MAHARASHTRA STATE BOARD OF TECHNICAL EDUCATION

(Autonomous)
(ISO/IEC - 27001 - 2005 Certified)
WINTER– 2023 EXAMINATION
Model Answer – Only for the Use of RAC Assessors
Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Important Instructions to examiners:

1) The answers should be examined by key words and not as word-to-word as given in the model answer
scheme.
2) The model answer and the answer written by the candidate may vary but the examiner may try to assess
the understanding level of the candidate.
3) The language errors such as grammatical, spelling errors should not be given more Importance (Not
applicable for subject English and Communication Skills.
4) While assessing figures, the examiner may give credit for principal components indicated in the figure.
The figures drawn by candidate and model answer may vary. The examiner may give credit for any
equivalent figure drawn.
5) Credits may be given step wise for numerical problems. In some cases, the assumed constant values may
vary and there may be some difference in the candidate’s answers and model answer.
6) In case of some questions credit may be given by judgement on part of the examiner of relevant answers
based on the candidate's understanding.
7) For programming language papers, credit may be given to any other program based on an equivalent
concept.
8) As per the policy decision of Maharashtra State Government, teaching in English/Marathi and Bilingual
(English + Marathi) medium is introduced in the first year of AICTE diploma Programme from academic
year 2021-2022. Hence if the students write answers in Marathi or bilingual language (English +Marathi),
the Examiner shall consider the same and assess the answer based on matching of concepts with model
answer.

Q. Sub Answers Marking

No. No. Scheme

1 Answer any SIX of the following: 30M

1 a 5M
Define ward round participation. Write the goal and procedure of ward round
participation by a clinical pharmacist.

Marking Scheme: 1M definition, 2M goals, 2M for procedure of ward round.

Definition :

A Ward round is a visit made by a medical practitioner, alone or with a team of

healthcare professionals and medical students to hospital in-patients at their bedside to
review and follow-up the progress in their health.

The goals of clinical pharmacists participation in ward rounds are to:

1.To gain a patients' clinical status and progress, currently planned investigations, and
therapeutic goals.

Page No: 1 of 31
 MAHARASHTRA STATE BOARD OF TECHNICAL EDUCATION
(Autonomous)
(ISO/IEC - 27001 - 2005 Certified)
WINTER– 2023 EXAMINATION
Model Answer – Only for the Use of RAC Assessors
Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

2.To get relevant information on drugs consumed, their effectiveness, and adverse
effects.

3.Optimize therapeutic management by influencing drug therapy selection, drug

administration, monitoring, and follow-up, investigate unusual drug orders or doses.

4.Additional Information about the patient comorbidities, medication compliance, or

alternative medicine use that might be relevant to their management.

5.Detect, manage, and prevent adverse drug reactions and drug interactions.

6.The doctors are visiting all the patients in an order beginning from the intensive care
unit

7. Documented case report reminds the case history of the patients to update and change
the strategies of treatment.

8.The ward team objective is to ensure safe, effective, economic, and patient-friendly
treatment.

9.Participants in the inpatient discharge planning.

10.Many learning opportunities are provided to pharmacists.

11.It strengthens the inter-professional ships among various HCP leading to better
healthcare research.

Procedure :

1.Pharmacists should complete pre -round preparation before participating in ward

rounds-like developing a patient log sheet(profile), choosing the best method of
communication(verbal/written) with the team members etc.

2.If a hospital has its own formulary, the pharmacist should ensure that all prescriptions
are in accordance with hospital formulary.

Page No: 2 of 31
 MAHARASHTRA STATE BOARD OF TECHNICAL EDUCATION
(Autonomous)
(ISO/IEC - 27001 - 2005 Certified)
WINTER– 2023 EXAMINATION
Model Answer – Only for the Use of RAC Assessors
Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

3.During the visit, pharmacists should identify any drug interaction, adverse drug events
or medication errors, if any and suggest an alternative solution for it.

4.Pharmacists have the opportunity to intervene while performing various activities like
medical history interview; medication chart review, therapeutic drug monitoring and
drug information during ward round participation.

5.Observe and participate in consultant-led patient management discussions.A

pharmacist must arrange at least one lecture/month for supportive staff regarding drug
related problems.

6.Take follow ups by phone calls.

7.Specific monitoring Aids- In specialised areas such as ICU, oncology, pulmonary,

renal etc. monitoring criteria and protocols may be written that help in determining the
degree of monitoring required.

Page No: 3 of 31
 MAHARASHTRA STATE BOARD OF TECHNICAL EDUCATION
(Autonomous)
(ISO/IEC - 27001 - 2005 Certified)
WINTER– 2023 EXAMINATION
Model Answer – Only for the Use of RAC Assessors
Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

1 b Define Inventory control. Enlist their methods and describe in detail “Economic 5M
Order Quantity” Method.
Marking scheme: 1 M for Inventory control definition, 2 M for enlisting any
eight inventory techniques,2 M for EOQ explanation
Definition: Inventory Control is the balance between not ordering too much and
avoiding stock out situations of material.
Different techniques of Inventory control:
● Economic Order Quantity (EOQ)
● Reorder quantity level
● Inventory turnover
● ABC analysis
● VED analysis
● ABC-VED matrix analysis
● FEFO, FIFO analysis
● Lead time
● Buffer stock
Economic Order Quantity:
Economic Order Quantity is the purchasing of item in bulk amount at which ordering
cost and inventory carrying cost will be minimum.
OR
The quantity of material to be ordered in economic lot size which minimizes both the
cost (carrying & ordering) is known as economic order quantity.
EOQ is a profitable quantity for those materials which are used regularly & in bulk
quantities are purchased in economic lot size
This technique is used to decide how much quantity of material is to be ordered.
Hence it is determined by following formula-

Where, AC - annual Consumption ,OC - ordering cost

UC - unit cost ,ICC - inventory carrying cost

Page No: 4 of 31
 MAHARASHTRA STATE BOARD OF TECHNICAL EDUCATION
(Autonomous)
(ISO/IEC - 27001 - 2005 Certified)
WINTER– 2023 EXAMINATION
Model Answer – Only for the Use of RAC Assessors
Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

1 c Explain distribution and storage of NDPS in hospitals. 5M

Marking scheme: 3 marks for distribution and 2 marks for storage
Distribution of NDPS:
1.A separate register should be maintained to record dispensing and a controlled
procedure is used to issue or receive NDPS drugs.
2.Following persons are involved in dispensing,
Medical superintendent is overall responsible for the proper safeguarding and handling
of narcotics and psychotropic substances.
Chief pharmacist responsible for the purchase, storage, accountability and appropriate
dispensing of the narcotics and psychotropic substances within the hospital.
Head nurse : Responsible for the record of proper storage.
3.Prescription order of the narcotics & psychotropic substances should be made by
using ink or indelible pencil, typing and duly sign by the respective doctor.
4. Prescriptions for Narcotic & psychotropic substances must include the following
information: Patient's full name, Address, Date, Name and strength of the drug,
Quantity of drug, Signature of prescriber, Dose and route of administration.
5. If the required drug is not in stock in the ward, the complete controlled drug
prescription must be written on a hospital prescription blank form by a registered
medical practitioner and then it is Signed and sent to the hospital pharmacy.
Abbreviation like p.r.n (Pro Re Nata) or S.O.S (Si Opus Sit) must be discouraged for
such drugs
6.The completed form along with the empty containers and nurses inventory sheet is
sent to the pharmacy for dispensing. The prescription signed by a Registered Medical
Practitioner will also permit the patient to purchase drugs from outside pharmacies.
7. The delivery of narcotic drugs from the pharmacy to the wards and nursing stations
must be carried out through some reliable persons.
8. Charges for Narcotic and Psychotropic Substances depend upon the policy of the
hospital. It could be like the charges may be made for individual dose received or flat
charges for all narcotics and hypnotics

Page No: 5 of 31
 MAHARASHTRA STATE BOARD OF TECHNICAL EDUCATION
(Autonomous)
(ISO/IEC - 27001 - 2005 Certified)
WINTER– 2023 EXAMINATION
Model Answer – Only for the Use of RAC Assessors
Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

9.After the dispensing of narcotics by the pharmacy, Nurse in charge must prepare
special form in duplicate entries to cover incidence of every dose of narcotics &
psychotropic substances given/administered to patient or drug is lost or wasted on
ward. Such accountability of control substances needs to be furnished to the pharmacy
department while requesting for new supply of drugs. Original is filled in the
pharmacy and duplicate copy is kept for record to the nursing office.
10. While administering a dose, if a patient refuses or the doctor cancels any dose, it is
the responsibility of the nurse to destroy the drug into the sink and record "Refused by
patient" or "order cancelled by doctor". Nurses should always preserve a proper record
in case of destruction/ wastage /contamination.
11. Pharmacists need to preserve the records of the receipt and return of narcotics &&
psychotropic substances for disposal. Documentation of the return of narcotics &
psychotropic substances for demolition by the pharmacist from the respective ward of
hospital is considered as good practice of record.
Storage:
● A separate register should have been maintained to register them and record
the addition and/or deletions of NDPS in Red Ink along with their signature.
● Record barrow narcotics in separate- Borrowing Narcotics Administration
Register.
● Registered nurses will be responsible for records of proper storage.
● NDPS must be stored in a separate cupboard with double lock and key. The
key of the locks should be kept with two different people. Other than narcotic
drugs no other items are permitted to be stored in the cupboard.
● NDPS must be procured and stored in such a manner so as to prevent misuse
by unauthorized persons.
● The storage area for NDPS must be opened and accessed by a specific
pharmacist in charge and specific nursing in charge of the respective
department.

Page No: 6 of 31
 MAHARASHTRA STATE BOARD OF TECHNICAL EDUCATION
(Autonomous)
(ISO/IEC - 27001 - 2005 Certified)
WINTER– 2023 EXAMINATION
Model Answer – Only for the Use of RAC Assessors
Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

● Send completed narcotics Administration Records to the pharmacy daily. Enter

shift count (Count narcotics at the change of shift each shift) in Red on the
Narcotics and controlled drug record.

1 d 5M
Define Drug information centre and Poison information centre. Write the various
sources of drug information with explain.

(Marking scheme - 1 mark each for definition, 3 marks for various sources of
information)

Drug information centre: ( 1 mark)

It is defined as "A branch in the hospital designed for receiving, collecting, analyzing
& providing unbiased,accurate & up-to-date information about drugs & their use".

Poison information centre : ( 1 mark )

It is a specialized unit providing information on prevention, early diagnosis and

treatment of poisoning and hazard management.

Sources of drug information:

On the basis of the origin, composition & function, the sources of information can be
classified into three types,

1.Primary sources

2.Secondary sources

3.Tertiary sources.

Primary resources: ( 1 mark with any 2 examples)

It includes the original research papers published in scientific journals; proceedings of

seminars and conferences; newsletters; and patents. It can also include the care
reports, case series, editorials and letters to the editors.

Some good journal representing science and practice of pharmacy are given below:

1, The American Journal of Health System Pharmacy

Page No: 7 of 31
 MAHARASHTRA STATE BOARD OF TECHNICAL EDUCATION
(Autonomous)
(ISO/IEC - 27001 - 2005 Certified)
WINTER– 2023 EXAMINATION
Model Answer – Only for the Use of RAC Assessors
Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

2. Drug Discovery Today

3. American Journal of Hospital Pharmacy

4 Advanced Drug Delivery Reviews

5. Journal of Clinical Pharmacy and Therapeutics

6. Journal of Ethnopharmacology

7. Pharmacology and therapeutics

8. Journal of Medicinal Chemistry

9. Journal of Pharmacy Practice

Secondary Resources :( 1 mark with any 2 examples)

It comprises the second-hand information including summary of information

appearing in the primary sources.Here original information selected, summarized,
modified, condensed from primary source.

These usually include various print and electronic abstracting and indexing services
like international pharmaceutical abstracts UPA), EMBASE, SEDBASE, Science
Direct, Micromedex, Biosis, CA search, BRS, Natural Medicine Comprehensive
Database (NMCD), India Drug Index, AHFS drug information, etc.

Tertiary Resources: ( 1 mark with any 2 examples)

The tertiary resources provide overview of the topic in a concise and readable form,
like encyclopedia, medical dictionaries, directories, desk references, drug compendia
and textbooks. These are the summary of the primary resources.

Some of the frequently used tertiary resources of drug information are given below:

1 The United States Pharmacopeia

2. The British Pharmacopoeia

3 British National Formulary (BNF)

4. Martindale Extra Pharmacopoeia

Page No: 8 of 31
 MAHARASHTRA STATE BOARD OF TECHNICAL EDUCATION
(Autonomous)
(ISO/IEC - 27001 - 2005 Certified)
WINTER– 2023 EXAMINATION
Model Answer – Only for the Use of RAC Assessors
Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

5. Remington's Science and Practice of Pharmacy

6. The Merk Index

7. Indian Pharmacopoeia

8. Goodman and Gillman's Pharmacological Basis of Therapeutics

9. Physician's Desk Reference

1 e Enlist different Test of Liver Functioning and explain any two of them. 5M
( 3M for enlisting and 2 marks for explanation of any 2 tests )
Liver Functioning tests are:
1.Tests based on excretory functions-
● Measurement of Serum bilirubin
● Measurement of Urine bilirubin
● Measurement of Urine bile salts
● Measurement of Bromosulphophthalein (BSP) dye test
2. Tests based on serum enzymes derived from liver determination of :
● Serum aspartate transaminase (AST)
● Serum alanine transaminase (ALT)
● Serum alkaline phosphatase (ALP)

3. Tests based on metabolic capacity-

● Tests related to carbohydrate metabolism - galactose tolerance test
● Test related to lipid metabolism - determination of serum cholesterol and ratio
of free to esterified cholesterol
● Test related to protein metabolism - serum protein estimation and serum
ammonia estimation

4. Tests based on synthetic functions-

● Determination of plasma proteins, albumins and globulins

● Determination of prothrombin time

Page No: 9 of 31
 MAHARASHTRA STATE BOARD OF TECHNICAL EDUCATION
(Autonomous)
(ISO/IEC - 27001 - 2005 Certified)
WINTER– 2023 EXAMINATION
Model Answer – Only for the Use of RAC Assessors
Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

5. Tests based on detoxification- Hippuric acid test, Blood ammonia and bilirubin
● Determination of Hippuric acid test
● Determination of Blood ammonia and bilirubin

BILIRUBIN
Bilirubin is a bile pigment, & is the excretory end product of heme degradation.
It is conjugated in the liver to form bilirubin diglucuronide, & excreted in bile.
1. Serum bilirubin
● The normal concentration of serum bilirubin is in the range of 0.2- 1.0 mg/dl. Of
this, the conjugated bilirubin is about 0.2-0.4 mg/dl, while the unconjugated
bilirubin is 0.2 - 0.6 mg/dl.
● Jaundice symptoms include yellow coloration of conjunctiva, mucous membrane &
skin due to increased level of bilirubin. Jaundice is visible when serum bilirubin level
exceeds 2.5 mg/dl.
Van den bergh reaction
● This is a specific reaction to identify the increase in serum bilirubin(above
reference level). Normal serum gives a negative van den Bergh reaction.
● This reaction is very useful to understand the nature of jaundice.
● The response of van dan Bergh reaction can differentiate the jaundice as follows-
● Indirect positive —Hemolytic jaundice
● Direct positive —Obstructive jaundice
● Biphasic—Hepatic jaundice
2. Bilirubin in Urine
The conjugated bilirubin, being water soluble, is excreted in urine.
The bilirubin in urine can be detected by Fouchet’s test or Gmelin’s test.
bilirubin in urine tests measures the levels of bilirubin in your urine. Normally,
urine doesn't have any bilirubin. If there is bilirubin in your urine, it may be an
early sign of a liver condition.
A positive (+) result of bilirubin in urine (bilirubinuria) is indicative of a liver
problem or a bile obstruction.
Bilirubin in urine can be detected by Fouchet’s test or Gmelin test

Page No: 10 of 31
 MAHARASHTRA STATE BOARD OF TECHNICAL EDUCATION
(Autonomous)
(ISO/IEC - 27001 - 2005 Certified)
WINTER– 2023 EXAMINATION
Model Answer – Only for the Use of RAC Assessors
Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

A)Fouchet’s test :
Principle : Bilirubin is precipitated by Barium Chloride . This bilirubin is oxidized to
green biliverdin by Fouchet’s reagent.
TEST :
i)Acidity 10ml of urine with a few drops of dilute acetic acid and add 5ml of 10%
solution .
ii)If there is not much ppt add 2 drops of saturated solution of magnesium sulphate ,
mix and allow to stand for a few minutes.
iii)Filter and unfold the filter paper.
iv) Add one drop of Fouchet’s reagent to ppt.
v)The development of green coloration indicates the presence of bile pigments.
B) Modified Gmelin’s test:
To 10 ml of urine, add 2-3 drops of dil.HCL .filter it through paper, allow it to dry and
put a drop of conc HNO3 at the apex of paper.Different coloration can be seen in the
order of green , blue, violet , red and yellowish red, showing the presence of bile
pigments.
3. Measurement of Urine bile salts
The amount of urobilinogen present in urine depends on the amount of bilirubin
entering the intestine. It is estimated semi-quantitatively by Ehrlich’s aldehyde
reagent.

Clinical interpretation:

● In increase in urobilinogen in urine, is found in hemolytic jaundice due to

excess production of bilirubin
● In hepatitis urobilinogen in urine may be normal or decreased
● In post hepatic obstructive jaundice, due to the complete or almost complete
biliary obstruction, no urobilinogen is found in urine because bilirubin is
unable to enter the intestine
4.Measurement of Bromosulphophthalein (BSP) dye test
In addition to excreting bilirubin, the liver is capable of eliminating various dyes or

Page No: 11 of 31
 MAHARASHTRA STATE BOARD OF TECHNICAL EDUCATION
(Autonomous)
(ISO/IEC - 27001 - 2005 Certified)
WINTER– 2023 EXAMINATION
Model Answer – Only for the Use of RAC Assessors
Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

drugs by the same excretory pathway as bilirubin.

Bromosulfophthalein excretion test:

A 5% solution of BSP is injected intravenously (the dose is 5 mg/kg body wt) and a
sample of blood is tested 45 minutes later for percentage of injected dye remaining in
the blood.

Clinical interpretation:

In normals, the retention of BSP at 45 minutes is less than 5 %. Impairment of liver

cell function causes an increase in BSP retention.

TESTS BASED ON SERUM ENZYMES FROM LIVER

➔ Liver cells contain several enzymes which may be released into the circulation in
liver damage.
➔ Measurement of selected enzymes in serum is often used to assess the liver
function.
1.Transaminases or aminotransferases
● The activities of 2 enzymes-serum glutamate pyruvate transaminase(SGPT;
recently known as alanine transaminase-ALT) & serum glutamate oxaloacetate
transaminase( SGOT; recently known as aspartate transaminase-AST)--are
widely used to assess liver function.
● The activity of these enzymes is low in normal serum(SGPT-5-40 IU/litre;
SGOT-5-45 IU/Iitre).
● Serum SGPT & SGOT are increased in liver damage.However, SGPT is more
sensitive & reliable for the assessment of LFT.
Clinical Significance of SGPT & SGOT TESTS
● In liver diseases, the concentration of these enzymes increase in the serum.
● Both enzymes increase in obstructive jaundice.
● Very high concentrations of these enzymes indicate toxic hepatitis.

Page No: 12 of 31
 MAHARASHTRA STATE BOARD OF TECHNICAL EDUCATION
(Autonomous)
(ISO/IEC - 27001 - 2005 Certified)
WINTER– 2023 EXAMINATION
Model Answer – Only for the Use of RAC Assessors
Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

2. ALKALINE PHOSPHATASE (ALP)

Alkaline phosphatase(ALP) is mainly derived from bone & liver.
A rise in serum ALP( normal 3-13 KAunits/dl KING ARMSTRONG), usually
associated with elevated serum bilirubin is an indicator of biliary
obstruction(obstructive jaundice).
ALP is also elevated in liver cirrhosis & hepatic tumors.
Measurement of other serum enzymes like γ-glutamyl transpeptidase(GGT),
5’-Nucleotidase, isocitrate dehydrogenase & isoenzymes of lactate
dehydrogenase are also useful in LFT.
3.Gamma – Glutamyl transpeptidase: (GGT)
Measurement of (GGT )activity provides a sensitive index to assess liver abnormality
Serum GGT is highly elevated ( Normal 10 – 15U/L) in biliary obstruction and
alcoholism
LFT BASED ON SERUM PROTEINS (Albumin)
● Albumin is only synthesized by the liver.
● It is a good marker to assess chronic liver damage.
● Low serum albumin is commonly observed in patients with severe liver damage.
● It must however, be noted that the serum albumin concentration is also
decreased due to malnutrition.
LFT BASED ON SERUM PROTEINS(Globulin)
● Increased synthesis of Globulins indicates impairment of liver.
● Cirrhosis of the liver is indicated by the reversal of albumin/globulin(A/G) ratio.
GALACTOSE TOLERANCE TEST
● Galactose is a monosaccharide, almost exclusively metabolized by the liver.
● The liver function can be assessed by measuring the utilization of galactose.
● This is referred to as the Galactose Tolerance Test.
● In normal individuals, the half-life of galactose is about 10-15 minutes.
● This is markedly elevated in infective hepatitis & cirrhosis.

Page No: 13 of 31
 MAHARASHTRA STATE BOARD OF TECHNICAL EDUCATION
(Autonomous)
(ISO/IEC - 27001 - 2005 Certified)
WINTER– 2023 EXAMINATION
Model Answer – Only for the Use of RAC Assessors
Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

PROTHROMBIN TIME
● The liver synthesizes all the blood clotting factors.
● A decrease in the concentration of plasma clotting factors is found in the
impairment of liver function.
● This can be checked by measuring prothrombin time which is prolonged in
patients with liver damage compared to normal.
● The half-lives of clotting factors are relatively short(5-72 hrs.), therefore, changes
in prothrombin time occur quickly.
● Hence this test is useful to assess acute as well as chronic liver damage.
HIPPURIC ACID SYNTHESIS
● The liver is the major site for the metabolism of xenobiotics(detoxification).
● Measurement of hippuric acid synthesis is an ideal test for assessing the
detoxification function of the liver.

1 f Define medication errors. Write various strategies to minimise medication error. 5M

Marking scheme: 1 M for definition, 4 M for strategies to minimize medication
errors.
Definition:
Medication error is defined as any error in the prescribing, dispensing or
administration of drugs which are the single most preventable cause of patient harm.
OR
Any preventable event that may cause or lead to inappropriate medication use or
patient harm while the medication is in the control of the healthcare professional,
patient, or consumer.
Strategies for prevention of medication error: (any 8)
1.If not sure about the dose or drug consult to the pharmacist
2.If the illegible writing, confirm the drug or dose by calling healthcare provider and
then dispense medicines
3.Recheck the calculation to confirm that patient will get right therapeutic dose
4.Ask another clinician to recheck your calculations of dose.
5.When writing orders do not use drug abbreviations

Page No: 14 of 31
 MAHARASHTRA STATE BOARD OF TECHNICAL EDUCATION
(Autonomous)
(ISO/IEC - 27001 - 2005 Certified)
WINTER– 2023 EXAMINATION
Model Answer – Only for the Use of RAC Assessors
Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

6.To each prescription always add the patient’s weight and age
7.Do not use abbreviations for route and frequency of dosage
8.When writing a prescription state treatment condition
9.Always specify duration of therapy
10.Do not hesitate to check dose and frequency if you are not knowing
11.Always remember each medication has potential for adverse reaction
12.Be aware of high risk medications
13.Before ordering any medication,analyse blood samples for liver and renal function.
14.Double check the frequency and dosing of all high alert medications

1 g Define National Accreditation Board for Hospital and write its benefits and Role 5M
of pharmacist in it.
(Marking scheme: 1 mark - definition, 2 marks for any 2 benefits, 2 marks for
any 4 role of pharmacist)
NABH- It is a constituent Board of Quality Council of India, that is set up to improve
the standards of health care organisations with the purpose of improving health care
quality and patient safety in public and private hospitals.
Benefits of Accreditation: (any 2 benefits)
1.For patients: (any 2 points - 1mark)
a) Patients can feel safe due to implementation of accreditation standards ensures
Patient safety, commitment to quality care resulting in good clinical outcomes.
(b) Improves patient satisfaction and increases community confidence as services are
provided by credentialed medical staff.
(c) Provides good marketing advantage in competitive healthcare.
(d) Accreditation by ISQua gives international recognition which will boost medical
tourism.
(e) Provides an objective system of empowerment by insurance and other third parties.
(f) The rights of patients are respected and protected.
2.For a Hospital/Organisation:(any 2 points - 1mark)
(a)Guide the hospital to provide quality healthcare, patient safety as per global
standards so continuous improvement in health care organisation.

Page No: 15 of 31
 MAHARASHTRA STATE BOARD OF TECHNICAL EDUCATION
(Autonomous)
(ISO/IEC - 27001 - 2005 Certified)
WINTER– 2023 EXAMINATION
Model Answer – Only for the Use of RAC Assessors
Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

(b)The testimony that the hospital wishes to increase the patient's experience
positively.
(c) It provides International recognition for any hospital which helps to promote
medical tourism.
(d) It provides a marketing advantage in a competitive health care.
3. Benefits for staffs: (any 2 points - 1mark)
(a) The staff are satisfied as it provides for continuous learning, good working
environment and leadership.
(b) It improves efficiencies and competencies of staff.
(c) It improves overall professional development, knowledge and competencies.
Role of pharmacist in NABH: (any 4 )
The primary duty of a hospital pharmacist is to support safe, rational and economic
use of medicines for the benefit of the patient and in interest of hospital. The
pharmacist performs his role in management of medication while going for the NABH
accreditation. The various roles of a hospital pharmacist include:
1.Provide guidelines for the organization for pharmacy services, management and
drug use.
2.Set up a multidisciplinary committee called the Pharmacy Therapeutic Committee
which provides best information on medication management and the same shall be
updated and implemented.
3.Provide guidelines for the storage of the medication. This defines a list of high-risk
medication, emergency medication and LASA (Look Alike and Sound Alike) drugs
etc. Also suggests guidance for storing these drugs physically apart from each other.
4.Establish guidelines and policy to find error or illegible prescription for rational and
safe prescription of medication.
5.To set the standards for medication writing in a uniform manner. Medication orders
are legible, dated, timed and signed.
6.Identify potential high risk medications and to outline steps to prevent errors that
may result from confusion of these medications.

Page No: 16 of 31
 MAHARASHTRA STATE BOARD OF TECHNICAL EDUCATION
(Autonomous)
(ISO/IEC - 27001 - 2005 Certified)
WINTER– 2023 EXAMINATION
Model Answer – Only for the Use of RAC Assessors
Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

7.Establish policies / guidelines for dispensing only against valid prescription or

medication orders. Dispensing shall be preceded by checking the expiry date, strength,
generic component of the drug.
8. Ensure patient safety after the administration of medication creating a system for
monitoring, reporting and analysing the medication errors and adverse drug reactions.
9.Prepare very vital standards on safe use of narcotic, psychotropic, chemotherapeutic
agents and radioactive agents.
10. Ensure the availability of medication as per the hospital formulary and maintain as
per the inventory. Pharmacists know the procedure of purchasing and also audit
documentation of periodic stock including physical verification.
11. Fire safety arrangement in the pharmacy and store room. Pharmacist know about
chemical spill management
12. Quality indicator for pharmacy-
a) Incidence of dispensing errors
b) % of wastage of drug
c) % of medicine expiring in a period
d) % of stock out of drugs
e) % of stock out of emergency drugs
f) % of medicines procured through local purchase
Pharmacists collect data of all above quality indicators from the pharmacy department
every month and analyse it.

2 Answer any TEN of the following: 30 M

2 a Define Hospital Pharmacy and write its scope 3M

Marking scheme: 1 M for definition, 2 M for any 4 points in scope.
Definition:
Hospital pharmacy is defined as a department of hospital wherein procurement,
storage, compounding, dispensing and distribution of medicines and professional
supplies is done to inpatients and outpatients under the control of legally qualified
pharmacists.

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Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

Scope of hospital pharmacy:

1. To professionalize the functioning of pharmaceutical services in hospital
2. To perform functions of material management
3. To make the hospital self-sufficient in respect of critical drugs
4. To ensure availability of right medication at the right time, right dose and at
minimum possible cost
5. To serve as source of drug information
6. To serve as counselling department
7. To organise and participate in research projects, educational programs
8. To cooperate and coordinate with other departments
9. To participate inpatient care system more actively than performing only the
counting, pouring and dispensing job
10. To educate patients, nurses, interns and pharmacy trainers on various aspects of
drug.

2 b Define Drug related problems and classify it. 3M

Marking scheme: 1 M for definition, 2 M for classification
Definition:
Drug related problem is an event or circumstance involving drug therapy that actually
or potentially interferes with desired health outcome.
Classification:
1.New drug therapy-
patient has a medical condition that require new drug therapy
e.g.-Need for additional drug
2.Unnecessary drug therapy-
A patient is taking a drug therapy which is not suitable for his/her condition.
3.Use of wrong drug-
A patient has a medical condition for which the wrong drug is prescribed.
4.Too low dose-
A patient has a medical condition for which too low a dose of the correct drug is taken.

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Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

5.Too high dose-

A patient has a medical condition for which too high a dose of the correct drug is taken.
6. ADR-
A patient has a medical condition that occurs due to ADR.
7.Drug interaction-
A patient has a medical condition because of drug-drug interaction, drug-food
interaction or drug-disease interaction.
8.Non-compliance-
A patient has a medical condition for which the patient ignores the doctor's instructions
to take the medication and follow the self-prescription.
9.Lack of monitoring of effect and toxicity of drugs: e.g Clinical examination e.g.
blood pressure weight with heart failure, blood tests e.g. regular counting of HbC with
clozapine treatment.

2 c Explain the dispensing of Radiopharmaceuticals. 3M

Marking scheme: 3 M for any 6 points
Dispensing of Radiopharmaceuticals
 Dispensing should be safe, straightforward and reliable
 Radiopharmaceuticals can be prepared in the form of ready to use kits or cold
kits which provide individual or multiple doses and can be reconstituted by the
addition of the radionuclide at the time of intended use
 Chemical reagents are prepared in a sterile environment using pyrogenic free
raw materials and dispensed into single or multiple unit dose containers.
 The cold kit preparation should be subjected to terminal sterilization preferably
by autoclaving or by membrane filtration
 Radiopharmaceuticals are never dispensed directly to patients, they are
provided to trained healthcare professional at the hospital or clinics and then
administered to the patients
 Recommended dosage level is calculated on the basis of patient history, age,
weight, surface area and other factors
 Dispensing of prescription is done as per applicable pharmacy law and

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Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

appropriate records are maintained

 Policies and procedures are developed for the rational use of
radiopharmaceuticals
 Good radiation practices (GRP) should be strictly followed to reduce the
unwanted and avoidable radiation exposure.

2 d Write about any 3 equipment used for maintaining cold storage conditions. 3M
Marking scheme: 1 M each
Refrigerator:
● The medicines are kept safely in narrow temperature range and their efficiency is
maintained
● It comprises of thermally protected compartments
● Temperature range is between 2℃ to 8℃
● Medicines stored in the refrigerator include vaccines, insulin, chemotherapy drugs,
topical preparations, eye drops, insulin, glucagon etc.
ILR ( Ice lined refrigerator):
● This device has a lining of ice packs hence the name is ice lined refrigerator
● Internal lining contains ice, ice packs or cold water filled compartments
● If electricity fails, the ice lining keeps the inside temperature at a safe level
● 2℃ to 8℃ temperature can be maintained with just 8 hours of power supply in 24
hours
● Additionally, top opening lid prevents loss of cold air during door opening hence
temperature can be maintained for a longer span in deep freezer
● They are mostly used in the vaccine cold chain
Walk in cold room:
● Walk in cold rooms ensure the temperature is constant and within range in all over
the room
● It is designed for exact observing of temperature conditions required for cold
storage
● It works between 0℃ to 25℃

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Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

● It maintains precise temperature for long term cold storage.

2 e Define PTC and write the functions and scope of the committee. 3M
Marking scheme: 1 M for definition 2 M for Function and scope (any 4 points)
Definition:
PTC is a committee which formulates policies regarding evaluation, selection and
therapeutic use of drugs.
Functions and scope of PTC
1.To advise medical staff and hospital administration in matters relating to use of
drugs, prevention of waste and confusion.
2.Establish and develop suitable educational schemes to improve hospital’s
professional staff on matters related to use of drugs.
3.Develop and compile a formulary of drugs.
4.To constantly review formulary and update if necessary.
5.To study problems related to drug administration, distribution, drug stocking and
drug use.
6.To review ADR or interactions occurring in the hospital.
7.To recommend about drugs to be stocked in patient care areas.
8.To advise pharmacy in implementation of effective drug distribution and control
procedures.
9.To develop written policies and procedures for selection, procurement, storage,
distribution and use of drugs.
10.To develop policies regarding drug safety.

2 f Define Hospital formulary and write about contents of hospital formulary 3M

Marking scheme: 1 M for definition 2 M for content
Definition: Hospital Formulary is a continually revised compilation of
pharmaceuticals (plus ancillary information) which reflects the current clinical
judgement of medical staff.
Content of hospital formulary:
PTC will take the decision regarding content of hospital formulary, but it generally

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Model Answer – Only for the Use of RAC Assessors
Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

contains 3 parts -
1.Information of hospital policies and procedures regarding drugs. This will include
following items:
a) Formulary policies and procedures
b) Brief description of PTC
c) Hospital regulations governing prescribing, dispensing and administration of drugs.
d) Pharmacy operating procedures
e) Information on using formulary
2. Drugs product listing - This includes information on drug products which have been
approved by PTC
a) List of approved drugs
b) Information about each approved drug
This section is the heart of formulary and consists of one or more index to facilitate
use of formulary. e.g. 1) Generic brand name, cross-reference list
2) Pharmacologic-therapeutic index
3. Special information - This section includes:
a) Prescription writing - This section is to guide young physicians who are appointed
as trainee staff. This gives information about parts of prescription, systems of
measurement, abbreviations used, essentials of narcotic prescription, etc.
b) Other data -
i) Normal laboratory values
ii) Calculation of doses for children
iii) Weights and measures
iv) Toxicology section
v) mEq calculations
vi) Diagnostic and pathological reagents in common use.
And other such data that PTC considers useful is included in formulary.

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Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

2 g Enlist different software used in pharmacy and explain pharmacy management 3M

software
Marking scheme: 2 M to Enlist,1 M for pharmacy management software.
Different software used in pharmacy

● Electronic health record (EHR) software: E.g. eClinical Works, Allscripts,

Nextgenclinic

● Medical billing software: e.g.Epic care

● Hospital management software: E.g. Availity

● Medical equipment management software: E.g. Sortly

● Medical research software: E.g. Pubmed.gov

● E-prescribing software: E.g. MediTab, ScriptSure

● Telemedicine software:

● Therapeutic drug monitoring: E.g. WinNOpNLIN, USC Pack

● Personal Health Record software (medical diaries): E.g. Tulipa app

● Pharmacy management software (PMS): This software helps to achieve two

business goals-

1.It helps automate the pharmacy workflow more efficiently- This includes such tasks
as reviewing physician orders and preparing medications, controlling the inventory
and making drug orders, handling billing and insurance, providing counselling,
identifying incompatibilities, and more–all while following legal protocols and
compliance.

2.It provides better customer experience and improves patients outcomes by attracting
them.-By computer communication, prescriptions can be easily handled by software,
freeing more time for pharmacists to interact with patients. Here pharmacists can
communicate with patients online on a patient portal. Also setting up a connection to a
hospital's EHR, a pharmacist can access a patient's medication history to make better
recommendations.

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Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

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No. No. Scheme

2 h Write in brief about Drug Food Interaction with example 3M

Marking scheme: Explain any 3 examples, 1 mark each)
Food affects the absorption of the drug. It may be attributed to

1) Dilution of the drug

2) Adsorption or complexation of drug

3) The alteration of gastric emptying

1.The interaction of drug and Tyramine containing drug ex. Cheese.

MAO is an enzyme abundantly present in liver and other tissues. It causes metabolism
of Serotonin (5- hydroxytyramine), Tyramine and noradrenaline. When the action of
MAO is inhibited , the concentration of serotonin, tyramine and noradrenaline
increases in CNS. This causes sudden hypertension and severe headache.

Hence tyramine containing food like cheese, banana, some beers,yeast products and
caffeine-containing drinks are restricted in patients on MAO inhibitor therapy .

2.milk reduces absorption of tetracycline by forming an insoluble complex.

3.Fatty food delays gastric emptying time and alters rate of absorption.

4.Absorption of some drugs reduces in presence of food e.g. Ampicillin, Rifampicin,

Isoniazid. Iron absorption is reduced if food has been taken within the previous two
hours. If Iron is taken on an empty stomach it can cause nausea. Therefore, Iron tablets
are often given with food.

5.Absorption of drugs like- riboflavin, spironolactone, lithium, citrate, Carbamazepine

increases in the presence of food.

6.Nitrofurantoin is given with food to avoid GIT irritation this also increases drug
absorption.

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Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

2 i Define unit dose drug distribution with its advantages and disadvantages. 3M
Marking scheme: 1 M for definition, 1 M each for advantages and disadvantages
(any 2 points in each)

Definition: Unit dose medications can be defined as those medications which are
ordered, packaged, handled, administered and charged in multiples of single dose units
containing a predetermined amount of drug or supply sufficient for one regular dose,
application or use.
Advantages: (any 2)
1. Less/no pilferage and wastage.
2. Avoids duplication of orders and extra paperwork.
3. Medication errors are reduced.
4. Services round the clock become possible.
5. Better financial control
6. Patients are charged only for the doses they receive.
7. Less space required as compared to bulky floor stock.
8. More efficient utilisation of personnel.
9. It allows nurses more time for direct patient care.
Disadvantages: (any 2 )
1. Need separate manpower for pre-packaging
2. Separate containers, closures, machinery and space is required.
3. Unit dispensing should be handled by skilled person and supervised by
pharmacist only
4. All the formulations cannot be made available in UDDS

2 j Define Total Parenteral Nutrition with its contents. 3M

Marking scheme: 1 M for definition 2 M for contents
Definition: Total Parenteral Nutrition (TPN) is the method of infusing nutrition to the
patients through Intravenous (IV) route. The nutrition is in the form of fluids.

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Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

CONTENTS OF TPN

TPN is mixture of separate components which contain

Carbohydrates, Lipids (fat), Amino acids, Electrolytes, Trace elements, Vitamins and
Fluids. TPN composition adjusted as per requirement of individual patients.
● Carbohydrates: Carbohydrates are the main source of energy. Dextrose and
monohydrates of glucose used as primary source of carbohydrate in TPN
● Lipids (Fat): Linoleic acid is used as the primary source of essential fatty acid in
TPN.
● Electrolytes:
Sodium (Na) - 100 to 200 mEq,
Potassium (K)- 80 to 120 mEq,
Magnesium (mg) - 8 to 16 mEq,
Calcium (Ca) - 5 to 10 mEq, Chloride
(C)- 100 to 200 mEq. Vitamins:
● Vitamins are required for the metabolism of carbohydrates, proteins, fats. water
soluble (B1, B2,B3, B5, B6, B7, B9, B12 & C) & fat-soluble vitamins (A, D, E &
K) used in TPN formulation

2 k Write various storage conditions with temperature as per IP 3M

Marking scheme: 3 M for any 3 storage conditions
As per IP 1996
● Cold: Any temperature not exceeding 8℃ and usually between 2℃ to 8℃.
● Cool: Any temperature between 8℃ to 25℃
● Room temperature: The temperature prevailing in a working area. This
temperature fails between 15℃ to 30℃
● Warm: Any temperature between 30℃ to 40℃
● Excessive heat: Any temperature above 40℃
● Light resistant container
● Well closed container

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Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

OR
As per IP 2022 the storage conditions are defined as following terms:
● Store in dry, well-ventilated place at a temperature not exceeding 30℃
● Store in a refrigerator (2℃ to 8℃). Do not freeze.
● Store in a freezer (-2℃ to -18℃)
● Store in a deep freezer ( below -18℃)
● Store protected from light
● Store protected from light and moisture

3 Attempt any FOUR of the following 12 M

3 a 1M
Define clinical pharmacy.It is a newborn discipline that carries traditional hospital
pharmacists from product oriented approach to patient oriented approach so as to ensure
patients maximum well being while on drug therapy. OR

Clinical pharmacy is defined as the area of pharmacy which is concerned with the
various aspects of patient care and deals with the dispensing of medicines, advising the
patient on safe and rational use of drugs to promote health, wellness, and disease
prevention. OR

Clinical pharmacy is a health science discipline in which pharmacists provide patient

care that optimizes medication therapy and promotes health, wellness and disease
prevention.

3 b 1M
Give the dose for BAL Antidote.

Ans. BAL is administered in a dose of 3-5 mg/kg I.M. at an interval of 4 hours for the
first 2 days, and an interval of 6-12 hours for additional 10 days.

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Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

3 c 1M
Define the term HMR.

Ans. Home Medication Review (HMR) is a patient-focused and collaborative health

care service provided in the community setting to enhance the quality use of medicines
and patient understanding. OR

Home Medication Review (HMR) is a service designed to assist patients living at home
to maximize the benefit of their medication regimen & prevent medication related
problems.

3 d 1M
Give the composition of Universal Antidote.

Ans. Composition of Universal Antidote:

Magnesium oxide 1 part

Activated charcoal 2 parts

Tannic acid 1 part

3 e 1M
Give the meaning of following Latin term:

1) Auristille- Eye drops

ii) Ante jentaculum - Before breakfast

3 f 1M
Define Radiopharmaceuticals.

Ans. Radiopharmaceuticals are pharmaceutical preparations containing radioactive

components. OR

Radiopharmaceuticals are medicinal formulations containing radioisotopes which are

used in major clinical areas for diagnosis and/or treatment

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Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

3 g 1M
Define Anit-natal care.

Ans. Antenatal care is the care a pregnant woman receives from the maternity team to
ensure that both mother and baby are as healthy as possible.

3 h 1M
Blood Pressure can be measured by________________.

Ans. Sphygmomanometer

3 i 1M
Pharmacist required for 100 bed Hospital

i) 02 ii) 05 iii) 05 iv) 08

Ans. ii) 5 OR iii) 05

3 j 1M
AST has a wide distribution in

i) Tissue ii) Cardiac iii) Renal iv) Blood

Ans. ii) Cardiac

3 k 1M
Give the full form of ASHP.

Ans. American Society of Health-System Pharmacists OR American Society of

Hospital Pharmacists

3 l 1M
T3 and T4 mainly for

i) Mental functioning ii) Physical functioning

iii) Body Temperature iv) All the above.

Ans. iv) All of the above

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Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

3 m 1M
The patients who come to the hospital with general symptoms like fever, cough
and cold are known as_____________

Ans. Ambulatory patient

3 n 1M
Thyrocalcitonin is used to maintain.

i) Phosphate level ii) Mg level iii) CAL level iv) None

Ans. iii) CAL level

3 o 1M
Give the ingredients in TPN.

Ans. Ingredients in TPN are: Carbohydrate, amino acids lipids(fats/triglycerides),

electrolytes, trace elements, vitamins and fluids

3 p 1M
What are Reserved antibiotics?

Ans. Reserved antibiotics are drugs that are accessible but reserved for treatment of
confirmed or suspected infections caused by multi-drug-resistant micro organisms.

3 q 1M
Define pharmacovigilance.

Ans. Pharmacovigilance is the science and activities relating to the detection,

assessment, understanding and prevention of adverse effects or any other
medicine/vaccine related problem.

3 r 1M
Vitamins store in

i) Room temp ii) Freezer iii) Cold temp iv) Cool temp

Ans. iv) Cool temp

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Model Answer – Only for the Use of RAC Assessors
Subject Name: HOSPITAL AND CLINICAL PHARMACY Subject Code: 20225

Q. Sub Answers Marking

No. No. Scheme

3 s 1M
Where is the WHO ADR monitoring centre situated?

Ans. Uppsala, Sweden.

3 t 1M
Which disposal method is used for cytotoxic drugs.

i) Incineration Method ii) Disposal to Sewers

iii) Directly to land fill iv) All the above

Ans. i) Incineration method

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