PEBC Ethics

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Code of Ethics

In May 1996, Council approved in principle a revised Code of Ethics based on a patient-centred care approach to practice. The draft was circulated in the Jul/Aug 1996 issue of Pharmacy Connection for feedback from members. Input from pharmacists and further discussions by the Ethics Committee were incorporated into this; the final version of the College's Code of Ethics. PREAMBLE: All pharmacists have the obligation to act in the best interest of the patient, observe the law, uphold the dignity & honour of the profession, & practice in accordance with ethical principles. The following ethical principles of professional conduct are intended to guide pharmacists in their relationships with patients, other health care practitioners, & the public. Principle One:

COVENANT

•

The pharmacist establishes & maintains a unique relationship with each patient that is based on an ethical covenant. The word "covenant" means that pharmacists have moral obligations in return for the trust given them by society.

•

Pharmacists encourage shared responsibility for adherence to medication regimens & achieving desired drug therapy outcomes.

•

This principle implies that the best pharmaceutical service, no matter how provided, occurs where the opportunity exists for direct patient contact between patient & pharmacist.

Principle Two:

CARING & COMPASSIONATE

•

The pharmacist actively promotes the well-being of every patient in a caring, compassionate manner. The patient’s well-being is at the centre of the pharmacist's professional & business practices.

•

This principle ensures that no patient shall be deprived of pharmaceutical services because of the personal convictions or religious beliefs of a pharmacist. Where such circumstances occur, the pharmacist refers the patient to another pharmacist who can meet the patient's needs.

•

The pharmacist exercises his or her professional judgement to ensure the patients' needs are met in situations where emergency services or care may be required.

Principle Three:

CONFIDENTIALITY

•

The pharmacist preserves the confidentiality of information about individual patients acquired in the course of his or her professional practice & does not divulge this information except where authorized by the patient or required by law. Pharmacists protect their patients by serving them in a private & confidential manner.

•

Pharmacists do not divulge information that identifies the patient; except in instances where there is a compelling need, in the pharmacist's professional judgement, to share information in order to protect the patient or another person from harm, or where authorized by the patient or required by law.

Principle Four:

AUTONOMY

1

•

The pharmacist respects the autonomy, individuality & dignity of each patient. Pharmacists acknowledge the right to self-determination, & recognize individual self-worth by encouraging patients to participate in decisions about their health.

•

Pharmacists respect personal & cultural differences, & do not discriminate against any patient for reasons of race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, sex, sexual orientation, age, marital status, family status or handicap.

Principle Five:

HONESTY

•

The pharmacist acts with honesty & integrity. Pharmacists never knowingly condone the dispensing, promoting or distributing of drugs or medical devices which are not of good quality.

•

Pharmacists do not participate in any promotional methods or campaigns which encourage the inappropriate use of medicines or in any professional or business dealings which are not marked by honesty and integrity.

Principle Six: •

The pharmacist continuously improves his or her professional competence & strives to enhance the quality of pharmaceutical service & care provided by the profession. Pharmacists take responsibility for assurance of their own competence, & strive always to perfect & enhance their professional knowledge. Pharmacists further develop the quality of pharmaceutical service & care provided to the public through association with organizations whose mandated include this goal.

Principle Seven: •

CO-OPERATIVE

The pharmacist collaborates with other health care professionals to achieve the best possible outcomes for the patient. Pharmacists understand the individual roles & contributions of other health care professionals & consult or refer where appropriate. Pharmacists also acknowledge that colleagues & other health care professionals may differ in the beliefs & values they apply to the care of the patient. Pharmacists may not participate in any promotional methods or campaigns which undermine the exercise of professional judgement by the pharmacist or any other health care professional.

Principle Eight: •

COMPETENT

ADVISABLE

The pharmacist advocates for health promotion at the individual, community & societal levels. Pharmacists have a primary obligation to promote the health of individuals. This obligation can be extended beyond the individual to the community & society as a whole. Pharmacists engage in dialogue with patients, provide public education to community groups & seek opportunities to advocate for health promotion to benefit society as a whole.

Principle Nine: •

The pharmacist promotes the appropriate utilization of health care resources. Pharmacists promote the use of cost-effective therapies and discourage the purchase or use of unnecessary products or quantities.

Principle Ten: •

The pharmacist practices only under conditions which do not compromise professional standards & enables other pharmacists to practice in accordance with high professional standards. Pharmacists act in accordance with the highest professional standards when carrying 2

out their duties & do not accept employment where their ability to do so may be compromised. Pharmacists in control of a pharmacy practice as owner, manager or in-charge pharmacist, ensure that there are no conditions which compromise another pharmacist's ability to practice in accordance with high professional standards & exercise solid professional judgment.

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Ethical Principles Within this framework, there are four important ethical principles that permit a consistent defense of a position on specific issues: Autonomy, nonmaleficance, beneficence and justice. By applying these principles from the perspective of either an idealist, or a consequentialist, a pharmacist can determine the patient’s rights & the pharmacist's correspollding duties for a given dilemma. The primary objective is to enable pharmacists to juslify ethical conduct if that conduct is challenged. Autonomy: The principle of autonomy requires that persons make their own evaluations & choices when their own interests are at stake. If individuals are viewed as agents with their own unique approach to life (their values, interests, attitudes, etc.), then it would be disrespectful of individuals to reject their considered judgments or to deny them the liberty to act on those judgments. Autonomous individuals are at liberty to perform whatever actions they wish, as long as another autonomous individual’s actions are not infringed, even if the actions appear to be foolish or unwise based upon conventional & generally accepted wisdom. Under the principle of autonomy a person who is a competent decision maker is free to use a medicinal drug in a way that is 1ess than optimally safe & effective, if he generally recognized ‘right way” to use the drug interferes with the person’s life-style. Non-maleficence: The principle of non-maleficence (doing no harm) requests that we refrain from acting in ways that will harm or injure others. Students sitting in a classroom can continue indefinitely to stare out the window & daydream without violating the principle of nonmaleficence because it is through acts of commission that this principle is viotated. Non-maleficence prohibits both deliberate harmful action (substituting one drug product for another without authorization & without evidence of equivalence) & unintentional harm (carelessly typing take one tablet 4 times daily, on the label of a digoxin Rx). Beneficence: The principle of beneficence (doing good) requires positive action to: 1) prevent what is bad, 2) remove bad or evil & 3) do or promote good. It is through acts of omission that this principle is violated. E.g., the pharmacist who neglects to counsel patients on the appropriate use of medications has violated the principle of beneficence, even if the Rx was filled correctly. Unfortunalely, health care-givers have at times used beneficence as an excuse to do for patients what is in the caregiver's view is best for the patient, even if the patient prefers that it not be done. Beneficence of this type is often referred to as paternalism, a concept that moral philosophers love to criticize. Justice: The principle of justice (fairness) requires that people receive that to which they are entitled. Equals should be treated equally, unequals should be treated unequally. A pharmacist who provides sub standard service or who refuses to provide service to a patient receiving medication to treat AIDS has violated the principle of justice. Pharmacists are the health care professionals most closely linked to the drug distribution system, so it is important for pharmacy students to understand that drug distribution is inherently paternalistic. Even that great champion of liberty, John Stuart Mill, recognized the need to prohibit the use of drugs by people who, under the influence of drugs, might harm other members of the society & the need to reduce undue pressure on potential buyers of drugs who might unknowingly act against their own best interests.

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Ethical Terminology Autonomy: Autonomy refers to one's moral right to make choices & decisions about one's own course of action. Paternalism: occurs when one fails to respect another's autonomy, & acts with disregard to that individual's rights. Substitute their own beliefs, opinions, & judgements for the patient's judgement, claim they acted in the person's best interest. Non-maleficence: “Do no Harm". This principle, one of the oldest ethical principles, reminds us that if we cannot help patients, at the very least, we owe a duty not to harm them. (Benefit vs. risk) Beneficence: Stands for the duty to prevent harm to others, remove harm from others & to promote good. One's obligation to this moral duty ends where action can bring harm to oneself. Often one must the duty to act with the harm acting may cause to oneself, in which case the obligation to this moral ends. Justice: fairly distributing burdens & benefits in society, & giving individuals their due. One can balance the needs of the individual with the needs of others in society competing for the same resources, called comparative justice. Veracity: Honesty. One's obligation to speak & act truthfully affects all communication with patients. (e.g. if a cancer patient is told he is alright, veracity is broken) Confidentiality: All health care providers have a duty, or obligation to limit access to information gathered in the course of treatment, & to keep the information strictly between the health care provider & the patient. Informed consent: obligates health care providers to present patients with details, benefits, risks, & potential risks of all proposed intervention strategies (so patients can make willing, informed choices in their care). Fidelity: means the moral duty to keep promises & commitments. (Graber, 1998; Beauchamp & Childress, 1994). Duty: obligation individuals have to others in society. Sometimes those duties exist because of the nature of the relationship between the parties. Rights: ability to take advantage of a moral entitlement to do something, or not to do something. Competency: A pharmacist does his duties.

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Code of Ethics:

In brief

1.

Pharmacists hold health & safety of each patient to be of 1ry consideration.

2.

Pharmacists form a professional relationship with each patient.

3.

Pharmacists honour the autonomy, values & dignity of each patient.

4.

Pharmacists respect & protect the patient’s right of confidentiality.

5.

Pharmacists respect rights of patients to receive pharmacy products & services & ensure these rights are met.

6.

Pharmacists observe the law, preserve high professional standards & uphold the dignity & honour of the profession.

7.

Pharmacists continuously improve their levels of professional knowledge & skills.

8.

Pharmacists co-operate with colleagues & other health care professionals so that maximum benefits to patients can be realized.

9.

Pharmacists contribute to the health care system & to societal needs.

Ethical Principles:

In brief

Autonomy: One’s moral right to make choices & decisions about one’s own course of action. “Every human being of adult years & sound mind has the right to determine what shall be done to his own body.” Nonmaleficence: Do no harm. If we can’t help patients, at the very least, we have an obligation not to harm them. “Risk vs. benefit”. Beneficence: Do good. The duty to prevent harm to others, remove harm from others, & to promote good. If action can bring harm to oneself, the obligation to this moral duty ends. Balance: Duty to act vs. harm acting may cause. Justice: fairness Veracity: act with honesty, without deception. Confidentiality Compliance: a. The act of complying with a wish, request or demand, acquiescence b. Medicine = willingness to follow a Rx course of treatment c. A disposition or tendency to yield to the will of others Adherence: a.

The process or condition of adhering

b.

Faithful attachment & devotion (adherence to the rule of law).

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Ethical Principles: Examples Autonomy: we respect the rights of others to make choices & bare the responsibility of consequences. Examples: •

If a pharmacist refuses to dispense OCP to a girl due to religious concepts, then he broke autonomy.

•

If an end stage cancer patient, his family wants the physician to do a last therapeutic trial without informing the patient which principle prevents the physician?  autonomy

Beneficence: we do good to patients placing the benefit of the patient over other factors such as cost. Examples: •

Pt needs a refill Rx of phenytoin on Saturday evening, there is no refill authorization remaining & the patient’s Dr is out of town. If the pharmacist refuses to refill the Rx he is breaking which principle?  Beneficence

Veracity (Fedility): To be honest & responsible. We act with honesty without deception. Examples: •

A cancer patient has only 1 month to live. If we do not tell him (or tell him he is alright) you broke the principle of  veracity

Other Examples: •

If a pharmacist refuses to councel an AIDS patient he broke which principle  Justice

•

A girl took OCP; her father wants to know which drug his daughter is taking. If you tell him you broke the principle of  Confidentiality.

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Canada Health Act Overview The Canada Health Act received Royal Assent on April 17, 1984. The Act which came into force in April 1, 1984, repealed the Hospital Insurance & Diagnostic Services Act & the Medical Care Act. The purpose of the Canada Health Act is to “establish criteria & conditions in respect of insured health services & extend health care services provided under provincial law that must be met before a full cash contribution may be made. The criteria, provisions & conditions relating to extra-billing & user charges are set out in sections 7 through 12 & sections 13, 18 & 19 of the act. The criteria & extra billing & user charge provisions apply to insured health services only, & do not pertain to extended health care services (EHCS). Only the conditions, as set out in section 13, relate to both insured health services & EHCS. The insured health services defined by the Canada Health Act include all medically necessary hospital services & medically required physician services, as well as medically or dentally required surgical-dental services requiring a hospital for their proper performance. Extended Health Care Services (EHCS) payments are made in respect of nursing home intermediate care, adult residential care, home care & ambulatory health care. The services are part of a broad range of health & social services offered by a variety of community & institutional programs & facilities to residents of a province. The majority of residents using these services are aged 65 & over. The criteria & conditions that each provincial health insurance plan must meet in order to receive full fedral cash contributions under the Canada Health & Social Transfer (CHST) in each fisical year are: 1. Public Administration: Pursuant to section 8, the health care insurance plan must be administered & operated on a non-profit basis by a public authority, responsible to the provincial government & subject to audit of its accounts & financial transactions. 2. Comprehensiveness: Pursuant to section 9, the plan must insure all insured health services provided by hospitals, medical-practitioners or dentists &, where permitted, services rendered by other health care practitioners. 3. Universality: section 10 requires that 100 % of the insured persons of a province be entitled to the ensured health services provided for by the plan on uniform terms & conditions. 4. Portability: in accordance with section 11, residents moving to another province must continue to be covered for insured health services forby the home province during any minimum waiting period imposed by the new province of residence not to exceed 3 months. For insured persons, insured health services must be made available while they are temporarily abscent from their own provinces on the basis that: insured services recieved out of a province, but still in Canada, are to be paid for by the home province at host province rates, unless another arrangment for the payment of costs exists between the provinces. Prior approval may be required for elective services; out-of-the country services are to be paid as a minimum, on the basis of the amount that would have been paid by by the home province for for similar services rendered in the province. Prior approval may also be required for elective services. 5. Accessability: by virtue of section 12, the hea1th care insurance plan of a province must provide for insured health services on uniform terms & conditions & reasonable access by insured persons to insured health services, unprecluded or unimpeded, either directly or indirectly, by charges or other means; reasonable compensation to physicians & dentists for all insured health services rendered; payments to hospitals in respect of the cost of insured health services. Conditions: In addition to the aforementioned criteria, the conditions that provincia1 governments must meet in order to be eligible for the full cash portion of the fedral contribution & payment in respect of insured health services, as well as extended health care services, are: the provision of information that the Minister of Health may require for the purpose of this Act, at the times & in the manner prescribed by the regulations; & the appropriate recognition to the Canada Health & Social Transfer relating to insured health services & extended health care services in the province. 8

Other: The Canada Health Act also prescribes a consultation process in the case of compliance questions.

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1.

Nonmaleficence means do no harm

2.

Beneficence means doing good for patients by placing their benefits over other factors.

3.

Why don’t we try new drugs on children?  The concept of paternalism

4.

The ethical principles of veracity requires that a pharmacist should: a.

respect the rights of others to make choice

b.

do good for the patient placing his benefit over other factors, e.g. cost

c.

avoid, remove or prevent harm

d.

act with fairness to allow people to receive that to which they are entitled

e.

act with honesty, without deception

Answer: E. Choice A is autonomy, Choice B is beneficence, Choice C is non-maleficence, Choice D is Justice. 5.

Which of the following are ethical principles? a.

Autonomy

b.

Beneficence

c.

Veracity

d.

Non-maleficence

e.

Justice

Answer: A, B, C, D, E 6.

If a pharmacist refused to dispense OCP to a girl due to religious concepts, which principle he violates? a.

Beneficence

b.

Non-maleficence

c.

Justice

d.

Autonomy

e.

Veracity

Answer: D 7.

If a pharmacist refused to counsel a patient with AIDS, which principle he violates? a.

Beneficence

b.

Incompetence

c.

Justice

d.

Veracity

Answer: C 8.

A cancer patient has only 1 month to live, if you do not tell him the truth you violate: a.

Fidelity (veracity) 10

b.

Confidenciality

c.

Beneficience

d.

Autonomy

Answer: A 9.

A patient on phenytoin & his physician is abroad; if the pharmacist refused to given him the drug due to restriction of law, which of the following ethical principles may have been most violated: a.

Non-maleficience

b.

Beneficience

c.

Confidentiality

d.

Common sense

Answer: B 10. Mr. Jones is working Saturday evening at his community pharmacy in a small village. He is approached by a patient who needs a refill prescription for his phenytoin, & no refill authorization remains. The patient's doctor is out of town. Mr. Jones chooses to not refill the Rx since he feels that he may be at risk of being disciplined by his licensing body if he does not follow the law. Which of the following ethical principles may have been most violated if he does not provide any medication? a.

Nonmaleficence

b.

Autonomy

c.

Beneficence

d.

Justice

e.

Veracity

Answer: C Competency: 2.1 11. A 16 year old girl is getting O.C. Her parent came to the pharmacy asking you. What are the two contradicting ethics? a.

veracity - non-maleficence

b.

veracity - autonomy

c.

veracity - confidentiality

d.

non-maleficence

- beneficence

Answer: C 12. If you impose or imply your opinion so that the patient should take the medication you are recommending, this is called: a.

Patenralism

b.

Nonmaleficence

c.

Autonomy

d.

Beneficence 11

Answer: A 13. Which of the following ethical principles is beening most violated by the wrong filling of a Rx a.

Nonmaleficence

b.

Autonomy

c.

Beneficence

Answer: A 14. A physician who has recommended urography for her comptent 68 year old male patient is trying to decide whether or not to disclose the remote risk (1 in 10,000) of a fatal reaction. If the physician favors non-disclosure, reasoning that it would not be in the patient’s best interest to worry him with such remote risks she is guided by: a.

beneficience but not non-maleficence

b.

justice

c.

non-maleficence but not beneficence

d.

gratitude

e.

both beneficence and non-maleficence

A & E: E. If the doctor’s concern is not to harm the patient with unnecessary worry, the guiding principle is non-maleficence; if her concern is to be able to benefit the patient with urography (which is impossible since the patient refuses to risk) the guiding principles is beneficence. 13. If she believes that her decision should be determined by what other physicians would do in similar circumstances, she is guided by: a.

both beneficence & non maleficence

b.

respect for autonomy

c.

strong paternalism

d.

professional practice std.

e.

weak paternalism

A & E: D. Depending on what the professional practice standard dictates, the decision would still be guided by professional practice & if she decides whether or not the patient would want to learn about such risks, she is guided by respect for autonomy. 14. When a pharmacist does not counsel a patient for warfarin S/E, he violates: a.

Non maleficence

b.

Beneficence

c.

Justice

d.

Veracity

Answer: A 15.

A pharmacist refuses to counsel a patient who takes half the prescribed dose although he advised him several times before, he is violating: a.

Beneficence 12

b.

Justice

c.

Autonomy Answer: A

16.

A patient came to you & badly needs a repeat for Ventolin, has no repeat, if you don’t give you violate: a.

Nonmaleficence

b.

Beneficence

c.

Justice

d.

Veracity

Answer: B 17.

Physicians may go for the beneficence of their patients & break a law e.g. a Dr does not tell his patient about his illness to make him take the medication, he breaks which law a. Autonomy b. Veracity c. Confidentiality

Answer: A 18.

A physician phoned a pharmacist to ask him not to tell the patient about the side effects of a drug because if he does, the patient will not take it. Both the physician & pharmacist seek for which ethics a. Beneficence. b. Nonmaleficence c. Autonomy d. Veracity

Answer: A 19.

A physician asked a pharmacist to tell the patient that the drug prescribed is a multivitamin & not a hypnotic so that he might not commit suicide. What ethics is the physician looking for? a. Beneficience b. Nonmaleficence. c. Autonomy

Answer: B 20. A patient taking terbutaline inhaler & using it a lot, if the pharmacist fails to advice him to see his doctor to add a corticosteroids inhaler to his medications, then he mostly violated? a. Beneficence b. Nonmaleficence c. Veracity 13

d. Autonomy Answer: A 21. A patient taking a drug in a wrong way & the pharmacist counselled him many times & now the pharmacist does not want to counsel him again, then he mostly violated? a. Beneficence b. Nonmaleficence c. Veracity d. Autonomy Answer: B 22. A cancer patient does not want to take her medication due to S.E. & her doctor asked the pharmacist to tell her that the medication is a multivitamins, what is the doctor seeking for? a. Beneficence b. Nonmaleficence c. Veracity d. Autonomy e. Paternalism Answer: A 23. The parents of a very smart boy who has cancer ask you not to tell him, in order to make him take the medication, which law does the pharmacist violate a. Autonomy b. Veracity Answer: A 24. If we tell someone that his medication is just for a multivitamin, in order to make him use it, which law is that against a. Autonomy b. Veracity Answer: A a pharmacist w 25. What is the ethics definition of ho does his duties? a. Justice b. Veracity c. Nonmaleficence e. Beneficence d. Competency Answer: E 26. A pharmacist isn't convinced with the patient’s refusal to take a medication, what is it called? 14

a. Paternalism b. Veracity c. Nonmaleficence d. Beneficence Answer: A 27. What is the first principle in the code of ethics a. to obey the law of practice b. to protect public health c. to be a member of the board Answer: B 28. A pharmacist carelessly did not councel a patient on an asthma medication (puffer) so he violated a. beneficence b. nonmaleficence c. autonomy d. veracity e. justice Answer: A 29. A physician wants to try a new medication but the patient refused so he told him that it is only a vitamin, so he aimed to a. Paternalism b. beneficence c. veracity d. autonomy e. nonmaleficence Answer: B 30.

A drug that has trials on geriatrics with-holding it from pediatrics, this is obeying which of following a. nonmaleficence b. justice c. autonomy d. paternalism e. beneficence

Answer: A 15

31. A patient on B2 agonist, he has recurrent attacks, if you donot refer him to the doctor you violate: a. nonmaleficence b. justice c. autonomy d. paternalism e. beneficence Answer: E 32. JN, a 17 year old male with a highly resistant form of testicular cancer, is in hospital for treatment. He is an intelligent, articulate young man. His parents are insisting that the physician treat him with the latest experimental therapy, but JN does not want to undergo the treatment. If the physician goes ahead and gives the experimental therapy what ethical principle will have been violated the most? a. Beneficence b. Veracity c. Non-maleficence d. Autonomy e. Justice Answer: D Competency: 2.1 37. A pharmacist refuses to fill a prescription for a patient with AIDS because he fears he will contract the disease; this violates the ethical principle of: a. nonmaleficence b. beneficence c. autonomy d. veracity e. justice Answer: B 38. The correct definition of nonmaleficence is a. any action that produces good for the patient b. any action that protects the patient from harm or evil. c. treatment of the patient autonomously. d. acting with honesty Answer: B 39. A pharmacist gives a patient losec instead of lasix, it is against which law? a. nonmaleficence 16

b. beneficence c. autonomy d. veracity Answer: A 40. In the above case what should the pharmacist owner do? a. He should accept the mistake & ask the patient's doctor what to do 41. What ethics is broken if you insist on giving a medication to a cancer pt who refuses taking it a. nonmaleficence b. beneficence c. autonomy d. veracity Answer: C 42. A patient came to a pharmacy to dispense a Rx of ethinyl estradiol 17-B; the pharmacist noticed that the dose is very high, he is religious so he refused to dispense it, which ethical principle is he seeking a. Autonomy b. Beneficence c. Nonmaleficence d. Veracity Answer: C 43. A Dr is treating a patient who is not ready to take the medication because of side effects, eventhough the Dr goes ahead; which law he violates a. Autonomy b. Justice c. Veracity d. Nonmalifecence Answer: A 44. A patient has a serious disease & the Dr asks the pharmacist not to tell him anything about it; they are favoring which law a. Autonomy b. Justice c. Paternalism d. Nonmalifecence Answer : D 45. Paternalism  to give others instructions as if giving orders 17

46. Canadian Health Act bans extra billing 47. The pharmacy legislation is controlled by: a. Canadian drug law 1961 b. Canadian drug law 1999 c. Canadian drug law 1984 Answer: C 48. The standards & legislation of pharmacy practice are controlled by: a. Canadian Federal Act of 1984 b. Provincial & federal authorities c. Metropolitan authorities Answer: A. The Canadian Federal Act of 1984 controls legislation and practice 49. The Canadian parliament approved a law to protect: a. The patient b. The pharmacist c. Answer: A. 50. The Canadian health act (1984) embodies all of the following principles except: a. Affordability b. Accessibility c. Comprehensiveness d. Portability e. Universality f. Public administration Answer: A 51. The most important changes in pharmacy practice in the last 20 years is / are: 18

a. increase in dispenmsing fee b. increase the number of new pharmacies c. increase the average size of pharmacies in Canada d. Increased involvement of the government & other 3rd party agencies as payors i.e. health insurance & drug benefits e. decreased drug sampling to physicians Answer: D 52. What is the responsibility for Canada Health Act? a. mandates the pharmacist to counsel each patient b. universal the health care of Canada c. extended health care service d. a person must be insured before a full cost might be made Answer: B 53. Who is costing (pricing): a. Federal government b. Provincial government c. Canadian drug law 1984 Answer: A, B & C 54. Which of the following agencies is responsible for revising the quality of a drug a. Bureau of surveillance b. Food & Drug Administation c. College Answer: B 55. If the pharmacist wants to change provinces, what should he do? a. passing the board exam again b. take a permission from the college c. passing the jurisprudence exam again of the new province Answer: C 56. Pricing view association committee is responsible for a. to control prices of sales of manufacturer. b. to protect the patient c. Controlling prices of sales of pharmacies Answer: A 57. What is the duty of the ministry for designing drug prices? a. Protecting clients 19

b. Supervising the prices to be the same 58. Answer: B What is the duty of the ministry for designing drug prices? 59. What do provinces and territories have to do to get their supply? a. Each province has its own regulations, minister of health and drug benefit plan 60. Open formulary: a. Contains uses of the drug b. Comprehensive c. Makes restriction for non-formulary drug Rx even if they are under clinical supervision Answer: B 61. The co-payment program is concerned with all of the following EXCEPT: a. help people who are not able to afford drug prices b. make the patient pay a portion to decrease the cost of medication Answer: A 62. Pharmaceutical care concerns with all except: a. Disease cure b. Disease prevention c. Prevent progression of the symptoms of disease d. Identify D.D.I e. Decrease severity of the symptom Answer: A 63. The Canadian health act 1984 includes: a. No extra-billing or user fees

(Accessibility)

b. Medically required services provided must be covered

(Comprehensiveness)

c. Benefits must be portable from province to another

(Portability)

Answer: A, B & C 64. Canadian health act includes: a. Accessibility, comprehensiveness, affordability b. Portability, universality, affordability, accessibility c. Universality, public administration, accessibility Answer: C 65. The aim of Canadian health care system is: a. Only the Canadian citizens get medical services b. All Canadian citizens & immigrants get easy accessibility to medical services c. Visitors to Canada are covered with medical services 20

Answer: B 66. Canada health care system is mostly concerned about a. All patients get access to all services (accessibility) 67. Canada health act pays for all except: a. Veterans b. Over mountain c. Police d. Native Canadians (Indian affairs) e. Indegnity for people Answer: C 68. Somebody comes with ADR to a new drug. As a pharmacist you should take the medication history of the patient and report ADR to the reporting unit in Ottawa. 69. PEBC defines the rules and takes the exam 70. Health Care plan makes sure on a. Prices of medications in pharmacies are the same b. Dispensing fees are the same Answer: A & B 71. Hospitals work according to federal rules to be elegible for a. Tax free b. Part of money Answer: 72. NDSAC (National Drug Scheduling Advisory Committee) is responsible for: a. Drugs that are dispensed by prescription. b. Drugs that are not dispensed by Rx but must be dispensed by a pharmacist c. OTC drugs Answer: A, B & C 73. Patent Medical Pricing Review Committee reviews a. cost of patent medication b. benefits of patent medication c. comparing prices of patent & generic medications d. Controlling pricing of sales of manufacturer Answer: A 74. Health Canada makes sure that a. all Canadians are covered b. seniors get medications free 21

Answer: A & B 75. Canada health care system offers services to a. All permanent residents of Canada 76. What regulates the pharmacy practice in Canada: a. Collage b. OCP c. Provincial Institutes d. NAPRA Answer: C 77. A medical rep brings you a new drug to promote. What should you consider a. it is approved by medical health b. it is approved by provincial health c. it is peered by medical magazines Answer: A, B & C 78. The most important change in health care is based upon coverage by: a. federal government b. private organization c. provincial government d. Indian affairs Answer: C 79. What is the duty of the ministry in designing drugs prices? a. Protecting clients b. Supervising the prices to be the same Answer: A & B 80. Canada health act gives more …. & free medicine to a. First nations b. financially poor c. 65 yrs old d. pets Answer: A, B & C 81. From co-payment increase results: a. Patient cannot afford to buy the drug b. Decrease overall production Amswer: B ?? 82. Role of registration committee? 22

83. Accreditation committee? 84. Pt medication price review board who handles it : Fedral government (not provincial, manufacturer nor whole saler) 85. What does this mean in fedral law RCMP? 86. A Rx from USA is dispensed only in USA. Regulation prohibits any Rx from USA to be dispensed in Canada. 87. Prescription coming from USA  Patient should go to emergency clinic with his Rx to authenticate 88. Rx coming from USA  Do not send Rx to walk in clinic alone. Patient must accompany his Rx. 89. A very busy patient coming from USA for a conference in Canada has HT & he forgot to bring his medicine with him, what do you do as a pharmacist: a. You use your professional judgement & give him his medicine just for his stay in Canada b. You are looking for the best interest of the patient c. You send him to a walk-in clinic. Answer: C 90.

Rx by e-mail from USA for a patient visiting Canada for 2 days, what to do? a. Must get a new script signed by a Canadian doctor

91.

Patient from USA has Rx from USA & can't go back to get the medication, what to do: a. Co sign with Canadian doctor b. Do not fill it c. Import drug d. See Canadian Dr.

Answer: D 92.

An anticancer drug was given to a lady by a US physician & she comes with the US Rx to the pharmacy; what would be your response to this: a. send her to the nearest walk-in clinic

93.

A lady comes from US, & you gave her 2 days supply for pain; you apply which law: ethics of benefit

94.

A person has a Rx from USA, what is correct to do? a. The drug should be ordered from the USA b. Because 2 weeks later the drug is released in Canada, it is OK to dispense it c. It is not allowed to prepare it.

Answer: C ?? 95.

The feedback from USA, is not valid in Canada , because USA differs from Canada in health expenses, insurance and ,.., 23

96.

A patient has a Rx from USA, he wants 2 tab. only for 2 days till he returns home. What will you do a. give 2 tab b. get new prescript from emergency c. Co-sign d. send e-mail to doctor in USA

Answer: C 97.

A patient from USA, his plane was delayed for 2 days & he ran out of his medication (Metformine, enalapril, atorvastatin). He brought the empty vials & asked for 2 days supply, the pharmacist agreed to give him the 2 days supply; this is considered a. legal according to health canada act b. Ethical according to pt. beneficence c. Ethical according to professional judgment

Answer: B & C 98.

A patient wants to take cough syrup (large amounts) to USA, the pharmacist refuses to give her because of all of the following except a. it is not allowed to take drugs to USA except for personal use b. this drug may cause addiction c. it will be taken by USA authority d. no pharmacy-patient intervention about the drug

Answer: A & B 99.

A pharmacy is getting medication from Asia, brand name, licensed to be sold in Canada only manufactured in Asia, all are right except a. manufacturing conditions may not be approved in Canada b. shipping conditions may not be suitable c. it is OK if this is done by Health Canada

Answer: 100. A USA Dr. sends an e-mail to dispense a few days supply for a DM patient. What should you do a. Dispense as it is an emergency b. Get a new Rx from a Canadian Dr Answer: B 101. A physician near your pharmacy asked you to change samples for other drugs from your pharmacy: a. you change the samples if they can be taken b. you change the samples if the physician is your friend 24

c. This is against the Canadian Pharmacy Law & code of ethics d. This is not ethical Answer: C 102. Samples can be exchanged with: a. doctors only b. companies c. cannot be exchanged d. friends only Answer: C 103. A Dr. gives a sample to the pharmacist & asks him to give it free to a pt: a. Pharmacist can not accept it as this is illegal, he cannot keep samples in the pharmacy b. Fill Rx with these samples c. Give samples free to needy people Answer: A 104. An active pharmacist asks for salary increase; what should the owner do? On which basis? a. on the basis of prices of salaries/hr b. on the basis of the effect of this on other staff c. Bases of the effectiveness of this pharmacist in comparison to others Answer: A 105. What should a hospital pharmacist who does not have enough personnel at weekend do? a. stop overlapping in shifts b. flexible shifts for staff c. increase working hours d. take more shifts himself e. Leave the pharmacy to the nurse in charge Answer: A, B, C & D 106. Who makes the orders for drugs, according to which basis? a. According to inventory items 107. How would you improve the health care service in your pharmacy? a. invite a nurse b. educational program Answer: A 108. The control of a supervisor in management is considered to be: a. to set the standard of control b. to take the output according to the set standards 25

Answer: B 109. Interference factor that affect the inventory? a. not checking the expiration dates regularly b. let medical reps. make order to the pharmacy c. you cover the need of your area only Answer: A, B & C 110. To prevent the internal drug diversion (Stealing) in your pharmacy, what to do? a. Unpredictable inventory check up (unexpected audit) b. Ask references upon hiring c. Do not leave premises & watch employees during lunch break Answer: A & B 111. You are a pharmacy owner, you increase the duties of a pharmacist by 30% to 50%; you should do all except: a. discuss the suitable way to ↑ the efficacy of these activities b. give some of his duties to another person c. cancel some activities that have shown no benefits to the pharmacy. d. Increase his salary e. review his performance lately Answer: D 112. To improve the relation between the pharmacist & the technician a. describe the responsibilities of each gp b. engage them in continuous education program Answer: A & B 113. Soln. Y is revoked (discontinued) temporarily by the company, you should do all except: a. try to have lots from all suppliers b. call doctor and tell him that the medical is in short c. order suitable alternative Answer: A 114. Drug generic X, and the manufacturer is trying to convince the pharmacist to have a stock of it which are the least important thing for the pharmacist to know? a. what is the minimum order & bonus, what is the shelf capacity b. the patient needs for this medication c. how frequent will it be written by the physician d. effectiveness of drug e. the cost Answer: A 26

115. The pharmacy staff are complaining about one pharmacist who has just come back from maternity leave, also patient complains because of the frequent errors in Rx filling and due to delay in their Rx filling due to lengthy phone calls, what is the best response from the manager especially when he asked the pharmacist and knew that a problem with the nanny of the baby is found and she is looking for a better one: a. he might tell the pharmacy staff and patient that this is a temporary situation and it will be solve soon b. he might tell the pharmacists that the existing behavior is unacceptable and so a discipline might be applied if it is continued & it is better to change his behaviour. c. hire more staff temporarily to help the pharmacist, ↓↓ frequency of errors d. arrange a trusted co-worker to follow the pharmacist behavior to ensure that the future decision is the right one. e. apply a discipline for her Answer: B 116. If a pharmacy assistant had a common cold; while dispensing a dosage form he sneezed in it. What is the role of the pharmacy manager? a. Dispense the dosage form, then apply discipline with the assistant. b. Discard the dosage form and then send the assistant home for rest c. Discard the dosage form and apply discipline to the assistant d. Keep him away from the dispensing area and apply discipline to him e. Discard the dosage form, keep him away from the dispensing area and review the primary aseptic techniques in dispensing with him Answer: E 117. What can reduce the pharmacy income: a. Large expenses b. The bills Answer: A 118. All must be audited except medications bought from wholesalers 119. A manager finds that a pharmacist is drunk and does not behave well enough, what to do: a. report to the college ( after warning him verbally several times) 120. To reduce the work load on the pharmacist to fulfil clinical duties the pharmacist manager should do the following: assign the duties to the technician 121. Pharmacy Manager wants to increase pharmacist concerns about pt. more than other duties without hiring more pharmacists. What to do a. Recruit Pharmacists b. Give pharmacists' training c. Reduce other duties done by pharmacists Answer: B & C

27

122. Pharmacy manager wants to change his computer system, what is the correct order of his action? a. Calculate his budget or cost of project b. Find out the capability of existing machines c. Find out the vendors requirements d. Find out if the software capable of fulfilling these functions Answer: Correct order: C, B, D, A 123. Pharmacy manager wants to delegate some of the ph. work to technician, all of the following, prevent this from being done except? a. Ph. attitude b. Ph. being available c. Technician not well trained d. College regulation that some duties must be done by ph. Answer: B 124. Manager of hospital pharmacy wants to talk about ways to be aware of dispensing errors, he would invite all of the following except? a. Patient b. Pharmacist c. Risk management representative d. Nurse e. Good practice manager Answer: A 125. Manager of pharmacy putting schedule program, is concerned with all except a. Workers are treated equally b. Schedule is template from month to month c. Schedule can be predictable for future d. They feel committed. Answer: B 126. A hospital will begin to buy commercial Pot. Chloride instead of preparing it, the commercial product will make difference in all following except. a. Waste amount of Pot. Chloride b. Fulfilling needs of Pt. c. Total amount used of Pot. Chloride d. Reduce errors in preparations e. Reduce number of bags used for solution 28

Answer: B 127. What's the problem if in inventory rate is less than that what it should be in the pharmacy? a. Then there is theft b. The cost of drug dispensed is more than that recorded in computer for the Drug benefit Plan Answer: B 128. A pharmacist who is always sick at weekends & uses many medical offs, what is best thing to do a. Fire him b. Asking his doctor c. just talk to him d. Decrease his salary Answer: C 129. A pharmacist wants to take a week-end off but the manager does not allow him, he calls the pharmacy & says he is sick & can not come. What can the pharmacy manager do? a. Give him disciplinary notice b. It is the pharmacist’s right to take a day-off c. The pharmacy manager should ask him when he will come back Answer: B 130. It is aweek end & very busy hours, a pharmacist wants to finish his work to go home because he has a weekend party, suddenly the physician calls to say that he has 17 patients who came to his clinic with meningitis & need help, what should be the approach of the pharmacy manager? a. Send the pharmacist home & ask the physician to send the patients to another pharmacy b. Call additional workers for help & ask the pharmacist to stay as long as he can c. Send the pharmacist home & ask the physician to send the patients as they need prophylactic treatment d. Tell the pharmacist not to go home as this is an emergrncy Answer: B 131. Before hiring a technician a manager should: a. ask reference b. interview the technician Answer: A & B 132. A pharmacy owner wants to decrease expenses, what to do? a. ↑ hrs of work for the pharmacists b. take shift himself 29

c. remove overlap Answer: B & C 133. For control of pharmacy products you should do all of following except a. control climate of pharmacy b. regular cleaning of counter c. check on temp of refrigerator d. clean of the shelf & ground Answer: A 134. You are a pharmacy manager and you found there is a regular error in Rx dispensing so you do all of following except a. get a 2 dispensry staff (extra) b. make a meeting for pharmacist staff c. tell them that a displine will occur if it repeated again d. an action by deductn from salary will occur Answer: A & D 135. Ph. Manager wants to watch inventory a. record date of purchases b. record amount of sales c. watch technician during lunch time Answer: A & B 136. An active pharmacist demand an increase in salary you have flexibility in budget so manager should consider all except a. other ph. that can do this job are available b. budget c. other ph. asking for raise d. life allowance e. consider his experience Answer: A 137. A medical representative is negotiating with a hospital ph. manager for a drug contract & gave him tickets for a hockey game & a gift, what is the correct action: a. manager accept it as hospital already agreed to get drug b. manager accept ticket & refuse gift as it is his personal life c. manager refuse both as its not ethical d. manager refuse ticket & accept gift e. manager accept ticket & gift Answer: C 30

138. A pharmacy owner is getting another manager to do all except financial matters, so he can do all except a. order medication b. change shifts c. contract of computers d. narcotic signer Answer: C 139. What should an owner do to increase the profitability of his pharmacy? a. ↓ overlapping b. ↓ time for mixing extremporanous preparation Answer: A 140. An owner should do certain things by himself only a. change shifts b. change hours c. personal awarding or apprazing d. putting business goals e. order medication Answer: D 141. The highest amount of expenses in pharmacy a. payrolls b. utilities c. inventory d. taxes Answer: A 142. A ph. manager wants to increase the cash money, what should he do a. ↑ stock of fast moving medication b. ↑ stock of medication c. decrease stock Answer: C 143. The hospital pharmacies in a certain area decide to use one type of generics this will help in a. avoid double using of certain generic b. getting the medication with a good price Answer: A 144. You are responsible of a hospital education programme within the hospital pharmacy & you have lack of funds to support this programme, a medical rep from a manufacturer offers you cash to support your system, what you will do? 31

a. Accept the cash as long as it is unconditional b. Refuse to keep the pharmacy integrity c. Accept the cash in your name rather than the hospital Answer: A 145. MT, a pharmacy technician, has worked in a community pharmacy for 5 years. He is welltrained and welcomes new learning opportunities. His manager, now wanting to delegate a new technical project to him, should: I discuss suggested steps to accomplish the project. II negotiate a time schedule for completion of the project. III provide support and follow-up as required. a. I only

d. II and III only

b. III only

e. I, II and III

c. I and II only Answer: E Competency: 6.1 146. Hire a New Pharmacist  No need to discuss with the colleagues 147. Selecting drug for a patient with cancer in a hospital setting should involve all of the following except: refer to hospital formulary 148. Formulary is used for all of the following except insurance deductibles 149. What are the formulary drugs & where can you find them? a. These are drugs covered by the drug benefit plan. They are found in the computer system of a pharmacy or in the formulary drug book (ODB book). 150. A hospital pharmacy manager notices that there is a lot he should do as he noticed that there is a large number of mistakes a. Invite the pharmacists to a meeting b. Check if pharmacists are over worked c. Write a letter to the pharmacists Answer: A & B ?? 151. A technician is frequently sick, what can the manager do: a. Ask for doctor declaration b. Ask for HR assessment c. Ask for Rx (to check) Answer: B ?? 152. Students want to train in a pharmacy , the pharmacist must worry about what before accepting?  efficiency 153. Pharmacy technician which is wrong: a. can take prescription from patient 32

b. can give drug to the patient c. must ask patient about his health problem Answer: C 154. A technician starts to counsel the patient after dispensing the Rx a. The pharmacist should politely take his place in counseling the patient, he reviews all the sales process and tells the assistant not to counsel patients again. 155. Role of technician to assist the pharmacist a. Take verbal Rx from Dr b. councel the patient c. take Rx from regular customer Answer: C 156. While the pharmacist is busy, a technician gave Tylenol # 1 to one of his friends; the pharmacy manger saw him; what should the Pharmacy manger do? a. Interfere & take place and after the patient has gone you have to discuss and warn the technician not to do it again. (talk to him about right regulation) b. give displenary action Answer: A 157. Technician can do all of the following except: a. Prepare admixture of chemotherapy & label it b. Order medication c. Take Rx from patient (not a new one) d. Prepare pt files e. Take verbal Refill Rx. Answer: E 158. Technician can do all of the following except: a. prepare Rx b. Councelling pt for a new Rx c. sell behind counter & OTC d. Make filing of Rx e. put data Answer: B & C 159. Technician can do under supervision a. Rx completion b. Entering data c. preparing Rx d. Councelling pt 33

Answer: C 160. Which duties are ideal for a pharmacy tech.: a. prepare the label 161. Hospital pharmacy tech expansion duties include all except: a. tech can check the drug profile and recommend a product 162. A man approached a technician and asked him for a recommendation which will he can recommend: a. Deodorant 163. Pharmacy Manager saw technician giving exempted Codeine to the pt., he interfered because a. Pharmacist should document sales by himself b. Pharmacist should interpret about medication with pt. c. Manger should interfere in narcotic matters by himself Answer: B & C 164. Which task is not permitted to the dispenser (technician) a. Counseling the patient 165. You noticed the technician come down to help a patient choosing a Cough Product containing Codeine. You may do all of the following actions EXCEPT a. Go down to interrupt the discussion and make the sale b. Ask the technician if the patient has allergy to Codeine after the sale c. Review with her the Law of dispensing over the counter drugs d. Don't humiliate the technician in front of the customer e. Send her to additional training courses Answer: B 166. Pharmacist saw technician give valium to his friend what to do? a. tell pharmacy manager b. talk to technician c. call the police Answer: A & B 167. Pt. came to the pharmacy with Rx for HC 1% in Betaderm cream, she was in a hurry & a lot of pt. waiting for their Rx & ph. is on phone with Dr., technician do all of the following except a. take her phone no. & arrange a delivery for her medication b. Dr. has to check conc. of mixture before mixing it c. dispense medication & give it to her right away as she is in a hurry Answer: C 168. Technician work: insert computer data, writing work (desk), Rx prepn. 169. roles of technician include: a. fix label

b. prepare label

c. order medications. 34

170. A pham1acist give a patient Losec instead of Lasix, this is against which law? a. Against interchangebility act. 171. In the above example what should the pharmacist owner do? a. take the wrong medicine and give patient the right one and tell nothing wrong b. Apologize for the patient, call the doctor and return the right med. to patient Answer: B 172. What should he do to the pharmacist a. fire him b. reduce his salary c. tell the other staff d. worn him & may apply penalty if not the first time Answer: D 173. Lasix was dispensed instead of Losec, pt now suffering of urgency; how will you handle the situation? a. tell the patient that everything is OK and it is just a different form to keep the reputation of the pharmacy b. reassure the patient that nothing serious and change the medication c. say that it is a small error & exchange medication d. take the responsibility, change the drug & report the error to the family physician e. Inform Ontario College about the mistake Answer: D 174. A pharmacy staff did a mistake and gave Lasix instead of Losec what do you do as a manager: a. Cut his salary b. Have a meeting & mention it to him c. reminding the medicine with a similar spelling on your staff Answer: B & C 175. A pt got 2 medicines from your pharmacy, but he saw that the label on a vial is wrong (cross labelling), what is your role as a manager: a. ask patient to return her medicine and give her the right medicine on a right vial b. give her money back c. appologize for the inconvenience Answer: A 176. Celexia and Celecoxib  Mistake in prescription; 177. Technician made a dispensing error and pharmacist signed, who is responsible a. pharmacist. 35

b. Technician Answer: A 178. A student of U of T is training in a pharmacy, so he can do all of the following except: a. Prepare Rx b. Patient counseling c. Filling on-line Rx Answer: B & C. He can take verbal Rx under pharmacist supervision. 179. Doctor makes a mistake, and pharmacist in hospital was not present and the technician dispensed the Rx, pt took the drug, when discovered, tell: a. nurse b. family doctor c. pharmacist d. patient e. hospital doctor Answer: A & E 180. Sound-like drugs, for the manager to decrease errors he should do all except a. put them away from each other b. put label on vial (call for error) c. put in computer system alarm to work on dispensing d. make 2 persons double check before dispensing e. technician ask pt. for disease being treated from Answer: E 181. A ph. did a dispensing error, what do you do as a pharmacy manager a. discuss with him 182. Lescol is mixed with Losec 183. Insurance company needs information on patient, can it be done? a. No for reasons of confidentiality b. Need patient written permission Answer: A & B 184. An insurance company puts a plan to cover the lowest price medication and also covers the 10% higher than the lowest price. You have the following data. Based on the daily dose. What medications should be covered by this company? A

25mg/day

25mg/$ 2.20

B

100mg/QID

50mg/$ 0.30

C

40mg/BID

20mg/$ 0.45 36

D

12mg/BID

12mg/$ 0.91

a. Drug A only b. Drug B c. Drug C & D d. Drug B & D Answer: C & D 185. In deciding what drugs are appropriate for its formulary, the hospital must consider a drug's efficacy, associated workload, and acquisition cost. Several new antifungal IV drugs (drug A, drug B, drug C, and drug D), all with equal efficacy, have recently become available. Currently the hospital stocks drug E, which has been available for several years. Data for the medications is as follows: Drug Cost/day

Dosing Frequency

Treatment Duration (days)

A

$2.50

QID

14

B

$2.25

once daily

14

C

$5.00

BID

7

D

$2.25

BID

7

E

$2.25

QID

7

The most appropriate choice for the hospital is: a. Drug A

d. Drug D.

b. Drug B

e. Drug E

c. Drug C Answer: D Competency: 6.4 186. You ask your patient about all except: a. Religion b. Race c. Color Answer: A, B & C 187. The pharmacist will be more involved in home care products in the future, why? a. The government policy will favour patient’s care at their homes. b. This helps to diversify the pharmacy operations. Answer: A & B 188. Patient incompliance may be due to (Barriers to the proper use of medications include): a. Language problem b. Different opinion about treatment c. Misunderstanding the directions of use (unclear instructions) 37

Answer: A & C 189. When ordering digoxin brand what do you keep in mind? a. The brand used by the nearby hospital b. manufacturer reputation c. product dating (stability, bio-availability) Answer: A 190. A patient maintained on Warfarin for 2 weeks in a hospital if he wants warfarin from your pharmacy a. Give him the same brand Warfarin as the hospital used to give b. give him the more bio-available brand c. look for the more stable and  shelf life Answer: A 191. Expiry date of pharmaceutical products: a. Usually determined by accelerated stability studies. 192. A customer demands receipts of the drug usage for the year for tax reasons for his family a. obtain a written permission from his wife 193. A mother told you that her insurance company lost the receipts for her daughter for the last month and she asked you if you can reprint for her and you noticed that her daughter has taken 2 antibiotics and a birth control so: a. you should give the receipts directly to the mother free of charge b. you should give the receipts directly to the mother with extra charge c. you should contact the insurance company at first d. you should ask a permission from the daughter at first (not to break confidentiality) Answer: D 194. A man asked the pharmacist to make a photocopy of his receipts and of his family to send it to the insurance company because they are lost. Upon investigation, the pharmacist found that among the members of the man's family are his wife and two teenagers. What is the decision of the pharmacists? a. Make a photocopy of the receipts immediately b. Tell the man that it will take time and they will be ready next time c. Get permission from the wife first d. Get permission from all members of the family first Answer: D 195. A woman who wants to commit suicide came to your pharmacy with Elavil prescription what would you do? a. short fill the Rx b. not fill 38

c. counsel the patient not to take overdose d. tell her it is a safe drug Answer: A & C 196. A diabetic patient came to you complaining about his hyperglycemia; you realized the increased dose, sometimes you realize that he is buying a rich chocolate, sugar a. should you advice him and explain the risks. b. Let him decide what he wants c. But not (do not) obligate him and forbid him Answer: A, B & C 197. Which barriers are considered between pharmacist and customers? a. language skills b. fear and anxiety regarding the confidence c. inexperience, lack of confidence d. difficulty in expressing e. inability to interpret verbal questions f. inability to communicate at the level of customer g. limited time and opportunity Answer: A, B, C, D, E & F 198. A ventolin repeat Rx came to you. There is no refil, the time is late, doctor is closed but you realized that patient is complaining and he used Ventolin for 4 weeks and no improvement a. don’t give him the Rx & advice him to go back to his doctor to prescribe something else. b. If you give you broke non-maleficience Answer: A & B 199. A continued education program about hypertension will be arranged in your place: the most important things for the patient to know & to make them interested to come are all except: a. cost per participant b. The history of each one of the lecturers Answer: A 200. The least effective method to advertise this program is: a. The national newspaper (a letter in it) b. Brochures arranged in a bag and given to patients c. telling the doctors to tell the patient d. through the computer (determine the patient candidate) Answer: D 201. What do we say to seniors in a lecture about health care? a. Check on your medication and get rid of the old ones, not in use 39

b. Always counsel with the pharmacist if you want to ask about anything. Answer: A & B 202. There are now reports of seizures associated with ginkgo, the popular herbal for dementia. In light of this you should now counsel patients using ginkgo to: a. avoid ginkgo if they have a risk for seizures b. be careful using it if they take drugs that lower the seizure threshold. c. Both A and B. Answer: C 203. Drug Company CEO. Most important factor for a new drug is Demand and side effects; the least important factor is whether Doctor writes Generic or brand name.

40

204. A pharmacist preparing patient information materials about oral contraceptive pills, he has to review these materials with all except: a. Teenagers b. Parents c. Male partner d. Physician, e. Pharmacist. Answer: B 205. You want to make osteoporosis clinic in your pharmacy, so you will put in the clinic: a. Physician, nurse, physiotherapist. b. Physician, nurse, Chiropodist c. Physician, nurse, dietician. Answer: A 206. A daughter for a cancer patient, who is on Tamoxifen came to your pharmacy asking about a new medication for cancer which is Anastrazole, so what are you going to do: a. Tell her that this new medication is working by the same mechanism as Tamoxifen. b. Refer her to the physician to discuss the other treatment options with him. Answer: B 207. Doctor do things wrong and the pt tells the pharmacist to judge him: a. write reports and go to college of physician, even if there is no problem with him 208. A 4th year pharmacy student goes to a rotation in a pharmacy the student will refer to all except a. increase the staff. 209. All are included in GMP in a hospital except a. Cleaning floors b. Sanitary conditions c. Keeping narcotics Answer: C 210. A man came to you an eye drops, which is very expensive, to return it. It was sealed container. This eye drops belong to his mother who passed away two days ago. You may discuss with him all of the following EXCEPT a. Take the eye drops, give him a credit, and destroy it b. Tell him that the pharmacy cannot accept returned medications to resell them again c. Tell him to give it to seniors homes as donation d. Take it and re-dispense it Answer: D 41

211. Dr. wrote Rx for his wife, what should you do a. fill Rx as it is b. do not fill if its naccotic c. it is illegal for him to write it d. it is not ethical to write it Answer: D. legal only in emergency 212. Pt. coming for an OTC cough syrup & ph. noticed that she took the same medication yesterday, what to do a. tell her no more medication available b. ask her why does she need medication c. give her name of addiction gp d. call police Answer: C 213. Ph. will do seminar on depression for pt. what is not suitable to talk about a. signs & symptoms b. medication effect & S.E. c. no. of mental health organization d. comparison between drugs Answer: D 214. Ph. morals protibit him from giving OC to teenger, what to do? a. tell her that it is not available b. send her to another ph. c. do not give her so that he would not break his morals & protect her d. give her & put pt. needs above his personal morals Answer: D 215. When you prepare a talk for heart problems, what topics do you include in speech a. primarly talk about medication of company supporting the lecture b. talk about non-pharmacological ways c. talk about medication used in heart problems Answer: B & C 216. You were asked to be a witness in a case against a physician, whom you were not on good terms with, so what to do a. refuse to go 42

b. refuse to go to not to loose Rx that he writes c. go & testify to get rid of this type of physicians d. refusing to go is not ethical Answer: D 217. Ph. in hosp. & the Dr. wants to give his pt. a medication for certain disease so what is the 1 st thing to do a. verify with dr. exactly the type of information he needs b. select suitable database in computer to answer his question Answer: A & B 218. Ph was called by the court for a Dr misconduct case a. He should testify about the truth to prove his professionality in front of his community 219. If you have to order a generic drug, which is least important: a. The space in pharmacy 220. Pt who is not working right now, his doctor switched him from Erythromycin to Levofloxacin (Levoquine), what is his concern? a. Timing of doses b. Frequency of doses (levofloxacin is OD) c. High price (levofloxacin is more expensive, note he is not working) Answer: C 221. If a therapeutic intervention is necessary, all of the following information should be communicated to the prescriber EXCEPT: a. A declaration that "a mistake was made". b. A brief description to the problem. c. A reference sourcc that documents the problem. d. An alternative or sugestion to resolve the problem. e. A description of the clinical significance of the problem. Answer: A 222. Auxiliary & cautious labels should be utilized for all of the following purposes except to: a. Substitute for verbal councelling. b. Ensure proper usage. c. Inform of storage requirement. d. Comply with regulatory requirements. e. Warn against the concomitant use of certain drugs. Answer: A 223. The following items are essential for a patient profile system except: 43

a. The prescriber's DEA registeration number b. Patient’s name c. Patient’s allergies d. Patient's birth date e. Instructions for medication use Answer: A 224. Switching from IV to oral is not important for nurse compliance 225. The morals of a pharmacist prevents him from giving abortive medication for a lady with plan B, what is the appropriate action he must take? 226. Give her a list of nearest pharmacies from where she can get her Rx 227.

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General Rx Rules of Economy 1.

By law you have to give the patient the generic (low cost) not the brand drug (high cost) unless specified.

2.

Least economic depends on: a. Cost/Unit b. Quality unit c. Natural unit Answer: A

3.

Reason (s) for keeping low inventory: a. Minimize the cost of inventory b.

Something related to shelf.

Answer: A 4.

What is the problem if the inventory is less than it should be? a. Theft b. Pricing Answer: B

5.

High cost and low inventory means: a. Goods are being stolen b. Buying from wholesaler c. Buying a lot of low-price goods Answer: A & B

6.

Calculate stock turnover if the inventory is 35000 (lowest), 40000 (highest) and the total annual sales is 200,000 Turnover = Sales / largest inventory Turnover

7.

=

200,000 40,000

=5 %

If cost of drug = $8 and it sells by $12.50 what is growth margin %? Profit = $12.50 – $8.00 = $4.50 Growth Margin

=

4.5 x 100 12.5

=

= 36%

profit x 100 customer price

8.

The mandatory substitution is a principle of inventory only change the low brand. a. To control the cost b. To reduce the inventory c. To make more money 45

d. To follow the law Answer: D 9.

To improve the turnover liability by decreasing the cost and increasing the turnover

10.

Cost of things added afterwards is called? a. Incremental cost b. Acquisition cost Answer: A

11.

Which financial statement could be used to determine the total value of prescription drug sales for a pharmacy for a period of a year? a. Balance Sheet b. Statement of investments c. Statement of changes in financial position d. Income statement e. Statement of equity Answer: D Competency: 6.3

12.

If the assets = 200,000 & the liabilities = 150,000, then the current rotation = Current assets / Current liabilities = 200,000 / 150,000 = 1.33 (low should be 1.7)

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