QUESTIONS

SECTION A : LAW AND ETHICS (25 MARKS)

Answer all questions in the answer sheet provided

1. (a) What do you understand by ethical dilemma? (3 Marks)

(b) Give two examples of ethical dilemma you may encounter in your practice as a
pharmacist (4 Marks)

2. Explain why it is important for pharmaceutical personnel to abide to Code of Ethics and
Professional Conducts and give at least five examples of Code of Ethics for
Pharmaceutical personnel.(5 Marks)

3. According to Pharmacy Act, Cap 311.

a) Who is the superintendent? (1 Mark)
b) What are the accompanied requirements that have to be observed for this
superintendent to be acceptable by the law? (3 Marks)

4. Section 77 (1) of the Tanzania Food, Drugs and Cosmetics Act stated that “No person
shall offer for sale; procure for sale; sell; administer to any person or animal, any
medicines which is unfit for intended purpose”
a) What do the unfit medicines mean as per the Act? (1 Marks)
b) How do these medicines kept and marked in the stores? (4 Marks)

5. You are a pharmacist in charge of a pharmacy in town and you have received a
prescription requesting for pethidine injection. Give all necessary procedures which you
will take on honoring this prescription assuming that you have the drug. (4 Marks)

SECTION B : CLINICAL PHARMACY (25 MARKS)

Answer all questions in the answer sheet provided

1. A patient is on warfarin at a dose of 3mg daily. He started using Cimetidine for a

stomach ulcer. His warfarin dose was lowered to 2mg daily. After three months his ulcer
healed, and the Cimetidine was stopped.

a) Why was the warfarin dose lowered to 2mg? (3 Marks)

b) Suppose the patient must continue using warfarin after his ulcers healed, will the
dose be 2mg? (2 Marks)

1
 c) Suppose there was an overdose of warfarin to the patient, how will you help the
patient? ( 2 Marks)

2. From the knowledge you have acquired during your pharmacological studies and other
experiences in the course of practical training, explain how type II diabetes mellitus is
treated in a pregnant woman (6 Marks)

3. You have learnt that patients with comorbidity of heart failure and bronchial asthma
cannot be treated with propranol even though this drug is very helpful in patients with
heart failure. Explain why so? (6 Marks)

4. Comment on the following Scenarios:

a) You are asked by a nursing Sister to inform the staff of her ward about the
recommendations for drug therapy for HIV Post Exposure Prophylaxis (PEP) for
low risk and high risk. (3 Marks)

b) A terminal ill patient is prescribed morphine prescription for pain management

(3 Marks)

SECTION C: GENERAL PHARMACY PRACTICE (35 MARKS)

Answer all questions in the answer sheet provided

1. (a) What are Adverse Drug Reactions? How are they detected? (2 Marks)
(b) Describe role of a pharmacist in adverse drug reaction monitoring? (3 Marks)

2. (a) What is a Hospital Formulary and who is responsible for developing it? ( 2 Marks)
(b) What are the significances of Hospital Formulary? (3 Marks)

3. (a) Mention at least four (4) areas of practice in pharmacy? (2 Marks)

(b) What are the different roles of a hospital pharmacist (4 Marks)
(c) How is effective patient counseling done by a pharmacist? (3 Marks)

4. Explain the procurement and storage procedures of medicines in the hospital (4 Marks)

5. A mother with a child of 3years old has been prescribed with Amoxicillin125mg/5m to
take every eight hourly, for five (5) days. In a hospital pharmacy there are two
categories of formulations; dispersible tablet 125mg and dry powder for reconstitution.
a) Explain the two dosage form above (3 Marks)
b) Which one would you prefer to dispense and why? (4 Marks)

2
6. The label on a bottle of dry powder mix for reconstitution states that when 128ml of
water are added, 150ml of an oral suspension, containing 250mg of amoxycillin in each
5ml results. How many milliliters of water should be added to the dry powder mix if the
strength of 150mg of amoxycillin per 5ml is desired? (5 Marks)

SECTION D: CASE QUESTIONS (15 MARKS)

Answer all questions in the answer sheet provided

1. You are appointed as an inspector, during your inspection you have found a shop
with no premises registration and business permit from the Council, a person selling
medicine has no pharmaceutical knowledge, expired drugs are in the dispensing
area, the shop also stocked unregistered cosmetics and medicines.
a) Explain what steps will you follow do as an inspector to handle the situation
(3 Marks)
b) Identify each mistake stipulated above and laws governing the malpractices
encountered (3 Marks)
c) What will you advise the regulators to deal with such malpractices (2 Marks)

2. You are a pharmacist in charge at Morogoro Regional Hospital,

during the weekend an epileptic patient in critical condition was brought to the
hospital. The doctor who was supposed to be on duty had an emergency; he called
you asking to dispense Phenobarbitone Sodium injection 60mg/ml BID for 5
days.
a) As a pharmacist how will you handle this situation? (2 Marks)
b) Under which condition a pharmacist can supply medicine in such case? Explain
your answer (5 Marks)

3
 ANSWERS
SECTION A: LAW AND ETHICS (25 MARKS)
Answer all questions in the answer sheet provided

6. (a) What do you understand by ethical dilemma? (3 Marks)

(b) Give two examples of ethical dilemma you may encounter in your practice as a
pharmacist (4 Marks)

7. Explain why it is important for pharmaceutical personnel to abide to Code of Ethics and
Professional Conducts (1mark)
o Because it provides best possible care for consumers, patients and
care-takers with due regard for the eliminations of available resources
and the principles of equity and justice.

o It enable professionals to capture philosophical foundation of

pharmacy practice and to express the responsibilities and
professional values that are fundamental and inherent to the
pharmacy profession.

o The code of ethics reflects and support development in profession,

patient-centered practice and take into consideration patient’s rights
and responsibility.

• Code of ethics (4marks) any four

o Must have regard for human life
o Must honor and dignify the profession
o Should ensure availability of safe, efficacious and quality medicines.
o Should ensure access to essential medicines
o Should promote and ensure rational use of medicines
o Should have good pharmaceutical personnel – patient/clients
relationship
o Must ensure privacy and confidentiality

4
 o Should be competent and have a lifelong learning
o Should have good pharmaceutical personnel-other health care
providers relationship
o Must ensure well-being of the community

8. According to Pharmacy Act, Cap 311.

c) Who is the superintendent? (1 Mark)
Means a pharmacist In-charge who supervises a pharmacy and is registered in
such by the Council under the Act.

d) What are the accompanied requirements that have to be observed for this
superintendent to be acceptable by the law? (3 Marks)
Registered by the Council

9. Section 77 (1) of the Tanzania Food, Drugs and Cosmetics Act stated that “No person
shall offer for sale; procure for sale; sell; administer to any person or animal, any
medicines which is unfit for intended purpose”
c) What do the unfit medicines mean as per the Act? (1 Marks)

; means a product regulated under Tanzania Food, Drugs and Cosmetics Act
which violates any provision of this Act (1mark

d) How do these medicines kept and marked in the stores?(4 Marks)

o Maintain a register book for unfit medicines and cosmetic

products.(1mark)

o Keep them into different categories such as dosage , controlled drugs,

antineoplastics, antibiotics and any other hazardous medicines or
cosmetic products. (1mark)

o Demarcate an area for keeping containers of unfit medicines and

cosmetic products which shall be labeled conspicuously with words
“Expired medicines/ cosmetic products – Not for Sale” or “Unfit
medicines/cosmetics – Not for sale” or “Dawa/Vipodozi hivi muda wake
wa matumizi umekwisha – visiuzwe” au “Dawa/Vipodozi hivi havifai kwa
matumizi – zisiuzwe” in red ink. (1mark)

5
 o Maintain safe custody of unfit pharmaceutical products in registered
premises until they are disposed off to avoid pilferage. (1mark)

10. You are a pharmacist in charge of a pharmacy in town and you have received a
prescription requesting for pethidine injection. Give all necessary procedures which you
will take on honoring this prescription assuming that you have the drug. (4 Marks)

SECTION B : CLINICAL PHARMACY (25 MARKS)

Answer all questions in the answer sheet provided

5. A patient is on warfarin at a dose of 3mg daily. He started using Cimetidine for a

stomach ulcer. His warfarin dose was lowered to 2mg daily. After three months his ulcer
healed, and the Cimetidine was stopped.

d) Why was the warfarin dose lowered to 2mg? (3 Marks)

because Cimetidine inhibits cytochrome P-450 and can slow the metabolism and
hence potentiate the action of warfarin, which may cause bleeding, that is why the
dose was lowered to 2mg

e) Suppose the patient must continue using warfarin after his ulcers healed, will the
dose be 2mg? (2 Marks)
If the patient ceases to use Cimetidine (his ulcer healed) the dose of warfarin should
be adjusted to the previous 3mg

f) Suppose there was an overdose of warfarin to the patient, how will you help the
patient? ( 2 Marks)
Overdose of warfarin is antagonized by vitamin K

6. From the knowledge you have acquired during your pharmacological studies and other
experiences in the course of practical training, explain how type II diabetes mellitus is
treated in a pregnant woman (6 Marks)

7. You have learnt that patients with comorbidity of heart failure and bronchial asthma
cannot be treated with propranol even though this drug is very helpful in patients with
heart failure. Explain why so? (6 Marks)

8. Comment on the following Scenarios:

6
 c) You are asked by a nursing Sister to inform the staff of her ward about the
recommendations for drug therapy for HIV Post Exposure Prophylaxis (PEP) for
low risk and high risk. (3 Marks)
- low risk Zidovudine(AZT) and Lamivudine (3TC ) (1.5 mark)

- high risk Zidovudine(AZT) ,Lamivudine (3TC ), and Neviparine (NVP) or

Effevirenz (1.5 mark)

d) A terminal ill patient is prescribed morphine prescription for pain management

(3 Marks)
-to relieve excessive pain in dying patients (3maks)

SECTION C: GENERAL PHARMACY PRACTICE (35 MARKS)

Answer all questions in the answer sheet provided

(a) Adverse reaction is a response to a medicine that is noxious and unintended, and which occurs
at doses normally used in man for the prophylaxis, diagnosis, or therapy of disease or the
modification of physiological function (1mark)

How are they detected? (1 Marks)

In both the inpatient and outpatient setting, a patient’s new or worsening symptom may be
the first sign of an ADR.
In a community pharmacy, patients often seek advice from the pharmacist to treat various
symptoms at home. This can be an opportunity for the pharmacist to inquire about the
patient’s symptoms to determine whether they might have been caused by an ADR.

In the inpatient setting, patients may tell their nurse or physician about the new symptom
they are having, which may result in a telephone call to the pharmacist.

Asking detailed questions about the patient’s symptoms, rather than immediately providing
a treatment recommendation, could uncover an ADR and prevent unnecessary drug therapy
or further ADR symptoms

Common laboratory tests can also assist in identifying an ADR

Another way to identify an ADR is by reading the daily multidisciplinary notes in a patient’s
chart

(b) Describe role of a pharmacist in adverse drug reaction monitoring? (3 Marks)

i. Detecting
ii. Management

7
 iii. Reporting

7. (a) What is a Hospital Formulary and who is responsible for developing it? ( 2 Marks)
A list consisting of the most cost-effective, safe, readily available medicines of assured
quality that will satisfy the health care needs of the majority of the patients in the hospital

Hospital Therapeutical Commetee

(b) What are the significances of Hospital Formulary? (3 Marks)

8. (a) Mention at least four (4) areas of practice in pharmacy? (2 Marks)

i. Hospital settings
ii. Regulatory authorities
iii. Industrial settings
iv. Academic areas
v. Research

(b) What are the different roles of a hospital pharmacist (4 Marks)

(c) How is effective patient counseling done by a pharmacist? (3 Marks)

9. Explain the procurement and storage procedures of medicines in the hospital (4 Marks)

10. A mother with a child of 3years old has been prescribed with Amoxicillin125mg/5m to
take every eight hourly, for five (5) days. In a hospital pharmacy there are two
categories of formulations; dispersible tablet 125mg and dry powder for reconstitution.

(a)
• Dispersible Tablet (1.5marks)
Dispersible tablets are uncoated or film-coated tablets that can be
dispersed in liquid before administration giving a homogenous
dispersion. Dispersible tablets usually disintegrate within three minutes
when put in water or a small amount of breast milk

• Powder for Reconstitution (1.5marks)

Some drugs must be stored in powdered form because they rapidly lose
their power once they are mixed into a solution. These drugs will then
have to be reconstituted, or mixed with water before they can be
administered.

c) Which one would you prefer to dispense and why?(4 Marks)

8
 • Dispersible tablets are preferred than powder for reconstitution for
the following reasons

o Advantages of dispersible tablets versus liquid

formulations;(2marks)
▪ Dissolved in water immediately before use.

▪ Easy to dispense and they require minimal manipulation by health

professionals and parents prior to use which minimizes the risk of
errors.

▪ Require a small amount of water for administration.

o Disadvantages of powder for reconstitution over dispersible

tablets;(2marks)
▪ Drug reconstitution can be a challenging task for non-healthcare
trained patients trying to prepare a drug for self-administration.
▪ Dosing accuracy may suffer and may become an impediment to
patient compliance.

▪ Wastage; Pharmaceutical manufacturers often overfill the bottle to

ensure that there is a sufficient quantity of the reconstituted drug
to administer the correct dose.

11. The label on a bottle of dry powder mix for reconstitution states that when 128ml of
water are added, 150ml of an oral suspension, containing 250mg of amoxycillin in each
5ml results. How manymilliliters of water should be added to the dry powder mix if the
strength of 150mg of amoxycillin per 5ml is desired?(5Marks)

SECTION D: CASE QUESTIONS (15 MARKS)

Answer all questions in the answer sheet provided

3. You are appointed as an inspector, during your inspection you have found a shop
with no premises registration and business permit from the Council, a person selling
medicine has no pharmaceutical knowledge, expired drugs are in the dispensing
area, the shop also stocked unregistered cosmetics and medicines.
d) Explainwhat stepswill you follow do as an inspector to handle the situation

9
 (3 Marks)
e) Identify each mistake stipulated above and laws governing the malpractices
encountered(3 Marks)
f) What will you advise the regulators to deal with such malpractices(2 Marks)

4. You are a pharmacist in charge at Morogoro Regional Hospital,

during the weekend an epileptic patient in critical condition was brought to the
hospital. The doctor who was supposed to be on duty had an emergency; he called
you asking to dispensePhenobarbitone Sodium injection 60mg/ml BID for 5
days.
c) As a pharmacist how will you handle this situation? (2 Marks)
d) Under which condition a pharmacist can supply medicine in such case? Explain
your answer (5 Marks)

SECTION A:
11. (a) What do you understand by ethical dilemma? (3 Marks)
(b) Give two examples of ethical dilemma you may encounter in your practice as a
pharmacist (4 Marks)

Answer:
(a) Ethical Dilemma: is a decision-making problem between two possible moral
imperatives, neither of which is acceptable or preferable. The complexity arises out of
the situational conflict in which obeying one would result in transgressing another
(b) - Not telling the truth for patient benefit
- Receiving an overprescribed prescription
- A client sending you money after receiving services

12. Explain why it is important for pharmaceutical personnel to abide to Code of Ethics and
Professional Conducts and give at least five examples of Code of Ethics for
Pharmaceutical personnel.(5 Marks)
Answer:
It is important for a pharmaceutical personnel to abide to code of ethics because they are
the road map to making the right decisions in the provision of pharmaceutical services.
- Regard For Human Life
- Honour And Dignity Of Profession
- Availability Of Safe, Efficacious And Quality Medicines
- Access To Essential Medicines
- Promote Rational Use Of Medicines
- Pharm. Personnel-Patient Relationship
- Privacy And Confidentiality
- Life-long Learning
- Relationship To Other Health Care Providers
- Well-being Of The Community

10
13. 5. You are a pharmacist in charge of a pharmacy in town and you have received a
prescription requesting for pethidine injection. Give all necessary procedures which you
will take on honoring this prescription assuming that you have the drug. (4 Marks)

ANSWER:
- Before dispensing, check for legal validity of the prescription
Date of prescription, patient information (name, address) and drugs information (name of
medicine, form, strength, dose or number of dosage unit) prescriber’s information including
the name, address, profession, contacts and signature)

-Communicate with the doctor if there is any query about the prescription, or care of the
patient before dispensing
 Dispensing and Patient counselling on the use of medication (Why he needs the
medication, it is a controlled drug and should be used with precaution and storage of the
medication/never to share the medicine with other people)
- Record in the pharmacy’s controlled drugs register (patients information, medicines
information and dispenser information)
- Store controlled drugs safely under lock and key

SECTION D:
5. You are appointed as an inspector, during your inspection you have found a shop
with no premises registration and business permit from the Council, a person selling
medicine has no pharmaceutical knowledge, expired drugs are in the dispensing
area, the shop also stocked unregistered cosmetics and medicines.
g) Explain what steps will you follow do as an inspector to handle the situation
(3 Marks)
h) Identify each mistake stipulated above and laws governing the malpractices
encountered (3 Marks)
i) What will you advise the regulators to deal with such malpractices (2 Marks)

Answer:
(a) - Introduce myself and stating the purpose of inspection
- State all the malpractice to the client and explain to him/her that it is against the law to
sell medicines under such conditions
- Explain to him/her steps to take in order to operate the business legally
- Fill the inspection form with the directives he/she should follow and tell the client to sign
and leave them with a copy
- confiscate unregistered medicine and cosmetics and document all the confiscated items
- Close the premise and report to the Council and TFDA about the malpractice for further
actions such as medicine conscification

No. Malpractice Law

1. no premises registration and business Pharmacy Act. 2011
permit from the Council, a person selling
medicine has no pharmaceutical knowledge
2. expired drugs are in the dispensing area, TFDA Act. 2003
the shop also stocked unregistered

11
 cosmetics and medicines.

© - Frequent inspections should be conducted

- Public awareness/education about the laws, regulations, standards and procedures to
operate medicine business

6. You are a pharmacist in charge at Morogoro Regional Hospital,

during the weekend an epileptic patient in critical condition was brought to the
hospital. The doctor who was supposed to be on duty had an emergency; he called
you asking to dispense Phenobarbitone Sodium injection 60mg/ml BID for 5
days.
e) As a pharmacist how will you handle this situation? (2 Marks)
f) Under which condition a pharmacist can supply medicine in such case? Explain
your answer (5 Marks)

Answer:
(a) I will dispense the medicine to save then patient life and explain to the doctor that
he need to provide the prescription for that medicine within 72 hours

(b) A pharmacist will supply medicine in this case under Emergency Supply of
Medicine
➢ After satisfying that Prescriber cannot provide prescription immediately due to
emergency
➢ Patient has been previously supplied with prescription only medicine and needs the
medicine immediately and cannot obtain the prescription immediately
➢ Prescriber will provide the prescription within 72 hours

12. (a) What is a Hospital Formulary and who is responsible for developing it? ( 2 Marks)
(b) What are the significances of Hospital Formulary? (3 Marks)

Answer:
(a) medical staff of a hospital with the help of pharmacy and therapeutic committee

(b) Significance of Hospital Formulary

- The hospital formulary system provides the information for procuring, prescribing,
dispensing and administrative of drug in the hospital
- It can be one of the most effective methods of ensuring rational drug therapy and
controlling drug cost
- It set standards for best practice of the hospital
- promote high quality; evidence based prescribing and reduces variation in the level of
treatment provided to patients

12
SECTION A:
14. (a) What do you understand by ethical dilemma? (3 Marks)
(b) Give two examples of ethical dilemma you may encounter in your practice as a
pharmacist (4 Marks)

Answer:
(a) Ethical Dilemma: is a decision-making problem between two possible moral
imperatives, neither of which is acceptable or preferable. The complexity arises out of
the situational conflict in which obeying one would result in transgressing another
(b) - Not telling the truth for patient benefit
- Receiving an overprescribed prescription
- A client sending you money after receiving services

15. Explain why it is important for pharmaceutical personnel to abide to Code of Ethics and
Professional Conducts and give at least five examples of Code of Ethics for
Pharmaceutical personnel.(5 Marks)
Answer:
It is important for a pharmaceutical personnel to abide to code of ethics because they are
the road map to making the right decisions in the provision of pharmaceutical services.
- Regard For Human Life
- Honour And Dignity Of Profession
- Availability Of Safe, Efficacious And Quality Medicines
- Access To Essential Medicines
- Promote Rational Use Of Medicines
- Pharm. Personnel-Patient Relationship
- Privacy And Confidentiality
- Life-long Learning
- Relationship To Other Health Care Providers
- Well-being Of The Community

16. 5. You are a pharmacist in charge of a pharmacy in town and you have received a
prescription requesting for pethidine injection. Give all necessary procedures which you
will take on honoring this prescription assuming that you have the drug. (4 Marks)

ANSWER:
- Before dispensing, check for legal validity of the prescription
Date of prescription, patient information (name, address) and drugs information (name of
medicine, form, strength, dose or number of dosage unit) prescriber’s information including
the name, address, profession, contacts and signature)

-Communicate with the doctor if there is any query about the prescription, or care of the
patient before dispensing
 Dispensing and Patient counselling on the use of medication (Why he needs the
medication, it is a controlled drug and should be used with precaution and storage of the
medication/never to share the medicine with other people)
- Record in the pharmacy’s controlled drugs register (patients information, medicines
information and dispenser information)

13
- Store controlled drugs safely under lock and key

SECTION D:
7. You are appointed as an inspector, during your inspection you have found a shop
with no premises registration and business permit from the Council, a person selling
medicine has no pharmaceutical knowledge, expired drugs are in the dispensing
area, the shop also stocked unregistered cosmetics and medicines.
j) Explain what steps will you follow do as an inspector to handle the situation
(3 Marks)
k) Identify each mistake stipulated above and laws governing the malpractices
encountered (3 Marks)
l) What will you advise the regulators to deal with such malpractices (2 Marks)

Answer:
(b) - Introduce myself and stating the purpose of inspection
- State all the malpractice to the client and explain to him/her that it is against the law to
sell medicines under such conditions
- Explain to him/her steps to take in order to operate the business legally
- Fill the inspection form with the directives he/she should follow and tell the client to sign
and leave them with a copy
- confiscate unregistered medicine and cosmetics and document all the confiscated items
- Close the premise and report to the Council and TFDA about the malpractice for further
actions such as medicine conscification

No. Malpractice Law

1. no premises registration and business Pharmacy Act. 2011
permit from the Council, a person selling
medicine has no pharmaceutical knowledge
2. expired drugs are in the dispensing area, TFDA Act. 2003
the shop also stocked unregistered
cosmetics and medicines.

© - Frequent inspections should be conducted

- Public awareness/education about the laws, regulations, standards and procedures to
operate medicine business

8. You are a pharmacist in charge at Morogoro Regional Hospital,

during the weekend an epileptic patient in critical condition was brought to the
hospital. The doctor who was supposed to be on duty had an emergency; he called
you asking to dispense Phenobarbitone Sodium injection 60mg/ml BID for 5
days.
g) As a pharmacist how will you handle this situation? (2 Marks)
h) Under which condition a pharmacist can supply medicine in such case? Explain
your answer (5 Marks)

14
 Answer:
(c) I will dispense the medicine to save then patient life and explain to the doctor that
he need to provide the prescription for that medicine within 72 hours

(d) A pharmacist will supply medicine in this case under Emergency Supply of
Medicine
➢ After satisfying that Prescriber cannot provide prescription immediately due to
emergency
➢ Patient has been previously supplied with prescription only medicine and needs the
medicine immediately and cannot obtain the prescription immediately
➢ Prescriber will provide the prescription within 72 hours

13. (a) What is a Hospital Formulary and who is responsible for developing it? ( 2 Marks)
(b) What are the significances of Hospital Formulary? (3 Marks)

Answer:
(c) medical staff of a hospital with the help of pharmacy and therapeutic committee

(d) Significance of Hospital Formulary

- The hospital formulary system provides the information for procuring, prescribing,
dispensing and administrative of drug in the hospital
- It can be one of the most effective methods of ensuring rational drug therapy and
controlling drug cost
- It set standards for best practice of the hospital
- promote high quality; evidence based prescribing and reduces variation in the level of
treatment provided to patients

15