. The secondary structure of proteinconsists of :

I. Alfa-helixII. Beta-sheetIII. Beta-bend



related. A dose of more than 800 mg is strictlyprohibited by the FDA. NMS, tardive dyskine-sia, and extrapyramidal symptoms are reportedside effects of the drug.

Drugs that may cause ocular toxicity include:

* Chloroquine* Hydroxychloroquine* Amiodarone* Chlorpromazine* Phenothiazine class of drugs* Corticosteroid, by increasing

intraocular pressure of eyes

131 (d) All. Bleomycin, Amiodarone andNitrofurantoin are associated with pulmonary tox-icity.

132 (a) Extensive clinical trials on humansgenerally include phase III clinical trials.

Clinical studies of new drugs on humans are gen-erally subdivided into four phases:

Phase I : This phase includes a cautious trial ofthe drug in humans.

Phase II : This phase includes more depth than aclinical trial in normal patients and initial trials indisease patients.

Phase III : This phase consists of broad clinicaltrials in disease patients to ensure that the drug isof clinical benefit for what it claims for.

Phase IV : Postmarketing clinical trials are con-ducted only after the drug is passed by the FDA.

133 (c) When two structurally different chemi-cals produce the same clinical effect, it is knownas therapeutic equivalence.

When two or more dosage forms of adrug contain the same amount of drug in eachdosage form, it is known as chemical equivalence.

When the same drug in two or more dos-age forms produces the same in vivo effect thatcan be measured by pharmacological responsesor by control of a symptom or disease, it is knownas clinical equivalence.

When a drug in two or more similar dos-age forms produces an identical rate of drug ab-sorption and superimposable area under thecurve, the drug is said to be bioequivalent.

134 (b) Concentration of a drug at a receptorsite is not included in bioequivalency studies. Peakheight concentration, the time required to reachpeak concentration, and AUC are used to evalu-ate the bioequivalency of two or more formula-tions of the same drug.

135 (c) A substance that kills microorganismsbut not the bacterial spore is defined as a germi-cide.

Anything that kills bacteria is defined as abactericide. The absence of viable microorgan-isms is defined as sterility. The process of de-stroying microorganisms is defined as disinfec-tion. A substance that prevents the growth of mi-croorganisms, but does not necessarily destroythem, is known as an antiseptic.

136 (c) 1 quart of solution contains 960 cc ofsolution. Therefore the quantity of drug in 1 quartof 0.45% solution is :

= 960 x 0.45 / 100= 4.32 grams

137 (a) The sterilization methods are divided infive different categories :

I Moist heat sterilizationII Dry heat sterilizationIII Gas sterilizationIV FiltrationV Radiation



Moist heat sterilization: It is the mostwidely used method for sterilization. The causeof death of organisms is attributed to coagulationof the cellular protein of the organism. The sub-stance should be kept under pressure for at least15 minutes at a temperature of 121o. Moist heatsterilization is not the suitable method sterilizationof petroleum jelly, mineral oil, greases, waxes andtalcum powder.

Dry heat sterilization : It is the suitablemethod to sterilize oily substances such as min-eral oil, waxes and greases. Because it is less ef-ficient compared to moist heat, the substanceshould be kept for prolonged time under high tem-perature. The death of the organism is a result ofan oxidation process.

Gaseous sterilization: Ethylene oxide isthe most widely used gas for sterilization. Theadvantage of ethylene oxide is that products canbe sterilized and packaged for shipment since itcan easily penetrate through plastic films and car-tons. Formaldehyde and chlorine dioxide can alsobe used a for gas sterilization.

Filtration: It is one of the oldest methodsof sterilization. It removes the particulate matterfrom the solution. It is a widely used method forthe sterilization of heat sensitive substances. Thecommon pore size of the membrane filter is 0.22micrometer.

Radiation: Sterilization by radiation iscommonly employed in hospitals to sterilize hos-pital supplies, vitamins, antibiotics, steroids, hor-mones, medical devices and tissue transplants, Itcan be achieved by use of electromagnetic radia-tion or particle radiation. U.V. radiation with awavelength of 253 nm also serves as a germicidalagent.

138 (b) Ethylene oxide and formaldehyde arecommonly employed gases for sterilization.

139 (a)192.30 cc. To solve this problem use thealligation method :

75 25 (75% of alcohol)

35

10 40 (10% of alcohol)Total parts 65 (35% of alcohol)

Total parts Parts of 75% require65 25500 ?

= 500 x 25/65= 192.30 cc

140. (c)

LD= Vd x (Cp desired-Cp observed)F x S

= 10x 70 x (1.5-1.0)= 350 mcg

* Therefore approximately three tablets of0.125 mg is required to produce a loading dose.

141 (b) Sterilization by U.V. radiationgenerally requires a wavelength of 253 nm.

142 (c) 1 teaspoon of solution of (30 mg/cc) contains 150 mg of a drug. This solution isdiluted with water the 480 cc mark, therefore wecan say that :

480 cc solution contains 150 mg of drug1 cc solution contains?

= 150 / 480= 0.31 mg/cc

143 (d) All tests can be used to identify theefficiency of laminar flow and the quality of steril-



ization. The laminar flow equipment is necessaryto perform various sterility tests, aseptic filling andcertain assembling operations. Laminar flowdevices that deliver horizontal, vertical and curvi-linear air flow are available.

For most sterility testing operations, thehorizontal laminar flow is more preferable thanvertical laminar flow since the former one is lesslikely to wash the organisms from operators handsor equipment into sterility test media.

The vertical laminar flow is most suitablefor preparation of cytotoxic substances or drugsthat may cause severe harm when inhaled, sincethe blow of air in this case is less likely to affectthe operators (since it will move from top to bot-tom).

The velocity of air used in such devices isgenerally 90 fpm + 20%. The filters that are gen-erally used in laminar flow are known as HEPA(High Efficiency Particulate Air) filters.

Smoke tests (usually check the quality ofair) and DOP (Dioctyl phthalate) tests usuallyemployed to find out the efficiency of filters. Mi-crobial tests check the effectiveness of HEPA fil-ters.

144 (c) The rate of hydrolysis generally dependson the temperature and pH of the solution andthe amount of water present. It is independent ofpressure. It has been found that for each 10o risein temperature, the rate of hydrolysis almostdoubles.

145 (d) The % mark-up on prescriptions is 20%,therefore we can say :

For each $100 cost the retail price is $120.For $2250?

= 2250 x 120 / 100= $ 2700

For 1000 tabs retail price is $ 2700For 30 tablets is ?= 30 x 2700 / 1000= $81

146 (b) Decarboxylation. The removal ofcarboxylic acid groups from the compound isknown as decarboxylation.

147 (c) According to the International Pharma-ceutical Federation, the maximum % of overagesshould be limited to 30% over the label potencyof the ingredient.

Overages is defined as the addition of anextra active ingredient to balance the potency ofthe active ingredient due to degradation during itsshelf life period.

148 (c) At the concentration of 65% w/w, su-crose retards the growth of microorganisms.

149 (c) Ingram’s regimen consists of anthralinand UVB. Anthralin, by its DNA inhibition andantiproliferative action, helps in controlling pso-riasis. UVB inhibits the DNA synthesis ofepidermal cells.

The combination of Coal tar and UVB isknown as Goeckerman region. Coal tar is a mix-ture of thousands of hydrocarbons which by theirenzyme inhibition and antimitotic actions are use-ful for psoriasis.

150 (a) Pulmozyme (Dornase alfa) is indicatedfor the treatment of cystic fibrosis. It reduces theviscosity of sputum by helping in the breakdownof DNA nucleus of neutrophils (due to infectionof the lung). Pharyngitis, apnea, voice alternation,and laryngitis are commonly reported side effectsof the drug. The recommended dose of the drugis 2.5 mg via inhalation once daily.



151 (a) pH = pKa + log salt acid

7 = 5 + log salt/acid2 = log salt/acid100 = salt/acid

152 (b) Ocusert pilo 20 delivers 20 mgof pilocarpine per hour for 7 days. It is indicatedfor the treatment of glaucoma.

153 (c) Dorzolamide inhibits the carbonicanhydrase enzyme that is responsible for the pro-duction of aqueous humor in the eyes. It is indi-cated for the treatment of glaucoma.

Timolol is classified as a beta blocker, andit appears to lower the intraocular pressure of theeyes by inhibiting production of aqueous humor.Other agents in this same class are Betaxolol andLevobunolol

Dipivefrine is a prodrug of epinephrine.It is converted into epinephrine by enzymatic hy-drolysis inside the eyes. It is a sympathomimeticagent that inhibits the production of the aqueoushumor and increases the outflow of the aqueoushumor. This results in the reduction of intraocularpressure of eyes.

Latanoprost increases the outflow of theaqueous humor and decreases the intraocularpressure of eyes.

154 (c) According to Fried’s formula :

= age in months x adult dose 150= 15 x 325 150

= 32.5 milligram.

For each 325 mg dose 0.6 cc is requiredFor 32.5 mg of dose ?

= 32.5 x 0.6/325

= 0.06 cc

155 (b) Triphasic oral contraceptives generallyaffect the follicular, ovulatory and luteral phasesof the menstrual cycle and provide a morefavorable effect than biphasic and monophasiccontraceptives.

It is formulated with a low progesterone content.The only disadvantage associated with the use oftriphasic is its lack of availability of uniform direc-tion for taking oral contraceptives.

156 (a) The follicular phase is dominated byestrogen.

157 (c) Metabolic acidosis occurrs due to lossof bicarbonate from the body. It stimulates therespiratory center to increase excretion of CO2from the body.

It can be further subdivided into meta-bolic acidosis with normal anion gap and meta-bolic acidosis with elevated anion gap.

Metabolic acidosis with a normal aniongap generally occurs due to a loss of bicarbon-ate from the body such as hypokalemia.

Metabolic acidosis with elevated aniongap occurs due to overproduction of organic ac-ids such as lactic acids and formic acids.

It can be corrected by administration ofI.V. sodium bicarbonate to an elevate arterial pH.

158 (c) Pyrethrin acts as a contact poison thatdisturbs the parasites’ nervous system. It is usedas a scabicide and pediculicide agent.

159 (a) Guaifenesin is a cough expectorant; anagent that may help in excretion of cough.Dextromethorphan, benzonatate and diphenhy-



dramine are antitussive; agents that may suppressthe cough production.

160 (b) HbA1/C

is defined as a stable complex ofglucose and hemoglobin. It remains stable up to120 days. The higher the blood glucose level, themore the fraction of glycocylated hemoglobin willbe formed. It indicates the average blood glucosevalues over 3 to 4 months and helps in assessingoverall glycemic control.

A value of HBA1/C

6% indicates a plasma glucoseconcentration of 120 mg/dL. Each 1 % changeindicates approximately 30 mg/dL of mean plasmaglucose concentration.

161 (d) 4.28 meq.

Equivalent weight = molecular weight number of valence

Equivalent weight = 151.85 = 75.922

Milliequivalents = Weight in milligram equivalent wt

= 32575.92

= 4.28 meq

162 (d) Insulin therapy is associated withhypoglycemia, lipoatrophy and lipohypertrophyside effects.

Vigorous exercise, overdose of insulin andskipping meals leads to hypoglycemia.

It is recommended to the rotate site of aninsulin injection to avoid lipoatrophy.

163 (d) Precose (Acarbose) is classified as anantidiabetic agent. It is indicated for the treatmentof diabetes. It inhibits pancreatic alpha-amylaseand alpha-glucosidase hydrolase enzymes. Thismay result in a smaller increase in blood glucose

following meals. It is contraindicated to use inpatients with inflammatory bowel disease, coloniculceration, and intestinal obstruction. Abdominalpain, diarrhea, and flatulence are reported sideeffects of the drug. The recommended dose ofthe drug is 25 mg to 50 mg t.i.d. with the first biteof each main meal.

164 (b) Confusion, tachycardia, difficulty inconcentration and sweating are common symp-toms associated with hypoglycemia.Bradycardiais not a symptom of hypoglycemia.

165 (b) Most oral sulfonylurea agents have beenfound to produce disulfiram like reactions withalcohol. Chlorpropamide is an oral sulfonylureaagent.

These drugs inhibit the aldehyde dehy-drogenase enzyme that is responsible for convert-ing acetaldehyde into acetic acid. The accumula-tion of acetaldehyde in the body produces throb-bing headache, nausea and vomiting, commonsymptoms associated with disulfiram.

166 (c) Normal renal threshold value for glucoseis 180 mg/dl.

167 (b) 250 cc of 0.9% NaCl solution contains2.25 grams of NaCl.

Meq = Weight in milligram Equivalent weight

= 225058.5

= 38.5 milliequivalents of Na+

168 (b) Acarbose is an oral alfa-glucosidase in-hibitor used in the management of NIIDM. In thecase of hypoglycemia, it is recommended to usedextrose instead of table sugar (sucrose) sinceAcarbose may block the breakdown of tablesugar.



169 (c) 10.34 days.

t1/2 = 0.693/k= 0.693 / 0.067= 10.34 days

170 (b) Vancomycin is indicated for the treat-ment of antibiotic-induced p.colitis and methicil-lin resistant infections. Therapy should be closelymonitored for ototoxicity and nephrotoxicity.Parenteral administration of Vancomycin isindicated for methicillin resistant types of infec-tions. Oral administration of Vancomycin is indi-cated for treatment of p.colitis.

Rapid infusion of Vancomycin has beenassociated with anaphylactoid reactions, hypoten-sion, wheezing dyspnea and urticaria. It may alsocause flushing of upper body and pain and musclespasm of the chest and neck. This syndrome isknown as “Red Neck syndrome”. These reac-tions are usually resolved within 20 minutes, butsometimes may persist for several hours.

171 (d) All. The active ingredient of all thementioned choices is Mesalamine (5-aminosali-cylic acid). It is indicated for the treatment of ul-cerative colitis. It is chemically related to acetyl-salicylic acid. It inhibits cyclooxygenase enzymesand prostaglandin synthesis, resulting in inflam-mation of the colitis. Anaphylaxis, diarrhea, ab-dominal cramps, G.I. ulcers and bleeding are re-ported side effects of the drug. The recommendeddose of the drug is 1 gram q.i.d.

172 (b)Excessive secretion of the thyroid hor-mone causes Grave’s disease. Staring eyes, weightloss, soft skin, fast heartbeat, high BMR and asharp and anxious mind are the symptoms of theGrave’s disease.

173 (b) Thyroid hormone deficiency causes cre-tinism in children and myxedema in adults. Thebasal metabolic rate is low. A puffy face with dryskin, slow speech, amenorrhea, slow pulse andscanty hair are signs and symptoms of myxedema.

A bloated face with idiotic looks and protrudingeye balls are signs of cretinism.

174 (b) Tapazole (Methimazole) is classified asan antithyroid agent. It is indicated for the treat-ment of hyperthyroidism. The recommended doseof the drug is 15 mg to 40 mg per day. It shouldbe avoided by pregnant women because of theserious side effect of agranulocytosis.

175 (d) All. Liothyronine is associated with nu-merous side effects such as headache, palpita-tion, tremor and diarrhea, and is less recom-mended for treatment of hypothyroidism. Desic-cated thyroid preparations have a variable T3 andT4 ratio and therefore are less recommended byphysicians. Levothyroxine is the most recom-mended thyroid supplement for treatment of hy-pothyroidism.

176 (a) Wellbutrin (Bupropion) is classified asan antidepressant agent. It is indicated for de-pression and smoking cessation therapy. It re-duces the urge to smoke. Seizure is the principalside effect of the drug. The recommended doseof the drug is 100 mg t.i.d.

177 (d) All. Ticlopidine, Aspirin and Clopidrogelare platelets aggregations inhibitor drugs. Theyare indicated for the prevention of heartstroke.Bleeding is the principal side effects of these drugs.

178 (b) Calcitriol and Dihydrotachysterol are in-dicated for the treatment of hypocalcemia bymobilizing bone calcium into blood. They are alsoindicated for treatment of tetany, idiopathic tetanyand hypoparathyroidism .

The other choices such as Estrogen, Cal-citonin salmon and Alendronate Na are indicatedfor treatment of osteoporosis by mobilizing bloodcalcium into the bone.

179 (d) All. Diphydrotachysterol is indi-cated for treatment of tetany, idiopathic tetany andhypoparathyroidism.



180 (c)Cold and clammy skin, convulsion, confu-sion, respiratory depression and pinpoint pupilconstriction are signs of opioid analgesic over-dose.

181 (d)30.13 minutes.

t 1/2 = 0.693/ K= 0.693 / 0.023= 30.13 minutes

182 (a) Type I borosilicate glass is mostchemically resistant and least leachable. It is com-posed of silicon dioxide and boric oxide. It has alow thermal coefficient of expansion.

Type II soda-lime treated glass and TypeIII soda-lime glass are composed of a high pro-portion of sodium and calcium oxide. This willmake glass chemically less resistant.

Both these glasses can melt at low tem-peratures and have a high thermal coefficient ofexpansion.

183 (b) A class 100 room is defined as an envi-ronment that contains no more than 100 particlesper cu ft of 0.5 mcm or larger size. Laminar flowof a HEPA filter should meet the standard for class100 as defined by Federal standard.

A class 10,000 clean room is a conven-tional clean room so it is less appropriate to carryout aseptic techniques.

184 (b) A HEPA filter is described as a HighEfficiency Particulate Air filter. It is employed withLaminar flow for preparation of aseptic parenteralproducts. It is used for a class 100 clean roomsas defined by Federal standard. Smoke test, DOPtest and microbiological essays are applied to findout the efficiency and quality of air provided by aHEPA filter. It has an efficiency of removing 99.97% particles of 0.3 mcm or larger.

185 (b) The process of removing 0.2 mcm orlarger particles, including microorganisms fromparenteral solution is defined as “cold steriliza-tion”. Removing 2 mcm or larger particles fromthe solution is defined as the polishing of the solu-tion.186 (a) Lyophilization is a process of drying inwhich water is removed by process of sublima-tion after a product frozen. This process is usedto store pharmaceutical products which are rela-tively unstable in aqueous solution or are heat sen-sitive.

The major disadvantage associated withthis process is its high cost.

187 (d) Sterility tests, pyrogen tests and particu-late evaluation tests are important quality assur-ance tests for parenteral solution.

In sterility testing, a sample from the finalproducts are incubated with various cultures todetect the presence of microorganisms. If thegrowth of microorganisms is found, the samplewould be failed sterility test.

In pyrogen testing, the fever produced bythe test solution (due to presence of pyrogen) inrabbits is counted as a positive response. Pyro-gen tests cannot be used to identify the presenceof pyrogens for the type of the solution or drugswhich may mask the fever response. Rabbit isthe choice of animal for pyrogen tests since it maysensitize to pyrogen the same way as the humanbody does. The new pyrogen test is known as aLimulus test, and is generally carried out in vitro,based on the formation of gel or color in the pres-ence of pyrogen in the culture of Limuluspolyphemus. It is more rapid and of greater sen-sitivity than the rabbit test.

The third test generally puts stress on thepresence of any particulate matter. The size oferythrocytes in the blood is 4.5mcm in diameterand therefore particles of more than 5mcm in di-ameter should be considered the basis of evalua-tion.



188 (c) Body posture, facial expression and dis-tance of the patient are nonverbal communica-tions. They generally describe the patients condi-tion. Open ended questions are not a part of non-verbal communication. i.e What kinds of symp-toms have you been experiencing ?

189 (b) An HMO (Health MaintenanceOrganization) is a private or nonprofit organiza-tion that includes all the important components ofa health care delivery services such as physi-cians, hospital, and long-term care facilities. Theyprovide these facilities to the consumer by takinga fixed prepaid amount of fees from them. Theadditional services are also provided for addi-tional payments as the need arises. They offer acombined package of primary physicians, physi-cians specialized for various diseases, hospitalsand long-term care facilities. They are generallyclassified into four different categories :

Staff model HMO : Staff model HMO generallyemploys the physicians and owns the facilities.They provide services to a consumer for a fixedmonthly fee on a yearly basis. The services pro-vided by this kind of HMO are independent ofservices used by consumers or patients.

Group model HMO: Group model HMO directlycontacts the group of the physicians to provideservices to consumers on a capitation basis or ona fee basis.

Independent Practice Association: It is also knownas IPA. It is one of the fast growing HMO typesthat contacts the physician on an individual basisand pays them fees for services with a profit sharingplan.

Preferred Provider Organization: It is basically thesame as IPA, except the consumer/patient/mem-ber has a choice to select the physician that is outof the HMO network.

190 (d) All. The disadvantage associated withmail-order pharmacy services are :

I. A lack of pharmacist counseling.II. A lack of review of patient’s profile.III. The use of recycled prescription drugs.

191 (b) To cut down unnecessary hospitaliza-tion costs, the Prospective Payment system isintroduced. Generally, the consumer/patient paysfixed amounts of fees to its primary insurancecompany such as Bluecross Blueshield, SignaHealth Care etc. When a patient visits the physi-cian for any existing problem, the physician pre-scribes him unnecessary tests that are not requiredby the patient. Patients do not care for those testssince he/she have to pay only a fixed amount offees and the rest of the cost of such tests is ful-filled by primary insurance companies. This is aburden to the insurance companies. To stop un-necessary hospitalization of patient, Congressdeveloped a prospective payment system. Thissystem precalculates (by considering all the fac-tors) the cost of hospitalization associated withparticular disease. For Example, the cost of hos-pitalization for coronary bypass surgery (includ-ing minimum days required to stay in hospital,physician fees of hospitals, rent of room for hos-pital etc.) is listed as $ 2000. If the hospital pro-duces a bill for $5000, the insurance will onlypay $ 2000 as listed under DRG (Diagnosis Re-lated Groups). This will discourage hospitals fromkeeping the patient for a longer time then requiredto save health care cost burden.

Normally the prospective payment sys-tem is interpreted as any service cost you pay inadvance for services that have not been providedyet or may be provide in the future such as fixedmonthly premium of insurances.

In a retrospective payment system youpay for the services after service completed suchas paying the hospital at the time of discharge.



192 (c) Most hospitals are now ordering theirmedications from only one wholesaler and pay asmall fee for the service (provided by the whole-saler) This is know as the Prime Vendor Sys-tem.

193 (b) Drugs that are dispensed under the floorstock system are generally classified into two cat-egories.

I Free floor stock systemII Charge floor stock system

Free Floor stock system: In hospitals, each nurs-ing unit has a predetermined list of medicationsthat can be given to patients free of charge suchas acetaminophen, bisacodyl etc. These medi-cations are not expensive and used in large quan-tities. The charge of such medications is generallyincluded in the cost of hospital room.

The inventory of such medications is usu-ally done on a spot basis by a pharmacy techni-cian on a predetermined day of week.

Charge floor stock system: There are certain drugsthat require immediate use after the physician pre-scribes them such as antibiotics, and certain painmedications. It is not practical to go to pharmacyeach time to obtain them, and they must requirebe charged to a patient.

When a nurse removes such medicationsfrom a cabinet, he/she will pull the preprinted la-bel from the medication and affix it to the inpa-tient prescription. This is used later for the re-placement of drugs and to charge the patient.

194 (b) Gaze is not a vocal qualities. Pitch, toneand range express the qualities of personal voice.

195 (a) Closed ended questions should be an-swered only in the form of “yes” or “no”.

To better serve the patient, pharmacistsmust develop skills of an active listening. Askopen-ended or direct questions, and interpret non-verbal communication (face expression, body pos-ture, eye reflection, distance of the patient) suc-cessfully.

Active listening: This will allow the pa-tient to define the problem completely. A phar-macist has to listen to the patient with completeattention. After a patient’s speech is complete,the pharmacist has to assure him that he under-stood his medical problem and medical needsthoroughly.

Open-ended questions : This skill initiatespatients to speak about their problems i.e. tell meabout the symptoms you have been experienc-ing?

Direct-ended question: This type ofquestion emphasizes on a specific inquiry, i.e.how long have you noticed pain in your bladder?

Nonverbal communication : Interpreta-tion of nonverbal communication gives an ideaabout the patient’s existing disease condition. i.e.facial expression, eye reflection, hand gestures,body posture.

196 (c) 1 drop to both eyes four times a day for10 days.

197 (c) $ 30

Retail price = CD + CD x % mark up = $ 20 + $ 20 x 0.5

= $ 20 + $ 10 = $ 30CD = Cost of drug

198 (b) $ 71

Retail price = CD + Professional fee = $ 65 + 6 = $ 71



983. (d) Hectorol (Doxercalciferol) isindicated for the reduction of elevated iPTHlevels in the management of secondary hyper-parathyroidism in patients undergoing chronicrenal dialysis. It is a synthetic vitamin D ana-log which undergoes metabolic activation to1-alpha-25 dihydroxy vitamin D

2, an active

form of Vitamin D2 .

984. (c) Phoslo (Calcium acetate) is indi-cated for the treatment of hyperphosphatemia inend stage renal failure. The recommended doseof PhosLo for the adult dialysis patient is 2 tab-lets with each meal.

985. (b) Reye’s syndrome is a rare but se-rious illness reported with aspirin or aspirin con-taining products. Aspirin (Acetylsalicylic acid) isindicated for treatment of pain. It is also used toreduce the risk of stroke in CHF. The recom-mended dose of the drug for pain is 325 mg ev-ery 4 to 6 hours as needed. G.I. ulcer and bleed-ing are reported side effects of the drug.

986. (c) The active ingredients of Avalideare Irbersartan and Hydrochlorothiazide. It is in-dicated for the treatment of hypertension. Irber-sartan is an Angiotensin II receptor antagonist.The recommended dose of drug is 150/12.5 mgto 300/25 mg per day. It should be given oncedaily.

987. (b) Lactic acidosis is a rare but seri-ous side effect associated with Glucophage(Metformin) therapy. It is characterized by el-evated blood lactate levels (> 5mmol/L). Glu-cophage is indicated for the treatment of diabe-tes. The recommended dose of the drug is 500mg b.i.d.

988. (b) Glucophage (Metformin) nor-mally decreases hepatic glucose production andintestinal absorption of glucose. It also improvesinsulin sensitivity by increasing peripheral glucoseuptake and utilization.

989. (c) Plavix (Clopidrogel) is an in-hibitor of platelets aggregation. It is indicatedfor the reduction of atherosclerotic events suchas myocardial infarction, stroke, and vasculardeath. The recommended dose of drug is 75mg once a day with or without food.

990. (d) Pravachol (Pravastatin) is anHMG COA inhibitor. It is indicated for the treat-ment of atherosclerosis with elevated lipid level.The recommended dose of drug is 10, 20 or 40mg once day. It can be administered at any timeof the day.

991. (b) Serzone (Nefazodone) is indi-cated for the treatment of depression. It is struc-turally unrelated to SSRI, MAO inhibitor andTCA. The recommended dose of drug is 200 mgday in two divided doses. The drug should becarefully used with terfenadine, astemizole,cisapride, TCA and MAO inhibitor.

992. (b) Stadol NS (Butorphanol) is theopioid analgesic available in nasal formulation. Itis indicated for the treatment of pain. It is a mixedagonist-antagonist type. The recommended dosefor initial nasal administration is 1 mg (one sprayin nostril). If adequate pain relief is not achievedwithin 60-90 minutes, an additional 1 mg dosemay be given.

993. (b) Pulmonary fibrosis is the most se-vere adverse effect associated with Bleomycin. Itis indicated for the treatment of Squamous cellcarcinoma, non-Hodgkin’s lymphoma and testicu-lar carcinoma.

994. (d) Cystic fibrosis is an autosomal re-cessive disorder in which defective CFTR pro-teins are found. The CFTR facilitates the trans-port of chloride ions across the membrane ofepithelial lined cells. The altered chloridetransport results in altered sodium and waterdistribution, causing thickened epithelial se-cretions and mucus. This will lead to pulmo-



nary, gastrointestinal, pancreatic, and hepaticmanifestations.

995. (b) Droxia (Hydroxyurea) is indi-cated to reduce the frequency of painful crisesand to reduce the need for blood transfusions inadult patients with sickle cell anemia.

996. (b) PH = PKw - PKb + log base/salt

PH = PKa + log base/salt (PKa = PKw-PKb)10 = 8 + log base/saltlog base/salt = 2 and therefore,

base/salt = 100 : 1.

997. (a) LDL (Low Density Lipoproteins)is the major cholesterol carrying lipoprotein in hu-man plasma. It is derived from catabolism ofVLDL. This process normally occurs in bloodvessels. LDL is converted into cholesterol by theenzyme HMG COA reductase. This is the ratelimiting step in synthesis of cholesterol. LDL isinvolved in the transport of cholesterol to periph-eral tissues and is potentially atherogenic, whereasHDL is involved in the transport of cholesterolfrom the periphery to the liver and isantiatherosclerosis.

998. (a) The active ingredient of Mesnex(Mesna) is sodium-2mercaptoethane sulfonate.It is indicated as a prophylactic agent in reducingthe incidence of ifosfamide-induced H.cystitis.

999. (c) Glycogen storage disease is alsoknown as Mcardle’s disease. It is an inborn errorof the metabolism in which a deficiency ofthe enzyme Myophosphorylase is found. Itprevents the breakdown of glycogen to lactatein exercising muscles. This results in fatigue,pain, and cramps in exercising muscles.

1000. (a) Nausea, vomiting and bone mar-row suppression are dose related side effects of

Carboplatin. It is indicated for the treatmentof ovarian carcinoma.

***************END*****************



Table-1

Name Causative organism Recommended dose

Diptheria Corynebacterium diphtheria Adult dose, boost every 10 years.

H.Influenza b H.influenza Most children have 3 to 4 doses betweenage 2 months to 15 months.

Hepatitis A HAV 3 doses at 1 month, 6 to 12months oldinfant and for patients age 2 years to18 years, while 2 doses every 6 monthsto 1 year apart for patients age more than18 years.

Hepatitis B HBV 3 doses at 1 to 2 months old infants andadults.

Influenza Influenza 1 dose every year

Measles, Mumps Measles, Mumps and Rubella 2 MMR vaccine at 12-15 months of ageand Rubella and again at 4 to 6 years of age.

Pertussis B.Pertusis It should be given to children aged 6weeks to 7 months.

Poliomyelitis Polio virus It should be given at 2 months, 4 months,12-18 months and at 4 to 6 years.

Pneumococcal S. pneumonia 1 dose

Tetanus Clostridium tetani 3 to 4 doses plus booster every 10 years.

Table-2

Drugs with prolong half life

* Chlorpropamide* Corgard* Piroxicam* Amiodarone* Bromocriptine* Azithromycin* Clofazimine



Table-3

DISULFIRAM REACTION PRODUCING DRUGS

* Metronidazole* Chlorpropamide* Cefotetan* Cefoperazone* Moxalactam* Cefamandole* Tolbutamide* Acetohexamide* Glyburide* Glipizide* Disulfiram

DRUGS THAT PRECIPITATE DISULFIRAM-LIKE REACTIONS WITH TABLE-3

* Alcohol* Benadryl Elixir* Digoxin Elixir* Lanoxicap

PLATELET AGGREGATION INHIBIT ORS

* Cefamandole* Cefoperazone* Moxalactam* Cefotetan* Plicamycin* Ketorolac* Aspirin* Ticlid* Plavix

URINE DISCOLORATION PRODUCING DRUGS

* Phenazopyridine* Senna* Rifampin* Phenolphthalein* Levodopa* Sulfasalazine



DRUGS THAT REQUIRE PATIENTS PACKAGE INSERT

* Isotretinoin* Oral contraceptive* Isoproterenol* Ticlid* Progesterone* Estrogen* Intrauterine device

DRUGS CONTRAINDICATED IN PREGNANCY

* Isotretinoin* Tetracycline* Chloramphenicol* Sulfonamide* Misoprostol* Finasteride* Methimazole* Coumadin* Metronidazole* Valproic acid* Lithium carbonate* Alcohol

DRUGS & THEIR NORMAL BLOOD THERAPEUTIC CONCENTRATIONS

* Digoxin 0.7 to 1.4 ng/ml Primidone 04 to 12 mcg/ml* Phenytoin 10 to 20 mcg/ml Vancomycin 05 to 15 mcg/ml* Amikacin 10 mcg/ml Lithium 0.6 to 1.2 mEq/L* Carbamazepine 10 to 20 mcg/ml Valproic acid 40 to 100 mcg/ml* Gentamicin 2 mcg/ml Haloperidol 05 to 20 ng/ml* Tobramycin 2 mcg/ml* Fosphenytoin 10 to 20 mcg/ml* Theophylline 10 to 20 mcg/ml* Streptomycin 5 mcg/ml* Digitoxin 09 to 25 mcg/ml* Quinidine 02 to 06 mcg/ml* Carbamazepine 04 to 12 mcg/ml* Phenobarbital 10 to 40 mcg/ml



ANTIDOTE OF DRUGS

Naloxone=Narcan

Nalmefene=Revex

Naltrexon= Revia

Digoxinfab=Digibind

LeucovorinCa+2= Wellcovorin

Mesna = Mesnex

Vitamin K

Protamine sulfate

Deferoxamine mesylate= Desferal

Dimercaptol

Sodium thiosulfate

Flumazenil=Romazicon

Physostigmine=Antilirium

Acetylcysteine= Mucomyst

Dexrazoxane=Zinecard

Pralidoxime = Protopam cl

Glucagon

Edetate disodium

Edetate calcium disodium

Atropine

Hydroxocobalamin

DRUGS

Opioid

Opioid

Opioid

Digoxin, Digitoxin

Methotrexate, Trimethoprim, Pyrimethamine

Cyclophosphamide, Ifosfamide

Coumadin

Heparin

Iron

Arsenic, Gold

Cyanide

Benzodiazepine

Atropine, Anticholinergic

Acetaminophen

Doxorubicin

Organophosphorus compound

Insulin

Digitalis toxicity, hypercalcemia

Lead

Acetylcholine, Cholinergic agent

Cyanide



Drugs that cause photosensitivity reaction

* Accutane * Cipro * Rheumatrex* Micronase * DiaBeta * Sulfonamide* Retin-A * Doxycycline * Tetracycline* Bactrim * Griseofulvin * Thiazide diuretic* Carbamazepine * Methotrexate * Tricyclic antidepressant* Sulfonylureas * Noroxin * Glucotrol

Abbreviations

* aa of each * D.A.W dispense as written* N and V nausea and vomiting * gtt drop* a.c. before meals * a.m. morning* p.c. after meals * p.m. evening* a.d. right ear * h.s at bed time* a.s. left ear * o.d. right eye* a.u. both ears or each ear * o.s. left eye* q.d daily * o.u. both eyes or each eye* b.i.d. twice daily * o2 both eyes* t.i.d three times daily * p.o. by mouth* q.i.d four times daily * pr per rectum* q.o.d every other day * q.6h every 6 hours* pt. pint * prn as needed

Drugs that cause enzyme induction

* Rifampin* Carbamazepine* Phenobarbital* Troglitazone* Phenytoin* Nicotine* Omeprazole* Rifabutin

Drugs that cause enzyme inhibition

* Cipro * Clopidogrel* Cimetidine * Ritonavir* Erythromycin* Fluvoxamine* Ketoconazole* Nelfinavir



COMMONL Y USED UNITS FOR PHARMACEUTICAL CALCULA TIONS

* 1 kilogram = 1000 grams* 1 gram = 1000 milligrams* 1 milligram = 1000 micrograms* 1 microgram = 0.001 milligrams* 1 microgram = 10-6 grams* 1 nanogram = 10-9 grams* 1 grain = 65 milligrams* 1 liter = 1000 cc* 1 ounce (oz) = 30 cc* 16 ounce (oz) = 480 cc = 1 pint* 1 pint = 480 cc* 1 quart = 960 cc = 2 pints* 1 gallon = 3840 cc = 8 pints = 4 quarts* 1 kg = 2.2 lbs* 1 lb = 454 grams* 1 teaspoonful = 5 cc* 1 tablespoonful = 15 cc* 1 teacupful = 120 cc* Density = weight/volume* Proof gallon = (gal x % v/v strength) / 50% v/v* % strength = proof spirit / 2* Proof gal = (gal x proof spirit) / 100* PV = nRT* PV = W/M x R x T* Equivalent wt = molecular weight / number of valence* mEq = equivalent weight in mg / 1000* mOsmol/L = (weight of substance [g/L] x no of species x 1000) / mol wt* pH = pKa + log (salt/acid)* Young (child) = (age in years / age + 12) x adult dose* Clark’s = (weight in lbs / 150) x adult dose* Child’s dose = (body surface area of child / 173 mm2 ) x adult dose* Fried’s rule = (age in months / 150) x adult dose* FP of blood = -0.52oC

* Each gm of hydrous dextrose provides = 3.4 calories / kcal* Each gm of anhydrous dextrose provides = 4 calories / kcal* Each gm of fat provides = 9 calories / kcal* Each gm of protein/aminoacid provides = 4 calories / kcal* Each gm of medium chain triglyceride (mct) = 8.3 calories / kcal* Each gm of glycerol provides = 4.3 calories / kcal* Each cc of alcohol provides = 5.6 calories / kcal* 1 cc of 10% fat emulsion provides = 1.1 calories / kcal* 1 cc of 20% fat emulsion provides = 2.0 calories / kcal



Stool discolor producing drugs

Drug Color

Rifampin Red orangePhenolphthalein RedPyrinium RedAntacid WhiteKao-pectin BlackIron salt Black brownWarfarin Black

Drugs that need to be stored in refrigerator

Calcimar Wycillin (Injection)Xalatan (opthalamic solution) Bicillin ( Injection)Viroptic (opthalamic solution) Permapen (Injection)Opthetic (opthalamic solution) Intron-A (Injection)Fluorocaine (opthalamic solution) Epogen (Injection)Occusert Pilo Neupogen (Injection)Phospholine Iodine (opthalamic solution) Hyperstat (Injection)Erythromycin Ethyl Succinate Suspension Sandostatin (Injection)Promethazine suppository Novolin (Injection)Fosphenytoin (Injection) Humulin (Injection)Bicillin-LA (Injection) Regranex ( Cream )Mose (Injection)Harvix-A (Injection)Neupogen (Injection)ThyrolarMycostatin pastillesFortovase capsulesNorvir CapsulesCalcitonin Salmon (Injection, nasal spray)Bacid (dietary supplement)Lactinex (dietary supplement)Sterile Bacitracin powderDiltiazem injectionPepcid injectionUrokinaseSus-Phrine (injection)Dornase-alphaTetanus ToxoidHepatitis-AMMR vaccine



Pancrelipase supplement products

Ku-Zyme-HPViokaseCreonCotazymIlozymeFestal

List of drugs that should not be used by patients with Belladonna alkaloids orPhenobarbital allergy

BarbidonaKinesedSpasmophenDonnapineHyosophenSpaslinSpasmolineRelaxadonMalatal

List of drugs available in Depot preparation

Haloperidol Decanoate = HaldolFluphenazine Decanoate = ProlixinMethylprednisolone = Depo MedrolMedroxyprogesterone = Depo ProveraEstradiol = Depo EstradiolLuprolide = Lupron Depot

List of the drugs that should not be used by patients with Sulfonamide allergy

Sulfonamide DiazoxideOral sulfonylurea CelebrexThiazide diureticDapsone

List of drugs that should not be used by patients with TCA allergy

Tricyclic antidepressantCarbamazepineCyclobenzaprine



List of drugs that are available in Transdermal dosage form

Name of Drug Need to change

Climara Once a weekCatapres Every dayEstradiol Twice a weekNitrodur Applied in morning and remove in

the eveningTransdermal nitro Applied in morning and remove in

the eveningDeponit Applied in morning and remove in

the eveningNicoderm Every 24 hoursProstep Every 24 hoursHabitrol Every 24 hoursNicotrol Applied upon awakening and remove at

bed timeDuragesic Every 72 hoursTransderm scop Every 72 hours

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