make your mark 2014 handout

1

Acknowledgements

Amar Iqbal Pre-registration and Student

Support Lead

Fawzia Lokat Pre-registration Support Officer

Georgia Malesi

Student Support Officer

Bindya Tailor

Communications Officer

Katrina Earle

LPF Events Team

Bijal Tailor

LPF Events Team

Akila Ahmed

LPF Deputy Lead

Ebraheem Junaid Paediatric Pharmacist

Birmingham Children’s Hospital

Louise Chamberlain

Pre-registration and Student

Support Deputy Lead

Launch: BNFc Guidance

Make Your Mark 2014

BNFc Quick Reference Guide (QRG)

Make Your Mark 2014

BNFc QRG – Support Presentation

Make Your Mark 2014

Make Your Mark 2014 Birmingham & Solihull LPF

No part of this document may be reproduced without prior permission of the author(s).

How to use the BNFc QRG.pdf

How to use the BNFc QRG.pdf

BNFc Guide - Show.ppsx

2

Part 1: BNF Tagging

Make Your Mark 2014

By: Georgia Malesi,

Amar Iqbal, Fawzia Lokat,

Louise Chamberlain and Bindya Tailor

Common Themes Introductory sections e.g. palliative care

Colour coding of chapters

Highlighting cautions, side effects, interactions

Useful tables e.g. H. Pylori eradication, TB treatment,

electrolytes,

Stepwise treatments e.g. hypertension, asthma

Equivalent doses e.g. steroids, hypnotics, antipsychotics

Appendices marked

Interactions tagged A-Z

Index tagged A-Z

Useful tables and sections

Opioid equivalents Steroid equivalents

H.Pylori eradication COC and HRT

Hypertension guidelines Iron salts

Warfarin Electrolytes

Antipsychotic equivalents G6PD deficiency

Antiepileptic interactions Acute porphyria

TB Emollient quantities

Malaria Topical steroid quantities

and potencies

Annotating



3

GPhC rules for annotation The text printed may be supplemented by hand-written

(not printed) highlights, tabs, corrections and

comments.

The annotation should complement the purposes of

the adjacent text and therefore the inclusion of

additional material, including photocopies, is not

allowed.

Invigilators will check reference sources on the day of

the assessment and remove additional materials. If

serious misconduct is suspected it may result in you

being awarded a fail

Highlighting and

Underlining

http://www.preregpharm

.co.uk/a-guide-to-

tagging-you-bnf/

Tag your current BNF and get used to using it and find what works for you

Don’t over-tag your BNF

Think carefully about how much you highlight

Don’t forget your BNFc



http://www.preregpharm.co.uk/a-guide-to-tagging-you-bnf/












4

Part 2: Drug Tariff

Make Your Mark 2014

By: Amar Iqbal Pre-registration and Student Support Lead

Which of the following information can be found by looking in the Drug Tariff? 1. Basic prices of drugs and appliances 2. Details of the reward scheme for fraudulent prescriptions 3. National Out of Hours Formulary

Answer: A

Directions Summarised

A

1, 2, 3

B

1, 2

only

C

2, 3

only

D

1

only

E

3

only

The Registration Assessment: Make your mark

Borderline Substances (ACBS) Part XV Appendix 2 (BNF) Professional fees and charges Part XVI Exemptions Part XVI Dental and Nurse Prescribers Part XVII A/B Back of BNF Black list Part XVIII A Selected List Scheme (SLS) Part XVIIII B

• Some of the information may be found in another open book reference source (No change to question)

• Some questions can be answered without an open book reference source (No change to question)

• The information cannot be found in reference source (Question changed to add factual detail)

• Question unanswerable without a reference source (Question removed)


CD2

CD3

CD4-1

CD4-2

POM



5

Which of the following is not a substance which is reimbursable when prescribed for the dietary management of phenylketonuria? A. Easiphen B. Milupa PKU 3-advanta C. PK Foods Orange Jelly D. PKU Start E. Sno-Pro

Answer: C (see BNF)

Borderline Substances

In certain conditions some food and toiletry preparations have characteristics of drugs

and the Advisory Committee on Borderline Substances advises as to the circumstances

in which such substances may be regarded as drugs. Prescriptions issued in accordance

with the Committee's advice and endorsed "ACBS" will normally not be investigated.


Preparing for the exam ACBS

See BNF Appendices

Individual monograph

You receive a lilac coloured prescription in your pharmacy. The new

student technician asks you what type of prescription it is as he has not

seen one previously. You tell him that it is a:

A. FP10-SS B. FP10-MDA C. FP10-D D. FP10-HP E. FP10-CN

Answer: E

Each of the questions or incomplete statements in this section is

followed by three responses. For each question ONE or MORE of the

responses is/are correct. Decide which of the responses is/are

correct. Then choose:

You receive a prescription from your local nurse practitioner, which of

the following items are you legally able to dispense for this prescriber?

1. Aciclovir Oral Suspension BP (200mg/5mL)

2. Choline Salicylate Dental Gel BP

3. Ibuprofen Tablets BP

Answer: C

(see BNF Appendices)


A

1, 2, 3 B

1, 2 only C

2, 3 only D

1 only E

3 only



6

You receive a prescription from Mr JS, who is not exempt from paying charges. The prescription is for the following items:

Phenoxymethylpenicillin 250mg Caps (Mitte 56)

How much money does Mr JS have to pay for this item? A. £7.10 B. £7.20 C. £7.65 D. £7.85

E. £8.00

Answer: D

You receive a prescription for the following items:

Amoxicillin 250mg Caps (Mitte 21)

‘Microgynon 30’ Tablets (Mitte 21)

How many professional fees and charges apply? A. 1 professional fee, 1 charge B. 1 professional fee, 2 charges C. 2 professional fees, 1 charge D. 2 professional fees, 2 charges

E. 1 professional fee, 0 charges

Answer: C


Single Multiple Same drug/prep is supplied in >1 container

Different strengths of the same drug are ordered

separately on the same Rx

>1 appliance of the same type (other than

hosiery) is supplied

A set of parts making up a complete appliance is

supplied

Drugs are supplied in a powder form with a

solvent separate for subsequent admixing (e.g.

Zineryt)

A drug is supplied with a dropper, throat brush or

vaginal applicator

Several flavours of the same preparation are

supplied

Different drugs, types of dressings or appliances

are supplied.

A single preparation of more than one formulation

is supplied (e.g. Premique Cycle – contains two

different tablets: Conjugated Oestrogen and

Medroxyprogesterone Acetate)

>1 piece of elastic hosiery is supplied.

Different formulations or presentations of the

same drug or preparation are prescribed and

supplied.

Additional parts are supplied together with a

complete set

Current charge £7.85 (England) for each prescription item, preparation or type of appliance

including each anklet, legging, knee-cap, below-knee, above knee or thigh stocking.

Professional fees and charges

Which of the following items when dispensed on an FP10 prescription would attract an additional fee? 1. Pethidine 50mg tablets 2. 1 pair below knee, class 1 stockings 3. Betnovate 10% in Unguentum Merck

Answer: A


A

1, 2, 3

B

1, 2

only

C

2, 3

only

D

1

only

E

3

only



7

First

Statement

Second

Statement


A B C D E

True

True

True

False

False

True

True

False

True

False

2nd statement is a correct explanation of the first

2nd statement is NOT a correct explanation of the first

The following question relates to Mrs JM who presents to your pharmacy with a prescription for Carbimazole 5mg OD (Mitte 28).

FIRST STATEMENT SECOND STATEMENT

Mrs JM is exempt from

prescription charges for this

prescription.

Hypothyroidism requiring

hormone replacement is a valid

reason for exemption under the

NHS Act 2006.

Answer: D

First

Statement

Second

Statement


A B C D E

True

True

True

False

False

True

True

False

True

False



The following question relates to Mr FN who presents to your pharmacy with a prescription for Ondansetron 4mg BD (Mitte 10). Mr FN tells who that he is entitled to free prescriptions as he is having the medication following his chemotherapy.

FIRST STATEMENT SECOND STATEMENT

Mr FN is exempt from

prescription charges for this

prescription.

Prescription charges do not

apply to those who are receiving

medication for the effects of

cancer treatment.

Answer: A

"No charges shall be payable by a person with a

valid exemption certificate issued by the Secretary

of State on the ground that the person is

undergoing treatment for –

(i) cancer;

(ii) the effects of cancer; or

(iii) the effects of cancer treatment".


Exemption from charges

Provided that the appropriate declaration is received, a charge is not payable to the pharmacist,

appliance contractor or dispensing doctor for drugs or appliances, including elastic hosiery, supplied for:

Children aged under 16, and young people aged 16, 17 or 18

in qualifying full-time education;

Contraceptive purposes (where marked appropriately)

People aged 60 and over.

People holding a valid exemption certificate or either have or

are one of the following:

> JSA, IS, or ESA

> A partner on Pension Credit Guarantee Credit

> An HC2 certificate

> expectant mothers;

> women who have borne a child or women who have given

birth to a child in the last 12 months;

War pensioners holding a War Pension exemption certificate

for prescriptions needed for treating their accepted disablement;

Released prisoners who present an FP10 or FP10 (MDA) will

not have to pay a prescription charge if:

> `HMP', the prison name, address and the prison telephone

number is printed in the box provided for the practice address on

the front of the form, with the prescribing code and responsible

Primary Care Trust code.

People who have purchased a PPC, which is valid at the point

of dispensing.

People suffering from the following specified conditions who

have a valid medical exemption certificate:

> permanent fistula (e.g. colostomy or ileostomy) requiring

continuous surgical dressing;

> a form of hypoadrenalism (e.g. Addison's) for which specific

substitution therapy is essential;

> diabetes insipidus and other forms of hypopituitarism;

> diabetes mellitus, except where treatment is by diet alone;

> hypoparathyroidism;

> myasthenia gravis;

> myxoedema (that is, hypothyroidism requiring thyroid hormone

replacement);

> epilepsy requiring continuous anti-convulsive therapy;

> a continuing physical disability which means they cannot go

out without the help of another person;

> cancer

NHS



8


Part XVIIIA - drugs, medicines and other substances not to be ordered under a General Medical Services contract.

Blacklist

NHS


Drug Patient Purpose Clobazam Any Epilepsy

Cyanocobalamin Tabs Vegan or proven Vit. B12 deficiency Treatment or prevention of

Vit. B12 deficiency

Locabiotal Aerosol Any Infection and inflammation of

the oropharynx

Niferex Elixir Paed (30mL) Premature infants Prophylaxis in treatment of

iron deficiency

Nizoral Cream Any Seborrhoeic dermatitis and

pityriasis versicolor

Oseltamivir; Zanamivir At risk adult patients (e.g. chronic respiratory disease, CV disease,

renal disease, immuno-compromised, DM, or >65yrs)

Prophylaxis or treatment of

influenza

Alprostadil

Apomorphine

Moxisylyte

Sildenafil

Tadalafil

Thymoxamine,

Vardenafil

Started treatment prior to the 14 Sept 1998, a man suffering from:

DM, MS, PD, polio, prostate cancer, severe pelvic injury, single gene

neurological disease, or spinal cord injury (incl. spina bifida)

OR

Receiving treatment for renal failure by dialysis

OR

Who has had any of the following types of surgery: prostatectomy,

radical pelvic surgery, renal transplant

Treatment of erectile

dysfunction

Part XVIIIB - drugs, medicines and other substances that may be ordered only in certain circumstances

Selected List Scheme


Exemptions

Know who is exempt from prescription

charges and why they are exempt.

Professional fees and charges

Be aware of the current prescription

charge.

Make sure you know how many fees

and charges are reimbursed depending

on the product(s) prescribed.

Be aware of any simple professional

fees.

KEYPOINTS

ACBS

Be aware of ACBS products and where

to find them in the BNF.

Drug Tariff

Remember this is no longer an open book

reference source but you may still be asked

questions on it.



9

Part 3: Medicines, Ethics, and Practice

Make Your Mark 2014

By: Louise Chamberlain Deputy Pre-registration and Student Support Lead

Hospital Pharmacist SWBH NHS Trust

The MEP is no longer a

reference source for the

exam BUT contains

important information on

the legal and professional

aspects of pharmacy that

can be tested.

Core concepts and clinical skills

Professionalism and professional judgement

Clinical check

Medication histories

Just culture

Legislation and professional issues

P meds POM to P switches

Pseudoephedrine and ephedrine

EHC

Cough and colds in children

POMs General prescription requirements

Private prescriptions

Labelling

Exemeptions

EEA and Swiss prescribers

Self prescribing


Wholesale dealing

Additional issues Child resistant locks

Expiry dates

Homeopathic and herbal meds

Electronic cigarettes

Social media

Collection by children

Veterinary medicines Prescription requirements

Labelling

Cascade

Record keeping


Controlled drugs Prescription requirements

Private prescriptions

Requisitions

Safe custody

Registers

Destruction



10

Conduct, ethics and performance

CPD

Confidentiality

Consent

Raising concerns

Maintaining sexual boundaries

Religious/moral beliefs

Responsible pharmacist

Dealing with complaints and concerns

Appendices: GPhC Standards and Guidance

Which of the following is the maximum number of

paracetamol 500mg capsules that can be sold

from a registered pharmacy without a

prescription?

a. 16

b. 32

c. 64

d. 100

e. 120

See appendix 11: GPhC guidance on responding to

complaints

You are working as a community pharmacist, you

realise that on the previous day when you were not on

duty atenolol was dispensed instead of allopurinol.

What would be your first course of action?

a. Contact the GPhC for advice

b. Contact the NPA for advice

c. Leave a note for the pharmacist involved to deal with it

d. Complete a dispensing error form

e. Contact the patient to inform them of the error

section 3.2.5 in MEP

A 4 year old child presents to the community pharmacy.

Her mother states that she has had a runny nose, sore

throat and dry cough for the past couple of days. Which of

following would you advise?

a. Pholcodeine linctus

b. Otrivine (xylometazoline) child nasal drops

c. Paracetamol and ibuprofen

d. Paracetamol

e. Benylin children’s night coughs (contains levomenthol

and diphenhydramine)

A B C D E

Subject to prescription

requirements Yes Yes Yes No No

Subject to safe

custody Yes Yes No No Yes

Requires CD register

to be kept Yes No No Yes No

Select from A to E which one of the above descriptions applies to the

following medicines:

1. Temazepam 10mg tablets

2. Buprenoprhine 400microgram sublingual tablets

3. Sativex oromucosal spray



11

Directions summarised

A

1,2,3

B

1,2

only

C

2,3

only

D

1

only

E

3

only

Mr Taylor a regular patient at your community pharmacy has run out

of Novomix 30 Flexpens and asks for a supply without a prescription

Looking at his PMR you can see that he has these as a regular

repeat medication. You make the supply, which of the following

apply?

1. A full pack of 5 pens should be supplied

2. The words emergency supply need to be on the dispensing label

3. An entry must be made in the POM register

Miss Green, aged 28, presents with a prescription for isotretinoin 25mg daily.

Which of the following apply when supplying isotretinoin?

Directions summarised

A

1,2,3

B

1,2

only

C

2,3

only

D

1

only

E

3

only

1. The prescription has an expiry date of 6 months.

2. A maximum of 60 days can be supplied

3. The patients age does not need to be on the prescription

Directions summarised First Second statement statement A

B

C

D

E

True

True

True

False

False

True

True

False

True

False



Mr Ludwig is on holiday in the UK. He presents a prescription to you

that has been written in his home country, Germany (an EEA country).

No patient address has been written on the prescription.

First Statement Second Statement A legal supply can be made The patient’s address is not a legal

against this prescription as it stands requirement for prescriptions issued

by a doctor registered in an EEA country

Directions summarised First Second statement statement A

B

C

D

E

True

True

True

False

False

True

True

False

True

False



You are preparing to destroy the out of date and patient returned

controlled drugs that have been kept in the CD cupboard. 10 morphine

sulphate MR 60mg capsules have been returned by Mrs Watson as she

no longer needed them.

First Statement Second Statement Destruction must take place in the Morphine is a schedule 2 controlled

presence of an authorised witness drug



12

Part 4: Over the counter sales

Make Your Mark 2014

By: Fawzia Lokat Pre-registration and Student Support Officer

Community Pharmacist (Boots UK Ltd)

Todays session…

Overview of OTC topics

Topics that the GPHC commonly ask questions from

Quiz / Scenarios

Childhood diseases

Licensing indications

Vitamins

POM to P

Reference sources

Questions

Respiratory Cold + Flu

Cough

Sore throat

Allergic Rhinitis GI Heartburn/Indigestion

Constipation/Diarrhoea

IBS

Motion sickness/ N+V

Hemorrhoids

Mouth ulcers

Women’s Health Cystitis

Thrush

EHC

Eye/Ear

Childhood Conditions Colic

Head lice

Threadworms

Childhood rashes

Fever

Skin Eczema/Dermatitis

Psoriasis

Acne

Fungal infections

Cold sores

Warts/Verruca’s

Scabies

Hair loss

Pain Musculoskeletal

Headaches

Responding to symptoms: Overview of topics Commonly covered topics by the GPHC

Sale of Hydrocortisone

Thrush – vaginal and oral

Use of products in pregnancy

Skin conditions

Childhood skin conditions

Eczema/dermatitis and Psoriasis

Eye conditions

Conjunctivitis and the sale of chloramphenicol

Viral, allergic and bacterial eye conditions

Heartburn and indigestion

Cough and cold referral

Warm up quiz…

Question 1

Which viral pathogen is responsible for the majority of viral conjunctivitis cases?

A. The rhinovirus

B. The Epstein-Barr virus

C. The adenovirus

D. The Norwalk-virus

E. The rotovirus



13

Question 2

Which of the following products contains peanut

oil?

A. Otex

B. Earcalm

C. Earex

D. Molcer

E. Exterol

Question 3 Questions 1 and 2 concern the following skin conditions:

A. Acne vulgaris

B. Herpes zoster

C. Molluscum contagiosum

D. Seborrhoea capitis

E. Tinea corporis

Select from A to E which one of the above can be recognised by the dermatological sign(s) described below:

1) Isolated erythrematous scaly lesions with defined edges, often round or oval in shape

2) A vesicular rash, occurring unilaterally over the scalp and forehead, extending to the eye on

Question 4

A patient comes in your pharmacy asking for an antacid.

Which of the following medicines, would be affected by an

antacid leading to reduced absorption of the drug?

A. Amiodarone

B. Disopyramide

C. Digoxin

D. Verapamil

E. Propanolol

Question 5

What is the name of the virus that causes warts?

A. Rotavirus

B. Rhinovirus

C. Human papilloma virus

D. Coltivirus

E. Baculovirus

Question 6

Questions 1 to 3 concern the following ingredients often included in cough mixtures:

A. Diphenhydramine

B. Theophylline

C. Guafenesin

D. Dextromethorphan

E. Pseudoephedrine

Select from A to E which one of the above:

1. Has a sedative effect which is enhanced by alcohol

2. Interacts with MAOIs with the risk of a dangerous rise in blood pressure

3. Interacts with quinolones to cause an increase risk in convulsions

Childhood Health and Diseases



14

Paracetamol doses (popular GPhC question)

Age How much

How often

3 months up to 6 months 2.5ml Up to 4 times in any 24 hours

Leave at least 4 hours between

doses 6 months up to 2 years 5ml

2 years up to 4 years 7.5ml

4 years up to 6 years 10ml

Don’t give more than 4 times in any 24 hours

Age How much How often

6 years up to 8 years 5ml Up to 4 times in any 24 hours

Leave at least 4 hours between

doses 8 years up to 10years 7.5ml

10 years up to 12 years 10ml

12 years up to 16 years 10ml -15ml

Adults and children aged 16

and over

15ml – 20ml

Don’t give more than 4 times in any 24 hours

Paracetamol

250mg/5ml

Paracetamol

120mg/5ml

Fever When to refer: < 3months old, as diagnosis is difficult

Associated stiff neck or febrile convulsions

Prolonged fever or unresponsive to medicines

Antipyretics should be given to reduce fever. The child’s fluid

intake should be increased to avoid dehydration from excessive

sweating. Any prolonged fever should be referred.

Diarrhoea When to refer: Referral to a doctor is based on age of child and duration of diarrhoea

<1 year old > 24 hours duration = referral

<3 years old > 48 hours duration = referral

>3 years old / adults > 72 hours duration = referral

In most cases the condition is self limiting and does not exceed 2-3

days

FIRST LINE: increase fluid intake with possible addition of oral

rehydration salts (ORS)

Question 1

Questions 1 to 3 concern the following conditions:

A. Chicken pox

B. Epidemic parotitis

C. Rubella

D. Herpes virus

E. Pertusssis

Select from A to E which one of the above is:

1. Whooping cough

2. Mumps

3. German measles

Image taken from NHS choices 2014

Childhood diseases: BRIEF overview Question 2 Questions 1 to 4 concern the following childhood diseases:

A. Mumps (epidemic parotitis)

B. German measles (rubella)

C. Measles

D. Chicken pox (herpes zoster)

E. Whooping cough (pertussis)

Select, from A to E, which one of the above fits the following statements:

1. The vesicles produced by this disease contain large quantities of the virus

2. Women who are pregnant should avoid contact with people infected with this disease because of risk of congenital abnormalities

3. Vaccination against this disease is routinely given during the first year of life in the form of a combined vaccine with diptheria, tetanus, Haemophilus influenza type b and polio

4. The disease causes characteristic white spots surrounded by a red ring (koplik spots) on the inner cheek and gum



15

Licensing Indications

Common OTC licensing indications you

should be aware of

o Hydrocortisone 1% cream

o Clotrimazole thrush cream

oDaktarin gel – contraindications and age

restrictions

o All POMs to Ps

o Diclofenac

o Constipation in pregnancy

Licensing continued.. Aciclovir Products will be P unless the following

conditions are met:

• For external use

• For the treatment of HSV of the lips

and face (Herpes Labialis)

• Max Strength: 5%

• Min pack size: 2g

Additional product information

requirements:

• The leaflet should advise the patient to

consult a pharm/doctor if in any doubt

as to whether the sore is a cold sore,

and to consult the doctor if the cold

sore becomes severe.

http://www.mhra.gov.uk/Howweregulat

e/Medicines/Licensingofmedicines/Leg

alstatusandreclassification/Listsofsubst

ances/index.htm

Vitamins

Question 1

Questions 1 to 3 concern the following vitamins

A. Vitamin A

B. Vitamin B12

C. Vitamin C

D. Folic acid

E. Vitamin E

Select from A to E which one of the above vitamins

1. Aids intestinal absorption of iron from plant sources

2. Is present in vegetable oils

3. Is not absorbed from the gut in patients with pernicious anaemia

Question 2 Questions 1 to 4 concern the following vitamins

A. Vitamin A

B. Vitamin C

C. Vitamin D

D. Vitamin E

E. Vitamin K

Select, from A to E, which one of the above vitamins is referred to in the following statements:

1. It leads to an increased risk of birth defects if taken in excess during pregnancy

2. A deficiency contributes to the development of osteoporosis

3. It effects the time it takes for blood to clot

4. It is produced by the action of ultraviolet light on the skin



http://www.mhra.gov.uk/Howweregulate/Medicines/Licensingofmedicines/Legalstatusandreclassification/Listsofsubstances/index.htm





16

POM to P Switches

1. Omeprazole

2. Tranexamic Acid

3. Chloramphenicol

4. Simvastatin

5. Orlistat

6. Sumatriptan

7. Tamsulosin

8. Azithromycin

9. Amorolfine

10.Levonorgestrel

11.Diclofenac

www.rpharms.com

Tamsulosin

What do I need to know before I supply?

Indication: Benign prostatic hyperplasia in men aged 45-75 years

Symptoms: difficulty when starting urinating, urinating for longer or more

frequently, needing to urinate again within in a short period of time, needing

to get up to urinate several times a night

Symptoms need to have been present for a minimum of 3 months

Ask if patient takes any other medication or suffers from any other

medical condition

Good practice to use the International Prostate Symptom Score to

assess symptoms of BPH

Tamsulosin

When should it not be supplied?

Symptoms present for less than 3 months

Patient has had prostate surgery

There is unstable or potentially undiagnosed diabetes (e.g. characterised by

excessive thirst and tiredness)

The patient has problems with their liver, kidney or heart

The patient reports fainting, dizziness or weakness when standing (postural

hypotension)

Cataract surgery is planned

The patient has recent blurred or cloudy vision that has not been examined by a GP

or optician (as cataracts may be indicated)

The patient has allergy or hypersensitivity to tamsulosin

If the patient takes any antihypertensive medicines with significant alpha blocking

activity e.g. doxazosin, indoramin, prazosin, terazosin, verapamil.

Tamsulosin

Key points for sale:

• You can make a 2 week initial supply to patients with BPH symptoms.

• If there has been an improvement in urinary symptoms, you can make a

further 4 weeks OTC supply of tamsulosin.

• If there are contraindications or symptoms are not relieved or are getting

worse after the first 2 weeks then the patient must be referred to a doctor.

• Patients must be advised to see their doctor within 6 weeks of starting

treatment for assessment of their symptoms and confirmation they can

continue to take OTC tamsulosin



http://www.rpharms.com

17

Case Scenarios

Question 1

A 48 year old woman asks you to recommend a treatment for itching, The itchiness is widespread over her body and started about 2 days ago. She had a yellow-brown tanned appearance and has returned from a holiday in Turkey 2 weeks ago. On questioning she reveals that she feels generally unwell and has difficulty sleeping. She does not take any medication and since returning from holiday she had not changed her diet, or used any new cosmetics or detergents. Which one of the following courses of action is the most appropriate for you to take?

A. Advise her to take Piriton (chlorphenamine / chlorpheniramine maleate 4 mg) tablets

B. Advise her to use calamine lotion

C. Advise her to use hydrocortisone cream 1%

D. Advise her to use a soap substitute such as emulsifying ointment

E. Advise her to see her GP

Question 2

A woman visits your pharmacy asking to buy something to relieve her symptoms as she is needing to pass urine more frequently than usual, and is experiencing a burning sensation when doing so. She has no other symptoms, is otherwise healthy, and takes no regular medication. Which one of the following would it be appropriate for you to recommend?

A. Advise that she uses Canestan (clotrimazole) cream Advise her to use

calamine lotion

B. Advise that she takes Cystopurin (potassium citrate) sachets

C. Advise that she takes Diflucan One (fluconazole capsule 150 mg)

D. Reassure her and advise that the condition will improve on its own without

any intervention

E. Refuse the sale and advise that she makes an appointment to see her GP

urgently

Question 3

A patients father comes into the pharmacy requesting treatment for his 10 year old son. You have confirmed the patient has active head lice. He has asthma and uses ventolin 100mcg evohaler and seretide 125 mcg evohaler. Which of the following would be the most appropriate treatments?

A. Malathion 1% cream shampoo, applied to the hair for 10 minutes before

rinsing and repeating in 114 days time

B. Dimeticone 4% lotion, applied to the hair for 8 hours before rinsing and

repeated after 7 days

C. Permethrin 1% creme rinse applied to the hair for 10 minutes before rinising

and repeated after 7 days

D. Malathion 1% cream shampoo, applied to the hair for 10 minutes before

rinsing and repeated after 7 days

E. Phenothrin 0.2% lotion, applied to the hair for 12 hours before rinsing and

repeat in 7 days

Question 4

Mrs L asks you to recommend something for her irritating dry cough. She is otherwise well, and takes no regular medication. It would be most appropriate for you to recommend a non-prescription product containing:

A. Ammonium chloride

B. Dextromethorphan

C. Squill

D. Ipecacuanha

E. Guaifenesin

Question 5

A patient aged 30 years comes into the pharmacy. She tells you that she would like you to recommend something for her headaches that she has recently been getting. She explains that the pain is across her forehead and around the back of her head. The headaches have been occurring several times a week, for several weeks. There are no GI symptoms associated. After questioning any lifestyle changes it was identified that she has recently started a new job. Which of the following most describes the headache the patient is suffering from?

A. Migraine

B. Tension headache

C. Subarachnoid Hemorrhage

D. Trigeminal neuralgia



18

References

• Community Pharmacy: Symptom, diagnosis and treatment, 2e [Paul Rutter

Bpharm MRPharmS PhD]

• Symptoms in the Pharmacy: A Guide to the Management of Common Illness, 6th

Edition Alison Blenkinsopp, P. Paxton and J. Blenkinsopp © 2009 Alison

Blenkinsopp, Paul Paxton and John Blenkinsopp.

• British National Formulary 64

• The Ultimate GPhC Registration Assessment Exam Guide book; by Wojtek Michael

Bereza, MpharmS, Founder of Pharmacycpa.com and School of Pharmacy London.

• www.emc.co.uk

• www.rpharms.co.uk

• www.nhschoices.co.uk

ADVICE

Keep calm

Answer the question thinking about how you

would respond when working in a pharmacy…as a

PHARMACIST

Take your time and READ the question

Don’t over think the question

If there is an OTC question in open book,

remember to look at the footnotes in the BNF

Make Your Mark 2014

Finally.....

For revision

Section Title

BNF and BNFc

BNFc guide

MEP

OTC directory

Responding to symptoms textbook

RPS POM to P switches QRG

RPS pharmacy law and ethics QRG

GPhC sample papers (take care with archived ones)

GPhC practice questions

Calculation papers

Your own notes!!

Top Tips

o Book your time off for the exam now

o Make a revision plan

o Practice exam papers in exam conditions

with reference sources tagged

o Base your revision around the GPhC

syllabus

o With RPS membership , you will have 1

months access to TP On Track, giving you

access to exam like questions to practice.

o Make use of free CPPE on line learning

http://www.cppe.ac.uk



http://www.emc.co.uk/

http://www.rpharms.co.uk/

http://www.nhschoices.co.uk/

http://www.cppe.ac.uk/

19

Section Title

What next…

Section Title

Contact details

Section Title

Amar Iqbal

[email protected]

Louise Chamberlain

[email protected]

Fawzia Lokat

[email protected]

[email protected]

Georgia Malesi

[email protected]

Bindya Tailor

[email protected]



mailto:[email protected]






make your mark 2014 handout

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