CBA mock Flashcards
Customer asks to speak with you about a rash on his hands which is worse at night.
The rash is mainly between his fingers and is
intensely itchy.
He is 23-year-old-man, takes no prescribed or OTC medicines or have any other
significant medical history. NKA
name of condition and cause?
scabies, caused by the Sarcoptes scabiei mite.
What would you recommend as first line treatment option? What are the dosage instructions you would give to the patient? (max 4 marks)
Permethrin 5% cream
applied once weekly for 2 doses
applied all over body but not head and face
leave for 8-12 hours then wash off with soap and water
Particular attention to areas between fingers and toes, under nails, wrists, armpits,
external genitalia, breasts, and buttocks
Re-apply 7 days after 1st application. (to ensure all mites killed).
adult = at least 30 g of cream or 100 ml of lotion to cover whole body.
So, for two applications = at least 60 g of cream or 200 ml of lotion per adult.
Apply cream or lotion to cool dry skin (not after a hot bath).
After 4 weeks the customer comes back to the pharmacy complaining of the same symptoms. What else might you consider and what would you advise? (max 4 marks)
Check if px used cream as per dosage instructions (i.e. all over body etc)
Was treatment re-applied after 7 days/whether any improvement seen after 1st use
could be another infestation such as animal scabies (1 mark) - covered in Vet practical
Ask if they own pet e.g. dog, cat and if they are displaying any symptoms (1 mark).
Advise seek help from Vet surgeon for appropriate treatment (1 mark)
Could it be an undiagnosed skin condition such as eczema or other (see :
https://cks.nice.org.uk/topics/scabies/diagnosis/differential-diagnosis/)?
Get more background information such as PMH, FH, occupation (1 mark) to determine if this is an alternative skin condition.
Referral to GP/ACP/Pharmacist Prescriber
with Special Interest for assessment/diagnosis
Later in the afternoon, Mrs Francis hands over the school request below and says she is happy to pick up later in the week. She explains that this is the first time the school have requested the inhalers, but they have previously received a supply of EpiPen auto-injectors against a similar request.
- Comment on the legalities around the signed order and how you would proceed (3 marks)
name and address of the patient, the name and strength of the medicine, and the dose and quantity to be supplied. The order must also be signed and dated by a prescriber who is authorized to issue such orders
Signed order does not meet the legislative requirements (1 mark)
Signed order can only be made by a Head Teacher of a school (1 mark)
Return the Signed order to be corrected/re-written by the Head Teacher (1 mark)
What are the record keeping requirements associated with this Signed Order? (3 marks)
kept for at least two years from the date of supply.
recording the details of the order in the patient’s pharmacy record, including the date of supply, the name and quantity of the medicine supplied, and the name and address of the prescriber who signed the order
POM register
In the supply of medicines against a Signed Order, it is important to confirm understanding, particularly if this is the first supply. What are the key counselling points regarding the administration of this inhaler device to school students? (Max 4 marks)
Consider using a spacer device to improve deposition of droplets to lungs
Explain how the inhaler should be used/directing them to patient information leaflet
Test the spray to prime the inhaler
Check nothing is obstructing the mouthpiece
Shake the inhaler well
Patient should breathe out fully before inhaling
Patient to sit or stand up straight and slightly tilt chin up as it helps the medicine reach your lungs
Put lips around the mouthpiece of the inhaler to make a tight seal
Start to breathe in slowly and steadily and, at the same time, press the canister on the inhaler once
Patient should hold breathe for 10 seconds
If a second puff is needed wait 30 seconds to a minute and shake the inhaler again, then repeat the
steps
