TANDABUI INSTITUTE OF HEALTH SCIENCES AND TECHNOLOGY

BASIC TECHNICAL CERTIFICATE IN PHARMACEUTICAL SCIENCES

NTA LEVEL 5 SEMESTER I

PST05105: RATIONAL USE OF MEDICINES

CAT ONE EXAM

DURATION: 2 HOURS DATE: 04/12/ 2017

CANDIDATE NO …………………………………
INSTRUCTIONS
a) This examination paper consists of five (5) sections A, B, C, D and E.
b) Candidates are required to answer ALL questions.
c) Cellular phones and other unauthorized materials are NOT allowed in the examination room.
d) Write your examination number on every page of your answer booklet/sheet provided.

SECTION TYPE OF MARKS SCORES EXAMINER EXTERNAL

QUESTION ALLOCATED S INITIALS REMARKS
A MULTPLE 10
CHOICE
B TRUE/FALSE 20
C MATCHING 10
ITEMS
D SHORT NOTES 40
E ESSAY 20
TOTAL 100
SECTION A: MULTIPLE CHOICE QUESTIONS (10 MARKS)
INSTRUCTIONS:
 This section consists of ten (10) questions
 Circle the letter of the most correct answer
 There is the only one correct answer
 One mark will be awarded for each correct answer

1. ______ is the preparation and distribution of a course of therapy to appropriate patient

without appropriate instruction based on prescription
a) Irrational dispensing
b) Irrational prescribing
c) Irrational prescription
d) Generic prescribing
e) Rational dispensing
2. The following are the factor contributing to irrational use of medicine
a) Unaffordable medicine and over work of health worker
b) Ethical promotion of drug
c) Restricted availability of medicine
d) Coordinate national pharmaceutical policy
e) Adequate supervision
3. Instruction to the patient on use of medicine should be given
a) In English
b) In language not understood by patient
c) If it is at all necessary
d) Until the patient understand
e) In Swahili
4. Good dispensing practice involve the several steps among the following
a) Interviewing the patient to establish exact nature of the disease
b) Writing the prescription in terms of the dose and the patient information
c) Calculating and measuring irrationally the required quantity of medicine to be
dispensed
d) Recording details of the dispensed prescription to ensure accountability
e) Proper diagnosis of the patient by the dispenser
5. To ensure patient compliance to the prescribed drug, the dispenser should stress on the
following points
a) When and how to take the drug
b) To share the drug with the immediate members of the family
c) To take all the drug on empty stomach
d) To take all the drug immediate after food
e) To take all the drug immediate after breakfast
6. The length of time a drug may be stored without affect its stability, efficacy, and potent
referred as
a) Shelf life
b) Expiration date
c) Duration of treatment
d) Rational dispensing
e) Rational use of medicine
7. Medicine selection done by the central committee meet the criteria based on the following
except
a) Prescriber interest
b) Efficacy of drug
c) Quality of drug
d) Safety of drug
e) Cost effectiveness
8. The following are the benefit of generic Prescribing:
a) It need multiple stocks
b) It is difficult to remember the generic names of drugs.
c) Patients may get inappropriate medicines.
d) Reduced costs of drugs and multiple stocks.
e) Excluded in the essential medicine list.
9. Prescription become a legal document if it is signed by
a) Qualified dispenser
b) Qualified prescriber
c) Patient
d) Relative whose patient is unconscious
e) Both qualified prescriber and dispenser
10. ____ is a standard treatment guideline or prescribing policy systematically developed to
help prescribers make decision on treatment for specific clinical conditions.
a) Clinical guideline
b) Rational use of drug
c) Generic drug
d) Prescription audit and feedback
e) Drug therapeutic committee
SECTION B: MULTIPLE TRUE AND FALSE QUESTIONS (20 MARKS)
INSTRUCTIONS:
 This section consists of eight(8) questions with five options
 Write the word TRUE for correct statement and word FALSE for wrong
statement in the space provided
 0.5 mark will be awarded for each correct answer

1. The following are component of rational prescribing

a) __F__ Inaccurate diagnosis
b) __F__ Selection of best and unaffordable medicine to prescribe
c) __F__ Prescribe adequate dose for insufficient length of time
d) __F__ Incomplete communication between doctor and doctor
e) __T__ Appropriate patient information and evaluation

2. As far as dispensing of pharmaceutical is concerned

a) __F__ Supervision of the pharmacy practice can be done by anybody

b) __T__ Generic product are normally cheaper than brand name product
c) __F__ Drug that have expired are normally can still be used for some period
d) __F__ the abbreviation “TDS” means twice a daily
e) __F__ it is necessary to be familiar with brand name as opposed to generic name of drug

3. In ethical standard a qualified pharmaceutical personnel

a) __F__ Must agree to practice under any conditions which compromise
professional independence or judgment
b) __T__ Must respect the confidentiality or information acquired in the course of
professional practice relating to a patient and patient family
c) __T__ Must take precaution to safeguard the patient and public welfare when
dispensing any drug or compounding any preparation
d) __F__ Should not safeguard drug and pharmaceutical facilities in health units
against theft, pilferage deterioration and other physical hazards
e) __T__ Should exercise cleanliness, tidiness and politeness during the course of
pharmaceutical

4. The following are the roles of pharmaceutical personnel except

a) __F__ Being counselor to the patient
b) __F__ Being custodian of medication information
c) __F__ Being companion of the physician
d) __F__ Being record keeper of both prescribed and purchased medicine
 e) __T__ Being custodian of medication information and sells medicine for their
own profit

5. In a good dispensing practice (GDP)

a) __T__ Proper labeling is necessary to give patient the opportunity to regularly
check for the right use of the medicine they take
b) __F__ Correct use of medicine is not an important key to success of treatment
and therefore dispenser need not to give full and clear information to the user
c) __T__ The drug order must contain in sequence drug name,dosage,route and
frequency of dosing
d) __F__ When label are not available in the compounding section, medicine may
be dispensed without label and instruction a given verbally to the patient
e) __T__ Patient require information on safe storage of their medicine at home to
ensure that they remain effective and not mistakenly used by children

6. Ethics practice that control pharmaceutical dispensing

a) __T__ Dispensing medicine in accordance to problem of the patient visited
pharmacy
b) __T__ Encourage communication between prescriber and dispenser for more
clarification
c) __T__To keep all prescription for record
d) __F__ To dispense medicine without prescription
e) __F__ Proper labeling is enough, no need to explain more to patient

7. The most effectively approach for improving medicine use in primary health care in
developing countries is combination of
a) __T__ Education and supervision of healthy personnel
b) __F__ insufficient supply of appropriate medicine
c) __F__ inappropriate continuing education to dispenser
d) __F__ unaffordable cost of medicine
e) __F__ inadequate provision of information to consumer
8. The following chain of people contribute to irrational use of medicine
a) ---T--------Nurse
b) ----T-------Laboratory technician
c) ----T-------Doctor
d) -----T------Patient
e) -----T------dispenser
SECTION C MATCHING ITEMS QUESTIONS (10 MARKS)

INSTRUCTIONS:

 This section consists of ten (10) matching item questions with two parts each
containing five questions
 Match the items in column A with corresponding statements in column B by
writing a letter of correct response in the space provided
 Each correct response is awarded one mark
 Each item from column B is used only once
PART A

COLUMN A COLUMN B
1. Component of rationality ___F_____ a. Rational prescribing
2. Generic ____G____ b. Rational dispensing
3. International Nonproprietary Name c. overuse of limited medicines
___E____

4. Polypharmacy ____D_____ d. Irrational Prescribing

5. irrational use of medicines ___C______ e. Internationally recognized name for a
chemical entity
f. Appropriate indication

g. Obviates the need for multiple stocks

PART B

COLUMN A COLUMN B
1. Lack of skills and knowledge ___G_____ a. Factor contribute to rational use of
medicine
2. Appropriate and enforced regulation ____ b. interventions to overcome rational use of
F_____ medicine
3. Drug and therapeutic committees c. Useful ways to disseminate information
____E____ about rational use of medicine
4. Continuing in-service medical education d. Is a requirement for licensure of health
____D______ professionals in many countries.
5. Drug information centers ___C_____ e. Providing on-going staff education
f. Strategy to overcome irrational use of
medicine
g. Factor contribute to irrational use of
medicine
 SECTION D: SHORT ANSWERS QUESTIONS (40MARKS)
INSTRUCTIONS:

 This section consists of eight (8) questions.

 Write a readable handwrite; DIRTY WORK IS NOT ALLOWED.

1. Describe measures to alleviate irrational use of medicine.

a) A mandated mult-disciplinary national body to coordinate medicines use policies.
b) Clinical guidelines.
c) Essential medicines list based on treatment of choice.
d) Drug and therapeutic committees in district and hospitals.
e) Problem-based pharmacotherapy training in undergraduate curricula.
f) Supervision, audit and feedback.
g) Independent information on medicines.
h) Public education about medicines.
i) Avoid of perverse financial incentives.
j) Appropriate and enforced regulation.
k) .Sufficient government expenditure to ensure availability of medicines and staff.
l) Continuing in-services medical education as a licensure requirement
2. What are the factors contributing to irrational use of medicine
a) Lack of skills and knowledge.
b) Inappropriate unethical promotion of drugs
c) Profit from selling medicines.
d) Unrestricted availability of medicines.
e) Overwork of health workers.
f) Unaffordable medicines.
g) Lack of coordinated national pharmaceutical policy.
h) Unreliable supplies.
 i) Shortage of medicines (out of stock)
j) Short expiry medicines.
k) Poor communication skills.
l) Inadequate supervision
m) Misleading beliefs.
n) Irrational self medication
o) Inability to communicate problems
3. What are the mistake which can be avoided during prescribing practice
a) Prescribing multiple drugs
b) Prescribing to keep up with the latest fashion
c) Prescribing an older drug out of habit
d) Prescribing in order to satisfy the expectations of the patient
e) Prescribing out of pressure from drug companies, other prescribers or media

4. Explain five outcomes of irrational use medicine to the community

a) Antimicrobial resistance.
b) Adverse drug reactions and medication errors.
c) Lost resources.
d) Eroded patient confidence
e) increase in morbidity and mortality
5. Outline steps necessary for rational dispensing
a) Approach patient cordially and receive the prescription
b) Analyze prescription
c) Calculate required quantities for each drug to be dispensed
d) Dispense right quantity for each drug
e) Check if right medicines are dispensed
f) Label each dispensed medicine adequately
g) Counter check dispensed medicines
h) Counsel patient on medication use
i) Retain prescription for records
6. What are the problem caused by irrational use of medicine
a) use of too many medicines per patient;
b) inappropriate use of antimicrobials, often in inadequate
c) dosage and insufficient duration;
d) overuse of injections when oral medication would be more appropriate;
e) failure to prescribe in accordance with clinical guidelines including standard
treatment guidelines and prescribing policy; and
f) inappropriate self-medication, often of prescription-only medicines
7. Define the following terms
 a) Rational use of medicine requires that Patients receive medications appropriate to their
clinical needs, in doses that meet their own individual requirements, for an adequate
period of time, and at the lowest cost to them and their community.”
b) Irrational prescribing is the prescribing that does not conform to good standards of
treatment –for example, extravagant prescribing, overprescribing, incorrect prescribing,
and multiple prescribing or under prescribing.

c) Irrational dispensing the preparation and distribution of a course of therapy to a patient,

without appropriate instructions, based on a prescription.

d) Generic name A generic name is the unique INN given to the active ingredients) of a
drug and is recognized worldwide.

e) Expiration date the date after which the manufacturer can no longer guarantee the
stability, safety and potency of a drug.

8. What are factors which hinder the practice of rational drug use
a) Prescribing exceedingly high doses
b) Prescribing more toxic drugs than necessary
c) Prescribing an unnecessary drug
d) Prescribing a drug which leads to a drug-drug interaction
e) Inability to write a coherent and complete prescription
SECTION E: ESSAY TYPE QUESTIONS (20MARKS)
INSTRUCTIONS:
 This section consits of two (2) questions which are supposed to be
answered in a narrative way
 Write your answer on sheet of paper provided; each question should
start on a new page
 Each question carr 10 marks

1. Describe advantages of generic prescribing

a) Reduced costs
b) Easier availability
c) Obviates the need for multiple stocks
d) Easier to remember

2. Explain the regulatory measures to support the rational use of medicine

a) Registration of medicines to ensure that only safe
Efficacious medicines of good quality are available in the market and that unsafe non-
efficacious medicines are banned;

b) limiting prescription of medicines by level of prescriber;

This includes limiting certain medicines to being available only with a prescription and
not available over-the counter;

c) Setting educational standards for health professionals

and developing and enforcing codes of conduct; this requires the cooperation of the
professional societies and universities;

d) licensing of health professionals – doctors, nurses, paramedics – to ensure that all

practitioners have the necessary competence with regard to diagnosis, prescribing and
dispensing;
e) licensing of medicine outlets – retail shops, wholesalers