Originally published under the title "Could You Open a Pharmacy in Islamic State Territory?"

The Islamic State's propaganda videos give the impression of a highly developed healthcare system.

As should be familiar by now, the Islamic State (ISIS) has a health department as part of its bureaucracy (Diwan al-Siha). From the documentary evidence, multiple instances emerge of the Islamic State trying to regulate pharmaceutical practices in the territories under its control. These regulations include insistence on competence, such as proof of study of pharmacology in the form of some kind of certificate, as well as price controls. The Islamic State also encouraged the study of pharmacology among students, keeping the pharmacology college at Mosul University open.

For those wishing to open a new pharmacy, licensing is required from the Islamic State, with the prospective investor needing to take an exam to demonstrate knowledge of pharmacy. The previously unseen documents below feature a sample exam issued by the health admin centre in Aleppo province in northern Syria. I have intentionally obscured most of the marking and answers on this sample exam paper obtained from al-Bab in north Aleppo within the Turkish-backed Euphrates Shield Syrian rebel operations that recaptured the town from the Islamic State. Have a go at the paper and see whether you yourself are competent enough to open a pharmacy in Islamic State-held territory. You may do better than the person who took this paper and only scored 18.5 out of 100.


Islamic State
Wilayat Halab
Health Centre

In the name of God, the Compassionate, the Merciful

Competency exam for investors of pharmacies

No. 606
Date: 14 Dhu al-Qi'da 1436 AH/29 August 2015 CE

Name:
Pharmacy:

Answer the following questions:

1. What is the aspirin dosage as an inhibitor of platelet aggregation?

2. Name 5 medicines that can be purchased without a prescription and name 5 medicines that cannot be purchased except by a doctor's prescription.

3. What is the difference between the antibiotic and the anti-inflammatory drug?

4. In what case is iron transferred from oral to intravenous?

5. What is the most appropriate antispasmodic for pregnant women?

6. What does it mean that the drug is from group:

- A during pregnancy
- B during pregnancy
- C during pregnancy
- D during pregnancy

7. What is the medicine that causes the colour of urine to turn red?

8. What is the group of antimicrobial medicine that are placed in the bones and teeth and causes them to tint?

9. What is the side-effect of ACE inhibitors and how can it be avoided?

10. What is the safest anticonvulsant during pregnancy?


11. Nicotine is considered to be one of the cholinergic antagonists. What are its most important uses?

12. When is it allowed for a pharmacist to give a replacement for a medicine composed of one medicinal substance?

13. What is meant by the medicine's half-life?

14. Name one medicine of what follows:

a) Hypoglycemic agents of the Sulfonyl urea group?
b) Anti-cancer of the ACE inhibitors group?
c) 1st generation of the Cephalosporins?

15. What is the lethal side-effect of Tramadol?

16. The most important side-effect of Verapamil?

17. Put each antihypertensive with its group:

Enlapril

Calcium channels blockers

Spironolactone

Potassium sparing diuretics

Diltiazim

Angiotensin II receptor antagonists

Valsartan

Alpha blockers

Doxazosin

ACE inhibitors


- Put a circle around the correct response:

1. Is it possible to treat influenza with the following drugs:

a) Dexamethasone
b) Diclofenac
c) Ceftriaxone
d) a) and b)
e) a) and c)
f) All of the responses are wrong

2. To what class of drugs does Spironolactone belong?

a) Loop diuretics
b) Potassium sparing diuretic
c) Hypoglycemic
d) Beta blockers

3. Which of the following medicines cause extrapyramidal syndromes?

a) Domperidone
b) Metoclopramide
c) Ondansetron
d) Granisetron

4. Which of the following medicines is not to be given to someone below 18?

a) Warfarin
b) Chloramphenicol
c) Ciprofloxacin
d) Tetracyline

5. Which of the following is not an expectorant or mucolytic?

a) Ambroxol
b) Carbocisteine
c) Bromhexine
d) Dextromethorphan

6. Misoprostol can be used in:

a) Induce uterine contractions
b) Protect the stomach
c) Suppress pain
d) Pituitary gland
e) a) and b)
f) All the responses are incorrect.

7. Doxazosin is an alpha-blocker used to treat prostatic hyperplasia, and among its side effects:

a) Lowering pressure
b) Raising pressure
c) Difficulty urinating
d) Decrease in blood sugar

8. As regards aminoglycosides, all of the following is true except:

a) They are antibiotics that inhibit the synthesis of bacterial protein.
b) They are classed with antibiotics of type Beta-lactam.
c) They are antibiotics that fight bacteria.
d) They have a nephrotoxicity and ototoxicity
e) They cannot penetrate the blood-brain barrier.

9. Which of the following medicines binds bile acids in the intestine and prevents their absorption?

a) Fenofibrate
b) Atorvastatin
c) Alistatin
d) Cholestyramine

10. All of the following medicines have an effect to counter rheumatism except:

a) Diclofenac
b) Ibuprofen
c) Meloxicam
d) Paracetamol


11. The following medicine is used to suppress nerval pains:

a) Gabapentin
b) Pregabilin
c) Amitriptyline
d) Carbamizine
e) All of the above is true

12. Cream is tantamount to:

a) Ointment composed of one fatty phase
b) Emulsion (water with oil) that is not very adhesive
c) Emulsion (water with oil) that is semi-solid
d) Multiple emulsion
e) Miniemulsion

13. It is preferred for the sake of prepared emulsions given as injections to use:

a) Emulsifying agents in the dispersed phase positively
b) Dispersed phase negatively
c) Non-dispersed
d) It is preferred not to use emulsifying agents
e) Dual charge

14. It is possible to use the following sweeteners in syrups that can be given to diabetic patients except:

a) Methyl cellulose
b) Sucrose
c) Hydroxyethyl cellulose
d) Sodium saccharine
e) Aspartame

15. All of the following oils can be used in emulsions prepared for internal consumption except:

a) Castor oil
b) Cod liver oil
c) Soybean oil
d) Cottonseed oil
e) Benzyl benzoate

16. In the event that penicillin (or one of its derivatives) is prescribed as an intravenous injection to treat a patient who has not previously received this medication, the pharmacist must advise:

a) To give the penicillin without cautions
b) Replace the means of insertion: instead of an intravenous injection, it is possible to do an intramuscular injection.
c) Inject the penicillin along with adrenaline to avoid possible risks.
d) Carry out a penicillin allergy test or advise to do it before injection.

17. Among the harmful effects of steroids are the following except:

a) Decrease blood sugar
b) Brittle bones
c) Cushing's syndrome
d) Rise of blood pressure
e) Blood obstruction

18. The safest anti-histamine in pregnancy is

a) Dexchlorpheniramine
b) Loratadine
c) Hydroxyzine
d) Cetirizine
e) No anti-histamines should be given in pregnancy, but rather corticosteroids are used.

19. A patient who has high blood pressure and asthma: which of the following medicines cannot be prescribed for the patient?

a) Captopril
b) Amlodipine
c) Bisoprolol
d) Hydrochlorothiazide

20. A patient complains of abdominal pain and you as a pharmacist suspect that he has an abdominal surgical condition. The first procedure you do is:

a) Give the patient an antibiotic
b) Give the patient a pain-suppresser
c) Send him to a radiologist for an ultrasound scan.
d) Seek an image of the patient's abdomen.
e) Refer the patient to a general surgeon doctor to evaluate his situation.


Mark true or false:

1. Amiodarone is used in treating bradycardia and heart block.

2. Phenazopyridine is a medicine used to reduce cystitis.

3. In the event of the existence of more than one Leishmaniasis wound, pentostam is given through intra-muscular means rather than locally.

4. In the event of injecting theophylline slowly, it will result in the stopping of the heart.

5. Hydrocortisone is considered the first medicine to treat an intense asthma attack.

6. Anti-epilepsy drugs are resulting in a rise in the rate of suicide.

7. Warfarin is a safe medicine for a pregnant woman in the fifth month.

8. Chromoglycate is used for relief from sudden asthma crises.

9. Metformin is considered to be the medicine of choice for the diagnosed diabetic currently.

10. It is not possible to give esomeprazole to the pregnant woman.


Aymenn Jawad Al-Tamimi is a research fellow at Middle East Forum's Jihad Intel project.