Learning Module

Introduction

Learning is a never-ending journey.

A colleague told me that not all pharmacists are professionally trained to perform their clinical service.

  • I believe, a great majority of pharmacists started this career with great passion to help patients. However, not all of us has an equal accessibility to excellent training and support. Despite enormous efforts, the knowledge gap widens.
  • Plus, once graduated, learning is mostly on our own initiatives.

This post is dedicated for fresh provisional registered pharmacists who would like to learn more. But, what you should know as a pharmacist is never limited to what have been presented here.

NOTE: You may also visit Medicines Learning Portal for a well-structured program targeted at fresh pharmacy graduates entering hospital.

Learning is a Choice



Legislation

Poisons Act 1952 and Regulations

  1. Who are the members in Poisons Board?
  2. State the poison groups for medications below (Exempted, Group B or Group C)
    • Acetylcysteine sachet
    • Amlodipine
    • Amorolfine 5% nail lacquer
    • Amoxicillin capsule
    • Bisacodyl
    • Bisoprolol
    • Benzydamine gargle
    • Bromhexine
    • Cabergoline
    • Celecoxib capsule
    • Chloramphenicol eye drop
    • Clotrimazole pessary
    • Diclofenac tablet
    • Famotidine tablet
    • Guaifenesin
    • Hyoscine
    • Ibuprofen syrup
    • Ibuprofen tablet
    • Insulins
    • Ketoprofen patch
    • Loratadine
    • Metformin
    • Omeprazole tablet
    • Oxymetazoline nasal spray
    • Paracetamol
    • Pantoprazole tablet
    • Pizotifen
    • Selenium shampoo
    • Salbutamol inhaler
    • Sulfasalazine
    • Terbinafine gel
    • Terbinafine tablet
    • Theophylline tablet
    • Tretinoin cream
    • Ursodeoxycholic acid capsule
  3. According to the Poisons Act 1952, who has the authority to amend poisons list?
  4. What are the minimum requirements for Group B poisons prescription?
  5. Are pharmacists allowed to sell poisons to a person under 18 years old?
  6. Who are allowed to dispense or compound any poison for use in medical treatment?
  7. What are the legal requirements of labelling on a medication for a dispensed medicine by pharmacist?
  8. How long should a fully dispensed prescription be kept for?
  9. How much medications can a traveller bring into Malaysia legally?
  10. What are the powers of a minister?

Poisons (Psychotropic Substances) Regulations 1989 & Dangerous Drugs Act 1952 and Regulations

  1. What are considered as "psychotropic substances"?
  2. Explain on record keeping and storage for dangerous drugs and psychotropic substances in accordance to the Dangerous Drugs Act 1952, Poisons Act 1952 and Poisons (Psychotropic Substances) Regulations 1989.
  3. How to dispose psychotropic substances properly as per legal requirements?
  4. If there is a missing of psychotropic substances and dangerous drugs in pharmacy, what should we do?

Sales of Drugs Act 1952 and Regulations

  1. How to identify if a registered product is a controlled medicine, over the counter medicine (OTC) or health supplement by MAL number?

Medicines (Advertisement & Sale) Act 1956 and Regulations

  1. What are the listed disease where no one shall take any part in the publication of any advertisement?
  2. What are the conditions where advertisement on medical matters is allowed?
  3. Who can sign an approval for advertisement?

Registration of Pharmacists Act 1951 and Regulations

  1. What is the difference between registered pharmacist and licensed pharmacist?
  2. Who are in Pharmacy Board Malaysia and Committee of Inquiry?
  3. Under what conditions, can Pharmacy Board remove the name of a registered pharmacist from the register?



Essentials

Drug Basis

  1. List down 3 references for
  2. List down the generic name for
    • Aprovel
    • Alphagan
    • Alphanate
    • Avamys
    • Berodual-N
    • Brilinta
    • Clarinase
    • Concor
    • Cosmofer
    • Coversyl
    • Cozaar
    • Crestor
    • Diamicron
    • Duodart
    • Dynastat
    • Entresto
    • Epilim
    • Galvus
    • Hemabate
    • Hyzaar
    • Janumet
    • Lasix
    • Lipitor
    • Lumigan
    • Madopar
    • Motilium
    • Naropin
    • Nasonex
    • Neulin
    • Nootropil
    • Norvasc
    • Pegasys
    • Plavix
    • Plendil
    • Ponstan
    • Pradaxa
    • Rebif
    • Seretide
    • Simbrinza
    • Sinemet
    • Singulair
    • Symbicort
    • Tegretol
    • Trusopt
    • Ultibro
    • Unasyn
    • Vastarel
    • Venofer
    • Xalatan
    • Xarelto
    • Xyzal
    • Zemplar
    • Zydis
    • Zyprexa
    • Zyrtec
  3. List down maximum dosage per day for medications below
    • Allopurinol
    • Amlodipine
    • Amoxicillin and clavulanate
    • Azithromycin
    • Bromhexine
    • Carbimazole
    • Chlorpheniramine
    • Doxycycline
    • Febuxostat
    • Felodipine
    • Frusemide
    • Ibuprofen
    • Gliclazide IR and MR
    • Levothyroxine
    • Metformin
    • Olanzapine
    • Paracetamol
    • Phenytoin
    • Pravastatin
    • Prazosin
    • Quetiapine
    • Simvastatin
    • Tramadol
    • Vortioxetine

Drug Administration

  1. Discuss the advantages and disadvantages of different administration routes (e.g. oral, inhalers, subcutaneous, nasal, pulmonary, ophthalmic and rectal).
  2. Theoretically, does effervescent tablet have better absorption than plain tablet?
  3. A patient who is on Glucophage XR 500 mg, come to pharmacy and voices out her concern that she saw some tablet-like looking structures in faeces. Is she still getting the whole dose of medication since the tablet is not dissolving?
  4. By providing few examples, what are the reasons that a tablet should not be halved or crushed?
  5. What should patient do if they miss the monthly dose of ibandronic acid?
  6. If a patient missed her dose on combined contraceptive pills on the third day of her cycle, what precautions should be taken?
  7. Most statins are taken once daily at night. Which statin can be taken at any time of the day?
  8. How should patient take isosorbide dinitrate three times daily to prevent nitrate tolerance?
  9. Explain why patients cannot apply benzoyl peroxide 5% gel together with tretinoin 0.05% cream.
  10. Should the oral drugs below be taken before food or after food?
    • Alendronate
    • Amlodipine
    • Amoxicillin
    • Amoxicillin and clavulanate
    • Ampicillin
    • Bilastine
    • Calcium carbonate
    • Celecoxib
    • Cefuroxime
    • Dabigatran
    • Efavirenz
    • Famotidine
    • Felodipine
    • Gliclazide MR
    • Griseofulvin
    • Hyoscine
    • Itopride
    • Levetiracetam
    • Levothyroxine
    • Meloxicam
    • Metformin
    • Metoclopramide
    • Orlistat
    • Paracetamol
    • Pantoprazole
    • Perindopril
    • Phenytoin
    • Simvastatin
    • Sodium valproate
    • Unasyn
    • Vortioxetine
    • Warfarin
  11. A patient is currently on Ryle's tube feeding. Explain to patients on how to administer
    • Amlodipine tablet
    • Asenapine sublingual tablet
    • Calcitriol capsule
    • Carbamazepine tablet
    • Cardiprin tablet
    • Esomeprazole tablet
    • Omeprazole tablet
    • Phenytoin tablet
    • Rifampicin capsule
    • Sodium valproate syrup
  12. What is the stability after using
    • Nasonex nasal spray
    • Giona easyhaler
    • Foster MDI
    • Insulins: Toujeo, Levemir, Humalog, Insulatard
    • Eye drops: Xalatan, Timo-Comod, Hylo-Comod, Systane Ultra
    • Clopixol drops
    • Alfacalcidol drops
    • Zidovudine syrup
  13. List down the counselling points for

Adverse Drug Reactions

  1. A patient is complaining reddish urine post started on rifampicin for few days. Is it worrying?
  2. Compare and contrast adverse drug reactions and drug allergy. Should diarrhoea post antibiotic be considered as adverse drug reactions or drug allergy?
  3. How to report an adverse drug reaction to NPRA?

Miscellaneous

  1. A mother comes into the pharmacy with her new-born baby and tells you she is not expressing enough milk. Her neighbour told her that domperidone (motilium) can stimulate lactation and she asks you whether this is true. How do you respond?
  2. During Ramadan, a patient is keen to fast, but was prescribed with cloxacillin 1g QID. What will be your course of action?
  3. What is the purpose of adding atropine to diphenoxylate?
  4. A customer was wondering if any difference between pravastatin 20 mg and atorvastatin 10 mg. Is pravastatin 20 mg stronger?
  5. What is the purpose of benserazide or carbidopa in combination with levodopa?



Community Pharmacy

Cough

  1. What is the paediatric dose of bromhexine for a child aged 1 years 3 month with wet cough?
  2. Should bromhexine be prescribed together with dextromethorphan?
  3. A patient is recently started on enalapril and complained that he is having dry cough since then. What would be your recommendation?
  4. A customer is complaining on unresolving cough for more than 3 weeks, what would you recommend?

Cold

  1. What products can be recommended for a 3-month-old baby with blocked nose?
  2. What is the maximum duration for using oxymetazoline nasal spray?
  3. Is there much difference in terms of efficacy among sedating and nonsedating antihistamines?

Eye

  1. Among the artificial tear products, which is better?
  2. A young man came to your pharmacy for an alarming blood spot in the eye. What can he apply or should he seek immediate medical attention?

Gastrointestinal

  1. What is the age limit for loperamide capsule?
  2. Is it safe to take bisacodyl tablet chronically for constipation?
  3. A customer complaining that her stomach is always bloated with discomfort. What would be your recommendation?
  4. What is the difference between taking antacid or proton pump inhibitor for gastric discomfort?

Skin

  1. A customer is asking if he can take cetirizine 10 mg twice daily for his chronic eczema? Is it safe to consume antihistamine for long term?
  2. Is there a role of topical antifungal in the treatment of tinea capitis and onychomycosis?
  3. Miss D asks to buy a tube of acyclovir 5% cream. Miss D tells you that she is going on holiday and is concerned as exposure to the sun seems to trigger an ‘attack’ of cold sores around her mouth. When counselling Miss D on the use of acyclovir, when should you recommend that she uses the cream?
  4. Is Cloderm cream or Elomet cream more potent?

Pain

  1. What is the maximum dose of paracetamol for a dialysis patient?
  2. Are COX-2 inhibitors associated with a lower GI upset risk than non-selective agent? What are examples of COX-2 inhibitors?
  3. What is the difference between diclofenac sodium and diclofenac potassium?
  4. Should allopurinol be restarted when patient is having gout attack?

Female Health

  1. A female customer is asking for medication to delay her period since she plans to travel next week. What could be your recommendation.
  2. What are your considerations before supplying morning after pill to a patient?
  3. A newly married couple ask, how accurate is the urine pregnancy test?
  4. A pregnant woman is requesting some over-the-counter medication for her morning sickness.
  5. A customer is asking if mefenamic acid shorten the period duration apart from reducing pain.
  6. What is the characteristic feature of vulvovaginal candidiasis?
  7. Is it safe to use medications below during pregnancy?
    • Bromhexine for wet cough
    • Mefenamic acid for pain
    • Paracetamol for pain
    • Bisacodyl for constipation
    • Lactulose for constipation
    • Proctosedyl suppository for haemorrhoids
    • Daflon for haemorrhoids
    • Clotrimazole pessary for vaginal thrush
    • Metoclopramide for morning sickness
    • Famotidine for gastric
    • Pantoprazole for gastric

Supplements

  1. A patient came to your pharmacy and complain that he has been taking high dose fish oil for half a year, but there is no improvement in blood LDL result. Please explain.
  2. An elderly woman came to your pharmacy, requesting supplements for damaged macula in her eyes (as informed by her ophthalmologist). What would be your recommendations?
  3. A man came to your pharmacy, requesting supplements that is good for fatty liver due to his heavy alcohol drinking. What would be your recommendations?
  4. List down the traditional uses of the following supplements.
    • Bilberry
    • Bitter melon
    • Coenzyme Q10
    • Evening primrose oil
    • Ginkgo biloba
    • Glucosamine sulphate
    • Grape seed
    • Fish oil
    • Milk thistle
    • Saw palmetto
    • Valerian
Miscellaneous
  1. What is homeopathy?
  2. How much elemental calcium is in each 300 mg calcium lactate tablet, in comparison to 500 mg calcium carbonate tablet/capsule?
  3. When a male who had just taken sildenafil presents with acute coronary syndrome, can glyceryl trinitrate tablet be given?
  4. What product can be given to a 5-year-old child with mouth ulcer?
  5. What is the difference between a needle with a gauge size of 22 and 18?
  6. Explain how to use
  7. What are the treatment targets for



Public Hospital

Clinical Pharmacokinetic Services

  1. Explain EMIT (enzyme multiplied immunoassay technique) used in drug analysis. Also, discuss the importance of quality control and calibration in EMIT.
  2. What are the indications of therapeutic drug monitoring?
  3. What is the definition of
    • Zero and first order reaction
    • Bioavailability
    • Elimination rate constant
    • Half-life
    • Steady-state
  4. Given a drug has volume distribution of 0.2 L/kg and elimination clearance of 7L/hour. What is the estimated half-life for a 100 kg patient?
  5. Mr Z is started with an antiepileptic drug with an elimination half-life of 10 hours. Provided no loading dose is given, how long will it take for the patient plasma level to reach steady state?
  6. The current TDM level of drug X (half-life = 2 days) is 6 mcg/L. How long to withhold till it falls to 1 mcg/L?
  7. List down the creatinine clearance formula for
    • 3-month-old baby
    • Adult with normal body weight
    • Obese adult
  8. What is the correct sampling tube (e.g. plain tube, gel tube or EDTA tube) for
    • Amikacin
    • Digoxin
    • Sodium valproate
    • Cyclosporin
  9. What is the recommended sampling time for
  10. How much of blood sample is needed for analysis of 1-3 drugs?
  11. What are the monitoring parameters to monitor patient's progression of these drugs?
    • Aminoglycosides
    • Antiepileptics
    • Digoxin
  12. List down factors affecting aminoglycosides clearance.
  13. Is therapeutic monitoring suggested for oral vancomycin in Clostridium difficile infection?
  14. How to manage red man syndrome post rapid infusion of vancomycin?
  15. Explain on auto-induction of carbamazepine.
  16. When the sample concentration is subtherapeutic yet patient is responding well, is dosage adjustment necessary?
  17. Post dosage adjustment of sodium valproate, how long should we wait at least prior to TDM reassessment?
  18. What are the signs and symptoms of phenytoin toxicity?
  19. How to calculate time to withhold when there is a phenytoin toxicity post loading dose?
  20. List down important drug-drug interactions with digoxin.
  21. What are the symptoms of digoxin toxicity? Explain how hypokalaemia increases risk of digoxin toxicity.
  22. What is the therapeutic range of digoxin in atrial fibrillation?
  23. What are the limitations of Rumack-Matthew Nomogram in paracetamol poisoning cases?
Drug Information Services
  1. Discuss the level of evidences of references (e.g. systematic review, randomised controlled trial, expert opinion).
  2. How to report adverse drug reaction (ADR) or medication error (MER)?
  3. List down the prescriber categories of MOH formulary.
  4. List down the function of each Dossier forms
  5. List down the criteria of drugs eligible for KPK application. How long is the validity period for each successful KPK application?
  6. What are the medicine selection criteria in hospital formulary?
  7. What is meant by open and closed formulary?
  8. Is Good Clinical Practice a requirement prior to starts research?
  9. Explain Good Governance of Medicine and Malaysian National Medicine Policy.

Inpatient Pharmacy Services

  1. Explain
  2. List non-medical items that should be available in the emergency trolley.
  3. State the immunoglobulin, vaccines and antivenoms available in your facility.
  4. What are the objectives of performing ward check?

Manufacturing and Repacking

  1. What are the facility requirements for manufacturing and repacking?
  2. List down at least 4 references of extemporaneous formulations?
  3. Familiarise yourself with references below.
    • Good Compounding Practice
    • Good Manufacturing Practice
    • PIC/S Guidelines
  4. Briefly explain basic principles of compounding.
  5. Describe how to
  6. To maintain sterility, which part of the syringe and needle that you cannot touch?
  7. In the absence of stability data, how long is the duration before the compounded preparations need to be discarded?
  8. List down the indications of galenical preparations in your facility.

Oncology Pharmacy Services

  1. Define hazardous drugs.
  2. Describe how to handle cytotoxic agents safely during preparation, storage, transportation, administration and disposal (including appropriate PPE) and health monitoring.
  3. Define extravasation and how to manage extravasation.
  4. Define vesicant and irritant, and list out 3 examples for each.
  5. Explain how to manage a cytotoxic spill.
  6. Define TNM classification.
  7. Define curative, adjuvant, neo-adjuvant and palliative therapy of cancer.
  8. What are the prechemotherapy checks before initiating chemotherapy.
  9. For the condition below, list down 3 chemotherapy regimens (including dosing and interval)
    • Acute myeloid leukaemia
    • Breast cancer
    • Colorectal cancer
    • Hodgkin's lymphoma
    • Non-Hodgkin's lymphoma
    • Multiple myeloma
    • Ovarian cancer
  10. State 5 examples of targeted therapies of cancer.
  11. What the purpose of giving folinic acid to patients receiving
    • Fluorouracil
    • Methotrexate
  12. Explain why is mesna used along with certain nitrogen mustard cytotoxic agents.
  13. List down the formula for
  14. What are the pre-medications of IV rituximab?
  15. Which chemotherapy drugs can be given via intrathecal route?
  16. Discuss common side effects of chemotherapy and the management plan.
    • Myelosuppression - anaemia, neutropenia, thrombocytopenia
    • Alopecia
    • Constipation/diarrhoea
    • Lethargy
    • Peripheral neuropathy
    • Pregnancy and fertility problems
  17. Briefly describe the aetiology and management of chemotherapy related complications.
  18. Which agent is approved to treat doxorubicin-induced cardiomyopathy?

Outpatient Pharmacy Practice

  1. Briefly discuss sub-store management (including standard and end user item)
  2. Briefly discuss good dispensing practice (GDsP) and all process involved.
  3. What are the value-added services provided at your facility?
  4. What medications cannot be delivered to patient through Pos Laju service?
  5. Please identify the intervention needed.
    • Atorvastatin 40 mg ON and Gemfibrozil 600 mg ON
    • Morphine 5 mg QID and Lomotil 1/1 TDS/prn.
    • Amlodipine 15 mg OD
    • Etoricoxib 120 mg OD for 1 month
    • Metformin XR 1.5 g
    • Micardis Plus 1/1 OD
    • CBZ 10 mg OD
    • Vildagliptin 100 mg OD
    • Gutt Xalatan 1/1 BD
  6. What are some examples of common medication errors?

Parenteral Nutrition or Intravenous Admixture Services

  1. Explain the principles and maintenance of laminar flow cabinet and clean room design.
  2. Explain aseptic techniques.
  3. Discuss the indications and contraindications of parenteral nutrition.
  4. Discuss the nutritional screening and assessment tools.
  5. Explain why we infuse fat emulsion and 2-in-1 separately during TPN administration for neonates.
  6. What are the ingredients used for water-soluble vitamins, fat-soluble vitamins and trace elements for neonates and adults? What is the usual and maximum dose?
  7. What are the factors affecting the calcium-phosphate precipitation and methods to reduce the risk?
  8. Compare the differences between
    • Peripheral and central administration of parenteral nutrition.
    • Cyclic and continuous parenteral nutrition
  9. What is the normal target of lipid, carbohydrate and protein in adults, and how to decide the NPC ratio of glucose: lipid?
  10. What is the maximum infusion rate of lipid, carbohydrate and protein?
  11. How many calories are provided by a pint of dextrose 5%?
  12. Discuss refeeding syndrome and how to manage it.
  13. Discuss complications of parenteral nutrition.
  14. What are the monitoring parameters for patients on parenteral nutrition (including frequency and justification)?

Pharmacy Store Management

  1. Discuss inventory systems used in pharmacy practice.
  2. Explain the principles of stock movement and control
    • Drug usage pattern
    • Formulas to calculate usage, max, buffer, min stock level
    • Identification of slow and non-moving items
    • Expiry date monitoring
    • Stock checking and verification (system vs physical check) - the roles? actions needed if the stock is not tally
    • Non-conformance products
  3. Explain on procurement process (e.g. ordering, quotation, receiving and distributing of stocks and penalty management).
    • APPL, direct purchase, central contract
    • Budget code
    • Vote book
    • Procurement system: ePerolehan and PhIS
  4. Briefly explain the process of receiving including inflammables, cold-chain product and dangerous drugs/psychotropic. What is in the receiving checklist?
  5. Under what condition, will we reject and return delivered stock to supplier?
  6. Understand the storage requirements according to Good Distribution Practice, including cold chain management.
  7. Briefly explain how to use min-max thermometer and perform temperature monitoring chart.
  8. What should be done when there is a cold chain breach?
  9. Explain on issuing of items to end users following FEFO (first-expiry-first out), batch number and recording on bin card (if applicable).
  10. Explain on disposal/write-off of stocks and its procedures and documentation.
  11. Explain on handling of product complaints and reporting procedures.
  12. Explain on degree and type of product recall. Also include quarantine requirement.

Ward Pharmacy Practice

  1. Discuss documentations for
    • Medication history assessment (CP1)
    • Pharmacotherapy review (CP2)
    • Clinical pharmacy report (CP3)
    • Patient referral notes (CP4)
  2. Explain how to perform medication reconciliation and its roles.
  3. Explain the principles of antimicrobial stewardship.
  4. Please state the abbreviations
    • ABG
    • AEBA
    • AGE
    • ALP
    • BHT
    • C&S
    • FEME
    • KIV
    • MVA
    • OGDS
    • TCA
    • UTI
    • URTI
  5. Explain
  6. List down
  7. What is the antidote for
  8. What are the indications of stress ulcer prophylaxis and complications? Also, explain what is proton pump inhibitor stepping down approach.
  9. Which antibiotic is indicated for Pseudomonas Aeruginosa?
  10. What is the dose of penicillin V in nephrotic syndrome general management?
  11. What is the role of propranolol in hyperthyroidism? Is it safe to be used in pregnancy?
  12. Which drug is preferred in pregnant patients with hyperthyroidism: Propylthiouracil or carbimazole?
  13. What are the criteria in oralizing IV antibiotics?
  14. A 19-year-old woman, Miss P, is receiving long-term treatment with minocycline 100 mg daily for acne. She wishes to start using the combined oral contraceptive, and her doctor has prescribed a low-strength pill (containing ethinylestradiol 20 micrograms with norethisterone 1 mg). The doctor contacts the pharmacist for advice on whether the tetracycline will interfere with the efficacy of the oral contraceptive.
  15. Why oral ketoconazole is no longer used for fungal infection?
  16. A patient just started on griseofulvin 500 mg once daily for fungal nail infection and come to pharmacy for advice.
  17. What is the oral dosing of metronidazole in bacterial vaginosis?
  18. Some beta-blockers are lipid soluble and some are water soluble. Those water-soluble are less likely to enter the brain and may therefore cause less sleep disturbance and nightmares. What are the examples?
  19. When there is no suitable alternative, a cardioselective beta-blocker may be selected for patients with a history of asthma. What are the examples?
  20. What are the monitoring parameters when patients recently started on ACE inhibitors?
  21. Can a patient be started concomitantly on both ACE inhibitors and angiotensin receptor 2 blocker?
  22. Explain how to manage if a patient is having hyperkalaemia.
  23. Why verapamil and diltiazem should usually be avoided in heart failure?
  24. Mr A is taking simvastatin 40mg ON. Blood test results show cholesterol levels are still high. Is it appropriate to increase simvastatin to 80mg ON?
  25. An 83-year-old woman is on isosorbide mononitrate MR 50mg daily, aspirin 75mg daily and amlodipine 10mg daily. She has been newly prescribed simvastatin 40mg at night. What is the most likely possible consequence of the drug interaction?
  26. Mr A, a 76-year-old man, presents on your admission ward with acute kidney injury. His medication history is simvastatin 40 mg ON, atenolol 50 mg OD, amlodipine 5 mg OD, paracetamol 1 g QID and ibuprofen 400 mg TDS. Which is the most likely medication to be responsible for acute kidney injury?
  27. Is it safe to prescribe a patient allergic to amoxicillin with cefuroxime?
  28. Should long-term anticonvulsant prophylaxis started for patients with first episode of febrile convulsion?
  29. Discuss family planning of antiepileptic in women before pregnancy. Which antiepileptic is safe to be used?
  30. Is budesonide (oral inhalation) safe in pregnancy?
  31. PZ, a 26-year-old woman, experiences complex partial and secondarily generalized tonic-clonic seizures. She is taking phenytoin 400 mg/day and divalproex 2000 mg/day. Despite taking norgestrel 0.3 mg with ethinyl estradiol 30 mcg, she has just learned she is pregnant. Her last menstrual period was 6 weeks ago. What is the relationship between PZ antiepileptic drug therapy and her apparent contraceptive failure?
  32. Why aspirin should not be given to children aged under 16 years old? What are the exception cases?
  33. What is the dose of colchicine in acute gout and gout prophylaxis?
  34. Mr D is complaining that tramadol 50 mg is not providing much for his pain relief. He would like to know if is it possible?
  35. Today, you received a script with baclofen 30 mg QID. You noted the maximum dose is 80 mg in product leaflet, you called to the doctor but rehab doctor insisted and will hold responsibility for the high dose. Is it safe to prescribe such a dose?
  36. Why is caffeine preferred over theophylline in the management of apnoea of prematurity?
  37. What are the long-term side effects of systemic corticosteroids?
  38. What is the suggested treatment regimen of Helicobacter Pylori?
  39. Can metformin be continued in diabetes during pregnancy?
  40. What is the preferred antiretroviral regimen for post exposure prophylaxis of needle stick injury?
  41. Is statin safe in pregnancy?
  42. What are absolute and relative contraindications of thrombolysis?
  43. When should clopidogrel be stopped before elective surgery or other invasive procedures?
  44. Which group of patients is recommended for annual influenza vaccination?
  45. How long is the duration of tuberculosis treatment?
  46. Is there a role for acetylcysteine in preventing contrast nephropathy?
  47. What are the considerations when changing antidepressants?
  48. Is egg allergy a contraindication for vaccination?
  49. Apart from constipation, lactulose is also indicated for?

Comments

  1. AnonymousJune 3, 2023 at 8:26 PM

    Hi, may i know if there is any answer scheme available to check with my answer?

    ReplyDelete
    Replies
    1. Soon SengJune 3, 2023 at 9:24 PM

      There is no complete answer scheme available. However, you most probably can find most answers within the blog itself.

      Delete
  2. AnonymousDecember 27, 2023 at 5:26 PM

    Hi, may I know under which part mostly the answers could be found? Thanks

    ReplyDelete
    Replies
    1. Soon SengDecember 29, 2023 at 10:51 PM

      Personally, I feel the most important part of this learning process is not about acquiring facts and figures. It is about exploring new knowledge, developing critical thinking skills, learning to question and analyze, and ultimately forming our own unique perspectives. With experiences, everything will become common sense.

      Delete

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