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LPN INTENSIVE CALCULATIONS� SPECIAL CLASS 3 �� INTENSIVE GPHC Exam revision � programme

LONDON PHARMACIST NETWORK (LPN)

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QUESTION 1

In your pharmacy you have a stock solution of chlorhexidine with a concentration of 12% w/v . Chlorhexidine is used as a mouthwash at a concentration of 0.25% w/v. You are required to supply 250 mL of an intermediate strength, such that when the patient dilutes this solution 1 in 20, they obtain the correct concentration immediately before use.

How many mL of stock solution is required to make the 250 mL intermediate strength solution to be supplied?

Round your answer to the nearest 5ml.

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ANSWER 1

C1V1 STOCK = C2V2 INTERMEDIATE

12 X V1 = 5 X 250 note C2 = 0.25 x 20 dilution factor

V1 = 5 X 250

12

V1 = 104.1ML

ANSWER = 105ml to nearest 5ml

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QUESTION 2

Alfie a male child weighs 3kg . He is to be treated with dexamethasone via a dose reduction regimen . Calculate how many tablets of dexamethasone 0.5mg soluble tablets you would supply to complete the 28-day course. The patient complete 2 weeks of treatment before quitting due to side effects. Calculate the % adherence. Answer as a whole number.

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ANSWER 2

  • 4MG/KG means 12mg per 3kg . Hence 24 tablets per day and 168 tablets for 1 week
  • 2mg/kg means 6mg per 3kg . Hence 12 tablets per day and 84 tablets for 1 week.
  • 1mg/kg means 3mg per 3kg . Hence 6 tablets per day and 42 tablets for 1 week
  • 0.5mg/kg means 1.5mg per 3kg . Hence 3 tablets per day and 21 tablets for 1 week

= Total = 315 tablets

  • first 2 weeks = 252

  • Adherence = 252/ 315 x 100 = 80%

  • ANSWER = 80%

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QUESTION 3

The GP surgery where you work has asked you to review their proprietary prescribing and identify any cost savings. From the practice data , you notice that they have prescribed 1176 LIPITOR 20mg tablets over the last 3 months at a cost of 465.36 pounds . You obtain the following information from the drug tariff.

Generic Atorvastatin 20mg tablets - 81 pence for 28 tablets

How much would be saved monthly if the patients on Lipitor were switched to generic atorvastatin 20mg tablets.

Give your answer to nearest pound

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ANSWER 3

  • Number to treat x duration x cost difference
  • 14 boxes x 1 month x 10.27 = 143.78 i.e. 144 pounds

  • OR ALTERNATIVELY …….
  • TOTAL LIPITOR TABLETS RX IN 3 MONTHS = 1176 WHICH IS 42 BOXES OF 28 TABLETS
  • THEREFORE, IN ONE MONTH = 42/3 = 14 BOXES OF 28 TABS
  • COST PER MONTH = 465.36/ 3 = 155.12

  • COST OF 14 BOXES OF GENERIC ATORVASTATIN = 0.81 PENCE X 14 = £11.34
  • £155.12 - £11.34 = £143.78

  • ANSWER = £144

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QUESTION 4

Grace is a 3-month-old child weighing 12.1kg. The doctor has prescribed omeprazole 2mg/ml oral suspension sugar free at a dose of 0.65mg/kg/day using a 5ML syringe as shown in the picture underneath. Calculate the volume Grace will use in a month (28 days).

ANSWER in ml to 1.d.p

UK’s most INTENSIVE GPhC exam calculations

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ANSWER 4

0.65mg/kg/day

0.65 X 12.1mg = 7.865mg per day

2mg = 1ml

7.865 = 3.9325ml

ROUND TO NEAREST 0.1ml as per syringe marking

3.9 x 28 = 109.2

ANSWER = 109.2ml

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QUESTION 5

Ms. B is a palliative care patient who has been prescribed 60mg morphine sulphate modified release (ZOMORPH) capsules twice daily. The doctor wishes to prescribe medication for breakthrough pain and asks you to calculate the required volume.

What is the minimum entire dosage volume in ml of morphine sulphate 10mg/5ml oral solution that Ms. B should be prescribed for a month given that she takes her breakthrough pain dose every four hours on alternate days?

Answer in ml to nearest five.

THE HOME OF GPHC EXAM PHARMACY CALCULATIONS

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ANSWER 5

  • Daily dose of morphine = 120mg per day
  • Minimum for breakthrough = 1/10
  • 120/10 = 12mg
  • If 10mg = 5ml
  • 12mg = 6ml
  • 6ml x 6 = 36ml
  • ALTERNATE DAYS IN A MONTH = 14 days
  • 36 x 14 days = 504

  • ANSWER = 505ml

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QUESTION 6

  • You work as a hospital pharmacist have been instructed to make an infusion bag by mixing 77g of glucose powder with 330ml of glucose 3.5%w/v solution and 470ml of glucose 15%w/v solution and 200ml of water.
  • What would be the concentration in percentage strength of the new solution ?
  • Give your answer to one decimal place.

THE HOME OF GPHC EXAM PHARMACY CALCULATIONS

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QUESTION 6 ANSWER

WORKING

  • 3.5g = 100ml so 11.55g in 330ml
  • 15g = 100ml SO, 70.5g in 470ml
  • 11.55g + 70.5g + 77g = 159.05g

  • 159.05g = 1000ml
  • x = 100ml
  • ANSWER = 15.9% w/v

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QUESTION 7

  • Baby P a 3-week-old baby weighing 3.6kg has cholestasis associated with total parenteral nutrition that is to be treated with ursodeoxycholic acid at the recommended dose.  The drug will be administered using an oral syringe calibrated at 0.1ml intervals.
  • Dosing guidance from the BNFC is provided in link below.
  • How many ml of ursodeoxycholic acid 250mg/5mL oral suspension should be supplied for 5 days treatment?
  • Give your answer to one decimal place.

THE HOME OF GPHC EXAM PHARMACY CALCULATIONS

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ANSWER 7

  • FROM RESOURCE,
  • cholestasis associated with total parenteral nutrition
  • Neonate , 10 mg/kg 3 times a day.
  • 10mg x 3.6kg = 36mg
  • If 250mg = 5ml
  • 36mg = 0.72ml
  • Using a syringe calibrated at 0.1ml intervals , we will give 0.7ml per dose
  • So, 0.7ml x 3 times a day x 5 days = 10.5 ml
  • ANSWER = 10.5 ml

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QUESTION 8

  • Ms. Little is a 62-year-old woman who has been taking a 10mg citalopram tablet alongside a 20mg citalopram tablet every day for the last 12 months. She gives you a new prescription for citalopram oral drops 40mg/ml and explains that her consultant prescribed the drops as she was experiencing side effects due to some excipients in the tablets.
  • The prescriber asks you to find out the volume that will be sufficient for 8 weeks supply. Use the resource provided to help . Approximate answer to nearest whole number of bottles you would supply to Ms. Little given that each bottle is 15ml.
  • See link below

THE HOME OF GPHC EXAM PHARMACY CALCULATIONS

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ANSWER 8

  • 4 drops = 10mg tab
  • 12 drops = 30mg

  • 672 drops needed
  • 20 drops = 1ml
  • 33.6ml
  • 3 bottles

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QUESTION 9

Mr. B is a 65year old man who weighs 11 stones 5lb, he regularly takes phenytoin capsules for epilepsy. He is admitted in hospital and is due to be administered phenytoin by I.V. injection over five minutes at a dose of 90mg/10kg. phenytoin injection is available as a 650mg vial which is reconstituted with 10ml of water for injections prior to administration to yield a concentration of 60mg/ml.

1 lb = 0.45kg 1 stone = 6.35kg

  • Calculate the infusion rate in ml/min. Give your answer to 2.d.p

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ANSWER 9

  • 11 stones and 5 lb. = 72.1kg
  • 9mg = 1 kg
  • 648.9mg = 72.1kg
  • conc is 60mg = 1 ml
  • 649mg = 10.8166 ml
  • 10.8166/ 5 = 2.16ml

  • ANSWER = 2.16 ml/min

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QUESTION 10 - IDEAL BODY WEIGHT-

Consider the following information about the patient below.

  • TENNY ,Aged 67 years, Weight – 113kg, Height – 175cm
  • TENNYY is to be treated with Amikacin For a UTI. Note - To avoid excessive dosage in obese patients use ideal body weight to calculate the dose required.
  • Do you think TENNY is obese or not? Use the formula provided to help you decide.
  • (BMI kg/m2 = weight/height) & ( IBW = 2.3kg for each inch over 5 feet + 50kg)
  • 30.48cm = 1 foot and 2.54cm = 1 inch
  • Calculate how much Amikacin is required per dose using the resource provided? Give answer in mg to WHOLE NUMBER.
  • Amikacin 250 mg/ml Injection - Summary of Product Characteristics (SmPC) - (emc) | 3784

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ANSWER 10 -

  • use ibw formula
  • 2.3kg x 8.8976 inches = 20.464kg
  • 20.464kg + 50kg = 70.464kg
  • From resource
  • 7.5mg x 70.464kg = 528.48mg
  • 528.48/2 = 264.24

 

  • 264mg answer

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