Mm

Code of Ethics

In May 1996, Council approved in principle a revised Code of Ethics based on a patient-centred care approach to practice. The draft was circulated in the ul!"u# 1996 issue of $har%acy Connection for feedbac& fro% %e%bers. Input fro% phar%acists and further discussions by the Ethics Co%%ittee were incorporated into this' the final version of the Colle#e(s Code of Ethics. PREAMBLE: "ll phar%acists have the obli#ation to act in the best interest of the patient, observe the law, uphold the di#nity ) honour of the profession, ) practice in accordance with ethical principles. The followin# ethical principles of professional conduct are intended to #uide phar%acists in their relationships with patients, other health care practitioners, ) the public. Principle One: COVENANT

The phar%acist establishes ) %aintains a uni*ue relationship with each patient that is based on an ethical covenant. The word +covenant+ %eans that phar%acists have %oral obli#ations in return for the trust #iven the% by society. $har%acists encoura#e shared responsibility for adherence to %edication re#i%ens ) achievin# desired dru# therapy outco%es. This principle i%plies that the best phar%aceutical service, no %atter how provided, occurs where the opportunity e,ists for direct patient contact between patient ) phar%acist. CARING COMPA!!IONATE The phar%acist actively pro%otes the well-bein# of every patient in a carin#, co%passionate %anner. The patient-s well-bein# is at the centre of the phar%acist(s professional ) business practices. This principle ensures that no patient shall be deprived of phar%aceutical services because of the personal convictions or reli#ious beliefs of a phar%acist. .here such circu%stances occur, the phar%acist refers the patient to another phar%acist who can %eet the patient(s needs. The phar%acist e,ercises his or her professional /ud#e%ent to ensure the patients( needs are %et in situations where e%er#ency services or care %ay be re*uired. CON"I#ENTIALIT$ The phar%acist preserves the confidentiality of infor%ation about individual patients ac*uired in the course of his or her professional practice ) does not divul#e this infor%ation e,cept where authori0ed by the patient or re*uired by law. $har%acists protect their patients by servin# the% in a private ) confidential %anner. $har%acists do not divul#e infor%ation that identifies the patient' e,cept in instances where there is a co%pellin# need, in the phar%acist(s professional /ud#e%ent, to share infor%ation in order to protect the patient or another person fro% har%, or where authori0ed by the patient or re*uired by law. A&TONOM$

Principle Two:

Principle Three:

Principle "o%r:

The phar%acist respects the autono%y, individuality ) di#nity of each patient. $har%acists ac&nowled#e the ri#ht to self-deter%ination, ) reco#ni0e individual self-worth by encoura#in# patients to participate in decisions about their health. $har%acists respect personal ) cultural differences, ) do not discri%inate a#ainst any patient for reasons of race, ancestry, place of ori#in, colour, ethnic ori#in, citi0enship, creed, se,, se,ual orientation, a#e, %arital status, fa%ily status or handicap. (ONE!T$ The phar%acist acts with honesty ) inte#rity. $har%acists never &nowin#ly condone the dispensin#, pro%otin# or distributin# of dru#s or %edical devices which are not of #ood *uality. $har%acists do not participate in any pro%otional %ethods or ca%pai#ns which encoura#e the inappropriate use of %edicines or in any professional or business dealin#s which are not %ar&ed by honesty and inte#rity. COMPETENT The phar%acist continuously i%proves his or her professional co%petence ) strives to enhance the *uality of phar%aceutical service ) care provided by the profession. $har%acists ta&e responsibility for assurance of their own co%petence, ) strive always to perfect ) enhance their professional &nowled#e. $har%acists further develop the *uality of phar%aceutical service ) care provided to the public throu#h association with or#ani0ations whose %andated include this #oal. CO*OPERATIVE

Principle "i'e:

Principle !i):

Principle !e'en:

The phar%acist collaborates with other health care professionals to achieve the best possible outco%es for the patient. $har%acists understand the individual roles ) contributions of other health care professionals ) consult or refer where appropriate. $har%acists also ac&nowled#e that collea#ues ) other health care professionals %ay differ in the beliefs ) values they apply to the care of the patient. $har%acists %ay not participate in any pro%otional %ethods or ca%pai#ns which under%ine the e,ercise of professional /ud#e%ent by the phar%acist or any other health care professional. A#VI!ABLE The phar%acist advocates for health pro%otion at the individual, co%%unity ) societal levels. $har%acists have a pri%ary obli#ation to pro%ote the health of individuals. This obli#ation can be e,tended beyond the individual to the co%%unity ) society as a whole. $har%acists en#a#e in dialo#ue with patients, provide public education to co%%unity #roups ) see& opportunities to advocate for health pro%otion to benefit society as a whole.

Principle Ei+ht:

Principle Nine: The phar%acist pro%otes the appropriate utili0ation of health care resources. $har%acists pro%ote the use of cost-effective therapies and discoura#e the purchase or use of unnecessary products or *uantities. The phar%acist practices only under conditions which do not co%pro%ise professional standards ) enables other phar%acists to practice in accordance with hi#h professional standards. $har%acists act in accordance with the hi#hest professional standards when carryin#
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Principle Ten:

out their duties ) do not accept e%ploy%ent where their ability to do so %ay be co%pro%ised. $har%acists in control of a phar%acy practice as owner, %ana#er or in-char#e phar%acist, ensure that there are no conditions which co%pro%ise another phar%acist(s ability to practice in accordance with hi#h professional standards ) e,ercise solid professional /ud#%ent.

Ethic,l Principles
.ithin this fra%ewor&, there are four i%portant ethical principles that per%it a consistent defense of a position on specific issues1 "utono%y, non%aleficance, beneficence and /ustice. 2y applyin# these principles fro% the perspective of either an idealist, or a conse*uentialist, a phar%acist can deter%ine the patient-s ri#hts ) the phar%acist(s correspolldin# duties for a #iven dile%%a. The pri%ary ob/ective is to enable phar%acists to /uslify ethical conduct if that conduct is challen#ed. A%tonom-: The principle of autono%y re*uires that persons %a&e their own evaluations ) choices when their own interests are at sta&e. If individuals are viewed as a#ents with their own uni*ue approach to life 3their values, interests, attitudes, etc.4, then it would be disrespectful of individuals to re/ect their considered /ud#%ents or to deny the% the liberty to act on those /ud#%ents. "utono%ous individuals are at liberty to perfor% whatever actions they wish, as lon# as another autono%ous individual-s actions are not infrin#ed, even if the actions appear to be foolish or unwise based upon conventional ) #enerally accepted wisdo%. 5nder the principle of autono%y a person who is a co%petent decision %a&er is free to use a %edicinal dru# in a way that is 1ess than opti%ally safe ) effective, if he #enerally reco#ni0ed 6ri#ht way7 to use the dru# interferes with the person-s life-style. Non*m,leficence: The principle of non-%aleficence 3doin# no har%4 re*uests that we refrain fro% actin# in ways that will har% or in/ure others. 8tudents sittin# in a classroo% can continue indefinitely to stare out the window ) daydrea% without violatin# the principle of non%aleficence because it is throu#h acts of co%%ission that this principle is viotated. 9on-%aleficence prohibits both deliberate har%ful action 3substitutin# one dru# product for another without authori0ation ) without evidence of e*uivalence4 ) unintentional har% 3carelessly typin# ta&e one tablet : ti%es daily, on the label of a di#o,in ;,4. Beneficence: The principle of beneficence 3doin# #ood4 re*uires positive action to1 14 prevent what is bad, <4 re%ove bad or evil ) =4 do or pro%ote #ood. It is throu#h acts of o%ission that this principle is violated. E.#., the phar%acist who ne#lects to counsel patients on the appropriate use of %edications has violated the principle of beneficence, even if the ;, was filled correctly. 5nfortunalely, health care-#ivers have at ti%es used beneficence as an e,cuse to do for patients what is in the care#iver(s view is best for the patient, even if the patient prefers that it not be done. 2eneficence of this type is often referred to as paternalis%, a concept that %oral philosophers love to critici0e. .%stice: The principle of /ustice 3fairness4 re*uires that people receive that to which they are entitled. E*uals should be treated e*ually, une*uals should be treated une*ually. " phar%acist who provides sub standard service or who refuses to provide service to a patient receivin# %edication to treat "I>8 has violated the principle of /ustice. $har%acists are the health care professionals %ost closely lin&ed to the dru# distribution syste%, so it is i%portant for phar%acy students to understand that dru# distribution is inherently paternalistic. Even that #reat cha%pion of liberty, ohn 8tuart Mill, reco#ni0ed the need to prohibit the use of dru#s by people who, under the influence of dru#s, %i#ht har% other %e%bers of the society ) the need to reduce undue pressure on potential buyers of dru#s who %i#ht un&nowin#ly act a#ainst their own best interests.

Ethic,l Terminolo+A%tonom-: "utono%y refers to one(s %oral ri#ht to %a&e choices ) decisions about one(s own course of action. P,tern,lism: occurs when one fails to respect another(s autono%y, ) acts with disre#ard to that individual(s ri#hts. 8ubstitute their own beliefs, opinions, ) /ud#e%ents for the patient(s /ud#e%ent, clai% they acted in the person(s best interest. Non*m,leficence: ?>o no @ar%+. This principle, one of the oldest ethical principles, re%inds us that if we cannot help patients, at the very least, we owe a duty not to har% the%. 32enefit vs. ris&4 Beneficence: 8tands for the duty to prevent har% to others, re%ove har% fro% others ) to pro%ote #ood. Ane(s obli#ation to this %oral duty ends where action can brin# har% to oneself. Aften one %ust the duty to act with the har% actin# %ay cause to oneself, in which case the obli#ation to this %oral ends. .%stice: fairly distributin# burdens ) benefits in society, ) #ivin# individuals their due. Ane can balance the needs of the individual with the needs of others in society co%petin# for the sa%e resources, called co%parative /ustice. Ver,cit-: @onesty. Ane(s obli#ation to spea& ) act truthfully affects all co%%unication with patients. 3e.#. if a cancer patient is told he is alri#ht, veracity is bro&en4 Confidenti,lit-: "ll health care providers have a duty, or obli#ation to li%it access to infor%ation #athered in the course of treat%ent, ) to &eep the infor%ation strictly between the health care provider ) the patient. Informed consent: obli#ates health care providers to present patients with details, benefits, ris&s, ) potential ris&s of all proposed intervention strate#ies 3so patients can %a&e willin#, infor%ed choices in their care4. "idelit-: %eans the %oral duty to &eep pro%ises ) co%%it%ents. 3Braber, 199C' 2eaucha%p ) Childress, 199:4. #%t-: obli#ation individuals have to others in society. 8o%eti%es those duties e,ist because of the nature of the relationship between the parties. Ri+hts: ability to ta&e advanta#e of a %oral entitle%ent to do so%ethin#, or not to do so%ethin#. Competenc-: " phar%acist does his duties.

Code of Ethics:
1. <. =. :. D. 6. E. C. 9.

In /rief

$har%acists hold health ) safety of each patient to be of 1ry consideration. $har%acists for% a professional relationship with each patient. $har%acists honour the autono%y, values ) di#nity of each patient. $har%acists respect ) protect the patient-s ri#ht of confidentiality. $har%acists respect ri#hts of patients to receive phar%acy products ) services ) ensure these ri#hts are %et. $har%acists observe the law, preserve hi#h professional standards ) uphold the di#nity ) honour of the profession. $har%acists continuously i%prove their levels of professional &nowled#e ) s&ills. $har%acists co-operate with collea#ues ) other health care professionals so that %a,i%u% benefits to patients can be reali0ed. $har%acists contribute to the health care syste% ) to societal needs.

Ethic,l Principles:

In /rief

A%tonom-: Ane-s %oral ri#ht to %a&e choices ) decisions about one-s own course of action. ?Every hu%an bein# of adult years ) sound %ind has the ri#ht to deter%ine what shall be done to his own body.7 Nonm,leficence: >o no har%. If we can-t help patients, at the very least, we have an obli#ation not to har% the%. ?;is& vs. benefit7. Beneficence: >o #ood. The duty to prevent har% to others, re%ove har% fro% others, ) to pro%ote #ood. If action can brin# har% to oneself, the obli#ation to this %oral duty ends. B,l,nce: >uty to act vs. har% actin# %ay cause. .%stice: fairness Ver,cit-: act with honesty, without deception. Confidenti,litCompli,nce: a. The act of co%plyin# with a wish, re*uest or de%and, ac*uiescence b. Medicine F willin#ness to follow a ;, course of treat%ent c. " disposition or tendency to yield to the will of others Adherence: a. b. The process or condition of adherin# Gaithful attach%ent ) devotion 3adherence to the rule of law4.

Ethic,l Principles: E),mples

A%tonom-: we respect the ri#hts of others to %a&e choices ) bare the responsibility of conse*uences. E,a%ples1 If a phar%acist refuses to dispense AC$ to a #irl due to reli#ious concepts, then he bro&e autono%y. If an end sta#e cancer patient, his fa%ily wants the physician to do a last therapeutic trial without infor%in# the patient which principle prevents the physicianH autono%y

Beneficence: we do #ood to patients placin# the benefit of the patient over other factors such as cost. E,a%ples1 $t needs a refill ;, of phenytoin on 8aturday evenin#, there is no refill authori0ation re%ainin# ) the patient-s >r is out of town. If the phar%acist refuses to refill the ;, he is brea&in# which principleH 2eneficence

Ver,cit- 0"edilit-1: To be honest ) responsible. .e act with honesty without deception. E,a%ples1 " cancer patient has only 1 %onth to live. If we do not tell hi% 3or tell hi% he is alri#ht4 you bro&e the principle of veracity

Ather E,a%ples1 If a phar%acist refuses to councel an "I>8 patient he bro&e which principle ustice " #irl too& AC$' her father wants to &now which dru# his dau#hter is ta&in#. If you tell hi% you bro&e the principle of Confidentiality.

C,n,d, (e,lth Act O'er'iew The Canada @ealth "ct received ;oyal "ssent on "pril 1E, 19C:. The "ct which ca%e into force in "pril 1, 19C:, repealed the @ospital Insurance ) >ia#nostic 8ervices "ct ) the Medical Care "ct. The purpose of the Canada @ealth "ct is to ?establish criteria ) conditions in respect of insured health services ) e,tend health care services provided under provincial law that %ust be %et before a full cash contribution %ay be %ade. The criteria, provisions ) conditions relatin# to e,tra-billin# ) user char#es are set out in sections E throu#h 1< ) sections 1=, 1C ) 19 of the act. The criteria ) e,tra billin# ) user char#e provisions apply to insured health services only, ) do not pertain to e,tended health care services 3E@C84. Anly the conditions, as set out in section 1=, relate to both insured health services ) E@C8. The insured health services defined by the Canada @ealth "ct include all %edically necessary hospital services ) %edically re*uired physician services, as well as %edically or dentally re*uired sur#ical-dental services re*uirin# a hospital for their proper perfor%ance. E,tended @ealth Care 8ervices 3E@C84 pay%ents are %ade in respect of nursin# ho%e inter%ediate care, adult residential care, ho%e care ) a%bulatory health care. The services are part of a broad ran#e of health ) social services offered by a variety of co%%unity ) institutional pro#ra%s ) facilities to residents of a province. The %a/ority of residents usin# these services are a#ed 6D ) over. The criteria ) conditions that each provincial health insurance plan %ust %eet in order to receive full fedral cash contributions under the Canada @ealth ) 8ocial Transfer 3C@8T4 in each fisical year are1 23 P%/lic Administr,tion: $ursuant to section C, the health care insurance plan %ust be ad%inistered ) operated on a non-profit basis by a public authority, responsible to the provincial #overn%ent ) sub/ect to audit of its accounts ) financial transactions. 43 Comprehensi'eness: $ursuant to section 9, the plan %ust insure all insured health services provided by hospitals, %edical-practitioners or dentists ), where per%itted, services rendered by other health care practitioners. 53 &ni'ers,lit-: section 1I re*uires that 1II J of the insured persons of a province be entitled to the ensured health services provided for by the plan on unifor% ter%s ) conditions. 63 Port,/ilit-: in accordance with section 11, residents %ovin# to another province %ust continue to be covered for insured health services forby the ho%e province durin# any %ini%u% waitin# period i%posed by the new province of residence not to e,ceed = %onths. Gor insured persons, insured health services %ust be %ade available while they are te%porarily abscent fro% their own provinces on the basis that1 insured services recieved out of a province, but still in Canada, are to be paid for by the ho%e province at host province rates, unless another arran#%ent for the pay%ent of costs e,ists between the provinces. $rior approval %ay be re*uired for elective services' out-of-the country services are to be paid as a %ini%u%, on the basis of the a%ount that would have been paid by by the ho%e province for for si%ilar services rendered in the province. $rior approval %ay also be re*uired for elective services. 73 Access,/ilit-: by virtue of section 1<, the hea1th care insurance plan of a province %ust provide for insured health services on unifor% ter%s ) conditions ) reasonable access by insured persons to insured health services, unprecluded or uni%peded, either directly or indirectly, by char#es or other %eans' reasonable co%pensation to physicians ) dentists for all insured health services rendered' pay%ents to hospitals in respect of the cost of insured health services. Conditions: In addition to the afore%entioned criteria, the conditions that provincia1 #overn%ents %ust %eet in order to be eli#ible for the full cash portion of the fedral contribution ) pay%ent in respect of insured health services, as well as e,tended health care services, are1 the provision of infor%ation that the Minister of @ealth %ay re*uire for the purpose of this "ct, at the ti%es ) in the %anner prescribed by the re#ulations' ) the appropriate reco#nition to the Canada @ealth ) 8ocial Transfer relatin# to insured health services ) e,tended health care services in the province.
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Ather1 The Canada @ealth "ct also prescribes a consultation process in the case of co%pliance *uestions.

1. <. 3. :. a. b. c. d. e.

9on%aleficence %eans do no har% 2eneficence %eans doin# #ood for patients by placin# their benefits over other factors. .hy don-t we try new dru#s on childrenH The concept of paternalis% The ethical principles of veracity re*uires that a phar%acist should1 respect the ri#hts of others to %a&e choice do #ood for the patient placin# his benefit over other factors, e.#. cost avoid, re%ove or prevent har% act with fairness to allow people to receive that to which they are entitled act with honesty, without deception

Answer: E. Choice A is autonomy, Choice B is beneficence, Choice C is non-maleficence, Choice D is Justice. D. a. b. c. d. e. 6. .hich of the followin# are ethical principlesH "utono%y 2eneficence Keracity 9on-%aleficence ustice

Answer: A, B, C, D, E If a phar%acist refused to dispense AC$ to a #irl due to reli#ious concepts, which principle he violatesH a. b. c. d. e. Answer: D E. a. b. c. d. C. a. If a phar%acist refused to counsel a patient with "I>8, which principle he violatesH 2eneficence Inco%petence ustice Keracity " cancer patient has only 1 %onth to live, if you do not tell hi% the truth you violate1 Gidelity 3veracity4
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2eneficence 9on-%aleficence ustice "utono%y Keracity

Answer: C

b. c. d. Answer: A 9.

Confidenciality 2eneficience "utono%y

" patient on phenytoin ) his physician is abroad' if the phar%acist refused to #iven hi% the dru# due to restriction of law, which of the followin# ethical principles %ay have been %ost violated1 a. b. c. d. Answer: B 9on-%aleficience 2eneficience Confidentiality Co%%on sense

1I. Mr. ones is wor&in# 8aturday evenin# at his co%%unity phar%acy in a s%all villa#e. @e is approached by a patient who needs a refill prescription for his phenytoin, ) no refill authori0ation re%ains. The patient(s doctor is out of town. Mr. ones chooses to not refill the ;, since he feels that he %ay be at ris& of bein# disciplined by his licensin# body if he does not follow the law. .hich of the followin# ethical principles %ay have been %ost violated if he does not provide any %edicationH a. b. c. d. e. 9on%aleficence "utono%y 2eneficence ustice Keracity

Answer: C Competency: 2.1 11. " 16 year old #irl is #ettin# A.C. @er parent ca%e to the phar%acy as&in# you. .hat are the two contradictin# ethicsH a. b. c. d. Answer: C 1<. If you i%pose or i%ply your opinion so that the patient should ta&e the %edication you are reco%%endin#, this is called1 a. b. c. d. $atenralis% 9on%aleficence "utono%y 2eneficence
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veracity - non-%aleficence veracity - autono%y veracity - confidentiality non-%aleficence - beneficence

Answer: A 1=. .hich of the followin# ethical principles is beenin# %ost violated by the wron# fillin# of a ;, a. b. c. Answer: A 1:. " physician who has reco%%ended uro#raphy for her co%ptent 6C year old %ale patient is tryin# to decide whether or not to disclose the re%ote ris& 31 in 1I,III4 of a fatal reaction. If the physician favors non-disclosure, reasonin# that it would not be in the patient-s best interest to worry hi% with such re%ote ris&s she is #uided by1 a. b. c. d. e. beneficience but not non-%aleficence /ustice non-%aleficence but not beneficence #ratitude both beneficence and non-%aleficence 9on%aleficence "utono%y 2eneficence

A E: E. !f the "octor#s concern is not to harm the patient with unnecessary worry, the $ui"in$ principle is non-maleficence% if her concern is to be able to benefit the patient with uro$raphy &which is impossible since the patient refuses to ris'( the $ui"in$ principles is beneficence. 1=. If she believes that her decision should be deter%ined by what other physicians would do in si%ilar circu%stances, she is #uided by1 a. b. c. d. e. both beneficence ) non %aleficence respect for autono%y stron# paternalis% professional practice std. wea& paternalis%

A E: D. Depen"in$ on what the professional practice stan"ar" "ictates, the "ecision woul" still be $ui"e" by professional practice if she "eci"es whether or not the patient woul" want to learn about such ris's, she is $ui"e" by respect for autonomy. 1:. .hen a phar%acist does not counsel a patient for warfarin 8!E, he violates1 a. b. c. d. Answer: A 1D. " phar%acist refuses to counsel a patient who ta&es half the prescribed dose althou#h he advised hi% several ti%es before, he is violatin#1 a. 2eneficence
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9on %aleficence 2eneficence ustice Keracity

b. c. Answer: A 16.

ustice "utono%y

" patient ca%e to you ) badly needs a repeat for Kentolin, has no repeat, if you don-t #ive you violate1 a. b. c. d. 9on%aleficence 2eneficence ustice Keracity

Answer: B 1E. $hysicians %ay #o for the beneficence of their patients ) brea& a law e.#. a >r does not tell his patient about his illness to %a&e hi% ta&e the %edication, he brea&s which law a. "utono%y b. Keracity c. Confidentiality Answer: A 1C. " physician phoned a phar%acist to as& hi% not to tell the patient about the side effects of a dru# because if he does, the patient will not ta&e it. 2oth the physician ) phar%acist see& for which ethics a. 2eneficence. b. 9on%aleficence c. "utono%y d. Keracity Answer: A 19. " physician as&ed a phar%acist to tell the patient that the dru# prescribed is a %ultivita%in ) not a hypnotic so that he %i#ht not co%%it suicide. .hat ethics is the physician loo&in# forH a. 2eneficience b. 9on%aleficence. c. "utono%y Answer: B <I. " patient ta&in# terbutaline inhaler ) usin# it a lot, if the phar%acist fails to advice hi% to see his doctor to add a corticosteroids inhaler to his %edications, then he %ostly violatedH ,3 2eneficence b. 9on%aleficence c. Keracity
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d. "utono%y Answer: A <1. " patient ta&in# a dru# in a wron# way ) the phar%acist counselled hi% %any ti%es ) now the phar%acist does not want to counsel hi% a#ain, then he %ostly violatedH a. 2eneficence b. 9on%aleficence c. Keracity d. "utono%y Answer: B <<. " cancer patient does not want to ta&e her %edication due to 8.E. ) her doctor as&ed the phar%acist to tell her that the %edication is a %ultivita%ins, what is the doctor see&in# forH a. 2eneficence b. 9on%aleficence c. Keracity d. "utono%y e. $aternalis% Answer: A <=. The parents of a very s%art boy who has cancer as& you not to tell hi%, in order to %a&e hi% ta&e the %edication, which law does the phar%acist violate a. "utono%y b. Keracity Answer: A <:. If we tell so%eone that his %edication is /ust for a %ultivita%in, in order to %a&e hi% use it, which law is that a#ainst a. "utono%y b. Keracity Answer: A a phar%acist w <D. .hat is the ethics definition of ho does his dutiesH a. ustice b. Keracity c. 9on%aleficence e. 2eneficence d. Co%petency Answer: E <6. " phar%acist isn(t convinced with the patient-s refusal to ta&e a %edication, what is it calledH
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a. $aternalis% b. Keracity c. 9on%aleficence d. 2eneficence Answer: A <E. .hat is the first principle in the code of ethics a. to obey the law of practice b. to protect public health c. to be a %e%ber of the board Answer: B <C. " phar%acist carelessly did not councel a patient on an asth%a %edication 3puffer4 so he violated a. beneficence b. non%aleficence c. autono%y d. veracity e. /ustice Answer: A <9. " physician wants to try a new %edication but the patient refused so he told hi% that it is only a vita%in, so he ai%ed to a. $aternalis% b. beneficence c. veracity d. autono%y e. non%aleficence Answer: B =I. " dru# that has trials on #eriatrics with-holdin# it fro% pediatrics, this is obeyin# which of followin# a. non%aleficence b. /ustice c. autono%y d. paternalis% e. beneficence Answer: A
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=1. " patient on 2< a#onist, he has recurrent attac&s, if you donot refer hi% to the doctor you violate1 a. non%aleficence b. /ustice c. autono%y d. paternalis% e. beneficence Answer: E =<. 9, a 1E year old %ale with a hi#hly resistant for% of testicular cancer, is in hospital for treat%ent. @e is an intelli#ent, articulate youn# %an. @is parents are insistin# that the physician treat hi% with the latest e,peri%ental therapy, but 9 does not want to under#o the treat%ent. If the physician #oes ahead and #ives the e,peri%ental therapy what ethical principle will have been violated the %ostH a. 2eneficence b. Keracity c. 9on-%aleficence d. "utono%y e. ustice Answer: D Competency: 2.1 =E. " phar%acist refuses to fill a prescription for a patient with "I>8 because he fears he will contract the disease' this violates the ethical principle of1 a. non%aleficence b. beneficence c. autono%y d. veracity e. /ustice Answer: B =C. The correct definition of non%aleficence is a. any action that produces #ood for the patient b. any action that protects the patient fro% har% or evil. c. treat%ent of the patient autono%ously. d. actin# with honesty Answer: B =9. " phar%acist #ives a patient losec instead of lasi,, it is a#ainst which lawH a. non%aleficence
16

b. beneficence c. autono%y d. veracity Answer: A :I. In the above case what should the phar%acist owner doH a. @e should accept the %ista&e ) as& the patient(s doctor what to do :1. .hat ethics is bro&en if you insist on #ivin# a %edication to a cancer pt who refuses ta&in# it a. non%aleficence b. beneficence c. autono%y d. veracity Answer: C :<. " patient ca%e to a phar%acy to dispense a ;, of ethinyl estradiol 1E-2' the phar%acist noticed that the dose is very hi#h, he is reli#ious so he refused to dispense it, which ethical principle is he see&in# a. "utono%y b. 2eneficence c. 9on%aleficence d. Keracity Answer: C :=. " >r is treatin# a patient who is not ready to ta&e the %edication because of side effects, eventhou#h the >r #oes ahead' which law he violates a. "utono%y b. ustice c. Keracity d. 9on%alifecence Answer: A ::. " patient has a serious disease ) the >r as&s the phar%acist not to tell hi% anythin# about it' they are favorin# which law a. "utono%y b. ustice c. $aternalis% d. 9on%alifecence Answer : D 45. $aternalis% to #ive others instructions as if #ivin# orders
17

:6. Canadian @ealth "ct bans e,tra billin# :E. The phar%acy le#islation is controlled by1 a. Canadian dru# law 1961 b. Canadian dru# law 1999 c. Canadian dru# law 19C: Answer: C :C. The standards ) le#islation of phar%acy practice are controlled by1 a. Canadian Gederal "ct of 19C: b. $rovincial ) federal authorities c. Metropolitan authorities Answer: A. )he Canadian Gederal "ct of 19C: controls le#islation and practice :9. The Canadian parlia%ent approved a law to protect1 a. The patient b. The phar%acist c. Answer: A. DI. The Canadian health act 319C:4 e%bodies all of the followin# principles e,cept1 a. "ffordability b. "ccessibility c. Co%prehensiveness d. $ortability e. 5niversality f. $ublic ad%inistration Answer: A D1. The %ost i%portant chan#es in phar%acy practice in the last <I years is ! are1
18

a. increase in dispen%sin# fee b. increase the nu%ber of new phar%acies c. increase the avera#e si0e of phar%acies in Canada d. Increased involve%ent of the #overn%ent ) other =rd party a#encies as payors i.e. health insurance ) dru# benefits e. decreased dru# sa%plin# to physicians Answer: D D<. .hat is the responsibility for Canada @ealth "ctH a. %andates the phar%acist to counsel each patient b. universal the health care of Canada c. e,tended health care service d. a person %ust be insured before a full cost %i#ht be %ade Answer: B D=. .ho is costin# 3pricin#41 a. Gederal #overn%ent b. $rovincial #overn%ent c. Canadian dru# law 19C: Answer: A, B C D:. .hich of the followin# a#encies is responsible for revisin# the *uality of a dru# a. 2ureau of surveillance b. Good ) >ru# "d%inistation c. Colle#e Answer: B DD. If the phar%acist wants to chan#e provinces, what should he doH a. passin# the board e,a% a#ain b. ta&e a per%ission fro% the colle#e c. passin# the /urisprudence e,a% a#ain of the new province Answer: C D6. $ricin# view association co%%ittee is responsible for a. to control prices of sales of %anufacturer. b. to protect the patient c. Controllin# prices of sales of phar%acies Answer: A DE. .hat is the duty of the %inistry for desi#nin# dru# pricesH a. $rotectin# clients
19

b. 8upervisin# the prices to be the sa%e DC. Answer: B .hat is the duty of the %inistry for desi#nin# dru# pricesH D9. .hat do provinces and territories have to do to #et their supplyH a. Each province has its own re#ulations, %inister of health and dru# benefit plan 6I. Apen for%ulary1 a. Contains uses of the dru# b. Co%prehensive c. Ma&es restriction for non-for%ulary dru# ;, even if they are under clinical supervision Answer: B 61. The co-pay%ent pro#ra% is concerned with all of the followin# ELCE$T1 a. help people who are not able to afford dru# prices b. %a&e the patient pay a portion to decrease the cost of %edication Answer: A 6<. $har%aceutical care concerns with all e,cept1 a. >isease cure b. >isease prevention c. $revent pro#ression of the sy%pto%s of disease d. Identify >.>.I e. >ecrease severity of the sy%pto% Answer: A 6=. The Canadian health act 19C: includes1 a. 9o e,tra-billin# or user fees b. Medically re*uired services provided %ust be covered c. 2enefits %ust be portable fro% province to another Answer: A, B C 6:. Canadian health act includes1 a. "ccessibility, co%prehensiveness, affordability b. $ortability, universality, affordability, accessibility c. 5niversality, public ad%inistration, accessibility Answer: C 6D. The ai% of Canadian health care syste% is1 a. Anly the Canadian citi0ens #et %edical services b. "ll Canadian citi0ens ) i%%i#rants #et easy accessibility to %edical services c. Kisitors to Canada are covered with %edical services
20

3"ccessibility4 3Co%prehensiveness4 3$ortability4

Answer: B 66. Canada health care syste% is %ostly concerned about a. "ll patients #et access to all services 3accessibility4 6E. Canada health act pays for all e,cept1 a. Keterans b. Aver %ountain c. $olice d. 9ative Canadians 3Indian affairs4 e. Inde#nity for people Answer: C 6C. 8o%ebody co%es with ">; to a new dru#. "s a phar%acist you should ta&e the %edication history of the patient and report ">; to the reportin# unit in Attawa. 69. $E2C defines the rules and ta&es the e,a% EI. @ealth Care plan %a&es sure on a. $rices of %edications in phar%acies are the sa%e b. >ispensin# fees are the sa%e Answer: A B E1. @ospitals wor& accordin# to federal rules to be ele#ible for a. Ta, free b. $art of %oney Answer: E<. 9>8"C 39ational >ru# 8chedulin# "dvisory Co%%ittee4 is responsible for1 a. >ru#s that are dispensed by prescription. b. >ru#s that are not dispensed by ;, but %ust be dispensed by a phar%acist c. ATC dru#s Answer: A, B C E=. $atent Medical $ricin# ;eview Co%%ittee reviews a. cost of patent %edication b. benefits of patent %edication c. co%parin# prices of patent ) #eneric %edications d. Controllin# pricin# of sales of %anufacturer Answer: A E:. @ealth Canada %a&es sure that a. all Canadians are covered b. seniors #et %edications free
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Answer: A

ED. Canada health care syste% offers services to a. "ll per%anent residents of Canada E6. .hat re#ulates the phar%acy practice in Canada1 a. Colla#e b. AC$ c. $rovincial Institutes d. 9"$;" Answer: C EE. " %edical rep brin#s you a new dru# to pro%ote. .hat should you consider a. it is approved by %edical health b. it is approved by provincial health c. it is peered by %edical %a#a0ines Answer: A, B C EC. The %ost i%portant chan#e in health care is based upon covera#e by1 a. federal #overn%ent b. private or#ani0ation c. provincial #overn%ent d. Indian affairs Answer: C E9. .hat is the duty of the %inistry in desi#nin# dru#s pricesH a. $rotectin# clients b. 8upervisin# the prices to be the sa%e Answer: A B CI. Canada health act #ives %ore M. ) free %edicine to a. Girst nations b. financially poor c. 6D yrs old d. pets Answer: A, B C C1. Gro% co-pay%ent increase results1 a. $atient cannot afford to buy the dru# b. >ecrease overall production Amswer: B ** C<. ;ole of re#istration co%%itteeH
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C=. "ccreditation co%%itteeH C:. $t %edication price review board who handles it 1 Gedral #overn%ent 3not provincial, %anufacturer nor whole saler4 CD. .hat does this %ean in fedral law ;CM$H C6. " ;, fro% 58" is dispensed only in 58". ;e#ulation prohibits any ;, fro% 58" to be dispensed in Canada. 87. $rescription co%in# fro% 58" $atient should #o to e%er#ency clinic with his ;, to authenticate 88. ;, co%in# fro% 58" >o not send ;, to wal& in clinic alone. $atient %ust acco%pany his ;,. C9. " very busy patient co%in# fro% 58" for a conference in Canada has @T ) he for#ot to brin# his %edicine with hi%, what do you do as a phar%acist1 a. Nou use your professional /ud#e%ent ) #ive hi% his %edicine /ust for his stay in Canada b. Nou are loo&in# for the best interest of the patient c. Nou send hi% to a wal&-in clinic. Answer: C 9I. 91. ;, by e-%ail fro% 58" for a patient visitin# Canada for < days, what to doH a. Must #et a new script si#ned by a Canadian doctor $atient fro% 58" has ;, fro% 58" ) can(t #o bac& to #et the %edication, what to do1 a. Co si#n with Canadian doctor b. >o not fill it c. I%port dru# d. 8ee Canadian >r. Answer: D 9<. "n anticancer dru# was #iven to a lady by a 58 physician ) she co%es with the 58 ;, to the phar%acy' what would be your response to this1 a. send her to the nearest wal&-in clinic 9=. 9:. " lady co%es fro% 58, ) you #ave her < days supply for pain' you apply which law1 ethics of benefit " person has a ;, fro% 58", what is correct to doH a. The dru# should be ordered fro% the 58" b. 2ecause < wee&s later the dru# is released in Canada, it is AO to dispense it c. It is not allowed to prepare it. Answer: C ** 9D. The feedbac& fro% 58", is not valid in Canada , because 58" differs fro% Canada in health e,penses, insurance and ,..,
23

96.

" patient has a ;, fro% 58", he wants < tab. only for < days till he returns ho%e. .hat will you do a. #ive < tab b. #et new prescript fro% e%er#ency c. Co-si#n d. send e-%ail to doctor in 58"

Answer: C 9E. " patient fro% 58", his plane was delayed for < days ) he ran out of his %edication 3Metfor%ine, enalapril, atorvastatin4. @e brou#ht the e%pty vials ) as&ed for < days supply, the phar%acist a#reed to #ive hi% the < days supply' this is considered a. le#al accordin# to health canada act b. Ethical accordin# to pt. beneficence c. Ethical accordin# to professional /ud#%ent Answer: B 9C. C " patient wants to ta&e cou#h syrup 3lar#e a%ounts4 to 58", the phar%acist refuses to #ive her because of all of the followin# e,cept a. it is not allowed to ta&e dru#s to 58" e,cept for personal use b. this dru# %ay cause addiction c. it will be ta&en by 58" authority d. no phar%acy-patient intervention about the dru# Answer: A 99. B " phar%acy is #ettin# %edication fro% "sia, brand na%e, licensed to be sold in Canada only %anufactured in "sia, all are ri#ht e,cept a. %anufacturin# conditions %ay not be approved in Canada b. shippin# conditions %ay not be suitable c. it is AO if this is done by @ealth Canada Answer: 1II. " 58" >r. sends an e-%ail to dispense a few days supply for a >M patient. .hat should you do a. >ispense as it is an e%er#ency b. Bet a new ;, fro% a Canadian >r Answer: B 1I1. " physician near your phar%acy as&ed you to chan#e sa%ples for other dru#s fro% your phar%acy1 a. you chan#e the sa%ples if they can be ta&en b. you chan#e the sa%ples if the physician is your friend
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c. This is a#ainst the Canadian $har%acy Paw ) code of ethics d. This is not ethical Answer: C 1I<. 8a%ples can be e,chan#ed with1 a. doctors only b. co%panies c. cannot be e,chan#ed d. friends only Answer: C 1I=. " >r. #ives a sa%ple to the phar%acist ) as&s hi% to #ive it free to a pt1 a. $har%acist can not accept it as this is ille#al, he cannot &eep sa%ples in the phar%acy b. Gill ;, with these sa%ples c. Bive sa%ples free to needy people Answer: A 1I:. "n active phar%acist as&s for salary increase' what should the owner doH An which basisH a. on the basis of prices of salaries!hr b. on the basis of the effect of this on other staff c. 2ases of the effectiveness of this phar%acist in co%parison to others Answer: A 1ID. .hat should a hospital phar%acist who does not have enou#h personnel at wee&end doH a. stop overlappin# in shifts b. fle,ible shifts for staff c. increase wor&in# hours d. ta&e %ore shifts hi%self e. Peave the phar%acy to the nurse in char#e Answer: A, B, C D 1I6. .ho %a&es the orders for dru#s, accordin# to which basisH a. "ccordin# to inventory ite%s 1IE. @ow would you i%prove the health care service in your phar%acyH a. invite a nurse b. educational pro#ra% Answer: A 1IC. The control of a supervisor in %ana#e%ent is considered to be1 a. to set the standard of control b. to ta&e the output accordin# to the set standards
25

Answer: B 1I9. Interference factor that affect the inventoryH a. not chec&in# the e,piration dates re#ularly b. let %edical reps. %a&e order to the phar%acy c. you cover the need of your area only Answer: A, B C 11I. To prevent the internal dru# diversion 38tealin#4 in your phar%acy, what to doH a. 5npredictable inventory chec& up 3une,pected audit4 b. "s& references upon hirin# c. >o not leave pre%ises ) watch e%ployees durin# lunch brea& Answer: A B 111. Nou are a phar%acy owner, you increase the duties of a phar%acist by =IJ to DIJ' you should do all e,cept1 a. discuss the suitable way to Q the efficacy of these activities b. #ive so%e of his duties to another person c. cancel so%e activities that have shown no benefits to the phar%acy. d. Increase his salary e. review his perfor%ance lately Answer: D 11<. To i%prove the relation between the phar%acist ) the technician a. describe the responsibilities of each #p b. en#a#e the% in continuous education pro#ra% Answer: A B 11=. 8oln. N is revo&ed 3discontinued4 te%porarily by the co%pany, you should do all e,cept1 a. try to have lots fro% all suppliers b. call doctor and tell hi% that the %edical is in short c. order suitable alternative Answer: A 11:. >ru# #eneric L, and the %anufacturer is tryin# to convince the phar%acist to have a stoc& of it which are the least i%portant thin# for the phar%acist to &nowH a. what is the %ini%u% order ) bonus, what is the shelf capacity b. the patient needs for this %edication c. how fre*uent will it be written by the physician d. effectiveness of dru# e. the cost Answer: A
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11D. The phar%acy staff are co%plainin# about one phar%acist who has /ust co%e bac& fro% %aternity leave, also patient co%plains because of the fre*uent errors in ;, fillin# and due to delay in their ;, fillin# due to len#thy phone calls, what is the best response fro% the %ana#er especially when he as&ed the phar%acist and &new that a proble% with the nanny of the baby is found and she is loo&in# for a better one1 a. he %i#ht tell the phar%acy staff and patient that this is a te%porary situation and it will be solve soon b. he %i#ht tell the phar%acists that the e,istin# behavior is unacceptable and so a discipline %i#ht be applied if it is continued ) it is better to chan#e his behaviour. c. hire %ore staff te%porarily to help the phar%acist, fre*uency of errors d. arran#e a trusted co-wor&er to follow the phar%acist behavior to ensure that the future decision is the ri#ht one. e. apply a discipline for her Answer: B 116. If a phar%acy assistant had a co%%on cold' while dispensin# a dosa#e for% he snee0ed in it. .hat is the role of the phar%acy %ana#erH a. >ispense the dosa#e for%, then apply discipline with the assistant. b. >iscard the dosa#e for% and then send the assistant ho%e for rest c. >iscard the dosa#e for% and apply discipline to the assistant d. Oeep hi% away fro% the dispensin# area and apply discipline to hi% e. >iscard the dosa#e for%, &eep hi% away fro% the dispensin# area and review the pri%ary aseptic techni*ues in dispensin# with hi% Answer: E 11E. .hat can reduce the phar%acy inco%e1 a. Par#e e,penses b. The bills Answer: A 11C. "ll %ust be audited e,cept %edications bou#ht fro% wholesalers 119. " %ana#er finds that a phar%acist is drun& and does not behave well enou#h, what to do1 a. report to the colle#e 3 after warnin# hi% verbally several ti%es4 1<I. To reduce the wor& load on the phar%acist to fulfil clinical duties the phar%acist %ana#er should do the followin#1 assi#n the duties to the technician 1<1. $har%acy Mana#er wants to increase phar%acist concerns about pt. %ore than other duties without hirin# %ore phar%acists. .hat to do a. ;ecruit $har%acists b. Bive phar%acists( trainin# c. ;educe other duties done by phar%acists Answer: B C

27

1<<. $har%acy %ana#er wants to chan#e his co%puter syste%, what is the correct order of his actionH a. Calculate his bud#et or cost of pro/ect b. Gind out the capability of e,istin# %achines c. Gind out the vendors re*uire%ents d. Gind out if the software capable of fulfillin# these functions Answer: Correct or"er: C, B, D, A 1<=. $har%acy %ana#er wants to dele#ate so%e of the ph. wor& to technician, all of the followin#, prevent this fro% bein# done e,ceptH a. $h. attitude b. $h. bein# available c. Technician not well trained d. Colle#e re#ulation that so%e duties %ust be done by ph. Answer: B 1<:. Mana#er of hospital phar%acy wants to tal& about ways to be aware of dispensin# errors, he would invite all of the followin# e,ceptH a. $atient b. $har%acist c. ;is& %ana#e%ent representative d. 9urse e. Bood practice %ana#er Answer: A 1<D. Mana#er of phar%acy puttin# schedule pro#ra%, is concerned with all e,cept a. .or&ers are treated e*ually b. 8chedule is te%plate fro% %onth to %onth c. 8chedule can be predictable for future d. They feel co%%itted. Answer: B 1<6. " hospital will be#in to buy co%%ercial $ot. Chloride instead of preparin# it, the co%%ercial product will %a&e difference in all followin# e,cept. a. .aste a%ount of $ot. Chloride b. Gulfillin# needs of $t. c. Total a%ount used of $ot. Chloride d. ;educe errors in preparations e. ;educe nu%ber of ba#s used for solution
28

Answer: B 1<E. .hat(s the proble% if in inventory rate is less than that what it should be in the phar%acyH a. Then there is theft b. The cost of dru# dispensed is %ore than that recorded in co%puter for the >ru# benefit $lan Answer: B 1<C. " phar%acist who is always sic& at wee&ends ) uses %any %edical offs, what is best thin# to do a. Gire hi% b. "s&in# his doctor c. /ust tal& to hi% d. >ecrease his salary Answer: C 1<9. " phar%acist wants to ta&e a wee&-end off but the %ana#er does not allow hi%, he calls the phar%acy ) says he is sic& ) can not co%e. .hat can the phar%acy %ana#er doH a. Bive hi% disciplinary notice b. It is the phar%acist-s ri#ht to ta&e a day-off c. The phar%acy %ana#er should as& hi% when he will co%e bac& Answer: B 1=I. It is awee& end ) very busy hours, a phar%acist wants to finish his wor& to #o ho%e because he has a wee&end party, suddenly the physician calls to say that he has 1E patients who ca%e to his clinic with %enin#itis ) need help, what should be the approach of the phar%acy %ana#erH a. 8end the phar%acist ho%e ) as& the physician to send the patients to another phar%acy b. Call additional wor&ers for help ) as& the phar%acist to stay as lon# as he can c. 8end the phar%acist ho%e ) as& the physician to send the patients as they need prophylactic treat%ent d. Tell the phar%acist not to #o ho%e as this is an e%er#rncy Answer: B 1=1. 2efore hirin# a technician a %ana#er should1 a. as& reference b. interview the technician Answer: A B 1=<. " phar%acy owner wants to decrease e,penses, what to doH a. hrs of wor& for the phar%acists b. ta&e shift hi%self
29

c. re%ove overlap Answer: B C 1==. Gor control of phar%acy products you should do all of followin# e,cept a. control cli%ate of phar%acy b. re#ular cleanin# of counter c. chec& on te%p of refri#erator d. clean of the shelf ) #round Answer: A 1=:. Nou are a phar%acy %ana#er and you found there is a re#ular error in ;, dispensin# so you do all of followin# e,cept a. #et a < dispensry staff 3e,tra4 b. %a&e a %eetin# for phar%acist staff c. tell the% that a displine will occur if it repeated a#ain d. an action by deductn fro% salary will occur Answer: A D 1=D. $h. Mana#er wants to watch inventory a. record date of purchases b. record a%ount of sales c. watch technician durin# lunch ti%e Answer: A B 1=6. "n active phar%acist de%and an increase in salary you have fle,ibility in bud#et so %ana#er should consider all e,cept a. other ph. that can do this /ob are available b. bud#et c. other ph. as&in# for raise d. life allowance e. consider his e,perience Answer: A 1=E. " %edical representative is ne#otiatin# with a hospital ph. %ana#er for a dru# contract ) #ave hi% tic&ets for a hoc&ey #a%e ) a #ift, what is the correct action1 a. %ana#er accept it as hospital already a#reed to #et dru# b. %ana#er accept tic&et ) refuse #ift as it is his personal life c. %ana#er refuse both as its not ethical d. %ana#er refuse tic&et ) accept #ift e. %ana#er accept tic&et ) #ift Answer: C
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1=C. " phar%acy owner is #ettin# another %ana#er to do all e,cept financial %atters, so he can do all e,cept a. order %edication b. chan#e shifts c. contract of co%puters d. narcotic si#ner Answer: C 1=9. .hat should an owner do to increase the profitability of his phar%acyH a. R overlappin# b. R ti%e for %i,in# e,tre%poranous preparation Answer: A 1:I. "n owner should do certain thin#s by hi%self only a. chan#e shifts b. chan#e hours c. personal awardin# or appra0in# d. puttin# business #oals e. order %edication Answer: D 1:1. The hi#hest a%ount of e,penses in phar%acy a. payrolls b. utilities c. inventory d. ta,es Answer: A 1:<. " ph. %ana#er wants to increase the cash %oney, what should he do a. stoc& of fast %ovin# %edication b. stoc& of %edication c. decrease stoc& Answer: C 1:=. The hospital phar%acies in a certain area decide to use one type of #enerics this will help in a. avoid double usin# of certain #eneric b. #ettin# the %edication with a #ood price Answer: A 1::. Nou are responsible of a hospital education pro#ra%%e within the hospital phar%acy ) you have lac& of funds to support this pro#ra%%e, a %edical rep fro% a %anufacturer offers you cash to support your syste%, what you will doH
31

a. "ccept the cash as lon# as it is unconditional b. ;efuse to &eep the phar%acy inte#rity c. "ccept the cash in your na%e rather than the hospital Answer: A 1:D. MT, a phar%acy technician, has wor&ed in a co%%unity phar%acy for D years. @e is welltrained and welco%es new learnin# opportunities. @is %ana#er, now wantin# to dele#ate a new technical pro/ect to hi%, should1 I discuss su##ested steps to acco%plish the pro/ect. II ne#otiate a ti%e schedule for co%pletion of the pro/ect. III provide support and follow-up as re*uired. a. I only b. III only c. I and II only Answer: E Competency: +.1 146. @ire a 9ew $har%acist 9o need to discuss with the collea#ues 1:E. 8electin# dru# for a patient with cancer in a hospital settin# should involve all of the followin# e,cept1 refer to hospital for%ulary 1:C. Gor%ulary is used for all of the followin# e,cept insurance deductibles 1:9. .hat are the for%ulary dru#s ) where can you find the%H a. These are dru#s covered by the dru# benefit plan. They are found in the co%puter syste% of a phar%acy or in the for%ulary dru# boo& 3A>2 boo&4. 1DI. " hospital phar%acy %ana#er notices that there is a lot he should do as he noticed that there is a lar#e nu%ber of %ista&es a. Invite the phar%acists to a %eetin# b. Chec& if phar%acists are over wor&ed c. .rite a letter to the phar%acists Answer: A B ** 1D1. " technician is fre*uently sic&, what can the %ana#er do1 a. "s& for doctor declaration b. "s& for @; assess%ent c. "s& for ;, 3to chec&4 Answer: B ** 152. 8tudents want to train in a phar%acy , the phar%acist %ust worry about what before acceptin#H efficiency 1D=. $har%acy technician which is wron#1 a. can ta&e prescription fro% patient
32

d. II and III only e. I, II and III

b. can #ive dru# to the patient c. %ust as& patient about his health proble% Answer: C 1D:. " technician starts to counsel the patient after dispensin# the ;, a. The phar%acist should politely ta&e his place in counselin# the patient, he reviews all the sales process and tells the assistant not to counsel patients a#ain. 1DD. ;ole of technician to assist the phar%acist a. Ta&e verbal ;, fro% >r b. councel the patient c. ta&e ;, fro% re#ular custo%er Answer: C 1D6. .hile the phar%acist is busy, a technician #ave Tylenol S 1 to one of his friends' the phar%acy %an#er saw hi%' what should the $har%acy %an#er doH a. Interfere ) ta&e place and after the patient has #one you have to discuss and warn the technician not to do it a#ain. 3tal& to hi% about ri#ht re#ulation4 b. #ive displenary action Answer: A 1DE. Technician can do all of the followin# e,cept1 a. $repare ad%i,ture of che%otherapy ) label it b. Arder %edication c. Ta&e ;, fro% patient 3not a new one4 d. $repare pt files e. Ta&e verbal ;efill ;,. Answer: E 1DC. Technician can do all of the followin# e,cept1 a. prepare ;, b. Councellin# pt for a new ;, c. sell behind counter ) ATC d. Ma&e filin# of ;, e. put data Answer: B C 1D9. Technician can do under supervision a. ;, co%pletion b. Enterin# data c. preparin# ;, d. Councellin# pt
33

Answer: C 16I. .hich duties are ideal for a phar%acy tech.1 a. prepare the label 161. @ospital phar%acy tech e,pansion duties include all e,cept1 a. tech can chec& the dru# profile and reco%%end a product 16<. " %an approached a technician and as&ed hi% for a reco%%endation which will he can reco%%end1 a. >eodorant 16=. $har%acy Mana#er saw technician #ivin# e,e%pted Codeine to the pt., he interfered because a. $har%acist should docu%ent sales by hi%self /3 Ph,rm,cist sho%ld interpret ,/o%t medic,tion with pt3 c3 M,n+er sho%ld interfere in n,rcotic m,tters /- himself Answer: B C 16:. .hich tas& is not per%itted to the dispenser 3technician4 a. Counselin# the patient 16D. Nou noticed the technician co%e down to help a patient choosin# a Cou#h $roduct containin# Codeine. Nou %ay do all of the followin# actions ELCE$T a. Bo down to interrupt the discussion and %a&e the sale b. "s& the technician if the patient has aller#y to Codeine after the sale c. ;eview with her the Paw of dispensin# over the counter dru#s d. >on(t hu%iliate the technician in front of the custo%er e. 8end her to additional trainin# courses Answer: B 166. $har%acist saw technician #ive valiu% to his friend what to doH a. tell phar%acy %ana#er b. tal& to technician c. call the police Answer: A B 16E. $t. ca%e to the phar%acy with ;, for @C 1J in 2etader% crea%, she was in a hurry ) a lot of pt. waitin# for their ;, ) ph. is on phone with >r., technician do all of the followin# e,cept a. ta&e her phone no. ) arran#e a delivery for her %edication b. >r. has to chec& conc. of %i,ture before %i,in# it c. dispense %edication ) #ive it to her ri#ht away as she is in a hurry Answer: C 16C. Technician wor&1 insert co%puter data, writin# wor& 3des&4, ;, prepn. 169. roles of technician include1 a. fi, label b. prepare label c. order %edications.
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1EI. " pha%1acist #ive a patient Posec instead of Pasi,, this is a#ainst which lawH a. "#ainst interchan#ebility act. 1E1. In the above e,a%ple what should the phar%acist owner doH a. ta&e the wron# %edicine and #ive patient the ri#ht one and tell nothin# wron# b. "polo#i0e for the patient, call the doctor and return the ri#ht %ed. to patient Answer: B 1E<. .hat should he do to the phar%acist a. fire hi% b. reduce his salary c. tell the other staff d. worn hi% ) %ay apply penalty if not the first ti%e Answer: D 1E=. Pasi, was dispensed instead of Posec, pt now sufferin# of ur#ency' how will you handle the situationH a. tell the patient that everythin# is AO and it is /ust a different for% to &eep the reputation of the phar%acy b. reassure the patient that nothin# serious and chan#e the %edication c. say that it is a s%all error ) e,chan#e %edication d. ta&e the responsibility, chan#e the dru# ) report the error to the fa%ily physician e. Infor% Antario Colle#e about the %ista&e Answer: D 1E:. " phar%acy staff did a %ista&e and #ave Pasi, instead of Posec what do you do as a %ana#er1 a. Cut his salary b. @ave a %eetin# ) %ention it to hi% c. re%indin# the %edicine with a si%ilar spellin# on your staff Answer: B C 1ED. " pt #ot < %edicines fro% your phar%acy, but he saw that the label on a vial is wron# 3cross labellin#4, what is your role as a %ana#er1 a. as& patient to return her %edicine and #ive her the ri#ht %edicine on a ri#ht vial b. #ive her %oney bac& c. appolo#i0e for the inconvenience Answer: A 176. Cele,ia and Celeco,ib Mista&e in prescription' 1EE. Technician %ade a dispensin# error and phar%acist si#ned, who is responsible a. phar%acist.
35

b. Technician Answer: A 1EC. " student of 5 of T is trainin# in a phar%acy, so he can do all of the followin# e,cept1 a. $repare ;, b. $atient counselin# c. Gillin# on-line ;, Answer: B C. ,e can ta'e -erbal ./ un"er pharmacist super-ision. 1E9. >octor %a&es a %ista&e, and phar%acist in hospital was not present and the technician dispensed the ;,, pt too& the dru#, when discovered, tell1 a. nurse b. fa%ily doctor c. phar%acist d. patient e. hospital doctor Answer: A ) E 1CI. 8ound-li&e dru#s, for the %ana#er to decrease errors he should do all e,cept a. put the% away fro% each other b. put label on vial 3call for error4 c. put in co%puter syste% alar% to wor& on dispensin# d. %a&e < persons double chec& before dispensin# e. technician as& pt. for disease bein# treated fro% Answer: E 1C1. " ph. did a dispensin# error, what do you do as a phar%acy %ana#er a. discuss with hi% 1C<. Pescol is %i,ed with Posec 1C=. Insurance co%pany needs infor%ation on patient, can it be doneH a. 9o for reasons of confidentiality b. 9eed patient written per%ission Answer: A B 1C:. "n insurance co%pany puts a plan to cover the lowest price %edication and also covers the 1IJ hi#her than the lowest price. Nou have the followin# data. 2ased on the daily dose. .hat %edications should be covered by this co%panyH " 2 C <D%#!day 1II%#!UI> :I%#!2I> <D%#!T <.<I DI%#!T I.=I <I%#!T I.:D
36

> a. >ru# " only b. >ru# 2 c. >ru# C ) > d. >ru# 2 ) > Answer: C D

1<%#!2I>

1<%#!T I.91

1CD. In decidin# what dru#s are appropriate for its for%ulary, the hospital %ust consider a dru#(s efficacy, associated wor&load, and ac*uisition cost. 8everal new antifun#al IK dru#s 3dru# ", dru# 2, dru# C, and dru# >4, all with e*ual efficacy, have recently beco%e available. Currently the hospital stoc&s dru# E, which has been available for several years. >ata for the %edications is as follows1 >ru# Cost!day " 2 C > E T<.DI T<.<D TD.II T<.<D T<.<D >osin# Gre*uency UI> once daily 2I> 2I> UI> d. >ru# >. e. >ru# E Treat%ent >uration 3days4 1: 1: E E E

The %ost appropriate choice for the hospital is1 a. >ru# " b. >ru# 2 c. >ru# C Answer: D Competency: +.0 1C6. Nou as& your patient about all e,cept1 a. ;eli#ion b. ;ace c. Color Answer: A, B C 1CE. The phar%acist will be %ore involved in ho%e care products in the future, whyH a. The #overn%ent policy will favour patient-s care at their ho%es. b. This helps to diversify the phar%acy operations. Answer: A B 1CC. $atient inco%pliance %ay be due to 32arriers to the proper use of %edications include41 a. Pan#ua#e proble% b. >ifferent opinion about treat%ent c. Misunderstandin# the directions of use 3unclear instructions4
37

Answer: A

1C9. .hen orderin# di#o,in brand what do you &eep in %indH a. The brand used by the nearby hospital b. %anufacturer reputation c. product datin# 3stability, bio-availability4 Answer: A 19I. " patient %aintained on .arfarin for < wee&s in a hospital if he wants warfarin fro% your phar%acy a. Bive hi% the sa%e brand .arfarin as the hospital used to #ive b. #ive hi% the %ore bio-available brand c. loo& for the %ore stable and V shelf life Answer: A 191. E,piry date of phar%aceutical products1 ,3 &s%,ll- determined /- ,cceler,ted st,/ilit- st%dies3 19<. " custo%er de%ands receipts of the dru# usa#e for the year for ta, reasons for his fa%ily a. obtain a written per%ission fro% his wife 19=. " %other told you that her insurance co%pany lost the receipts for her dau#hter for the last %onth and she as&ed you if you can reprint for her and you noticed that her dau#hter has ta&en < antibiotics and a birth control so1 a. you should #ive the receipts directly to the %other free of char#e b. you should #ive the receipts directly to the %other with e,tra char#e c. you should contact the insurance co%pany at first d. you should as& a per%ission fro% the dau#hter at first 3not to brea& confidentiality4 Answer: D 19:. " %an as&ed the phar%acist to %a&e a photocopy of his receipts and of his fa%ily to send it to the insurance co%pany because they are lost. 5pon investi#ation, the phar%acist found that a%on# the %e%bers of the %an(s fa%ily are his wife and two teena#ers. .hat is the decision of the phar%acistsH a. Ma&e a photocopy of the receipts i%%ediately b. Tell the %an that it will ta&e ti%e and they will be ready ne,t ti%e c. Bet per%ission fro% the wife first d. Bet per%ission fro% all %e%bers of the fa%ily first Answer: D 19D. " wo%an who wants to co%%it suicide ca%e to your phar%acy with Elavil prescription what would you doH a. short fill the ;, b. not fill
38

c. counsel the patient not to ta&e overdose d. tell her it is a safe dru# Answer: A C 196. " diabetic patient ca%e to you co%plainin# about his hyper#lyce%ia' you reali0ed the increased dose, so%eti%es you reali0e that he is buyin# a rich chocolate, su#ar a. should you advice hi% and e,plain the ris&s. b. Pet hi% decide what he wants c. 2ut not 3do not4 obli#ate hi% and forbid hi% Answer: A, B C 19E. .hich barriers are considered between phar%acist and custo%ersH a. lan#ua#e s&ills b. fear and an,iety re#ardin# the confidence c. ine,perience, lac& of confidence d. difficulty in e,pressin# e. inability to interpret verbal *uestions f. inability to co%%unicate at the level of custo%er #. li%ited ti%e and opportunity Answer: A, B, C, D, E 1 19C. " ventolin repeat ;, ca%e to you. There is no refil, the ti%e is late, doctor is closed but you reali0ed that patient is co%plainin# and he used Kentolin for : wee&s and no i%prove%ent a. don-t #ive hi% the ;, ) advice hi% to #o bac& to his doctor to prescribe so%ethin# else. b. If you #ive you bro&e non-%aleficience Answer: A B 199. " continued education pro#ra% about hypertension will be arran#ed in your place1 the %ost i%portant thin#s for the patient to &now ) to %a&e the% interested to co%e are all e,cept1 a. cost per participant b. The history of each one of the lecturers Answer: A <II. The least effective %ethod to advertise this pro#ra% is1 a. The national newspaper 3a letter in it4 b. 2rochures arran#ed in a ba# and #iven to patients c. tellin# the doctors to tell the patient d. throu#h the co%puter 3deter%ine the patient candidate4 Answer: D <I1. .hat do we say to seniors in a lecture about health careH a. Chec& on your %edication and #et rid of the old ones, not in use
39

b. "lways counsel with the phar%acist if you want to as& about anythin#. Answer: A B <I<. There are now reports of sei0ures associated with #in&#o, the popular herbal for de%entia. In li#ht of this you should now counsel patients usin# #in&#o to1 a. avoid #in&#o if they have a ris& for sei0ures b. be careful usin# it if they ta&e dru#s that lower the sei0ure threshold. c3 Both A ,nd B3 Answer: C <I=. >ru# Co%pany CEA. Most i%portant factor for a new dru# is >e%and and side effects' the least i%portant factor is whether >octor writes Beneric or brand na%e.

40

<I:. " phar%acist preparin# patient infor%ation %aterials about oral contraceptive pills, he has to review these %aterials with all e,cept1 a. Teena#ers b. $arents c. Male partner d. $hysician, e. $har%acist. Answer: B <ID. Nou want to %a&e osteoporosis clinic in your phar%acy, so you will put in the clinic1 a. Ph-sici,n8 n%rse8 ph-siother,pist3 b. $hysician, nurse, Chiropodist c. $hysician, nurse, dietician. Answer: A <I6. " dau#hter for a cancer patient, who is on Ta%o,ifen ca%e to your phar%acy as&in# about a new %edication for cancer which is "nastra0ole, so what are you #oin# to do1 a. Tell her that this new %edication is wor&in# by the sa%e %echanis% as Ta%o,ifen. b. ;efer her to the physician to discuss the other treat%ent options with hi%. Answer: B <IE. >octor do thin#s wron# and the pt tells the phar%acist to /ud#e hi%1 a. write reports and #o to colle#e of physician, even if there is no proble% with hi% <IC. " :th year phar%acy student #oes to a rotation in a phar%acy the student will refer to all e,cept a. increase the staff. <I9. "ll are included in BM$ in a hospital e,cept a. Cleanin# floors b. 8anitary conditions c. Oeepin# narcotics Answer: C <1I. " %an ca%e to you an eye drops, which is very e,pensive, to return it. It was sealed container. This eye drops belon# to his %other who passed away two days a#o. Nou %ay discuss with hi% all of the followin# ELCE$T a. Ta&e the eye drops, #ive hi% a credit, and destroy it b. Tell hi% that the phar%acy cannot accept returned %edications to resell the% a#ain c. Tell hi% to #ive it to seniors ho%es as donation d. Ta&e it and re-dispense it Answer: D
41

<11. >r. wrote ;, for his wife, what should you do a. fill ;, as it is b. do not fill if its naccotic c. it is ille#al for hi% to write it d. it is not ethical to write it Answer: D. le#al only in e%er#ency <1<. $t. co%in# for an ATC cou#h syrup ) ph. noticed that she too& the sa%e %edication yesterday, what to do a. tell her no %ore %edication available b. as& her why does she need %edication c. #ive her na%e of addiction #p d. call police Answer: C <1=. $h. will do se%inar on depression for pt. what is not suitable to tal& about a. si#ns ) sy%pto%s b. %edication effect ) 8.E. c. no. of %ental health or#ani0ation d. co%parison between dru#s Answer: D <1:. $h. %orals protibit hi% fro% #ivin# AC to teen#er, what to doH a. tell her that it is not available b. send her to another ph. c. do not #ive her so that he would not brea& his %orals ) protect her d. #ive her ) put pt. needs above his personal %orals Answer: D <1D. .hen you prepare a tal& for heart proble%s, what topics do you include in speech a. pri%arly tal& about %edication of co%pany supportin# the lecture b. tal& about non-phar%acolo#ical ways c. tal& about %edication used in heart proble%s Answer: B C <16. Nou were as&ed to be a witness in a case a#ainst a physician, who% you were not on #ood ter%s with, so what to do a. refuse to #o
42

b. refuse to #o to not to loose ;, that he writes c. #o ) testify to #et rid of this type of physicians d. refusin# to #o is not ethical Answer: D <1E. $h. in hosp. ) the >r. wants to #ive his pt. a %edication for certain disease so what is the 1 st thin# to do a. verify with dr. e,actly the type of infor%ation he needs b. select suitable database in co%puter to answer his *uestion Answer: A B <1C. $h was called by the court for a >r %isconduct case a. @e should testify about the truth to prove his professionality in front of his co%%unity <19. If you have to order a #eneric dru#, which is least i%portant1 a. The space in phar%acy <<I. $t who is not wor&in# ri#ht now, his doctor switched hi% fro% Erythro%ycin to Pevoflo,acin 3Pevo*uine4, what is his concernH a. Ti%in# of doses b. Gre*uency of doses 3levoflo,acin is A>4 c. @i#h price 3levoflo,acin is %ore e,pensive, note he is not wor&in#4 Answer: C <<1. If a therapeutic intervention is necessary, all of the followin# infor%ation should be co%%unicated to the prescriber ELCE$T1 a. " declaration that +a %ista&e was %ade+. b. " brief description to the proble%. c. " reference sourcc that docu%ents the proble%. d. "n alternative or su#estion to resolve the proble%. e. " description of the clinical si#nificance of the proble%. Answer: A <<<. "u,iliary ) cautious labels should be utili0ed for all of the followin# purposes e,cept to1 a. 8ubstitute for verbal councellin#. b. Ensure proper usa#e. c. Infor% of stora#e re*uire%ent. d. Co%ply with re#ulatory re*uire%ents. e. .arn a#ainst the conco%itant use of certain dru#s. Answer: A <<=. The followin# ite%s are essential for a patient profile syste% e,cept1
43

a. The prescriber(s >E" re#isteration nu%ber b. $atient-s na%e c. $atient-s aller#ies d. $atient(s birth date e. Instructions for %edication use Answer: A <<:. 8witchin# fro% IK to oral is not i%portant for nurse co%pliance <<D. The %orals of a phar%acist prevents hi% fro% #ivin# abortive %edication for a lady with plan 2, what is the appropriate action he %ust ta&eH <<6. Bive her a list of nearest phar%acies fro% where she can #et her ;, <<E.

44

Gener,l R) R%les of Econom1. <. 2y law you have to #ive the patient the #eneric 3low cost4 not the brand dru# 3hi#h cost4 unless specified. Peast econo%ic depends on1 ,3 Cost9&nit b. Uuality unit c. 9atural unit Answer: A =. ;eason 3s4 for &eepin# low inventory1 a. Mini%i0e the cost of inventory b. :. 8o%ethin# related to shelf. Answer: A .hat is the proble% if the inventory is less than it should beH a. Theft b. $ricin# Answer: B D. @i#h cost and low inventory %eans1 a. Boods are bein# stolen b. 2uyin# fro% wholesaler c. 2uyin# a lot of low-price #oods Answer: A 6. B Calculate stoc& turnover if the inventory is =DIII 3lowest4, :IIII 3hi#hest4 and the total annual sales is <II,III T%rno'er : !,les 9 l,r+est in'entorTurnover E. F <II,III :I,III FD J

If cost of dru# F TC and it sells by T1<.DI what is #rowth %ar#in JH $rofit F T1<.DI W TC.II F T:.DI Browth Mar#in F F :.D , 1II 1<.D profit , 1II custo%er price F =6J

C.

The %andatory substitution is a principle of inventory only chan#e the low brand. a. To control the cost b. To reduce the inventory c. To %a&e %ore %oney
45

d. To follow the law Answer: D 9. 1I. To i%prove the turnover liability by decreasin# the cost and increasin# the turnover Cost of thin#s added afterwards is calledH a. Incre%ental cost b. "c*uisition cost Answer: A 11. .hich financial state%ent could be used to deter%ine the total value of prescription dru# sales for a phar%acy for a period of a yearH a. 2alance 8heet b. 8tate%ent of invest%ents c. 8tate%ent of chan#es in financial position d. Inco%e state%ent e. 8tate%ent of e*uity Answer: D Competency: +.2 1<. If the assets F <II,III ) the liabilities F 1DI,III, then the current rotation F Current assets ! Current liabilities F <II,III ! 1DI,III F 1.== 3low should be 1.E4

46