PHAY2001

UCL SCHOOL OF PHARMACY

M.PHARM. EXAMINATION
PHAY2001
CLINICAL AND PROFESSIONAL CONSIDERATIONS

May 2015

TIME ALLOWED: 3 HOURS

The Examination is comprised of TWO (2) sections. You must answer BOTH
sections of the paper.

Section A
This consists of 30 MCQ questions. Each question has the same value.
Answer ALL questions in the grid supplied.
This section contributes 30% of the total paper marks. You are advised to spend
no more than ONE hour on this section.

To fill out the MCQ answer grid:

For each question there are five associated answers: A, B, C, D and E.
Decide which of A, B, C, D and E is the most appropriate answer.
Draw a HORIZONTAL LINE across the centre of the correct box.
Use an HB pencil only.
Mark ONLY ONE answer for each question. If you change your mind about an
answer RUB OUT the incorrect one using an eraser.

Section B
Answer SIX (6) of the EIGHT (8) questions.
Use ONE (1) answer book for all the questions you select.
Each question has the same value.
The marks distribution is shown clearly for each section of the question. Answer
all parts of each of the individual questions you select.
This part contributes 70% of the total paper marks. You are advised to spend
TWO hours on this section.
You are advised to spend no more than 20 minutes on each question.

The following is supplied:

Answer grid.

Notes are not permitted in this examination.

Dictionaries are not permitted in this examination.
Calculators are not permitted in this examination.
Do not turn over until you are told to do so by the invigilator.
Do not take this question paper out of the examinations room.
TURN OVER

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SECTION B

Answer SIX (6) of the EIGHT (8) questions. Use ONE (1) answer book for all the
questions you select.

1. Answer BOTH parts of the question.

a) Define and describe non-adherence. Using an example, describe how it

differs from concordance. (40 % of marks)

b) Describe key factors which might make it more difficult for patients to adhere
to their medication. (60 % of marks)

2. Answer ALL parts of the question.

Mrs QW is a regular customer at your community pharmacy. She comes in to see

you and tells you she is going on holiday to the Dominican Republic and would like
some advice.

a) Explain to Mrs QW what the term "SPF" means in relation to sunscreens and
what advice you should give her about protecting her skin in the sun.
(40 % of marks)

b) Briefly describe what the term "DVT" means in relation to long-haul travel by
plane. Describe which patient population groups have the highest risk of
developing DVT. (20 % of marks)

c) Mrs QW is particularly concerned about developing DVT during her travels.

What advice should you give Mrs QW to reduce the risk of developing DVT
while on a flight? (20 % of marks)

d) Mrs QW is also worried about contracting travellers' diarrhoea. Outline the

standard treatment options for patients who contract travellers' diarrhoea,
include dosage regimens as appropriate. (20 % of marks)

TURN OVER

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3. Answer BOTH parts of the question.

It is Sunday 6th April 2015. You are the Responsible Pharmacist at Brunswick
Pharmacy in Gatwick Airport and you are presented with the prescription below:

Dr Jose Elena De la Cruz MBBS

44 Spanish Avenue
Granada
Espana
00 34 958827588

Miss Emily Jones 21/03/75

2 Shore Street, London WC1X 2JR

Amoxicillin 250mg Caps

1 tds
7 days

J.E. De la Cruz
05/04/2015

a) Describe how you would manage this prescription in a community pharmacy,

up until the point of dispensing the medication. Include in your answer the
relevant legislation and details of what legal checks you would make.
(60 % of marks)

b) Using a clean page in your answer booklet, create a private prescription

record entry for this precription. (40 % of marks)

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4. Answer ALL parts of the question.

Mr DD is a 44 year old banker who has been diagnosed with severe cirrhosis of the
liver due to alcohol abuse. He presents with a profoundly swollen abdomen, shows
signs of mental confusion and the nurses have made a note in the PMR about the
patient's incessant scratching of his skin. In addition, the lab tests show abnormal
clotting and an upper GI bleed.

a) Using medical terminology, list and explain Mr DD's presenting signs and
symptoms. What treatment strategies should you employ to treat this patient?
Suggest appropriate therapeutic agents for each strategy. (75 % of marks)

b) In addition to the specific measures discussed in your answer to (a) above,

describe the general management strategy used to treat alcoholic liver
cirrhosis. (25 % of marks)

5. Answer ALL parts of the question.

Mr AW is a 61 year old man who suffered from a myocardial infarction one year ago
and also has atrial fibrillation. He has now become a regular patient of yours and
after about 6 months you ask him if he would like to have a Medicines Use Review
(MUR). During the MUR several issues are raised:

He mentions that he sometimes finds it hard to take warfarin at the same time
each day. He asks what he should do if he misses a dose.
He is worried about going to the dentist, as he remembers the hospital
pharmacist had mentioned to take care, but as it was 6 months ago, he can't
remember what he should do.
He is trying to lose weight and is looking to change his diet to improve his heart
health and wonders whether this will have an impact on his treatment.

a) How should Mr AW take his warfarin? What advice should you give to Mr AW
with regards to a missed dose? (30 % of marks)

b) What action should Mr AW take with regard to his upcoming dentist

appointment? (10 % of marks)

c) How should Mr AW be monitored with regards to his current treatment?

(20 % of marks)

d) Describe any additional counselling points you would give to the patient taking
warfarin, including lifestyle advice. (40 % of marks)

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6. Answer ALL parts of the question.

Mr LK, age 32, presents at your pharmacy with a symmetrical rash on his knees and
elbows. Upon further questioning, you discover that Mr LK has had these lesions on
and off in the past, but did not see a GP about the issue. You suspect that he is
suffering from psoriasis.

a) What are the signs and symptoms of psoriasis? (25 % of marks)

b) What are the differences between plaque psoriasis, guttate psoriasis and
pustular psoriasis? Which form is most common? (25 % of marks)

c) Provide FIVE (5) examples of prescription- or hospital-based treatments that

are available for psoriasis. What other advice would you give this patient?
(50 % of marks)

7. Answer ALL parts of the question.

Mrs LA presents at your pharmacy with an irritated right eye with mucopurulent
discharge. Upon questioning and examination you are able to ascertain that she is
suffering from bacterial conjunctivitis.

a) List the signs and symptoms of bacterial conjunctivitis. (25 % of marks)

b) What are the differences between bacterial, viral and allergic conjunctivitis?
(25 % of marks)

c) Describe the available OTC treatment options for bacterial conjunctivitis.

(15 % of marks)

d) How would you counsel the patient regarding the use of eye drops for
bacterial conjunctivitis? (35 % of marks)

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8. Answer ALL parts of the question.

a) Mrs KL has been suffering from heartburn. Discuss the various over-the-
counter treatment options which are available for dyspepsia. In your answer,
include the mode of action of each drug class, examples of drugs in each
class and which drug classes as considered as first line and second line
options. (40 % of marks)

b) Mrs KL is also experiencing some symptoms which she thinks may be due to
cystitis. What symptoms would you expect the patient to complain of?
Discuss any differential diagnoses for cystitis in women. (40 % of marks)

c) Mrs KL's husband comes into the pharmacy. He asks for some general
advice about constipation, which he occasionally suffers from. What detailed
DIETARY advice could you give to this patient? Include examples in your
answer. (20 % of marks)

END OF SECTION B

END OF PAPER