QUESTION 1
Ben, aged 52, has type 2 diabetes mellitus and has been commenced on gabapentin capsules for neuropathic pain. The British National Formulary (Joint Formulary Committee, 2019) states that he should be prescribed the following regimen:
- Day 1 – gabapentin 300 mg capsule once daily
- Day 2 – gabapentin 300 mg capsules twice daily
- Day 3 onwards – gabapentin 300 mg capsules three times a day
- How many capsules will Ben take in the first 7 days?
- 18 capsules
- How many capsules will you prescribe for 1 month's supply from the day of commencement (28 days)?
- 81 capsules
- Ben tolerates this dose and you prescribe a further 1-month supply at his review. The pack size of gabapentin 300 mg capsules = 100 capsules/pack. How many full packs will you request in order to supply Ben with an adequate amount of tablets for 28 days' treatment and how many capsules will remain?
- 1 pack (100) to be supplied with 19 capsules left after 28 days
QUESTION 2
Janet, aged 45, was prescribed buprenorphine transdermal patch 10 micrograms per hour/one patch weekly. After 3 months' use, her pain is not adequately controlled and you decide to increase the strength of the patch by 50%.
- What is the new strength of the buprenorphine transdermal patch?
- 15 micrograms per hour/one patch weekly
- If there are 4 patches in a pack, how many packs will she use in 12 months? Assume a calendar month is 28 days.
- 12 packs
- The cost of one pack of 4 patches is £49.15. What is the total cost for 6 months' supply?
- £294.90
QUESTION 3
Morphine sulfate 2 mg/ml oral solution (Oramorph) is prescribed for Ian who is in chronic pain at the end of life. The recommended dose for Ian is 10 mg every 4 hours.
- How many ml of morphine sulfate should Ian take per dose?
- 5 ml
- How many ml of morphine sulfate will Ian require in 24 hours?
- 30 ml
- Ian is supplied with a bottle containing 300 ml. Assuming Ian takes the full-recommended dose, calculate how many days his oral solution will last.
- 10 days
QUESTION 4
Charlotte has chronic back pain due to previous orthopaedic surgery. Tramadol hydrochloride (modified-release) was prescribed and she has been taking one 200 mg tablet every 12 hours for 6 months. Charlotte has decided she wants to reduce this medication. As a prescriber, you agree to reduce the strength by 25% every 2 weeks.
- What is the strength of tramadol that you will prescribe first?
- 150 mg tablet every 12 hours
- How many tablets will you prescribe for the first 2 weeks' treatment?
- 28 tablets
- After 6 weeks, what strength of tramadol will Charlotte be prescribed?
- 50 mg tablets every 12 hours