Sorry for delayed reply. We have been in the process of moving and settling in to NZ.

Regarding
the exam - they have extended the time to 3 hours and I needed all the time. I prepared by
getting familiar with the AMH and used it almost exclusively in the exam. Essay - COPD patient has
an exascerbation, Dr drops off RX for Clarithromycin, Prednisone taper. Patient takes 5mg pred
daily and warfarin daily. Write letter to patient with any information required. Note the interaction
is not between warfarin and clarithromycin as expected but between pred and warfarin.
Clarithromycin only decreases the metablolism of the inactive isomer of warfarin. It had me
stumped but I went with what the AMH said and passed. So stick to the AMH information and get
to know how to get around quickly. I alphabetised the index and used that mostly. I think you need
a core of knowledge so that you do not have to refer to the book every time, it chews up the time.
I perhaps referred a bit too much and got stretched for time. Go with your intuition when you are
fairly confident of an answer. The calculations are now in the CAOP and not after supervised
practice. They are straight forward. Sorry I cannot remember any specific questions, but all you
need is in the AMH. I started using the AMH at work in the USA as a reference because it had the
nitty gritty for patient counselling and some useful tips for causes of common ailments such as
ringing ears etc. Hope this helps and good luck. Cheers Linton
Hey scottie sorry for late reply! I hope studies are going well. U wud mostly need the AMH book for the exam
and its true you would have to look up nearly all the answers. Only a few quest came up frm APF. so no u wnt b
very disadvantaged. Try and use mcqs in clinical pharmacy by Lillian A too as there a lot of similar senario based
quest. The essay quest i had was a patient taking celecoxib from his GP and was started on methotrexate from
his specialist. I had to write a letter to councel him on using methotrexate n highlight the interaction. A few
other quest i can remember is constituent of mother's milk, few quest on anaemia, infection and alternate
antibiotics, few quest on eyes and patient was allergic to sulfonamide and prescribed sulfacetamide eye drops.
The calculation quest were quiet straight forward. There were a few quest which u wouldnt find answers in the
reference sources allowed. I hope this can be of some help. Good luck to you all.. Any one taking the exam in
sydney in Sept?
COPD patient has an exascerbation, Dr drops off RX for Clarithromycin, Prednisone taper. Patient
takes 5mg pred daily and warfarin daily. Write letter to patient with any information required. Note
the interaction is not between warfarin and clarithromycin as expected but between pred and
warfarin. Clarithromycin only decreases the metablolism of the inactive isomer of warfarin. It had
me stumped but I went with what the AMH said and passed. So stick to the AMH information and
get to know how to get around quickly. I alphabetised the index and used that mostly. I think you
need a core of knowledge so that you do not have to refer to the book every time, it chews up the
time. I perhaps referred a bit too much and got stretched for time. Go with your intuition when you
are fairly confident of an answer. The calculations are now in the CAOP and not after supervised
practice. They are straight forward. Sorry I cannot remember any specific questions, but all you
need is in the AMH. I started using the AMH at work in the USA as a reference because it had the
nitty gritty for patient counselling and some useful tips for causes of common ailments such as
ringing ears etc. Hope this helps and good luck. Cheers Linton
For anyone doing this exam in the future, I did the March 2010 session and here are a few
questions that I can remember:

The essay question was on a young woman getting a new prescription for isotretinoin; write a
letter counselling her on it.

Some of the MCQ questions were tricky enough. One that sticks in my head was "which is an
important side effect of piroxicam?"; options included acute renal failure and exacerbation of
asthma, both of which are correct so it was a total judgement call on which to go for.

Other areas focussed on were:
Management and monitoring of diabetes
Lots of questions on HRT
NSAIDs, especially side-effects
Opioid analgesics
There wasn't as much focus on cardiovascular, asthma or GI as I expected.

If you know your interactions and renal/hepatic cautions well (which I didn't), you'll breeze
through. The time-limit is ludicrously short though...
Hello everyone,

I'd just like to thank everyone for their previous posts. I found this thread extremely valuable when
revising for the CAOP. I sat the December exam in London and thought I'd contribute for future
candidates by listing any questions I could remember.

1. Which TCA is most likely to cause orthostatic hypotension

2. Drugs and coloured urine question (which appears to be an APC favorite)

3. How long can interactive dressings be left on for? (answer in APF)

4. How long is a child with chicken pox classified as contagious? none of the options were until the
blisters have dried- answer in APF

5. Which food allergy makes pts unable to take glucosamine?

6. Allopurinol and azathioprine interaction

7. Doxarubicin and cardio toxicity question

8. Counseling points of Alendronic acid

9. What micro organisms cause osteomylitis

10. Calculating CrCL and what degree of renal impairment pt has and which drugs require dose
reduction

11. If a patient has adrenal insufficiency and has the flu what dose change in hydrocortisone would
be required

12. Calculate the dose of oral paracetamol for a child

13. What monitoring is required for patients on methotrexate and amiodarone

Those are all I can remember for now.

Fingers crossed I've passed and dont have to re sit!!
Also, the short answer question was about a lady who had an intra abdominal infection post C
section. She was breastfeeding and we had to write a letter to accompany the prescription with
counselling points etc. Easy, as all the info was in the AMH!
There were 2 seperate MCQs with regards to amiodarone and methotrexate monitoring the
answers were in the AMH
The part I was most unsure about was the short answer it involved a pt who was stabilised on
carbamazepine, GP brings in script for erythromycin you get it changed to Azithromycin due to
interaction. Pts friend will collect meds from you later, write a letter to counsel patient. I really
couldnt find much to say! It seemed so different from the other short answers people have put on
here.
acc, I passed the June exam and so I'll try to recount what i wrote for the letter

Dear [patient name]
I am writing to let you know about the medication that your neighbour will be picking up for you
today. I understand that doctor X has been to see you today and has already told you about the
medication that he was going to give you. Unfortunatley we have had to change the medication
that you are going to need to take.
You were initially going to be given erythromycin, but this can interact with your regular epilepsy
medication, carbamazepine. It can cause an increase in the carbamazepine levels and potentially
cause toxicity. The medication you are now going to receive is called azithromycin, which does not
affect carbamazepine levels. This has been discussed with Dr X, who has agreed with the change.
Azithromycin is an antibiotic for your pneumonia. It is not penicillin based and so should not affect
your penicillin allergy. The dose is one tablet a day for 3 days. You should try to take the tablets at
the same time of day each day. I would recommend taking the first tablet straight away and then
take the next one 24 hours later. Azithromycin is normally very well tolerated, but side effects do
include nausea - this can be reduced by taking the tablets with a bit of food. You need to ensure
that you complete the course of antibiotics even if you feel well - this will help to make sure that
the infection does not come back.
If you have any questions, please do not hesitate to contact me on 12345678
-N&V: what to use with which conditions (PD, HF, DM, HTN, etc)
-Hperglycemic Tx when first line Tx fails
-MTX: SE, monitoring parameters
-major SE of ACEI, BB, nitrates (best to know this for all your major classes of drugs)
-situations of hyper/hypokalemia including various drug interactions and SEs that can lead to it
-pt on nitrate but waking up at night due to chest pain: what to do next
-antibiotics: know this section well so you can easily answer ques without flipping through the book
too much: the one I remember was about meningitis Tx for a child that came with a pt profile and
medical HX
-chemo: doxorubicin: monitoring parameters, SE, what to do when pt exp cardiotoxicity
-Tx dose for folic acid deficiency in males
-lots of DI; CYP 450 mediated, p-glycoprotein mediated and renal clearance interactions
-SE of systemic corticosteroids
-Rheumatoid ARthritis Tx
-Bipolar D/O and tx options and SEs
-amiodarone monitoring parameters and SE
-secondary prevention of stroke (pt was allergic to ASA)

My short answer question was: pt's mom brings in Rx for accutane and pt was young female who
had just broken off with boyfriend and now moved back home; haven't filled Rx for COC in 6
months, wants to get ready for summer (acne problem on her back); needed to write letter to pt
with concerns and necessary counselling info since medication was being delivered.
Hi guys,

This is extracted from my memory, so I hope it helps whomever is attempting the CAOP exam. I
really expected the exam to be worse. Fingers crossed that I will pass, if not, I'll be sitting for the
Sept exam

1) Lots of antidepressant/ couple of antipsychotic qustions- which one causes dose-related
hypertension, 2 questions of stopping/ starting antidepressants, what do you monitor with
clozapine= So I think this is one chapter that you may want to focus on.

2) Contraceptives (COC)/ Hormone replacement therapy (HRT)- what precautions to take with
COC+ doxycycline, which method of contraceptive do you use if you take enzyme inducers, what
risk to you have when you take continuous+combined HRT pills (note is it breast cancer vs.
endometrial cancer vs. thrombosis etc)

3) Interactions- what do you do when you take amiodarone and digoxin?, which increases digoxin
concentration?, which increases INR? what happens when you give valproate and lamotrigine?
Note: good to know the common ones

4) Analgesia nephropathy- the 3 of us who sat the exam in Sydney had no clue what this was!

5) What laxatives do you recommend for someone on opioids?

6) Baby with diarrhoea for 24 hours. What do you do? (Note: send to doctor? discontinue
breatfeeding and give rehydration salts? continue breastfeeding and supplement with water? etc)

7) What do you use in methotrexate toxicity? (note folinic acid, etc)

8) A few questions on vaccines- how do you store oral typhoid capsules, how do you give oral
typhoid capsules? what is the DTP schedule, the different pneumococcal vaccines. Another good
area to focus your study on- the AMH has all the answers

9) One patient profile on herpes zoster- patient liked to minimise number of tablets he takes/ day.
What is best time to start on antiviral therapy? (note 24 hours, 48 hours, 72 hours etc), What do
you recommend for treatment ?(note: famciclovir, aciclovir etc...). What topical agent would you
recommend to him? (note capsaicin, anaesthetic agent, etc)

10) One patient profile on gout- patient had high uric acid but has never had attack of gout. What
do you recommend based on the uric acid level? (note: nothing/ allopurinol/ colchicine etc..).
Which of his other drugs can cause high uric acid? (note frusemide/ etc)

11) One patient profile on a Type II diabetic patient, >70 years old. What blood pressure target
would you aim for? What BP agents would you recommend for him? (note choices between ACE
inhibitors, Bblockers etc).

12) One patient profile on a respiratory patient- old lady on regular courses of steroids. What is
most likely side-effects of long-term steroids on her? (note osteoporosis, psychosis)

13) How long do you keep a child at home when he has chicken pox?

14) Which virus causes chicken pox?

15) Calculate steroid dose for a 9kg child with acute asthma attack?

16) Child with discharge from ears and pain. 24 hours later, the earcahe has lessened. What do
you do? (note go to doctor and get antibiotics/ nothing/ etc)

17) Which antihistamine would you recommend for a pregnant lady- 2nd trimester? (note choices
between loratadine/ fexofenadine/ cetirizine, cyproheptadine etc)

18) How long between GTN doses? (note 1 min, 4 minutes, 6 minutes, 10 minutes etc)

18) How long do you treat a pregnant woman for DVT?

19) How long can you store insulin out of fridge for?

20) Side-effects of steroids?

21) How do you counsel someone on nasal decongestant?


The short essay question they asked was about a patient being given a prescription for morphine-
dose was too high for her (100mg morphine). Patient was comfortable on previous dose of 60mg/
day (including breakhrough doses). You can't get hold of doctor cos he had left for the day. Write a
letter to him explaining the problem and the action you took as a result of not being able to contact
him.

Cheers, Pixi
This is an example from a prereg pharmacy oral exam some time back. I am an anzac prereg
pharmacist who has had their 'Gallipolli' and looks forward to 'Beersheba' in August this year. 1.
Demonstrate Spiriva how to use and clean, what is the purpose of piercing the capsule. No
patient consultation.
2. EES 440 prescription 5ml q6h for 10 days. The boy is 6 years old, 21 kg. For chest infection.
Dose was high but not maximum. Called doctor to query dose. Dr said boys chest infection was
particularly bad and wanted to give maximum dose. Gave 80mg/mL suspension, 3.3ml (or 3ml)
qid. Forgot to mention that there wont be enough suspension for ten days or that pt needs to take
it for ten days!!! Counseled on everything else.
3. Women presents prescription for maxolon (forget dose) she also complains of cramping. When
questioned, shes also feeling breathless.

Her other medications
Maxolon
Digoxin 125mcg bd
Celebrex
Endep 3n
Lasix
Losec
Coversyl
Panadeine forte 1-2 qid
Coloxyl with senna
Lipex 80mg n (increased from 40mg)

I only remember the dosages that stood out to me. Examiners asked me for generics, indication
and class. What I thought of it, what I thought she had

- Concerned about digoxin dose too high for elderly/renal impairment. Monitor dig concentration.
- Nausea could be caused from possible digoxin toxicity.
- Endep dose too high for elderly, prolongs QT interval, causes sedation risk of falling. High dose
serotonin syndrome
- Celebrex impaired renal function, caused hyperkalemia, coupled with ACE-I. Monitor renal
function, serum potassium,
- Wanted to initiate regular paracetamol to reduce need for panadeine forte and then coloxyl with
senna
- Lipex increase may be causing leg cramps
- Maxolon can cause EPSE esp in elderly pt.

Ran out of time. Should have also mentioned: triple whammy, gord possibly due to or exacerbated
by celebrex. Change antidepressant to SSRI. Digoxin 70% renally cleared. Monitor BP, all
electrolytes (although did say Lasix may cause hyponatraemia and electrolyte imbalance etc),
hepatic function.

4. Pt comes in with prescription for panamax 5mg/ml asks if I can change it to Nurofen? What do
you do? Cant change a prescription and cant submit a false claim to PBS. Was confused with the
question, didnt realise pt had concession card??

5. Man comes in asks for something for head lice. Turns out was for daughter who had itchy head.
No other medical conditions etc. Asked if saw headlice on head. No. Recommended comb and
conditioner technique, if has headlice return to pharmacy, recommend KP24. went to through
usage and duration of use. Was also asked to name other products for headlice, if child can go to
school and preventative methods.

6. Its late, youre closing the shop and a regular customers comes and hands you this
prescritption.

Codeine phosphate mdu. Not valid prescription. Pt and doctor is KNOWN to pharmacist.
Prescription is invalid (no qty, directions, strength etc in words or figures). Doctor not available. Pt
has chronic diarrhea. Cannot give 2 days supply because not a valid prescription. Recommended
anti-dirrheal. Pt said that it doesnt work. Examiner asked me if I could give codeine product. I said
ok but codeine amt will not be as high and most products contain paracetamol. Forgot to mention
the most basic of all basic thing max 8 tabs/d.
The short Q in June was about a script for Morphine SR with info about the patient's PRN morphine
liquid history. Basically the SR dose was way too excessive and you had to write a letter to the GP
as the practice was closed. So it was all about showing how to work out and equivalent dose and
phrase it well. The exact same maths applied to one of the MCQ's on the day with the same
numbers involved!
As for the short question - it was about a patient on morphine liquid converting to tablets. The
dose the GP calculated was well in excess of the dose equivalent to the PRN liquid formulation.
From memory the patient was on a total daily dose of 60mg liquid morphine which should have
equated to 30mg BD tablets but he'd prescribed 50mg Bd.

My letter explained how to work out the equivalent dose and recommended reducing the prescribed
dose but with PRN oramorph also available.

As for % answered without texts - not many! I started off wanting to be sure I had the right
answers which in hindsight was time wasteful. The majority of questions I could get down to 2
possible answers but not many were answered completely without help.