a) You would like to prepare 30 ml of an eye drop containing 1% of pilocarpine and 2% procaine. How many mg of sodium chloride should be used to make the above eye drops isotonic? (Freezing points depression of 1% solution of pilocarpine and 1% solution of procaine are 0.14 and 0.11, respectively.) 

(4 marks) 

b) How many mL of 36% (w/w) hydrochloric acid having a density of 1.18 g/mL are required to make 20 L of 10% (w/v) hydrochloric acid? 

(3 marks) 

c) You have 20%, 15%, 5% and 2% zinc oxide ointment. In what proportion should they be mixed together in order to make a 10% zinc oxide ointment? All these four ointments must be used. 

(3 marks) 

d) Patient requires dobutamine continuous infusion for shock resuscitation. Patient weighs 158.4 lbs. Your pharmacy stocks dobutamine concentrate solution for infusion in 250mg/20mL vials. 

(i)  In your hospital, the standard concentration for dobutamine is 2 mg/mL. How much volume of dobutamine concentrate solution is needed if the final volume is 250mL? 

(ii) Physician orders dobutamine to be infused at a rate of 6 mcg/kg/min. What is the infusion rate, in mL/h? 

(iii) What is the expected steady state plasma dobutamine concentration, if the 

clearance is 75 mL/kg/min? 

(3 marks) 

e) A bag of total parenteral nutrition (“TPN') is made by mixing 350mL of Amino acids 15% (osmolarity, 1357 mOsmol/L), 240 mL of Dextrose 70% (molecular weight of hydrous dextrose, 198.17 g/mol) and 410 mL of sterile water for injection. What is the expected osmolarity of the TPN bag? 

(2 marks) 

f) A lady presents a prescription for fluconazole 6 mg/kg orally on day 1, followed by 3 mg/kg orally once daily for 20 days. The prescription is for treating oral candidiasis. 

(i) The prescription is for her son (4-year-old, weight 16kg). What is an appropriate dosage to be taken for each dose? 

(ii) What is the total amount to be dispensed? 

(3 marks) 

g) A commonly used chemotherapy protocol for acute lymphoblastic leukemia 

(“ALL”) in adolescents and young adults is Hyper-CVAD. It includes the following chemotherapy medications. 

Cycle A: Cyclophosphamide 300 mg/m2 IV twice daily on days 1, 2 and 3, with Mesna, Vincristine 1.4 mg/m2 (max 2 mg) IV once daily on days 4 and 11; Doxorubicin 50 mg/m2 IV once on day 4; and Dexamethasone 40 mg IV/PO on days 1-4 and 8-11. 

Cycle B: High dose methotrexate 1 g/m2 IV 24hr infusion on day 1; Folinic acid starting on day 2, adjusted per methotrexate level; and High dose cytarabine 3 g/m2 IV infusion every 12 hours on days 3 and 4. 

Cycles repeat every 3 weeks, alternating between cycle A and B, for a total of 8 cycles 

(i) Patient is a 20-year-old male, 6 feet 4 inch tall and weighs 156.6 lbs. What is his body surface area? 

(ii) The risk of developing heart failure increases with the cumulative dose of anthracyclines. What is the total cumulative anthracycline dose, in mg, when he completes his chemotherapy? 

(2 marks)