LPN CALCULATIONS QUESTION BANK

CALCULATIONS MOCK ��JUNE 2024 EXAM

40 intensive test questions

LONDON PHARMACIST NETWORK

PLEASE NOTE-

• ENSURE YOU ARE FIT TO SIT
• GPHC APPROVED CALCULATOR ONLY
• TIME PERMITTED IS 2 HOURS FOR 40 QUESTIONS. Except extra-time candidates.
• LINKS ARE HYPERLINKED ON THE SLIDES IF NECESSARY
• WRITE ALL YOUR ANSWERS IN AN ANSWER SHEET.
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• NO FORM OF MALPRACTICE WILL BE TOLERATED.
• SUBMIT YOUR ANSWERS FOR MARKING TO MICAH VIA WHATSAPP.
• BEST WISHES X
• www.LONDONPHARMACISTNETWORK.co.uk

QUESTION ONE – JUNE 2024

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You work as a pharmacist in a hospital. A young patient presents with a severe chest infection.

Adam a 4-year-old child, weighs 15.5kg. He has been prescribed intravenous amoxicillin 20 mg/kg every 8 hours. 250mg of amoxicillin has a displacement value of 0.2mL in water for injection. 10 mL of water for injection is added to a 1g vial of amoxicillin.

How many mL would you draw out of the vial for the dose?

Round your answer to the nearest 0.01.

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QUESTION TWO – JUNE 2024

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Mrs. E. is a 71-year-old Parkinson’s disease patient who needs to be switched to rotigotine patches. She currently takes

• Sinemet, one tablet QDS
• Entacapone 100mg tablets 1 Daily
• Ropinirole 7mg every day.

Calculate what strength of rotigotine patches, Miss E should be prescribed every 24 hours.

Use resource provided.

• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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QUESTION THREE – JUNE 2024

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Mr. and Mrs. Muazu and their daughter who regularly use your pharmacy will be travelling from the UK to Belgium for a week then from Belgium to Zimbabwe for 5 weeks before travelling back to the UK. After a brief consultation, you are required to supply Mefloquine for malaria prophylaxis. You only have 7 tablets of mefloquine in stock. Mr. Muazu weighs 88kg , Mrs. Muazu weighs 69kg and their daughter weighs 25kg.

Specifically using the resource provided on next page, calculate the minimum quantity of tablets to be supplied and state your answer as how many tablets owed?

• . LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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QUESTION FOUR – JUNE 2024

Adelaide has been prescribed Amoxicillin 1g three times a day for a urinary tract infection. Each dose is to be administered by slow intravenous infusion over one hour. The antibiotic is available as a 500mg vial, and the powder is reconstituted initially with 50ml water for injection and then diluted with glucose 5% infusion to give a final concentration of 2mg/ml.

What is the infusion rate in ml/minute per dose? Give your answer to one decimal place

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QUESTION FIVE – JUNE 2024

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You have the following KCL solutions in stock:

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1. 650ml of 1000ppm

2. 450ml of 1 in 200

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You are asked to mix both solutions together and calculate the concentration of the resulting solution in %w/v.

Answer to 1.d.p.

• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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QUESTION SIX – JUNE 2024

You are assessing the kidney function of a male transgender patient, who has been admitted to the renal ward of your hospital. The patient has not undergone any hormonal, medical or surgical changes. Given that the patient is 80-years-old and has a weight of 66kg and is 165cm tall with a serum creatinine is 280 micromol/L. Calculate the recommended total daily dose of meropenem in mg/Kg for management of febrile neutropenia. Answer to 2.dp. Use link below

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Male constant = 1.23 female = 1.04

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Meronem IV 500mg - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk)

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QUESTION SEVEN – JUNE 2024

You work in a hospital. You are asked to administer sodium chloride to one of your patients.

Mrs. Patel needs an initial intravenous infusion of 500mL 0.9% sodium chloride over 15 minutes, followed by 80ml of a 0.9% sodium chloride over 30 minutes then 80ml/hour of a 0.9% sodium chloride for the remainder time .

Assuming the infusion will run over a total time of 24 hours. Calculate how many grams of sodium chloride Mrs. Patel will receive within 24 hours?

GIVE ANSWER AS WHOLE NUMBER

• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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QUESTION 8- JUNE 2024

Miss. V a-9-year-old patient has been prescribed phenytoin 20mg/5ml solution at a dose of 0.5mg/kg twice daily . Every 5ml of Phenytoin solution contains 2.2mmol of sodium. The child weighs 70 lbs . Given that the RDA of NaCl for a child is 3g (1.2g sodium) . Calculate the % RDA of sodium in her daily sodium intake from phenytoin .units =1 lb = 0.45kg

Na = 23, Cl = 35.5 , NaCl = 58.5

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Answer to 1 D.P.

• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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QUESTION NINE – JUNE 2024

A stock solution containing 25% w/v of glucose is used to prepare a solution such that when the solution is diluted 1 in 5, a 1 in 1000 solution is produced. What volume of the intermediate solution is required to prepare 5 litres of the final solution?

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Answer in ml as a whole number.

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• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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QUESTION 10 JUNE 2024

A patient has been instructed to take 100mg of phenytoin sodium TDS. Using the resource provided (on left of the slide) calculate what volume in ml of epanutin 30mg/5ml oral suspension will provide the equivalent phenytoin base to this patient’s daily dose of phenytoin sodium. Answer to nearest 5.

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• LONDON PHARMACIST NETWORK
• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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QUESTION 11

• Mr. D. a 70-year-old male patient takes TRAMADOL 100MG TDS , metformin 500mg BD , zomorph 60mg in the morning and one sevredol 10mg QDS. She also takes 8ml of oramorph oral solution 10mg/5ml QDS for breakthrough pain. What is the minimum dose of morphine she can have per day if her GP decides to increase her dose ? Answer in mg to 2.d.p. Link below
• Prescribing in palliative care | Medicines guidance | BNF | NICE

QUESTION 12- JUNE 2024

In your pharmacy you have a stock solution of chlorhexidine with a concentration of 15% w/v . Chlorhexidine is used as a mouthwash at a concentration of 0.3% w/v. You are required to supply a solution of an intermediate strength, such that when the patient dilutes this solution 1 in 15, they obtain the correct concentration immediately before use.

How much volume of the intermediate solution is required to make 500 mL of the final solution?

Answer in litre to 2.d.p.

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• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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QUESTION 13 – JUNE 2024

Calculate ideal body weight for the patient below.

Weight – 98kg, Height – 179cm, 1 ft = 30.48cm and 1 inch = 2.54cm

Mrs. James is to be treated for UTI by intramuscular injection with an aminoglycoside at the lowest possible dose due to renal impairment. Use the formula provided below.

( IBW = 2.3kg for each inch over 5 feet + constant)

Male = 50kg , female = 45.5kg

Calculate ideal body weight in Kg and state answer to 1.d.p.

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• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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QUESTION 14 – JUNE 2024

A 9-year-old boy who weighs 23kg is prescribed lorazepam at 0.25mg/kg twice a day. The drug is available as lorazepam 2mg/ml oral suspension. His mother has been given an oral syringe calibrated at 1ml intervals for administration of the drug.

Calculate the volume required for a month.

Answer in ml.

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• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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QUESTION 15 – JUNE 2024

A patient weighs 23kg. He has been prescribed a dose of methotrexate at 6.5mg/m2 for Juvenile idiopathic arthritis. BSA ranges resource for children depending on their weight is provided. Methotrexate is available as 2.5mg tablets in your stock. The drug ought to be taken weekly. How many tablets is required per week.

See resource on next page.

• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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QUESTION 15 resource

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QUESTION 16 – JUNE 2024

A Patient is prescribed titrated dose of cefalexin. Patient weighs 65kg. Cefalexin oral suspension 250mg/5ml is available in your stock.

Rx

5mg/kg BD for 1 week then increase to 10mg/kg BD for 3 weeks. For ease of administration each dose is given using syringe with 0.1ml graduations.

What is the total volume of 250mg/5ml to be supplied to this patient for 4 weeks?

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Answer to 1dp IN LITRES.

• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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Question 17 RESOURCE

Question 17- JUNE 2024

• Tommy (54kg) suffers from hyponatremia. He requires sodium at 3mmol/kg to be given via IV infusion over 12 hours. Hartmann’s solution will be used to provide the infusion for the patient. Calculate the infusion rate in ml/minute for this infusion in order for the correct dose to be delivered .
• Use the resource provided.
• Answer to nearest 0.05ml.
• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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SYNCHRONISE A PRESCRIPTION- 18

You are working in a community pharmacy and one of the patients complained to you that she runs out of one of her medicines rather quickly. She would like you to mention it to her practice pharmacist during your next surgery run. See details of her medication below . SYNCHRONISE RISEDRONATE TABLETS

• DRUG & STRENGTH DOSE REMAINDER STOCK
• CO-CARELDOPA 12.5mg 1 QDS 328
• RISEDRONATE 35MG 1 WEEKLY 6
• RAMIPRIL 2.5MG 1 OD 22
• LANSOPRAZOLE 15MG 1 BD 122
• Co-codamol 30/500 1 - 2 QDS 640
• Metformin 500MG 2 TDS 474
• SITAGLIPTIN 50MG 1 OD 14
• CREON 25000 8 PER DAY 632

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• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS JUNE 2024

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QUESTION 19- JUNE 2024

You work as a hospital pharmacist. Mr. P is to be administered 1.5L of glucose 5% solution via IV over a total of 15 hours. After running for 10 hours and 25 minutes, 175ml of the fluid remain. What is the rate in drops/min that the remaining fluids need to be given so that the IV ADMINISTRATION FINISHES IN THE required time?

Give answer to nearest whole number of drops.

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QUESTION 20- JUNE 2024

You work as a pharmacist in a GP surgery. A patient is prescribed quetiapine titrating dose.

Rx

25mg BD Day 1

50mg BD Day 2

100mg BD Day 3

150 mg BD Day 4 to 28

You have in stock 2 boxes of Quetiapine 25mg. Each box has 60 tablets.

How many tablets will you owe the patient?

Answer as whole number.

• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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QUESTION 21- JUNE 2024

Mrs. K a 78-year-old female had her pancreas removed due to pancreatic cancer and has to take Creon 25000 capsules as a result. She weighs 116 lb. and is 6 foot tall. Using the resource provided, calculate the maximum number of creon capsules she can take a day to stay within the limit of lipase recommended. Do not exceed 10,000 lipase units per kg. Give your answer as whole number. 1lb = 0.45kg

See link to resource below.

Creon 25000 Capsules - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk)

• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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QUESTION 22- JUNE 2024

Mrs. C. has been prescribed cetirizine 5mg/5ml oral solution twice daily for hay fever. She presents in your pharmacy with the patient information leaflet and looks worried about an excipient in the solution. She asks you to calculate the amount of Propylene glycol she would consume in a 28-day period. Answer in gram to nearest 5.

See link to resource below. Check Section 2

Cetirizine Hydrochloride 5 mg/5 ml Oral Solution - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk)

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QUESTION 23- JUNE 2024

A 58-year-old female patient requires sodium citrate for cystitis treatment . Note that when a sachet is dissolved in 200ml water, the following electrolytes and their content in mg are found within.

Glucose=325mg,

Sodium=277mg,

Disodium hydrogen citrate =530mg .

Na+ RMM is 23g/mol.

How many mmols of sodium are available in a 1 litre solution?

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Answer to 1 d.p.

• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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BIOAVAILABILTY -QUESTION 24 -JUNE 2024

Using bioavailability data provided, calculate the equivalent daily dose of digoxin elixir for a 70-year-old who normally takes 62.5mcg BD tablets but cannot swallow presently as he developed dysphagia after an ischaemic stroke.

• Bioavailability of tablets is 0.7 and suspension is 0.8.
• Give answer to nearest TEN.
• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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QUESTION 25- JUNE 2024

Mr. A.B. needs an infusion via IV. The hospital stocks 500 mL Potassium chloride (KCL) 0.45% infusion bags. The RMM of potassium chloride is 74.5 g/mol. What volume of potassium chloride 0.45% infusion, in mL, is required to administer 10 mmol of potassium chloride to Mr. A.B.?

Give your answer to the nearest 10 mL

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Answer to 10ml

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QUESTION 26- JUNE 2024

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You work a pharmacist prescriber. Ms. F. is a new patient whom you are required to prescribe Ozempic injection for type 2 diabetes. She has never used the drug before and requires titration treatment regimen for new beginners as stated in the resource. She currently takes metformin 1g twice a day.

See resource on the next page.

How many pre-filled Ozempic 0.25mg injection pens will you supply for the first 2 months of treatment?

State your answer as whole pens.

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• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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QUESTION 26 RESOURCE

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QUESTION 27- JUNE 2024

You are conducting a health check with Jess, a 50 -year-old woman.  You advise her on healthy eating and exercise and, as part of this are discussing her weekly alcohol intake.  She informs you that, on average, in a week she enjoys a glass of red wine (13% ABV) with her dinner daily , then on Fridays, she also drinks 3 pints of larger (4% ABV) after work and on Saturday nights she drinks 3 glasses of pina-colada cocktail (10%) which is her favourite cocktail in a local bar.

Units of alcohol = volume of drink (ml) x ABV (%)

1000

Where ABV is alcohol by volume

Given that each glass of wine is 175ml, a glass of cocktail is 100ml and 1 pint is 568ml, by how many units of alcohol should this patient reduce her intake in order to be at the recommended weekly limit?  Give your answer to nearest 0.5 units.

• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

QUESTION 28- JUNE 2024

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You work as a pharmacist in a hospital. You are required to make 500ml of a chlorhexidine solution for a patient such that when 10ml is diluted to 20ml with water, a 1 in 1000 solution is produced. Calculate the concentration of the solution you will supply to the patient in PPM.

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Round your answer to as whole number.

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• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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QUESTION 29- JUNE 2024

• Ms. Z a 38-year-old is a breastfeeding mother who weighs 60kg and takes Apixaban 2.5mg twice a day. She mentions to you that she breastfeeds her 1-year-old baby who weighs 10kg. Using the formular below calculate the Relative infant dose in percentage (%RID) assuming Ms. Z’s child receives 0.0625mg of apixaban daily via breast milk. ANSWER to nearest 1.d.p.
• NB
• RID unit in %
• Infant daily dose per kg via milk in ug/kg/day
• Maternal daily dose per kg in ug/kg/day

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• London Pharmacist Network Intensive Calculations

QUESTION 30- JUNE 2024

• Mark a-76-year-old male with arrythmias who is 178cm tall is admitted to hospital and needs to be prescribed digoxin. His creatinine clearance is 25ml/min. The doctor prescribes a dose of digoxin to be administered orally BD . The target concentration for him is 1.6mcg/L . Work out which strength of tablets the doctor should prescribe for this patient .
• CHOICES - 62.5mcg tablets , 125mcg tablets or 250mcg tablets
• 1 foot = 30.48cm , 1 inch = 2.54cm

CPss = F X S X D

Cl x T

• CL = 0.053 x CrCl + (0.02 x IBW )
• IBW = 50 + 2.3kg for every inch over 5ft
• F = bioavailability 0.8 , D = dose (mcg) , Cl = clearance (L/hour) , T = dosage interval (hours) , S = Salt factor 1.
• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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QUESTION 31- JUNE 2024

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You work as a Pharmacist in a GP surgery. You have been asked to switch 8 eligible patients on Keppra 500mg tablets to the generic levetiracetam 500mg tablets. Out of the 8 patients, 2 patients are prescribed 120 tablets per patient every month, 5 patients are prescribed 60 tablets per patient every month and 1 patient is prescribed 30 tablets every month. Assuming Keppra 500mg costs £59 for a box of 60 tablets and generic levetiracetam costs £28 for a box of 60 tablets, calculate the cost savings per month if all eight patients are switched to generic levetiracetam. Assume boxes can be split.

Answer in pounds to nearest £5.

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• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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QUESTION 32- JUNE 2024

Mrs. K is a 66-year-old woman who is receiving treatment for bipolar disorder. She is taking Priadel liquid 520mg/5ml at 20ml twice a day. Priadel liquid contains a certain amount of lithium carbonate as stipulated in the SPC extract below. The molecular formula for lithium carbonate is Li₂CO_3. The molecular weights are

• Lithium 7g/mol
• Carbon 12g/mol
• Oxygen 16g/mol
• What quantity of lithium will Mrs K. receive per daily dose, give your answer in mg to nearest 0.5mg.

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QUESTION 33- JUNE 2024

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A 10-year-old male patient has been prescribed Amoxicillin suspension at a dose of 250mg four times a day for 2 weeks whilst in hospital. You only have Amoxicillin 125mg/5ml suspension in stock. Each bottle is 100ml. The doctor decides to discharge the patient after sixteen doses of the medicine and instructs his mother to continue the course at home until completion. Based on your available stock, you are required to calculate the total volume in ml needed to complete the course upon discharge.

Express your answer as number of bottles to be supplied.

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• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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QUESTION 34- JUNE 2024

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A patient is prescribed a drug for chemotherapy at a dose of 30mg/m2 per day. The patient weighs 86kg and is 184 cm tall.

The drug is available as a suspension 10mg/5ml in a 500ml bottle.

Calculate the volume required for 168 hours of treatment. Express your answer in ml to 1.dp

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• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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QUESTION 35- JUNE 2024

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Miss. B. a 28-year-old has been prescribed dexamethasone eye drops.

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Rx -

Apply one drop to R.E every 8 hours starting 24 hours after GP appointment and continue until the next doctor’s appointment. Assuming miss. B starts treatment with the eye drops at 12 noon on 10th June and sees the doctor at 4.15pm on 14th June. Calculate the volume of dexamethasone eye drops miss Q would have used when she attends the doctor’s appointment on 14th of June. Assume no wastage. Answer to 2.d.p

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• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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QUESTION 36- JUNE 2024

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You work as a pharmacist in a hospital.A 34-year-old man, who weighs 67 kg, has been diagnosed with Guillain Barre Syndrome. He is to be commenced on Human Normal Immunoglobulin. Its use for this patient has been approved.

The dose is 400mg/kg/day for 5 days.

What is the correct daily dose in g of Human Normal Immunoglobulin for this patient?

Round your answer to the nearest 0.5g.

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QUESTION 37- JUNE 2024

• Ms. F, a 5-year-old child who weighs 20kg requires morphine at a dose of 135mcg/kg four times a day . morphine is available as morphine 50mg/5ml oral solution and is to be administered using a 1ml syringe.
• Calculate the volume of morphine that will be administered to the patient in one-week.

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• Give answer in ml to nearest whole number.
• London Pharmacist Network

QUESTION 38- JUNE 2024

• Mr. Mark 54 yrs usually takes carboceisteine 375mg capsules 2 TDS . Currently, carboceisteine capsules are out of stock and his doctor would like to prescribe carboceisteine 250mg/5ml oral solution . Use the information below to calculate the cost of supplying carboceistene oral solution for 28 days .
• Assume carboceisteine 250mg/5ml oral solution costs £7.55 Per 300ml bottle
• Assume that carboceistene oral solution should be supplied in its original container.
• Give your answer to 2.d.p.

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• London Pharmacist Network intensive calculations

QUESTION 39- JUNE 2024

• Mrs K is a 55-year-old woman who has been taking citalopram 40mg tablets per day for the last six 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 Mrs K given that each bottle is 15ml. See link below
• London Pharmacist Network Calculations

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• Citalopram | Drugs | BNF | NICE

QUESTION 40- JUNE 2024

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A baby weighs 3.1 kg and has been initiated on a continuous morphine infusion at 20 micrograms/kg/hour. The syringe concentration is 5mg/50mL.

What is the correct infusion rate in mL/hour?

Give your answer to nearest 0.5.

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. London Pharmacist Network Calculations

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THANKS FOR PARTICIPATING

QUESTION ONE ANSWER – JUNE 2024

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15.5KG X 20mg = 310mg

If 250mg displaces 0.2ml

Then 1g i.e., 1000mg displaces 0.8ml.

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Total volume = 10ml plus 0.8ml = 10.8ml

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Hence, 1000mg = 10.8ml

310mg = 3.348

ANSWER = 3.35ml

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QUESTION TWO ANSWER – JUNE 2024

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Step 1 - 50 x 4 = 200mg

Step 2 - 200mg x 1.3 = 260mg

Step 3 – 7mg x 20 = 140

Step 4 - 260 + 140 = 400

Step 5 - 400 x 0.55 = 220 mg

220/20 = 11mg

ANSWER =Supply 12mg ropinirole patches

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QUESTION THREE ANSWER- JUNE 2024

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BEFORE + 5 DURING + 4 WEEKS AFTER

11 weeks of treatment for Mr. Adams = 11 tablets

11 weeks of treatment for Mrs. Adams = 11 tablets

11 weeks of treatment for their son = 5.5 tablets

TOTAL = 27.5 = 28 TABLETS

28 – 7 = 21

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ANSWER = 21 TABLETS

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QUESTION FOUR ANSWER- JUNE 2024

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Dose is 500mg

If 2mg = 1ml

1000mg = 500ml

500ml/ 60 mins

Then, 8.333ml/ min

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ANSWER = 8.3ml/min

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QUESTION FIVE ANSWER- JUNE 2024

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C1v1 + C2V2 = C3V3

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0.1 X 650 + 0.5 X 450 = C3 X 1100

65 X 225 = C3 X 1100

C3 = 0.2636

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ANSWER = 0.3% w/v

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QUESTION SIX ANSWER- JUNE 2024

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USE CONSTANT for female = 1.04

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CRCL = 14.70

From resource, half of one unit dose every 12 hours

So, 500mg BD = 1000mg daily

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1000mg / 66kg = 15.15mg/kg

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ANSWER SEVEN- JUNE 2024

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0.9% means 0.9g = 100ml .

Hence 4.5g = 500ml

Then 0.72g = 80ml

Time remaining is 23 hours and 15 minutes

Rate @ 80ml per hour

Hence, 1860ml = 23 hours and 15 minutes

16.74g = 1860ml

Total grams = 4.5 + 0.72g + 16.74 = 21.96

ANSWER = 22g

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QUESTION 8 ANSWER- JUNE 2024

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0.5mg per kg

0.5mg x 31.5kg = 15.75mg

15.75mg x 2 = 31.5mg per DAY

20mg = 5ml

31.5mg = 7.875 ml

5ml = 2.2 mmol then 7.875 = 3.465 mmol

3.465 mmol x 23 = 79.695mg i.e 0.079695g

0.079695/1.2 x 100 = 6.64125%

ANSWER = 6.6%

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QUESTION NINE ANSWER- JUNE 2024

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C1V1 = C2V2

INTERMEDIATE VS FINAL

REMEMBER intermediate conc = final x Dilution factor

( 0.1 x 5 = 0.5%)

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0.5 x v1 = 0.1 x 5000ml

V1 = 1000

ANSWER = 1000ml

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QUESTION TEN ANSWER- JUNE 2024

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Daily dose is 100mg x 3 = 300mg

From resource , 100mg = 92 of base

So , 300mg = 276mg of base

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If 30mg = 5ml

276mg = 46ml

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ANSWER = 45ml to nearest 5ml

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ANSWER 11- JUNE 2024

30mg plus 60mg plus 40mg plus 64mg = 194MG 

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• 1/ 3 of 194 = 64.6667

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• 194 + 64.6667 = 258.67 mg per day

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QUESTION 12 ANSWER- JUNE 2024

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C1V1 = C2V2

INTERMEDIATE VS FINAL

REMEMBER intermediate conc = final x Dilution factor

( 0.3 x 15 = 4.5%)

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4.5 x v1 = 0.3 x 500ml

V1 = 33.3333

ANSWER = 0.03 Litre

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QUESTION 13 ANSWER- JUNE 2024

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IBW = 2.3kg for each inch over 5 feet + constant

30.48cm x 5 = 152.4cm

179 – 152.4 = 26.6cm

26.6 / 2.54 = 10.47244 inches

2.3 x 10.47244 + 45.5 = 69.581

ANSWER = 69.6kg

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QUESTION 14 ANSWER- JUNE 2024

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23 x 0.25 = 5.75mg

2mg = 1ml

5.75mg = 2.875ml

Give 3ml per dose and 6ml per day

6ml x 28 days = 168ml

ANSWER = 168ml

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QUESTION 15 ANSWER- JUNE 2024

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BSA = 0.87m2

0.87 x 6.5mg = 5.655mg

5.655mg required so we will give 2 x 2.5mg tablets

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ANSWER = 2 tablets per week

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QUESTION 16 ANSWER- JUNE 2024

5 x 65 = 325mg

250mg = 5ml

325mg = 6.5ml

6.5m x 2 = 13ml per day

13ml x 7 = 91ml for week 1

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10mg x 65kg = 650mg

250 = 5ml , 650mg = 13ml

13ml x 2 = 26ml per day . Hence 546ml in 3 weeks

Total = 91ml + 546ml = 637

ANSWER = 0.6 litre

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QUESTION 17 ANSWER- JUNE 2024

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54kg x 3 = 162 mmol

131 mmol = 1 litre

162mmol = 1.236641 litre

1236.641 ml over 12 hours

103.05ml over 1 hour

1.71756ml per minute

ANSWER = 1.70ml/min

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ANSWER 18- JUNE 2024

• highest duration is co-careldopa = 82 day
• Risedronate = 6 weeks' worth = 42 days
• Difference 82 – 42 = 40 days , about 6 weeks
• 1 week = 1 tab
• 6 weeks = 6 tabs

​

• ANSWER = 6 TABLETS

QUESTION 19 ANSWER- JUNE 2024

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15 hours – 10hrs and 25 mins

4 hours and 35 minutes remaining i.e. 275 mins

275 mins = 175ml

1 min = 0.63636ml

1ml = 20 drops

0.63636 = x

ANSWER = 13 drops/min

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QUESTION 20 ANSWER- JUNE 2024

25mg BD Day 1 = 2 tabs

50mg BD Day 2 = 4 tabs

100mg BD Day 3 = 8 tabs

150 mg BD Day 4 to 28 = 300 tabs

Stock is 120 tabs

314 – 120 = 194 tabs

ANSWER = 194 tabs

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QUESTION 21 ANSWER- JUNE 2024

Patients weight = 52.2kg

so maximum lipase per day = 522000 units

one capsule = 25000

522000 / 25000 = 20.88

​

Answer = 20 capsules

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QUESTION 22 ANSWER- JUNE 2024

250.76 mg Propylene glycol in 5ml

501.52 mg = 10ml in one day

14042.56mg = 28 days

​

14.042g

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Answer = 15g

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QUESTION 23 ANSWER- JUNE 2024

Mole = mass/ Mr

MMol = 277 / 23

​

12.04mmol = 200ml

​

12.04 x 5 = 60.21mmol in 1000ml

​

ANSWER = 60.2MMOL

ANSWER 24 - JUNE 2024

• daily dose of tabs x bioavailability = daily dose of elixir x

bioavailability

• 125 x 0.7 = dose x 0.8

​

• ANSWER 110 mcg

25 ANSWER- JUNE 2024

RMM = 74.5 grams per mole

KCl 0.45% means 0.45 g in 100 mL, so 2.25 g KCL in 500 mL

Moles = Mass/RMM = 2.25 g / 74.5 g = 0.030201 moles of POTASSIUM chloride in 500 mL

0.030201 moles x 1000 = 30.201 mmol in 500 mL

500 mL / 30.201 mmol = 16.56 mL contains 1 mmol

16.56 mL x 10 mmol = 165.6 mL contains 10 mmol

​

ANSWER = 170 ML to nearest ten

​

QUESTION 26 ANSWER- JUNE 2024

​

There are four 0.25mg doses in a pen

Dose = 0.25mg weekly

For 4 weeks = 1 pen

​

Next dose is = 0.5mg weekly

For 4 weeks = 2 pens

​

Total = 3 pens

​

ANSWER = 3 pens

​

ANSWER 27- JUNE 2024

​

• Units of wine = 1225(ml) x 13 (%) = 15.925
• 1000
• Units of alcohol = 1704(ml) x 4 (%) = 6.816

1000

• Units of alcohol = 300 x 10 = 3
• 1000
• 15.925 + 6.816 = 22.741 plus 3 = 25.741
• 25.741 – 14 = 11.741

​

• Units of alcohol FORMULA = volume of drink (ml) x ABV (%)

1000

• ANSWER = 11.5 units

​

QUESTION 28 ANSWER- JUNE 2024

Final concentration = 0.1% w/v

Initial concentration = final conc x DF

0.1 x 2 = 0.2%w/v

​

If 0.2 = 100

x = 1000000

​

​

X = 2000

​

ANSWER = 2000PPM

ANSWER 29- JUNE 2024

NB- CHILD DOSE - Change to the correct units

• 0.0625mg per day
• 0.0625/ 10kg = 0.00625mg per kg/day same as 6.25 ug/kg/day

​

• MOTHER dose = 5mg / 60kg = 0.08333mg/kg/day same as 83.33 ug/kg/day

​

• Formula RID = 6.25/83.33 x 100 = 7.5%

​

• ANSWER = 7.5%

ANSWER 30- JUNE 2024

• CPss = F X S X D / Cl x T

​

• CL = 0.053 x 25 + (0.02 x 73.18 )

​

• 1.6mcg/l = 0.8 x 1 X D

2.7886 X 12

​

• D = 66.9

​

• ANSWER = 62.5mcg

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QUESTION 31 ANSWER

2 PATIENTS USE 4 BOXES, 5 PATIENTS USE 5 BOXES AND 1 PATIENT USES HALF A BOX

​

COST OF 9 AND HALF BOXES OF KEPPRA = 59 X 9.5 = 560.5 POUNDS

COST OF 9 AND HALF BOXES OF GENERIC = 28 X 9.5 = 266 POUNDS

​

HENCE 560.5 – 266 = 294.5 POUNDS

​

ANSWER = £295

​

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ANSWER 32- JUNE 2024

• Each 5 ml contains 520 mg of the active substance lithium citrate equivalent to 204 mg lithium carbonate.
• 5ML = 204 mg
• 40ml = 1632 mg
• Mol = mass/mr
• Mol = 1.632/74
• Mol = 0.02205
• 0.022054 = mass/14
• Mass = 0.308756g
• ANSWER = 309.0mg

QUESTION 33 ANSWER- JUNE 2024

Total quantity required of stock = 10ml QDS X 14 DAYS = 560ml

​

16 doses = 10ml x 16 = 160ml

​

560ml -160ml = 400ml

​

400ml = 4 bottles

​

ANSWER = 4 bottles

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ANSWER 34- JUNE 2024

• Calculate BSA = 2.096m2
• 2.096 x 30 = 62.88mg per day
• 10mg = 5ml
• 62.88mg = 31.44ml
• 31.44ml = 24 hours
• 220.1ml = 168 hrs.

​

• ANSWER 220.1ml

​

ANSWER 35- JUNE 2024

• 10^th June = 2 drops
• 11^th June = 3 drops
• 12^th June = 3 drops
• 13^th June = 3 drops
• 14th June = 2 drops

​

• Total drops = 13 drops

​

• If 20 drops = 1 ml
• 13 drops = 0.65ml

​

• ANSWER = 0.65ML

ANSWER 36- JUNE 2024

• 400mg/kg/day for 1 days
• 26800mg
• 26.8g
• ANSWER 27.0g

​

ANSWER 37- JUNE 2024

• 135mcg x 20kg = 2700 mcg
• 2700mcg = 2.7mg
• SOLUTION IS 50mg per 5ml so 10mg per ml
• SO if 10mg = 1ml then 2.7mg = 0.27ml
• ROUND UP DOSE TO NEAREST 0.05 . Hence 0.25ml

0.25ml x 4 = 1 ml

• 1ml x 7 = 7ml
• 7ML IS ANSWER

​

ANSWER 38- JUNE 2024

• 375 X 2 = 750mg TDS
• 750mg x 3 = 2250 mg
• 2250 / 250 = 9
• 9 x 5ml = 45ml per day
• 28 days x 45 = 1260 ml
• 1260ml/300ml = 4.2 bottles
• Approximately 5 bottles
• 5 bottles x 7.55 = £37.75

​

• ANSWER = £37.75

ANSWER 39 – JUNE 2024

• 4 oral drops (8 mg) is equivalent in therapeutic effect to 10 mg tablet.
• 16 DROPS required per day i.e 0.8ml per day
• 8 weeks ( 56 days)
• 0.8ml x 56
• 44.8ml
• ANSWER = 3 bottles

ANSWER 40 – JUNE 2024

​

3.1 x 20 = 62mcg

If 5mg = 50ml

0.062mg = 0.62ml

ANSWER = 0.5ml/hr

​

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INTENSIVE�CALCULATIONS MOCK EXAM �NOVEMBER 2023�

LONDON PHARMACIST NETWORK CALCULATIONS.

LEARNING IS A JOURNEY; SUCCESS IS THE DESTINATION.

PLEASE NOTE-

• ENSURE YOU ARE FIT TO SIT
• GPHC APPROVED CALCULATOR ONLY
• TIME PERMITTED IS 2 HOURS FOR 40 QUESTIONS. Except extra-time candidates.
• LINKS ARE HYPERLINKED ON THE SLIDES IF NECESSARY
• WRITE ALL YOUR ANSWERS IN AN ANSWER SHEET.
• EXAM CONDITIONS ONLY – NO DEVICES, EQUIPMENT OR RESOURCES SHOULD BE USED TO ASSIST YOU
• NO FORM OF MALPRACTICE WILL BE TOLERATED.
• SUBMIT YOUR ANSWERS FOR MARKING TO MICAH VIA WHATSAPP.
• BEST WISHES X
• www.LONDONPHARMACISTNETWORK.co.uk

QUESTION 1- NOV 2023

• You work as a community pharmacist and receive a prescription for one of your regular patients named Jay.
• Rx

Prednisolone 60mg daily for 5 days, then reduce by 10mg every 5 days until you reach 10mg. Then take 10mg for 3 days, then take 5 mg for 7 days and stop treatment.

• Assuming you supply the patient with all 131 tablets you have in stock, calculate the number of prednisolone 5mg tablets owed to Jay.

QUESTION 2- NOV 2023

• Ms. Patel weighs 45 kg and requires treatment with Clarithromycin via IV at a dose of 100 mg/kg daily in two divided doses. The displacement value of clarithromycin is 1.1 mL/g. You have 3g clarithromycin vials available which you should reconstitute with normal saline to produce a solution containing 100 mg/mL .
• Calculate the volume of normal saline you need to add to the Clarithromycin 3g vial to produce a solution of the required strength? Give your answer in ml to 1.d.p.
• London Pharmacist Network

QUESTION 3 - SERIAL DILUTION

• You have 300ml of a 300ppm glucose solution in stock . 5ml of your stock solution was diluted to 20ml with water. Finally, one part of resulting solution was then diluted with four parts of water.
• Calculate the concentration of the final solution .
• Answer in % w/v to 3.d.p
• London Pharmacist Network - nov 2023

QUESTION 4 - NOV 2023

• Miss. Q a 40-year-old old has been prescribed dexamethasone 0.5%w/v eye drops. B.E. . Mitte 5ml
• Rx - Apply one drop to B.E. every 8 hours starting 24 hours after GP appointment and continue until the next doctor’s appointment. Assume miss. Q starts treatment with the eye drops at 12 noon on 10th oct, uses the eye drops continuously and sees the doctor at 4.15pm on 14th oct.
• Calculate the volume of dexamethasone eye drops miss Q would have used when she attends the doctor’s appointment on 14th of oct. Assume no wastage. Answer to 0.5ml
• London Pharmacist Network Calculations

QUESTION 5- NOV 2023 (L.P.N)

• A patient requires a daily dose of vancomycin 1g, an IV medicine that is available as a 5mg/mL solution. The drug will be given in four equally divided doses each day. The medicine can be diluted to a concentration of between 1mg/mL and 4mg/mL with glucose 5% solution. The minimum volume that a dose of the drug can be infused in is 50ml. You have been instructed to dilute a dose of vancomycin to a concentration of 4mg/ml with glucose 5% before it is given to the patient . What volume of glucose 5% solution is required for dilution of each dose ? ANSWER in ml as whole number.

QUESTION 6- NOV 2023

• You work as a Pharmacist in a GP surgery. You have been asked to switch 8 eligible patients on Keppra 500mg tablets to the generic levetiracetam 500mg tablets. Out of the 8 patients, 2 patients are prescribed 120 tablets per patient every month, 5 patients are prescribed 60 tablets per patient every month and 1 patient is prescribed 30 tablets every month. Assuming Keppra 500mg costs £59 for a box of 60 tablets and generic levetiracetam costs £28 for a box of 60 tablets, calculate the cost savings per month if all eight patients are switched to generic levetiracetam. Answer in pounds as whole number. LONDON PHARMACIST NETWORK

QUESTION 7- NOV 2023

• Doxazosin m/r 8mg tablets - £9.98 per 28 tablets
• Doxazosin m/r 4mg tablets- £5 per 28 tablets
• Doxazosin 4mg tablets - £1.07 per 28 tablets(immediate release)
• In your GP surgery, you identify 6 patients who take doxazosin m/r 8mg daily and 12 patients who take doxazosin m/r 4mg daily that could be switched to the 4mg immediate release preparation. The surgery has a repeat policy of one month (28 days) . Calculate the total cost saving for 6 months assuming all 18 patients are switched to an equivalent dose of immediate release preparation.
• Answer as nearest whole pound.
• London Pharmacist Network Calculations

QUESTION 8- NOV 2023

• Mr P. takes 10ml of carbamazepine 200mg/5ml oral solution twice a day. You are advised that carbamazepine 200mg/5ml solution contains small amounts of ethanol and the SPC states that it is less than 0.1ml per 5ml . Calculate how many ml of 5% ABV beer would be equivalent to ethanol content in a dose the patient takes, assuming there is 0.1ml of ethanol per 5ml. Answer as whole number.
• London Pharmacist Network

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QUESTION 9 -- NOV 2023

• Miss. F is a palliative care patient who was prescribed 60mg morphine sulphate modified release (ZOMORPH) capsules twice daily. She also take oramorph 10mg/5ml solution at a dose of 6ml every four hours. If the doctor decides to increase her daily morphine dose by the minimum possible increase according to guidelines, what would her new daily dose of morphine be?
• Answer as in mg to nearest ten.
• Watch London pharmacist Network on YouTube

�QUESTION 10

• Miss G is a 62 year old Parkinson’s disease patient who needs to be switched to rotigotine patches. She currently takes
• madopar 25/125 capsules 1 TDS
• Entacapone 100mg tablets 1 TDS
• Donepezil 5mg tablets every evening.
• Calculate what strength of rotigotine patches, Miss G should prescribed every 24 hours. Use resource provided
• London Pharmacist Network - Nov 2023

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QUESTION 11- NOV 2023

Mr. P suffered two hyponatraemic convulsions within the last 90 days . His blood test shows that his serum sodium level is 120mmol/L. This could be a possible cause of his seizures. He is due to receive sodium via infusion. The only strength of sodium bags available to you is 3.5%w/v which will be given as 5ml per kg every 5 minutes as per the consultant’s request.

• Mr. P is 165cm tall and weighs 140 lbs.
• Based on the information given about Mr P, how much sodium in grams will he receive after a period of 120 minutes ? ANSWER to 1.d.p. 1lb = 0.45kg
• London Pharmacist Network calculations

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QUESTION 12- NOV 2023

• You are working as a pharmacist, and you receive a prescription requesting amoxicillin 250mg/5ml. You have available amoxicillin 250 mg/5ml oral suspension powder. The label for amoxicillin 250 mg/5ml suspension states 68 mL of water should be added to the suspension to give a final volume of 100 ml. Unfortunately, the dispenser added the wrong volume of water and a concentration of 200mg/5ml is produced instead. Calculate the volume that was added to the amoxicillin power suspension to produce a concentration of 200mg/5mL? (Give your answer to the nearest whole number).
• London Pharmacist Network calculations

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SYNCHRONISE A PRESCRIPTION- 13

You are working in a community pharmacy and one of the patients complained to you that she runs out of one of her medicines rather quickly. She would like you to mention it to her practice pharmacist during your next surgery run. See details of her medication below . SYNCHRONISE METHOTREXATE TABLETS - November 2023

• DRUG & STRENGTH DOSE REMAINDER STOCK
• CO-CARELDOPA 12.5mg 1 QDS 240
• METHOTREXATE 2.5MG 5 WEEKLY (12.5mg weekly) 15
• RAMIPRIL 2.5MG 1 OD 22
• LANSOPRAZOLE 15MG 1 BD 122
• Co-codamol 30/500 1 - 2 QDS 648
• Metformin 500MG 2 TDS 474
• SITAGLIPTIN 50MG 1 OD 14
• CREON 25000 8 PER DAY 632

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QUESTION 14- NOV 2023

• In your pharmacy you have a stock solution of chlorhexidine with a concentration of 15% w/v . Chlorhexidine is used as a mouthwash at a concentration of 0.3% w/v. You are required to supply 500 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 500 mL intermediate strength solution to be supplied? Answer in litre to 1.d.p.
• London Pharmacist Network

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QUESTION 15

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• What is the recommended total daily dose of meropenem in mg/Kg for this man?
• See link below
• Meronem IV 500mg - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk)

​

QUESTION 15-

QUESTION 16- NOV 2023

• Miss. K. weighs 30kg and is to receive carbamazepine intravenous infusion for the management of epilepsy at a dose of 10mg/kg/day in two divided doses. A 200mg carbamazepine vial is to be reconstituted with 5ml of water and diluted further to 100ml with glucose 5% solution. Given that each dose is to be infused over an hour, what is the infusion rate per dose in ml/min?
• ANSWER to nearest 0.1ml/min
• London Pharmacist Network Calculations

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QUESTION 17- NOV 2023

A 5-year-old child, who weighs 24.2 kg, has had IV Cefuroxime at 50 mg/kg every 8 hours as recommended by microbiology for a susceptible infection.  The required number of 750 mg vials have been diluted with 6 mL of water for injection each, ready for IV bolus administration.

• How many ml of the reconstituted cefuroxime will be required for each dose? Give your answer to nearest whole number. Answer to nearest 0.5ml . RESOURCE is provided below.

Question 18 RESOURCE

QUESTION 18- NOV 2023

• A 21kg child has hypokalemia. He requires potassium chloride 2mmol/kg to be given via IV infusion over 12 hours. An infusion bag containing sodium chloride 0.9% and potassium chloride 0.3% will be given to the patient. Calculate the infusion rate in ml/minute for this infusion in order for the correct dose to be delivered . Use the resource provided. Answer to nearest 0.05ml.
• London Pharmacist Network

- November 2023

QUESTION 20- NOV 2023

• A 72-year-old elderly patient weighs 78kg and is to be treated with phenytoin oral solution twice a day. The target plasma concentration is 10.5mg/ Litre.
• Formula CP = dose x s

F x T

Cp = Desired peak conc. of drug

VD = volume of distribution (1.5L/kg)

F = Bioavailability (0.8)

S = Salt factor is 1

T = time interval in hours

Calculate the dose using the formula provided. Answer in mg to 1.d. p

London Pharmacist Network

QUESTION 21- NOV 2023

• You are preparing a stock of glucose 5% bags by mixing the contents of a 50% glucose bag with sterile water for injection. Each glucose 5% bag will have a volume of 250 ml. What quantity of glucose 50% solution, in ml, will be required to produce 15 bags.
• Answer in ml to nearest ten.
• London Pharmacist Network

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QUESTION 22- NOV 2023

• Mrs K is a 55-year-old woman who has been taking citalopram 40mg tablets per day for the last six 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 Mrs K given that each bottle is 15ml. See link below
• London Pharmacist Network Calculations

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• Citalopram | Drugs | BNF | NICE

QUESTION 23 - NOV 2023

• 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.
• London Pharmacist Network Calculations

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​

QUESTION 24- NOV 2023

• Francis a-9-year-old patient has been prescribed phenytoin 20mg/5ml solution at a dose of 0.5mg/kg twice daily . Every 5ml of Phenytoin solution contains 2.2mmol of sodium. The child weighs 70 lbs . Given that the RDA of NaCl for a child is 3g (1.2g sodium) . Calculate the % RDA of sodium in her daily sodium intake from phenytoin .units =1 lb = 0.45kg
• Na = 23, Cl = 35.5 , NaCl = 58.5
• ANSWER TO 1 D.P

QUESTION 25 – DOSE TAPERING

• 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.
• London Pharmacist Network Calculations

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QUESTION 26- NOV 2023

• Mr. T a 68-year-old male had his pancreas removed due to pancreatic cancer and has to take Creon 25000 capsules as a result. He weighs 160 lb and is 6 foot tall. Using the resource provided, calculate the maximum number of creon capsules he can take a day to stay within the limit of lipase recommended. Do not exceed 10,000 lipase units per kg. Give your answer as whole number. 1lb = 0.45kg
• Creon 25000 Capsules - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk)
• London Pharmacist Network calculations

QUESTION 27- NOV 2023

• A six-year-old with body weight of 6.5 kg, has been prescribed amikacin continuous infusion at a dose of 5mg/kg/hour. To give this infusion, 125 mg amikacin will be diluted in 60 mL of glucose 5%. The infusion pump rate can be set in 0.5 mL/hour increments. What volume of drug, in ml, will be administered every 6 hours? Give your answer to nearest 5ml .
• London Pharmacist Network calculations

QUESTION 28- NOV 2023

• A 20kg infant requires 20mg/kg of Amoxicillin to treat a chest infection. A 5ml vial of 50mg/ml of amoxicillin is available in stock for dilution before infusion. You are given instructions to dilute the dose required by this patient up to 100ml with purified water. The infusion rate must not exceed 3mg/kg/minute.
• Calculate the maximum infusion rate in ml/minute for this infusion . Answer as whole number.
• London Pharmacist Network calculations

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QUESTION 29- NOV 2023

• You work as a pharmacist when you receive a prescription for Jimmy. Paracetamol has been prescribed at a dose of 15 mg/kg three to four times daily for Jimmy a young child with pyrexia. The child’s mother will administer the medicine using an oral 5ml syringe with graduations. Jimmy weighs 9.9 kg. You dispense 120 mg/5mL oral suspension. What is the maximum volume of paracetamol 120 mg/5 mL oral suspension, in mL, will Jimmy need for 7 days? Give your answer to one decimal place

QUESTION 30- NOV 2023

• Mrs. K a 50-year-old woman is to receive IV vancomycin at a dose of 3mg per kg daily in three divided doses. You have 20mg/ml vancomycin injection vials in stock. What volume of this will be required for a dose ? Use the ideal body weight in your calculation as she suffers from renal disease. Answer to 1.d.p.
• His Actual Body Weight = 92kg
• Height = 173cm
• Constant - male = 50 and female = 45.5
• IBW = (2.3 x number of inches above 5ft in height ) + constant
• London Pharmacist Network calculations

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QUESTION 31- NOV 2023

• A pharmacist needs to make anhydrous Aminophylline. What weight of Aminophylline which contains 10% moisture should be added when preparing a 5L batch of a solution with a final concentration of 5% w/v anhydrous Aminophylline. Answer in grams to nearest 5g

QUESTION 32- NOV 2023

• Mr. R. is a 23-year-old male with type 1 diabetes who uses Levemir Flexpen 100units/ml as part of his insulin regimen at a dose of 18 units in the morning and 23 units in the evening. Given that each Levemir Flexpen contains a total of 3ml, how many pens will you recommend for a month (28 DAYS) assuming each complete dose is taken out of one solitary pen.
• London Pharmacist Network calculations

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QUESTION 33- NOV 2023

Mrs. D. is a 49-year-old woman who is receiving treatment with calcium carbonate . She is receiving calcium carbonate 2% oral solution at a dose of 5ml per minute for an hour. The molecular formula for calcium carbonate is CaCO_3. The molecular weights are

• Ca - 40g/mol
• Carbon 12g/mol
• Oxygen 16g/mol
• What quantity of calcium will Mrs D receive during the infusion, give your answer in mg as whole number.
• London Pharmacist Network calculations

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QUESTION 34 - ALCOHOL

You are conducting a health check with Amy, a 45 -year-old woman.  You advise her on healthy eating and exercise and, as part of this are discussing her weekly alcohol intake.  She informs you that, on average, in a week she enjoys a glass of red wine (13% ABV) with her dinner daily , then on Fridays, she also drinks 3 pints of larger (4% ABV) after work and on Saturday nights she drinks 2 glasses of pina-colada cocktail (10%) which is her favourite cocktail in a local bar.

Units of alcohol = volume of drink (ml) x ABV (%)

1000

Where ABV is alcohol by volume

Given that each glass of wine is 175ml, a glass of cocktail is 100ml and 1 pint is 568ml, by how many units of alcohol should this patient reduce her intake in order to be at the recommended weekly limit?  Give your answer to as whole number.

• WATCH LONDON PHARMACIST NETWORK ON YOUTUBE

QUESTION 35- NOV 2023

• Mr and Mrs Adams and their son who regularly use your pharmacy will be travelling from the UK to France for a week then from France to Uganda for 5 weeks before travelling back to the UK. After a brief consultation, you are required to supply Mefloquine for malaria prophylaxis. You only have 5 tablets of mefloquine in stock. Mr. Adams weighs 71kg , Mrs Adams weighs 65kg and their son weighs 30kg.
•  Specifically using the resource provided on next page, calculate the minimum quantity of tablets to be supplied and state your answer as how many tablets owed?

​

• London pharmacist Network

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QUESTION 36- NOV 2023

• Mr. Lee. who weighs 56kg takes 2.5ml Amoxicillin 250mg/5ml oral suspension QDS. The suspension contains an excipient propylene glycol 2% w/v. You are required to calculate the mass of propylene glycol the patient would take in 28 days. Answer as whole number in mg/kg .
• London pharmacist Network

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QUESTION 37- NOV 2023

• A patient is prescribed a loading dose of Vancomycin for C-diff treatment at
• 250mg TDS for 7 days,
• then 250mg BD for 7 days,
• then 250mg OD thereafter.
• She has had 3 days treatment during her admission and is now going home.
• How many Vancomycin 250mg Capsules need to be dispensed to provide a 28-day supply on discharge for her.

QUESTION 38- NOV 2023

• Mr. Patel is receiving an intravenous infusion with the following formula
• Sodium bicarbonate (Na2C03) 125mmol/Litre
• Potassium Chloride (KCL) 60mmol/Litre
• Molecular weight of sodium is 23g/mol , carbon is 12g/mol, oxygen is 16g/mol chlorine is 35.5g/mol and potassium is 39g/mol.
• Given that the rate of infusion is 5ml/minute, what weight of sodium will Mr. Patel receive after one hour of having the infusion ? Answer in grams to one d.p.
• LONDON PHARMACIST NETWORK

QUESTION 39- NOV 2023

• You have 0.2%w/v of potassium citrate in stock. 5ml of the potassium citrate solution was measured out and diluted to 50ml with water. This resulting solution was then also diluted 1 in 10 further . What is the concentration of the final solution in %w/v ?
• Answer to 3.d.p.
• LONDON PHARMACIST NETWORK

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OXYGEN THERAPY�QUESTION � 40- NOV 2023

Mr. Terry is due to receive 100% oxygen for cluster headache treatment. Oxygen should be given at a rate of 10–15 litres/minute for 10–20 minutes.

Calculate how long required for minimum dose treatment to take place using the entire oxygen in cylinder size D in your stock.

​

• ANSWER IN MINUTES AS WHOLE MINUTE.

THANKS FOR PARTICIPATING

ANSWER 1 – NOV 2023

• Total required= 213

​

• 213 – 131 = 82

​

• ANSWER = 82 TABLETS

ANSWER 2 – NOV 2023

• The displacement value of clarithromycin is 1.1 mL/g,
• So 3g will displace 3.3 mL of diluent.
• vial contains 100 mg/ml and this is equivalent to
• 3000 mg in 30 ml.
• Final volume should be 30ml,
• Therefore, volume of diluent to add is 30 – 3.3 = 26.7 mL
• ANSWER = 26.7ml

​

ANSWER 3-NOV 2023

• First CHANGE 300 PPM TO %
• 300 PPM = 0.03%
• 5ML TO 20ML dilution factor is 4
• 0.03 / 4 = 0.0075%
• Then 1 with 4 means total of 5 parts. Dilution factor is 5
• 0.0075/5 = 0.0015%

​

• ANSWER = 0.002% W/V

​

ANSWER 4-NOV 2023

• 10th oct = 4 drops
• 11th oct = 6 drops
• 12th oct = 6 drops
• 13^th oct = 6 drops
• 14th oct = 4 drops
• Total drops = 26 drops
• If 20 drops = 1 ml
• 26 drops = 1.3 ml
• ANSWER = 1.5 ML

ANSWER 5-NOV 2023

• Each dose is 250mg = as 1g/4 = 0.25g
• 5mg = 1 ml
• 250mg = 50 ml of phenytoin
• final concentration is 4mg = 1ml
• so 250mg = x ml
• x 62.5ml
• So, 62.5ml – 50ml = 12.5ml of glucose 5%
• ANSWER = 13ml

ANSWER 6-NOV 2023

• 2 PATIENTS USE 4 BOXES, 5 PATIENTS USE 5 BOXES AND 1 PATIENT USES HALF A BOX
• COST OF 9 AND HALF BOXES OF KEPPRA = 59 X 9.5 = 560.5 POUNDS
• COST OF 9 AND HALF BOXES OF GENERIC = 28 X 9.5 = 266 POUNDS
• HENCE 560.5 – 266 = 294.5 POUNDS

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• ANSWER = £295

ANSWER 7-NOV 2023

• NB- do them separately first
• FORMULA – NUMBER OF PATIENTS X DURATION X COST DIFFERENCE
• DOXAZOSIN M/R 8mg – 6 patients x 6 months x 7.84 = 282.24
• DOXAZOSIN M/R 4mg – 12 patients x 6 months x 3.93 = 282.96

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• 282.24 + 282.96 = £565.2

• ANSWER = £565

ANSWER 8-NOV 2023

• Each dose = 10ml
• each dose contains 0.2ml of ethanol
• 5% means 5ml in 100ml
• 5ml = 100 ml
• 0.2ml = 4ml

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• ANSWER = 4 ml

QUESTION 9-NOV 2023

• Daily dose of Zomorph = 120mg per day from zomorph
• If 10mg = 5ml
• 12mg = 6ml
• 6ml x 6 = 36ml
• 36ml contains 72mg of morphine
• 72 + 120 = 192mg
• 1/3 x 192 = 64

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• NEW DOSE = 192 + 64 = 256mg
• ANSWER = 260mg

ANSWER 10-NOV 2023

• first step - 125 x 3 = 375mg
• Step 2 - 375mg x 1.3 = 487.5
• 487.5 + 0 = 487.5
• Step 4 487.5 x 0.55 = 268.125 mg
• 268.125/20 = 13.40
• ANSWER = 14mg patches

ANSWER 11-NOV 2023

• 3.5%w/v = 3.5g = 100ml
• 140 lbs = 63 kg
• 5ml = 0.175g
• 5ml/kg = 0.175 x 63kg = 11.025g
• So, 11.025g every 5 minutes
• 120 minutes = 264.6g
• ANSWER = 264.6g

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ANSWER 12 -NOV 2023

• Addition of 68mL will give 100mL at a final concentration of 250mg/5mL. Hence displacement value is 32mL.
• Hence total mass of amoxicillin in the container: 250mg/5mL > 5000mg in 100mL
• The volume needed to prepare 5000mg at 200mg/5mL = 125mL
• Due to error,
• Total Volume is 125mL – displacement volume 32mL = 93mL
• ANSWER = 93ml

ANSWER 13-NOV 2023

• highest duration is co-codamol = 81 days
• Methotrexate = 3 weeks worth = 21 days
• Difference 81 – 21 = 60 days , about 9 weeks
• 1 week = 5 tabs
• 9 weeks = 45 tabs

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• ANSWER = 45 TABLETS

ANSWER 14-NOV 2023

• STOCK VS INTERMEDIATE
• C1V1 = C2V2
• 15 X V1 = 6 X 500
• V1 = 200 ML
• ANSWER = 0.2 L

ANSWER 15-NOV 2023

• Crcl = 26.54ml/min
• For renal impairment = dose is 2g every 12 hours
• so 4g per day
• 4000/67 = 59.70mg

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• Answer. 60mg as whole number

QUESTION 16-NOV 2023

• 30kg x 10mg = 300mg per day
• 300mg / 2 = 150 mg per dose
• since 200mg is diluted in 100ml
• 150mg = 75ml
• 75ml = 1 hour I.e., 60 minutes
• 75ml/60 mins
• 1.25 ml/min
• ANSWER = 1.3ml

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ANSWER 17-NOV 2023

• 24.2kg x 50 = 1210mg
• reconstituted concentration is 116 / ml
• therefore 1210 = 10.431

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• ANSWER = 10.5ml

ANSWER 18-NOV 2023

• 21kg x 2 = 42 mmol
• From resource 40mmol = 1 litre
• 42 mmol = 1050ml
• 1050ml = 12 hours
• 87.5ml = 1 hour
• 1.45833ml = 1 minute
• ANSWER = 1.45ml/min

ANSWER 20-NOV 2023

• Formula cp = d x S

F x T

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• 10.5 = dose x 1

0.8 x 12

• rearrange the equation
• 100.8 = dose x 1
• Dose = 100.8

​

• ANSWER = 100.8 mg

ANSWER 21-NOV 2023

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• 5% IS 5g = 100ml
• 12.5g = 250 ml
• 1 bag = 12.5g
• 15 bags = 12.5 x 15 = 187.5g
• 50% = 50g = 100ml

187.5g = x 375ml

• Answer = 380ml
• London Pharmacist Network

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ANSWER 22-NOV 2023

• 4 oral drops (8 mg) is equivalent in therapeutic effect to 10 mg tablet.
• 16 DROPS required per day i.e 0.8ml per day
• 8 weeks ( 56 days)
• 0.8ml x 56
• 44.8ml
• ANSWER = 3 bottles

ANSWER 23-NOV 2023

• C1V1 STOCK = C2V2 INTERMEDIATE
• 12 X V1 = 5 X 250 note C2 = 0.25 x 20 dilution factor

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• V1 = 5 X 250

12

V1 = 104.1ML

ANSWER = 105ml to nearest 5ml

ANSWER 24-NOV 2023

• 0.5mg per kg
• 0.5mg x 31.5kg = 15.75mg
• 15.75mg x 2 = 31.5mg per DAY
• 20mg = 5ml
• 31.5mg = 7.875 ml
• 5ml = 2.2 mmol then 7.875 = 3.465 mmol
• 3.465 mmol x 23 = 79.695mg i.e 0.079695g
• 0.079695/1.2 x 100 = 6.64125%
• ANSWER = 6.6%

ANSWER 25-NOV 2023

• 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

​

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• ANSWER = 315 tablets

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ANSWER 26-NOV 2023

• Patients weight = 72kg
• so maximum lipase per day = 720000 units
• one capsule = 25000
• x = 720000
• X = 28.8
• ANSWER = 28 capsules

ANSWER 27-NOV 2023

• Dose prescribed is 5 mg x 6.5 kg = 32.5 mg/hour
• Product we’re using contains 125 mg in 60 mL,
• 32.5mg = 15.6 mL/hour
• The pump is set in 0.5 mL/hour increments; therefore the hourly rate is 15.5mL for one hour
• (Remember: the pump will only allow you to set either 0.5ml intervals )
• 15.5 mL/hr. x 6 hours = 93ml
• ANSWER = 95 ml

ANSWER 28-NOV 2023

• 20kg x 20 = 400mg
• 400mg WILL BE IN 100ml

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• 3mg x 20kg = 60mg per minute

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• 400mg = 100ml
• 60mg = 15ml

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• ANSWER = 15ml/ minute

QUESTION 29-NOV 2023

• Dose = 15 mg/kg x 9.9 kg = 148.5mg/dose, given four times daily
• 120 mg/5 mL suspension
• 148.5 mg = 6.1875 mL
• Closest measurable amount using oral syringe available = 6.2 mL, this is the actual dose to be given.
• 6.2 mL x 4 = 24.8 mL daily
• 24.8ml x 7 days = 173.6

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• ANSWER = 173.6ml

ANSWER 30-NOV 2023

• first, Calculate IBW
• 173 – 152.4 = 20.6cm
• 20.6cm = 8.110 inches
• 2.3 x 8.110 plus 45.5 = 64.153kg
• 64.153kg x 3 = 192.459mg
• 20mg = 1ml

192.459mg = x

• X = 9.62295ml
• 9.62295/ 3 = 3.20765
• ANSWER = 3.2ml

​

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ANSWER 31-NOV 2023

• Final concentration is 5% means 5g in 100ml
• In 5 Litres there will be = 250g
• So, 250g is 90% of aminophyline i.e minus 10%
• CALCULATE for a 100%
• if 250g = 90
• 275 = 100
• 275g
• ANSWER = 275g

ANSWER 32-NOV 2023

• 23 + 18 = 41 UNITS
• 1 PEN = 300 UNITS
• 1 PEN = 7 DAYS
• 4 PENS = 28 DAYS

ANSWER 33 -NOV 2023

• MR = 100g/mol
• 5ml x 60 mins = 300ml
• 2g = 100ml then 6g = 300ml
• MOLE = Mass/ mr
• Mole = 6g/100
• Mole = 0.06
• Mass of calcium = 0.06 x 40= 2.4g
• Mg = 2400mg ANSWER

ANSWER 34-NOV 2023

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• Units of wine = 1225(ml) x 13 (%) = 15.925
• 1000
• Units of alcohol = 1704(ml) x 4 (%) = 6.816

1000

• Units of alcohol = 200 x 10 = 2
• 1000
• 15.925 + 6.816 = 22.741 plus 2 = 24.741
• 24.741 – 14 = 10.741

​

• Units of alcohol FORMULA = volume of drink (ml) x ABV (%)
• 1000
• ANSWER = 11 units

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QUESTION 35-NOV 2023

• 2 BEFORE + 5 DURING + 4 WEEKS AFTER
• 11 weeks of treatment for Mr Adams = 11 tablets
• 11 weeks of treatment for Mrs. Adams = 11 tablets
• 11 weeks of treatment for their son = 5.5 tablets
• TOTAL = 27.5 = 28 TABLETS
• 28 – 5 = 23
• ANSWER = 23 TABLETS

ANSWER 36-NOV 2023

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• 2.5ml QDS = 10ml daily
• 28 days = 280 ml
• 2g = 100ml propylene glycol
• X = 280ml
• X = 5.6g
• 5.6g/56kg = 0.1g
• ANSWER = 100mg/kg

ANSWER 37-NOV 2023

• 3 Caps x 7 days = 21
• 2 caps x 7 days = 14
• 1 cap x 17 days = 17

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• Total = 52 capsules
• 52 – 3 days of loading dose ( 9 capsules)

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• ANSWER = 43 CAPSULES

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ANSWER 38-NOV 2023

• 5ml = 1 minute
• 300ml = 60 minutes (1 hour )

​

• If 125 mmol = 1000 ml ( 1 litre)
• 37.5 mmol = 300ml
• Mol = mass/ MR
• 37.5 = mass/ 46
• Mass = 37.5 x 46 = 1725mg
• Mass = 1.725g
• ANSWER = 1.7 grams

ANSWER 39-NOV 2023

• 0.2g = 100 ml
• 0.2 = 5 ml
• Diluted to 50ml means dilution factor is 10
• 0.2/10 = 0.02

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• Further 1 in 10 means 0.02/10 again

​

• FINAL CONC = 0.002%w/v

ANSWER 40-NOV 2023

• Minimum dose = 10 litres per minute
• OXYGEN CYLINDER D HAS A CAPACITY OF 340 LITRES.
• HENCE, 10 LITRES = 1 min
• 340 LITRES = X

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• X = 34

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• ANSWER = 34 MINUTES

INTENSIVE�GPHC CALCULATIONS ��MOCK EXAM.

FOR TRAINEE PHARMACISTS.

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LONDON PHARMACIST NETWORK

JUNE 2023

GPHC CALCULATIONS �MOCK EXAM.

FOR TRAINEE PHARMACISTS.

LONDON PHARMACIST NETWORK

JUNE 2023

OPENING REMARKS

QUESTION 1- JUNE 2023

• Mr. Chippy presents a prescription for prednisolone tablets.
• Take 60mg daily for 5 days, then reduce by 10mg every 5 days until you reach 10mg. Take 10mg for 5 days then reduce to 5mg daily for a fortnight. You supply the patient with 56 tablets in your stock.
• Calculate how many boxes of 28 prednisolone 5mg tablets owed . Answer as whole number.
• Watch London pharmacist Network on YouTube

QUESTION 2 – JUNE 2023

• Miss B. a 5-year-old child weighs 18kg and has been prescribed levetiracetam 100mg/ml oral solution.
• Instructions is given as follows :
• Rx – 28 days
• Take 10mg/kg daily for four days, then increase by 2.5mg/kg every four days until you reach 20mg/kg and continue at this dose for the rest of the treatment period.
• Calculate the volume of the oral solution you are required to supply to cover the treatment period. Answer in ml as whole number.
• London pharmacist Network

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QUESTION 3- JUNE 2023

• You are required to mix three glucose solutions together.
• Solution A - 300ml of glucose 5% solution
• Solution B – 500ml of glucose 12.5% solution
• Solution C – 700ml of glucose 7.5% solution

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• Calculate the concentration of the resulting solution.
• Give your answer in % to 1 d.p.
• London pharmacist Network

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QUESTION 4- JUNE 2023

• Amy a -20-year-old pharmacy student needs to make anhydrous NaCl. What weight of NaCl which contains 5% moisture should be added when preparing a 5L batch of a solution with a final concentration of 5% w/v anhydrous NaCl. Answer in g to 1.d.p.
• London pharmacist Network

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QUESTION 5– JUNE 2023

• Miss N , a 5-year old child in palliative care who weighs 24kg requires morphine at a dose of 225mcg/kg every six hours . Morphine is available as 10mg/ml oral solution and is to be administered using a syringe calibrated at 0.5ml increments.
• Calculate the volume of morphine that will be administered to miss N in 14 days.
• Give answer in ml to nearest whole number.

QUESTION 6– JUNE 2023

• A patient requires a daily dose of Phenytoin 500mg, an IV medicine that is available as a 5mg/mL solution. The drug will be given in two equally divided doses each day. The medicine can be diluted to a concentration of between 1mg/mL and 4mg/mL with glucose 5% solution. The minimum volume that a dose of the drug can be infused in is 50ml. You have been instructed to dilute a dose of phenytoin to a concentration of 2mg/ml with glucose 5% before it is given to the patient . What volume of glucose 5% solution is required for dilution of each dose ? ANSWER in ml as whole number.

QUESTION 7– JUNE 2023

• Mrs. McDonalds a 55-year-old Patient weighs 225lbs and has a height of 170cm. She has recently started a new diet and exercise regimen and has been following it accordingly. Given that the ideal BMI is 18.5 - 24.9kg/m2 and Mrs. McDonalds loses weight according to the diet plan, how much weight in kg does she need to lose to reach an ideal BMI?
• Give your answer in kg to the nearest whole number.
• 1 lb = 0.45kg
• 1 stone = 6.35kg

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• Watch London pharmacist Network on YouTube

QUESTION 8– JUNE 2023

• Ms. Z is a palliative care patient who has been prescribed 60mg morphine sulphate modified release (ZOMORPH) capsules twice daily. She also takes 2.5ml of oramorph 10mg/5ml oral solution every four hours for breakthrough pain. Her doctor would like to increase her opioid medication by the maximum possible amount. What would her new daily dose of morphine be once the doctor has made this change?
• Answer in mg to nearest ten.
• Watch London pharmacist Network on YouTube

QUESTION 9

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• A stock solution containing chlorphenamine 10% w/v was used to prepare a solution of intermediate strength such that when the solution is diluted 1 in 5 , a 1 in 1000 solution is produced. What volume of the intermediate solution is required to produce 2.5 litres of the final solution.
• Give your answer in Litre to 1 d.p.
• London pharmacist Network

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QUESTION 10– JUNE 2023

• Mr. Jay is a palliative care patient who is about to be switched from codeine to oral morphine sulphate modified release (MST Continus) tablets . He currently takes 100mg codeine tablets BD. The doctor wishes to prescribe him medication for breakthrough pain as well and asks you for your advice. What is the maximum volume in ml of morphine sulphate 10mg/5ml oral solution that Mr. Jay can take per dose for breakthrough pain? Use the link/resource provided
• Give answer to 2.dp.
• Prescribing in palliative care | Medicines guidance | BNFC | NICE
• Watch London pharmacist Network on YouTube

-11 - SYNCHRONISE A PRESCRIPTION-

You are working in a community pharmacy and one of the patients complained to you that she runs out of two of her medicines rather quickly. She would like you to mention it to her practice pharmacist during your next surgery run. See details of her medication below . SYNCHRONISE LEVOTHYROXINE 50mcg tablets.

• DRUG & STRENGTH DOSE REMAINDER
• METHOTREXATE 2.5MG 4 WEEKLY 48
• CO-CARELDOPA 12.5mg 1 QDS 300
• LISINOPRIL 2.5MG 1 OD 16
• LEVOTHYROXINE 25MCG 1 OD 22
• RISEDRONATE 35MG 1 PER WEEK 8
• Paracetamol tablets 500MG 2 QDS 500
• LEVOTHYROXINE 50MCG ONE ON ALTERNATE DAYS 35
• CARBOCEISTEINE 375 2 TDS 96
• Watch London pharmacist Network on YouTube

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QUESTION 12 – JUNE 2023

Calculate how many millitres of water must be added to 120ml of 40% w/v solution of potassium permanganate solution in order to produce a 5%w/v potassium permanganate solution?

• Give answer in litres to nearest 0.05.
• Watch London pharmacist Network on YouTube

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QUESTION 13– JUNE 2023

Mr. Darren is a 45year old man who weighs 11 stones 5lb. He is admitted in hospital and is due to be administered cefalexin by I.V. injection over ten minutes at a dose of 90mg/10kg. Cefalexin 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 1.d.p
• Watch London pharmacist Network on YouTube

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QUESTION 14

• Mr P is a 60-year-old Parkinson’s disease patient who needs to be switched to rotigotine patches. He currently takes stalevo at a dose of one tablet three times a day.

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• Calculate what strength of rotigotine patches, Mr P should prescribed every 24 hours.

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Watch London pharmacist Network on YouTube

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QUESTION 15– JUNE 2023

• Mr. JONES is 33years old and weighs 141 lbs. He is being treated for DKA. Required units of soluble insulin is diluted in sodium chloride 0.9% w/v intravenous infusion fluid to a concentration of 10units of insulin per 10ml solution and infused at a rate of 0.5units /kg/hour.
•  At what rate in ml/min should the infusion be administered to Mr. Jones ? 

Answers To 1.d.p

1 lb = 0.45kg

• London Pre-Reg pharmacists Study Group

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QUESTION 16– JUNE 2023

Miss . G a 3-year-old has been prescribed Gaviscon Infant Sachets one dose with feeds, 6 times in 24 hours. Assume Gaviscon Infant sachets contain 0.95mmol Na+/dose. The recommended daily allowance (RDA) of salt for this patient is 3g (equivalent to 1.2 g sodium) per day. The atomic mass of sodium is 23.

What percentage of this child’s recommended daily salt allowance is contained in a total daily dose of Gaviscon Infant Sachets?

Give your answer to the nearest whole number.

Watch London pharmacist Network on YouTube

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QUESTION 17– JUNE 2023

Potassium permanganate solution is needed as a stock solution, which is then diluted down to the appropriate concentration before use by a patient. You are asked to prepare 100ml of the stock solution which when 10ml is diluted to 5 litres, produces a final concentration of 1 in 10000. What quantity of potassium permanganate, in g, is required to make the stock solution?

Give your answer to the nearest whole number.

Watch London pharmacist Network on YouTube

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QUESTION 18– JUNE 2023

Mr. T is receiving an IV infusion containing the following

• KCL – 70mmol/L
• Glucose – 50 mmol/L
• Na2CO3– 125 mmol/L

Given that Mr. T receives the infusion at a rate of 50ml per hour. Calculate the weight of sodium in grams he will receive after 45 mins. ANSWER as to 2.d.p.

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• K= 39g/mol CL=35.5g/mol Na = 23g/mol C = 12g/mol O = 16g/mol

Give your answer to 2. d.p.

Watch London pharmacist Network on YouTube

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QUESTION 19– JUNE 2023

• Consider the drug chart below for a Mr. T who weighs 54kg and is 100cm tall. calculate the total time for infusion in minutes as a whole number.

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QUESTION 20– JUNE 2023

Miss. H. a 59-year-old patient has been admitted with an overdose of a benzodiazepine . She weighs 60kg. A decision has been made to administer flumazenil via an intravenous infusion at a dose of 2mg/kg . Flumazenil is available as 50mg/5ml solution for injection. The nurse dilutes the required amount of flumazenil to 100ml with sodium chloride 0.9%. The maximum rate this infusion can be given at is 5mg/min.

What is the maximum rate (L/hour) that this infusion can be given at ?

Give your answer to 2.d.p.

Watch London pharmacist Network on YouTube

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QUESTION 21 – JUNE 2023

Mrs. A is a 54 year old woman who is receiving treatment for mania. She is taking Priadel liquid 520mg/5ml at 20ml twice a day. Priadel liquid contains a certain amount of lithium carbonate as stipulated in the SPC. The molecular formula for lithium carbonate is Li₂CO_3. The molecular weights are

• Lithium 7g/mol
• Carbon 12g/mol
• Oxygen 16g/mol

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• What quantity of lithium will Mrs Z. receive per daily dose, give your answer in mg to two decimal place.
• Priadel 520 mg/5 ml Liquid - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk)

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NNT QUESTION 22– JUNE 2023

• You are a pharmacist involved in a clinical study testing a new drug that aims to decrease the number of clots in older women with atrial flutter. The study involves 1000 women who take a new drug for 2 years and 1000 who are given regular Rx. At the end of the study period, 6% of the women in the regular therapy group suffered a blood clot while 3% of the women in the new drug group suffered a clot.
• Absolute risk reduction (ARR) = difference in the rate of an event in the treatment group compared with the control
• ARR = (event rate in control group) – (event rate in treatment group)
• Number needed to treat (NNT) = number of people needed to be treated to achieve the desired goal of treatment.
• NNT = 1/ARR . What is the NNT for drug A?

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QUESTION 23 – JUNE 2023

• Miss. R. a 39-year-old is being switched from Citalopram tablets to Mirtazapine for the management of depression . Use the cross tapering information below to calculate how many citalopram 10mg tablets you would supply for cross tapering to occur over 4 weeks.

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• first week – continue on current dose of 40mg OD
• Second week – take dose of 30mg OD
• Third week – take dose of 20mg OD
• Fourth week – take dose of 10mg OD

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• Give your answer as whole number .

QUESTION 24– JUNE 2023

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• Mrs. Jones is prescribed Ciprofloxacin 0.3% eye drops to treat an infection in BE. Mitte 4 x 5ml
• Instill one drop every hour for twelve hours into both eyes , then instill two drops every hour for two days, then one drop every two hours thereafter. Assume no wastage.
• Assume that she starts first treatment on 12^th May 2023 at 10am and stops at 8.30pm on 15^th May 2023, calculate the amount of ciprofloxacin 0.3% eye drops she would have used. Assume no wastage. Answer in drops as whole number.
• London pharmacist Network

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QUESTION 25– JUNE 2023

• Miss Y. who weighs 56kg takes 5ml Fluoxetine 20mg/5ml oral solution BD. The solution contains an excipient propylene glycol 2% w/v. You are required to calculate the mass of propylene glycol the patient would take in 28 days. Answer as whole number in mg/kg .

QUESTION 26 – HEALTH ECONOMICS– JUNE 2023

• You work as a pharmacist in a GP surgery and the practice manager would like you to help the surgery make some savings. Records show that 2352  CARDURA 4mg XL tablets were prescribed over the last 6 months at a cost of £ 930.72. How much can be saved per month if  these patients were switched to generic DOXASOZIN 4mg XL tablets (costs 81 pence per 28 tablets). Give your final answer to nearest 5 pounds.

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• London Pre-Reg pharmacists Study Group

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QUESTION 27– JUNE 2023

• The diabetes center has initiated a patient on an insulin pump for type 1 diabetes, and prescribing is now being taken over by your GP surgery. The patient’s average daily insulin requirement is 45 units, and they will get 28-day prescriptions for Novorapid® 100 units/mL vials. Each vial contains 10 mL and has a shelf life of 28 days once opened. You have been asked to set up a repeat template for this patient. Calculate how many vials should be prescribed for each prescription ?

QUESTION 28– JUNE 2023

Consider the following information about the patient below.

• Mr. S
• Aged 65years
• Weight – 92kg, Height – 175cm ------ 1 ft = 30.48cm and 1 inch = 2.54cm
• Mr. S is to be treated for serious infection with Tobramycin at the dose recommended. He has good renal function.
• - To avoid excessive dosage in obese patients use ideal body weight to calculate the dose required for Tobramycin.

Use the formula provided

• ( IBW = 2.3kg for each inch over 5 feet + 50kg)
• Calculate how much Tobramycin is required per dose? Give answer in mg to nearest whole number
• Tobramycin 40mg/ml Injection - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk)

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QUESTION 29– JUNE 2023

• Freddie is a 7-year-old patient who usually takes omeprazole 10mg dispersible tablets BD. He develops side-effects to the dispersible tablets and his doctor decides to switch him to omeprazole 10mg/5ml oral suspension. Each 100ml bottle costs £49 on the drug tarrif. How much will be spent by the surgery if the doctor writes a prescription for omeprazole suspension for 28 days ? Answer as whole number.

QUESTION 30

• A 63-year-old woman has meningitis that is sensitive to meropenam.
• She weighs 87 kg and has an ideal body weight of 67kg.
• She has a serum creatinine of 267 micromol/litre.
• (140 – Age) × Weight × Constant

Serum creatinine

• • Age in years , Weight in kilograms (use ideal bodyweight where fat is likely to be the major contributor to body mass)
• • Serum creatinine in micromol/litre
• • Constant = 1.23 for men; 1.04 for women
• What is the recommended dose of meropenem for this woman in mg/kg? Answer to 2.d.p
• Meropenem | Drugs | BNF | NICE

QUESTION 31– JUNE 2023

• Adam suffers from anxiety . He has been prescribed propranolol 5mg/ml oral solution with each ml of the solution containing 39mg of ethanol . 1 unit of alcohol is equivalent to 10ml of 96% ethanol found in beer. Calculate how many units of alcohol are contained in a daily dose, given that Adam takes 3ml four times a day using a syringe that is calibrated at 1ml intervals.
• Give your answer to nearest 0.05
• London Pharmacist Network on YouTube

QUESTION 32– JUNE 2023

You work a night shift in a diabetic hospital ward where an old patient should start receiving a 250ml sodium chloride infusion at 8pm on Sunday night set at a rate of 4ml per 60 minutes and the infusion is meant to finish at 5.30pm the next day (Monday) .At 11.30 pm that same Sunday night, you receive instructions to increase the rate of infusion.

• Calculate what rate in ml/hour you would need to increase the rate to from 11.30pm on Sunday night in order for the infusion to finish at 5.30pm the next day (Monday).
• ANSWER TO 2.DP.

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QUESTION 33- BSA

• Alfie a 7-year-old boy is prescribed the usual methotrexate dose for severe chron’s disease. What oral dose of methotrexate is suitable for Alfie who weighs 40 pounds and 109 cm tall? Answer to 1 d.p
• Methotrexate | Drugs | BNFC | NICE

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QUESTION 34 – HEALTH REGISTER

• In one year , approximately 396 per 100,000 people in the UK are diagnosed with diabetes, and of these 1/5 are diagnosed with type 1 diabetes. Given that the UK population is 64 million approximately how many people in the UK were diagnosed with type 1 diabetes in that year?
• Answer as a whole number of people.
• London Pharmacist Network

QUESTION 35– JUNE 2023

• A 72 year-old elderly patient weighs 78kg and is to be treated with phenytoin oral solution twice a day. The target plasma concentration is 10.5mg/ Litre.
• Formula CP = dose x s

F x T

Cp = Desired peak conc of drug

Vd = volume of distribution (1.5L/kg)

F = Bioavailability (0.8)

S = Salt factor is 1

T = time interval in hours

Calculate the dose using the formula provided. Answer in mg to 1.d. p

QUESTION 36- DILUTION

• You have 500ml of chlorhexidine 0.5%v/v solution in stock. You are required to supply a 100ml chlorhexidine solution to a patient by making 1 in 20 dilution of your stock . Calculate the concentration of the solution you will supply to the patient. Express your concentration in parts per million.

BIOAVAILABILITY 37– JUNE 2023

An elderly woman is admitted in hospital after she fell in her flat in London. Before admission, she was taking Erythromycin 250mg tablets QDS for a chest infection of which she had only taken for three whole days (note- she is meant to take it for a total of 7 days).Unfortunately, she is now nil by mouth and needs to be given erythromycin 250mg/5ml suspension QDS intranasally.

• Using bioavailability, calculate the equivalent amount of erythromycin suspension for the rest of the course?
• Give answer in grams to one d.p.

​

• NOTE - Bioavailability of erythromycin tablets = 0.7
• Bioavailability of erythromycin suspension = 0.8

​

QUESTION 38

• A child who weighs 20Kg is to be given a 56mg/kg loading dose of drug X. In order to be administered by intravenous infusion the drug is going to be diluted to a concentration of 50mg/5ml with sodium chloride 0.9% and administered over half an hour.
• What rate in mL/hour will the infusion need to be given at? Give your answer to the nearest 5ml.

QUESTION 39– JUNE 2023

A 45-year-old man ­is prescribed phenytoin capsules, 150mg twice daily.  He has had a gastrostomy and now requires an oral solution.

 Phenytoin is available as 30 mg per 5 mL oral suspension.

�How many mls of oral solution will be required per dose? Use resource provided.

Give your answer to the nearest 0.5 mL. 

• https://bnf.nice.org.uk/drug/phenytoin.html

QUESTION 40- JUNE 2023

Amoxicillin is available as a powder for reconstitution with water. The concentration of amoxicillin in the reconstituted suspension is 250mg/5ml. To reconstitute 100ml of the suspension, the required volume of water to be added is 82ml. What is the displacement volume, in ml/g of amoxicillin powder for reconstitution?

Give your answer to 1 d.p.

• London Pharmacist Network

THANKS FOR PARTICIPATING

• ANSWERS BELOW

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• GOODLUCK !!!

ANSWER 1 – JUNE 2023

• 12 tablets x 5 = 60
• 10 tablets x 5 = 50
• 8 tablets x 5 = 40
• 6 tablets x 5 = 30
• 4 tablets x 5 = 20
• 2 tablets x 5 = 10
• 1 tablet x 14 = 14
• 224 tablets – 56 = 168
• 168/ 28 = 6
• ANSWER = 6 BOXES

ANSWER QUESTION 2 – JUNE 2023

• 10MG X 18kg = 180mg x 4 days = 720mg
• 12.5 x 18 = 225mg x 4 days = 900mg
• 15mg x 18 = 270mg x 4 days = 1080mg
• 17.5mg x 18kg = 315mg x 4 days = 1260 mg
• 20mg x 18kg = 360mg x 12 days = 4320 mg
• Total = 8280mg
• 100 mg = 1ml
• 8280mg = 82.8 ml

​

• ANSWER = 83 ML

ANSWER QUESTION 3 – JUNE 2023

• C1V1 + C2V2 + C3V3 = C4V4 ( final solution )
• 5 X 300 + 12.5 X 500 + 7.5 X 700 = C4 X 1500 ML
• 1500 + 6250 + 5250 = C4 X 1500
• 13000/ 1500 = 8.6667

​

• C4 = 8.7%

ANSWER - 4– JUNE 2023

• Final concentration is 5% means 5g in 100ml
• In 5 Litres there will be = 250g
• So, 250g is 95% of NaCl i.e minus 5%
• CALCULATE for a 100%
• if 250g = 95
• 263.157 = 100
• ANSWER = 263.2g

ANSWER 5– JUNE 2023

• 225mcg x 24kg = 5400 mcg

5400mcg = 5.4mg

• SO if 10mg = 1ml then 5.4mg = 0.54ml
• ROUND DOSE TO NEAREST 0.5ML . Hence 0.5ml
• 0.5ml x 4 = 2ml
• 2ml x 14 = 28ml
• THEREFORE 28ML IS ANSWER

ANSWER 6– JUNE 2023

• Each dose is 250mg
• 5mg = 1 ml
• 250mg = 50 ml of phenytoin
• final concentration is 2mg = 1ml
• so 250mg = x ml
• x 125ml
• So 125ml – 50ml = 75ml of glucose 5%
• ANSWER = 75ml

ANSWER 7– JUNE 2023

• Current weight – target weight
• 101.25kg – 71.96 kg = answer
• ANSWER = 29 kg

ANSWER 8 – JUNE 2023

• Zomorph – 60mg x 2 = 120mg
• Oramorph 10mg/5ml – 2.5 x 6 = 15ml per day i.e 30mg
• Total morphine per day = 150mg
• ½ x 150 = 75mg
• 150mg + 75mg = 225mg
• ANSWER = 230mg

ANSWER 9– JUNE 2023

• C1V1 = C2V2
• intermediate final solution
• 0.5 X V1 = 0.1 X 2500
• V1 = 0.1 X 2500/ 0.5
• V1 = 500ml
• V1 = 0.5 Litres

ANSWER 10– JUNE 2023

• 200mg daily = 200mg
• 100mg codeine = 10mg of morphine
• 200mg = 20mg of morphine
• 1/6th of 20 = 3.33mg
• 10mg = 5ml
• Answer 1.67ml

​

ANSWER 11– JUNE 2023

• Calculate highest one first
• Methotrexate is 12 weeks or 84 days
• 84 - 70 = 14
• one on alternate days = 7
• ANSWER IS 7 TABLETS

ANSWER 12 - – JUNE 2023

​

• c1v1 = c2v2
• 40 x 120 = 5 x v2
• V2 = 960 ml
• 960ML – 120ML = 840ML

Change to litres

• ANSWER 0.85 Litres

​

ANSWER 13– JUNE 2023

• 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/ 10 = 1.08166ml

​

• ANSWER = 1.1 ml/min

​

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ANSWER 14– JUNE 2023

• first step - 125 x 3 = 375mg
• Step 2 - 375mg x 1.3 = 487.5
• Step 3 – no dopamine agonist so = 0
• 487.5 + 0 = 487.5
• Step 4 – 487.5 x 0.55 = 268.125 mg
• 268.125/20 = 13.406
• ANSWER = 14mg ropinirole patches

ANSWER TO QUESTION 15– JUNE 2023

• 63.45kg x 0.5 units = 31.725 units
• 10 units = 10ml
• 31.725 units = 31.725 ml
• 31.725ml = 60 minutes

1min = 0.53ml

Answer = 0.5ml/min

​

​

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ANSWER 16– JUNE 2023

• 0.95 X 6 = 5.7 MMOL
• MOLE = mass/ Mr
• 5.7 mmol = mass / 23
• Mass = 131.1mg or 0.1311g OF SODIUM
• We know that 1.2g = 3g of salt
• Hence 0.1311g = 0.32775 OF salt
• 0.32775/ 3 = 0.10925
• 0.10925 x 100 = 10.925
• ANSWER = 11%

ANSWER 17– JUNE 2023

• 1 = 10000 IS 0.01%
• Dilution factor is 500
• 0.01 x 500 = 5%
• THEREFORE , if 5g = 100ml

​

• ANSWER = 5g

ANSWER 18– JUNE 2023

• Na2CO3
• 50ml = 1 hour
• 37.5ml = 45 minutes
• 125 mmol = 1000 ml
• 4.6875mmol = 37.5 ml
• Mol = mass/mr
• 4.6875 mmol = Mass/46mg/mmol
• Mass = 215.625mg
• ANSWER = 0.22g

​

ANSWER 19– JUNE 2023

​

• BSA = 1.224745
• Total drug = 0.5 x 1.224745 = 0.6123725g = 612mg
• First infusion = if 0.9 (900mg) = 100ml then 45mg = 5ml 45x 1.224745 = 55.1mg/hr
• 27.555mg for 30 minutes
• Second infusion
• if 0.9 (900mg) = 100ml then 90mg = 10ml 90 x 1.224745m2 = 110.227mg/hr
• 55.11mg for 30 minutes
• 612mg – 82.665 = 529.335 mg 
• 20ml = 180mg
• 180 x 1.224745 = 220.4541
• If 220.45mg = 60 mins
• 529.335 mg = 144.069mins
• 144.069 + 60 mins = 204.069
• ANSWER = 204mg

​

​

ANSWER 20– JUNE 2023

• 2mg x 60 = 120mg
• 120mg = 100ml
• 1.2mg = 1ml
• Max rate is 5mg = 4.167 ml
• so 4.167ml per minute
• 250.02 = 60 minutes
• ANSWER = 0.25L/hr

​

ANSWER 21– JUNE 2023

• Each 5 ml contains 520 mg of the active substance lithium citrate equivalent to 204 mg lithium carbonate.
• 5ML = 204 mg
• 40ml = 1632 mg
• Mol = mass/mr
• Mol = 1.632/74
• Mol = 0.02205
• 0.022054 = mass/14
• Mass = 0.308756g
• ANSWER = 308.76mg

ANSWER 22– JUNE 2023

• NNT = 1 / ARR
• ARR = 60/1000 - 30/1000 = 0.03

​

• NNT = 1/0.03

​

• ANSWER = 34 PEOPLE

ANSWER 23– JUNE 2023

• WEEK 1 = 28
• WEEK 2 = 21
• WEEK 3 = 14
• WEEK 4 = 7

​

• TOTAL = 70 TABLETS

ANSWER 24– JUNE 2023

​

• 12^{th - 26 DROPS}
• 13^th – 96 drops
• 14^{th – 96 drops}
• 15^th is 20 drops
• total of 238 drops
• ANSWER = 238 ml

ANSWER 25– JUNE 2023

​

• 5ml BD = 10ml daily
• 28 days = 280 ml
• 2g = 100ml propylene glycol
• X = 280ml
• X = 5.6g
• 5.6g/56kg = 0.1g
• ANSWER = 100mg/kg

ANSWER TO QUESTION 26

• Working
• Cardura total tablets in 6 months = 2352   ----- which is 84 boxes of 28)
• Therefore one month = 84/6 = 14 boxes of 28
• 930.72/6 = 155.12
• Doxazosin 14 boxes = 0.81 x 14 = 11.34
• 155.12 - 11.34 = £144
• ANSWER = £145

ANSWER 27– JUNE 2023

• The patient uses 45 units per day. The prescription is for 28 days.
• 45 units x 28 days = 1260 units.
• Each 10mL vial contains 1000 units (10 mL x 100 units / mL = 1000 units per vial).
• We have to supply full vials, therefore we wouldn’t round DOWN to 1 vial (1000 units) but would instead give two.
• Answer = 2 vials (2000 units)

​

ANSWER 28– JUNE 2023

• Patient’s BMI is = or > 30kg/m2
• So use ibw formula
• 2.3kg x 8.897 inches = 20.464kg
• 20.464kg + 50kg = 70.464kg
• 3mg x 70.464kg = 211.39mg
• 211.39
• 211.4mg /3
• 70 mg answer

ANSWER 29– JUNE 2023

• 20mg = one day
• 10ml = 1 day
• 280ml = 28 days

​

• 100ml = 49 POUNDS
• 280 but approximate to 300ml = 147

​

• ANSWER = £147

​

ANSWER 30– JUNE 2023

• (140 – Age) × Weight × Constant

Serum creatinine

• (140 – 63) × 67 × 1.04 = 20.09 ml/ min

267

​

• From spc 10 – 25 ml / min use half of normal dose every 12 hours
• 1g dose for our patient . 1000mg / 67kg = 14.9253
• ANSWER = 14.93

ANSWER 31– JUNE 2023

• daily dose = 60mg of propranolol
• 60mg = 12 ml
• 39mg ethanol in 1 ml
• 468mg of ethanol in 12ml

​

• 1 unit alcohol = 10ml 96% ethanol i.e 9.6g or 9600mg
• 468/9600 = 0.04875
• ANSWER = 0.05 UNITS

ANSWER 32– JUNE 2023

• 8pm to 11.30pm = 3.5 hrs.
• 4ml per 60 mins
• 14ml infused in 3.5hrs
• So, 236 ml remaining
• There are 18 hours between 11.30pm Sunday and 5.30pm on Monday
• 236/18hrs = 13.11
• ANSWER 13.11 ml / hr
•  

​

ANSWER 33– JUNE 2023

• The oral dose of methotrexate is 15mg/m² weekly
• The body surface area for Alfie is 0.74m².
• If there is 15mg in every 1m², how many mg is in 0.74m²?
• Divide 1m²/0.74m², we learn the proportionate factor difference. In this case, the factor is 1.35.
• Answer: By dividing 15mg by 1.35, we learn that the weekly dose of methotrexate should be 11.1mg.

​

​

• ANSWER = 11.1mg.

​

ANSWER 34– JUNE 2023

• For Diabetes
• 396/100,000 x 64, 000,000 = 253440
• for type 1 diabetes
• 1/5 x 253440 = x
• ANSWER = 50688 people

ANSWER 35– JUNE 2023

• Formula cp = d x S

F x T

​

• 10.5 = dose x 1

0.8 x 12

• rearrange the equation
• 100.8 = dose x 1
• Dose = 100.8

​

• ANSWER = 100.8 mg

ANSWER 36– JUNE 2023

• YOUR STOCK IS 0.5% WHICH MEANS 0.5 = 100
• DILUTION FACTOR IS 20
• 0.5/ 20 = 0.025

​

• IF 0.025 = 100
• THEN 250 = 1 000 000
• ANSWER = 250 PPM

ANSWER 37 – JUNE 2023

• 7 days dose – 3 days dose
• 7000mg – 3000mg = 4000mg

​

• 0.7 x 4000mg = 3500mg
• 0.8

​

• Change to grams
• Answer is 3.5g

ANSWER 38– JUNE 2023

• 56 x 20 = 1120mg loading dose
• 50mg/5ml
• 1120mg = 112ml
• 112 = 30 minutes
• 224 ml = 1 hour

​

• ANSWER = 225ml/ hour

ANSWER 39– JUNE 2023

• 23 ml ANSWER

​

ANSWER 40– JUNE 2023

• Final concentration is 250mg/5ml
• In 100ml= 5000mg I.E 5g
• 100 - 82=18ml
• 5g displaces 18ml
• 1g can displace 3.6ml
• ANSWER = 3.6ML

INTENSIVE�CALCULATIONS��INTENSIVE MOCK EXAM �

LONDON PHARMACIST NETWORK

NOV 2022

INTENSIVE CALCULATIONS PROGRAMME

OPENING REMARKS

QUESTION 1- -NOVE 2022

• You work as a community pharmacist and receive a prescription for one of your regular patients named Liz.
• Rx

Prednisolone 60mg daily for 5 days, then reduce by 10mg every 5 days until you reach 10mg. Then take 10mg for 3 days, then take 5 mg for 7 days and stop treatment.

• Assuming you supply the patient with all 131 tablets you have in stock, calculate the number of prednisolone 5mg tablets owed to Liz.

QUESTION TWO -NOV 2022

Mr. T is receiving an IV infusion containing the following

• KCL – 70mmol/L
• Glucose – 50 mmol/L
• Na2CO3– 125 mmol/L

Given that Mr. T receives the infusion at a rate of 50ml per hour. Calculate the weight of sodium in grams he will receive after 45 mins. ANSWER as to 2.d.p.

​

• K= 39g/mol CL=35.5g/mol Na = 23g/mol C = 12g/mol O = 16g/mol

QUESTION THREE

• Consider the drug chart below for a Miss. Brown who weighs 54kg and is 100cm tall. calculate the total time for infusion in minutes as a whole number.

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QUESTION 4 - BODY MASS INDEX

Grace is a 33-year old female patient who is planning to get married. She is keen to lose weight before her wedding day .She currently weighs 14 stone and 7lb and is 6 foot tall. Calculate how long in weeks it will take her to reach her target of 69kg if she loses 2 Lbs per week.

Give your final answer as nearest whole number.

1lb = 0.45kg 1 stone = 6.35kg 1 foot = 30.48cm

​

QUESTION 5-NOV 2022

• Mr. N. is a diabetic patient who is currently using Toujeo solostar insulin. Due to episodes of hypogylcaemia , his doctor would like to switch him from Toujeo solostar to lantus solostar. He is currently using 20 units in the morning and 20 units at night . Calculate how many pens of lantus Insulin he would need for initial 2 weeks supply given that Lantus insulin contains 100units/ml and each pen is 3ml . Assume a complete dose will be taken from a solitary pen.
• Toujeo 300 units/ml SoloStar, solution for injection in a pre-filled pen - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk)

QUESTION 6-NOV 2022

• Mark a-76-year-old male with arrythmias who is 178cm tall is admitted to hospital and needs to be prescribed digoxin. His creatinine clearance is 25ml/min. The doctor prescribes a dose of digoxin to be administered orally BD . The target concentration for him is 1.6mcg/L . Work out which strength of tablets the doctor should prescribe for this patient .
• CHOICES - 62.5mcg tablets , 125mcg tablets or 250mcg tablets
• 1 foot = 30.48cm , 1 inch = 2.54cm

CPss = F X S X D

Cl x T

• CL = 0.053 x CrCl + (0.02 x IBW )
• IBW = 50 + 2.3kg for every inch over 5ft
• F = bioavailability 0.8 , D = dose (mg) , Cl = clearance (L/hour) , T = dosage interval (hours) , S = Salt factor 1.

​

QUESTION 7-NOV 2022

Mrs. Z is a 54 year old woman who is receiving treatment for mania. She is taking Priadel liquid 520mg/5ml at 20ml twice a day. Priadel liquid contains a certain amount of lithium carbonate as stipulated in the SPC. The molecular formula for lithium carbonate is Li₂CO_3. The molecular weights are

• Lithium 7g/mol
• Carbon 12g/mol
• Oxygen 16g/mol

​

• What quantity of lithium will Mrs Z. receive per daily dose, give your answer in mg to two decimal place.
• Priadel 520 mg/5 ml Liquid - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk)

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QUESTION 8-NOV 2022

• Ms. P a 77-year-old woman who weighs 80kg and 180cm tall is being treated for breast cancer .She is to receive doxorubicin at a dose of 44mg per m2 every 3 weeks. Using the national dosing banding table provided , calculate the volume of doxorubicin Ms. P will receive per dose.
• national-tables-2-mgml-multi-syringe-v2.pdf (england.nhs.uk)

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NNT QUESTION 9-NOV 2022

• You are a pharmacist involved in a clinical study testing a new drug that aims to decrease the number of clots in older women with atrial flutter. The study involves 1000 women who take a new drug for 2 years and 1000 who are given regular Rx. At the end of the study period, 6% of the women in the regular therapy group suffered a blood clot while 2% of the women in the new drug group suffered a clot.
• Absolute risk reduction (ARR) = difference in the rate of an event in the treatment group compared with the control
• ARR = (event rate in control group) – (event rate in treatment group)
• Number needed to treat (NNT) = number of people needed to be treated to achieve the desired goal of treatment.
• NNT = 1/ARR . What is the NNT for drug A?

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QUESTION 10-NOV 2022

• A 60-year-old woman weighs 60kg and is to be administered 70ml of Erythromycin 125mg/5ml solution at a rate of 7.5mg/kg/hour. After 1 hour , you are instructed to reduce the rate to 2.5mg/kg/hr. Calculate how many minutes it would take to administer the entire solution.
• Answer to nearest whole number of minutes.

QUESTION 11 - CONCENTRATION

• You are working as a pharmacist and are required to dispense a solution of chlorhexidine by making 1 in 2 dilution of your stock in order to produce 500ml of a 1 in 5000 solution for a patient to use. What is the concentration of your stock solution in parts per million ?

QUESTION 12

• Mr. Jerry a 68-year-old male had his pancreas removed due to pancreatic cancer and has to take Creon 25000 capsules as a result. He weighs 320 lb and is 6 foot tall. Using the resource provided, calculate the maximum number of creon capsules he can take a day to stay within the limit of lipase recommended. Do not exceed 10,000 lipase units per kg. Give your answer as whole number. 1lb = 0.45kg
• Creon 25000 Capsules - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk)

QUESTION 13

• Mr. X a-67-year-old suffers from bipolar disorder . He has been prescribed priadel 520mg/5ml oral solution. Assume one unit of alcohol is equivalent to 10ml of 96% ethanol found in beer. Calculate how many units of alcohol are contained in a daily dose of priadel liquid, given that he takes 5ml two times a day using a syringe that is calibrated at 5ml intervals.
• Priadel 520 mg/5 ml Liquid - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk)
• Give your answer to 2.d.p
• London Pharmacist Network on YouTube

QUESTION 14

• Mrs. Borders is a 49-year-old female patient admitted in your hospital ward with severe acute pain. She has been prescribed 90mg of diamorphine per day via a 12cm syringe driver. The diamorphine dose has been made up to 75ml with water for injection and the syringe driver has been set at a rate of 3.5 mm/hour. Mrs. Borders weighs 120 lbs . What dose of diamorphine is she going to receive per minute? Give your answer in mcg/kg.
• ANSWER TO 1 D.P
• 1lb = 0.45kg , 100mm = 10cm

QUESTION 15

• Mrs .G. takes carboceisteine 375mg capsules at a dose of 2 caps TDS every day. Her doctor would like to switch her to carboceisteine 250mg/5ml oral solution which costs £5.29 per 300 ml bottle. Assume you have to supply the drug in original containers, How much would it cost the surgery to provide a month’s supply for Mrs. G. ? Answer to nearest ten pounds.

QUESTION 16 - BREAKTHROUGH PAIN

• Mr. B is a palliative care patient who is about to be switched from oxycodone to oral morphine sulphate modified release (MST Continus) tablets . He currently takes 33ml of oxynorm 5mg/5ml liquid BD. The doctor wishes to prescribe him medication for breakthrough pain as well and asks you for your advice. Assuming the doctor prescribes the maximum volume in ml of morphine sulphate 10mg/5ml oral solution that Mr. B can take per dose for breakthrough pain. Calculate the total volume he requires for a fortnight if he takes his breakthrough pain dose every four hours .
• Prescribing in palliative care | Medicines guidance | BNF | NICE
• Give answer as whole number in ml .

QUESTION 17

A 9 year old male patient has been prescribed Amoxicillin suspension at a dose of 250mg four times a day for 2 weeks whilst in hospital. You only have Amoxicillin125mg/5ml suspension in stock. Each bottle is 100ml. The doctor decides to discharge the patient after sixteen doses of the medicine and instructs his mother to continue the course at home until completion. Based on your available stock, you are required to calculate the total volume in ml needed to complete the course upon discharge. Express your answer as number of bottles to be supplied.

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QUESTION 18

Mr. F is a 55year old man who weighs 11 stones 5lb, he regularly takes sodium valproate tablets for epilepsy. He is admitted in hospital and is due to be administered sodium valproate by I.V. injection for 10 minutes at a dose of 9mg/kg. Sodium valproate injection is available as a 400mg vial which is reconstituted with 4ml of water for injections prior to administration to yield a concentration of 95mg/ml.

1 stone = 6.35kg 1 lb = 0.45kg

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

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QUESTION 19

You are conducting a health check with Ian , a 21 -year-old man.  You advise him on healthy eating and exercise and, as part of this are discussing his weekly alcohol intake.  He informs you that, on average, in a week he enjoys a glass of red wine (13% ABV) with his evening meal daily, on Fridays he drinks 3 pints of larger (4% ABV) after work and on Saturday nights he drinks 4 shots of spirits (40%) whilst out with the lads.

Units of alcohol = volume of drink (ml) x ABV (%)

1000

Where ABV is alcohol by volume

Given that each glass of wine is 175ml, a spirit measure is 25ml and 1 pint is 568ml, by how many units of alcohol should Ian reduce his intake in order to be at the recommended weekly limit?  Give your answer to nearest 0.05.

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QUESTION 20

You currently have a 300ml stock of glucose 20%w/v, you have been asked to remove 125ml from your stock and add 125ml of a glucose 5%w/v solution to it. What is the concentration of the new solution in %w/v?

Give answer to 1.d.p

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-21 - SYNCHRONISE A PRESCRIPTION-

You are working in a community pharmacy and one of the patients complained to you that she runs out of two of her medicines rather quickly. She would like you to mention it to her practice pharmacist during your next surgery run. See details of her medication below . SYNCHRONISE risedronate tablets.

• DRUG & STRENGTH DOSE REMAINDER tablets
• METHOTREXATE 2.5MG 4 WEEKLY 12
• CO-CARELDOPA 12.5mg 1 QDS 300
• LISINOPRIL 2.5MG 1 OD 16
• LEVOTHYROXINE 100MCG 1 OD 22
• RISEDRONATE 35MG 1 PER WEEK 8
• Paracetamol tablets 500MG 1- 2 QDS 160
• LEVOTHYROXINE 25MCG ONE ON ALTERNATE DAYS 42
• CARBOCEISTEINE 375 2 TDS 96

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QUESTION 22

You receive a prescription for latanoprost 0.05% eye drops with the following instructions.

• Instil 2 drops into each eye every 3 hours for 18 hours, then instil 2 drops into each eye four times a day for a further 6 days, then instil one drop into both eyes every 12 hours for a week.
• Mitte 4 x 2.5ml.
• Store in a fridge
• Calculate the amount of active drug that would have been used at the end of the treatment. Assume no wastage! Answer in mg to the nearest whole number.

QUESTION 23

• Azithromycin is available as a powder for reconstitution . The pharmacist adds 35ml of water to constitute 60 mL of suspension Once reconstituted, the concentration of Azithromycin in the reconstituted suspension is 250 mg per 5 ml. What is the displacement volume, in ml/g, of Azithromycin powder for reconstitution?
• Give your answer to two decimal places.

QUESTION 24

• A 64-year-old woman is receiving maintenance treatment for cytomegalovirus disease.
• her actual weight is 75kg, her IBW is 67 kg and her height is 175cm.
• She has a serum creatinine of 267 micromol/litre.
• (140 – Age) × Weight × Constant

Serum creatinine

• •Weight in kilograms
• • Serum creatinine in micromol/litre
• • Constant = 1.23 for men; 1.04 for women
• What is the recommended daily dose of ganciclovir in mg/kg for this woman? one d.p.
• Cymevene 500mg powder for concentrate for solution for infusion - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk)

QUESTION 25

• Mr. Y a 34-year-old male has been recently diagnosed with asthma and has been prescribed a Ventolin 100 micrograms DPI inhaler at a dose of one to two puffs four times a day when required for asthma symptoms. Ventolin is available in a pack size of 200 doses per pack. Calculate the number of packs you would supply if the patient is prescribed the maximum dose for 2 months’ supply. Answer as whole number.

QUESTION 26

• You are working as a pharmacist and you receive a prescription requesting amoxicillin 250mg/5ml. You have available amoxicillin 250 mg/5ml oral suspension powder. The label for amoxicillin 250 mg/5ml suspension states 68 mL of water should be added to the suspension to give a final volume of 100 ml. Unfortunately, the dispenser added the wrong volume of water and a concentration of 200mg/5ml is produced instead. Calculate the volume that was added to the amoxicillin power suspension to produce a concentration of 200mg/5mL? (Give your answer to the nearest whole number).

QUESTION 27

Mr. P suffered two hyponatraemic convulsions within the last 90 days . His blood test shows that his serum sodium level is 120mmol/L. This could be a possible cause of his seizures. He is due to receive sodium via infusion. The only strength of sodium bags available to you is 3.5%w/v which will be given as 5ml per kg every 5 minutes as per the consultant’s request.

• Mr. P is 165cm tall and weighs 140 lbs.
• Based on the information given about Mr P, how much sodium in grams will he receive after a period of 120 minutes ? ANSWER to 1.d.p
• 1lb = 0.45kg

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QUESTION 28 – DILUTION

• You are instructed to prepare 200 mL of a solution of potassium permanganate of such strength that when diluted 20 times with distilled water, a 1 in 5000 solution is produced. What quantity of potassium permanganate would 50ml of the prepared solution contain?
• Give your final answer in mg as whole number.

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BIOAVAILABILTY --- 29

Miss A is a 35 year old who takes 50% of the maximum LICENSED daily dose of METFORMIN. She also takes 10ml of a herbal medicine daily to treat cough.

• Assume the bioavailability of METFORMIN is 60% and the herbal medicine can reduce the eventual plasma concentration of metformin by 20%.

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• Considering the information above, calculate the dose of METFORMIN that will REACH her blood stream after one week?
• Express your answer in milligrams. ANSWER

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QUESTION 30

• A pharmaceutical company have developed a new drug and are in the process of conducting a phase 3 trial. The trial will include a 3 arm randomised controlled study with an allocation ratio of 1:2:2.
• What is the total number of patients required to participate in the study so that there at least 99 patients in arm?

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QUESTION 31

• Nancy has been admitted to hospital where you work with acute pyelonephritis. She is prescribed intravenous gentamicin at a dose of 5mg/kg twice a day. Nancy weighs 16kg and requires treatment for 7 days. Calculate how many 2 mL ampoules of cidomycin solution for injection will be required to complete this course of treatment? Give your answer as whole number. Use the resource provided
• Gentamicin | Drugs | BNF | NICE

QUESTION 32

A patient with weight of 0.565 kg, has been prescribed a vancomycin continuous infusion at a dose of 0.8 mg/kg/hour. To give this infusion, 125 mg vancomycin will be diluted in 30 mL of glucose 5%. The infusion pump rate can be set in 0.01 mL/hour increments. What volume of drug, in mL, will be administered every 6 hours?

Give your answer to two decimal places